T229. CAREGIVER BURDEN IN TREATMENT RESISTANT VERSUS NON-TREATMENT RESISTANT SCHIZOPHRENIA
Authors: Di Sarno Elaine , Napolitano Izabel , Louza Neto Mario 
Published: May 2020

Abstract

Background
About one-third of patients with schizophrenia are treatment-resistant (TRS). They cause a significative burden for their caregivers (1). Our objective is to compare caregiver burden in TRS versus non-TRS outpatients with schizophrenia.

Methods
Patients with diagnosis of schizophrenia (DSM-5), 18–50 years, both sexes, and a relative/caregiver, both sexes, aged 18 to 70 years, living in contact with the patient ≥30 hours/week. The use of clozapine for more than 6 months, in stable daily dosage was used as a proxy for TRS; non-TRS were patients using other antipsychotics, with stable dosage for at least 6 months. Psychopathology was evaluated with the CGI-Schizophrenia Scale (2). Family burden was assessed with the Family Burden Interview Schedule (FBIS-BR), objective and subjective total and subscores (3). Student’s t-test and chi-square test were used to compare TRS versus non-TRS patients and caregivers.

Results
TRS patients: n = 45; (31 male, 14 female); mean age: 37.11 ± 8.93 years; age at onset of illness 20.84 ± 6.20 years; duration of disease: 16.51 ± 9.14 years. CGI: positive: 3.96 ± 1.22; negative: 3.62 ± 1.17; depressive: 2.36 ± 0.98; cognitive: 3.76 ± 1.26; total: 13.66 ± 3.31.
TRS Caregivers: n=45 (12 male, 33 female); mean age: 56.7 ± 11.04 years; in contact with the patient 82.53 ± 36.98 hours/week.
Non-TRS patients: n= 15 (9 male, 6 female); mean age: 36.00 ± 12.49 years; age onset of illness 21.93 ± 9.73 years; duration of disease: 14.20 ± 13.66 years. CGI: positive: 2.40 ± 1.40; negative: 3.40 ± 1.24; depressive: 2.33 ± 1.11; cognitive: 3.20 ± 0.86; total: 11.33 ± 3.51.
Non TRS Caregivers: n=15 (2 males, 13 female); mean age: 53.13 ± 13.61 years; in contact with the patient 106.13 ± 62.47 hours/week.
Sociodemographic variables showed no significant differences were observed between TRS and non-TRS groups. CGI positive and total scores were significantly higher in TRS patients compared to non-TRS patients (p&lt;0.001 and p&lt;0.024 respectively).
FBIS-BR Scores:
TRS caregivers: The mean total score of the objective burden was 2.41 ± 0.66 and subjective burden was 2.00 ± 0.64. Assistance to the patient in daily life (objective) was 2.99 ± 0.55 and its subjective score was 1.56 ± 0.80. Supervision of patients’ problematic behaviors was 1.81 ± 0.61 and its subjective score was 1.00 ± 1.00. Impact on family routine was 2.43 ± 1.13 and worries about the patients’ present and future life (subjective) was 3.45 ± 0.70.
Non TRS caregivers: The mean total score of the objective burden was 2.42 ± 0.58 and subjective burden was 2.18 ± 0.51. Assistance to the patient in daily life (objective) was 3.30 ± 0.80 and its subjective score was 1.91 ± 0.93. Supervision of patients’ problematic behaviors was 1.80 ± 0.51 and its subjective score was 0.94 ± 0.59. Impact on family routine was 2.16 ± 0.86 and worries about the patients’ present and future life (subjective) 3.68 ± 0.55.
No significant differences were observed between the TRS and non-TRS caregivers’ groups.

Discussion
Contrary to our initial expectation (1), TRS and non-TRS caregivers showed similar burden, even though TRS patients had higher positive scores on the CGI. This lack of difference may be due to small number of patients in the non-TRS group; non-TRS patients might be refractory but did not receive clozapine yet. It is also possible that TRS caregivers adapt to the caring of these severe patients and learn to deal with the burden the disease.