SCHIZOPHRENIC SUBJECTS WITH NO HISTORY OF ADMISSION TO HOSPITAL

It has often been assumed that all subjects with schizophrenia will ev entually be admitted to hospital and therefore little bias is introduc ed by restricting research to hospitalized subjects. Using the Lothian Psychiatric Case Register, 66 subjects were identified who had been d iagnosed in Edinburgh as suffering from schizophrenia between 1978 and 1989 but had no history of hospital admission by December 1991. This represented an adjusted average of 6.7% of the estimated annual rate o f first diagnosis of schizophrenia: the proportion of such patients di d not change over the period. Using a case-control design, the index c ases were compared with a control group of schizophrenic patients who had been admitted to hospital within 3 months of diagnosis. At the tim e of diagnosis, the cases were generally less disturbed with lower lev els of violent behaviour and less evidence of neglect or hallucination s. They had a longer duration of illness prior to diagnosis, were more often diagnosed by a consultant and unemployed. In a follow-up study of the index cases, 59 (89%) were traced, of whom 6 (10%) were decease d. The outcome of the illness was heterogeneous although the course wa s often chronic. The general practitioner provided most of the care th ey received. The small proportion of such patients suggests that their exclusion from most published series does not seriously bias our pict ure of the natural, history of schizophrenia. Moreover, as there was n o increase in the proportion over the period, first admission rates fo r schizophrenia in Scotland are a reasonable approximation to incidenc e rates.