Potential sampling and recruitment source impacts in schizophrenia research.

Most schizophrenia research is undertaken on clinical samples in current contact with mental health services. It is not clear to what extent such samples are representative of the population of people with schizophrenia or whether they differ significantly, for example, from those who are being treated predominantly in primary care settings or who are recruited from non-clinical sources. Data from a volunteer schizophrenia research register and two recent Australian studies are reported, the Low Prevalence (psychotic) Disorders Study and an associated study of schizophrenia in general practice, in which all participants completed the same clinical assessment interview. Participants meeting criteria for schizophrenia or schizoaffective disorder were classified according to their source of recruitment: volunteer research register (n=128), general practice (n=123), community (n=236) or public inpatient (n=178) mental health services. Hierarchical discriminant function analyses revealed significant differences between these recruitment sources with respect to illness-onset factors, relationship and support factors, current functioning and course of illness. A severity/functioning gradient was observed across the four recruitment sources, possibly reflecting a spectrum of neurobiological impairment from good to poor prognosis. The implications of these findings for sampling strategies in schizophrenia research are discussed.

Attitudes and roles of general practitioners in the treatment of schizophrenia compared with community mental health staff and patients.

BACKGROUND: Most general practitioners (GPs) are currently treating a small number of patients with schizophrenia; however, little is known about GPs' experiences in this area. This paper examines the attitudes and roles of Australian GPs in the treatment of schizophrenia and their relationships with specialist services. METHODS: A total of 192 GPs' ratings of possible sources and forms of help for patients with schizophrenia were compared with the ratings of 50 mental health services (MHS) staff and 129 patients. Comparisons within the health professionals were also made in relation to diagnostic and treatment confidence, perceived roles, and typical problems encountered. RESULTS: Perceived helpfulness ratings were reasonably consistent across groups. However, patients tended to rank close family members as more helpful. GPs and MHS staff reported complementary roles, with a shared responsibility for early detection and relapse prevention. Treatment compliance, and communication and accessibility to specialist agencies were identified as major problems. CONCLUSIONS: GPs fulfil a valuable role in the treatment of schizophrenia, which could be enhanced through improved training. Mental health services need to work more effectively with GPs in treating schizophrenia and acknowledge their complementary roles.

Comparisons between schizophrenia patients recruited from Australian general practices and public mental health services.

OBJECTIVE: To examine differences between samples of schizophrenia patients recruited from general practice and public mental health services. METHOD: Demographic, psychosocial, disability and 12-month service utilization data are reported from a multicentered survey of psychotic disorders and an associated study of schizophrenia in general practice. Patients with schizophrenia from three recruitment sources (in-patient, community services, general practice) were compared. RESULTS: General practice patients had fewer symptoms, better functioning, lower service use, but comparable substance abuse, to patients from mental health services. They were generally similar to community mental health patients, with the exception of family support, premorbid work adjustment, negative symptoms and disability. Service contact models are also reported which demonstrate that general practitioners deal with schizophrenia patients across the range of illness severity and acuity. CONCLUSION: Recruitment source impacts in schizophrenia research need to be more carefully considered during sample selection and better accounted for in the interpretation of results.