Summary
Schizophrenia is a stress-related biomedical condition of the brain. characterised by unusual internal experiences. severe and often persistent functional disability and socially inappropriate behaviour. It is estimated that schizophrenia affects approltimateiy 1 % of all adults worldwide. Young adults are especially vulnerable. It is an illness with profound economic impact on patients. their families and society at large.
Before the 1950s, most patients with schizophrenia were admitted to hospital for long inpatient stays. Keeping the patient in an institutional setting was all that psychiatry could offer, because there was little active treatment available. After World War II, and especially fol lowing the introduction of chlorpromazine in 1954, treatment was offered increasingly in outpatient settings. At present, more than 90% of individuals with schizophrenia will receive most healthcare services in outpatient facilities, supplemented by brief hospital treatment.
The trend toward community-based care continues into the 1990s, supported in part by recent pharmacotherapeutic developments that are making a new generation of drug treatment options available. Clozapine, the mosl widely used of these new drugs, has been the subject of several studies that compared its costs with those of conventional drug treatments. These early studies suggest that further reductions in the cost of hospital treatment are possible in the near future.
At the same time, despite the increasing availability of effective treatment in outpatient settings, the shift of resources from institutional to community care will not occur as quickly as some might wish. Delays in the transformation of care systems are caused by political interest groups and the sheer inertia of the infrastructure left over from the era of institutional care. These factors must be taken into account in estimating the cost of schizophrenia care during the next decade.
The aim of this review is to provide a clinical picture of schizophrenia, emphasising features that contribute most to the cost of illness. We define and quantify the direct and indirect costs of the illness, discuss the cost implications of new pharmacotherapeutic and psychosocial treatments, and critique strategies for measuring the economic efficacy of these new treatments. The difficulties in measuring the costs of schizophrenia that are related to the transition from institutional to community-based systems of care in the US are also reviewed.
Similar content being viewed by others
References
Hyde TM, Weinberger DR. The brain in schizophrenia. Semin Neurol 1990; 10 (3): 276–86
Kendler KS, Diehi SR. The genetics of schizophrenia; a current, genetic-epidemiologic perspective. Schizophr Bull 1993; 19(2): 261–85
Brixley SN, Gallagher BJ, McFalls JA, et al. Gestational and neonatal factors in the etiology of schizophrenia. J Clin Psychol 1993; 49(3): 447–56
Pilowsky LS, Kerwin RW, Murray RM. Schizophrenia: a neurodevelopmental perspective. Neuropsychopharmacology 1993; 9 (1): 83–91
Pert CB, Knight JG, Laing P, et al. Scenarios for a viral etiology of schizophrenia. Schizophr Bull 1988; 14(2): 243–7
Freedman R, Waldo M, Bickford-Wimer P, et al. Elementary neuronal dysfunction in schizophrenia. Schizophr Res 1991; 4(2): 233–43
Judd LL, McAdams L, Budnick B. et al. Sensory gating deficits in schizophrenia; new results. Am J Psychiatry 1992; 149(4): 488–93
Adler LE, Waldo MC, Tatcher A, et al. Lack of relationship of auditory gating defects to negative symptoms in schizophrenia. Schizophr Res 1990; 3(2): 131–8
Crow TJ. Molecular pathology of schizophrenia: more than one disease process? BMJ 1980; 280: 66–8
Andreasen NC. The broken brain. New York: Harper & Row, 1984
Toney EF. A viral-anatomical explanation of schizophrenia. Schizophr Bull 1991; 17(I): 15–8
Adler LE, Waldo MC. Counterpoint; a sensory gating-hippocampal model of schizophrenia. Schizophr Bull 1991; 17(1): 19–24
Sarlorius N, Jablensky A, Korten A, et al. Early manifestations and first-contact incidence of schizophrenia in different cultures: a preliminary report on the evaluation of the WHO Collaborative Study in Determinants of Outcome of Severe Mental Disorders. Psychol Med 1986; 16: 909–28
Robins LN, Heizer JE, Weissman MM. et al. Lifetime prevalence of specific psychiatric disorders in three sites. Arch Gen Psychiatry 1984; 41: 949–58
Leff JP. Schizophrenia and sensitivity to the environment. Schizophr Bull 1976; 2: 566–74
North CS. Current concepts of schizophrenia. Compr Ther 1989; 15(3): 8–21
Andreasen NC, Flaum M. Schizophrenia: the characteristic symptoms. Schizophr Bull 1991; 17(1): 27–49
Amador X, Strauss DH, Yale SA, et al. Awareness of illness in schizophrenia. Schizophr Bull 1991; 17(1): 113–32
McGlashan TH, Fenton WS. The positive-negative distinction in schizophrenia: review of natural history validators. Arch Gen Psychiatry 1992; 49(1): 63–72
Tabbane K, Joober R, Spadone C. et al. Mortality and cause of death in schizophrenia: review of the literature. Encephale 1993; 19(1): 23–8
Glassman AH. Cigarette smoking: implications for psychiatric illness. Am J Psychiatry 1993; 150(4): 546–53
Ziedonis DM, Kosten TR, Glazer WM, et al. Nicotine dependence and schizophrenia. Hosp Community Psychiatry 1994; 45(3): 204–6
Martinez JA, Velasco JJ, Urbistondo MD. Effects of pharmacological therapy on anthropometric and biochemical status of male and femaie institutionalized psychiatric patients. J Am Coll Nutr 1994; 13(2): 192–7
Mortensen PB, Juel K. Mortality and causes of death in schizophrenic patients in Denmark. Acta Psychiatr Scand 1990; 81(4): 372–7
Masterson E, O’Shea B. Smoking and malignancy in schizophrenia. Br J Psychiatry 1984; 145: 429–32
Koran LM, Sox HC, Marton KI, et al. Medical evaluation of psychiatric patients. Arch Gen Psychiatry 1989; 46(8): 733–40
Minkoff K, Drake RE. Dual diagnosis of major mental illness and substance disorder. San Francisco: Jossey-Bass, 1991
Cournos F, Empfield M, Horwalh E, et al. HIV seroprevalence among patients admitted to two psychiatric hospitals. Am J Psychiatry 1991; 148: 1225–30
Sacks M, Dermatis H, Burton W, et al. Acute psychiatric illness: effects on HIV-risk behavior. Psychosoc Rehabil J 1994; 17: 5–18
Regier DA, Burke JD, Manderschcid RW, et al. The chronically mentally ill in primary care. Psychol Med 1985; 15: 265–73
Wing JK. A simple and reliable subelassification of chronic schizophrenia. J Ment Sci 1961; 107: 862–75
Liddle PF. The symptoms of chronic schizophrenia: are-examination of the positive-negative dichotomy. Br J Psychiatry 1987; 151: 145–51
Blackwell B. Drug therapy: patient compliance. N Engl J Med 1973; 289: 249–52
Blackwell B. Treatment adherence. Br J Psychiatry 1976; 129: 513–31
Van Putten T. Why do schizophrenic patients refuse to take their drugs? Arch Gen Psychiatry 1974; 31: 67–72
Bartkó G, Kerczeg I, Zádor G. Clinical symptomatology and drug compliance in schizophrenic patients. Acta Psychiatr Scand 1988; 77: 74–6
Günther V, Meise U. Compliance: ein komplexes problem. Wien Med Wochenschr 1990; 140: 365–9
Van Putten T, Marder SR, Wirshing WC, et al. Surreptitious noncompliance with oral fluphenazine in a voluntary inpatient population [letter]. Arch Gen Psychiatry 1990; 47(8): 786–7
Green JH. Frequent rehospitalization and noncompliance with treatment. Hosp Community Psychiatry 1988; 39(9): 963–6
Teplin LA. The prevalence of severe mental disorder among male urban jail detainees: comparison with Epidemiological Catchment Area Program. Am J Public Health 1990; 80: 639–69
Opler LA, Caton CLM, Shrout P, et al. Symptom profiles and homelessness in schizophrenia. J Nerv Ment Dis 1994; 182: 174–8
Weiden PJ. The cost of relapse: the noncompliance factor. 147th American Psychiatric Association Annuai Meeting; 1994 May 24: Philadelphia (PA). 311
Susser E, Streuning EL, Conover S. Psychiatric problems in homeless men: lifetime psychosis, substance use, and current distress in new arrivals at New York City shelters. Arch Gen Psychiatry 1989; 46: 845–50
Geddes J, Newton R, Young G, et al. Comparison of prevalence of schizophrenia among residents of hostels for homeless people in 1966 and 1992. BMJ 1994; 308: 816–9
Drake RE, Wallach MA, Teague GB, et al. Housing instability and homelessness among rural schizophrenic patients. Am J Psychiatry 1991; 148: 330–6
Virgona A, Buhrich N, Teeson M. Prevalence of schizophrenia among women in refuges for the homeless. Aust N Z J Psychiatry 1993; 27: 405–10
Grinspoon L, Ewalt JR, Shader RL editors. Schizophrenia: pharmacotherapy and psychotherapy. Baltimore: Williams & Wilkins, 1972
Hogarty GE, Goldberg SC. the Collaborative Study Group. Drug and sociotherapy in the aftercare of schizophrenic patients: one year relapse rates. Arch Gen Psychiatry 1973; 28: 54–64
Bachrach L. Principles of planning for chronic psychiatric patients: a synthesis. In; Talbotl JA, editor. The chronic mental patient; five years later. Orlando (FL): Grime & Stratton, 1984: 165–82
Wyatl RJ. Antipsychotics and the natural course of schizophrenia. Schizophr Bull 1991; 17: 325–51
Delay J, Deniker P, Harl JM. Utilization en thérapeutique psychiatrique d’une phenothiazine d’action cenlrale elective (4560 RP). Ann Med Psychol 1952; 110: 112–7
Lehmann HE, Hanrahan GE. Chlorpromazine, a new inhibiting agent for psychomotor excitement and manic states. AMA Arch Neurol Psychiatry 1954; 71: 227–37
Casey JF, Bennett IR, Lindley CJ, et al. Drug therapy in schizophrenia. Arch Gen Psychiatry 1960; 2: 210–20
National Institute of Mental Health Psychopharmacology Service Center Collaborative Study Group. Phenothiazine treatment in acute schizophrenia. Arch Gen Psychiatry 1964; 10: 246-61
Kline NS, Stanley AM. Use of reserpine in a neuropsychiatric hospital. Ann N Y Acad Sci 1955; 61: 85–91
Finn MHP, Nadolski F, Guy W, et al. Clinical, psychological, and myoneural changes in psychotic patients under oral Serpasil medication. J Nerv Ment Dis 1955; 122: 458–62
Cheung HK, Schizophrenics fully remitted on antipsychotics for 3-5 years: to slop or continue drugs? Br J Psychiatry 1981; 138: 490–4
Wistedt B, Jorgensen A, Wiles D. A depot antipsychotic withdrawal study. Psychopharmacology 1982; 78: 301–4
Johnson DAW, Pasterski C, Ludlow JM, et al. The discontinuance of maintenance antipsychotic therapy in chronic schisophrenic patients: drug and social consequences. Acta Psychiatr Scand 1983; 67: 339–52
Gilbert PL, Harris J, McAdams LA, et al. Antipsychotic withdrawal in schizophrenic patients: a review of the literature. Arch Gen Psychiatry 1995; 52(3): 173–88
Siris SG. Adjunctive medication in the maintenance treatment of schizophrenia and its conceptual implications. Br J Psychiatry Suppl 1993; 22: 66–78
Schooler NR. Reducing dosage in maintenance treatment of schizophrenia: review and prognosis. Br J Psychiatry Suppl 1993; 22: 58–65
Kane JM. Dosage strategies with long-acting injectable antipsychotics, including haloperidol decanoate. J Clin Psychopharmacol 1986; 6(1 Suppl,): 20–3
Marder SR. Depot antipsychotics: side effects and safety. J Clin Psychopharmacol 1986; 6(1 Suppl.): 24–9
Christison GW, Kirsch DF, Wyatt RJ. When symptoms persist: choosing among alternative somatic treatments for schizophrenia. Schizophr Bull 1991; 17(1): 217–45
Brambilla F, Scarone J, Ponzano M, et al. Catecholamine drugs in chronic schizophrenia. Neuropsychobiology 1979; 5: 185–200
Plasky P. Antidepressant usage in schizophrenia. Schizophr Bull 1991; 17(4): 649–57
Amsler HA, Teerenhovi L, Barth E, et al. Agranulocytosis in patients treated with clozapine: a study of the Finnish epidemic. Acta Psychiatr Scand 1977; 56(4): 241–8
Kane JM, Honigfeld G, Singer J, et al. Clozapine for the treatment-resistant schizophrenic. Arch Gen Psychiatry 1988; 45: 789–96
Alvir JMJ, Liebcrman JA, Safferman AZ, et al. Clozapine-induced agranulocytosis: incidence and risk factors in the United States. N Engl J Med 1993; 329: 162–7
Land W, Salzman C. Risperidone: a novel antipsychotic medication. Hosp Community Psychiatry 1994; 45: 434–5
Moore NA, Tye NC, Axton MS, et al. The behavioral pharmacology of olanzapine, a novel ‘atypical’ antipsychotic agent. J Pharmacol Exp Ther 1992; 262(2): 545–51
Hyttel J, Arnt J, Costall B, et al. Pharmacological profile of the atypical antipsychotic sertindole. Clin Neuropharmacol 1992; 15Suppl. 1, Pt A: 267–8
Meltzer HY. Novel antipsychotic drugs. New York: Raven Press, 1992
Rothman D. Discovery of the asylum: social order and disorder in the new republic. Boston: Liltle Brown & Co., 1971
Cutting J. Outcome of schizophrenia: overview. In: Kerr TA, Shaith P. editors. Contemporary issues in schizophrenia. Washington, DC: American Psychiatric Press, 1986: 433–40
New York State Office of Mental Health (NYSOMH) Mental Health Statistics Unit. Statewide chartbook of mental health information. Albany: NYSOMH. 1994
Wilson GF, Phillips KL. Utilization review criteria for adult extended hospitalization. In: Maltson MR, editor. Manual of psychiatric quality assurance. Washington. DC: American Psychiatric Association, 1992: 121–6
Gabbard GO. Comparative indications for brief and extended hospitalization. In: Tasman A, Riba MB, editors. Review of psychiatry. Vol II. Washington. DC: American Psychiatric Press, 1992: 503–17
Love RE, The community support program: strategy for reform? In: Talbott JA. editor. The chronic mental patient: five years later. Orlando (FL): Grune & Stratton, 1984: 195–214
Turner JC, TenHoor WJ. The NIMH Community Support Program: pilot approach to a needed social reform. Schizophr Bull 1978; 4: 319–48
Foumier JP, Gagnon F. A crisis intervention service in an out-patient psychiatric clinic of a general hospital: function and clientele. Am J Psychiatry 1993; 38: 96–100
Pigott HE, Trott L. Translating research into practice: the implementation of an in-home crisis intervention triage and treatment service in the private sector. Am J Med Qual 1993; 8: 138–44
Pasaminick B, Scarpitti F, Dinitz S. Schizophrenics in the community: an experimental sludy in the prevention of hospitalization. New York: Appleton-Century-Crofts, 1967
Langsley DG, Kaplan DM. The treatment of families in crisis. New York: Grune & Stratton, 1968
Bengelsdorf H, Church JO, Kaye RA, et al. The cost effectiveness of crisis intervention: admission diversion savings can offset the high cost of service. J Nerv Ment Dis 1993; 181(12): 757–62
Stein LI. A system approach to reducing relapse in schizophrenia. J Clin Psychiatry 1993; 54Suppl.: 7–12
Stein LI, Test MA. Alternatives to menial hospital treatment. New York: Plenum, 1978
Stein LI, Test MA. Alternative to mental hospital treatment: I. Conceptual model, treatment program, and clinical evaluation. Arch Gen Psychiatry 1980; 37(4): 392–7
Weisbrod BA, Test MA, Stein LI. Alternative to mental hospital treatment: 11. Economic benefil-cost analysis. Arch Gen Psychiatry 1980; 37(4): 400–5
Hornstra RK, Bruce-Wolfe V, Sagduyu K, et al. The effect of intensive case management on hospitalization of patients with schizophrenia. Hosp Community Psychiatry 1993; 44(9): 844–7
Dixon L, Friedman N, Lehman A. Compliance of homeless mentally ill persons with assertive community treatment. Hosp Community Psychiatry 1993; 44(6): 581–3
Santos AB, Deci PA, Lachance KR, et al. Providing assertive community treatment for severely mentally ill patients in a rural area. Hosp Community Psychiatry 1993; 44(I): 34–9
Dincin J, Wasmer D, Witheridgc TF, et al. Impact of assertive community treatment on the use of stale hospital inpatient bed-days. Hosp Community Psychiatry 1993; 44(9): 833–8
Olfson M. Assertive community treatment: an evaluation of the experimental evidence. Hosp Community Psychiatry 1990; 41: 634–41
Brown GW, Birley JLT, Wing JK. Influence of family life on the course of schizophrenic disorders: a replication. Br J Psychiatry 1972; 121: 241–58
Vaughn CE, Leff JP. The influence of family and social factors on the course of psychiatric illness: a comparison of schizophrenic and depressed neurotic patients. Br J Psychiatry 1976; 129: 125–37
Lehtinen K. Need-adapted treatment of schizophrenia: a five-year follow-up study from the Turku project. Acta Psychiatr Scand 1993; 87(2): 96–101
Gottschalk LA, Kentingc C. Influence of patient caregivers on course of patient illness: ‘expressed emotion’ and alternative measures. J Clin Psychol 1993; 49(6): 898–912
Liberman RP, editor. Psychiatric rehabilitation of chronic mental patients. Washington. DC: American Psychiatric Press. 1988
Anthony W, Cohen M, Farkas M. Psychiatric rehabilitation. Boston: Center for Psychiatric Rehabilitation, 1990
Liberman RP, editor. Handbook of psychiatric rehabilitation. Boston: Allyn and Bacon, 1993
Dzhagarov M. Experience in organizing a half hospital for mental patients. Neuropathol Psikhatria 1937; 6: 137–47
Cameron DE. The day hospital: experimental forms of hospitalization for patients. Mod Hosp 1947; 69(3): 60–2
Bierer J. Therapeutic social clubs. London: HK Lewis, 1948
Herz MI, Endicott J, Spitzer RL, et al. Day versus inpatient hospitalization: a controlled study. Am J Psychiatry 1971; 127(10): 1371–82
Guilette W, Crowley B, Savitz SA, et al. Day hospitalization as a cost-effective alternative to inpatient care: a pilot study. Hosp Community Psychiatry 1978; 29(8): 525–7
Wiersma D, Kluiter H, Nienhuls FJ, et al. Costs and benefits of day treatment with community care for schizophrenic patients. Schizophr Bull 1991; 17(3): 411–9
Gudeman JE, Dickey B, Evans A, et al. Four-year assessment of a day hospital-inn program as an alternative to inpatient hospitalization. Am J Psychiatry 1985; 142(11): 1330–3
Linn MW, Caffey EM, Kielt J, et al. Day treatment and psychotropic drugs in the aftercare of schizophrenic patients: a Veterans Administration cooperative study. Arch Gen Psychiatry 1979; 36: 1055–66
Muiler P. Psychotherapy in schizophrenic psychoses - historical development, effectiveness and currently accepted methods. Fonschr Neurol Psychiatr 1991; 59(7): 277–85
Gunderson JG, Frank AF, Katz HM, et al. Effects of psychotherapy in schizophrenia: II. Comparative outcome of two forms of treatment. Schizophr Bull 1984; 10(4): 564–98
Kates J, Rockland LH. Supportive psychotherapy of the schizophrenic patient. Am J Psychother 1994; 48(4): 543–61
Kahn EM, Kahn EW. Group treatment assignment for outpatients with schizophrenia: integrating recent clinical and research findings. Community Ment Health J 1992; 28(6): 539–50
Falloon IR. Psychotherapy of schizophrenia. Br J Hosp Med 1992; 48(3-4): 164–70
Kuchenhoff B, Hell D. Treatment of schizophrenia in clinical practice. Schweiz Rundseh Med Prax 1993; 82(17): 510–5
Strauss JS. Intensive clinical studies: the psychotherapy of schizophrenia. Psychiatry 1993; 56(3): 282–3
May PRA. Treatment of schizophrenia: a comparative study of five treatment methods. New York: Science House, 1968
Mosher LR, Keith SJ. Psychosocial treatment: individual, group, family and community support approaches. Schizophr Bull 1980; 6: 10–41
Kraepelin E. Dementia praecox and paraphrenia (1919). Translated by RM Barclay. New York: Robert E Kreiger Publishing Company, 1971
Bleuler M. The long-term course of the schizophrenic psychoses. Psychol Med 1974; 4: 244–54
Bleuler M. The schizophrenic disorders: long-term patient and family studies. New Haven (CT): Yale University Press, 1978
Ciompi L. The natural history of schizophrenia in the long term. Br J Psychiatry 1980; 136: 413–20
Harding CM, Brooks GW, Ashikaga T, et al. The Vermont longitudinal study of persons with severe mental illness: II. Long-term outcome of subjects who retrospectively met DSM-lil criteria for schizophrenia. Am J Psychiatry 1987; 144(6): 727–35
Cohen P, Cohen J. The clinician’s illusion. Arch Gen Psychiatry 1984; 41: 1178–82
Harding CM, Zubin J, Strauss JS. Chronicity in schizophrenia: fact, partial fact or artifact? Hosp Community Psychiatry 1987; 38: 477–86
Eaton WW, Bilker W, Haro JM. et al. Long-term course of hospitalization for schizophrenia: II. Change with passage of time. Schizophr Bull 1992; 18(2): 229–41
Breier A, Strauss JS. Self-control in psychotic disorders. Arch Gen Psychiatry 1983; 40(10): 1141–5
Davidson L, Strauss JS. Sense of self in recovery from severe mental illness. Br J Med Psychol 1992; 65(Pt 2): 131–45
Sehlaff C. From dependency to self-advocacy: redefining disability. Am J Occup Ther 1993; 47(10): 943–8
Werry JS, McClellan JM. Predicting outcome in child and adolescent (early onset) schizophrenia and bipolar disorder. J Am Acad Child Adolesc Psychiatry 1992; 31(1): 147–50
Carpenter Jr WT, Kirkpatrick B. The heterogeneity of the long-term course of schizophrenia. Schizophr Bull 1988; 14: 645–52
Lamb RH. What did we really expect from deinstitutionalization? Hosp Community Psychiatry 1981; 32: 105–9
Anthony WA, Cohen MR, Vitalo R. The measurement of rehabilitative outcome. Schizophr Bull 1978; 4: 365–83
Hera MI. Recognizing and preventing relapse in patients with schizophrenia. Hosp Community Psychiatry 1984; 35: 344–9
Andreasen NC. Assessment issues and the cost of schizophrenia. Schizophr Bull 1991; 17(3): 475–81
Sharfstein SS. Prospective cost allocations for the chronic schizophrenic patient. Schizophr Bull 1991; 17(3): 395–400
Rice DP, Kelman S, Miller LS, et al. The economic costs of alcohol and drug abuse and mental illness: 1985. San Francisco; Institute for Health and Aging, University of California, 1990
Anient A, Evers S. Cost of illness studies in health care: a comparison of two cases. Health Policy 1993; 26: 29–42
Cassel EJ. The nature of suffering and the goals of medicine. N Engl J Med 1982; 306: 639–45
Scheffler RM, Foreman SE, Cuffel BJ, et al. Mental health benefits in the Clinton plan. Health Aff 1994; 13: 201–10
Terkelsen KG, Grosser RC, Estimating clozapine’s cost to the nation. Hosp Community Psychiatry 1990; 41(8): 863–9
Weisbrod BA. A guide to benefit-cost analysis as seen through a controlled Experiment in treating the mentally ill. J Health Polit Policy Law 1983; 7: 808–45
Hing E, Sekscenski E, Strahan G. The national nursing home survey: 1985 summary for the United Stales. Publication No. (PHS) 89-1758 (Vital Health Statistics; vol. 13, no. 97) Washington, DC: US Government Printing Office, Department of Health and Human Services, 1989
National prescription audit. Ambler (PA): IMS America, 1985
Zorc JJ, Larson DB, Lyons JS, et al. Expenditures for psychotropic medications in the United States in 1985. Am J Psychiatry 1991; 148: 644–7
Allebeck P. Schizophrenia; a life-shortening disease. Schizophr Bull 1989; 15: 81–9
Berren MR, Hill KR, Merikle E, et al. Serious mental illness and mortality rates. Hosp Community Psychiatry 1994; 45: 604–5
Goldman HH. Mental illness and family burden: a public health perspective. Hosp Community Psychiatry 1982; 33: 557–60
Franks DD, The high cost of caring: economic contributions of families to the care of the mentally ill [dissertation). Waltham (MA): Brandeis University, 1987
McGuire TG. Measuring the economic costs of schizophrenia. Schizophr Bull 1991; 17: 375–88
Clark RE. Family costs associated with severe mental illness and substance abuse. Hosp Community Psychiatry 1994; 45(8): 808–13
Goldman HH. Epidemiology In: Talbott JA, editor. The chronic mental patient: live years later. Orlando (FL): Grune & Stratton, 1984: 15–31
Salleh MR, The burden of care of schizophrenia in Malay families. Acta Psychiatr Scand 1994; 89(3): 180–5
Lehman AF, Linn LS. Crimes against discharged mental patients in board-and-care homes. Am J Psychiatry 1984; 141(2): 271–4
Brown P. The transfer of care: psychiatric deinstitutionalization and its aftermath. London: Routledge & Kegen Paul, 1985
Swanson JW, Holzer CE, Ganju VK, et al. Violence and psychiatric disorder in the community: evidence from the Epidemiologic Catchment Area. surveys. Hosp Community Psychiatry 1990; 41: 761–70
Link BG, Andrews H, Cullen FT. The violent and illegal behavior of mental patients reconsidered. Am Sociol Rev 1992; 57: 275–92
Guy E, Piatt JJ, Zwerling I, et al. Mental health status of prisoners in an urban jail. Crim Justice Behav 1985; 12: 29–53
Fein R. Economics of mental illness. New York: Basic Books. 1958
Davies LM, Drummond MF. Economics and schizophrenia: the real cost. Br J Psychiatry 1994; l65Suppl. 25: 18–21
Meltzer HY, Cola P, Way L. et al. Cost effectiveness of clozapine in antipsychotic-resistant schizophrenia. Am J Psychiatry 1993; 150(11): 1630–8
Meibach RC and the Risperidone Study Group. A fixed dose, parallel group study of risperidone vs haloperidol vs placebo [abstract]. Schizophr Res 1993; 9: 245
Marder SR, Meibach RC. Risperidone in the treatment of schizophrenia. Am J Psychiatry 1994; 151: 825–35
Mechanic D, Aiken LH. Improving the care of patients with chronic mental illness. N Engl J Med 1987; 317(26): 1635–8
Terkelsen KG, McCarthy RH, Munich RL, et al. Development of clinical methods for utilization review in psychiatric day treatment. J Ment Health Admin 1994; 21(3): 298–312
National Association of Psychiatric Hospital Systems. 1992 annual survey: final report. Washington, DC: National Association of Psychiatric Health Systems, 1993: 15
Rupp A, Keith SJ. The costs of schizophrenia: assessing the burden. Psychiatr Clin North Am 1993; 16(2): 413–23
Robinson JC. The changing boundaries of the American hospital. Milbank Q 1994; 72: 259–75
Lewandowski L, Buchkremer G, Hermann T. The effectiveness of ambulatory occupational therapy measures for patients with schizophrenia [in German]. Psychiatr Prax 1992; 19(4): 122–8
Leff JP. Developments in family treatment of schizophrenia. Psychiatric Q 1979; 51: 216–32
Cohen CI. Poverty and the course of schizophrenia: implications for research and policy. Hosp Community Psychiatry 1993; 44(1): 951–8
Asbaugh JW, Manderscheid RW. A method for estimating the chronic mentally ill population in stale and local areas. Hosp Community Psychiatry 1985; 36(4): 389–93
Black BJ. Substitute permanent employment of the deinslitulionalized mentally ill. J Rehabil 1977; 43(2): 32–9
Ozawa MN, Lindsey D. Is SSI too supportive of the mentally ill? Public Welfare 1977; 35 (4): 48–52
Lamb HR. Incentives and disincentives of disability insurance for the chronically mentally ill. In: Meyerson AT, Fine T, editors. Psychiatric rehabilitation: clinical, legal, and administrative dimensions. Washington, DC: American Psychiatric Press, 1987: 343–50
Berkowitz M. Disincentives and the rehabilitation of disabled persons. In: Pan EL, Backer TE, Vash CL, editors. Annual review of rehabilitation. Vol 2. New York: Springer Publishing, 1981
Black BJ. Work and mental illness: transitions to employment. Baltimore (MD): Johns Hopkins University Press, 1988
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Terkelsen, K.C., Menikoff, A. Measuring the Costs of Schizophrenia. Pharmacoeconomics 8, 199–222 (1995). https://doi.org/10.2165/00019053-199508030-00004
Published:
Issue Date:
DOI: https://doi.org/10.2165/00019053-199508030-00004