***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 
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    Input: STUDY OBJECTIVE To investigate whether total IV anesthesia with ketamine , propofol , and fentanyl affects the frequency of postoperative psychosis emergence or confusion in schizophrenic patients . DESIGN Prospect i ve , controlled study . SETTING Hirosaki National Hospital and Hako date Watanabe Hospital . PATIENTS 76 ASA physical status I and II schizophrenic patients taking chronic antipsychotic drugs and schedule for orthopedic surgery of extremities . INTERVENTIONS In Group A ( n = 38 ) patients , anesthesia was maintained with sevoflurane , nitrous oxide , and fentanyl . In Group B ( n = 38 ) patients , anesthesia was maintained with ketamine , propofol , and fentanyl . MEASUREMENTS AND MAIN RESULTS The frequency of psychosis emergence or confusion ( 54 % ) in Group A during the first 48 hours after surgery was significantly higher than the 30 % figure in Group B. CONCLUSION Ketamine , when combined with propofol and fentanyl , is an appropriate anesthetic drug for schizophrenic patients Abstract Objective : To determine whether compliance therapy , a cognitive-behavioural intervention , could improve compliance with treatment and hence social adjustment in acutely psychotic in patients , and if so , whether the effect persisted six months later . Design : R and omised controlled trial of compliance therapy and non-specific counselling , each comprising 4 - 6 sessions lasting 10 - 60 minutes . Setting : Acute psychiatric admissions ward serving an inner London catchment area . Subjects : 47 patients with psychosis . Main outcome measures : Informant and observer reported measure of compliance ; observer assessed global functioning after intervention and three and six months later ; self rated attitudes to drug treatment after the intervention and one month later ; symptom scores after intervention and six months later . Results : 25 patients received compliance therapy and showed significantly greater improvements in their attitudes to drug treatment and in their insight into illness and compliance with treatment compared with the control group . These gains persisted for six months . The intervention group was 5.2 times more likely than the control group to reach a criterion level of compliance ( 95 % confidence interval 1.5 to 18.3 ) . Global functioning showed a tendency to improve more in the intervention group after a delay ( odds ratio 3.0 ( 0.8 to 11.5 ) to reach the criterion level at six months ) . Four subjects given compliance therapy and six in the control group were readmitted during follow up ( odds ratio 2.0 ( 0.48 to 8.2 ) ) . Conclusions : Compliance therapy is a pragmatic method for improving compliance with drug treatment in psychotic in patients and its gains persist for at least six months . Overall functioning may also be enhanced . Key messages Key messages Compliance is strongly related to attitudes to treatment and to insight The study found that such attitudes may be influenced by a simple and brief intervention known as compliance therapy Compliance therapy compared with non-specific counselling leads to improved compliance The improvement is sustained for at least six months and may lead to improved social OBJECTIVE To develop and vali date a new st and ardized confusion assessment method ( CAM ) that enables nonpsychiatric clinicians to detect delirium quickly in high-risk setting s. DESIGN Prospect i ve validation study . SETTING Conducted in general medicine wards and in an outpatient geriatric assessment center at Yale University ( site 1 ) and in general medicine wards at the University of Chicago ( site 2 ) . PATIENTS The study included 56 subjects , ranging in age from 65 to 98 years . At site 1 , 10 patients with and 20 without delirium participated ; at site 2 , 16 patients with and 10 without delirium participated . MEASUREMENTS AND MAIN RESULTS An expert panel developed the CAM through a consensus building process . The CAM instrument , which can be completed in less than 5 minutes , consists of nine operationalized criteria from the Diagnostic and Statistical Manual of Mental Disorders ( DSM-III-R ) . An a priori hypothesis was established for the diagnostic value of four criteria : acute onset and fluctuating course , inattention , disorganized thinking , and altered level of consciousness . The CAM algorithm for diagnosis of delirium required the presence of both the first and the second criteria and of either the third or the fourth criterion . At both sites , the diagnoses made by the CAM were concurrently vali date d against the diagnoses made by psychiatrists . At sites 1 and 2 values for sensitivity were 100 % and 94 % , respectively ; values for specificity were 95 % and 90 % ; values for positive predictive accuracy were 91 % and 94 % ; and values for negative predictive accuracy were 100 % and 90 % . The CAM algorithm had the highest predictive accuracy for all possible combinations of the nine features of delirium . The CAM was shown to have convergent agreement with four other mental status tests , including the Mini-Mental State Examination . The interobserver reliability of the CAM was high ( kappa = 0.81 - 1.0 ) . CONCLUSIONS The CAM is sensitive , specific , reliable , and easy to use for identification of delirium CONTEXT In the intensive care unit ( ICU ) , delirium is a common yet underdiagnosed form of organ dysfunction , and its contribution to patient outcomes is unclear . OBJECTIVE To determine if delirium is an independent predictor of clinical outcomes , including 6-month mortality and length of stay among ICU patients receiving mechanical ventilation . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve cohort study enrolling 275 consecutive mechanically ventilated patients admitted to adult medical and coronary ICUs of a US university-based medical center between February 2000 and May 2001 . Patients were followed up for development of delirium over 2158 ICU days using the Confusion Assessment Method for the ICU and the Richmond Agitation-Sedation Scale . MAIN OUTCOME MEASURES Primary outcomes included 6-month mortality , overall hospital length of stay , and length of stay in the post-ICU period . Secondary outcomes were ventilator-free days and cognitive impairment at hospital discharge . RESULTS Of 275 patients , 51 ( 18.5 % ) had persistent coma and died in the hospital . Among the remaining 224 patients , 183 ( 81.7 % ) developed delirium at some point during the ICU stay . Baseline demographics including age , comorbidity scores , dementia scores , activities of daily living , severity of illness , and admission diagnoses were similar between those with and without delirium ( P>.05 for all ) . Patients who developed delirium had higher 6-month mortality rates ( 34 % vs 15 % , P = .03 ) and spent 10 days longer in the hospital than those who never developed delirium ( P<.001 ) . After adjusting for covariates ( including age , severity of illness , comorbid conditions , coma , and use of sedatives or analgesic medications ) , delirium was independently associated with higher 6-month mortality ( adjusted hazard ratio [ HR ] , 3.2 ; 95 % confidence interval [ CI ] , 1.4 - 7.7 ; P = .008 ) , and longer hospital stay ( adjusted HR , 2.0 ; 95 % CI , 1.4 - 3.0 ; P<.001 ) . Delirium in the ICU was also independently associated with a longer post-ICU stay ( adjusted HR , 1.6 ; 95 % CI , 1.2 - 2.3 ; P = .009 ) , fewer median days alive and without mechanical ventilation ( 19 [ interquartile range , 4 - 23 ] vs 24 [ 19 - 26 ] ; adjusted P = .03 ) , and a higher incidence of cognitive impairment at hospital discharge ( adjusted HR , 9.1 ; 95 % CI , 2.3 - 35.3 ; P = .002 ) . CONCLUSION Delirium was an independent predictor of higher 6-month mortality and longer hospital stay even after adjusting for relevant covariates including coma , sedatives , and analgesics in patients receiving mechanical ventilation Purpose To investigate whether antidepressants administered to patients for chronic depression patients should be continued or discontinued before anesthesia . Results We studied 80 depressed patients who were scheduled to undergo orthopedic surgery under general anesthesia . The patients were divided r and omly into two groups ; patients in Group A ( n = 40 ) continued antidepressants before surgery and patients in Group B ( n = 40 ) discontinued antidepressants 72 hr before surgery . Two ( 5 % ) out of 40 patients in Group A and eight ( 20 % ) out of 40 patients in Group B had deterioration of depressive symptoms ( P = 0.04 ) . Delirium or confusion during the perioperative course occurred in five patients ( 13 % ) in Group A and in 12 ( 30 % ) in Group B ( P = 0.05 ) . There were no significant differences in incidence ( 5 vs 6 % ) of hypotension and arrhythmias during anesthesia between the two groups . Conclusion Antidepressants administered to depressed patients should be continued before anesthesia . Discontinuation of antidepressants did not increase the incidence of hypotension and arrhythmias during anesthesia , but increased symptoms of depression and delirium or confusion . RésuméObjectifVérifier si le traitement antidépresseur administré aux patients atteints de dépression chronique devrait être ou non interrompu avant i’anesthésie . MéthodeNous avons étudié 80 patients déprimés qui devaient subir une intervention orthopédique sous anesthésie généraie .  Les patients ont été répartis au hasard en deux groupes : ceux du groupe A ( n = 40 ) ont poursuivi ie traitement antidépresseur jusqu’à i’opération et ceux du groupe B ( n = 40 ) l’ont interrompu 72 h avant . RésultatsDeux ( 5 % ) patients du groupe A et huit ( 20 % ) du groupe B ont subi une détérioration des symptômes dépressifs ( P = 0,04 ) . Le déiire et ! a confusion ont été observés chez cinq patients pendant ia période périopératoire ( 13 % ) chez les patients du groupe A et chez douze patients du groupe B ( 30 % ) ( P = 0,05 ) . Il n’y a pas eu de différence intergroupe significative quant à l’incidence ( 5 vs 6 % ) d’hypotension et d’arythmie pendant I’anesthésie . Conclusion Le traitement antidépresseur administré aux patients déprimés devrait se poursuivre avant I’anesthésie . Son arrêt n’augmente pas l’incidence d’hypotension ou d’arythmie pendant I’anesthésie , mais accentue les symptômes dépressifs , le délire ou la confusion Objectives : The objectives of this study were to provide estimates of the prevalence and strength of association between major depression and chronic pain in a primary care population and to examine the clinical burden associated with the two conditions , singly and together . Methods : A r and om sample of Kaiser Permanente patients who visited a primary care clinic was mailed a question naire assessing major depressive disorder ( MDD ) , chronic pain , pain-related disability , somatic symptom severity , panic disorder , other anxiety , probable alcohol abuse , and health-related quality of life ( HRQL ) . Instruments included the Patient Health Question naire , SF-8 , and Grade d Chronic Pain Question naire .  A total of 5808 patients responded ( 54 % of those eligible to participate ) . Results : Among those with MDD , a significantly higher proportion reported chronic ( i.e. , nondisabling or disabling ) pain than those without MDD ( 66 % versus 43 % , respectively ) . Disabling chronic pain was present in 41 % of those with MDD versus 10 % of those without MDD . Respondents with comorbid depression and disabling chronic pain had significantly poorer HRQL , greater somatic symptom severity , and higher prevalence of panic disorder than other respondents . The prevalence of probable alcohol abuse/dependence was significantly higher among persons with MDD compared with individuals without MDD regardless of pain or disability level . Compared with participants without MDD , the prevalence of other anxiety among those with MDD was more than sixfold greater regardless of pain or disability level . Conclusions : Chronic pain is common among those with MDD . Comorbid MDD and disabling chronic pain are associated with greater clinical burden than MDD alone . MDD = major depressive disorder ; HRQL = health-related quality of life ; HMO = health maintenance organization ; PHQ = Patient Health Question naire ; GCPS = Grade d Chronic Pain Scale ; CP = chronic pain ; DCP = disabling chronic pain ; GAD = generalized anxiety disorder ; SCID = Structured Clinical Interview for DSM-III-R ; PRIME-MD = Primary Care Evaluation of Mental Disorders ; CI = confidence interval ; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition ; DSM-III-R = Diagnostic and Statistical Manual of Mental Disorders , Third Edition Revised BACKGROUND Studies have shown that patients with schizophrenia have higher rates of cardiovascular disease and mortality compared with the general population . However , population -based data on the prevalence , incidence , and mortality of cardiovascular disease are needed . METHOD In this retrospective cohort study , the Saskatchewan Health data bases were search ed for all patients diagnosed with schizophrenia ( ICD-9 code 295 
    Output:
    
Both schizophrenia and depression patients experienced more postoperative confusion or delirium when psychiatric medications were discontinued preoperatively .