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 The authors evaluated the efficacy and safety of lurasidone in the treatment of patients with major depressive episodes associated with bipolar I disorder . METHOD Patients were r and omly assigned to receive double-blind treatment with lurasidone ( 20 - 60 mg/day [ N=166 ] or 80 - 120 mg/day [ N=169 ] ) or placebo ( N=170 ) for 6 weeks . Primary and key secondary endpoints were change from baseline to week 6 on the Montgomery-Åsberg Depression Rating Scale ( MADRS ) and depression severity score on the Clinical Global Impressions scale for use in bipolar illness ( CGI-BP ) , respectively . RESULTS Lurasidone treatment significantly reduced mean MADRS total scores at week 6 for both the 20 - 60 mg/day group ( -15.4 ; effect size=0.51 ) and the 80 - 120 mg/day group ( -15.4 ; effect size=0.51 ) compared with placebo ( -10.7 ) . Similarly , lurasidone treatment result ed in significantly greater endpoint reduction in CGI-BP depression severity scores for both the 20 - 60 mg/day group ( -1.8 ; effect size=0.61 ) and the 80 - 120 mg/day group ( -1.7 ; effect size=0.50 ) compared with placebo ( -1.1 ) . Both lurasidone groups also experienced significant improvements compared with placebo in anxiety symptoms and in patient-reported measures of quality of life and functional impairment . Discontinuation rates due to adverse events were similar in the 20 - 60 mg/day ( 6.6 % ) , 80 - 120 mg/day ( 5.9 % ) , and placebo ( 6.5 % ) groups . The most frequent adverse events associated with lurasidone were nausea , headache , akathisia , and somnolence . Minimal changes in weight , lipids , and measures of glycemic control were observed with lurasidone . CONCLUSION Monotherapy with lurasidone in the dosage range of 20 - 120 mg/day significantly reduced depressive symptoms in patients with bipolar I depression . Lurasidone was well tolerated , with few changes in weight or metabolic parameters OBJECTIVE The authors assessed gender differences in the proportion of clinical visits spent depressed , manic , or euthymic in patients with bipolar disorder . METHOD Data were analyzed from 711 patients with bipolar I or II disorder who were followed prospect ively over 7 years ( 13,191 visits ) . The main outcome measures were the presence of symptoms of depression or of hypomania or mania , measured by the Inventory of Depressive Symptomatology and the  Young Mania Rating Scale . Data were analyzed using three separate repeated- measures regressions with a logistic link function to model the probability that an individual was depressed , manic , or euthymic . The models controlled for bipolar I or bipolar II diagnosis , rapid cycling , age , time in the study , comorbid anxiety disorders , and comorbid substance use disorders . RESULTS In approximately half of visits , patients had depressive , manic , or hypomanic symptoms . The likelihood of having depressive symptoms was significantly greater for women than for men . This was accounted for by higher rates in women of rapid cycling and anxiety disorders , each of which was associated with increased rates of depression . All patient groups showed an increase in number of euthymic visits and a decrease in number of visits with depressive and manic symptoms with increased time in study . CONCLUSIONS Bipolar patients spend a substantial proportion of their time ill . Significant gender differences exist , with women spending a greater proportion of their visits in the depressive pole . This finding appears to be related to the corresponding differences in rates of rapid cycling and anxiety disorders BACKGROUND The impact of anxiety disorders has not been well delineated in prospect i ve studies of bipolar disorder . AIMS To examine the association between anxiety and course of bipolar disorder , as defined by mood episodes , quality of life and role functioning . METHOD A thous and thous and out- patients with bipolar disorder were followed prospect ively for 1 year . RESULTS A current comorbid anxiety disorder ( present in 31.9 % of participants ) was associated with fewer days well , a lower likelihood of timely recovery from depression , risk of earlier relapse , lower quality of life and diminished role function over I year of prospect i ve study . The negative impact was greater with multiple anxiety disorders . CONCLUSIONS Anxiety disorders , including those present during relative euthymia , predicted a poorer bipolar course . The detrimental effects of anxiety were not simply a feature of mood state . Treatment studies targeting anxiety disorders will help to clarify the nature of the impact of anxiety on bipolar course Background Bipolar disorder is highly recurrent and rates of comorbidity are high . Studies have pointed to anxiety comorbidity as one factor associated with risk of suicide attempts and poor overall outcome . This study aim ed to explore the feasibility and potential benefits of a new psychological treatment ( Mindfulness-based Cognitive Therapy : MBCT ) for people with bipolar disorder focusing on between-episode anxiety and depressive symptoms . Methods The study used data from a pilot r and omized trial of MBCT for people with bipolar disorder in remission , focusing on between-episode anxiety and depressive symptoms . Immediate effects of MBCT versus waitlist on levels of anxiety and depression were compared between unipolar and bipolar participants . Results The results suggest that MBCT led to improved immediate outcomes in terms of anxiety which were specific to the bipolar group . Both bipolar and unipolar participants allocated to MBCT showed reductions in residual depressive symptoms relative to those allocated to the waitlist condition . Limitations Analyses were based on a small sample , limiting power . Additionally the study recruited participants with suicidal ideation or behaviour so the findings can not immediately be generalized to individuals without these symptoms . Conclusions The study , although preliminary , suggests an immediate effect of MBCT on anxiety and depressive symptoms among bipolar participants with suicidal ideation or behaviour , and indicates that further research into the use of MBCT with bipolar patients may be warranted OBJECTIVES The purpose of this cohort study was to determine in patients with Panic Disorder ( PD ) : ( 1 ) . the prevalence of subsyndromal symptoms of hypomania , and ( 2 ) . whether subsyndromal hypomania symptoms affect the outcome of cognitive behavior therapy ( CBT ) for panic . METHODS Using the Diagnostic Interview Schedule , and DSM-III-R criteria we identified 18 individuals with a history of symptoms of hypomania among 56 patients with PD . Patients were treated in an open CBT group program . They were assessed before treatment and 6 and 12 months later . We used the  Brief Symptom Inventory ( BSI ) , the Perceived Stress Scale ( PSS ) , the Pearlin-Schooler Mastery Scale ( PMS ) , and the Social Adjustment Scale ( SAS )  at all assessment s. RESULTS The total group significantly improved on all measures . The Clinical ly Significant Change was 71.4 % and the Reliable Change Index 48.2 % . Between 6 and 12 months , there was a trend for the hypomania symptom subgroup ( PH ) to continue to improve on the BSI Depression Scale , the Perceived Stress Scale , the Pearlin-Schooler Mastery Scale , and the Social Adjustment Scale but to lose gains on the BSI Phobic Anxiety and Somatization subscales compared with the group without symptoms of hypomania ( PNH ) . CONCLUSIONS Thirty-two percent of patients with PD had symptoms of hypomania . With CBT for panic , patients with PD and symptoms of hypomania improve as much as those without hypomania symptoms . The presence or absence of symptoms of hypomania might help explain the inconsistent effects of depression and personality disorders on the treatment of PD In order to estimate the prevalence of affective disorders in Hungary a sample of the Hungarian adult population ( 18 - 64 years ) selected at r and om was interviewed using the Diagnostic Interview Schedule ( DIS ) which generated DSM-III-R diagnoses . The lifetime rate for Major Depressive Disorder ( MDD ) was 15.1 % , and for Bipolar Disorders ( BD ) 5.1 % . The female-to-male ratio was 2.7 for MDD and nearly equal for BD . The 1-year and 1-month period prevalence rates were 7.1 % and 2.6 % for MDD and 0.9 % and 0.5 % for manic episodes . A higher rate of divorced or separated persons was found among individuals with a lifetime diagnosis of MDD . Besides these , the lifetime diagnosis of BD coexisted with higher rates of the never-married state . The highest hazard rate for the development of BD or MDD was in the range 15 - 19 years but in MDD another peak was also found in the range 45 - 50 years . The first peak was characteristic of the recurrent , and the other one of the single form of MDD . Insomnia , loss of energy , decreased interest , concentration problems were the most common symptoms during the depressive episode , independent of polarity . Higher rates of lifetime diagnosis of dysthymia and all kinds of anxiety disorder were revealed among persons with MDD . BD was associated with GAD ( Generalized Anxiety Disorder ) , and panic disorder more often than chance OBJECTIVE To evaluate the prevalence of substance abuse dependence and /or alcohol abuse dependence among subjects with bipolar I versus bipolar II disorder in a voluntary registry . METHOD One hundred r and omly selected registrants in a voluntary case registry for bipolar disorder were interviewed , using the Structured Clinical Interview for DSM-IV Axis I Disorders , to vali date the diagnosis of this registry . Corroborative information was obtained from medical records , family members and the treating psychiatrist . Eighty-nine adults ( 18 - 65 years ) met criteria for bipolar disorder ( bipolar I = 71 , bipolar II = 18 ) and were included in this analysis . RESULTS Forty-one ( 57.8 % ) subjects with bipolar I disorder abused , or were dependent on one or more substances or alcohol , 28.2 % abused , or were dependent on , two substances or alcohol , and 11.3 % abused or were dependent on three or more substances or alcohol . Nearly 39 % of bipolar II subjects abused or were dependent on one or more substances , nearly 17 % were dependent on two or more substances or alcohol , and 11 % were dependent on three or more substances or alcohol . Alcohol was the most commonly abused drug among either bipolar I or II subjects . CONCLUSIONS Consistent with other epidemiologic and hospital population studies , this voluntary bipolar disorder registry suggests a high prevalence of comorbidity with alcohol and /or substance abuse dependence . Bipolar I subjects appear to have higher rates of these comorbid conditions than bipolar II subjects ; however , as the number of bipolar II subjects was rather small , this suggestion needs confirmation OBJECTIVE Given the adverse impact of anxiety on treatment outcome in unipolar depression and the paucity of data on the role of anxiety in bipolar disorder , the authors sought to determine the effect of anxiety on the acute treatment response of patients with bipolar I disorder . METHOD The authors examined the correlates of response to the acute treatment of 124 consecutively treated patients with bipolar I disorder . Measures of anxiety included history of panic attacks and a composite variable reflecting current or past anxiety symptoms . RESULTS History of panic attacks proved to be a significant correlate of nonremission . Anxiety , as assessed with the composite variable , was associated with longer time to remission , as was the treatment of depressive versus manic symptoms and mixed versus manic symptoms . Patients with anxiety as assessed with the composite variable and patients with a history of panic attacks reported more severe medication side effects . They also required a greater number of medications , either sequentially or in combination , in order to achieve remission . CONCLUSIONS The findings suggest that anxiety is a clinical ly meaningful correlate of poor outcome in the acute treatment of bipolar I disorder OBJECTIVE Few studies have been reported that support the efficacy of adjunctive therapy for patients with bipolar I depression who have had an insufficient response to monotherapy with mood-stabilizing agents . The authors investigated the efficacy of lurasidone , a novel antipsychotic agent , as adjunctive therapy with lithium or valproate for the treatment of bipolar I depression . METHOD Patients were r and omly assigned to receive 6 weeks of double-blind adjunctive treatment with lurasidone  ( N=183 )  or placebo  ( N=165 ) , added to therapeutic levels of either lithium or valproate . Primary and key secondary endpoints were change from baseline to week 6 on the Montgomery-Åsberg Depression Rating Scale ( MADRS ) and depression severity score on the Clinical Global Impressions scale for use in bipolar illness ( CGI-BP ) , respectively . RESULTS Lurasidone treatment significantly reduced mean MADRS total score at week 6 compared with the placebo group ( -17.1 versus -13.5 ; effect size=0.34 ) . Similarly , lurasidone treatment result ed in significantly greater endpoint reduction in CGI-BP depression severity scores compared with placebo ( -1.96 versus -1.51 ; effect size=0.36 ) as well as significantly greater improvement in anxiety symptoms and in patient-reported measures of quality of life and functional impairment . Discontinuation rates due to adverse events were 6. 
    Output:
    
agent
Our results suggest a high rate of lifetime concurrent anxiety disorders in bipolar disorder .
The diagnostic issues at the interface are particularly difficult because of the substantial symptom overlap .
***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 The authors evaluated the efficacy and safety of lurasidone in the treatment of patients with major depressive episodes associated with bipolar I disorder . METHOD Patients were r and omly assigned to receive double-blind treatment with lurasidone ( 20 - 60 mg/day [ N=166 ] or 80 - 120 mg/day [ N=169 ] ) or placebo ( N=170 ) for 6 weeks . Primary and key secondary endpoints were change from baseline to week 6 on the Montgomery-Åsberg Depression Rating Scale ( MADRS ) and depression severity score on the Clinical Global Impressions scale for use in bipolar illness ( CGI-BP ) , respectively . RESULTS Lurasidone treatment significantly reduced mean MADRS total scores at week 6 for both the 20 - 60 mg/day group ( -15.4 ; effect size=0.51 ) and the 80 - 120 mg/day group ( -15.4 ; effect size=0.51 ) compared with placebo ( -10.7 ) . Similarly , lurasidone treatment result ed in significantly greater endpoint reduction in CGI-BP depression severity scores for both the 20 - 60 mg/day group ( -1.8 ; effect size=0.61 ) and the 80 - 120 mg/day group ( -1.7 ; effect size=0.50 ) compared with placebo ( -1.1 ) . Both lurasidone groups also experienced significant improvements compared with placebo in anxiety symptoms and in patient-reported measures of quality of life and functional impairment . Discontinuation rates due to adverse events were similar in the 20 - 60 mg/day ( 6.6 % ) , 80 - 120 mg/day ( 5.9 % ) , and placebo ( 6.5 % ) groups . The most frequent adverse events associated with lurasidone were nausea , headache , akathisia , and somnolence . Minimal changes in weight , lipids , and measures of glycemic control were observed with lurasidone . CONCLUSION Monotherapy with lurasidone in the dosage range of 20 - 120 mg/day significantly reduced depressive symptoms in patients with bipolar I depression . Lurasidone was well tolerated , with few changes in weight or metabolic parameters OBJECTIVE The authors assessed gender differences in the proportion of clinical visits spent depressed , manic , or euthymic in patients with bipolar disorder . METHOD Data were analyzed from 711 patients with bipolar I or II disorder who were followed prospect ively over 7 years ( 13,191 visits ) . The main outcome measures were the presence of symptoms of depression or of hypomania or mania , measured by the Inventory of Depressive Symptomatology and the  Young Mania Rating Scale . Data were analyzed using three separate repeated- measures regressions with a logistic link function to model the probability that an individual was depressed , manic , or euthymic . The models controlled for bipolar I or bipolar II diagnosis , rapid cycling , age , time in the study , comorbid anxiety disorders , and comorbid substance use disorders . RESULTS In approximately half of visits , patients had depressive , manic , or hypomanic symptoms . The likelihood of having depressive symptoms was significantly greater for women than for men . This was accounted for by higher rates in women of rapid cycling and anxiety disorders , each of which was associated with increased rates of depression . All patient groups showed an increase in number of euthymic visits and a decrease in number of visits with depressive and manic symptoms with increased time in study . CONCLUSIONS Bipolar patients spend a substantial proportion of their time ill . Significant gender differences exist , with women spending a greater proportion of their visits in the depressive pole . This finding appears to be related to the corresponding differences in rates of rapid cycling and anxiety disorders BACKGROUND The impact of anxiety disorders has not been well delineated in prospect i ve studies of bipolar disorder . AIMS To examine the association between anxiety and course of bipolar disorder , as defined by mood episodes , quality of life and role functioning . METHOD A thous and thous and out- patients with bipolar disorder were followed prospect ively for 1 year . RESULTS A current comorbid anxiety disorder ( present in 31.9 % of participants ) was associated with fewer days well , a lower likelihood of timely recovery from depression , risk of earlier relapse , lower quality of life and diminished role function over I year of prospect i ve study . The negative impact was greater with multiple anxiety disorders . CONCLUSIONS Anxiety disorders , including those present during relative euthymia , predicted a poorer bipolar course . The detrimental effects of anxiety were not simply a feature of mood state . Treatment studies targeting anxiety disorders will help to clarify the nature of the impact of anxiety on bipolar course Background Bipolar disorder is highly recurrent and rates of comorbidity are high . Studies have pointed to anxiety comorbidity as one factor associated with risk of suicide attempts and poor overall outcome . This study aim ed to explore the feasibility and potential benefits of a new psychological treatment ( Mindfulness-based Cognitive Therapy : MBCT ) for people with bipolar disorder focusing on between-episode anxiety and depressive symptoms . Methods The study used data from a pilot r and omized trial of MBCT for people with bipolar disorder in remission , focusing on between-episode anxiety and depressive symptoms . Immediate effects of MBCT versus waitlist on levels of anxiety and depression were compared between unipolar and bipolar participants . Results The results suggest that MBCT led to improved immediate outcomes in terms of anxiety which were specific to the bipolar group . Both bipolar and unipolar participants allocated to MBCT showed reductions in residual depressive symptoms relative to those allocated to the waitlist condition . Limitations Analyses were based on a small sample , limiting power . Additionally the study recruited participants with suicidal ideation or behaviour so the findings can not immediately be generalized to individuals without these symptoms . Conclusions The study , although preliminary , suggests an immediate effect of MBCT on anxiety and depressive symptoms among bipolar participants with suicidal ideation or behaviour , and indicates that further research into the use of MBCT with bipolar patients may be warranted OBJECTIVES The purpose of this cohort study was to determine in patients with Panic Disorder ( PD ) : ( 1 ) . the prevalence of subsyndromal symptoms of hypomania , and ( 2 ) . whether subsyndromal hypomania symptoms affect the outcome of cognitive behavior therapy ( CBT ) for panic . METHODS Using the Diagnostic Interview Schedule , and DSM-III-R criteria we identified 18 individuals with a history of symptoms of hypomania among 56 patients with PD . Patients were treated in an open CBT group program . They were assessed before treatment and 6 and 12 months later . We used the  Brief Symptom Inventory ( BSI ) , the Perceived Stress Scale ( PSS ) , the Pearlin-Schooler Mastery Scale ( PMS ) , and the Social Adjustment Scale ( SAS )  at all assessment s. RESULTS The total group significantly improved on all measures . The Clinical ly Significant Change was 71.4 % and the Reliable Change Index 48.2 % . Between 6 and 12 months , there was a trend for the hypomania symptom subgroup ( PH ) to continue to improve on the BSI Depression Scale , the Perceived Stress Scale , the Pearlin-Schooler Mastery Scale , and the Social Adjustment Scale but to lose gains on the BSI Phobic Anxiety and Somatization subscales compared with the group without symptoms of hypomania ( PNH ) . CONCLUSIONS Thirty-two percent of patients with PD had symptoms of hypomania . With CBT for panic , patients with PD and symptoms of hypomania improve as much as those without hypomania symptoms . The presence or absence of symptoms of hypomania might help explain the inconsistent effects of depression and personality disorders on the treatment of PD In order to estimate the prevalence of affective disorders in Hungary a sample of the Hungarian adult population ( 18 - 64 years ) selected at r and om was interviewed using the Diagnostic Interview Schedule ( DIS ) which generated DSM-III-R diagnoses . The lifetime rate for Major Depressive Disorder ( MDD ) was 15.1 % , and for Bipolar Disorders ( BD ) 5.1 % . The female-to-male ratio was 2.7 for MDD and nearly equal for BD . The 1-year and 1-month period prevalence rates were 7.1 % and 2.6 % for MDD and 0.9 % and 0.5 % for manic episodes . A higher rate of divorced or separated persons was found among individuals with a lifetime diagnosis of MDD . Besides these , the lifetime diagnosis of BD coexisted with higher rates of the never-married state . The highest hazard rate for the development of BD or MDD was in the range 15 - 19 years but in MDD another peak was also found in the range 45 - 50 years . The first peak was characteristic of the recurrent , and the other one of the single form of MDD . Insomnia , loss of energy , decreased interest , concentration problems were the most common symptoms during the depressive episode , independent of polarity . Higher rates of lifetime diagnosis of dysthymia and all kinds of anxiety disorder were revealed among persons with MDD . BD was associated with GAD ( Generalized Anxiety Disorder ) , and panic disorder more often than chance OBJECTIVE To evaluate the prevalence of substance abuse dependence and /or alcohol abuse dependence among subjects with bipolar I versus bipolar II disorder in a voluntary registry . METHOD One hundred r and omly selected registrants in a voluntary case registry for bipolar disorder were interviewed , using the Structured Clinical Interview for DSM-IV Axis I Disorders , to vali date the diagnosis of this registry . Corroborative information was obtained from medical records , family members and the treating psychiatrist . Eighty-nine adults ( 18 - 65 years ) met criteria for bipolar disorder ( bipolar I = 71 , bipolar II = 18 ) and were included in this analysis . RESULTS Forty-one ( 57.8 % ) subjects with bipolar I disorder abused , or were dependent on one or more substances or alcohol , 28.2 % abused , or were dependent on , two substances or alcohol , and 11.3 % abused or were dependent on three or more substances or alcohol . Nearly 39 % of bipolar II subjects abused or were dependent on one or more substances , nearly 17 % were dependent on two or more substances or alcohol , and 11 % were dependent on three or more substances or alcohol . Alcohol was the most commonly abused drug among either bipolar I or II subjects . CONCLUSIONS Consistent with other epidemiologic and hospital population studies , this voluntary bipolar disorder registry suggests a high prevalence of comorbidity with alcohol and /or substance abuse dependence . Bipolar I subjects appear to have higher rates of these comorbid conditions than bipolar II subjects ; however , as the number of bipolar II subjects was rather small , this suggestion needs confirmation OBJECTIVE Given the adverse impact of anxiety on treatment outcome in unipolar depression and the paucity of data on the role of anxiety in bipolar disorder , the authors sought to determine the effect of anxiety on the acute treatment response of patients with bipolar I disorder . METHOD The authors examined the correlates of response to the acute treatment of 124 consecutively treated patients with bipolar I disorder . Measures of anxiety included history of panic attacks and a composite variable reflecting current or past anxiety symptoms . RESULTS History of panic attacks proved to be a significant correlate of nonremission . Anxiety , as assessed with the composite variable , was associated with longer time to remission , as was the treatment of depressive versus manic symptoms and mixed versus manic symptoms . Patients with anxiety as assessed with the composite variable and patients with a history of panic attacks reported more severe medication side effects . They also required a greater number of medications , either sequentially or in combination , in order to achieve remission . CONCLUSIONS The findings suggest that anxiety is a clinical ly meaningful correlate of poor outcome in the acute treatment of bipolar I disorder OBJECTIVE Few studies have been reported that support the efficacy of adjunctive therapy for patients with bipolar I depression who have had an insufficient response to monotherapy with mood-stabilizing agents . The authors investigated the efficacy of lurasidone , a novel antipsychotic agent , as adjunctive therapy with lithium or valproate for the treatment of bipolar I depression . METHOD Patients were r and omly assigned to receive 6 weeks of double-blind adjunctive treatment with lurasidone  ( N=183 )  or placebo  ( N=165 ) , added to therapeutic levels of either lithium or valproate . Primary and key secondary endpoints were change from baseline to week 6 on the Montgomery-Åsberg Depression Rating Scale ( MADRS ) and depression severity score on the Clinical Global Impressions scale for use in bipolar illness ( CGI-BP ) , respectively . RESULTS Lurasidone treatment significantly reduced mean MADRS total score at week 6 compared with the placebo group ( -17.1 versus -13.5 ; effect size=0.34 ) . Similarly , lurasidone treatment result ed in significantly greater endpoint reduction in CGI-BP depression severity scores compared with placebo ( -1.96 versus -1.51 ; effect size=0.36 ) as well as significantly greater improvement in anxiety symptoms and in patient-reported measures of quality of life and functional impairment . Discontinuation rates due to adverse events were 6. 
    Output:
    