OBJECTIVE: To examine the impact of clinical syndrome, type of medication and adherence on outpatient utilization. METHODS: Baseline data predicted 6-month outpatient utilization (n=985). Psychotherapy, clinic visits (specimen collection), and total number of outpatient visits were examined. Presence of medication (15 first-generation; 5 novel; both) was coded. Adherence reflected the 4-weeks prior to assessment. Clinical syndrome variables: deficit, hallucinations/ delusions, and disorganization. Negative binomial regression (adjusted standard errors). RESULTS: Psychotherapy Visits: Positive effect observed for higher hallucinations/delusions and use of both first- and second-generations. Clinic Visits: The probability of visit was positively impacted by higher disorganization, adherence, education less than high school graduation, and CHAMPUS. Negative effect noted for use of novel agents and having Medicare only. Number of visits higher for those with higher disorganization. Total Outpatient Visits: Positive effect observed for adherence at both periods and treatment with novel agents alone or in combination with first-generation agents. The clinical syndrome variables did not achieve significance. CONCLUSIONS: The positive correlation of medication adherence at both baseline and 6 months with clinic visits and total visits is an important driver in outpatient services utilization. The type of medication positively impacts the number of visits, however, a negative association was observed between type of medication and the probability of a clinic visit. It may be possible that some persons using novel agents achieve improvement through outpatient medication management (psychotherapy visits) and may require less frequent clinic visits (for specimen collection), suggesting that the favorable adverse event profile of second-generation agents may promote community functioning. Positive symptoms and disorganization drive the occurrence and number of visits while the presence of deficit syndrome did not achieve significance. These findings suggest that as treatment costs vary by method, payers could benefit by assessing clinical syndrome in order to estimate disease-related payments accurately.