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: Summary The associations between social disablement and socio-demographic factors have been examined in a r and om sample of 310 adults drawn from the general population of Camberwell , South London . Neither paternal social class nor the subject 's own social class are associated with social disablement in either men or women , except that men ( but not women ) of very low social class show significantly poorer social performance . Age and sex are not associated with social disablement , despite the fact that women in the general population have consistently been found to have higher rates of psychiatric disorder than men . For a given level of psychiatric disorder men show poorer social performance than women . Men who do not have children at home , or who live entirely alone have significantly poorer social performance , as do men who are widowed , separated or divorced , but these factors are not associated with poor social performance in women . By contrast , an unsatisfactory marital relationship is significantly associated with disablement in women , but not in men . The demographic factors associated with poor social performance are all indices of social disadvantage or social isolation BACKGROUND To our knowledge , this is the first prospect i ve natural history study of weekly symptomatic status of patients with bipolar I disorder ( BP-I ) during long-term follow-up . METHODS Analyses are based on ongoing prospect i ve follow-up of 146 patients with Research Diagnostic Criteria BP-I , who entered the National Institute of Mental Health ( Bethesda , Md ) Collaborative Depression Study from 1978 through 1981 .  Weekly affective symptom status ratings were analyzed by polarity and severity , ranging from asymptomatic , to subthreshold levels , to full-blown major depression and mania . Percentages of follow-up weeks at each level as well as number of shifts in symptom status and polarity during the entire follow-up period were examined . Finally , 2 new measures of chronicity were evaluated in relation to previously identified predictors of chronicity for BP-I. RESULTS Patients with BP-I were symptomatically ill 47.3 % of weeks throughout a mean of 12.8 years of follow-up . Depressive symptoms ( 31.9 % of total follow-up weeks ) predominated over manic/hypomanic symptoms ( 8.9 % of weeks ) or cycling/mixed symptoms ( 5.9 % of weeks ) . Subsyndromal , minor depressive , and hypomanic symptoms combined were nearly 3 times more frequent than syndromal-level major depressive and manic symptoms ( 29.9 % vs 11.2 % of weeks , respectively ) . Patients with BP-I changed symptom status an average of 6 times per year and polarity more than 3 times per year . Longer intake episodes and those with depression-only or cycling polarity predicted greater chronicity during long-term follow-up , as did comorbid drug-use disorder . CONCLUSIONS The longitudinal weekly symptomatic course of BP-I is chronic . Overall , the symptomatic structure is primarily depressive rather than manic , and subsyndromal and minor affective symptoms predominate . Symptom severity levels fluctuate , often within the same patient over time . Bipolar I disorder is expressed as a dimensional illness featuring the full range ( spectrum ) of affective symptom severity and polarity Recognition of prodromal symptoms of schizophrenia offers the potential of early intervention to avert relapse and re-hospitalization ( Carpenter & Heinrichs , 1983 ) . The present study investigated how a strategy to detect prodromal signs might be effectively applied in the clinical setting . A st and ard monitoring system was developed involving completion of a new early signs scale ( ESS ) measuring changes in key symptoms phenomenologically ( self-report ) and behaviourally ( observer report ) . The ESS was subject to rigorous psychometric evaluation and tested in a prospect i ve pilot investigation . The ESS reliably identified early signs and predicted relapse with an overall accuracy of 79 % . Several different patterns of relapse were identified . Observer reports compensated for loss of insight in some patients . In two cases where early signs indices were detected , prompt increases in medication appeared to arrest relapse and avert readmission . The ESS offers itself as a reliable , valid and administratively feasible measure and demonstrates considerable potential as a cost-effective procedure for secondary prevention In the UK , psychiatric care of patients with acute and chronic disorders has increasingly moved from hospital to the community . We have evaluated in a controlled trial patients with severe mental illness , who were assigned to early intervention by community services or to st and ard hospital treatment .  100 patients aged 16 to 65 years presenting as psychiatric emergencies to an inner London teaching hospital were r and omly allocated to a multidisciplinary community-based team ( n = 48 ) or conventional hospital-based psychiatric services ( n = 52 ) and assessed over a 3-month period . Ratings of psychopathology and social functioning were made before treatment and after 2 , 4 , and 12 weeks by independent assessors . 85 patients completed all assessment s , and all patients had evaluable data beyond 2 weeks . 3 patients  died during the study , 2 from natural causes and 1 from an accident . Patients referred to the community service showed greater improvement in symptoms and were more satisfied with services than those in the hospital-based service . Patients treated in the hospital-based service spent eight times as many days as psychiatric in patients as those treated in the community-based service . Patients both prefer and seem to benefit from community-based psychiatric care , and our early-intervention community service might be a good model for such care BACKGROUND Family therapy is sometimes used as adjunctive treatment to pharmacotherapy to help patients recover from mood episodes of bipolar I disorder . However , the efficacy of this practice is not known . METHODS Ninety-two patients meeting criteria for a current bipolar I mood episode were r and omly assigned to family therapy plus pharmacotherapy , multifamily psychoeducational group therapy plus pharmacotherapy , or pharmacotherapy alone . Time to recovery was analyzed with survival analysis . RESULTS The proportion of subjects within each treatment group who recovered did not significantly differ , nor did time to recovery . LIMITATIONS The analyses did not include other outcomes such as psychosocial functioning , prophylaxis against recurrences of mood episodes , or compliance with pharmacotherapy . CONCLUSIONS Neither adjunctive family therapy nor adjunctive multifamily psychoeducational group therapy significantly improves the rate of recovery from mood episodes of bipolar I disorder , compared to treatment with pharmacotherapy alone Family psychoeducational programs are efficacious adjuncts to pharmacotherapy for patients with schizophrenic and bipolar disorders , but little is known about what these programs change about families . The authors assessed changes in face-to-face interactional behavior over 1 year among families of bipolar patients who received a 9-month family-focused psychoeducational therapy ( FFT ; n = 22 ) or crisis management with naturalistic follow-up ( CMNF ; n = 22 ) , both administered with maintenance pharmacotherapy . Members of families who received FFT showed more positive nonverbal interactional behavior during a 1-year posttreatment problem-solving assessment than families who received CMNF , although no corresponding decreases were seen in negative interactional behaviors . The positive effect of family treatment on patients ' symptom trajectories over 1 year was partially mediated by increases in patients ' positive nonverbal interactional behaviors during this same interval For persons with psychiatric disabilities , maintaining a job is often more difficult than acquiring a job . A large proportion of jobs end unsatisfactorily . This study explored job terminations among 63 persons with severe mental illness who participated in competitive jobs through supported employment programs .  More than half of the job terminations were unsatisfactory , defined as the client quitting without having other job plans or being fired . Baseline ratings of demographic and clinical characteristics , preemployment skills training , and early ratings of job satisfaction and work environment did not predict unsatisfactory terminations . Clients with better work histories were less likely to experience unsatisfactory terminations . In addition , unsatisfactory terminations were associated retrospectively with multiple problems on the job that were related to interpersonal functioning , mental illness , dissatisfaction with jobs , quality of work , medical illnesses , dependability , and substance abuse . These results suggest that supported employment programs need to address job maintenance with interventions that identify and address different types of difficulties as they arise on the job Family affect was examined as a predictor of difficulty implementing a 9-month , manual-based , psychoeducational family therapy for recently manic bipolar patients . Prior to therapy , family members were administered measures to assess both their expressed emotion and affective behavior during a family interaction task . Following family treatment , both therapists and independent observers rated the overall difficulty of treating the family , and therapists also rated each participant 's problem behaviors during treatment , in the areas of affect , communication , and resistance . Therapists regarded affective problems among relatives and resistance among patients as central in determining the overall difficulty of treating the family . Relatives ' critical behavior toward patients during the pretreatment interaction task predicted both independent observers ' ratings of overall treatment difficulty and therapists ' perceptions of relatives ' affective problems during treatment . Moreover , patients ' residual symptoms predicted independent observers ' ratings of overall difficulty and therapists ' perceptions of patients ' resistance to the family intervention . Results suggest that difficulties in conducting a manual-based family intervention can be predicted from systematic , pretreatment family and clinical assessment A two-group r and omized experimental design was employed to assess the effects of monitoring and feedback on the compliance of 93 psychiatric out patients treated with lithium . Compliance in both groups was measured using self-report , lithium level , appointment-keeping , and medication refill frequency . The experimental group was also monitored using a unique electronic device that records the time and day pills are removed . At the midpoint of the study , the experimental group received feedback about serum lithium levels and patterns of removing medications from the monitoring device while the control group received feedback about serum lithium levels only . The study demonstrated no sustained effect of the monitoring and feedback interventions on compliance BACKGROUND The efficacy and effectiveness of cognitive therapy ( CT ) is well established for unipolar disorders , but little is known about its utility in bipolar disorders . This study aim ed to explore the feasibility and efficacy of using CT as an adjunct to usual psychiatric treatment in this patient population . METHOD Subjects referred by general adult psychiatrists were assessed by and independent rater and then r and omly allocated to immediate CT ( N = 21 ) or 6-month waiting-list control , which was then followed by CT ( N = 21 ) . Observer and self-ratings of symptoms and functioning were undertaken immediately prior to CT , after a 6-month course of CT and a further 6-months later . Data on relapse and hospitalization rates in the 18 months before and after commencing CT were also collected . RESULTS At 6-month follow-up , subjects allocated to CT showed statistically significantly greater improvements in symptoms and functioning as measured on the Beck Depression Inventory , the Internal State Scale , and the Global Assessment of Functioning than those in the waiting-list control group . In the 29 patients who eventually received CT  , relapse rates in the 1 8 months after commencing CT showed a 60 % reduction in comparison with the 18 months prior to commencing CT . Seventy per cent of subjects who commenced therapy viewed CT as highly acceptable . CONCLUSION Although the results of this study are encouraging , the use of CT in subjects with bipolar disorders is more complex than in unipolar disorders and requires a high level of therapist expertise . The therapy may prove to be particularly useful in the treatment of bipolar depression BACKGROUND Few studies have examined the combined effects of psychosocial treatment and pharmacotherapy for bipolar disorder . This study used a r and omized , controlled design to examine a 9-month , manual-based program of family-focused psychoeducational treatment ( FFT ) . METHODS Bipolar patients ( N = 101 ) were recruited shortly after an illness episode and r and omly assigned to 21 sessions of FFT ( n = 31 ) or to a comparison treatment involving two family education sessions and follow-up crisis management ( CM ; n = 70 ) . Both treatments were delivered over 9 months ; patients were simultaneously maintained on mood stabilizing medications . Patients were evaluated every 3 months for 1 year as to relapse status , symptom severity , and medication compliance . RESULTS Patients assigned to FFT had fewer relapses and longer delays before relapses during the study year than did patients in CM . Patients in FFT also showed greater improvements in depressive ( but not manic ) symptoms . The most dramatic improvements were among FFT patients whose families were high in expressed emotion . The efficacy of FFT could not be explained by differences among patients in medication regimes or compliance . CONCLUSIONS Family-focused psychoeducational treatment appears to be an efficacious adjunct to pharmacotherapy for bipolar disorder . Future studies should evaluate family treatment against other forms of psychotherapy matched in amount of therapist-patient contact Recently hospitalized bipolar , manic patients ( N = 53 ) were r and omly assigned to a 9-month , manual-based , family-focused psychoeducational therapy ( n = 28 ) or to an individually focused patient treatment ( n = 25 ) . All patients received concurrent treatment with mood-stabilizing medications . Structured follow-up assessment s were conducted at 3-month intervals for a 1-year period ofactive treatment and a 1-year period of posttreatment follow-up . Compared with patients in individual therapy , those in family-focused treatment were less likely to be rehospitalized during the 2-year study period . Patients in family treatment also experienced fewer mood disorder relapses over the 2 years , although they did not differ from patients in individual treatment in their likelihood of a first relapse . Results suggest that family psychoeducational treatment is a useful adjunct to pharmacotherapy in decreasing the risk of relapse and hospitalization frequently associated with bipolar disorder The relative benefit of adding a structured psychoeducational intervention to st and ard medic 
    Output:
    
agent
This review shows a beneficial effect of EWS in time to recurrence , percentage of people hospitalised and functioning in people with bipolar disorder .
***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: Summary The associations between social disablement and socio-demographic factors have been examined in a r and om sample of 310 adults drawn from the general population of Camberwell , South London . Neither paternal social class nor the subject 's own social class are associated with social disablement in either men or women , except that men ( but not women ) of very low social class show significantly poorer social performance . Age and sex are not associated with social disablement , despite the fact that women in the general population have consistently been found to have higher rates of psychiatric disorder than men . For a given level of psychiatric disorder men show poorer social performance than women . Men who do not have children at home , or who live entirely alone have significantly poorer social performance , as do men who are widowed , separated or divorced , but these factors are not associated with poor social performance in women . By contrast , an unsatisfactory marital relationship is significantly associated with disablement in women , but not in men . The demographic factors associated with poor social performance are all indices of social disadvantage or social isolation BACKGROUND To our knowledge , this is the first prospect i ve natural history study of weekly symptomatic status of patients with bipolar I disorder ( BP-I ) during long-term follow-up . METHODS Analyses are based on ongoing prospect i ve follow-up of 146 patients with Research Diagnostic Criteria BP-I , who entered the National Institute of Mental Health ( Bethesda , Md ) Collaborative Depression Study from 1978 through 1981 .  Weekly affective symptom status ratings were analyzed by polarity and severity , ranging from asymptomatic , to subthreshold levels , to full-blown major depression and mania . Percentages of follow-up weeks at each level as well as number of shifts in symptom status and polarity during the entire follow-up period were examined . Finally , 2 new measures of chronicity were evaluated in relation to previously identified predictors of chronicity for BP-I. RESULTS Patients with BP-I were symptomatically ill 47.3 % of weeks throughout a mean of 12.8 years of follow-up . Depressive symptoms ( 31.9 % of total follow-up weeks ) predominated over manic/hypomanic symptoms ( 8.9 % of weeks ) or cycling/mixed symptoms ( 5.9 % of weeks ) . Subsyndromal , minor depressive , and hypomanic symptoms combined were nearly 3 times more frequent than syndromal-level major depressive and manic symptoms ( 29.9 % vs 11.2 % of weeks , respectively ) . Patients with BP-I changed symptom status an average of 6 times per year and polarity more than 3 times per year . Longer intake episodes and those with depression-only or cycling polarity predicted greater chronicity during long-term follow-up , as did comorbid drug-use disorder . CONCLUSIONS The longitudinal weekly symptomatic course of BP-I is chronic . Overall , the symptomatic structure is primarily depressive rather than manic , and subsyndromal and minor affective symptoms predominate . Symptom severity levels fluctuate , often within the same patient over time . Bipolar I disorder is expressed as a dimensional illness featuring the full range ( spectrum ) of affective symptom severity and polarity Recognition of prodromal symptoms of schizophrenia offers the potential of early intervention to avert relapse and re-hospitalization ( Carpenter & Heinrichs , 1983 ) . The present study investigated how a strategy to detect prodromal signs might be effectively applied in the clinical setting . A st and ard monitoring system was developed involving completion of a new early signs scale ( ESS ) measuring changes in key symptoms phenomenologically ( self-report ) and behaviourally ( observer report ) . The ESS was subject to rigorous psychometric evaluation and tested in a prospect i ve pilot investigation . The ESS reliably identified early signs and predicted relapse with an overall accuracy of 79 % . Several different patterns of relapse were identified . Observer reports compensated for loss of insight in some patients . In two cases where early signs indices were detected , prompt increases in medication appeared to arrest relapse and avert readmission . The ESS offers itself as a reliable , valid and administratively feasible measure and demonstrates considerable potential as a cost-effective procedure for secondary prevention In the UK , psychiatric care of patients with acute and chronic disorders has increasingly moved from hospital to the community . We have evaluated in a controlled trial patients with severe mental illness , who were assigned to early intervention by community services or to st and ard hospital treatment .  100 patients aged 16 to 65 years presenting as psychiatric emergencies to an inner London teaching hospital were r and omly allocated to a multidisciplinary community-based team ( n = 48 ) or conventional hospital-based psychiatric services ( n = 52 ) and assessed over a 3-month period . Ratings of psychopathology and social functioning were made before treatment and after 2 , 4 , and 12 weeks by independent assessors . 85 patients completed all assessment s , and all patients had evaluable data beyond 2 weeks . 3 patients  died during the study , 2 from natural causes and 1 from an accident . Patients referred to the community service showed greater improvement in symptoms and were more satisfied with services than those in the hospital-based service . Patients treated in the hospital-based service spent eight times as many days as psychiatric in patients as those treated in the community-based service . Patients both prefer and seem to benefit from community-based psychiatric care , and our early-intervention community service might be a good model for such care BACKGROUND Family therapy is sometimes used as adjunctive treatment to pharmacotherapy to help patients recover from mood episodes of bipolar I disorder . However , the efficacy of this practice is not known . METHODS Ninety-two patients meeting criteria for a current bipolar I mood episode were r and omly assigned to family therapy plus pharmacotherapy , multifamily psychoeducational group therapy plus pharmacotherapy , or pharmacotherapy alone . Time to recovery was analyzed with survival analysis . RESULTS The proportion of subjects within each treatment group who recovered did not significantly differ , nor did time to recovery . LIMITATIONS The analyses did not include other outcomes such as psychosocial functioning , prophylaxis against recurrences of mood episodes , or compliance with pharmacotherapy . CONCLUSIONS Neither adjunctive family therapy nor adjunctive multifamily psychoeducational group therapy significantly improves the rate of recovery from mood episodes of bipolar I disorder , compared to treatment with pharmacotherapy alone Family psychoeducational programs are efficacious adjuncts to pharmacotherapy for patients with schizophrenic and bipolar disorders , but little is known about what these programs change about families . The authors assessed changes in face-to-face interactional behavior over 1 year among families of bipolar patients who received a 9-month family-focused psychoeducational therapy ( FFT ; n = 22 ) or crisis management with naturalistic follow-up ( CMNF ; n = 22 ) , both administered with maintenance pharmacotherapy . Members of families who received FFT showed more positive nonverbal interactional behavior during a 1-year posttreatment problem-solving assessment than families who received CMNF , although no corresponding decreases were seen in negative interactional behaviors . The positive effect of family treatment on patients ' symptom trajectories over 1 year was partially mediated by increases in patients ' positive nonverbal interactional behaviors during this same interval For persons with psychiatric disabilities , maintaining a job is often more difficult than acquiring a job . A large proportion of jobs end unsatisfactorily . This study explored job terminations among 63 persons with severe mental illness who participated in competitive jobs through supported employment programs .  More than half of the job terminations were unsatisfactory , defined as the client quitting without having other job plans or being fired . Baseline ratings of demographic and clinical characteristics , preemployment skills training , and early ratings of job satisfaction and work environment did not predict unsatisfactory terminations . Clients with better work histories were less likely to experience unsatisfactory terminations . In addition , unsatisfactory terminations were associated retrospectively with multiple problems on the job that were related to interpersonal functioning , mental illness , dissatisfaction with jobs , quality of work , medical illnesses , dependability , and substance abuse . These results suggest that supported employment programs need to address job maintenance with interventions that identify and address different types of difficulties as they arise on the job Family affect was examined as a predictor of difficulty implementing a 9-month , manual-based , psychoeducational family therapy for recently manic bipolar patients . Prior to therapy , family members were administered measures to assess both their expressed emotion and affective behavior during a family interaction task . Following family treatment , both therapists and independent observers rated the overall difficulty of treating the family , and therapists also rated each participant 's problem behaviors during treatment , in the areas of affect , communication , and resistance . Therapists regarded affective problems among relatives and resistance among patients as central in determining the overall difficulty of treating the family . Relatives ' critical behavior toward patients during the pretreatment interaction task predicted both independent observers ' ratings of overall treatment difficulty and therapists ' perceptions of relatives ' affective problems during treatment . Moreover , patients ' residual symptoms predicted independent observers ' ratings of overall difficulty and therapists ' perceptions of patients ' resistance to the family intervention . Results suggest that difficulties in conducting a manual-based family intervention can be predicted from systematic , pretreatment family and clinical assessment A two-group r and omized experimental design was employed to assess the effects of monitoring and feedback on the compliance of 93 psychiatric out patients treated with lithium . Compliance in both groups was measured using self-report , lithium level , appointment-keeping , and medication refill frequency . The experimental group was also monitored using a unique electronic device that records the time and day pills are removed . At the midpoint of the study , the experimental group received feedback about serum lithium levels and patterns of removing medications from the monitoring device while the control group received feedback about serum lithium levels only . The study demonstrated no sustained effect of the monitoring and feedback interventions on compliance BACKGROUND The efficacy and effectiveness of cognitive therapy ( CT ) is well established for unipolar disorders , but little is known about its utility in bipolar disorders . This study aim ed to explore the feasibility and efficacy of using CT as an adjunct to usual psychiatric treatment in this patient population . METHOD Subjects referred by general adult psychiatrists were assessed by and independent rater and then r and omly allocated to immediate CT ( N = 21 ) or 6-month waiting-list control , which was then followed by CT ( N = 21 ) . Observer and self-ratings of symptoms and functioning were undertaken immediately prior to CT , after a 6-month course of CT and a further 6-months later . Data on relapse and hospitalization rates in the 18 months before and after commencing CT were also collected . RESULTS At 6-month follow-up , subjects allocated to CT showed statistically significantly greater improvements in symptoms and functioning as measured on the Beck Depression Inventory , the Internal State Scale , and the Global Assessment of Functioning than those in the waiting-list control group . In the 29 patients who eventually received CT  , relapse rates in the 1 8 months after commencing CT showed a 60 % reduction in comparison with the 18 months prior to commencing CT . Seventy per cent of subjects who commenced therapy viewed CT as highly acceptable . CONCLUSION Although the results of this study are encouraging , the use of CT in subjects with bipolar disorders is more complex than in unipolar disorders and requires a high level of therapist expertise . The therapy may prove to be particularly useful in the treatment of bipolar depression BACKGROUND Few studies have examined the combined effects of psychosocial treatment and pharmacotherapy for bipolar disorder . This study used a r and omized , controlled design to examine a 9-month , manual-based program of family-focused psychoeducational treatment ( FFT ) . METHODS Bipolar patients ( N = 101 ) were recruited shortly after an illness episode and r and omly assigned to 21 sessions of FFT ( n = 31 ) or to a comparison treatment involving two family education sessions and follow-up crisis management ( CM ; n = 70 ) . Both treatments were delivered over 9 months ; patients were simultaneously maintained on mood stabilizing medications . Patients were evaluated every 3 months for 1 year as to relapse status , symptom severity , and medication compliance . RESULTS Patients assigned to FFT had fewer relapses and longer delays before relapses during the study year than did patients in CM . Patients in FFT also showed greater improvements in depressive ( but not manic ) symptoms . The most dramatic improvements were among FFT patients whose families were high in expressed emotion . The efficacy of FFT could not be explained by differences among patients in medication regimes or compliance . CONCLUSIONS Family-focused psychoeducational treatment appears to be an efficacious adjunct to pharmacotherapy for bipolar disorder . Future studies should evaluate family treatment against other forms of psychotherapy matched in amount of therapist-patient contact Recently hospitalized bipolar , manic patients ( N = 53 ) were r and omly assigned to a 9-month , manual-based , family-focused psychoeducational therapy ( n = 28 ) or to an individually focused patient treatment ( n = 25 ) . All patients received concurrent treatment with mood-stabilizing medications . Structured follow-up assessment s were conducted at 3-month intervals for a 1-year period ofactive treatment and a 1-year period of posttreatment follow-up . Compared with patients in individual therapy , those in family-focused treatment were less likely to be rehospitalized during the 2-year study period . Patients in family treatment also experienced fewer mood disorder relapses over the 2 years , although they did not differ from patients in individual treatment in their likelihood of a first relapse . Results suggest that family psychoeducational treatment is a useful adjunct to pharmacotherapy in decreasing the risk of relapse and hospitalization frequently associated with bipolar disorder The relative benefit of adding a structured psychoeducational intervention to st and ard medic 
    Output:
    