CORRELATES OF CODISORDERS IN HOMELESS AND NEVER HOMELESS INDIGENT SCHIZOPHRENIC MEN

We recently completed a case-control study of 100 literally homeless a nd 100 never homeless indigent schizophrenic men in New York City, in which concurrent substance abuse and antisocial personality disorder w ere widespread. In this paper we probe the correlates of 'pure' schizo phrenia (single disorder, N = 60), schizophrenia and substance abuse ( double disorder, N = 89), and schizophrenia, substance abuse, and anti social personality disorder (triple disorder, N = 50), across the home less/never homeless distinction. Subjects were recruited from a homele ss shelter and mental health service programmes in Upper Manhattan, Ps ychologist and social worker interviewers administered the Structured Clinical Interview for DSM-III-R, I, and II and other structured instr uments to explore social, family and illness history, the current illn ess, and aspects of treatment and family support. Codisorder subjects emerged from more disadvantaged family backgrounds, experienced greate r school difficulties, began drug use in early adolescence, were more prone to hyperactivity in childhood, and were more likely to have spen t time in jail. While codisorder groups did not differ on key aspects of schizophrenia, the triple disorder group was found to suffer from a more severe form of substance abuse than double disorder subjects, as sociated with an earlier age of onset and abuse of a wider array of su bstances. The widespread prevalence of codisorders among indigent schi zophrenic men has major significance for clinical psychiatry. Study of the correlates of codisorders has revealed important differences in s ocial, family, and illness history which may guide the development of more effective treatments and improved service delivery.