Patients were randomly selected from current psychiatric caseloads drawn from urban and suburban areas of Leicester, England.
Patients were included as participants if they had received a diagnosis of schizophrenia according to Diagnostic and Statistical Manual of Mental Diseases, 4th edition (DSM-IV) criteria and had no other psychosis, were aged 18 to 64 years, and had given their informed consent.
Relapse was identified retrospectively in this study as the reemergence or aggravation of psychotic symptoms for at least 7 days during the 6 months prior to the study.
In addition to instances of relapse identified by clinical staff, recorded changes in mental state were regarded as significant and amounting to relapse if there was a clearly documented assessment of a relapse. A change in management, as appropriate, might also have occurred, and not all relapses led to readmission. Relapse could thus be identified in cases of patients who had been admitted to a hospital in the past 6 months, who had consulted their psychiatrist and had had their medication changed for deterioration in their condition, or who had had an increase in intensive support at home from the community mental health team. A planned hospital admission was not classified as a relapse
Patients who relapsed demonstrated significantly higher expenditures in inpatient care, outpatient psychiatric visits, and visits by psychiatrists.
Higher costs in day care center visits were seen in patients who did not relapse.