***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Patient nonadherence is common for the st and ard mental health treatments in primary care : antidepressants and referrals to specialty mental health treatment . This is one of few studies to prospect ively identify predictors of nonadherence . METHODS We observed 95 veterans attending an internal medicine clinic prescribed antidepressant medication or referred to mental health treatment .  We collected information on sociodemographic factors , health beliefs , preferences about treatment , past experiences , and treatment knowledge . RESULTS At 1 month , medication adherence was greater when patients experienced previous pharmacy trouble and traveled for less than 30 minutes to reach the clinic . Appointment attendance improved when patients were ready for treatment , perceived benefits , and saw their physician as collaborative . At 6 months , medication adherence was greater when patients reported a preference for medicine treatment , traveled for less than 30 minutes , and perceived greater benefits . Fewer negative effects from previous mental health treatment improved adherence to appointments . In multivariate analyses examining adherence to all treatments , greater readiness for treatment predicted 1-month adherence , whereas being unmarried and seeing the physician as more collaborative improved 6-month adherence . CONCLUSIONS Adherence to antidepressant medications and to mental health referrals should be examined separately . A brief initial assessment for nonadherence risk factors may identify persons for targeted adherence promoting interventions BACKGROUND Many patients recovering from a first psychotic episode will discontinue medication against medical advice , even before a 1-year treatment course is completed . Factors associated with treatment adherence in patients with chronic schizophrenia include beliefs about severity of illness and need for treatment , treatment with typical versus atypical antipsychotic and medication side effects . METHOD In this 2-year prospect i ve study of 254 patients recovering from a first episode of schizophrenia , schizophreniform , or schizoaffective disorder we examined the relationship between antipsychotic medication non-adherence and patient beliefs about : need for treatment , antipsychotic medication benefits , and negative aspects of antipsychotic medication treatment . We also examined the relationship between medication non-adherence and treatment with either haloperidol or olanzapine , and objective measures of symptom response and side effects . RESULTS The likelihood of becoming medication non-adherent for 1 week or longer was greater in subjects whose belief in need for treatment was less ( HR=1.75 , 95 % CI 1.16 , 2.65 , p=0.0077 ) or who believed medications were of low benefit ( HR=2.88 , 95 CI 1.79 - 4.65 , p<0.0001 ) . Subjects r and omized to haloperidol were more likely to become medication non-adherent for > or=1 week than subjects r and omized to olanzapine ( HR-1.51 , 95 % CI 1.01 , 2.27 , p=0.045 ) . CONCLUSION Beliefs about need for treatment and the benefits of antipsychotic medication may be intervention targets to improve likelihood of long-term medication adherence in patients recovering from a first episode of schizophrenia , schizoaffective , or schizophreniform disorder Objective : To evaluate the efficacy of two community‐based programs that combined antipsychotic medication , family interventions and social skills training Dropout from prophylactic neuroleptic treatment is one major reason for relapse in schizophrenia patients . There is a lack of prospect i ve studies on factors that predict medication adherence . We investigated factors suspected to predict dropout from continuous neuroleptic treatment in a 2-year prospect i ve study involving 122 out patients with a DSM-III-R diagnosis of schizophrenia . Forty-two ( 34.4 % ) were classified as patient-related dropouts . No significant difference between compliant patients and dropouts was found with regard to sociodemographic variables , except that compliant patients were significantly older . Also , no differences in psychopathology were seen at the beginning of treatment , but compliant patients had a longer duration of illness . Compliant patients had higher doses of neuroleptics in the initial stabilization phase and correspondingly showed more extrapyramidal signs . Physicians rated compliant patients from the beginning as more cooperative . These patients also showed significantly higher scores in positive treatment expectations . In a stepwise regression analysis , positive illness concepts , the global assessment of functioning ( GAF ) , and the physicians ' view of patients ' cooperation predicted 19 percent of the variance . We concluded that the prediction of dropouts is insufficient and remains largely an unsolved problem . Future research should focus more on context factors in the search for clinical ly meaningful explanations of patient dropout from treatment RATIONALE Most first-episode schizophrenia patients will stop their medication after their acute symptoms improve . Underst and ing the salient motivations and attitudes that drive adherence -- as well as nonadherence -- is an important part of developing strategies to prevent or delay nonadherence during the early phases of the illness . METHODS Self-reported reasons for adherence and nonadherence among first-episode and multi-episode patients with schizophrenia were obtained from cross-sectional adherence interviews from two prospect i ve adherence studies : one composed of a first-episode sample ( n=33 ) and the other with recently relapsing multi-episode patients ( n=16 ) . Both groups received the Rating of Medication Influences ( ROMI ) Scale at approximately 16 to 20 weeks after an acute psychotic episode . The specific ROMI items were ranked in order of percentage ( % ) strong , and were compared both within each patient group for rank order of importance , and also compared between groups to determine the differences in specific adherence and nonadherence influences . RESULTS The  doctor-patient relationship was more likely to be endorsed as a strong adherence influence in the first-episode sample ( 74 % ) than in the multi-episode sample ( 13 % , X²=18.07 , p<.01 ) . Change in physical appearance attributed to medication was a more commonly endorsed nonadherence influence for the multi-episode sample ( 25 % ) relative to the first-episode sample ( 0 % , X²=9.2 , p<.01 ) . CONCLUSIONS The doctor-patient relationship st and s out as being the major reason for ongoing adherence for first-episode schizophrenia patients . Our post hoc interpretation is that lack of prior experience with medication and treatment elevates the importance of the relationship with the treating clinician for first-episode patients Abstract Objective : To identify reasons for discontinuation and continuation of antipsychotic medications in the treatment of schizophrenia from the patients ’ and their clinicians ’ perspectives . Research design and methods : Two measures were previously developed to assess the Reasons for Antipsychotic Discontinuation/Continuation ( RAD ) , one from the patient 's perspective and another from the clinician 's perspective . These measures were administered to acutely ill schizophrenia patients enrolled in a 12-week study of antipsychotic medications ( N = 596 ) and to their clinicians . The RAD was assessed at baseline and at endpoint . Reasons were rated on a 5-point scale from ‘ primary reason ’ to ‘ not a reason . ’ The single most important reason was also identified . The ‘ single most important reason ’ and the ‘ primary reasons ’ for discontinuing the drug used prior to enrollment , and for discontinuing or continuing the study drug were identified . Levels of concordance between patients ’ and clinicians ’ reasons were assessed . Clinical trial registration : The data source for this study is a clinical trial registered at www . clinical trials.gov ( NCT00337662 ) . Main outcome measures : Reasons for Antipsychotic Discontinuation/Continuation ( RAD ) . Results : Patients and clinicians identified several reasons for medication discontinuation and continuation ( 2.3 to 6.3 reasons , on average ) . The top ‘ single most important ’ reason for discontinuing the drug used prior to enrollment and for discontinuing the study drug was ‘ positive symptoms not sufficiently improved or made worse , ’ followed by ‘ medication-related adverse events . ’ The most frequent ‘ single most important ’ reason for medication continuation was ‘ improved positive symptoms , ’ followed by ‘ patient 's perception of improvement , ’ and ‘ functional improvement . ’ A high level of concordance was observed between patients ’ and clinicians ’ ratings . Conclusions : Medication efficacy appears to be the core driver of medication discontinuation and continuation , especially with regard to positive symptoms . There was a high level of concordance between patients ’ and clinicians ’ perspectives . Limitations include the study requirement that patients be at least moderately ill and experiencing acute psychotic exacerbation , a potential selection bias in the readiness to respond to measures , and small sample sizes for some analyses . Further research is needed to replicate findings in patients who are not acutely ill ABSTRACT Objectives : During a schizophrenia treatment episode , persistence with the initial antipsychotic may indicate optimal pharmacotherapy and be a precursor to longer-term effectiveness and other positive outcomes . The objective of this study was to examine the ability of selected variables to predict antipsychotic persistence  among patients receiving olanzapine or risperidone as initial treatment . Research design and methods : Data for this analysis , which was not defined in the original study protocol , came from a naturalistic , r and omized , open-label trial comparing costs and effectiveness of first-line antipsychotic treatment options in schizophrenia . Predictor variables were as follows : ( 1 ) patients ’ initial antipsychotic ( olanzapine [ n = 222 ] or risperidone [ n = 218 ] ) ; ( 2 ) current ( within 30 days ) comorbid diagnosis of substance abuse ; and ( 3 ) nine self-report items from the Rating of Medication Influence ( ROMI ) scale , including an item assessing patients ’ perceptions of the role of their therapeutic alliance in their adherence . Main outcome measures : For the primary analysis , a stepwise logistic regression was used in predicting antipsychotic persistence of at least 180 days . Variables found to be significantly predictive were included in a second analysis that assessed persistence at additional thresholds ( > 90 days , > 270 days , and completion of the 1‑year study ) . Results : Four variables predicted longer antipsychotic persistence ; olanzapine as initial antipsychotic ( p = 0.004 ) , absence of comorbid substance abuse ( p = 0.025 ) , and two of the ROMI items representing patients ’ subjective response to treatment – positive relationship with clinical staff ( p = 0.048 ) and fulfillment of life goals ( p = 0.050 ) . Conclusions : Within a r and omized trial design , this study corroborated the influence of several factors on antipsychotic persistence in schizophrenia . Results support the importance of the initial antipsychotic treatment option , presence of a comorbid substance abuse diagnosis , and the role of patients ’ subjective responses . Additional research is needed to further explore these and other factors as predictors of antipsychotic persistence , and of subsequent treatment outcomes OBJECTIVE Time to all-cause treatment discontinuation is considered a composite proxy measure of treatment efficacy , safety , and tolerability . Longer time to discontinuation of antipsychotic medication for any cause has been shown to be associated with greater symptom improvements in the treatment of schizophrenia . This study examines whether longer time to all-cause medication discontinuation is also linked to better functional outcomes . METHOD Using pooled data from 4 r and omized , double-blind antipsychotic trials of 24- to 28-weeks ' duration , this study examined the association between time to all-cause treatment discontinuation and functional outcomes , as assessed by a disease-specific , clinician-rated measure ( Quality of Life Scale [ QLS ] ) and a generic , patient-reported measure ( Medical Outcomes Study Short Form 36 [ SF-36 ] ) . Patients in these trials had a DSM-IV diagnosis of schizophrenia , schizophreniform disorder , or schizoaffective disorder . This post hoc analysis used Pearson partial correlations to assess relationships between time to treatment discontinuation and changes in functional scores , adjusting for baseline scores . Repeated measures analyses were also conducted to compare post-baseline functional outcome change over time between completers and noncompleters . RESULTS Longer time to all-cause treatment discontinuation was found to be significantly associated with greater improvements in all assessed functional domains ( p < .05 ) . Patients who completed their respective trials ( 46.8 % , 761/1627 ) experienced significantly greater improvement in functional outcome measures ( in 4 QLS domains and SF-36 mental health component summary score ; all , p < .001 ) compared to patients who discontinued for any cause . In addition , greater symptom improvement was significantly associated with greater functional improvements in assessed domains . CONCLUSIONS Findings from this post hoc analysis illustrate the importance of longer treatment duration with antipsychotics for improving functional outcomes in the treatment of patients with schizophrenia 
    Output:
    
Reasons for both adherence and non-adherence were largely similar ; medication efficacy , compatibility with personal medication or religious beliefs , side-effects and the influence of relationships with other people .