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: Objective : To examine if a cognitive remediation program could be a positive supplement to a psychoeducational treatment program for adolescents with early onset psychosis The first double-blind placebo-controlled clinical trial of an atypical neuroleptic medication is being conducted in symptomatic treatment-seeking patients meeting new diagnostic criteria for a putative prodromal syndrome . This identifies them as being at high risk for developing psychosis in the near future . The study aims include prevention of psychosis onset and disability , as well as palliation of ongoing symptomatology . This report presents the study rationale and design . Recent studies will be review ed that have advanced our knowledge about the early course of schizophrenia and our ability to predict onset prospect ively , advances that have rendered prodromal intervention research feasible and ethical . The study design has many novel features . It tests for prevention versus delay in psychosis onset , as well as for efficacy and safety in a newly defined clinical population . This has required the development of innovative clinical research assessment instruments and a new operational definition of psychosis onset . The integration of these novel elements into an otherwise typical clinical trial design is detailed . The companion report will address sample recruitment and the clinical phenomenology at baseline of this putative " prodromal " entity Atendency to extract spurious , message-like meaning from meaningless noise was assessed as a risk factor leading to schizophrenia-spectrum disorders by assessing word length of speech illusions elicited by multispeaker babble in 43 people with prodromal symptoms . These individuals were r and omised to olanzapine v. placebo groups during year 1 followed by no pharmacological treatment for those with no disorder conversion during year 2 . A time-dependent Cox regression analysis of conversion to schizophrenia-spectrum disorder revealed a significant interaction between condition ( olanzapine v. no drug ) and length of speech illusion , with the latter strongly predicting subsequent conversion during medication-free intervals but not during olanzapine treatment 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 OBJECTIVE To investigate whether intercessory prayer had an effect on the outcomes of a group of children with psychiatric conditions , using a triple blind r and omized study design . CONCLUSION This study was unable to show any additional benefits for patients who received intercessory prayer  compared to those who received treatment as usual OBJECTIVE To assess olanzapine 's  efficacy and tolerability in adolescents with schizophrenia . METHOD One hundred seven inpatient and outpatient adolescents ( olanzapine , n = 72 , mean age 16.1 years ; placebo , n = 35 , mean age 16.3 years ) with schizophrenia participated in this r and omized ( 2:1 ) , international , multisite , industry-sponsored trial . All patients met DSM-IV-TR criteria for schizophrenia , and they were treated for up to 6 weeks with flexible doses of olanzapine ( 2.5 - 20.0 mg/day ) or placebo . Last-observation-carried-forward mean changes from baseline to endpoint on the anchored version of the Brief Psychiatric Rating Scale for Children , Clinical Global Impression Scale-Severity of Illness , and Positive and Negative Syndrome Scale ( PANSS ) were assessed . RESULTS More olanzapine-treated versus placebo-treated  patients completed the trial ( 68.1 % versus 42.9 % , p = .020 ) . Compared with placebo-treated patients , olanzapine-treated adolescents had significantly greater improvement in Brief Psychiatric Rating Scale for Children total ( p = .003 ) , Clinical Global Impressions Scale-Severity of Illness ( p = .004 ) , PANSS total ( p = .005 ) , and PANSS positive scores ( p = .002 ) . Olanzapine-treated patients gained significantly more baseline-to-endpoint weight ( 4.3 kg versus 0.1 kg , p < .001 ) . Significantly more olanzapine-treated versus placebo-treated patients gained 7 % or greater of their body weight at any time during treatment ( 45.8 % versus 14.7 % , p = .002 ) . Prolactin and triglyceride mean baseline-to-endpoint changes were significantly higher in olanzapine-treated versus placebo-treated adolescents . The incidence of treatment-emergent significant changes in fasting glucose , cholesterol , or triglycerides did not differ between the groups at endpoint , but significantly more olanzapine-treated patients had high triglycerides at any time during treatment . CONCLUSIONS Olanzapine-treated adolescents with schizophrenia experienced significant symptom improvement . Significant increases in weight , triglycerides , uric acid , most liver function tests , and prolactin were observed during olanzapine treatment . Clinical trial registration information-Olanzapine Versus Placebo in the Treatment of Adolescents With Schizophrenia . URL : http://www . clinical trials.gov . Unique identifier : NCT00051298 BACKGROUND This paper investigates the durability of the effects of cognitive remediation therapy ( CRT ) . In a r and omised control trial , CRT was compared with a control therapy ( intensive occupational therapy activities ) , matched for length of therapist contact . The main three cognitive outcomes , ( i ) number of categories achieved on the Wisconsin Card Sort Test , ( ii ) age-scaled score on the Digit Span subtest of the WAIS-R , and ( iii ) mean number of moves on the Tower of London test , were chosen because they are known to be problematic in schizophrenia . In addition , a wide variety of other outcomes ( symptoms , social functioning , self-esteem and cognition ) were assessed . At the end of treatment , CRT conferred a benefit to people with schizophrenia in cognition and self-esteem [ Schizophr . Bull . 25 ( 1999 ) 291 ] . This study investigates these outcomes 6 months after the therapies were withdrawn . METHOD Participants were assessed at baseline , posttreatment and 6-month follow-up ( n=17 for the CRT group ; n=16 for the control therapy group ) . In addition to the functioning measures , data on use of services and cost of therapy were collected . RESULTS The effects of CRT on cognition were still apparent at follow-up , particularly in the memory domain . When these cognitive improvements reached a criterion threshold , there were also improvements in social behaviour and symptoms . The gains made in self-esteem disappeared following the withdrawal of therapy . The economic analysis showed overall reductions in the care packages of both patient groups but there was a significant increase in day-care costs for patients who have received CRT . This additional use of day care may confer further advantages to the  CRT group , such as improved social functioning and quality of life . CONCLUSIONS The overall results of this first trial of a novel CRT approach have produced encouraging results which merit further investigation The authors estimated components of variance and intraclass correlation coefficients ( ICCs ) to aid in the design of complex surveys and community intervention studies by analyzing data from the Health Survey for Engl and 1994 . This cross-sectional survey of English adults included data on a range of lifestyle risk factors and health outcomes . For the survey , households were sample d in 720 postal code sectors nested within 177 district health authorities and 14 regional health authorities . Study subjects were adults aged 16 years or more .  ICCs and components of variance were estimated from a nested r and om-effects analysis of variance . Results are presented at the district health authority , postal code sector , and household levels . Between-cluster variation was evident at each level of clustering . In these data , ICCs were inversely related to cluster size , but design effects could be substantial when the cluster size was large . Most ICCs were below 0.01 at the district health authority level , and they were mostly below 0.05 at the postal code sector level . At the household level , many ICCs were in the range of 0.0 - 0.3 . These data may provide useful information for the design of epidemiologic studies in which the units sample d or allocated range in size from households to large administrative areas An ongoing study of the phenomenology , genetics , neuropsychology , physiology ( eye tracking , autonomic responsivity ) , neuroimaging , biochemistry , and pharmacology of childhood-onset schizophrenia is described , and pilot data are presented for the first 22 subjects . Differentiation from autism " spectrum " disorders and other poorly defined , severe neurodevelopmental disorders is needed . Eye tracking and autonomic results are similar to patterns seen in later-onset schizophrenia and possibly more striking . Magnetic resonance imaging showed larger left frontal ventricular horn area for the schizophrenia subjects , larger left cau date , and lack of normal cau date asymmetry . Fluorodeoxyglucose positron emission tomography during an auditory continuous performance task revealed decreased right parietal/occipital glucose metabolic rate in the schizophrenia subjects , which may be secondary to poor attentional performance , and increased glucose metabolic rate in three left frontal regions , a left parietal region , and the right putamen . Clozapine has been effective and well tolerated in an open trial with 12 adolescents who responded poorly to typical neuroleptics ; 16 subjects have been enrolled in a double-blind comparison of haloperidol and clozapine . Longitudinal study of this narrowly defined and possibly more homogeneous group of very early-onset schizophrenia subjects will be relevant to current neurodevelopmental theories addressing the role of puberty , progression of pathology , and continuity or discontinuity with later-onset schizophrenia OBJECTIVE There is a limited evidence base to guide treatment of children and adolescents with nonaffective psychoses because few comparative studies of first-line second-generation antipsychotics ( SGAs ) have been undertaken . To plan the design of a subsequent r and omized controlled trial ( RCT ) , the authors conducted this pilot study to demonstrate the feasibility of the treatment and measurement protocol s. METHOD Thirty children and adolescents ( 20 males , 10 females ) , ages 10 - 18 years , who met unmodified Diagnostic and Statistical Manual of Mental Disorders , 4th edition ( DSM-IV ) criteria for a schizophrenia-spectrum disorder ( schizophrenia , schizoaffective , schizophreniform , psychotic disorder not otherwise specified ) were r and omized to receive 12 weeks of open-label , flexibly dosed treatment with either risperidone ( mean [ st and ard deviation , SD ] dose = 3.4 mg [ 1.5 ] ) , olanzapine ( mean [ SD ] dose = 14.0 mg [ 4.6 ] ) or quetiapine ( mean [ SD ] dose = 611 mg [ 253.4 ] ) . RESULTS Twenty one ( 70 % ) of 30 subjects completed the study . There was no overall statistically significant difference with regard to reduction in Positive and Negative Syndrome Scale ( PANSS ) total scores in treatment efficacy observed ( F((2,24 ) ) = 3.13 , p = 0.06 ) . However , the possibility of a large differential treatment effect with regard to change in PANSS total scores favoring risperidone relative to quetiapine ( risperidone vs. quetiapine , d = 1.10 [ 95 % confidence interval , CI , 0.09 - 2.01 ] ) was suggested by the point estimate . CONCLUSIONS These preliminary data , viewed together with the extant literature , suggest that a future larger RCT with only two treatment arms may be warranted to establish whether there is a clinical ly significant differential treatment effect between risperidone and quetiapine for children and adolescents with nonaffective psychoses . Additional challenges and considerations for mounting a larger RCT are explored BACKGROUND The relative effectiveness of second-generation ( atypical ) antipsychotic drugs as compared with that of older agents has been incompletely addressed , though newer agents are currently used far more 
    Output:
    
agent
No convincing evidence suggests that atypical antipsychotic medications are superior to typical medications for the treatment of adolescents with psychosis .
However , atypical antipsychotic medications may be more acceptable to young people because fewer symptomatic adverse effects are seen in the short term .
Little evidence is available to support the superiority of one atypical antipsychotic medication over another , but side effect profiles are different for different medications .
Treatment with olanzapine , risperidone and clozapine is often associated with weight gain .
Aripiprazole is not associated with increased prolactin or with dyslipidaemia .
Adolescents may respond better to st and ard-dose as opposed to lower-dose risperidone , but for aripiprazole and ziprasidone , lower doses may be equally effective .
***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: Objective : To examine if a cognitive remediation program could be a positive supplement to a psychoeducational treatment program for adolescents with early onset psychosis The first double-blind placebo-controlled clinical trial of an atypical neuroleptic medication is being conducted in symptomatic treatment-seeking patients meeting new diagnostic criteria for a putative prodromal syndrome . This identifies them as being at high risk for developing psychosis in the near future . The study aims include prevention of psychosis onset and disability , as well as palliation of ongoing symptomatology . This report presents the study rationale and design . Recent studies will be review ed that have advanced our knowledge about the early course of schizophrenia and our ability to predict onset prospect ively , advances that have rendered prodromal intervention research feasible and ethical . The study design has many novel features . It tests for prevention versus delay in psychosis onset , as well as for efficacy and safety in a newly defined clinical population . This has required the development of innovative clinical research assessment instruments and a new operational definition of psychosis onset . The integration of these novel elements into an otherwise typical clinical trial design is detailed . The companion report will address sample recruitment and the clinical phenomenology at baseline of this putative " prodromal " entity Atendency to extract spurious , message-like meaning from meaningless noise was assessed as a risk factor leading to schizophrenia-spectrum disorders by assessing word length of speech illusions elicited by multispeaker babble in 43 people with prodromal symptoms . These individuals were r and omised to olanzapine v. placebo groups during year 1 followed by no pharmacological treatment for those with no disorder conversion during year 2 . A time-dependent Cox regression analysis of conversion to schizophrenia-spectrum disorder revealed a significant interaction between condition ( olanzapine v. no drug ) and length of speech illusion , with the latter strongly predicting subsequent conversion during medication-free intervals but not during olanzapine treatment 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 OBJECTIVE To investigate whether intercessory prayer had an effect on the outcomes of a group of children with psychiatric conditions , using a triple blind r and omized study design . CONCLUSION This study was unable to show any additional benefits for patients who received intercessory prayer  compared to those who received treatment as usual OBJECTIVE To assess olanzapine 's  efficacy and tolerability in adolescents with schizophrenia . METHOD One hundred seven inpatient and outpatient adolescents ( olanzapine , n = 72 , mean age 16.1 years ; placebo , n = 35 , mean age 16.3 years ) with schizophrenia participated in this r and omized ( 2:1 ) , international , multisite , industry-sponsored trial . All patients met DSM-IV-TR criteria for schizophrenia , and they were treated for up to 6 weeks with flexible doses of olanzapine ( 2.5 - 20.0 mg/day ) or placebo . Last-observation-carried-forward mean changes from baseline to endpoint on the anchored version of the Brief Psychiatric Rating Scale for Children , Clinical Global Impression Scale-Severity of Illness , and Positive and Negative Syndrome Scale ( PANSS ) were assessed . RESULTS More olanzapine-treated versus placebo-treated  patients completed the trial ( 68.1 % versus 42.9 % , p = .020 ) . Compared with placebo-treated patients , olanzapine-treated adolescents had significantly greater improvement in Brief Psychiatric Rating Scale for Children total ( p = .003 ) , Clinical Global Impressions Scale-Severity of Illness ( p = .004 ) , PANSS total ( p = .005 ) , and PANSS positive scores ( p = .002 ) . Olanzapine-treated patients gained significantly more baseline-to-endpoint weight ( 4.3 kg versus 0.1 kg , p < .001 ) . Significantly more olanzapine-treated versus placebo-treated patients gained 7 % or greater of their body weight at any time during treatment ( 45.8 % versus 14.7 % , p = .002 ) . Prolactin and triglyceride mean baseline-to-endpoint changes were significantly higher in olanzapine-treated versus placebo-treated adolescents . The incidence of treatment-emergent significant changes in fasting glucose , cholesterol , or triglycerides did not differ between the groups at endpoint , but significantly more olanzapine-treated patients had high triglycerides at any time during treatment . CONCLUSIONS Olanzapine-treated adolescents with schizophrenia experienced significant symptom improvement . Significant increases in weight , triglycerides , uric acid , most liver function tests , and prolactin were observed during olanzapine treatment . Clinical trial registration information-Olanzapine Versus Placebo in the Treatment of Adolescents With Schizophrenia . URL : http://www . clinical trials.gov . Unique identifier : NCT00051298 BACKGROUND This paper investigates the durability of the effects of cognitive remediation therapy ( CRT ) . In a r and omised control trial , CRT was compared with a control therapy ( intensive occupational therapy activities ) , matched for length of therapist contact . The main three cognitive outcomes , ( i ) number of categories achieved on the Wisconsin Card Sort Test , ( ii ) age-scaled score on the Digit Span subtest of the WAIS-R , and ( iii ) mean number of moves on the Tower of London test , were chosen because they are known to be problematic in schizophrenia . In addition , a wide variety of other outcomes ( symptoms , social functioning , self-esteem and cognition ) were assessed . At the end of treatment , CRT conferred a benefit to people with schizophrenia in cognition and self-esteem [ Schizophr . Bull . 25 ( 1999 ) 291 ] . This study investigates these outcomes 6 months after the therapies were withdrawn . METHOD Participants were assessed at baseline , posttreatment and 6-month follow-up ( n=17 for the CRT group ; n=16 for the control therapy group ) . In addition to the functioning measures , data on use of services and cost of therapy were collected . RESULTS The effects of CRT on cognition were still apparent at follow-up , particularly in the memory domain . When these cognitive improvements reached a criterion threshold , there were also improvements in social behaviour and symptoms . The gains made in self-esteem disappeared following the withdrawal of therapy . The economic analysis showed overall reductions in the care packages of both patient groups but there was a significant increase in day-care costs for patients who have received CRT . This additional use of day care may confer further advantages to the  CRT group , such as improved social functioning and quality of life . CONCLUSIONS The overall results of this first trial of a novel CRT approach have produced encouraging results which merit further investigation The authors estimated components of variance and intraclass correlation coefficients ( ICCs ) to aid in the design of complex surveys and community intervention studies by analyzing data from the Health Survey for Engl and 1994 . This cross-sectional survey of English adults included data on a range of lifestyle risk factors and health outcomes . For the survey , households were sample d in 720 postal code sectors nested within 177 district health authorities and 14 regional health authorities . Study subjects were adults aged 16 years or more .  ICCs and components of variance were estimated from a nested r and om-effects analysis of variance . Results are presented at the district health authority , postal code sector , and household levels . Between-cluster variation was evident at each level of clustering . In these data , ICCs were inversely related to cluster size , but design effects could be substantial when the cluster size was large . Most ICCs were below 0.01 at the district health authority level , and they were mostly below 0.05 at the postal code sector level . At the household level , many ICCs were in the range of 0.0 - 0.3 . These data may provide useful information for the design of epidemiologic studies in which the units sample d or allocated range in size from households to large administrative areas An ongoing study of the phenomenology , genetics , neuropsychology , physiology ( eye tracking , autonomic responsivity ) , neuroimaging , biochemistry , and pharmacology of childhood-onset schizophrenia is described , and pilot data are presented for the first 22 subjects . Differentiation from autism " spectrum " disorders and other poorly defined , severe neurodevelopmental disorders is needed . Eye tracking and autonomic results are similar to patterns seen in later-onset schizophrenia and possibly more striking . Magnetic resonance imaging showed larger left frontal ventricular horn area for the schizophrenia subjects , larger left cau date , and lack of normal cau date asymmetry . Fluorodeoxyglucose positron emission tomography during an auditory continuous performance task revealed decreased right parietal/occipital glucose metabolic rate in the schizophrenia subjects , which may be secondary to poor attentional performance , and increased glucose metabolic rate in three left frontal regions , a left parietal region , and the right putamen . Clozapine has been effective and well tolerated in an open trial with 12 adolescents who responded poorly to typical neuroleptics ; 16 subjects have been enrolled in a double-blind comparison of haloperidol and clozapine . Longitudinal study of this narrowly defined and possibly more homogeneous group of very early-onset schizophrenia subjects will be relevant to current neurodevelopmental theories addressing the role of puberty , progression of pathology , and continuity or discontinuity with later-onset schizophrenia OBJECTIVE There is a limited evidence base to guide treatment of children and adolescents with nonaffective psychoses because few comparative studies of first-line second-generation antipsychotics ( SGAs ) have been undertaken . To plan the design of a subsequent r and omized controlled trial ( RCT ) , the authors conducted this pilot study to demonstrate the feasibility of the treatment and measurement protocol s. METHOD Thirty children and adolescents ( 20 males , 10 females ) , ages 10 - 18 years , who met unmodified Diagnostic and Statistical Manual of Mental Disorders , 4th edition ( DSM-IV ) criteria for a schizophrenia-spectrum disorder ( schizophrenia , schizoaffective , schizophreniform , psychotic disorder not otherwise specified ) were r and omized to receive 12 weeks of open-label , flexibly dosed treatment with either risperidone ( mean [ st and ard deviation , SD ] dose = 3.4 mg [ 1.5 ] ) , olanzapine ( mean [ SD ] dose = 14.0 mg [ 4.6 ] ) or quetiapine ( mean [ SD ] dose = 611 mg [ 253.4 ] ) . RESULTS Twenty one ( 70 % ) of 30 subjects completed the study . There was no overall statistically significant difference with regard to reduction in Positive and Negative Syndrome Scale ( PANSS ) total scores in treatment efficacy observed ( F((2,24 ) ) = 3.13 , p = 0.06 ) . However , the possibility of a large differential treatment effect with regard to change in PANSS total scores favoring risperidone relative to quetiapine ( risperidone vs. quetiapine , d = 1.10 [ 95 % confidence interval , CI , 0.09 - 2.01 ] ) was suggested by the point estimate . CONCLUSIONS These preliminary data , viewed together with the extant literature , suggest that a future larger RCT with only two treatment arms may be warranted to establish whether there is a clinical ly significant differential treatment effect between risperidone and quetiapine for children and adolescents with nonaffective psychoses . Additional challenges and considerations for mounting a larger RCT are explored BACKGROUND The relative effectiveness of second-generation ( atypical ) antipsychotic drugs as compared with that of older agents has been incompletely addressed , though newer agents are currently used far more 
    Output:
    