human
***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: A total of 480 patients were treated in a large , multicenter r and omized trial of a brief form of cognitive therapy , manual-assisted cognitive behavior therapy ( MACT ) versus treatment as usual ( TAU ) for recurrent deliberate self-harm . Each patient was r and omized after a self-harm episode assessed at an accident and emergency center and followed up over 1 year . The main hypothesis tested was that those allocated to MACT would have a lower proportion of self-harm episodes in the succeeding year . A total of 60 % of those allocated to MACT had face-to-face treatment and 430 ( 90 % ) of all patients had self-harm data recorded after 1 year . Although the results showed no significant difference between those repeating self-harm in the MACT group ( 39 % ) compared with the TAU group ( 46 % ) ( P = 0.20 ) , the treatment was cost effective ( 10 % cheaper than TAU ) and the frequency of self-harm episodes was fewer ( 50 % ) in the MACT group . A total of nine of 10 patients had some personality disturbance ( 42 % of these with disorder ) , and for those where information on parasuicide events was collected , the proportion having a repeat episode ranged from 33 % to 63 % for different personality disorders . Those with BPD were most likely to repeat episodes quickly ( mean 89 days for 25 % to repeat ) with dissocial personality disorder ( equivalent mean 384 days ) the slowest to repeat . Total costs were significantly greater in those with personality disorder and were reduced in those allocated to MACT ; this saving was reversed in those with borderline disorder . On average , MACT appeared to increase the cost of those patients with BPD ( BPD ) and reduce the cost of those with other personality disorders . It is concluded that MACT has value in preventing self-harm cost effectively but this appears to be confined mainly to those who do not have BPD BACKGROUND Health-related quality of life ( HRQoL ) data in depression are limited . We studied the impact of antidepressant ( AD ) treatment on HRQoL outcomes in depressed patients and investigated factors associated with these outcomes in routine practice setting s. METHODS The Factors Influencing Depression Endpoints Research ( FINDER ) study was a 6-month , European , prospect i ve , observational study , design ed to estimate HRQoL in 3468 adult patients with a clinical ly diagnosed episode of depression at baseline and at 3 and 6-months after commencing AD treatment .  HRQoL was assessed by the Medical Outcome Short-Form ( 36 ) Health Survey ( SF-36 ) and European Quality of Life-5 Dimensions ( EQ-5D ) . Regression analysis identified baseline and treatment variables independently and significantly associated with HRQoL outcomes . RESULTS Most HRQoL improvement occurred within 3 months of starting treatment . Better HRQoL outcomes were strongly associated with fewer somatic symptoms at baseline , AD treatment taken and not switching within AD groups . Education and occupational status were also important . Depression variables ( number of previous depressions and current episode duration ) were consistently associated with worse HRQoL outcomes . Self-rated depression severity was associated with poorer outcomes on the SF-36 mental component only . LIMITATIONS As this was an observational study , the important finding that between and within AD group switching impacted HRQoL will need to be investigated in more controlled setting s. CONCLUSIONS Receiving an AD treatment was associated with large improvements in HRQoL , but switching within AD groups was consistently associated with poorer outcomes . Somatic symptoms , including painful symptoms , are often present in depressed patients and appear to negatively impact HRQoL outcomes OBJECTIVES Schizophrenia causes significant impairments of quality of life . As treatment approaches have advanced , more attention has been given to re-integrating patients into their psychosocial environments , rather than simply monitoring psychotic symptoms . The development of the second-generation antipsychotics raised hope that these medications would provide better quality of life improvement than conventional antipsychotics . This improvement is particularly relevant early in the course of schizophrenia . METHODS To address these considerations , improvements in measures of general health and social function ( determined using the SF-36 ) were assessed in 195 patients with first-episode schizophrenia for up to one year following r and omization to either olanzapine or haloperidol  in a double blind clinical trial . We hypothesized that olanzapine would demonstrate better improvement on these measures than haloperidol . In order to test this hypothesis , we used a repeated measure model with SF-36 scores as the outcome , and treatment group , time , time2 , time-by-treatment group interaction , and time2-by-treatment group interaction as fixed effects . RESULTS Both treatments demonstrated similar changes on the SF-36 . Independent of treatment , patients demonstrated significant improvements in most of the SF-36 subscales , which approached normative scores by the end of one year of treatment . Forty-six of 100 olanzapine-treated patients and 37 of 95 haloperidol-treated patients completed the one year of this study ( p<.4 ) . CONCLUSIONS These results suggest an important initial treatment goal for patients with new onset schizophrenic disorders , namely that they can expect to recover significant quality of life and social function at least initially in treatment Various  preference-based measures of health are available for use as an outcome measure in cost-utility analysis . The aim of this study is to compare two such measures EQ-5D and SF-6D in mental health patients . Baseline data from a Dutch multi-centre r and omised trial of 616 patients with mood and /or anxiety disorders were used . Mean and median  EQ-5D  and  SF-6D utilities were compared , both in the total sample and between severity subgroups based on quartiles of SCL-90 scores . Utilities were expected to decline with increased severity . Both EQ-5D and SF-6D utilities differed significantly between patients of adjacent severity groups . Mean utilities increased from 0.51 at baseline to 0.68 at 1.5 years follow-up for EQ-5D and from 0.58 to 0.70 for SF-6D . For all severity subgroups , the mean change in EQ-5D utilities as well as in SF-6D utilities was statistically significant . St and ardised response means were higher for SF-6D utilities . We concluded that both EQ-5D and SF-6D discriminated between severity subgroups and captured improvements in health over time . However , the use of EQ-5D result ed in larger health gains and consequent lower cost-utility ratios , especially for the subgroup with the highest severity of mental health problems OBJECTIVE Despite the frequent use of the Positive and Negative Syndrome Scale ( PANSS ) for rating the symptoms of schizophrenia , the clinical meaning of its total score and of the cut-offs that are used to define treatment response ( e.g. at least 20 % or 50 % reduction of the baseline score ) are as yet unclear . We therefore compared the PANSS with simultaneous ratings of Clinical Global Impressions ( CGI ) . METHOD PANSS and CGI ratings at baseline ( n = 4091 ) , and after one , two , four and six weeks of treatment taken from a pooled data base of seven pivotal , multi-center antipsychotic drug trials on olanzapine or amisulpride in patients with exacerbations of schizophrenia were compared using equipercentile linking . RESULTS Being considered " mildly ill " according to the CGI approximately corresponded to a PANSS total score of 58 , " moderately ill " to a PANSS of 75 , " markedly ill " to a PANSS of 95 and severely ill to a PANSS of 116 . To be " minimally improved " according to the CGI score was associated with a mean percentage PANSS reduction of 19 % , 23 % , 26 % and 28 % at weeks 1 , 2 , 4 and 6 , respectively . The corresponding figures for a CGI rating " much improved " were 40 % , 45 % , 51 % and 53 % . CONCLUSIONS The results provide a better framework for underst and ing the clinical meaning of the PANSS total score in drug trials of schizophrenia patients with acute exacerbations . Such studies may ideally use at least a 50 % reduction from baseline cut-off to define response rather than lower thresholds . In treatment resistant population s , however , even a small improvement can be important , so that a 25 % cut-off might be appropriate BACKGROUND Deliberate self-harm can be costly , in terms of treatment and subsequent suicide . Any intervention that reduces episodes of self-harm might therefore have a major impact on the costs incurred by service providers and the productivity losses due to illness or premature death . METHOD Four hundred and eighty patients with a history of recurrent deliberate self-harm were r and omized to manual-assisted cognitive behaviour therapy ( MACT ) or treatment as usual .  Economic data were collected from patients at baseline , 6 and 12 months , and these data were complete for 397 patients .  Incremental cost-effectiveness was explored using the primary outcome measure , proportion of patients having a repeat episode of deliberate self-harm , and quality of life . The uncertainty surrounding costs and effects was represented using cost-effectiveness acceptability curves . RESULTS Differences in total cost per patient were statistically significant at 6 months in favour of MACT ( pounds sterling -897 , 95 % CI -1747 to -48 , P=0.04 ) , but these differences did not remain significant at 12 months ( pounds sterling -838 , 95 % CI -2142 to 466 , P=0.21 ) . Nevertheless , exploration of the uncertainty surrounding these estimates suggests there is > 90 % probability that MACT is a more cost-effective strategy for reducing the recurrence of deliberate self-harm in this population over 1 year than treatment as usual . The results for quality of life were not conclusive . CONCLUSION Cost-effectiveness acceptability curves demonstrate that , based on the evidence currently available , to reject MACT on traditional grounds of statistical significance and to continue funding current practice has < 10 % chance of being the correct decision in terms of cost-effectiveness The purpose of this study was to evaluate the psychometric properties of selected health-related quality of life ( HRQL )  self-report measures in 62 euthymic and depressed patients diagnosed with bipolar disorder . Patients completed the Quality of Life in Depression Scale ( QLDS ) , Mental Health Index-17 ( MHI-17 ) , Cognitive Function Scale , and Medical Outcomes Study Short Form-36 ( SF-36 ) at baseline and 8 weeks following treatment . Hamilton and Young Rating Scales were used to assess clinical status and vali date the HRQL measures . The MHI-17 , Cognitive Function Scale , QLDS , and SF-36 social function , vitality , role limitations -emotional , and mental health scales have good reliability and validity , and are responsive to changes in clinical status in patients with bipolar disorder . Although the small sample size limits generalizablity , euthymic and depressed out patients with bipolar disorder appear to contribute reliable self reports on selected aspects of their quality of life Background : No previous studies have compared the effectiveness of different modalities of psychotherapeutic treatment , as defined by different setting s and duration s , for patients with cluster C personality disorders . The aim of this multicentre study was to compare the effectiveness of 5 treatment modalities for patients with cluster C personality disorders in terms of psychiatric symptoms , psychosocial functioning , and quality of life . The following treatment modalities were compared : long-term outpatient ( more than 6 months ) , short-term day hospital ( up to 6 months ) , long-term day hospital , short-term inpatient , and long-term inpatient psychotherapy . 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 371 patients with a DSM-IV-TR axis-II cluster C diagnosis . Patients were assigned to 5 different modalities of psychotherapeutic treatment , and effectiveness was assessed at 12 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 treatment groups had improved on all outcomes 12 months after baseline . Patients receiving short-term inpatient treatment showed more improvement than patients receiving other treatment modalities . Conclusions : Psychotherapeutic treatment , especially in the short-term inpatient modality , is an effective treatment for patients with cluster C personality disorders For people at risk of depressive relapse , mindfulness-based cognitive therapy ( MBCT ) has an additive benefit to usual care ( H. F. Coelho , P. H. Canter , & E. Ernst , 2007 ) . This study asked if , among patients with recurrent depression who are treated with antidepressant medication ( ADM )  , MBCT is comparable to treatment with maintenance ADM ( m-ADM ) in ( a ) depressive relapse prevention , ( b ) key secondary outcomes , and ( c ) cost effectiveness . The study design was a parallel 2-group r and omized controlled trial comparing those on m-ADM ( N = 62 ) with those receiving MBCT plus support to taper/discontinue antidepressants ( N = 61 ) . Relapse/recurrence rates over 15-month follow-ups in MBCT were 47 % , compared with 60 % in the m-ADM group ( hazard ratio = 0.63 ; 95 % confidence interval : 0.39 to 1.04 ) . MBCT was more effective than m-ADM in reducing residual depressive symptoms and psychiatric comorbidity and in improving quality of life in the physical and psychological domains 
    Output:
    
agent
The EQ-5D and SF-36 achieved mixed results in the quantitative testing against psychometric criteria .
The qualitative analysis suggests this is because they provide a very limited coverage of themes identified by people with mental health problems .
***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: A total of 480 patients were treated in a large , multicenter r and omized trial of a brief form of cognitive therapy , manual-assisted cognitive behavior therapy ( MACT ) versus treatment as usual ( TAU ) for recurrent deliberate self-harm . Each patient was r and omized after a self-harm episode assessed at an accident and emergency center and followed up over 1 year . The main hypothesis tested was that those allocated to MACT would have a lower proportion of self-harm episodes in the succeeding year . A total of 60 % of those allocated to MACT had face-to-face treatment and 430 ( 90 % ) of all patients had self-harm data recorded after 1 year . Although the results showed no significant difference between those repeating self-harm in the MACT group ( 39 % ) compared with the TAU group ( 46 % ) ( P = 0.20 ) , the treatment was cost effective ( 10 % cheaper than TAU ) and the frequency of self-harm episodes was fewer ( 50 % ) in the MACT group . A total of nine of 10 patients had some personality disturbance ( 42 % of these with disorder ) , and for those where information on parasuicide events was collected , the proportion having a repeat episode ranged from 33 % to 63 % for different personality disorders . Those with BPD were most likely to repeat episodes quickly ( mean 89 days for 25 % to repeat ) with dissocial personality disorder ( equivalent mean 384 days ) the slowest to repeat . Total costs were significantly greater in those with personality disorder and were reduced in those allocated to MACT ; this saving was reversed in those with borderline disorder . On average , MACT appeared to increase the cost of those patients with BPD ( BPD ) and reduce the cost of those with other personality disorders . It is concluded that MACT has value in preventing self-harm cost effectively but this appears to be confined mainly to those who do not have BPD BACKGROUND Health-related quality of life ( HRQoL ) data in depression are limited . We studied the impact of antidepressant ( AD ) treatment on HRQoL outcomes in depressed patients and investigated factors associated with these outcomes in routine practice setting s. METHODS The Factors Influencing Depression Endpoints Research ( FINDER ) study was a 6-month , European , prospect i ve , observational study , design ed to estimate HRQoL in 3468 adult patients with a clinical ly diagnosed episode of depression at baseline and at 3 and 6-months after commencing AD treatment .  HRQoL was assessed by the Medical Outcome Short-Form ( 36 ) Health Survey ( SF-36 ) and European Quality of Life-5 Dimensions ( EQ-5D ) . Regression analysis identified baseline and treatment variables independently and significantly associated with HRQoL outcomes . RESULTS Most HRQoL improvement occurred within 3 months of starting treatment . Better HRQoL outcomes were strongly associated with fewer somatic symptoms at baseline , AD treatment taken and not switching within AD groups . Education and occupational status were also important . Depression variables ( number of previous depressions and current episode duration ) were consistently associated with worse HRQoL outcomes . Self-rated depression severity was associated with poorer outcomes on the SF-36 mental component only . LIMITATIONS As this was an observational study , the important finding that between and within AD group switching impacted HRQoL will need to be investigated in more controlled setting s. CONCLUSIONS Receiving an AD treatment was associated with large improvements in HRQoL , but switching within AD groups was consistently associated with poorer outcomes . Somatic symptoms , including painful symptoms , are often present in depressed patients and appear to negatively impact HRQoL outcomes OBJECTIVES Schizophrenia causes significant impairments of quality of life . As treatment approaches have advanced , more attention has been given to re-integrating patients into their psychosocial environments , rather than simply monitoring psychotic symptoms . The development of the second-generation antipsychotics raised hope that these medications would provide better quality of life improvement than conventional antipsychotics . This improvement is particularly relevant early in the course of schizophrenia . METHODS To address these considerations , improvements in measures of general health and social function ( determined using the SF-36 ) were assessed in 195 patients with first-episode schizophrenia for up to one year following r and omization to either olanzapine or haloperidol  in a double blind clinical trial . We hypothesized that olanzapine would demonstrate better improvement on these measures than haloperidol . In order to test this hypothesis , we used a repeated measure model with SF-36 scores as the outcome , and treatment group , time , time2 , time-by-treatment group interaction , and time2-by-treatment group interaction as fixed effects . RESULTS Both treatments demonstrated similar changes on the SF-36 . Independent of treatment , patients demonstrated significant improvements in most of the SF-36 subscales , which approached normative scores by the end of one year of treatment . Forty-six of 100 olanzapine-treated patients and 37 of 95 haloperidol-treated patients completed the one year of this study ( p<.4 ) . CONCLUSIONS These results suggest an important initial treatment goal for patients with new onset schizophrenic disorders , namely that they can expect to recover significant quality of life and social function at least initially in treatment Various  preference-based measures of health are available for use as an outcome measure in cost-utility analysis . The aim of this study is to compare two such measures EQ-5D and SF-6D in mental health patients . Baseline data from a Dutch multi-centre r and omised trial of 616 patients with mood and /or anxiety disorders were used . Mean and median  EQ-5D  and  SF-6D utilities were compared , both in the total sample and between severity subgroups based on quartiles of SCL-90 scores . Utilities were expected to decline with increased severity . Both EQ-5D and SF-6D utilities differed significantly between patients of adjacent severity groups . Mean utilities increased from 0.51 at baseline to 0.68 at 1.5 years follow-up for EQ-5D and from 0.58 to 0.70 for SF-6D . For all severity subgroups , the mean change in EQ-5D utilities as well as in SF-6D utilities was statistically significant . St and ardised response means were higher for SF-6D utilities . We concluded that both EQ-5D and SF-6D discriminated between severity subgroups and captured improvements in health over time . However , the use of EQ-5D result ed in larger health gains and consequent lower cost-utility ratios , especially for the subgroup with the highest severity of mental health problems OBJECTIVE Despite the frequent use of the Positive and Negative Syndrome Scale ( PANSS ) for rating the symptoms of schizophrenia , the clinical meaning of its total score and of the cut-offs that are used to define treatment response ( e.g. at least 20 % or 50 % reduction of the baseline score ) are as yet unclear . We therefore compared the PANSS with simultaneous ratings of Clinical Global Impressions ( CGI ) . METHOD PANSS and CGI ratings at baseline ( n = 4091 ) , and after one , two , four and six weeks of treatment taken from a pooled data base of seven pivotal , multi-center antipsychotic drug trials on olanzapine or amisulpride in patients with exacerbations of schizophrenia were compared using equipercentile linking . RESULTS Being considered " mildly ill " according to the CGI approximately corresponded to a PANSS total score of 58 , " moderately ill " to a PANSS of 75 , " markedly ill " to a PANSS of 95 and severely ill to a PANSS of 116 . To be " minimally improved " according to the CGI score was associated with a mean percentage PANSS reduction of 19 % , 23 % , 26 % and 28 % at weeks 1 , 2 , 4 and 6 , respectively . The corresponding figures for a CGI rating " much improved " were 40 % , 45 % , 51 % and 53 % . CONCLUSIONS The results provide a better framework for underst and ing the clinical meaning of the PANSS total score in drug trials of schizophrenia patients with acute exacerbations . Such studies may ideally use at least a 50 % reduction from baseline cut-off to define response rather than lower thresholds . In treatment resistant population s , however , even a small improvement can be important , so that a 25 % cut-off might be appropriate BACKGROUND Deliberate self-harm can be costly , in terms of treatment and subsequent suicide . Any intervention that reduces episodes of self-harm might therefore have a major impact on the costs incurred by service providers and the productivity losses due to illness or premature death . METHOD Four hundred and eighty patients with a history of recurrent deliberate self-harm were r and omized to manual-assisted cognitive behaviour therapy ( MACT ) or treatment as usual .  Economic data were collected from patients at baseline , 6 and 12 months , and these data were complete for 397 patients .  Incremental cost-effectiveness was explored using the primary outcome measure , proportion of patients having a repeat episode of deliberate self-harm , and quality of life . The uncertainty surrounding costs and effects was represented using cost-effectiveness acceptability curves . RESULTS Differences in total cost per patient were statistically significant at 6 months in favour of MACT ( pounds sterling -897 , 95 % CI -1747 to -48 , P=0.04 ) , but these differences did not remain significant at 12 months ( pounds sterling -838 , 95 % CI -2142 to 466 , P=0.21 ) . Nevertheless , exploration of the uncertainty surrounding these estimates suggests there is > 90 % probability that MACT is a more cost-effective strategy for reducing the recurrence of deliberate self-harm in this population over 1 year than treatment as usual . The results for quality of life were not conclusive . CONCLUSION Cost-effectiveness acceptability curves demonstrate that , based on the evidence currently available , to reject MACT on traditional grounds of statistical significance and to continue funding current practice has < 10 % chance of being the correct decision in terms of cost-effectiveness The purpose of this study was to evaluate the psychometric properties of selected health-related quality of life ( HRQL )  self-report measures in 62 euthymic and depressed patients diagnosed with bipolar disorder . Patients completed the Quality of Life in Depression Scale ( QLDS ) , Mental Health Index-17 ( MHI-17 ) , Cognitive Function Scale , and Medical Outcomes Study Short Form-36 ( SF-36 ) at baseline and 8 weeks following treatment . Hamilton and Young Rating Scales were used to assess clinical status and vali date the HRQL measures . The MHI-17 , Cognitive Function Scale , QLDS , and SF-36 social function , vitality , role limitations -emotional , and mental health scales have good reliability and validity , and are responsive to changes in clinical status in patients with bipolar disorder . Although the small sample size limits generalizablity , euthymic and depressed out patients with bipolar disorder appear to contribute reliable self reports on selected aspects of their quality of life Background : No previous studies have compared the effectiveness of different modalities of psychotherapeutic treatment , as defined by different setting s and duration s , for patients with cluster C personality disorders . The aim of this multicentre study was to compare the effectiveness of 5 treatment modalities for patients with cluster C personality disorders in terms of psychiatric symptoms , psychosocial functioning , and quality of life . The following treatment modalities were compared : long-term outpatient ( more than 6 months ) , short-term day hospital ( up to 6 months ) , long-term day hospital , short-term inpatient , and long-term inpatient psychotherapy . 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 371 patients with a DSM-IV-TR axis-II cluster C diagnosis . Patients were assigned to 5 different modalities of psychotherapeutic treatment , and effectiveness was assessed at 12 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 treatment groups had improved on all outcomes 12 months after baseline . Patients receiving short-term inpatient treatment showed more improvement than patients receiving other treatment modalities . Conclusions : Psychotherapeutic treatment , especially in the short-term inpatient modality , is an effective treatment for patients with cluster C personality disorders For people at risk of depressive relapse , mindfulness-based cognitive therapy ( MBCT ) has an additive benefit to usual care ( H. F. Coelho , P. H. Canter , & E. Ernst , 2007 ) . This study asked if , among patients with recurrent depression who are treated with antidepressant medication ( ADM )  , MBCT is comparable to treatment with maintenance ADM ( m-ADM ) in ( a ) depressive relapse prevention , ( b ) key secondary outcomes , and ( c ) cost effectiveness . The study design was a parallel 2-group r and omized controlled trial comparing those on m-ADM ( N = 62 ) with those receiving MBCT plus support to taper/discontinue antidepressants ( N = 61 ) . Relapse/recurrence rates over 15-month follow-ups in MBCT were 47 % , compared with 60 % in the m-ADM group ( hazard ratio = 0.63 ; 95 % confidence interval : 0.39 to 1.04 ) . MBCT was more effective than m-ADM in reducing residual depressive symptoms and psychiatric comorbidity and in improving quality of life in the physical and psychological domains 
    Output:
    