Caregiver Burden of Outpatients with Schizophrenia: A Post-Hoc Study Comparing Patients on Clozapine Versus Patients on Other Antipsychotics

Abstract

Background:

Schizophrenia is a severe mental disorder associated with a significant burden of care. Approximately 30% of patients have treatment-resistant schizophrenia (TRS), characterized by persistent psychotic symptoms, being clozapine the antipsychotic of choice for these individuals.

Aims:

To assess whether caregivers of patients on clozapine experience a higher burden of care compared to caregivers of patients on other antipsychotics.

Methods:

We conducted a post-hoc analysis of a cross-sectional study. Sixty caregiver-patient dyads were included (45 on clozapine; 15 on other antipsychotics). Caregivers were assessed using the Family Burden Interview Schedule – Short Form (FBIS-SF). Patients were evaluated using the Clinical Global Impression – Schizophrenia (CGI-SCH) and the Personal and Social Performance (PSP) scales.

Results:

Patients on clozapine exhibited more severe positive symptoms (3.96 ± 1.22 vs. 2.40 ± 1.40; p < .001) and higher total CGI-SCH scores (13.67 ± 3.32 vs. 11.33 ± 3.52; p = .024). No significant differences were found in total FBIS-SF scores between the groups. In the clozapine group, caregiver burden was associated with female patient gender, lower social functioning (PSP), and receiving social benefits. In the non-clozapine group, an earlier age of onset correlated with increased burden.

Conclusions:

Despite greater clinical severity in the clozapine group, the overall burden was comparable to the non-clozapine group, suggesting that clozapine treatment may help stabilize the impact on families. Factors such as female gender, low functioning, and receiving social benefits (a proxy for illness severity) are correlated with specific burden domains. Due to the small size of the non-clozapine subgroup, these associations should be interpreted with caution.

Keywords

caregiver burden family burden treatment-resistant schizophrenia schizophrenia

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