Sociodemographic, functional and clinical correlates in outpatients with schizophrenia: comparison with affective disorders.

Objectives: To describe the demographic, social and functional characteristics and service utilization of people with schizophrenia attending four public psychiatric services in New Zealand and to compare this with (i) people with severe affective disorders attending the same four services and (ii) the New Zealand general population; and to examine conformity with evidence-based pharmacological treatment of schizophrenia.

Methods: Clinical files for all adult outpatients attending the four specialist services were reviewed in October 2004 (n =6164). Patient characteristics, social and functional indicators, diagnosis, duration of illness, and admission information were recorded and analysed for schizophrenia, bipolar disorder and depression (n =5032). Antipsychotic treatment was recorded for those with schizophrenia.

Results: Outpatients with schizophrenia made up 47% of the outpatient population; 66% were male, the mean age 39 years and the mean illness duration was 14 years. Sixty-seven percent of schizophrenia outpatients had never been married, 69% had no regular occupational activity, 49% had no formal qualifications, 24% were living in group homes and 26% were treated compulsorily. These characteristics were consistently different compared to outpatients with severe affective disorders and the general population; schizophrenia patients were the most impaired, depression the least and the bipolar group in between. The majority of schizophrenia patients received evidence-based antipsychotic treatment; 84% received monotherapy; 81% prescribed an atypical; 33% prescribed clozapine.

Conclusions: The study shows significant impairment for schizophrenia patients in areas of intimate relationships, occupational activity, living situation, qualifications and specialist mental health service use despite evidence-based pharmacological treatment. To improve outcome optimal care must incorporate existing evidence-based, cost-effective interventions that focus on both symptoms and function. More effective treatments also need to be developed.