The family burden (FB) has been defined as a multidimensional impact imposed by an illness on caregivers. FB can be divided into objective (i.e. related to measurable problems) and subjective one (i.e. related to caregivers' emotions arising in response to objective difficulties). FB is known to be related to disturbances in the functioning of the family system, higher level of stress, and the presence of financial problems. Some gender-dependent differences in the characteristics of FB have been found. As Since a family member's illness can be not only a ballast, but also a potential source of satisfaction, it has been found that the level of caregiving-related satisfaction is a significant predictor of FB severity. FB dynamics does not seem to be parallel to the course of illness. Problem-focused and task-focused coping strategies are known to be related to lower values of FB. There is evidence suggesting that in families of patients with BD depressive episodes trigger substantially higher severity of FB, as compared to manic episodes. Data on FB related to major depressive disorder (MDD) are scarce. Assertive community treatment strategies are the main option of reducing FB in the context of affective disorders, yet data on their effectiveness are inconclusive.
Aim:The Polish multicenter Treatment Resistant Depression Project (TRES-DEP) has aimed to study a number of demographic, clinical and psychometric characteristics comparing patients with treatment-resistant (TR) and treatment non-resistant depression (TNR). Fifty patients with TR depression (group 1) and 50 patients with TNR depression (group 2) were included in this preliminary analysis.Method:Treatment-resistant depression was recognized on account of lack of significant improvement following at least two adequate courses of antidepressant treatment. The exclusion criteria were treatment with mood stabilizers, diagnosis of substance misuse, dementia or severe somatic disease. The presence of bipolarity features was assessed by Polish version of Mood Disorder Questionnaire (MDQ).Results:Significantly more patients with TR depression compared with TNR had family history of mental disorders, especially alcohol dependence (24% vs 8%, p=0,03), had more previous depressive episodes (8.5±5.0 vs 5.1±3.8; p=0.001), and reported shorter time from the last hospitalization (14.8±26.5 vs 41.9±71.1 months, p< 0.005). Patients from group 1 significantly more frequently fulfilled MDQ criteria for bipolarity than patients from group 2 (44% vs 12%, p< 0.001). Among TR patients, MDQ-positive compared with MDQ-negative more frequently reported treatment nonadherence (41% vs 18%, p=0.055), suicidal attempts (41% vs 18%, p=0.055) and inadequate remission (100% vs 21%; p< 0.05).Conclusion:Our preliminary results point to clinical differences between patients with TR and TNR depression, including higher scores on bipolarity scale in TR. The features of bipolarity may be an important reason for non-response during antidepressant treatment of depression and worse clinical course and outcome.
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