***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 Severe borderline personality disorder is associated with a very high psychosocial and economic burden . Current treatment guidelines suggest that several manualized treatments , including day hospital Mentalization-Based Treatment ( MBT-DH ) , are effective in these patients . However , only two r and omized controlled trials have compared manualized MBT-DH with treatment as usual . Given the relative paucity of data supporting the efficacy and cost-effectiveness of MBT-DH , the possible influence of research er allegiance in one of the trials , and potential problems with the generalization of findings to mental health systems in other countries , this multi-site r and omized trial aims to investigate the efficacy and cost-effectiveness of manualized MBT-DH compared to manualized specialist treatment as usual in The Netherl and s. Methods / design The trial is being conducted at two sites in The Netherl and s. Patients with a DSM-IV-TR diagnosis of borderline personality disorder and a score of ≥ 20 on the Borderline Personality Disorder Severity Index were r and omly allocated to MBT-DH or treatment as usual . The MBT-DH program consists of a maximum of 18 months ’ intensive treatment , followed by a maximum of 18 months of maintenance therapy . Specialist treatment as usual is provided by the City Crisis Service in Amsterdam , a service that specializes in treating patients with personality disorders , offering manualized , non-MBT interventions including family interventions , Linehan training , social skills training , and pharmacotherapy , without a maximum time limit . Patients are assessed at baseline and subsequently every 6 months up to 36 months after the start of treatment . The primary outcome measure is the frequency and severity of manifestations of borderline personality disorder as assessed by the Borderline Personality Disorder Severity Index . Secondary outcome measures include parasuicidal behaviour , symptomatic distress , social and interpersonal functioning , personality functioning , attachment , capacity for mentalizing and quality of life . Cost-effectiveness is assessed in terms of the cost per quality -adjusted life year . Outcomes will be analyzed using multilevel analyses based on intention-to-treat principles . Discussion Severe borderline personality disorder is a serious psychological disorder that is associated with high burden . This multi-site r and omized trial will provide further data concerning the efficacy and cost-effectiveness of MBT-DH for these patients .Trial registration Background / aim Day centres for people with psychiatric disabilities need to be evaluated for effectiveness in order to provide the best possible support . This study aim ed at investigating the effectiveness of a tailor-made intervention to improve day centre services for people with psychiatric disabilities . Methods The intervention was devised to bridge identified gaps in the services and lasted for 14 months . Eight centres were allotted to the intervention ( 55 attendees ) or comparison condition ( 51 attendees ) .  Fidelity to the intervention and major events in the day centres were assessed . The outcomes were degree of meaningfulness found in the day centre occupations , satisfaction with the rehabilitation received , satisfaction with everyday occupations and quality of life . Results The fidelity to the intervention was good , but more positive events , such as new occupational opportunities , had taken place in the comparison units . No differences were identified between the intervention and the comparison group regarding changes from baseline to the 14-month follow-up in perceived meaningfulness among day centre occupations , satisfaction with everyday occupations or quality of life . Conclusions The intervention seemed ineffective , but the positive events in the comparison group resembled the measures included in the tailor-made interventions . This first intervention study in the day centre context has hopefully helped to generate hypotheses and methods for future research Background Although psychotherapy is considered the treatment of choice for patients with personality disorders ( PDs ) , there is no consensus about the optimal level of care for this group of patients . This study reports the results from the 6-year follow-up of the Ullevål Personality Project ( UPP ) , a r and omized clinical trial comparing outpatient individual psychotherapy with a long-term step-down treatment program that included a short-term day hospital treatment followed by combined group and individual psychotherapy . Methods The UPP included 113 patients with PDs . Outcome was evaluated after 8 months , 18 months , 3 years and 6 years and was based on a wide range of clinical measures , such as psychosocial functioning , interpersonal problems , symptom severity , and axis I and II diagnoses . Results At the 6-year follow-up , there were no statistically significant differences in outcome between the treatment groups . Effect sizes ranged from medium to large for all outcome variables in both treatment arms . However , patients in the outpatient group had a marked decline in psychosocial functioning during the period between the 3- and 6-year follow-ups ; while psychosocial functioning continued to improve in the step-down group during the same period . This difference between groups was statistically significant . Conclusions The findings suggest that both hospital-based long-term step-down treatment and long-term outpatient individual psychotherapy may improve symptoms and psychosocial functioning in poorly functioning PD patients .  Social and interpersonal functioning continued to improve in the step-down group during the post-treatment phase , indicating that longer-term changes were stimulated during treatment . Trial registration NCT00378248 Background Day-hospital-based treatment programmes have been recommended for poorly functioning patients with personality disorders ( PD ) . However , more research is needed to confirm the cost-effectiveness of such extensive programmes over other , presumably simpler , treatment formats . Methods This study compared health service costs and psychosocial functioning for PD patients r and omly allocated to either a day-hospital-based treatment programme combining individual and group psychotherapy in a step-down format , or outpatient individual psychotherapy at a specialist practice . It included 107 PD patients , 46 % of whom had borderline PD , and 40 % of whom had avoidant PD .  Costs included the two treatment conditions and additional primary and secondary in- and outpatient services . Psychosocial functioning was assessed using measures of global ( observer-rated GAF ) and occupational ( self-report ) functioning . Repeated assessment s over three years were analysed using mixed models . Results The costs of step-down treatment were higher than those of outpatient treatment , but these high costs were compensated by considerably lower costs of other health services . However , costs and clinical gains depended on the type of PD . For borderline PD patients , cost-effectiveness did not differ by treatment condition . Health service costs declined during the trial , and functioning improved to mild impairment levels ( GAF > 60 ) . For avoidant PD patients , considerable adjuvant health services exp and ed the outpatient format . Clinical improvements were nevertheless superior to the step-down condition . Conclusion Our results indicate that decisions on treatment format should differentiate between PD types . For borderline PD patients , the costs and gains of step-down and outpatient treatment conditions did not differ . For avoidant PD patients , the outpatient format was a better alternative , leaning , however , on costly additional health services in the early phase of treatment . Trial registration Clinical Trials Background : For patients with cluster B personality disorders there is no consensus regarding the optimal treatment setting . The aim of this study was to compare the effectiveness of different psychotherapeutic setting s for patients with cluster B personality disorders , i.e. outpatient , day hospital , and inpatient treatment . Methods : The study was conducted between March 2003 and June 2008 in 6 mental health care centres in the Netherl and s , with a sample of 207 patients with a DSM-IV-TR axis II cluster B diagnosis . Patients were assigned to 3 different setting s of psychotherapeutic treatment and effectiveness was assessed at 18 months after baseline . An intention-to-treat analysis was conducted for psychiatric symptoms ( Brief Symptom Inventory ) , psychosocial functioning ( Outcome Question naire-45 ) , and quality of life ( EQ-5D ) , using multilevel statistical modelling . As the study was non-r and omised , the propensity score method was used to control for initial differences . Results : Patients in all 3 setting s improved significantly in terms of psychiatric symptoms , social and interpersonal functioning , and quality of life 18 months after baseline . The inpatient group showed the largest improvements . The comparison of outpatient and inpatient treatment regarding psychiatric symptoms showed a marginally significant result ( p = 0.057 ) in favour of inpatient treatment . Conclusions : Patients with cluster B personality disorders improved in all investigated treatment setting s , with a trend towards larger improvements of psychiatric symptoms in the inpatient setting compared to the outpatient setting . Specialised inpatient treatment should be considered as a valuable treatment option for cluster B personality disorders , both in research and in clinical practice OBJECTIVE In 2006 the psychosomatic day hospital for the treatment of acute mental illness of elderly people opened as the first clinic of its kind in Germany . The aim of this study was to determine treatment effectiveness and identify possible effects on health care utilization . METHODS Design ed as a naturalistic study with waiting time before admission as a control condition , the primary outcome was the level of depressive symptoms as measured by the hospital anxiety and depression scale . Secondary outcomes were depressive and somatoform symptoms and syndromes as measured with the patient health question naire , patient perception of interpersonal problems and health care use before and after treatment . RESULTS After treatment significant improvement ( p<0.01 ) with moderate effect sizes ( ES ) was found in all variables from admission to discharge ( ES from 0.3 to 0.8 ) and also to follow-up ( ES from 0.2 to 0.6 ) . Improvement remained stable at follow-up . Furthermore , after psychosomatic treatment a reduction in medical service usage was visible . Number of consultations ( pre : 13 , post : 9 ) , number and length of hospital stays ( pre : 1 , 7 weeks , post : 0 , 3 weeks ) were both significantly ( p<0.001 ) reduced six months after treatment as compared to the period six months prior to treatment . CONCLUSION Results indicate that the psychosomatic day hospital treatment of the elderly is successful . Reduced usage of health care and the lower costs for day hospital treatment compared to inpatient treatment point to a positive cost-effect-ratio . Exp and ing this psychosomatic intervention would be useful in reducing the current gap in mental health care for the elderly BACKGROUND Presently few studies demonstrate improved outcomes in patients with schizophrenia treated in day rehabilitation centres . One reason is the absence of an evidence based protocol for rehabilitation in such centres . Hence further research is required to assess whether such a protocol will improve psychosocial outcomes . AIMS We performed a controlled evaluation study of a protocol based rehabilitation day program ( RDC ) for persons suffering from schizophrenia . METHODS Patients from the experimental group ( N=50 ) were treated within the RDC for a 6 month period . The control group were patients on the waiting list for the RDC .  Quality of life ( MANSA ) , social functioning ( OSA ) and self-esteem ( Rosenberg ) were measured before and after the intervention . RESULTS Statistically significant improvement was shown in social functioning measured by OSA ( F(1,96)=33.7 ; p<0.001 ) , quality of life measured by MANSA ( F(1,96)=69.3 ; p<0.001 ) and self esteem measured by Rosenberg scale ( F(1,96)=84.5 ; p<0.001 ) for patients treated in the RDC compared with the control group , conversely , the control group outcomes deteriorated . CONCLUSION An evidence based protocol for rehabilitation within the RDC lead to improved social outcomes and recovery for persons suffering from schizophrenia OBJECTIVE Acute psychiatric day care has been proposed as an alternative to conventional inpatient care , yet the evidence of its effectiveness is inconsistent and based only on single-site studies in 3 countries . The aim of this multicenter r and omized controlled trial was to establish the effectiveness of acute day hospital care in a large sample across a range of mental health care systems . METHOD The trial was conducted from December 2000 to September 2003 in 5 European countries , with a sample of 1117 voluntarily admitted patients . Immediately before or very shortly after admission to the participating psychiatric facilities , patients were r and omly allocated to treatment in a day hospital or an inpatient ward .  Psychopathology , treatment satisfaction , subjective quality of life , and social disabilities were assessed at admission , at discharge , and 3 and 12 months after discharge . An intention-to-treat analysis was conducted using fixed-effects linear models with structured error covariance matrices and covariates . RESULTS Day hospital care was as effective as conventional inpatient care  with respect to psychopathologic symptoms , treatment satisfaction , and quality of life . It was more effective on social functioning at discharge and at the 3- and 12-month follow-up assessment s. CONCLUSION This study , which has more than doubled the existing evidence base , has shown that day hospital care is as effective on clinical outcomes as conventional inpatient care and more effective on social outcomes . CLINICAL TRIALS REGISTRATION Clinical Trials.gov identifier NCT00153959 Internalized stigma is a complicating feature in the treatment of schizophrenia spectrum disorders and considerably hinders the recovery process . The empowerment and recovery-oriented program of our day clinic might contribute to a reduction in internalized stigma . The aim of the study was to explore the influence of this day clinic program on internalized stigma and other subjectively important outcome measures such as quality of life and psychopathology . Data from two groups of patients had been collected twice , at baseline and after 5 weeks . The experimental group  attended the day clinic treatment ( N=40 ) and the control group waited for the day clinic treatment ( N=40 ) . The following significant differences between the two groups were found : Patients in day clinic treatment showed a reduction in internalized stigma while the control group showed a minimal increase ( Cohen 's d=0.446 ) . The experimental group as compared with the control group also showed a greater improvement in the quality of life domain psychological 
    Output:
    
Psychiatric day clinics act as a link between inpatient and outpatient treatment in community mental healthcare .