Parallel process as a tool for supervision and therapy: A cognitive behavioral and schema therapy perspective

INTRODUCTION

The parallel process is a psychosocial phenomenon where the relationship dynamics between the therapist and the client are repeated in the supervisory relationship between the therapist and the supervisor. The concept of the parallel process can be a useful tool for understanding and solving problems in therapy. However, it can induce supervision drift or block the supervision process.

OBJECTIVE

This article aims to familiarize the reader with parallel processes in cognitive-behavioural therapy (CBT) and schema therapy supervision and discuss how to manage this phenomenon in supervision.

METHOD

This article is a narrative review with illustrations of supervision interviews in which the parallel process unfolds. The text provides an overview of theoretical constructions and empirical studies related to the parallel process. We searched PubMed, PsycINFO, Web of Science, and Google Scholar for relevant resources using the keywords "parallel process," "cognitive behavioural therapy," "schema therapy," "transference," and "countertransference." Case vignettes were collected from trainees, training leaders and supervisors to provide real-life examples of how self-reflection and self-experience can enhance CBT and schema therapy training, practice, and supervision.

The river of life method in a schema therapy groups

Schema therapy is an integrative approach to treat patients with personality disorders and other complex psychological problems. Group schema therapy has been developed to enhance the effectiveness and efficiency of schema therapy by providing a supportive and stimulating environment for change. This article introduces the River of Life Method, a novel technique for facilitating group schema therapy, based on the metaphor of a river of life. The method helps patients to identify and modify their maladaptive schemas and modes in a nurturing process in the group. The article describes the theoretical background, the practical steps, and the clinical applications of the method. It also presents the patients' experience with the method, based on their feedback and self-reports. The results showed that the method was well received by both patients and therapists, and that it had positive effects on schema modes, psychological distress, and coping with adversities and hope for the future.

Exploring self-care within the context of cognitive behavioural therapy and supervision

This article emphasizes the critical role of self-care in the professional lives of cognitive behavioural therapy (CBT) therapists and supervisors. It delves into the importance of self-care, elucidating its significance in maintaining therapists' mental health and effectiveness. The article presents a range of practical strategies that promote self-care, providing therapists and supervisors with specific steps to incorporate self-care into their daily routines. Moreover, the article explores common challenges and barriers to self-care, such as a lack of time, feelings of guilt associated with prioritizing one's needs, and a lack of available resources for self-care. The article aims to deepen our understanding of the complexities of practising self-care by shedding light on possible obstacles. In addition, the article includes case vignettes that demonstrate tangible examples of the positive impact of self-care on therapists' mental health and effectiveness. The overarching goal of this article is to encourage ongoing discussion and research on self-care. It advocates a greater emphasis on self-care in CBT and CBT supervision (CBTS), intending to promote the health and well-being of those who dedicate their lives to caring for others. The insights and strategies presented in this article serve as a resource for therapists and supervisors striving to achieve a balanced lifestyle while effectively catering to the needs of their clients.

Self-stigma in patients with schizophrenia: Impact and management

BACKGROUND

Prejudices against individuals with schizophrenia can interfere with diagnostic and treatment processes, particularly with the patient's further adaptation and reintegration. Self-stigma could have significant detrimental consequences for patients suffering from psychotic disorders, including schizophrenia.

METHOD

This paper reviews findings about self-stigma connected to schizophrenia. The PubMed database used the keywords to find the papers published from January 1997 to March 2023, and 189 articles were included in the review process.

RESULTS

The schizophrenia-related stigma decreases patients' self-confidence, worsens their social functioning, and impedes daily functioning. Feelings of embarrassment are prominent in many patients with schizophrenia. Self-stigma predicts many unfavourable outcomes - more severe social anxiety and depressive symptoms, lower self-confidence, hopelessness, worse social functioning, lower quality of life, worse treatment cooperation, and lower adherence to medication adherence. Addressing self-stigma in psychoeducation or psychotherapy may increase the patient's stigma resistance and well-being. Self-help groups present an underutilised but potentially effective strategy.

CONCLUSION

Stigma presents a common issue in patients with schizophrenia. Targeting the issue in clinical management or psychotherapy may be beneficial. Still, more high-quality intervention studies are needed.

Black & white relations: Intimate relationships of patients with borderline personality disorder

BACKGROUND

Individuals with borderline personality disorder (BPD) suffer from an excessive fear of abandonment, leading to tense moments in their intimate relationships. These struggles translate into lower marital satisfaction perceived by both intimate partners. However, this connection is bidirectional, since conflicts with a romantic partner are the most common precipitating factors of decompensation in BPD patients.

METHOD

This narrative review was performed using PubMed, Web of Science, and Scopus databases with keywords "borderline personality disorder", "partnership", marital problems", and "marital conflicts". Articles, books, and book chapters published within January 1980 - December 2020 were extracted and analysed. Additional sources were found while reviewing references of relevant articles. The total of 131 papers met the inclusion criteria.

RESULTS

Patients with BPD struggle with reaching marital satisfaction. They often find themselves in disharmonic and unfulfilling relationships. The association between the relationship issues and BPD may partly come from misunderstanding one or both partners' behaviour. Individuals with BPD tend to misinterpret their partner's behaviour, struggle with communication, and sometimes be verbally and physically aggressive. They often do not recognize that their intrapersonal processes influence their interpersonal struggles. Understanding the role of the maladaptive personality traits in the relationship and their management could be beneficial for both partners.

CONCLUSION

Individuals with BPD often report dysfunctional romantic relationships characterized by insecure attachment, maladaptive communication, and lower relationship satisfaction. Future studies should focus on finding effective strategies of couples´ therapy working with this population.

Stigma and self-stigma in borderline personality disorder: A narrative review

INTRODUCTION

Borderline personality disorder (BPD) presents a highly stigmatised condition. Individuals with BPD may experience stigmatising attitudes and remarks from the general population and mental health professionals. Significant self-stigma also seems common. The paper reviews the current knowledge regarding the stigma connected to BPD.

METHOD

The Web of Science, Medline, and Scopus databases identified studies published from January 1990 to January 2023. Additional references were found using analyses of the primary articles. The search terms included "borderline", "stigma", and "self-stigma".

RESULTS

Public knowledge of BPD is scarce. The general population may interpret the BPD symptoms as "purposeful misbehaviour" rather than signs of a mental disorder. Mental health professionals commonly distance themselves from patients with BPD and may prematurely give up their treatment efforts. This stance often comes from believing BPD is difficult or impossible to treat. Therefore, treating patients with a personality disorder should be consulted with a supervisor, especially when the psychotherapist shows a negative attitude towards the patient. Generally, few BPD-specific destigmatisation interventions have been verified by research. Limited evidence suggests that targeted training of the healthcare providers can reduce stigmatising attitudes and that interventions combining positive messages of the recovery potential with biological aetiology of the disorder are most impactful in reducing the stigma.

CONCLUSION

BPD is commonly stigmatised by the general population and mental health professionals. Destigmatising efforts need to tackle the stigma's primary sources, namely the general population's lack of understanding and the pessimistic beliefs in the healthcare providers. More BPD-specific research on stigma is needed.

Problems in Cognitive-Behavioral Supervision: Theoretical Background and Clinical Application

Cognitive-behavioural therapists and trainees are encouraged to undergo supervision when offering therapy to troubled clients and to process personal attitudes and events likely to affect their therapeutic work. We discuss common problems in cognitive behavioural therapy (CBT) supervision, which may arise at the client, supervisee, or supervisor level. These issues include difficulties with case formulation, therapeutic strategies, and the therapeutic relationship. A supervisor can help their supervisee deal with clients with multifaceted or particularly challenging problems, such as difficulties with compliance, complex psychosocial problems, or chronic mental disorders. We also discuss matters related to the supervision process, the supervisor's role, different supervisory styles, and issues affecting a supervisee's feelings of vulnerability and shame. Furthermore, we analyze distinct supervision styles and potential problems arising from the supervision of experienced CBT therapists.

Cognitive Functions, Depressive and Anxiety Symptoms After One Year of CPAP Treatment in Obstructive Sleep Apnea

Objective

The study worked with depressive symptoms, anxiety score and cognitive functions in obstructive sleep apnea (OSA) patients treated with CPAP.

Methods

Eighty-one subjects with OSA and without psychiatric comorbidity were treated with CPAP for one year and completed the following scales and cognitive tests: Trail Making Test, Verbal Fluency Test, d2 Test, Beck Depression Inventory-II and Beck Anxiety Inventory. MINI ruled out psychiatric disorder. At the two months check-up, subjects were re-evaluated for depressive and anxiety symptoms, and after one year of CPAP treatment, subjects repeated cognitive tests and scales. Data about therapy adherence and effectiveness were obtained from the patient's CPAP machines.

Results

The study was completed by 59 CPAP adherent patients and eight non-adherent patients. CPAP therapy effectiveness was verified in all patients by decreasing the apnea-hypopnoea index below 5 and/or 10% of baseline values. The adherent patients significantly improved depressive and anxiety symptoms. There was also an improvement in overall performance in the attention test; however, performance in many individual items did not change. The adherent patients also improved verbal fluency and in the Part B of the Trail making test. The non-adherent group significantly increased the number of mistakes made in the d2 test; other results were non-significant.

Conclusion

According to our results, OSA patients' mood, anxiety and certain cognitive domains improved during the one-year therapy with CPAP.

Trial Registration Number

NCT03866161.

The importance of self-experience and self-reflection in training of cognitive behavioral therapy

PURPOSE

Self-awareness can be characterised as impartial, non-judgmental thoughtful attention towards the self. Self-reflection in therapy is when a therapist reviews their experiences, thoughts, and behaviours concerning therapy and changes them as needed to enhance the therapeutic process. Therapists with good quality self-reflection can make more effective and ethical decisions, differentiate their own needs from clients', understand transference and countertransference, and consider the optimal response during a session. Practising the CBT approach and reflecting on one's own experiences can be essential for successful therapeutic development. Furthermore, self-reflection forms the basis of a fruitful therapeutic relationship and the therapist's self-confidence and sense of competence.

Nightmares in borderline personality disorder - narrative review

BACKGROUND

Borderline personality disorder (BPD) patients commonly suffer from nightmares. Still, the prevalence of this issue does not match the little clinical attention it usually receives. Nightmares impact sleep and daily functioning and may play a role in BPD symptomatology, including suicidality. Since BPD has been linked with high rates of suicide, the potential connection with suicidality is crucial to address.

AIMS

To create an up-to-date review of current knowledge on nightmares in BPD and to explore the links between nightmares, insomnia, and suicidality or self-harm in BPD patients.

METHOD

This narrative review was conducted using the PubMed, Web of Science, and Google Scholar databases to search for articles published between January 1990 and October 2022, using the following key terms: 'borderline personality disorder' and 'nightmares' or 'insomnia' and 'suicidality' or 'self-harm' or 'self-injuring'. The final list consisted of 99 publications.

RESULTS

Sleep disturbances often occur in BPD patients. The prevalence of nightmares in BPD is higher than in general or clinical populations. Nightmares influence borderline personality traits and vice versa through emotional dysregulation, poorer sleep quality, nightmare anxiety, higher arousal, and worsened self-control. A link between nightmares and suicidal behaviour was established in some psychiatric conditions (depression, insomnia); studies on BPD are lacking in this area. Studies comparing nightmares in BPD to other disorders are also missing. There are some suggestions for pharmaceuticals or psychotherapy in treating nightmares, but their application to BPD needs more research.

CONCLUSION

Sleep disturbance and nightmares are common among individuals with BPD yet underrepresented in research. Nightmares have been linked with suicidality in other conditions (depression, PTSD) but only indirectly in BPD. More clinical studies are needed to explore the phenomenon further.

Role-playing in cognitive behavioral supervision

Role-play helps the supervisor present a moment of therapy, and reflect on what has happened to the therapist to the patient and further model the therapeutic skills. Usually, the supervisor or other supervisees (in group supervision) play the patient, and the therapist plays a significant moment in the psychotherapeutic session. Supervisors or supervisees in group supervision can play the patient in different situations, and can also reverse roles when the therapist plays their patient, and the supervisor plays the therapist. Before role-playing, there is a need to set a specific goal. Playing roles in supervision can focus on (a) conceptualizing the case; (b) assessing and optimizing therapeutic strategies; (c) a better understanding of the therapeutic relationship. A specific goal needs to be set before role-playing. The technique can focus on (a) case conceptualization; (b) assessment and optimization therapeutic strategies; (c) a better understanding of the therapeutic relationship. A variety of approaches can be used for role-playings, such as pattern learning, modelling, chaining, encouragement and feedback, or psychodrama techniques such as monologue, an empty chair, role change, alter-ego, using multiple chairs or toys.

Obstruction sleep apnoea and panic disorder

OBJECTIVE

Both panic disorder (PD) and obstructive sleep apnea (OSA) are frequent conditions that can be comorbid. This article reviews the current state of knowledge about the comorbidity of PD and OSA and the effectiveness of therapy in patients with this comorbidity.

METHOD

Articles obtained via PubMed and Web of Science search were selected; the publishing date was between January 1990 and December 2022. The applied search terms were: obstructive sleep apnea; panic disorder; CPAP; antidepressants; anxiolytics; antipsychotics. Eighty-one articles were chosen by primary search via keywords. After a complete assessment of the full texts, 60 papers were chosen. Secondary papers from the references of the primary documents were investigated, evaluated for suitability, and included in the list of documents (n = 18). Thus, seventy-eight papers were incorporated into the review article.

RESULTS

Studies describe a greater prevalence of panic disorder in OSA patients. So far, there is no data on the prevalence of OSA in PD patients. Limited evidence is found regarding the influence of CPAP treatment on PD, and this evidence suggests that CPAP can partially alleviate PD symptoms. Medication used in PD treatment can significantly impact comorbid OSA, as explored in several studies.

CONCLUSIONS

The relationship between the two conditions seems bidirectional, and it is necessary to assess OSA patients for comorbid panic disorder and vice versa. Both disorders can worsen the other and must be treated with a complex approach to ensure improvement in patients' physical health and psychological well-being.

Ethical reflection in cognitive behavioral therapy and supervision: Theory and practice

Ethical reflection is a process that comes from the deeper attitudes and values of the therapist and supervisor. The capability to recognize one's perspectives and ethical dimensions and how they affect own practice is one of the crucial tasks of a responsible therapist. Attitudes and values of an individual or a group may significantly influence the therapeutic process and a choice of strategies and behaviour towards the patient, often working at an unconscious, unreflected levels. Ethics is closely connected with psychotherapeutic treatment. Basic principles, such as expediency, honesty, integrity, justice, and respect, apply to all people equally, including psychologists, psychiatrists, psychotherapists, and supervisors. The goal of supervision is to cultivate the therapeutic process in the client's best interest. The supervisor-supervisee relationship is then grounded on principles similar to those in the therapeutic relationship.

Sleep Disturbance and Immunological Consequences of COVID-19

The overarching importance of sleep was further emphasized during the pandemic of COVID-19. The subjects infected by COVID-19 frequently experience sleep disturbances; some are long-lasting problems and decrease the quality of life. Insomnia is the most studied sleep disorder associated with COVID-19. Insomnia affects patients who have experienced an infection and the general population. Good sleep is important in maintaining mental and physical health, including immune system functions. The interconnections between insomnia, the immune system, and COVID-19 are complex. Insomnia triggers numerous immune system dysregulations and makes individuals more vulnerable to respiratory infections. This narrative review overviews the influence of the COVID-19 pandemic on the immune system through sleep disorders.

Early life experiences and adult attachment in obsessive-compulsive disorder. Part 1: Relationships between demographic, clinical, and psychological factors in pharmacoresistant OCD

OBJECTIVES

Obsessive-compulsive disorder (OCD) has been connected to various psychosocial factors that might influence its onset and course. Developmental factors, such as parenting styles or early adverse experiences, and adult attachment have been listed as examples. However, the research on the interconnections of these factors brought mixed results. The study explores the relationship between demographic, clinical, and selected psychosocial factors and the severity of adult OCD.

METHOD

Eighty-seven pharmacoresistant inpatients with OCD were admitted between October 2019 and August 2022 for a 6-week cognitive behavioural therapy inpatient program in the psychotherapeutic department. The participants completed the following scales at the start of the hospitalisation: the self-report Yale-Brown Obsessive-Compulsive Scale (Y-BOCS-SR), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI-II), Dissociative Experiences Scale (DES), Childhood Trauma Questionnaire-Short Form (CTQ-SF), PBI (Parental Bonding Instrument), ECR-R (Experiences in Close Relationships - Revised), and a demographic questionnaire. A skilled psychologist administered Mini International Neuropsychiatric Interview (MINI) to confirm the OCD diagnosis and Hamilton Anxiety Rating Scale (HAMA).

RESULTS

OCD patients with more severe adverse childhood experiences (ACEs) showed earlier onset of the disorder and more pronounced attachment anxiety, depressive symptoms, and dissociation and subjectively rated the severity of the disorder as more severe. Physical abuse and physical neglect were related to the severity of specific OCD symptoms. Maternal care negatively correlates with clinician-rated anxiety, patient-rated depressive symptoms, and dissociation. The maternal and paternal control positively correlated with patient-rated anxiety and depression. Attachment anxiety negatively correlated with the age of onset and positively with the severity of the clinician-rated anxiety and the patient-rated anxiety, depressive symptoms, and dissociation.

CONCLUSIONS

Early adverse experiences, perceived parental styles, and adult attachment anxiety could play a significant role in the symptoms of anxiety, depression, and dissociation. The connection with the specific obsessive-compulsive symptoms is less apparent. Still, adverse childhood events and adult attachment anxiety seem to influence the age of OCD onset.

Homework in Cognitive Behavioral Supervision: Theoretical Background and Clinical Application

The homework aims to generalize the patient's knowledge and encourage practicing skills learned during therapy sessions. Encouraging and facilitating homework is an important part of supervisees in their supervision, and problems with using homework in therapy are a common supervision agenda. Supervisees are encouraged to conceptualize the patient's lack of homework and promote awareness of their own beliefs and responses to non-cooperation. The supervision focuses on homework twice - first as a part of the supervised therapy and second as a part of the supervision itself. Homework assigned in supervision usually deals with mapping problems, monitoring certain behaviors (mostly communication with the patient), or implementing new behaviors in therapy.

Screening for obstructive sleep apnoea in high-risk patients with mood disorders

OBJECTIVE

Our study aimed to screen for obstructive sleep apnoea (OSA) in a clinical population of psychiatric patients with affective disorders and risk factors for OSA using screening devices in psychiatric clinical environments.

METHODS

Inpatients admitted with mood disorders in an inpatient psychiatric department were selected via inclusion and exclusion criteria and assessed for the risk factors of OSA. The inclusion criteria were: a diagnosis of an affective disorder confirmed by two independent psychiatrists, snoring or apnoeic pauses witnessed during regular night check-ups by nurses, and BMI > 25 kg/m2. The exclusion criteria were: a comorbid psychotic disorder, previously diagnosed OSA, intellectual disability, organic mental illness, acute coronary syndrome, acute or chronic heart failure, acute pulmonary diseases, a history of stroke, neuromuscular disorders, or a myorelaxant treatment. All included patients underwent overnight monitoring by a screening device SomnoCHECK Micro Cardio. A certified somnologist assessed obtained data.

RESULTS

A total of 32 subjects (23 women and nine men) were included in the study. The mean age was 49.8 ± 8.8 years. Most participants had major depressive disorder (n = 23); another nine individuals had bipolar disorder. Diagnostic criteria for OSA were found in 50% of the sample, specifically in 88% of men and 33% of women. The correlation analysis identified several risk factors and variables.

CONCLUSIONS

This pilot study showed an increased risk of OSA in patients with mood disorders. Psychiatric patients with identified risk factors should be routinely screened for obstructive sleep apnoea and referred to proper treatment.

Managing Transference and Countertransference in Cognitive Behavioral Supervision: Theoretical Framework and Clinical Application

Dysfunctional patterns, beliefs, and assumptions that affect a patient’s perception of other people often affect their perceptions and behaviours towards the therapist. This tendency has been traditionally called transference for its psychoanalytical roots and presents an important factor to monitor and process. In supervision, it is important to put the patient’s transference in the context of the conceptualization of the case. Countertransference occurs when the therapist responds complementary to the patient’s transference based on their own dysfunctional beliefs or assumptions. Transference and countertransference provide useful insights into the inner world of the patient, therapist, and supervisor. Guided discovery is one of the most common approaches used by a supervisor and a supervisee to map all types and directions of transference and countertransference. Other options to map transference and countertransference are imagery and role-playing techniques.

Schema Therapy for Patients with Bipolar Disorder: Theoretical Framework and Application

Bipolar disorder (BD) is a severe mood disorder characterized by episodes of depression and hypomania or mania. Despite its primarily biological roots, the onset and course of the disorder have also been related to psychosocial factors such as early adverse experiences and related maladaptive schemas. Several researchers proposed a schema therapeutic model to treat patients with BD. In this paper, we further develop the theoretical model and elaborate on seven elements that were found effective in the psychosocial interventions with individuals with BD: monitoring mood and early symptoms of relapse, recognizing and management of stressful situations and interpersonal conflicts, creating a relapse prevention plan, stabilizing the sleep/wake cycle and daily routine, encouraging the use of medication, and reducing self-stigma and substance use. Apart from that, we describe the elements of the schema work with patients who suffer from BD. Illustrative clinical cases accompany the theoretical framework. The research of the schema therapy with patients with severe mental illnesses has only recently started developing. The presented paper also aims to encourage further research in this area and highlight potentially beneficial research goals.

Hallucinations and Other Psychotic Symptoms in Patients with Borderline Personality Disorder

BACKGROUND

Psychotic symptoms in BPD are not uncommon, and they are diverse and phenomenologically similar to those in schizophrenia spectrum disorders. Despite their prevalence in BPD patients, knowledge about the characteristics and severity of hallucinations is limited, especially in modalities other than auditory.

AIM

This review summarises the causes, phenomenology, severity, and treatment options of hallucinations and other psychotic symptoms in BPD.

METHODS

The PubMed database was used with the following key terms: "borderline personality disorder" and 'hallucinations' and "psychotic symptoms". Articles were selected between January 1990 and May 2021. The primary keyword search yielded a total of 545 papers, of which 102 articles met the inclusion criteria and were fully screened. Papers from the primary source reference lists were also screened, assessed for eligibility, and then added to the primary documents where appropriate (n = 143). After the relevance assessment, 102 papers were included in the review. We included adult and adolescent studies to gather more recent reviews on this topic.

RESULTS

Hallucinations are significantly prevalent in BPD, mainly auditory, similar to schizophrenia spectrum disorders. The relationship between hallucinations and depression, anxiety, suicidality, schizotypy, and loneliness in BPD has been discovered but requires more research. Studies for treatment options for hallucinations in BPD are lacking.

CONCLUSION

Recognition of psychotic symptoms in patients with BPD as distinguished psychopathological phenomena instead of diminishing and overlooking them is essential in the clinical assessment and can be useful in predicting complications during treatment. More focused research in this area is needed.

Attachment in patients with an obsessive compulsive disorder

INTRODUCTION

This review aims to present the current state of knowledge about attachment and obsessive-compulsive disorder (OCD), the connection to the disorder's course, and the treatment effectiveness.

METHOD

A literature search was performed using PubMed, Google Scholar, Web of Science, and ScienceDirect databases using the following search terms: obsessive compulsive disorder, attachment, therapy, treatment, and long-term outcome. The period of extraction was between January 1990 and October 2020.

RESULTS

Insecure attachment leads to the formation of dysfunctional beliefs about the world and self, which influences the dynamics of OCD. It is associated with maladaptive cognitive processes such as an inflated sense of responsibility, perfectionism, and mind control. With worse emotional regulation and reduced self-esteem (which can also result from insecure attachment), it can lead to maladaptive behaviour such as perfectionistic and compulsive behaviour to secure and stabilize self-worth and safety. Of the two dimensions that define insecure adulthood attachment (anxiety and avoidance), attachment anxiety is more closely related to OCD. While anxious attachment can lead to a worse response in acute treatment, secure attachment is a protective factor that can improve remission.

CONCLUSIONS

Anxious attachment is common in patients with OCD and interconnects with primary OCD symptomatology. From this perspective, strategies that promote feelings of safety, acceptance, and appreciation within a therapeutic relationship may be essential in treating OCD.

Nightmares in obstructive sleep apnoea

OBJECTIVE

Obstructive events in patients with obstructive sleep apnoea (OSA) cause recurrent sleep fragmentation and occasional desaturation, which can cause various parasomnias, including nightmares. Several lines of evidence suggest that OSA may be potentially associated with a higher frequency of nightmares.

METHOD

We searched for studies published from January 2000 until November 2020 in PubMed, the Cochrane Library, Web of Science and Google Scholar. The keywords Obstructive Sleep Apnoea / OSA / Nightmares / CPAP / PTSD / Sleep Quality / Dream / were used in various combinations. The literature search identified 1361 articles which were eligible to more careful examination. Secondary texts were also examined, evaluated for suitability, and added to the primary document list. Finally, a total of 168 articles were included in the review.

RESULTS

According to current findings, OSA could affect emotional regulation via activation of limbic system during sympathetic activation and suppression of REM sleep essential to emotional regulation. The reviews also found an increased prevalence of nightmares in OSA patients. OSA is significantly associated with psychiatric morbidity, as was proved in several studies. There seems to be a strong link between nightmares, OSA, PTSD symptoms and other disorder such as unipolar depression.

CONCLUSIONS

It is clear that therapy of OSA patients, especially those with psychiatric comorbidity, must be complex. In the case of nightmares, we should not forget to use psychotherapy as a first choice, particularly in patients with poor compliance to continuous positive airway pressure (CPAP) and poor sleep and overall life quality. In the same time, we should emphasise the healthy lifestyle and sleep hygiene.

Self-Stigma and Treatment Effectiveness in Patients with SSRI Non-Responsive Obsessive-Compulsive Disorder

Purpose

Obsessive compulsive disorder (OCD) is a debilitating mental disorder that often takes a chronic course. One of the factors influencing the treatment effectiveness in anxiety and depressive disorders is the self-stigma. This study focused on the relationship between the self-stigma, symptomatology, and therapeutic outcomes in patients with OCD.

Patients and Methods

Ninety-four inpatients with OCD, who did not sufficiently respond to at least one selective serotonin reuptake inhibitor trial, participated in the study. They attended a six-week therapeutic program consisting of exposure and response prevention, transdiagnostic group cognitive behavioral therapy, individual sessions, mental imagery, relaxation, sport, and ergotherapy. The participants completed several scales: the Internalized Stigma of Mental Illness Scale (ISMI), the self-report Yale-Brown Obsessive Compulsive Scale (Y-BOCS-SR), Beck Anxiety Scale (BAI), Beck Depression Scale-II (BDI-II), and Dissociative Experiences Scale (DES). A senior psychiatrist filled in the Clinical Global Impression (CGI-S).

Results

The average scales' scores considerably declined in all measurements except for DES. The self-stigma positively correlated with all psychopathology scales. It was also higher in patients with a comorbid personality disorder (PD). The higher self-stigma predicted a lower change in compulsion, anxiety, and depressive symptoms but not the change of obsessions or the overall psychopathology.

Conclusion

The self-stigma presents an important factor connected to higher severity of OCD. It is also a minor predictor of a lower change in symptomatology after combined treatment.

Borderline personality disorder and recovery

Recovery focuses on the broader concept of having a good life with mental health problems than remission. This review aims to deliver up-to-date information on the concept of recovery in borderline personality disorder. A computerized database search was conducted in PubMed and Web of Science sites, using various combinations of keywords for the period between January 1990 and April 2020. According to current findings, a full remission or complete disappearance of symptoms of a borderline personality disorder usually does not occur soon after the initiation of treatment, but recovery is an achievable goal. A precondition for recovery is the patient's responsibility for their health. Apart from psychotherapy and psychosocial rehabilitation, pharmacotherapy can help individuals with BPD improve their quality of life and can provide significant aid on their path to recovery.

Insomnia in Patients with Borderline Personality Disorder

OBJECTIVE

Both sleep disorders and BPD are prevalent in the population, and one is often a comorbidity of the other. This narrative review aims to assess contemporary literature and scientific databases to provide the current state of knowledge about sleep disorders in patients with borderline personality disorder (BPD) and clinical suggestions for managing sleep disorders in BPD patients and future research direction.

METHODS

Articles were acquired via PubMed and Web of Science, and papers published between January 1980 and October 2020 were extracted. Authors made a series of literature searches using the keywords: Sleep problems, Insomnia, Nightmares, Obstructive sleep apnea, Borderline personality disorder. The inclusion criteria were: published in peer-reviewed journals; studies in humans; or reviews on the related topic; English language. The exclusion criteria were: abstracts from conferences; commentaries; subjects younger than 18 years. After an inspection of the full texts, 42 papers from 101 were selected. Secondary documents from the reference lists of the primary designated papers were searched, assessed for suitability, and included. In total, 71 papers were included in the review process.

RESULTS

Sleep disturbance is common among patients with BPD. Nevertheless, the number of investigations is limited, and the prevalence differs between 5-45%. Studies assessing objective changes in sleep architecture in BPD show inconsistent results. Some of them identify REM sleep changes and a decrease in slow-wave sleep, while other studies found no objective sleep architecture changes. There is also a higher prevalence of nightmares in patients with BPD. Untreated insomnia can worsen BPD symptoms via interference with emotional regulation. BPD itself seems to influence the subjective quality of sleep significantly. Proper diagnosis and treatment of sleep disorders in patients with BPD could lead to better results in therapy. Psychotherapeutic approaches can improve both sleep disorders and BPD symptoms.

CONCLUSION

Recognising and managing sleep disorders in patients with BPD may help alleviate the disorder's symptoms. Treatment of people with BPD may be more effective if the treatment plan explicitly addresses sleep problems. Further research is needed to reach reliable conclusions.

Sleep Disturbances in Patients with Nonepileptic Seizures

OBJECTIVE

Up to 20% of patients treated for epileptic seizures experience psychogenic nonepileptic paroxysms (PNES). These patients present a significant burden for the health care systems because of poor treatment outcomes. The presented review aims to summarize the current state of knowledge on sleep disturbances in patients with nonepileptic seizures.

METHODS

Articles were acquired via PubMed and Web of Science, and papers between January 1990 and March 2020 were extracted. Inclusion criteria were (1) published in a peer-reviewed journal: (2) studies in humans only; or (3) reviews on a related topic; (4) English language. The exclusion criteria were: (1) abstracts from conferences; (2) commentaries; (3) subjects younger than 18 years. From primary assessment, 122 articles were extracted; after obtaining full texts and secondary articles from reference lists, 45 papers were used in this review.

RESULTS

Limited data are available regarding sleep disorders in PNES patients, over the last 30 years only nine original research papers addressed sleep problems in patients with PNES with only six studies assessing objectively measured changes in sleep. Current literature supports the subjective perception of the sleep disturbances with mixed results in objective pathophysiological findings. Conflicting results regarding the REM phase can be found, and studies reported both shortening and prolonging of the REM phase with methodological limitations. Poor sleep quality and shortened duration have been consistently described in most of the studies.

CONCLUSION

Further research on a broader spectrum of patients with PNES is needed, primarily focusing on objective neurophysiological findings. Quality of life in patients suffering from PNES can be increased by good sleep habits and treatment of comorbid sleep disorders.

"Don´t tell me that I am hysterical": Unmet needs of patients with panic disorder

OBJECTIVES

In the new millennium, a growing focus on human rights and preserving individual autonomy urges the promotion of needs of the psychiatric patients. The topic of human needs takes its place also in patients with panic disorder. This review intended to explore current facts concerning the needs of the patients and present a broader understanding of patients' needs, due to the complexity of problems of patients with panic disorder. The text also focuses on psychosocial well-being and the quality of life of patients with panic disorder.

METHODS

The PubMed was used to search for articles published between January 2000 and February 2020 using the following keywords: "panic disorder" or "agoraphobia" and "unmet needs" in combination with "pharmacotherapy" or "psychotherapy" or "cognitive behavioural therapy" or "family" or "quality of life." A total of 264 articles were selected by primary keyword picking in different combinations. Altogether 182 articles were reviewed.

RESULTS

We identified the most important unmet needs of patients with panic disorder connected to symptoms, treatment and help-seeking, stigma and self-stigma, family and quality of life. To help the patients to improve the unmet needs connected with: (1) symptoms is to increase the awareness of treatment steps for patients and their families, good cooperation with therapists, and management of persistent symptoms, alleviation or elimination of anxiety symptoms, avoidance and safety behaviour. (2) treatment is the quick approach, effective one, not too difficult, without side effects and harmless, not requiring hospitalization and not disturbing the daily routine, increasing treatment compliance, improving patient self-confidence and an active social network, affordable health and social services and more suitable information for families; (3) stigma is to change of public opinion about people with mental health problems and to create effective antistigma programs; (4) family is to include the support for a functional and independent life, helping to manage everyday tasks and stop excessive protection, while reducing the stigmatization of the whole family. (5) the quality of life is to help to integrate into the community and improve the factors that affect the quality of life; like esteem, self-acceptance, social acceptance etc. CONCLUSIONS: This review aimed to explore the unmet needs in patients with panic disorder or agoraphobia. In selected articles we identified 5 basic unmet needs and described the basic strategies to cope with them. It is essential for every clinician to understand those needs as it can substantially help to alleviate patients' symptoms and improve their quality of life. The importance of this understanding further highlights that unmet needs described for panic disorder overlap with unmet needs of other psychiatric disorder and thus have broader utility.

Marriage in a panic: Panic disorder and intimate relationships

BACKGROUND

Panic disorder and agoraphobia not only affect the patients themselves but also may have a detrimental effect on their intimate relationships. A problem arising in the intimate sphere could be a trigger, a modulator, a maintenance factor, or the result of the panic disorder and agoraphobia. The consequences of panic disorder include increased demands on the non-affected partner to adapt, which may prove to be too challenging for some to manage. Panic disorder and agoraphobia can also change earlier relationship patterns which may result in partnership dysfunction. This review explores the effect of panic disorder and agoraphobia upon partnership problems and satisfaction.

METHOD

Relevant studies were identified via PubMed and Web of Science, published between January 1970 and April 2020. The search terms included "panic disorder", "agoraphobia", "marital problems", "marital conflicts" and "marital adjustment". Further references were found in reviews, books, and book chapters of the relevant papers. A total of 1154 articles were nominated by primary assortment using the keywords in different combinations. After selecting according to the inclusion and exclusion criteria, evaluating the complete texts and searching for secondary documents, 173 papers were finally chosen.

RESULTS

Problems in a relationship can act as a trigger for the development of the panic disorder and agoraphobia and could also function as modulating and maintenance factors. Panic disorder and agoraphobia often have a negative influence on the relationship and the non-affected partner. Partnership problems can be both a precursor and a consequence of panic disorder and agoraphobia.

Nightmares and their treatment

Nightmares are manifested by scary and devastating dreams. In severe cases, they are associated with sleep disorders, heart problems, permanent fatigue, high levels of anxiety, fear of falling asleep, or secondary cognitive deficits after sleep deprivation, and thus may increase vulnerability to the development of other mental disorders. Lucid dreaming, the dreaming experience, and the realization that one is dreaming are easy-to-learn techniques that can provide effective and significant relief.

Marriage under control: Obsessive compulsive disorder and partnership

BACKGROUND

People who have an obsessive-compulsive disorder (OCD) tend to manifest a need for excessive control over their partners and other relatives, which then constitutes a principal problem in their relationships. This behaviour probably relates to an unmet need for safety in their childhood. This review article aims to explore the interpersonal dimension of OCD.

METHOD

Sources used in this review were acquired via PubMed from January 1990 to January 2020. The search terms included "obsessive compulsive disorder", "OCD", "marital problems", "marital conflicts", "marital attachment", and "partnership". Primary search with keywords in various combinations yielded 242 articles. After applying inclusion and exclusion criteria, 68 articles were found eligible for further research, and a secondary search was performed by screening their reference lists for relevant articles. In total, 124 papers were included in the review.

RESULTS

OCD patients often have interpersonal problems that are related to symptomatology and the excessive need for control over the relationship. The patient is often addicted to his/her loved ones and transmits his excessive concerns to them. The studies describe increased marital distress, less satisfaction with their partner and couples experiencing less intimacy. The communication style of people suffering from OCD often shows a tendency to control others extensively, which is probably related to their exaggerated need for safety. Individuals with preoccupied or avoidant attachment styles are more likely to become jealous and to consider any rival as threatening than those people who have a safe attachment style.

CONCLUSION

Participation of the partner in the therapy can have positive effects. Furthermore, family-based exposure and response prevention programs might be useful for reducing OCD symptoms.

Imagery in cognitive behavioral supervision

OBJECTIVE

This article describes the role of imagery in supervision which is a part of the work of both the supervisee and the supervisor. Imagination bears outstanding importance in psychotherapy and supervision.

METHOD

The relevant texts for this narrative review were identified through the Web of Science and PubMed databases, within the period 1990-2019. The search terms included: Supervision, Cognitive behavioural therapy, Imagination, Imagery, Imagery rescripting, Therapeutic relationship, Supervisory relationship. The report also includes information from the books referred to by the articles. The supervisory experiences of the authors were also incorporated. The theoretical part is supplemented with case vignettes of strategies using imagination in CBT supervision.

RESULTS

Working with imagery can be used in transformative experiential learning. It can help to better map the situation with the patient, including its emotional components and basic psychological needs, to realise how the therapeutic relationship is set up, as well as to rework own therapist attitudes, schemas and emotional - behavioural responses, and plan future steps in the therapy. Many therapy steps could be learned during imagery exercises. Imagery also helps to understand and regulate the supervisory relationship.

CONCLUSION

It is useful to integrate imagery to the supervision. Using imagery can help to understand the patient, the therapeutic relationship better, and to plan optimal therapeutic strategies, as well as reflect/self-reflect and train difficult skills which promote professional and personal growth.

Severity of panic disorder, adverse events in childhood, dissociation, self-stigma and comorbid personality disorders Part 2: Therapeutic effectiveness of a combined cognitive behavioural therapy and pharmacotherapy in treatment-resistant inpatients

OBJECTIVES

A combination of antidepressants with the cognitive-behavioural therapy showed effectiveness in treatment-resistant patients with panic disorder. This prospective study intended to establish how childhood adverse experiences, self-stigma, dissociation, and severity of psychopathology influence the effectiveness of combined cognitive-behavioural therapy and pharmacotherapy in patients with treatment-resistant panic disorder.

METHODS

One hundred and ten patients were included into the study and one hundred five subjects finished the study. After admission, the subjects were assessed during the first two days of hospitalization. Rating scales were administered before the beginning of the cognitive behavioural therapy (measurement-1) and at the end of the treatment which was after six weeks (measurement-2). Patients with panic disorder were treated using a combination of group cognitive-behavioural therapy and antidepressants. The usual antidepressant dosage range was used. Before admission to intensive cognitive behavioural therapy program, the patients were unsuccessfully treated by antidepressants for minimum 3 months, which defined them as pharmacoresistant.

RESULTS

Hospitalized pharmacoresistant patients with panic disorder improved significantly throughout the 6-week intensive CBT program in all measurements that assessed the overall severity of the disorder, the degree of general anxiety and depression and the severity of specific symptoms of panic disorder and agoraphobia. The rate of improvement was negatively related to sexual abuse in childhood, presence of comorbid personality disorder, and positively with the severity of the disorder at the beginning, and the level of self-stigma at the beginning of treatment. Improvement in symptoms correlates significantly with decreasing of dissociation during the treatment.severity of depressive symptoms. The earlier development of the disorder is linked to higher score in childhood adverse events, higher level of dissociation and pathological dissociation, and higher level of self-stigma.

CONCLUSIONS

Our prospective study discovers importance of the role of adverse childhood experiences, self-stigma, dissociation and comorbid personality disorder in effectiveness of combined cognitive-behavioural therapy and pharmacotherapy treatment in patients with treatment-resistant panic disorder.

Severity of panic disorder, adverse events in childhood, dissociation, self-stigma and comorbid personality disorders Part 1: Relationships between clinical, psychosocial and demographic factors in pharmacoresistant panic disorder patients

OBJECTIVES

Little is known about the relation between severity of panic disorder, adverse events in childhood, dissociation, self-stigma and comorbid personality disorders. The aim of this study is to look for the intercorrelations between these factors.

METHOD

The study explores the relation between clinical, demographic and social factors in panic disorder using cross sectional design. The inpatients with pharmacoresistant panic disorder with and without agoraphobia were included in the study. Participants were also assessed for comorbidity with other anxiety or personality disorder. The Clinical Global Impression (CGI), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI-II), Dissociative Experiences Scale (DES), Internalized Stigma of Mental Illness (ISMI), Childhood Trauma Questionnaire-Short Form (CTQ-SF), Panic Disorder Severity Scale (PDSS) and demographic data were used as measurement tools.

RESULTS

A total of 142 pharmacoresistant patients with panic disorder with or without agoraphobia were admitted for 6-week cognitive behavioral therapy inpatient program in psychotherapeutic department between November 2015 and July 2019. One hundred and five inpatients (33 males and 72 females) with mean age 37.8 + 12.1 years were included in the study. Sixty-nine patients suffer from additional comorbid anxiety disorder and 43 had comorbid personality disorder.

Internal consistency and factorial validity of the Slovak Version of the Young Schema Questionnaire - Short Form 3 (YSQ-S3)

OBJECTIVE

Young schema questionnaire - short form (YSQ-S3) represents a useful method for the identification of early maladaptive schemas in clinical and non-clinical samples. The study aimed to examine the internal consistency and factorial structure of the recently adapted Slovak version of YSQ-S3 in a non-clinical sample.

METHODS

The sample consisted of 302 healthy participants from the general population in Slovakia. Slovak version of YSQ-S3 was used. Reliability analysis and confirmatory factor analysis were performed.

RESULTS

The results suggest an acceptable internal consistency of early maladaptive schemas (EMSs). The Cronbach's alpha coefficients of YSQ-S3 subscales ranged from 0.54 to 0.85. Confirmatory factor analysis supports the factor structures of 18 unifactorial EMSs. The results partially support Young's theoretical schema clusters and fail to support the second-order factor model.

CONCLUSION

In conclusion, the Slovak version of the YSQ-S3 is a psychometrically sound questionnaire that can be utilized for assessing EMS, both for research and clinical purposes.

Positive Self-Relation Scale - development and psychometric properties

PURPOSE

Self-relation is a profound connection that influences one's life. As such, it presents an important topic for various areas of research and psychotherapy. The goal of this study was to develop and evaluate a brief scale that would assess positive aspects of self-relation.

SAMPLE AND METHODS

The Positive Self-Relation Scale (PSRS) consists of 16 items divided into 4 subscales - Self-Acceptance, Self-Confidence, Authenticity and Assertiveness, and Fulfilled Experience. Two samples were used for the evaluation of its content and factor structure. The final sample's data used for validation assessment. This sample consisted of 1234 adults from a general population (mean age 34.8±14.2 years, 70.8% women). All participants completed PSRS. Subgroups also filled in Rosenberg Self-Esteem Scale (RSES), Adult Dispositional Hope Scale (ADHS), Beck Depression Inventory-II (BDI-II), Liebowitz Social Anxiety Scale (LSAS), and Dissociative Experiences Scale (DES).

RESULTS

Differences in scores among demographic groups were small to none. Internal consistency was good (Composite Reliability Coefficients - the whole scale: 0.93; the subscales: 0.73-0.80). Temporal stability, assessed 2 weeks apart, was satisfactory (intraclass correlation coefficients - the whole scale: 0.86, the subscales: 0.60-0.82). Factor loadings in confirmatory factor analysis were 0.45-0.80, fit indices mostly showed an adequate model. The correlation coefficients between PSRS and RSES/ADHS were strong (r=0.79/0.55). The scale also strongly correlated with LSAS, BDI-II, and DES (r=-0.61/-0.48/-0.30, all ps<0.001).

CONCLUSION

PSRS showed adequate psychometric properties in the general population. Future studies should include clinical samples. The areas of application lie mainly in research and psychotherapy.

Relation of personality factors and life events to waist/height ratio and percentage of visceral fat in women and men

PURPOSE

The investigation aimed to explore the association between personality traits, stressful life events, quality of life on anthropometric characteristics (waist/height ratio and percentage of visceral fat).

METHOD

A total of 227 participants took part in this cross-sectional study. Participants completed the Social Readjustment Rating Scale (SRRS), Temperament and Character Inventory-Revised, Type-D Scale (DS-14), EuroQol Group 5-Dimension Self-Report Questionnaire (EQ-5D), and demographic questionnaire. Two anthropometric parameters were measured: Waist/height ratio and Percentage of the visceral fat.

RESULTS

The average age of participants was 39.6±12.9 years, 60.4% women. The 41.8% of participants were overweight or obese. Regression analysis found a significant link between Harm-avoidance and EQ-5D visual analog scale (VAS) with Waist/height ratio in women and Reward dependence and Cooperativeness with Waist/height ratio in men. In regression analysis, the score of life events (SRRS) has statistically significant linked to Percentage of the visceral fat in women. The regression analysis also found a significant link between Novelty seeking, DS14, Negative affectivity, and EQ-5D VAS with Percentage of the visceral fat in women.

CONCLUSION

Significant associations between live events, personality traits, and body anthropometric measures were recognized. The differences were recognized between women and men. Outcomes propose some promising tools by which personality factors may influence overweight and obesity.

Quality of life, self-stigma, and coping strategies in patients with neurotic spectrum disorders: a cross-sectional study

Background

Modern psychiatry focuses on self-stigma, coping strategies, and quality of life (QoL). This study looked at relationships among severity of symptoms, self-stigma, demographics, coping strategies, and QoL in patients with neurotic spectrum disorders.

Methods

A total of 153 clinically stable participants who met criteria for generalized anxiety disorder, social phobia, panic disorder, agoraphobia, mixed anxiety-depressive disorder, adjustment disorders, somatoform disorders, or obsessive-compulsive disorder were included in a cross-sectional study. Psychiatrists examined patients during regular psychiatric checkups. Patients completed the Quality of Life Satisfaction and Enjoyment Questionnaire (Q-LES-Q), Internalized Stigma of Mental Illness Scale (ISMI), a sociodemographic questionnaire, the Stress Coping Style Questionnaire (Strategie Zvládání Stresu [SVF] 78), and the Clinical Global Impression (CGI) scale.

Results

The diagnostic subgroups differed significantly in age and use of negative coping strategies, but not in other measured clinical or psychological variables. The findings showed that neither sex nor partnership played a role in perceived QoL. All Q-LES-Q domains correlated negatively with all ISMI domains, except school/study. Unemployed and employed groups of patients differed in QoL. Each of the coping strategies, except the need for social support, was related to self-stigma. The findings showed that sex, partnership, education, and employment played no role in self-stigma. No differences between sexes in positive coping strategies, severity of disorder, self-stigma, or QoL were found. QoL correlated significantly with all coping strategies, except for guilt denial. Multiple regression showed the most important factors to be positive coping, employment, and overall self-stigma rating, explaining 32.9% of QoL. Mediation analysis showed self-stigma level and negative coping strategies to be the most influential. The most substantial factors associated with self-stigma, as indicated by regression analysis, were Q-LES-Q total, subjective CGI, and positive coping strategies, which clarified 44.5% of the ISMI.

Conclusion

The study confirmed associations among self-stigma, quality of life, disorder severity, and coping strategies of outpatients with neurotic spectrum disorders.

Three diagnostic psychiatric subgroups in comparison to self-stigma, quality of life, disorder severity and coping management cross-sectional outpatient study

BACKGROUND

Much attention has been paid to psychological factors influencing characteristics, severity, and course of mental disorders. The objective of our investigation was to examine the interrelations among quality of life (QoL), self-stigma, and coping strategies, demographics and severity of the disorder in neurotic spectrum disorders, schizophrenia, and depressive spectrum disorders.

METHODS

A total of 343 clinically stable Czech outpatients with different mental disorders (153 with neurotic spectrum disorders; 81 with depression, and 109 with schizophrenia spectrum disorders) were included. The patients were examined by their outpatient psychiatrists during regular psychiatric checkup and completed a sociodemographic questionnaire, the Quality of Life Satisfaction and the Enjoyment Questionnaire (Q-LES-Q), the Internalized Stigma of Mental Illness Scale (ISMI), the Stress Coping Style Questionnaire (SVF-78), and the Clinical Global Impression scale (CGI).

RESULTS

The study demonstrates that the self-stigma and coping strategies are significant factors linked to the QoL in all diagnostic groups of patients. Patients with schizophrenia spectrum disorders had lower scores in QoL compared to the other two groups. The patients with depression or neurotic spectrum disorders had a lesser degree of self-stigma than the patients with schizophrenia spectrum disorders. The severity of the illness significantly correlated with the QoL, self-stigma, and coping strategies.

CONCLUSIONS

The investigation confirmed the connection between the quality of life, self-stigma, coping strategies, and the severity of the illness, in outpatients with schizophrenia spectrum disorders, depressive, and neurotic spectrum disorders. A further longitudinal study would be useful to determine the causative relationships of these variables.

Positive and negative symptoms in schizophrenia and their relation to depression, anxiety, hope, self-stigma and personality traits - a cross-sectional study

OBJECTIVE

The purpose of the investigation was to explore the relationship between positive or negative symptoms, social anxiety, hope, personality, and self-stigma in patients with schizophrenia spectrum disorders.

METHOD

57 outpatients took part in this cross-sectional study. The structured interview M.I.N.I. International Neuropsychiatric Interview was used to confirm the diagnosis. All patients completed the Liebowitz Social Anxiety Scale, Internalized Stigma of Mental Illness Scale, Beck Depression Inventory-II, Beck Anxiety Inventory, Adult Dispositional Hope Scale, and Temperament and Character Inventory - Revised. The disorder severity was evaluated by Clinical Global Impression - Severity scale, and Positive and Negative Syndrome Scale. The patients were in a stabilized state that did not require hospitalization or modifications in the treatment.

RESULTS

Both positive and negative symptoms of schizophrenia positively correlated with the length of the disorder, global severity of the disorder, the severity of the general and social anxiety symptoms, the severity of self-stigma, and negatively with personality traits Self-directedness and Cooperativeness. Only negative symptoms significantly positively correlated with the severity of depressive symptoms and personality trait Harm-avoidance and negatively with the hope and personality trait Persistence. Comorbidity with social phobia is associated with statistically significantly higher mean scores on the total score of schizophrenic symptomatology, negative subscale average rating, and general psychopathological items measured by PANSS. Patient with comorbid depression would experience a higher level of negative symptomatology than patients without such comorbidity.

Suicidality, self-stigma, social anxiety and personality traits in stabilized schizophrenia patients - a cross-sectional study

BACKGROUND AND AIM

Patients who have schizophrenia are more prone to suicidal behavior than the general population. This study aimed to find connections between suicidality and self-stigma, hope, and personality traits in patients with schizophrenia.

METHODS

Forty-eight stabilized outpatients with schizophrenia attended this cross-sectional study. Patients were diagnosed by the Mini International Neuropsychiatric Interview (MINI) using the ICD-10 research diagnostic criteria. The assessments included Positive and Negative Syndrome Scale, objective and subjective Clinical Global Impression, Liebowitz Social Anxiety Scale, Beck Depression Inventory-second edition, Internalized Stigma of Mental Illness, the Temperament and Character Inventory, and Adult Dispositional Hope Scale.

RESULTS

The individual rate of suicidality (suicidal index from MINI) strongly positively correlated with self-stigma, level of depression, social anxiety, and harm-avoidance, and negatively correlated with hope, self-directedness, and stigma resistance.

CONCLUSION

Individuals with additional symptoms of depression, social anxiety, trait-like anxiety, and self-stigma should be carefully monitored for suicidal ideation. On the opposite side, patients with sufficient hope, self-esteem, and goal-directed attitudes are less likely to have suicidal thoughts and may potentially be role models in group rehabilitation programs, motivating more distressed colleagues and showing them ways to cope.

Quality of life and coping strategies of outpatients with a depressive disorder in maintenance therapy - a cross-sectional study

BACKGROUND

The quality of life (QoL) is a multidimensional view that represents all aspects of patient well-being in various areas of patient life. Specific coping strategies may be connected to both the QoL and the severity of mental disorder. The aim of this investigation was to examine the relationship between the QoL and the coping strategies of outpatients with a depressive disorder.

METHODS

Eighty-two outpatients, who met the criteria of the International Classification of Diseases, Tenth Revision, for a depressive disorder, were enrolled in the cross-sectional study. Data on sociodemographic and clinical variables were obtained from the medical records. Individuals filled the following standardized questionnaires: Quality of Life Satisfaction and Enjoyment Questionnaire, Stress Coping Style Questionnaire, and Clinical Global Impression. Multiple regression analyses with backward elimination were performed to discover the most influential factors contributing to QoL.

RESULTS

The participants with a depressive disorder showed an overuse of negative coping strategies, especially escape tendency and resignation. A positive self-instruction strategy was used by the patients less often. The coping strategies were significantly associated with the QoL. A more frequent use of positive coping strategies had a positive association with the QoL. The main factors related to QoL were the subjective severity of the disorder, employment, and positive coping strategies.

CONCLUSION

The study confirmed the relationship between QoL and the coping strategies of outpatients with a depressive disorder.

Self-stigma and treatment effectiveness in patients with anxiety disorders - a mediation analysis

GOAL

The goal of this study was to explore the impact of self-stigma on the treatment outcomes in patients with anxiety disorders and to find possible mediators of this relationship.

METHOD

Two hundred and nine patients with anxiety disorders, who were hospitalized in a psychotherapeutic department, attended the study. The average age was 39.2±12.4 years; two-thirds were women. Most of the patients used a long-term medication. The participants underwent either cognitive behavioral therapy (CBT) or short psychodynamic therapy. The selection to the psychotherapy was not randomized. All individuals completed several scales - Beck Depression Inventory, the second edition (BDI-II), Beck Anxiety Inventory (BAI), Dissociative Experience Scale (DES), Sheehan Disability Scale (SDS), subjective Clinical Global Impression (subjCGI), and The Internalized Stigma of Mental Illness Scale (ISMI). A senior psychiatrist filled out the objective CGI (objCGI).

RESULTS

The patients significantly improved in the severity of anxiety (BAI), depression (BDI-II), and overall severity of the mental disorder (objCGI). The self-stigma predicted a lower change of the objCGI, but not a change of the anxiety and depressive symptoms severity. Anxiety, depressive symptoms, dissociation, and disability were assessed as possible mediators of the relationship between the self-stigma and the treatment change. None of them were significant.

CONCLUSION

Self-stigma lowers the effectiveness of the combined treatment of anxiety disorders. Future research should explore other possible mediators influencing this relationship.

Adherence, self-stigma and discontinuation of pharmacotherapy in patients with anxiety disorders - cross-sectional study

INTRODUCTION

Treatment adherence is one of the main factors affecting the success of treatment and, secondarily, the quality of life and social adaptation of the patients. The aim of this study was to investigate the association between self-stigmatization, treatment adherence and history of discontinuation of drug treatment.

METHODS

The cross-sectional study was conducted on 120 (98 completed all the questionnaires) neurotic outpatients treated in the University Hospital Olomouc. The following variables were evaluated: the objective and subjective Clinical Global Impression (CGI) scale, Drug Attitude Inventory (DAI-10) questionnaire measuring adherence, Internalized Stigma of Mental Illness (ISMI) scale measuring self-stigma, and a demographic data questionnaire.

RESULTS

Data analysis showed no correlation between self-stigmatization and age, age of onset or length of the post-hospitalization phase. However, there were significant correlations between self-stigmatization and the severity of the disorder (assessed by both objective and subjective CGI), number of previous hospitalizations, total number of psychiatrists visited by the patient, the arbitrary discontinuation of medication in the past, and the dose of an antidepressant. Furthermore, self-stigma was significantly negatively correlated with the current treatment adherence. The rate of adherence was negatively correlated with both objective and subjective CGI only.

CONCLUSIONS

Self-stigma significantly affects the current adherence to the treatment of neurotic spectrum disorders.

Insight in schizophrenia - a double-edged sword?

Lack of insight is defined as a loss of ability to distinguish that one's unusual and unreal experiences should be the symptoms of the psychiatric disorder requiring treatment. Lack of insight may be considered as a core symptom of schizophrenia. The concept of insight has been regarded for a long time as necessary for treatment, which improves adherence and makes a better prognosis. Increased insight in schizophrenia has been associated not only with benefits, but also bring trouble in the form of self-stigma, low self-esteem, reduced patient's hope, diminished quality of life, and increased suicidality. Therefore, insight should be managed with sensitive monitoring of the risk factors, and be gradual, carefully supported by the encouragement of hope and confidence to managing everyday life.

Depression and obstructive sleep apnea

OBJECTIVE

Obstructive sleep apnea (OSA), is described as intermittent interruptions or reductions in airflow which are initiated by an incomplete or complete collapse of the upper airways despite respiratory effort. When left untreated, OSA is connected with comorbid conditions, such as cardiovascular and metabolic illnesses.

METHOD

The PubMed database was used to examine papers published until April 2017 using the subsequent terms: "obstructive sleep apnea" or "obstructive sleep apnoea" and "depression" in successive combination with "CPAP (continuous positive airway pressure)", "therapy", "pharmacotherapy", "psychotherapy", "cognitive behavioral therapy" or "quality of life".

RESULTS

After assessment for the suitability, 126 articles were chosen. The numerous evidence of a connection between OSA and depressive symptoms, as well as depressive disorder, were found. This connection may be directly or indirectly linked due to the participation of some OSA mediators consequences such as obesity, hypertension, and the decreased quality of life. Patients with the comorbid major depression and OSA reported more severe and longer episodes of depression. Nevertheless, the information on the effect of the treatment of OSA using CPAP on the depressive symptoms was limited. Still, the current state of the art suggests that this treatment decreases the severity of the comorbid depressive symptoms.

CONCLUSIONS

It is important to evaluate the symptoms of depression in the patients with OSA. On the other side, a psychiatrist should not just treat the depression, as it is also important to screen individuals at high risk of OSA when assessing patients for depressive disorder, especially those with depression resistant to treatment.

Borderline personality disorder and unmet needs

BACKGROUND

Borderline personality disorder (BPD) is a disabling psychiatric condition with a chronic and challenging course. BPD is reflected as a disorder of self-regulation" and is associated with both psychological vulnerabilities and social relations that fail to support basic emotional needs. The objective of the paper is to provide the up-to-date data on the unmet needs of BPD patients and their families.

METHOD

A computerized search of the literature printed between January 1990 and May 2017 was conducted in PubMed, and additional papers were extracted using keywords "borderline personality disorder,"needs," "pharmacotherapy," "psychotherapy," "CBT," and "family" in various combinations. According to the eligibility criteria, 57 articles were chosen. Secondary articles from the reference lists of primarily identified papers have been selected for the eligibility and added to the first list (N=151).

RESULTS

The results were divided into three categories: the needs connected with (1) the symptom control; (2) the treatment; (3) the quality of life. The needs connected with symptoms were described issues such as emotional needs, social interactions, self-harm, parasuicide, suicidality, comorbidity, mentalization, identity disturbance, moreover, barriers to treatment. The needs connected with the treatment described are focused on needs for early diagnosis, early intervention, holding environment, therapeutic relation, assertive community treatment, destigmatization, hospitalization, and primary care. The needs connected with the quality of life involve family needs, physical health, spiritual needs, advocacy needs, and needs for the separation-individuation. The part focused on implications for the treatment presented several treatment approaches, focusing mostly on the their basics and efficacy.

CONCLUSION

Observing the patients' needs may be essential to the treatment of the individuals suffering from BPD. However, many needs remain unmet in the areas linked to medical, personal, and social factors. A bigger focus on the patients' needs could be beneficial and should be targeted in the treatment.

Cognitive function and depressivity before and after cpap treatment in obstructive sleep apnea patients

OBJECTIVE

The target of the investigation was to find if there is any improvement of depressive symptoms and cognitive functioning after continuous positive airway pressure (CPAP) treatment in the severe obstructive apnea (OSA) patients.

METHOD

The study included 59 patients treated with CPAP for OSA in the Sleep Laboratory of the Department of Respiratory Medicine. Thirty-eight patients were treated with CPAP for one month, and twenty-one patients were in a control group. We used the following methods: Test of Visual Memory (ViMe), Numeric Rectangle, d2 (test of attention), and the Beck Depression Inventory-II, respectively.

RESULTS

Among the OSA patients, there were statistically significant improvements in all parameters: attention, working memory, and depressive symptoms after the treatment with CPAP. We found a statistically significant positive connection between the decrease in depressive symptoms and the improvement in attention. In the control group, there were no improvements in the investigated factors.

CONCLUSIONS

According to our results, the patients with sleep apnoea improved their mood and cognitive functions during the treatment by the CPAP device.

Self-stigma, Hope, Dissociation, and Personality Features in Treatment of Depressive Inpatients Resistant to Pharmacotherapy

Objective

The goal of this study was to examine the influence of dissociation, hope, personality trait and selected demographic factors in treatment response of this group of patients.

Methods

Pharmacoresistant depressive inpatients completed clinical global impression – both objective and subjective form, Beck depression inventory, and Beck anxiety inventory at baseline and after six weeks of combined pharmacotherapy and psychotherapy (group cognitive behavioral or group psychodynamic). The Internalized Stigma Of Mental Illness Scale, Dissociative Experience Scale Adult Dispositional Hope Scale, and temperament and character inventory were completed at the start of the treatment with the intention to find predictors of treatment efficacy.

Results

The study included 72 patients hospitalized for the pharmacoresistant major depression, 63 of them finished the study. The mean scores of BDI-II, BAI, subjCGI, and objCGI significantly decreased during the treatment. BDI-II relative change statistically significantly correlated with the total ISMI score, discrimination experience (ISMI subscale), and harm avoidance (TCI-R personality trait). According to stepwise regression, the strongest factors connected to BDI-II relative change were the duration of the disorder and discrimination experience (ISMI). ObjCGI relative change significantly correlated with the level of dissociation, the total ISMI score, and hope in ADHS total score, and self-directedness. According to stepwise regression, the strongest factor connected to objCGI relative change was discrimination experience (ISMI).

Conclusions

According to our results, the patients with pharmacoresistant depressive disorders, who have had more experience with discrimination because of their mental struggles, showed a poorer response to treatment.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Hope, self-stigma, personality traits and quality of life in patients with psychotic disorders

Introduction

Recently, as a result of an increased emphasis on patients’ needs, the awareness on the quality of life has been engaged into account in the exploration of schizophrenia.

Objectives

The aim of the study was to explore the relations between hope, self-stigma, personality traits and quality of life in patients with schizophrenia spectrum disorder.

Methods

Fifty-two stabilized outpatients with schizophrenia spectrum disorders participated in cross-sectional study. The psychiatrist assessed each patient with Mini International Neuropsychiatric Interview and Clinical Global Impression-Severity. The patients completed Quality of Life Satisfaction and Enjoyment Questionnaire, Internalized Stigma of Mental Illness Scale, Temperament and Character Inventory, Adult Dispositional Hope Scale, Drug Attitude Inventory, Liebowitz Social Anxiety Scale, Beck Depression Inventory – II, and Beck Anxiety Inventory.

Results

The quality of life was significantly higher in employed patients, and individuals with higher hope, self-directedness, and persistence. The quality of life was lower among the patients with higher number of hospitalizations, those with higher severity of the disorder and individuals who were taking more medication. The patients with more pronounced symptoms of depression, anxiety, and social anxiety had a lower quality of life. Finally, the quality of life was lower among the individuals with higher harm avoidance, and self-stigmatization.

Conclusions

Detection of the quality of life in the context of personality traits, hope, self-stigma and demographical and clinical factors may be an important part of the treatment of patients with schizophrenia.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Dissociation and Therapy of Depressive and Anxiety Disorders with or Without Personality Disorders

Objective

Goal of the study was to analyze the impact of dissociation on the treatment of the patients with anxiety/neurotic spectrum and depressive disorders, and with or without personality disorders.

Methods

The sample consisted of inpatients who met the ICD-10 criteria for the Depressive disorder, Panic disorder, GAD, Mixed anxiety-depressive disorder, Agoraphobia, Social phobia, OCD, PTSD, Adjustment disorders, dissociative/conversion disorders, Somatoform disorder or other anxiety/neurotic spectrum disorder. The participants completed Beck Depression Inventory, Beck Anxiety Inventory, subjective version of clinical global impression-severity, Sheehan Patient-Related Anxiety Scale, and Dissociative Experience Scale, at the start and the end of the therapeutic program.

Results

The total of 840 patients with anxiety or depressive spectrum disorders, who were resistant to pharmacological treatment in outpatients basis and were referred for hospitalization for the six-week complex therapeutic program, were enrolled in this study. Six hundred and six of them were statistically analyzed. The patients’ mean ratings on all measurements were significantly reduced during the treatment. The patients without comorbid personality disorder improved significantly more than patients with comorbid personality disorder in the reduction of depressive symptoms. However, there were no significant differences in change of anxiety levels and severity of the disorder between the patients with and without personality disorders. The higher degree of dissociation at the beginning of the treatment predicted minor improvement. The higher therapeutic change was connected to the greater reduction of the dissociation level.

Conclusions

Dissociation presents an important factor influencing treatment effectiveness in the treatment-resistant patients with anxiety/depression with or without personality disorders.

Disclosure of interest

The authors have not supplied their declaration of competing interest.