OBJECTIVES: To profile utilization of olanzapine and risperidone at baseline in a prospective study of treatment for schizophrenia, and evaluate factors associated with the receipt of these medications. METHODS: Data were obtained from the U.S. Schizophrenia Care and Assessment Program (US-SCAP), a prospective study of treatment for schizophrenia in six large community systems of care. The first 1,231 patients enrolled in the study were evaluated, including 321 patients treated with olanzapine and 231 patients treated with risperidone. RESULTS: 45 percent of patients received olanzapine and/or risperidone over a six-month baseline interval. Olanzapine-treated patients received a median dose of 10.4 mg/day [mean 13.0, mode 10]. Risperidone-treated patients received a median dose of 6.0 mg/day [mean 5.6, mode 6]. Among patients receiving both medications, risperidone was two times more likely to precede olanzapine than the reverse order. Patients initiating treatment with olanzapine were significantly more likely to receive prior treatment with clozapine and/or depot antipsychotics (p < .01) than risperidone-treated patients. Patients treated with olanzapine only were significantly less likely to receive antiparkinsonian or anticholinergic agents (p <.01) during the treatment interval than patients treated with risperidone only. CONCLUSIONS: Dosages of olanzapine and risperidone in this large community sample of patients receiving usual care were consistent with expectations from controlled studies. Olanzapine-treated patients were more likely to receive prior therapies associated with treatment resistance or noncompliance than risperidone-treated patients, suggesting the possibility of greater severity in the olanzapine treatment group. Olanzapine-treated patients were less likely to receive antiparkinsonian or anticholinergic medications during therapy.