Objective: The aim of this study was to determine how the disease course and type of episodes in patients with bipolar I disorder (BPD-I) affect caregiver burden.

Materials and Methods: The study was conducted between February and July 2010, and included 89 euthymic-state BPD-I patients (55 with a natural course and 34 with ≥1 mixed episode or a rapid cycling course) diagnosed according to DSM-IV-TR criteria and 89 of their caregivers. The patients were evaluated using a sociodemographic clinical form, the Hamilton Depression Rating Scale (HAM-D), Young Mania Rating Scale (YMRS), and Global Assessment of Functionality Scale (GAFS). The caregivers were evaluated using a sociodemographic form and the Zarit Caregiver Burden Interview (ZCBI).

Results:  In all, 44% of the BPD-I patients’ caregivers had moderate to severe burden. More of the caregivers of patients with rapid cycling or mixed episodes had social relationships negatively affected by caregiver burden (P < 0.01). The mean YMRS score was higher in the caregivers with moderate to severe burden (P< 0.01). As patient age, YMRS score, number of manic episodes, duration of illness, and duration of caregiving during the euthymic period increased (P < 0.05) the level of caregiver-perceived dependency also increased; as caregiver age and the duration of caregiving increased, the perception of economic burden decreased (P< 0.05).

Conclusion: BPD-I patient caregiving, even when patients are in  a euthymic state, results in considerable caregiver burden. Mixed episodes or rapid cycling increases the severity of caregiver burden, as does the number of manic episodes and the presence of subsyndromal manic features.