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Marie Ociskova,1,2 Jan Prasko,1– 4 Krystof Kantor,1,5 Jakub Vanek,1 Vlastimil Nesnidal,1 Kamila Belohradova1 1Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic; 2Jessenia Inc. Rehabilitation Hospital Beroun, Akeso Holding, MINDWALK, S.r.o, Beroun, Czech Republic; 3Department of Psychological Sciences, Faculty of Social Sciences and Health Care, Constantine the Philosopher University in Nitra, Nitra, Slovak Republic; 4Department of Psychotherapy, Institute for Postgraduate Training in Health Care, Prague, Czech Republic; 5Department of Child Psychiatry, University Hospital in Motol, Prague, Czech RepublicCorrespondence: Jan Prasko, Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University in Olomouc, Hnevotinska 3, Olomouc, 779 00, Czech Republic, Email praskojan@seznam.czPurpose: Child abuse and trauma are significant risk factors in the etiology of borderline personality disorder (BPD). Apart from affecting the risk of developing BPD, adverse childhood experiences seem to increase its symptoms and related disability. Self-stigma presents another common issue with equally prominent consequences for mental health. Despite being theoretically linked, the connections among childhood trauma, self-stigma, and mental health have not been explored in patients with BPD. This study aimed to provide first insights into this understudied topic.Patients and Methods: This cross-sectional study included 283 inpatients diagnosed with BPD participating in a residential transdiagnostic psychotherapeutic program. The patients completed several measurements – the Internalized Stigma of Mental Illness Scale, the Childhood Trauma Questionnaire – Short Form, the Clinical Global Impression – Severity, the Beck Depression Inventory-II, the Beck Anxiety Inventory, the Dissociative Experiences Scale, the Sheehan Disability Scale, and a demographic questionnaire. The data was statistically analyzed using IBM SPSS and AMOS 26 programs, and bivariate correlation tests and structural equation modeling explored the hypotheses.Results: Retrospectively reported childhood trauma positively correlated with current self-stigma. Both childhood trauma and self-stigma were also positively related to several indicators of general psychopathology and disability. The significance of these connections was subsequently confirmed by structural equation modeling, where self-stigma acted as a partial mediator of childhood trauma, general psychopathology, and disability.Conclusion: Self-stigma significantly mediates the relationship between childhood trauma and selected mental health symptoms among adult patients diagnosed with BPD. Longitudinal studies are necessary to explore the causality of the findings. Therapeutic and societal efforts to tackle childhood trauma or self-stigma might benefit from reflecting its broader psychosocial context.Keywords: borderline personality disorder, self-stigma, childhood trauma, depression, anxiety, disability

Jakub Vanek,1 Jan Prasko,1– 4 Samuel Genzor,5 Kamila Belohradova,1 Jozef Visnovsky,1 Jan Mizera,5 Jonas Bocek,1 Milan Sova,5,6 Marie Ociskova1,4 1Department of Psychiatry, Faculty of Medicine and Dentistry of Palacky University, Olomouc, the Czech Republic; 2Institute for Postgraduate Education in Health Care, Prague, The Czech Republic; 3Department of Psychology Sciences, Faculty of Social Science and Health Care of Constantine the Philosopher University, Nitra, the Slovak Republic; 4Jessenia Inc. - Rehabilitation Hospital, Akeso Holding, Beroun, the Czech Republic; 5Department of Respiratory Medicine, Faculty of Medicine and Dentistry of Palacky University, Olomouc, the Czech Republic; 6Department of Respiratory Medicine, University Hospital and Faculty of Medicine of Masaryk University, Brno, the Czech RepublicCorrespondence: Jan Prasko, Department of Psychiatry, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, I. P. Pavlova 6, Olomouc, 77520, the Czech Republic, Tel +420 603 414 930, Email praskojan@seznam.czObjective: 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.Keywords: obstructive sleep apnoea, depression, cognitive functions, CPAP treatment, treatment efficacy, Trail Making Test, Verbal Fluency Test

Jonas Bocek,1 Jan Prasko,1– 4,* Samuel Genzor,5,* Frantisek Hodny,1,* Jakub Vanek,1,* Pavol Pobeha,6,* Kamila Belohradova,1,* Marie Ociskova1,4,* 1Department of Psychiatry, Faculty of Medicine and Dentistry, University Palacky Olomouc, University Hospital, Olomouc, The Czech Republic; 2Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra, The Slovak Republic; 3Department of Psychotherapy, Institute for Postgraduate Training in Health Care, Prague, The Czech Republic; 4Rehabilitation Hospital Beroun, Jessenia Inc, Akeso Holding, Beroun, The Czech Republic; 5Department of Respiratory Medicine, Faculty of Medicine and Dentistry, University Palacky Olomouc and University Hospital, Olomouc, The Czech Republic; 6Department of Respiratory Diseases and Tuberculosis University Hospital and Faculty of Medicine and Dentistry Pavol Jozef Safarik University, Kosice, The Slovak Republic*These authors contributed equally to this workCorrespondence: Jan Prasko, Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital, I. P. Pavlova 6, Olomouc, 77520, The Czech Republic, Tel +420 603 414 930, Email praskojan@seznam.czAbstract: 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.Keywords: insomnia, COVID-19, circadian rhythms, immunity, sleep deprivation, mental disorders

Jan Prasko,1– 4 Ilona Krone,5 Julius Burkauskas,6 Jakub Vanek,1 Marija Abeltina,7 Alicja Juskiene,6 Tomas Sollar,2 Ieva Bite,7 Milos Slepecky,2 Marie Ociskova1,4 1Department of Psychiatry, University Hospital Olomouc, Faculty of Medicine, Palacky University in Olomouc, Olomouc, The Czech Republic; 2Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra, The Slovak Republic; 3Department of Psychotherapy, Institute for Postgraduate Training in Health Care, Prague, The Czech Republic; 4Jessenia Inc. - Rehabilitation Hospital Beroun, Akeso Holding, Beroun, The Czech Republic; 5Riga`s Stradins University, Riga, Latvia; 6Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania; 7University of Latvia, Latvian Association of CBT, Riga, LatviaCorrespondence: Jan Prasko, Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital, I. P. Pavlova 6, Olomouc, 77520, The Czech Republic, Tel +420 603 414 930, Email praskojan@seznam.czAbstract: 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.Keywords: supervision, cognitive behavioral therapy, homework, self-reflection

Jakub Vanek,1 Jan Prasko,1– 4 Samuel Genzor,5 Jan Mizera5 1Department of Psychiatry, University Hospital Olomouc, Faculty of Medicine, Palacky University in Olomouc, Olomouc, The Czech Republic; 2Department of Psychological Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra, The Slovak Republic; 3Department of Psychotherapy, Institute for Postgraduate Training in Health Care, Prague, The Czech Republic; 4Rehabilitation Hospital Beroun, Jessenia Inc, Akeso Holding, Závodí, The Czech Republic; 5Department of Respiratory Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, The Czech RepublicCorrespondence: Jan Prasko, Department of Psychiatry, Faculty of Medicine and Dentistry, University Hospital Olomouc, I. P. Pavlova 6, Olomouc, 77900, The Czech Republic, Email praskojan@seznam.czAbstract: Patients with schizophrenia commonly encounter a variety of sleep disorders. Disturbed sleep can be found in 30– 80% of patients, depending on the degree of psychotic symptomatology. Difficulty falling asleep, maintaining, or achieving restful sleep is associated with symptom severity and has been reported as a prodromal symptom of psychotic relapse. Although some sleep disorders improve with antipsychotic treatment, in many cases, even during disease remission, sleep continues to be fragmented, or even different pathophysiological mechanism is causing sleep disruption. Moreover, it may be complicated if the patient needs specific treatment, such as positive airway pressure (PAP) therapy, due to sleep-disordered breathing. The article presents case reports of patients with schizophrenia with sleep disturbances. As presented in our case reports, cognitive behavioral therapy seems effective in treating comorbid insomnia, even in patients with schizophrenia. The second and third case reports emphasise the need for broader clinical considerations, a cross-diagnostic approach, and cooperation in care for patients with severe mental disorders.Keywords: schizophrenia, sleep, REM sleep, NREM sleep, polysomnography, actigraphy, antipsychotics, hypnotics, cognitive behavioral therapy, symptomatology

Samuel Genzor,1,* Jan Prasko,2– 4,* Jan Mizera,1,* Petr Jakubec,1,* Milan Sova,1,5,* Jakub Vanek,2,* Nikoleta Šurinová,6,* Katerina Langova7,* 1Department of Respiratory Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc Czech Republic; 2Department of Psychiatry, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc Czech Republic; 3Institute for Postgraduate Education in Health Care, Prague Czech Republic; 4Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra The Slovak Republic; 5Department of Respiratory Medicine, Faculty of Medicine and Dentistry, Masaryk University Brno and University Hospital Brno, Brno Czech Republic; 6Palacky University Olomouc, Olomouc Czech Republic; 7Department of Biophysics, Palacky University Olomouc, Olomouc Czech Republic*These authors contributed equally to this workCorrespondence: Jan Prasko, Department of Psychiatry, Faculty of Medicine and Dentistry, University Hospital Olomouc, I. P. Pavlova 6, Olomouc, 775 20, Czech Republic, Email praskojan@seznam.czBackground: Patients with obstructive sleep apnoea (OSA) are at increased risk of severe course of COVID-19. Vaccination remains to be the most effective prevention of complicated courses of infection. The best contemporary conservative treatment of OSA is continuous positive airway pressure (CPAP) therapy.Purpose: To compare vaccination acceptance and outcomes of COVID-19 infection between OSA patients adhering to the CPAP therapy and those who rejected CPAP and surgical therapy.Patients and Methods: Subjects were divided into two groups: group A (N = 167) were individuals with sufficient CPAP adherence (more than 4 hours per night on average) over the last 10 years. Group B (N = 106) were individuals who did not use the CPAP therapy at all and had no indications to surgical therapy.Results: Three patients in group B died, and one had a severe course of COVID-19. None of the patients in group A died or experienced a severe course of COVID-19. Group A had a significantly higher proportion of males (77.8% compared to 66% in group B) and all parameters of OSA severity. The vaccination status was similar among both groups, with a complete triple dose vaccination rate of 69.5% and 67.9% in groups A and B, respectively.Conclusion: The results show that the patients with OSA adherent to CPAP therapy were less likely to experience a severe course of COVID-19 or death than the OSA patients non-compliant with therapy, despite the former group having more severe OSA. This result underlines the importance of adherence to CPAP therapy in OSA.Keywords: OSA, COVID-19, vaccination, treatment with CPAP, CPAP adherence

Jan Prasko,1– 4 Marie Ociskova,1 Jakub Vanek,1 Julius Burkauskas,5 Milos Slepecky,2 Ieva Bite,6 Ilona Krone,7 Tomas Sollar,2 Alicja Juskiene8 1Department of Psychiatry, Faculty of Medicine, Palacky University, University Hospital Olomouc, Olomouc, Czech Republic; 2Department of Psychological Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University, Nitra, Slovak Republic; 3Department of Psychotherapy, Institute for Postgraduate Training in Health Care, Prague, Czech Republic; 4Rehabilitation Hospital Jessenia Inc, Akeso Holding, Beroun, Czech Republic; 5Behavioral Medicine Clinic, Faculty of Nursing, Lithuanian University of Health Sciences, Institute of Neuromedicine, Kaunas, Lithuania; 6University of Latvia, Latvian Association of CBT, Riga, Latvia; 7Riga’s Stradins University, Latvian Association of CBT, Riga, Latvia; 8Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Kaunas, LithuaniaCorrespondence: Jan Prasko, Department of Psychiatry, Faculty of Medicine, Palacky University in Olomouc, University Hospital, I. P. Pavlova 6, Olomouc, 775 20, Czech Republic, Tel +420 603 414 930, Email praskojan@seznam.czAbstract: 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.Keywords: supervision, cognitive behavioral therapy, therapeutic relationship, supervisory relationship, transference, countertransference

Kamila Belohradova Minarikova,1 Jan Prasko,1– 4 Michaela Holubova,5,6 Jakub Vanek,1 Krystof Kantor,1 Milos Slepecky,3 Klara Latalova,1 Marie Ociskova1 1Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University, University Hospital, Olomouc, The Czech Republic; 2Institute for Postgraduate Education in Health Care, Prague, The Czech Republic; 3Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University, Nitra, The Slovak Republic; 4Jessenia, a.s., Rehabilitation Hospital Beroun, AKESO Holding, Beroun, The Czech Republic; 5Department of Psychiatry, Hospital Liberec, Liberec, The Czech Republic; 6Department of Pedagogy and Psychology, Faculty of Science, Humanities and education, Technical University, Liberec, The Czech RepublicCorrespondence: Jan Prasko, Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University, University Hospital, I. P. Pavlova 6, Olomouc, 779 00, The Czech Republic, Email praskojan@seznam.czBackground: 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.Keywords: borderline personality disorder, psychotic symptoms, hallucinations, treatment, pharmacotherapy, psychotherapy

Marie Ociskova,1 Jan Prasko,1– 3 Krystof Kantor,1 Frantisek Hodny,1 Pavel Kasyanik,4 Michaela Holubova,5,6 Jakub Vanek,1 Milos Slepecky,2 Vlastimil Nesnidal,1 Kamila Minarikova Belohradova1 1Department of Psychiatry, University Hospital Olomouc, Faculty of Medicine, Palacky University in Olomouc, Olomouc, The Czech Republic; 2Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra, The Slovak Republic; 3Department of Psychotherapy, Institute for Postgraduate Training in Health Care, Prague, The Czech Republic; 4Schema Therapy Institute, St. Petersburg, Russia; 5Department of Pedagogy and Psychology, Faculty of Science, Humanities and Education, Technical University of Liberec, Liberec, The Czech Republic; 6Department of Psychiatry, Regional Hospital Liberec, Liberec, The Czech RepublicCorrespondence: Jan Prasko Email praskojan@seznam.czAbstract: 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.Keywords: bipolar disorder, schema therapy, early adverse experiences, imagery rescripting, relapse prevention, self-stigma

Marie Ociskova,1 Jan Prasko,1– 3 Jakub Vanek,1 Michaela Holubova,4 Frantisek Hodny,1 Klara Latalova,1 Krystof Kantor,1 Vlastimil Nesnidal1 1Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University in Olomouc, University Hospital in Olomouc, Olomouc, The Czech Republic; 2Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra, The Slovak Republic; 3Institute for Postgraduate Education in Health Care, Prague, The Czech Republic; 4Department of Psychiatry, Hospital Liberec, Prague, The Czech RepublicCorrespondence: Jan PraskoDepartment of Psychiatry, Faculty of Medicine and Dentistry, University Hospital Olomouc, Olomouc, The Czech RepublicTel +420 603 414 930Email praskojan@seznam.czPurpose: 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.Keywords: obsessive compulsive disorder, self-stigma, exposure and response prevention, cognitive behavioral therapy, non-response

Jakub Vanek,1 Jan Prasko,1– 3 Marie Ociskova,1 Frantisek Hodny,1 Michaela Holubova,4 Kamila Minarikova,1 Milos Slepecky,2 Vlastimil Nesnidal1 1Department of Psychiatry, Faculty of Medicine and Dentistry, University Palacky Olomouc, University Hospital, Olomouc, 77520, The Czech Republic; 2Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra, The Slovak Republic; 3Institute for Postgraduate Education in Health Care, Prague, The Czech Republic; 4Department of Psychiatry, Hospital Liberec, Liberec, The Czech RepublicCorrespondence: Jan PraskoDepartment of Psychiatry, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, I. P. Pavlova 6, Olomouc, 77520, The Czech RepublicEmail praskojan@seznam.czObjective: 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.Keywords: insomnia, borderline personality disorder, cognitive behavioral therapy, dialectic behavioral therapy, transference focus therapy, mentalization therapy

Jakub Vanek,1 Jan Prasko,1– 3 Marie Ociskova,1 Samuel Genzor,4 Michaela Holubova,5 Frantisek Hodny,1 Vlastmil Nesnidal,1 Milos Slepecky,3 Milan Sova,4 Kamila Minarikova1 1Department of Psychiatry, Faculty of Medicine and Dentistry, University Hospital, University Palacky Olomouc, Olomouc, 77520, The Czech Republic; 2Institute for Postgraduate Education in Health Care, Prague, The Czech Republic; 3Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra, The Slovak Republic; 4Department of Respiratory Medicine, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, The Czech Republic; 5Department of Psychiatry, Hospital Liberec, Liberec, The Czech RepublicCorrespondence: Jan PraskoDepartment of Psychiatry, Faculty of Medicine and Dentistry, University Hospital, University Palacky Olomouc, I. P. Pavlova 6, Olomouc, 77900, The Czech RepublicEmail praskojan@seznam.czObjective: 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.Keywords: psychogenic seizures, sleep disturbances, insomnia, mental disorders, emotional regulation

Marie Ociskova,1 Jan Prasko,1 Martin Kupka2 1Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University in Olomouc, University Hospital Olomouc, Olomouc, The Czech Republic; 2Department of Psychology, Faculty of Arts, Palacky University in Olomouc, Olomouc, The Czech RepublicCorrespondence: Jan PraskoDepartment of Psychiatry, I. P. Pavlova 6, Olomouc 77520, The Czech RepublicTel +42058 844 3519Email praskojan@seznam.czPurpose: 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

Milos Slepecky,1 Antonia Kotianova,1 Jan Prasko,1,2 Ivan Majercak,3,4 Michal Kotian,5 Erika Gyorgyova,4 Marta Zatkova,1 Michaela Chupacova,5 Marie Ociskova,2 Tomas Sollar1,61Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra, The Slovak Republic; 2Department of Psychiatry, Faculty of Medicine and Dentistry, University Palacky Olomouc, University Hospital, Olomouc 77520, The Czech Republic; 31st Department of Internal Medicine, Faculty of Medicine, Pavol Josef Safarik University in Košice, Košice, The Slovak Republic; 4Internal Medicine and Cardiology, Private practice MUDr Ivan Majercak, Košice, The Slovak Republic; 5Department of clinical psychology, Psychagogia, Liptovsky Mikulas, 03101, The Slovak Republic; 6Institute of Applied Psychology, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra, The Slovak RepublicPurpose: 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.Keywords: life events, personality traits, anthropometric characteristics, overweight, quality of life, negative affectivity, sex differences

Michaela Holubova,1–3 Jan Prasko,1,2,4 Marie Ociskova,1,2 Kryštof Kantor,1,2 Jakub Vanek,1,2 Milos Slepecky,4 Kristyna Vrbova1,2 1Department of Psychiatry, University Hospital Olomouc, Olomouc, Czech Republic; 2Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic; 3Department of Psychiatry, Hospital Liberec, Liberec, Czech Republic; 4Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra, Slovakia 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. Keywords: self-stigma, quality of life, coping strategies, neurotic spectrum disorders

Dana Kamaradova,1 Martin Brunovsky,2 Jan Prasko,1 Jiri Horacek,2 Miroslav Hajda,1 Ales Grambal,1 Klara Latalova1 1Department of Psychiatry, University Hospital Olomouc, Olomouc, Czech Republic; 2National Institute of Mental Health, Klecany, Czech Republic Background: The underlying symptomatology of obsessive–compulsive disorder (OCD) can be viewed as an impairment in both cognitive and behavioral inhibition, regarding difficult inhibition of obsessions and behavioral compulsions. Converging results from neuroimaging and electroencephalographic (EEG) studies have identified changes in activities throughout the medial frontal and orbital cortex and subcortical structures supporting the cortico-striato-thalamo-cortical circuit model of OCD. This study aimed to elucidate the electrophysiological changes induced by autobiographical and general anxiety scenarios in patients with OCD.Methods: Resting-state eyes-closed EEG data were recorded in 19 OCD patients and 15 healthy controls. Cortical EEG sources were estimated by standardized low-resolution electromagnetic tomography (sLORETA). The changes in the emotional state were induced by two different scenarios: the autobiographical script related to patient’s OCD symptoms and the script triggering general anxiety.Results: During the resting state, we proved increased delta activity in the frontal, limbic and temporal lobe and the sub-lobar area in OCD patients. In a comparison of neural activities during general anxiety in OCD patients and the control group, we proved an increase in delta (parietal, temporal, occipital, frontal and limbic lobes, and sub-lobal area), theta (temporal, parietal and occipital lobes) and alpha-1 activities (parietal lobe). Finally, we explored the neural activity of OCD patients during exposure to the autobiographic scenario. We proved an increase in beta-3 activity (left frontal lobe).Conclusion: Our study proved differences in neural activation in OCD patients and healthy controls during imagination of general anxiety. Exposure to the autobiographic OCD scenario leads to activation of left frontal brain areas. The results show the possibility of using specific scenarios in OCD therapy. Keywords: anxiety, obsessive–compulsive disorder, autobiographical script, electroencephalography, cognitive-behavior therapy

Kristyna Vrbova,1,2 Jan Prasko,1–3 Marie Ociskova,1,2 Michaela Holubova,4 Krystof Kantor,1,2 Antonin Kolek,1,2 Aleš Grambal,1,2 Milos Slepecky3 1Department of Psychiatry, University Hospital Olomouc, Olomouc, Czech Republic; 2Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic; 3Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra, Slovak Republic; 4Department of Psychiatry, Hospital Liberec, Liberec, Czech Republic 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. Keywords: schizophrenia, suicidality, self-stigma, hope, positive and negative symptoms, personality traits, social anxiety

Antonia Kotianova,1,2 Michal Kotian,2 Milos Slepecky,1,2 Michaela Chupacova,2 Jan Prasko,1,3 Ingrid Tonhajzerova4,51Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra, Slovak Republic; 2Psychagogia, Garbiarska, Liptovsky Mikulas, Slovak Republic; 3Department of Psychiatry, Faculty of Medicine and Dentistry, University Palacky Olomouc, University Hospital, Olomouc, Czech Republic; 4Department of Physiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic; 5Biomedical Center Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak RepublicBackground: Alarming somatic symptoms, in particular, cardiovascular symptoms, are the characteristic feature of panic attacks. Increased cardiac mortality and morbidity have been found in these patients. Power spectral analysis of electrocardiogram R–R intervals is known to be a particularly successful tool in the detection of autonomic instabilities in various clinical disorders. Our study aimed to compare patients with panic disorder and healthy controls in heart rate variation (HRV) parameters (very-low-frequency [VLF], low-frequency [LF], and high-frequency [HF] band components of R–R interval) in baseline and during the response to the mental task.Subjects and methods: We assessed psychophysiological variables in 33 patients with panic disorder (10 men, 23 women; mean age 35.9±10.7 years) and 33 age- and gender-matched healthy controls (10 men, 23 women; mean age 35.8±12.1 years). Patients were treatment naïve. Heart rate, blood pressure, muscle tension, and HRV in basal conditions and after the psychological task were assessed. Power spectrum was computed for VLF (0.003–0.04 Hz), LF (0.04–0.15 Hz), and HF (0.15–0.40 Hz) bands using fast Fourier transformation.Results: In the baseline period, the VLF band was significantly lower in panic disorder group compared to controls (p

Marie Ociskova,1 Jan Prasko,1 Kristyna Vrbova,1 Petra Kasalova,1 Michaela Holubova,1 Ales Grambal,1 Klara Machu2 1Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University, University Hospital, Olomouc, 2Department of Psychology, Faculty of Arts, University of Ostrava, Ostrava, The Czech Republic 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. Keywords: self-stigma, anxiety disorders, treatment effectiveness, medication

Michaela Holubova,1,2 Jan Prasko,1 Marie Ociskova,1 Ales Grambal,1 Milos Slepecky,3 Marketa Marackova,1 Dana Kamaradova,1 Marta Zatkova3 1Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital Olomouc, Olomouc, 2Department of Psychiatry, Hospital Liberec, Liberec, Czech Republic; 3Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra-Chrenova, Slovak Republic 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. Keywords: coping strategies, quality of life, depressive disorder

Milos Slepecky,1 Antonia Kotianova,1 Jan Prasko,2 Ivan Majercak,3 Erika Gyorgyova,4 Michal Kotian,1,5 Marta Zatkova,1 Ingrid Tonhajzerova,6,7 Michaela Chupacova,1,5 Marta Popelkova1 1Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra, Slovak Republic; 2Department of Psychiatry, Faculty of Medicine and Dentistry, University Palacky Olomouc, University Hospital Olomouc, Olomouc, Czech Republic; 31st Department of Internal Medicine, Faculty of Medicine, Pavol Josef Safarik University in Košice, 4Internal Medicine and Cardiology Private Practice MUDr Ivan Majercak, Košice, 5Psychagogia, Liptovsky Mikulas, 6Department of Physiology, 7Biomedical Center Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic Abstract: The aim of this article is to describe the protocol of a trial focusing on the psychological, anthropometric, cardiac, and psychophysiological factors contributing to increased risk of cardiovascular diseases (CVDs). As background, the article provides a short overview of research literature linking personal traits, maladaptive schemas, and coping styles with CVDs through reactivity of the autonomic nervous system. Keywords: early maladaptive schemas, coping styles, personality traits, dissociation, heart rate variability

Milos Slepecky,1 Antonia Kotianova,1,2 Jan Prasko,1,3 Ivan Majercak,4,5 Erika Gyorgyova,5 Michal Kotian,1,2 Marta Zatkova,1 Marta Popelkova,1 Marie Ociskova,3 Ingrid Tonhajzerova6 1Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra, 2Psychagogia, Liptovsky Mikulas, Slovak Republic; 3Department of Psychiatry, Faculty of Medicine and Dentistry, University Palacky Olomouc, University Hospital Olomouc, Olomouc, Czech Republic; 4First Department of Internal Medicine, Faculty of Medicine, Pavol Josef Safarik University in Kosice, 5Internal Medicine and Cardiology Private Practice, MUDr Ivan Majercak, Kosice, 6Department of Physiology and Biomedical Centre Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia Objective: The aim of the study was to determine psychological, psychophysiological, and anthropometric factors connected with life events, level of depression, and quality of life in people at risk for cardiovascular disease and healthy controls.Methods: This is a cross-sectional study involving arterial hypertension patients and healthy controls. There were several measurements including physical, anthropological, cardiovascular, and psychophysiological measurements and administration of questionnaires.Results: A total of 99 participants were recruited for this study, 54 healthy controls (mean age: 35.59±13.39 years) and 45 patients with cardiovascular disease (CVD) (mean age: 46.33±12.39 years). The healthy controls and the patients with CVD significantly differed in the mean total score of life events, level of depression, quality of life score, temperature, blood pressure (BP), pulse transit time, heart rate, high-frequency total power, heart rate variability total power, waist-to-height ratio (WHtR), body fat percentage, fat control, pulse wave velocity, and augmentation index. In healthy subjects, the total score of the life events was not correlated with any cardiovascular or anthropometric factor. A score of depression significantly correlated with the WHtR, augmentation index, body fat percentage, and fat control. The quality of life – visual scale correlated with the body temperature, BP, and percentage of body fat. In the group of the patients with CVD, the score of the life events did not correlate with any measured cardiovascular or anthropometric factor. The level of depression correlated with the augmentation index. The quality of life – visual scale significantly correlated with body temperature, WHtR, and fat control.Conclusion: The patients with CVD reported higher scores of life events, worse quality of life, and a greater level of depressive symptoms than healthy controls. In healthy controls, a higher mean total score of life events significantly negatively correlated with high-frequency total power, and the degree of depression correlated with being overweight. In patients with CVD, a score of depression was linked to being overweight. Keywords: life events, depression, quality of life, heart rate variability, autonomic nervous system, parameters of cardiovascular system

Kristyna Vrbova,1 Jan Prasko,1 Marie Ociskova,1 Michaela Holubova1,2 1Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital Olomouc, Olomouc, Czech Republic; 2Department of Psychiatry, Hospital Liberec, Liberec, Czech Republic Objective: The purpose of the study was to explore whether the comorbidity of social phobia affects symptoms severity, positive and negative symptoms, self-stigma, hope, and quality of life in patients with schizophrenia spectrum disorders. Methods: This is a cross-sectional study in which all participants completed the Internalized Stigma of Mental Illness (ISMI) scale, Adult Dispositional Hope Scale (ADHS), Liebowitz Social Anxiety Scale (LSAS), Beck Anxiety Inventory (BAI), Beck Depression Inventory-II (BDI-II), Positive and Negative Syndrome Scale (PANSS), Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q), Temperament and Character Inventory – Revised (TCI-R), and the demographic questionnaire. The disorder severity was assessed both by a psychiatrist (Clinical Global Impression Severity – the objective version [objCGI-S] scale) and by the patients (Clinical Global Impression Severity – the subjective version [subjCGI-S] scale). The patients were in a stabilized state that did not require changes in the treatment. Diagnosis of schizophrenia, schizoaffective disorder, or delusional disorder was determined according to the International Classification of Diseases 10th Revision (ICD-10) research criteria. A structured interview by Mini International Neuropsychiatric Interview was used to confirm the diagnosis. Results: The study included 61 patients of both genders. Clinically, the patients with comorbid social phobia had the earlier onset of the illness, more severe current psychopathology, more intense anxiety (general and social), and higher severity of depressive symptoms. The patients with comorbid social phobia showed the significantly lower quality of life compared to the patients without this comorbidity. The patients with comorbid social phobia also had a statistically lower mean level of hope and experienced a higher rate of the self-stigma. They also exhibited higher average scores of personality trait harm avoidance (HA) and a lower score of personality trait self-directedness (SD). Conclusion: The study demonstrated differences in demographic factors, the severity of the disorder, self-stigma, hope, HA, and SD between patients with schizophrenia spectrum disorders with and without comorbid social phobia. Keywords: schizophrenia, social phobia, onset, hospitalizations, quality of life, self-stigma, hope, personality traits

Kristyna Vrbova,1 Jan Prasko,1 Marie Ociskova,1 Dana Kamaradova,1 Marketa Marackova,1 Michaela Holubova,1,2 Ales Grambal,1 Milos Slepecky,3 Klara Latalova1 1Department of Psychiatry, Faculty of Medicine and Dentistry, University Palacky Olomouc, University Hospital Olomouc, Olomouc, 2Department of Psychiatry, Hospital Liberec, Liberec, Czech Republic; 3Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra, Slovakia Goals: The aim of this study was to explore the quality of life, self-stigma, personality traits, and hope in patients with schizophrenia spectrum disorders. Patients and methods: A total of 52 outpatients participated in this cross-sectional study. The attending psychiatrist assessed each patient with Mini International Neuropsychiatric Interview (MINI). The patients then completed Quality of Life Satisfaction and Enjoyment Questionnaire (Q-LES-Q), Internalized Stigma of Mental Illness (ISMI) Scale, Temperament and Character Inventory – Revised (TCI-R), Adult Dispositional Hope Scale (ADHS), Drug Attitude Inventory 10 (DAI-10), and Liebowitz Social Anxiety Scale (LSAS)-Self-report. The psychiatrist evaluated Clinical Global Impression Severity – the objective version (objCGI-S), and the patients completed the Clinical Global Impression Severity – the subjective version (subjCGI-S). Each participant also completed Beck Depression Inventory-II (BDI-II), and Beck Anxiety Inventory (BAI).Results: The quality of life was significantly higher in employed patients and individuals with higher hope, self-directedness (SD), and persistence (PS). The quality of life was lower among patients with higher number of psychiatric hospitalizations, those with higher severity of the disorder, and individuals who were taking higher doses of antipsychotics. 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 individuals with higher harm avoidance (HA) and self-stigmatization (ISMI). Backward stepwise regression was applied to identify the most significant factors connected to self-stigma. The regression analysis showed that occupation, level of depression (BDI-II), attitude to using medication (DAI-10), social anxiety (LSAS), and antipsychotic index were the most relevant factors associated with lower quality of life. Conclusion: Detection of the quality of life in the context of personality traits, hope, self-stigma, and demographic and clinical factors may be an important part of the assessment of the patient with schizophrenia. Keywords: quality of life, schizophrenia, personality traits, self-stigma, hope, depression, anxiety

Kristyna Vrbova,1 Jan Prasko,1 Michaela Holubova,1,2 Dana Kamaradova,1 Marie Ociskova,1 Marketa Marackova,1 Klara Latalova,1 Ales Grambal,1 Milos Slepecky,3 Marta Zatkova3 1Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University in Olomouc, University Hospital Olomouc, Olomouc, 2Department of Psychiatry, Hospital Liberec, Liberec, Czech Republic; 3Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University, Nitra, Slovak Republic Objective: The aim of this study was to investigate the degree of self-stigma in schizophrenia and its association with clinical and demographic factors. Patients and methods: A total of 197 outpatients (54.3% females) diagnosed with schizophrenia spectrum disorders (schizophrenia, schizoaffective disorder, delusional disorder) according to International Classification of Diseases – tenth edition participated in the study. The mean age of the patients was 40.10±11.49 years. All individuals completed the Internalized Stigma of Mental Illness (ISMI) scale and a demographic questionnaire. The disorder severity was assessed by both a psychiatrist (the objective version of Clinical Global Impression – severity scale [objCGI-S]) and the patients (the subjective version of Clinical Global Impression – severity scale [subjCGI-S]). Treatment with antipsychotics stabilized the patients. Results: The overall level of self-stigma measured by the total score of the ISMI was 63.32±13.59. The total score of the ISMI positively correlated with the severity of the disorder measured by the objCGI-S and subjCGI-S. In addition, self-stigma positively correlated with the treatment duration and the number of psychiatric hospitalizations. The backward stepwise regression was applied to identify the most significant factors connected to self-stigma. The regression analysis identified the following regressors as the most relevant to self-stigma: the number of previous psychiatric hospitalizations, the severity of the disorder rated by a psychiatrist, and the difference between the objective rating and the subjective rating of the severity of the disorder. Conclusion: Outpatients with schizophrenia spectrum disorders, who have undergone a higher number of psychiatric hospitalizations, who dispose of a higher severity of the disorder and show a higher discrepancy between their rating of the severity and the psychiatric rating, showed a greater degree of self-stigma. The management of self-stigma in patients with schizophrenia should be implemented in the routine care. Keywords: schizophrenia, self-stigma, duration of the treatment, number of hospitalizations

Michaela Holubova,1,2 Jan Prasko,1 Stanislav Matousek,1 Klara Latalova,1 Marketa Marackova,1 Kristyna Vrbova,1 Aleš Grambal,1 Milos Slepecky,3 Marta Zatkova3 1Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital Olomouc, Olomouc, 2Department of Psychiatry, Hospital Liberec, Liberec, Czech Republic; 3Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra, Slovak Republic Background: The views of one’s self-stigma and quality of life (QoL) in patients with schizophrenia and depressive disorders are significant subjective notions, both being proven to affect patient’s functioning in life. The objective of this study was to investigate the QoL and self-stigma in connection with demographic factors and compare the two groups of patients in terms of those variables. Methods: In a cross-sectional study, the outpatients with schizophrenia spectrum disorders and depressive disorders completed the Quality of Life Satisfaction and Enjoyment Questionnaire, the Internalized Stigma of Mental Illness Scale, and a demographic questionnaire during a routine psychiatric control. Furthermore, both patients and their psychiatrists evaluated the severity of the disorder by Clinical Global Impression-Severity scale. Results: The QoL of patients with depressive disorders or schizophrenia spectrum disorders did not significantly differ between the two groups. In both groups, unemployment was perceived to be a significant factor decreasing the QoL. Self-stigma was detected to be higher in patients with schizophrenia spectrum disorders than in patients with depressive disorders. A strong correlation was found between the two scales, meaning that those with higher levels of self-stigmatization were less prone to see their life as fulfilling and joyful. Conclusion: This study shows that the degree of the internalized stigma can be an important aspect linked to the QoL irrespective of the diagnostic category. Keywords: self-stigma, quality of life, depressive disorders, schizophrenia spectrum disorders

Michaela Holubova,1,2 Jan Prasko,1 Marie Ociskova,1 Marketa Marackova,1 Ales Grambal,1 Milos Slepecky3 1Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital Olomouc, Olomouc, 2Department of Psychiatry, Hospital Liberec, Liberec, Czech Republic; 3Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University, Nitra, Slovak Republic Background: Self-stigma is a maladaptive psychosocial phenomenon that can affect many areas of patients’ lives and have a negative impact on their quality of life (QoL). This study explored the association between self-stigma, QoL, demographic data, and the severity of symptoms in patients with depressive disorder. Patients and methods: Patients who met the International Classification of Diseases, 10th revision, research criteria for depressive disorder were enrolled in this cross-sectional study. All outpatients completed the following measurements: the Quality of Life Enjoyment and Satisfaction Questionnaire, the Internalized Stigma of Mental Illness Scale, demographic questionnaire, and the objective and subjective Clinical Global Impression-Severity scales that measure the severity of disorder. A total of 81 depressive disorder patients (with persistent affective disorder – dysthymia, major depressive disorder, or recurrent depressive disorder) and 43 healthy controls participated in this study. Results: Compared with the healthy control group, a lower QoL was observed in patients with depressive disorder. The level of self-stigma correlated positively with total symptom severity score and negatively with QoL. Multiple regression analysis revealed that the overall rating of objective symptom severity and score of self-stigma were significantly associated with QoL. Conclusion: This study suggests a lower QoL in patients with depressive disorder in comparison with healthy controls and a negative impact of self-stigma level on QoL in patients suffering from depressive disorders. Keywords: self-stigma, quality of life, depressive disorder

Jan Prasko,1 Marie Ociskova,1 Ales Grambal,1 Zuzana Sigmundova,1 Petra Kasalova,1 Marketa Marackova,1 Michaela Holubova,1,2 Kristyna Vrbova,1 Klara Latalova,1 Milos Slepecky3 1Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital Olomouc, Olomouc, 2Department of Psychiatry, Hospital Liberec, Liberec, Czech Republic; 3Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra, Slovak Republic Objective: Identifying the predictors of response to psychiatric and psychotherapeutic treatments may be useful for increasing treatment efficacy in pharmacoresistant depressive patients. 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 were enrolled in the study. All patients completed Clinical Global Impression – both objective and subjective form (CGI), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) at baseline and after 6 weeks of combined pharmacotherapy and psychotherapy (group cognitive-behavioral or group psychodynamic) treatment as an outcome measures. The Internalized Stigma of Mental Illness Scale (ISMI), Dissociative Experience Scale (DES), Adult Dispositional Hope Scale (ADHS), and Temperament and Character Inventory (TCI-R) were completed at the start of the treatment with the intention to find the predictors of treatment efficacy.Results: The study included 72 patients who were hospitalized for the pharmacoresistant major depression; 63 of them completed 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 (domain of ISMI). ObjCGI relative change significantly correlated with the level of dissociation (DES), the total ISMI score, hope in ADHS total score, and Self-Directedness (TCI-R). According to stepwise regression, the strongest factor connected to objCGI relative change was Discrimination Experience (domain of ISMI). The existence of comorbid personality disorder did not influence the treatment response.Conclusion: According to the results of the present study, patients with pharmacoresistant depressive disorders, who have had more experience with discrimination because of their mental struggles, showed a poorer response to treatment. Keywords: depressive disorder, cognitive-behavioral therapy, pharmacotherapy, psychodynamic therapy, treatment efficacy, dissociation, personality features, hope, self-stigma

Jan Prasko,1 Ales Grambal,1 Petra Kasalova,1 Dana Kamardova,1 Marie Ociskova,1 Michaela Holubova,1,2 Kristyna Vrbova,1 Zuzana Sigmundova,1 Klara Latalova,1 Milos Slepecky,3 Marta Zatkova3 1Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University in Olomouc, University Hospital Olomouc, Olomouc, 2Psychiatric Department, Hospital Liberec, Liberec, Czech Republic; 3Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra, Slovak Republic Objective: The central goal of the study was to analyze the impact of dissociation on the treatment effectiveness in patients with anxiety/neurotic spectrum and depressive disorders with or without comorbid personality disorders.Methods: The research sample consisted of inpatients who were hospitalized in the psychiatric department and met the ICD-10 criteria for diagnosis of depressive disorder, panic disorder, generalized anxiety disorder, mixed anxiety–depressive disorder, agoraphobia, social phobia, obsessive compulsive disorder, posttraumatic stress disorder, adjustment disorders, dissociative/conversion disorders, somatoform disorder, or other anxiety/neurotic spectrum disorder. The participants completed these measures at the start and end of the therapeutic program – Beck Depression Inventory, Beck Anxiety Inventory, a subjective version of Clinical Global Impression-Severity, Sheehan Patient-Related Anxiety Scale, and Dissociative Experience Scale.Results: A total of 840 patients with anxiety or depressive spectrum disorders, who were resistant to pharmacological treatment on an outpatient basis and were referred for hospitalization for the 6-week complex therapeutic program, were enrolled in this study. Of them, 606 were statistically analyzed. Data from the remaining 234 (27.86%) patients were not used because of various reasons (103 prematurely finished the program, 131 did not fill in most of the questionnaires). The patients’ mean ratings on all measurements were significantly reduced during the treatment. Also, 67.5% reached at least minimal improvement (42.4% showed moderate and more improvement, 35.3% of the patients reached remission). The patients without comorbid personality disorder improved more significantly in the reduction of depressive symptoms than those with comorbid personality disorder. However, there were no significant differences in change in anxiety levels and severity of the mental issues between the patients with and without personality disorders. Higher degree of dissociation at the beginning of the treatment predicted minor improvement, and also, higher therapeutic change was connected to greater reduction of the dissociation level.Conclusion: Dissociation is an important factor that influences the treatment effectiveness in anxiety/depression patients with or without personality disorders resistant to previous treatment. Targeting dissociation in the treatment of these disorders may be beneficial. Keywords: depression, anxiety disorders, treatment resistance, panic disorder, GAD, OCD, social phobia, PTSD, adjustment disorders, personality disorders

Rostislav Horacek,1 Barbora Krnacova,2 Jan Prasko,2 Klara Latalova2 1Department of Central Intensive Care Unit for Surgery, 2Department of Psychiatry, Faculty of Medicine and Dentistry, University Hospital Olomouc, Palacky University Olomouc, Czech Republic Background: The aim of this study was to examine the impact of somatic illnesses, electrolyte imbalance, red blood cell count, hypotension, and antipsychotic and opioid treatment on the duration of delirium in Central Intensive Care Unit for Surgery.Patients and methods: Patients who were admitted to the Department of Central Intensive Care Unit for Surgery in the University Hospital Olomouc from February 2004 to November 2008 were evaluated using Riker sedation–agitation scale. Their blood pressure, heart rate, respiratory rate, and peripheral blood oxygen saturation were measured continually, and body temperature was monitored once in an hour. The laboratory blood tests including sodium, potassium, chlorides, phosphorus, urea and creatinine, hemoglobin, hematocrit, red and white blood cell count, and C-reactive protein, albumin levels and laboratory markers of renal and liver dysfunction were done every day. All measurements were made at least for ten consecutive days or longer until the delirium resolved.Results: The sample consisted of 140 consecutive delirious patients with a mean age of 68.21±12.07 years. Delirium was diagnosed in 140 of 5,642 patients (2.48%) admitted in CICUS in the last 5 years. The median duration of delirium was 48 hours with a range of 12–240 hours. Statistical analysis showed that hyperactive subtype of delirium and treatment with antipsychotics were associated with prolonged delirium duration (hyperactive 76.15±40.53 hours, hypoactive 54.46±28.44 hours, mixed 61.22±37.86 hours; Kruskal–Wallis test: 8.022; P

Ales Grambal,1 Jan Prasko,1 Dana Kamaradova,1 Klara Latalova,1 Michaela Holubova,1,2 Marketa Marackova,1 Marie Ociskova,1 Milos Slepecky3 1Faculty of Medicine and Dentistry, Department of Psychiatry, Palacky University Olomouc, University Hospital Olomouc, Olomouc, 2Department of Psychiatry, Hospital Liberec, Liberec, Czech Republic; 3Faculty of Social Science and Health Care, Department of Psychology Sciences, Constantine the Philosopher University, Nitra, Slovak Republic Introduction: Self-stigma arises from one’s acceptance of societal prejudices and is common in psychiatric patients. This investigation compares the self-stigma of a sample of patients with borderline personality disorder (BPD), schizophrenia spectrum disorder (SCH), major depressive disorder (MDD), bipolar affective disorder (BAD), and anxiety disorders (AD) and explores of the self-stigma with the subjective and objective measures of the severity of the disorder and demographic factors. Methods: The total of 184 inpatients admitted to the psychotherapeutic department diagnosed with BPD, SCH, MDD, BAP, and AD were compared on the internalized stigma of mental illness (ISMI) scale. The ISMI-total score was correlated with the subjective and objective evaluation of the disorder severity (clinical global impression), and clinical and demographic factors. Results: The self-stigma levels were statistically significantly different among the diagnostic groups (BPD 71.15±14.74; SCH 63.2±13.27; MDD 64.09±12.2; BAD 62.0±14.21; AD 57.62±15.85; one-way analysis of variance: F=8.698, df=183; P

Ales Grambal,1 Jan Prasko,1 Dana Kamaradova,1 Klara Latalova,1 Michaela Holubova,1,2 Zuzana Sedláčková,3 Radovan Hruby4 1Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital, Olomouc, 2Department of Psychiatry, Hospital Liberec, Liberec, 3Department of Psychology, Faculty of Arts, Palacky University Olomouc, Olomouc, Czech Republic; 4Private Practice, Martin, Slovak Republic Introduction: Borderline personality disorder (BPD) significantly reduces the quality of life (QoL) in mental, social, and work domains. Patients with BPD often suffer from depressive anxiety symptoms. The purpose of this cross-sectional study was to compare the QoL and demographic and clinical factors of inpatients diagnosed with BPD and comorbid anxiety spectrum disorders, and healthy controls.Methods: Ninety-two hospitalized patients treated in the psychotherapeutic department and 40 healthy controls were included. Subjects were assessed by the Quality of Life Satisfaction and Enjoyment Questionnaire (Q-LES-Q), Dissociative Experiences Scale, Beck Depression Inventory (BDI)-II, Beck Anxiety Inventory, Clinical Global Impression, demographic questionnaire, Sheehan Disability Scale (SDS), and Sheehan Anxiety Scale.Results: BPD patients suffered from comorbid anxiety disorders, panic disorder (18.5%), social phobia (20.7%), generalized anxiety disorder/mixed anxiety depression disorder (17.4%), adjustment disorder (22.8%), and posttraumatic stress disorder (8.7%); 19.6% patients had two or more anxiety disorder comorbidities. Patients score in Q-LES-Q (general) was 36.24±9.21, which was significantly lower in comparison to controls (57.83±10.21) and similar in all domains (physical health, feelings, work, household, school/study, leisure, social activities). The subjective level of depression measured by BDI and SDS (social life and family subscales) negatively correlated with all Q-LES-Q domains.Conclusion: Patients suffering from BPD and comorbid anxiety disorders have a lower level of QoL compared to healthy controls in all measured domains. Negative correlations of the Q-LES-Q domains with clinical scales (Dissociative Experiences Scale, BDI, Beck Anxiety Inventory, Sheehan Anxiety Scale, Clinical Global Impression, and SDS) are noticeable. Keywords: quality of life, borderline personality disorder, anxiety disorders, adjustment disorders, dissociation

Dana Kamaradova,1 Klara Latalova,1 Jan Prasko,1 Radim Kubinek,1 Kristyna Vrbova,1 Barbora Mainerova,1 Andrea Cinculova,1 Marie Ociskova,1 Michaela Holubova,2 Jarmila Smoldasova,1 Anezka Tichackova1 1Department of Psychiatry, University Hospital Olomouc, 2Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic Introduction: Self-stigma plays a role in many areas of the patient’s life. Furthermore, it also discourages therapy. The aim of our study was to examine associations between self-stigma and adherence to treatment and discontinuation of medication in patients from various diagnostic groups.Methods: This cross-sectional study involved outpatients attending the Department of Psychiatry, University Hospital Olomouc, Czech Republic. The level of self-stigma was measured with the Internalized Stigma of Mental Illness and adherence with the Drug Attitude Inventory. The patients also anonymously filled out a demographic questionnaire which included a question asking whether they had discontinued their medication in the past.Results: We examined data from 332 patients from six basic diagnostic categories (substance abuse disorders, schizophrenia, bipolar disorders, depressive disorders, anxiety disorders, and personality disorders). The study showed a statistically significant negative correlation between self-stigma and adherence to treatment in all diagnostic groups. Self-stigma correlated positively and adherence negatively with the severity of disorders. Another important factor affecting both variables was partnership. Self-stigma positively correlated with doses of antidepressants and adherence with doses of anxiolytics. Self-stigma also negatively correlated with education, and positively with a number of hospitalizations and number of psychiatrists visited. Adherence was further positively correlated with age and age of onset of disorders. Regression analysis showed that self-stigma was an important factor negatively influencing adherence to treatment and significantly contributing to voluntary discontinuation of drugs. The level of self-stigma did not differ between diagnostic categories. Patients suffering from schizophrenia had the lowest adherence to treatment.Conclusion: The study showed a significant correlation between self-stigma and adherence to treatment. High levels of self-stigma are associated with discontinuation of medications without a psychiatrist’s recommendation. This connection was present in all diagnostic groups. Keywords: self-stigma, adherence, discontinuation of drugs, mental disorders

Miroslav Hajda,1 Jan Prasko,1 Klara Latalova,1 Radovan Hruby,2 Marie Ociskova,1 Michaela Holubova,1,3 Dana Kamaradova,1 Barbora Mainerova1 1Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital Olomouc, Olomouc, Czech Republic; 2Outpatient Psychiatric Department, Martin, Slovak Republic; 3Department of Psychiatry, Regional Hospital Liberec, Liberec, Czech Republic Background: Bipolar disorder (BD) is a serious mental illness with adverse impact on the lives of the patients and their caregivers. BD is associated with many limitations in personal and interpersonal functioning and restricts the patients’ ability to use their potential capabilities fully. Bipolar patients long to live meaningful lives, but this goal is hard to achieve for those with poor insight. With progress and humanization of society, the issue of patients’ needs became an important topic. The objective of the paper is to provide the up-to-date data on the unmet needs of BD patients and their caregivers. Methods: A systematic computerized examination of MEDLINE publications from 1970 to 2015, via the keywords “bipolar disorder”, “mania”, “bipolar depression”, and “unmet needs”, was performed. Results: Patients’ needs may differ in various stages of the disorder and may have different origin and goals. Thus, we divided them into five groups relating to their nature: those connected with symptoms, treatment, quality of life, family, and pharmacotherapy. We suggested several implications of these needs for pharmacotherapy and psychotherapy. Conclusion: Trying to follow patients’ needs may be a crucial point in the treatment of BD patients. However, many needs remain unmet due to both medical and social factors. Keywords: bipolar disorder, unmet needs, stigma, treatment, medication, quality of life, family, psychotherapy

Marie Ociskova, Jan Prasko, Klara Latalova, Dana Kamaradova, Ales Grambal Department of Psychiatry, Olomouc University Hospital, Faculty of Medicine and Dentistry, Palacký University Olomouc, Czech Republic Background: Anxiety disorders are a group of various mental syndromes that have been related with generally poor treatment response. Several psychological factors may improve or hinder treatment effectiveness. Hope has a direct impact on the effectiveness of psychotherapy. Also, dissociation is a significant factor influencing treatment efficiency in this group of disorders. Development of self-stigma could decrease treatment effectiveness, as well as several temperamental and character traits. The aim of this study was to explore a relationship between selected psychological factors and treatment efficacy in anxiety disorders. Subjects and methods: A total of 109 inpatients suffering from anxiety disorders with high frequency of comorbidity with depression and/or personality disorder were evaluated at the start of the treatment by the following scales: the Mini-International Neuropsychiatric Interview, the Internalized Stigma of Mental Illness scale, the Adult Dispositional Hope Scale, and the Temperament and Character Inventory – revised. The participants, who sought treatment for anxiety disorders, completed the following scales at the beginning and end of an inpatient-therapy program: Clinical Global Impression (objective and subjective) the Beck Depression Inventory – second edition, the Beck Anxiety Inventory, and the Dissociative Experiences Scale. The treatment consisted of 25 group sessions and five individual sessions of cognitive behavioral therapy or psychodynamic therapy in combination with pharmacotherapy. There was no randomization to the type of group-therapy program. Results: Greater improvement in psychopathology, assessed by relative change in objective Clinical Global Impression score, was connected with low initial dissociation level, harm avoidance, and self-stigma, and higher amounts of hope and self-directedness. Also, individuals without a comorbid personality disorder improved considerably more than comorbid patients. According to backward-stepwise multiple regression, the best significant predictor of treatment effectiveness was the initial level of self-stigma. Conclusion: The initial higher levels of self-stigma predict a lower effectiveness of treatment in resistant-anxiety-disorder patients with high comorbidity with depression and/or personality disorder. The results suggest that an increased focus on self-stigma during therapy could lead to better treatment outcomes. Keywords: anxiety disorders, self-stigma, hope, personality, dissociation, treatment effectiveness

Michaela Holubova,1,2 Jan Prasko,1 Radovan Hruby,3 Klara Latalova,1 Dana Kamaradova,1 Marketa Marackova,1 Milos Slepecky,4 Terezia Gubova2 1Department of Psychiatry, Faculty of Medicine and Dentistry, Palacký University Olomouc, University Hospital Olomouc, Olomouc, Czech Republic; 2Department of Psychiatry, Hospital Liberec, Liberec, Czech Republic; 3Private Psychiatric Practice, Martin, Slovak Republic; 4Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University, Nitra, Slovak Republic Background: Maladaptive coping strategies may adversely disturb the overall functioning of people with mental disorders. Also, self-stigma is considered a maladaptive psychosocial phenomenon that can affect many areas of patient life. It has a negative impact on self-image, and may lead to dysphoria, social isolation, reduced adherence, using of negative coping strategies, and lower quality of life. The objective of this study was to determine the relationship between coping strategies and self-stigma among persons with schizophrenia and related psychotic disorders.Subjects and methods: A total of 104 clinically stable outpatients with chronic schizophrenia-spectrum disorders were enrolled in a cross-sectional study. Sociodemographic and clinical data were recorded. Patients were examined by psychiatrists with the Stress Coping Style Questionnaire, the Internalized Stigma of Mental Illness scale, and the Clinical Global Impression scale. Correlation and multiple-regression analyses were performed to discover contributing factors to self-stigma.Results: Positive coping strategies were used by patients with schizophrenia-spectrum disorders to the same extent as in the healthy population. Negative coping strategies were overused by these patients. There were significant associations between self-stigma, severity of the disorder, and coping strategies in schizophrenia. The ability to use positive coping strategies was connected with lower self-stigma. Use of negative coping strategies predominantly increased the self-stigma of patients with schizophrenia.Conclusion: This study revealed a significant association among self-stigma, severity of the disorder, and coping strategies in individuals suffering from schizophrenia-spectrum disorders. Thinking about coping strategies and self-stigma in practice may play a significant role in understanding people with schizophrenia-spectrum disorders, especially for mental health professionals. Keywords: self-stigma, coping strategies, schizophrenia, schizoaffective disorder, disorder severity, cross-sectional study

Dana Kamaradova,1,2 Miroslav Hajda,1,2 Jan Prasko,1,2 Jiri Taborsky,1,2 Ales Grambal,1,2 Klara Latalova,1,2 Marie Ociskova,1,2 Martin Brunovsky,3 Petr Hlustik4,5 1Department of Psychiatry, University Hospital Olomouc, 2Department of Psychiatry, Palacky University Olomouc, Olomouc, 3National Institute of Mental Health, Klecany, 4Department of Neurology, University Hospital Olomouc, 5Department of Neurology, Palacky University, Olomouc, Czech Republic Background: Obsessive–compulsive disorder (OCD) is associated with cognitive dysfunction. Although there are several studies focused on the neurobiology of OCD, little is known about the biological correlates of the cognitive deficit linked to this disorder. The aim of our study was to examine the association between cognitive impairment and current source density markers in patients with OCD.Methods: Resting-state eyes-closed electroencephalography (EEG) data were recorded in 20 patients with OCD and 15 healthy controls who were involved in the study. Cortical EEG sources were estimated by standardized low-resolution electromagnetic tomography in seven frequency bands: delta (1.5–6 Hz), theta (6.5–8 Hz), alpha-1 (8.5–10 Hz), alpha-2 (10.5–12 Hz), beta-1 (12.5–18 Hz), beta-2 (18.5–21 Hz), and beta-3 (21.5–30 Hz). Cognitive performance was measured by the Trail-Making Test (versions A and B), Stroop CW Test, and D2 Test.Results: Frontal delta and theta EEG sources showed significantly higher activity in the whole group of patients with OCD (N=20) than in control subjects (N=15). Subsequent analysis revealed that this excess of low-frequency activity was present only in the subgroup of eleven patients with cognitive impairment (based on the performance in the Trail-Making Test – A). The subgroup of patients with normal cognitive functions (N=9) did not differ in cortical EEG sources from healthy controls.Conclusion: The present results suggest that frontal low-frequency cortical sources of resting-state EEG rhythms can distinguish groups of cognitively impaired and cognitively intact patients with OCD. Based on our results, future studies should consider whether the present methodological approach provides clinically useful information for the revelation of cognitive impairment in patients with OCD. Keywords: obsessive–compulsive disorder, electroencephalography, standardized low-resolution electromagnetic tomography, low-frequency sources, frontal areas

Jana Vyskocilova,1 Jan Prasko,2 Jiri Sipek3 1Faculty of Humanities, Charles University in Prague, Prague, 2Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital Olomouc, Olomouc, 3Department of Psychology, Faculty of Arts, Charles University in Prague, Prague, Czech Republic Background: The aim of the study was to determine whether patients with obsessive–compulsive disorder (OCD) resistant to drug therapy may improve their condition using intensive, systematic cognitive behavioral therapy (CBT) lasting for 6 weeks, and whether it is possible to predict the therapeutic effect using demographic, clinical, and selected psychological characteristics at baseline. Methods: Sixty-six OCD patients were included in the study, of which 57 completed the program. The diagnosis was confirmed using the structured Mini International Neuropsychiatric Interview. Patients were rated using the objective and subjective forms of the Yale–Brown Obsessive Compulsive Scale, objective and subjective forms of the Clinical Global Impression, Beck Anxiety Inventory, Beck Depression Inventory, Dissociative Experiences Scale, 20-item Somatoform Dissociation Questionnaire, and the Sheehan Disability Scale before their treatment, and with subjective Yale–Brown Obsessive Compulsive Scale, objective and subjective Clinical Global Impression, Beck Anxiety Inventory, and Beck Depression Inventory at the end of the treatment. Patients were treated with antidepressants and daily intensive group CBT for the 6-week period. Results: During the 6-week intensive CBT program in combination with pharmacotherapy, there was a significant improvement in patients suffering from OCD resistant to drug treatment. There were statistically significantly decrease in the scores assessing the severity of OCD symptoms, anxiety, and depressive feelings. A lower treatment effect was achieved specifically in patients who 1) showed fewer OCD themes in symptomatology, 2) showed a higher level of somatoform dissociation, 3) had poor insight, and 4) had a higher initial level of overall severity of the disorder. Remission of the disorder was more likely in patients who had 1) good insight, 2) a lower initial level of anxiety, and 3) no comorbid depressive disorder. Keywords: obsessive–compulsive disorder, treatment, cognitive behavioral therapy, treatment resistance, treatment efficacy, predictors

Daniela Jelenova,1 Jan Prasko,1 Marie Ociskova,1 Klara Latalova,1 Eva Karaskova,2 Radovan Hruby,3 Dana Kamaradova,1 Vladimir Mihal21Department of Psychiatry, 2Department of Pediatrics, Faculty of Medicine and Dentistry, Palacký University, University Hospital, Olomouc, Czech Republic; 3Private Practice, Martin, Slovak RepublicBackground: Inflammatory bowel diseases (IBDs) in adolescents are chronic medical conditions with a substantial influence on the quality of life (QoL) of the families.Methods: A total of 27 adolescents suffering from IBD, 39 healthy adolescents, and their parents were included in the cross-sectional study. The adolescents completed the questionnaires ADOR (parenting styles), KidScreen-10 (QoL), SAD (The Scale of Anxiety in Children), and CDI (Children’s Depression Inventory). The parents completed the BAI (Beck Anxiety Inventory), BDI-II (Beck Depression Inventory, second version), and PedsQL (Pediatrics Quality of Life) Family Impact Module.Results: The parental styles of the parents of the IBD adolescents and controls were without significant differences. The only exception was that fathers’ positive parental style was significantly higher in the fathers of the controls. There were no statistically significant differences between the IBD children and controls in the QoL assessed using KidScreen-10. However, the QoL of the parents of the ill children was significantly lower than that of the parents of the controls (PedsQL total scores in mothers 66.84±14.78 vs 76.17±14.65 and in fathers 68.86±16.35 vs 81.74±12.89, respectively). The mothers of the IBD adolescents were significantly more anxious (BAI scores 9.50±10.38 vs 5.26±4.75) and the fathers more depressed (BDI-II scores 7.23±6.50 vs 3.64±3.51) than the parents of the controls, but there was no difference in the levels of anxiety or depression between the IBD adolescents and the controls. The positive parental style of both the parents of the children suffering from IBD positively correlated with the QoL of the adolescents evaluated by KidScreen-10. The positive parental style of the fathers negatively correlated with the children’s state and trait anxiety and negatively correlated with the severity of childhood depression.Conclusion: The fathers of the IBD adolescents may exhibit low levels of positive parenting style and be mildly depressed, and the mothers tend to exhibit higher levels of anxiety.Keywords: ulcerative colitis, Crohn’s disease, parenting style, quality of life, anxiety, depression

Michaela Holubova, Jan Prasko, Klara Latalova, Marie Ociskova, Aleš Grambal, Dana Kamaradova, Kristyna Vrbova, Radovan Hruby Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital Olomouc, Olomouc, Czech Republic Background: Current research attention has been moving toward the needs of patients and their consequences for the quality of life (QoL). Self-stigma is a maladaptive psychosocial phenomenon disturbing the QoL in a substantial number of psychiatric patients. In our study, we examined the relationship between demographic data, the severity of symptoms, self-stigma, and QoL in patients with schizophrenia spectrum disorder.Methods: Probands who met International Classification of Diseases-10 criteria for schizophrenia spectrum disorder (schizophrenia, schizoaffective disorder, or delusional disorder) were recruited in the study. We studied the correlations between the QoL measured by the QoL Satisfaction and Enjoyment Questionnaire, self-stigma assessed by the Internalized Stigma of Mental Illness, and severity of the disorder measured by the objective and subjective Clinical Global Impression severity scales in this cross-sectional study.Results: A total of 109 psychotic patients and 91 healthy controls participated in the study. Compared with the control group, there was a lower QoL and a higher score of self-stigmatization in psychotic patients. We found the correlation between an overall rating of self-stigmatization, duration of disorder, and QoL. The level of self-stigmatization correlated positively with total symptom severity score and negatively with the QoL. Multiple regression analysis revealed that the overall rating of objective symptom severity and the score of self-stigma were significantly associated with the QoL.Conclusion: Our study suggests a negative impact of self-stigma level on the QoL in patients suffering from schizophrenia spectrum disorders. Keywords: quality of life, self-stigma, schizophrenia, schizoaffective disorder, delusional disorder

Michaela Holubova,1 Jan Prasko,1,2 Radovan Hruby,3 Dana Kamaradova,1,2 Marie Ociskova,1,2 Klara Latalova,1,2 Ales Grambal1,2 1Department of Psychiatry, Faculty of Medicine and Dentistry, Palacký University, Olomouc, Czech Republic; 2Department of Psychiatry, University Hospital Olomouc, Czech Ministry of Health, Olomouc, Czech Republic; 3Psychiatric Outpatient Department, Martin, Slovak Republic Background: The modern psychiatric view of schizophrenia spectrum disorders and their treatment has led to an increasing focus on coping strategies and the quality of life of these patients. In the present study, the authors examined the relationship between demographic data, the severity of symptoms, coping strategies, and the quality of life in psychotic patients. It is important to study the inner experience and striving of these individuals as it has been linked to their well-being and treatment adherence.Methods: Psychiatric outpatients who met International Classification of Diseases, Tenth Revision criteria for a psychotic disorder (schizophrenia, schizoaffective disorder, or delusional disorder) were recruited in the study. Questionnaires measuring the coping strategies (The Stress Coping Style Questionnaire [SVF-78]), the quality of life (Quality of Life Satisfaction and Enjoyment Questionnaire [Q-LES-Q]), and symptom severity (objective and subjective Clinical Global Impression – objCGI; subjCGI) were assessed. The data were analyzed using one-way analysis of variance, Mann–Whitney U test, Pearson and Spearman correlation coefficients, and multiple regression analysis.Results: A total of 109 psychotic patients were included in the study. The quality of life was significantly related to both the positive and negative coping strategies. The severity of disorder was highly negatively correlated with the quality of life score. The results of multiple stepwise regression analysis using the quality of life as a dependent variable showed that symptom severity (subjCGI, difference between subjCGI, and objCGI), negative coping strategies, positive coping strategies, and the difference between positive and negative coping strategies explain more than half variance.Conclusion: Our study suggests the importance of utilizing the positive coping strategies in improving the quality of life in patients with psychotic disorders. Keywords: quality of life, coping strategies, psychotic disorders, schizophrenia, severity of the disorder

Marie Ociskova,1,2 Jan Prasko,1 Dana Kamaradova,1 Ales Grambal,1 Zuzana Sigmundova1 1Department of Psychiatry, University Hospital in Olomouc, Faculty of Medicine and Dentistry, 2Department of Psychology, Faculty of Arts, Palacky University in Olomouc, Olomouc, Czech Republic Background: A number of psychiatric patients experience stigma connected to prejudices about mental disorders. It has been shown that stigma is most harmful when it is internalized. Most of the studies were performed on individuals either with psychoses or with mood disorders, and hence, there are almost no studies with other diagnostic categories. The goals of this research were to identify factors that are significantly related to self-stigma in patients with anxiety disorders and to suggest possible models of causality for these relationships.Methods: A total of 109 patients with anxiety disorders and possible comorbid depressive or personality disorders, who were admitted to the psychotherapeutic department participated in this study. All patients completed several psychodiagnostic methods, ie, the Internalized Stigma of Mental Illness Scale, Temperament and Character Inventory-Revised Version, Adult Dispositional Hope Scale, Dissociative Experiences Scale, Beck Anxiety Inventory, Beck Depression Inventory-Second Edition, and Clinical Global Impression (also completed by the senior psychiatrist).Results: The overall level of self-stigma was positively associated with a comorbid personality disorder, more severe symptomatology, more intense symptoms of anxiety and depression, and higher levels of dissociation and harm avoidance. Self-stigma was negatively related to hope, reward dependence, persistence, self-directedness, and cooperativeness. Multiple regression analysis showed that the most significant factors connected to self-stigma are harm avoidance, the intensity of depressive symptoms, and self-directedness. Two models of causality were proposed and validated. It seems that the tendency to dissociate in stress increases the probability of development of self-stigma, and this relationship is entirely mediated by avoidance of harm. Conversely, self-directedness lowers the probability of occurrence of self-stigma, and this effect is partly mediated by hope.Conclusion: Patients with anxiety disorders accompanied with or without comorbid depressive or personality disorders may suffer from self-stigma. Individuals with greater sensitivity to rejection and other socially aversive stimuli are prone to the development of self-stigma. Other personality factors, such as hopeful thinking and self-acceptance serve as factors promoting resilience concerning self-stigma. Keywords: self-stigma, hope, Temperament and Character Inventory-Revised Version, clinical factors, demographic factors, anxiety disorders

Marie Ociskova,1,2 Jan Prasko,2 Dana Kamaradova,2 Ales Grambal,2 Petra Kasalova,2 Zuzana Sigmundova,2 Klara Latalova,2 Kristyna Vrbova2 1Department of Psychology, Faculty of Arts, 2Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital Olomouc, Olomouc, Czech Republic Background: Approximately 30%–60% of patients with neurotic spectrum disorders remain symptomatic despite treatment. Identifying the predictors of good response to psychiatric and psychotherapeutic treatment may be useful for increasing treatment efficacy in neurotic patients. The objective of this study was to investigate the influence of hope, coping strategies, and dissociation on the treatment response of this group of patients.Methods: Pharmacoresistant patients, who underwent a 6-week psychotherapeutic program, were enrolled in the study. All patients completed the Clinical Global Impression (CGI) – both objective and subjective forms, Beck Anxiety Inventory (BAI), and Beck Depression Inventory (BDI)-II at baseline and after 6 weeks. The COPE Inventory, the Adult Dispositional Hope Scale (ADHS), and the Dissociative Experiences Scale (DES) were completed at the start of the treatment.Results: Seventy-six patients completed the study. The mean scores for all scales measuring the severity of the disorders (BAI, BDI-II, subjective and objective CGI) significantly decreased during the treatment. Several subscores of the COPE Inventory, the overall score of ADHS, and the overall score of DES significantly correlated with the treatment outcome. Multiple regression was used to find out which factors were the most significant predictors of the therapeutic outcomes. The most important predictors of the treatment response were the overall levels of hope and dissociation.Conclusion: According to our results, a group of patients with a primary neurotic disorder, who prefer the use of maladaptive coping strategies, feel hopelessness, and have tendencies to dissociate, showed poor response to treatment. Keywords: neurotic spectrum disorders, treatment efficacy, dissociation, coping strategy, hope

Klara Latalova,1,2 Dana Kamaradova,1,2 Jan Prasko1,2 1Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic; 2Department of Psychiatry, University Hospital Olomouc, Olomouc, Czech Republic Abstract: The aims of this paper are to review data on the prevalence and correlates of violent victimization of persons with severe mental illness, to critically evaluate the literature, and to explore possible approaches for future research. PubMed/MEDLINE and PsycINFO databases were searched using several terms related to severe mental illness in successive combinations with terms describing victimization. The searches identified 34 studies. Nine epidemiological studies indicate that patients with severe mental illness are more likely to be violently victimized than other community members. Young age, comorbid substance use, and homelessness are risk factors for victimization. Victimized patients are more likely to engage in violent behavior than other members of the community. Violent victimization of persons with severe mental illness has long-term adverse consequences for the course of their illness, and further impairs the quality of lives of patients and their families. Victimization of persons with severe mental illness is a serious medical and social problem. Prevention and management of victimization should become a part of routine clinical care for patients with severe mental illness. Keywords: victimization, violence, severe mental illness, schizophrenia, bipolar disorder

Klara Latalova, Dana Kamaradova, Jan Prasko Department of Psychiatry, Faculty of Medicine and Dentistry, University Palacky Olomouc, Olomouc, Czech Republic Abstract: There are two principal types of stigma in mental illness, ie, “public stigma” and “self-stigma”. Public stigma is the perception held by others that the mentally ill individual is socially undesirable. Stigmatized persons may internalize perceived prejudices and develop negative feelings about themselves. The result of this process is “self-stigma”. Stigma has emerged as an important barrier to the treatment of depression and other mental illnesses. ­Gender and race are related to stigma. Among depressed patients, males and African-Americans have higher levels of self-stigma than females and Caucasians. Perceived stigma and self-stigma affect willingness to seek help in both genders and races. African-Americans demonstrate a less positive attitude towards mental health treatments than Caucasians. Religious beliefs play a role in their coping with mental illness. Certain prejudicial beliefs about mental illness are shared globally. Structural modeling indicates that conformity to dominant masculine gender norms (“boys don’t cry”) leads to self-stigmatization in depressed men who feel that they should be able to cope with their illness without professional help. These findings suggest that targeting men’s feelings about their depression and other mental health problems could be a more successful approach to change help-seeking attitudes than trying to change those attitudes directly. Further, the inhibitory effect of traditional masculine gender norms on help-seeking can be overcome if depressed men feel that a genuine connection leading to mutual understanding has been established with a health care professional. Keywords: stigma, self-stigma, depression, male gender

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