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Objective: This article focuses on utilizing therapeutic letters within group schema therapy-an innovative therapeutic approach that integrates elements from various therapeutic disciplines. The primary aim is to explore how therapeutic letters can enhance the therapeutic process and support the treatment of patients., Methods: To achieve this objective, we conducted a narrative literature review centred on schema therapy and using therapeutic letters as a therapeutic strategy. We systematically searched databases (PubMed, PsycINFO, and Google Scholar) using the keywords "schema therapy," "therapy letters," "group," "therapeutic strategies," and "adult psychotherapy." Additionally, we gathered clinical insights from schema therapists through interviews to gain a practical perspective., Results: Group schema therapy primarily targets identifying and modifying early maladaptive schemas and maladaptive schema modes that originate during childhood and persist into adulthood. Within this context, therapeutic letters are an effective tool, allowing individuals to process intense emotions stemming from their formative years. Individuals complete these letters as homework assignments and then, divided into small groups, read them aloud while receiving emotional support and encouragement from their peers. This process enables individuals to explore their thoughts and feelings, potentially reframe their life narratives, seek forgiveness, and ultimately progress. Various types of therapeutic letters are discussed, including the "uncensored letter", "letter from the other shore", "letter to an adult child", "business card", and "letter from the future"., Discussion: The article provides an in-depth overview of the techniques and exercises employed in group schema work when using letters. It also addresses potential challenges, such as difficulties with visualization, resistance to change, and trust issues., Conclusion: Therapeutic letters emerge as a valuable tool in group schema therapy, enhancing the therapeutic process and supporting individual treatment. However, further research is necessary to comprehend and fully maximize their potential.

Introduction: Panic disorder (PD), obsessive-compulsive disorder (OCD), and borderline personality disorder (BPD) are associated with various psychosocial factors that may influence their onset and psychopathology. Dissociation encompasses a wide range of manifestations, from benign experiences to severe mental health issues. Research comparing childhood trauma and dissociation, general psychopathology, and the onset of the disorder among patients with PD, OCD, and BPD has not yet been published., Results: The severity of dissociative symptoms negatively correlated with the onset of the disorder, whereas it positively correlated with the disorder's overall severity and general symptomatology. Patients with more severe childhood trauma had an earlier onset of the disorder and more severe depressive and dissociative symptoms. They rated higher on the overall severity of the disorder. Physical abuse and neglect were associated with more severe PD, OCD, and BPD. Patients with BPD had higher levels of dissociation than those with PD or OCD. BPD was also connected with more severe childhood trauma than PD and OCD patients. Comorbidity exacerbated the severity of the psychiatric disorders., Conclusions: Childhood trauma and dissociation play a significant role in anxiety and depressive symptoms in patients with PD, OCD, and BPD.

Introduction: PAdverse Childhood Experiences (ACEs) are associated with an increased risk of mental health issues in general, but their relationship with panic disorder (PD) and obsessive-compulsive disorder (OCD) has received less attention compared to borderline personality disorder (BPD). Dissociative experiences are significant predictors of increased symptoms, reduced treatment adherence, and poor prognosis in several psychiatric conditions, including PD, OCD, and BPD; still, their impact remains underexplored. This part of the study focuses on the overall efficiency of psychotherapeutic programs on treatment-resistant patients diagnosed with PD, OCD, and BPD (or combined), as well as the relationship between ACEs, dissociation rates, and treatment results., Method: The study was conducted under standard conditions in an inpatient psychotherapy unit that specialized in anxiety, affective disorders, and personality disorders. Patients were hospitalized for 6 weeks and treated with a comprehensive CBT program and pharmacotherapy. The study included patients diagnosed with PD, OCD, or BPD (or combined). Two independent psychiatrists confirmed the inclusion and exclusion criteria. Patients were assessed using the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI-II), Clinical Global Impression Scale - Severity (CGI-S), Dissociative Experience Scale (DES), and Childhood Trauma Questionnaire (CTQ-SF)., Results: A total of 349 out of 357 patients completed the study. The average age of patients was 33.33 ± 11.59 years. After the 6 week treatment, there was a statistically significant decrease in mean scores across all assessed scales. Changes in any scale during treatment did not correlate with the total CTQ-SF score or sub-scores. The relative change in CGI-S showed a statistically significant negative correlation with the total dissociation score on the DES scale at the beginning of treatment but not with pathological dissociation assessed by the DES-T questionnaire. Statistically significant decreases in mean CGI-S scores were observed in patients with a single diagnosis of PD, OCD, and BPD. Among comorbid groups, significant changes were observed only in patients with comorbid OCD and BPD. No statistically significant change in mean BDI-II scores was observed in patients with comorbid PD and OCD or comorbid OCD and BPD., Conclusions: Our analysis showed that treatment led to a significant decrease in the severity of depressive symptoms assessed by BDI-II and anxiety symptoms assessed by BAI in patients with PD, OCD, and BPD. This decrease was not statistically significant in patients with comorbid disorders, suggesting that the presence of multiple diagnoses may affect treatment efficacy. ACEs did not correlate to treatment results, but dissociation rates were linked with poorer treatment outcomes.

Drift is a phenomenon that can occur in cognitive-behavioral supervision, where core components of supervision are omitted, avoided, or deprioritized. This narrative review explores the signs, reasons, and impact of supervisory drift at the experiential, cognitive, and emotional levels for both the supervisor and the supervisee. Additionally, the article presents potential solutions for preventing and addressing supervisory drift, such as staying on track, anticipating problems before they arise, adapting supervision to the supervisee's needs, using active supervision methods to understand drift better, engaging in Supervision of Supervision (SoS), and using alliance measures. Through the use of case vignettes, we illustrate the potential solutions. We aim to provide a comprehensive understanding of supervisory drift and offer practical strategies for its prevention and management.

Aim: The paper describes the characteristics of relationship obsessive-compulsive disorder (R-OCD), including the types of obsessions and compulsions, the common triggers and the impact on psychological well-being and relationship functioning. It also offers basic cognitive-behavioural strategies to help patients change their attitudes towards obsessive thoughts and reduce compulsive behaviours., Methods: This article is a narrative review of the literature and case studies on R-OCD. To search for relevant sources, we used PubMed, PsycINFO and Web of Science databases with the keywords "relationship obsessive compulsive disorder", "R-OCD", "relationship OCD" and "partner-focused OCD". We included only studies published in English from January 1990 to June 2023. The paper provides examples of how basic cognitive-behavioural strategies help individuals with R-OCD., Results: People with R-OCD experience intrusive thoughts about whether they have the right feelings for their partner, whether their partner loves them, whether the relationship is suitable or whether their partner has flaws. These thoughts trigger the urge to perform various rituals to alleviate anxiety, such as repeated checking, reassurance or comparison. However, this behaviour leads to disruption of the relationship and long-term maintenance of the anxiety. Examples of basic cognitive-behavioural strategies can be applied in clinical practice to help individuals change their attitudes towards relational obsessive thoughts and reduce compulsive behaviours.

Background: Ethics is an inherent part of psychotherapy that protects the interests and rights of all parties engaged in the therapeutic relationship. This article focuses on ethical issues and dilemmas that may arise when using schema therapy., Method: We created a narrative review by searching the databases PubMed, Web of Science, and Scopus with the keywords "psychotherapy", "schema therapy", "therapeutic relationship", "ethics", "ethical questions", and "ethical dilemmas". In addition, we focused on the clinical experience of therapists, training instructors, and supervisors., Results: Ethical psychotherapy requires adherence to ethical codes and standards. Among the most important ethical principles are confidentiality, informed consent, boundaries of the therapeutic relationship, and dual relationships. Understanding transference, countertransference, and one's modes and schemas is essential to ethical reflection in schema therapy. The article presents examples of ethical dilemmas in schema therapy and suggests possible solutions. At the same time, we point out the need for further research in this field., Conclusion: Similarly to other psychotherapeutic approaches, one of the schema therapist's core competencies is following the profession's ethical principles and productively finding solutions to the occasional ethical dilemmas. Ethics is a prominent part of all psychotherapeutic sessions. Still, it becomes even more central when working with challenging issues such as personality disorders that schema therapy routinely treats. More research on the topic is needed.

The purpose of supervision is to ensure that clients' needs are met and to monitor the effectiveness of therapeutic interventions and the therapeutic relationship. Cognitive behavioural therapy (CBT) supervision is the systematic cooperation of the supervisee with the supervisor, which aims at increasing the therapists' competencies when working with specific clients. The advantage of supervision is the possibility to shape and develop the therapist's practical skills through specific techniques. This paper aims to review currently available CBT supervision strategies that boost the development of therapists' skills and provide possible examples. Various techniques are discussed, including behavioural, cognitive, imagery and psychodrama methods that facilitate supervisors in enhancing therapists' skills. In addition, complementary approaches are discussed, such as role-playing, modelling, chaining, or imitation to present at a particular moment of the therapy, increase the insight into the client's perspective or the treatment itself, and search for an alternative approach to improve the therapeutic outcomes for the client. Overall, the article describes the supervisor's need to have a flexible variety of skills and know which learning methods might be most effective for boosting the supervisee's skill level and needs with a particular client.

Introduction: The parallel process is a psychosocial phenomenon where the relationship dynamics between the therapist and the client are repeated in the supervisory relationship between the therapist and the supervisor. The concept of the parallel process can be a useful tool for understanding and solving problems in therapy. However, it can induce supervision drift or block the supervision process., Objective: This article aims to familiarize the reader with parallel processes in cognitive-behavioural therapy (CBT) and schema therapy supervision and discuss how to manage this phenomenon in supervision., Method: This article is a narrative review with illustrations of supervision interviews in which the parallel process unfolds. The text provides an overview of theoretical constructions and empirical studies related to the parallel process. We searched PubMed, PsycINFO, Web of Science, and Google Scholar for relevant resources using the keywords "parallel process," "cognitive behavioural therapy," "schema therapy," "transference," and "countertransference." Case vignettes were collected from trainees, training leaders and supervisors to provide real-life examples of how self-reflection and self-experience can enhance CBT and schema therapy training, practice, and supervision.

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

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

Background: Prejudices against individuals with schizophrenia can interfere with diagnostic and treatment processes, particularly with the patient's further adaptation and reintegration. Self-stigma could have significant detrimental consequences for patients suffering from psychotic disorders, including schizophrenia., Method: This paper reviews findings about self-stigma connected to schizophrenia. The PubMed database used the keywords to find the papers published from January 1997 to March 2023, and 189 articles were included in the review process., Results: The schizophrenia-related stigma decreases patients' self-confidence, worsens their social functioning, and impedes daily functioning. Feelings of embarrassment are prominent in many patients with schizophrenia. Self-stigma predicts many unfavourable outcomes - more severe social anxiety and depressive symptoms, lower self-confidence, hopelessness, worse social functioning, lower quality of life, worse treatment cooperation, and lower adherence to medication adherence. Addressing self-stigma in psychoeducation or psychotherapy may increase the patient's stigma resistance and well-being. Self-help groups present an underutilised but potentially effective strategy., Conclusion: Stigma presents a common issue in patients with schizophrenia. Targeting the issue in clinical management or psychotherapy may be beneficial. Still, more high-quality intervention studies are needed.

Background: Individuals with borderline personality disorder (BPD) suffer from an excessive fear of abandonment, leading to tense moments in their intimate relationships. These struggles translate into lower marital satisfaction perceived by both intimate partners. However, this connection is bidirectional, since conflicts with a romantic partner are the most common precipitating factors of decompensation in BPD patients., Method: This narrative review was performed using PubMed, Web of Science, and Scopus databases with keywords "borderline personality disorder", "partnership", marital problems", and "marital conflicts". Articles, books, and book chapters published within January 1980 - December 2020 were extracted and analysed. Additional sources were found while reviewing references of relevant articles. The total of 131 papers met the inclusion criteria., Results: Patients with BPD struggle with reaching marital satisfaction. They often find themselves in disharmonic and unfulfilling relationships. The association between the relationship issues and BPD may partly come from misunderstanding one or both partners' behaviour. Individuals with BPD tend to misinterpret their partner's behaviour, struggle with communication, and sometimes be verbally and physically aggressive. They often do not recognize that their intrapersonal processes influence their interpersonal struggles. Understanding the role of the maladaptive personality traits in the relationship and their management could be beneficial for both partners., Conclusion: Individuals with BPD often report dysfunctional romantic relationships characterized by insecure attachment, maladaptive communication, and lower relationship satisfaction. Future studies should focus on finding effective strategies of couples´ therapy working with this population.

Introduction: Borderline personality disorder (BPD) presents a highly stigmatised condition. Individuals with BPD may experience stigmatising attitudes and remarks from the general population and mental health professionals. Significant self-stigma also seems common. The paper reviews the current knowledge regarding the stigma connected to BPD., Method: The Web of Science, Medline, and Scopus databases identified studies published from January 1990 to January 2023. Additional references were found using analyses of the primary articles. The search terms included "borderline", "stigma", and "self-stigma"., Results: Public knowledge of BPD is scarce. The general population may interpret the BPD symptoms as "purposeful misbehaviour" rather than signs of a mental disorder. Mental health professionals commonly distance themselves from patients with BPD and may prematurely give up their treatment efforts. This stance often comes from believing BPD is difficult or impossible to treat. Therefore, treating patients with a personality disorder should be consulted with a supervisor, especially when the psychotherapist shows a negative attitude towards the patient. Generally, few BPD-specific destigmatisation interventions have been verified by research. Limited evidence suggests that targeted training of the healthcare providers can reduce stigmatising attitudes and that interventions combining positive messages of the recovery potential with biological aetiology of the disorder are most impactful in reducing the stigma., Conclusion: BPD is commonly stigmatised by the general population and mental health professionals. Destigmatising efforts need to tackle the stigma's primary sources, namely the general population's lack of understanding and the pessimistic beliefs in the healthcare providers. More BPD-specific research on stigma is needed.

Background: Borderline personality disorder (BPD) patients commonly suffer from nightmares. Still, the prevalence of this issue does not match the little clinical attention it usually receives. Nightmares impact sleep and daily functioning and may play a role in BPD symptomatology, including suicidality. Since BPD has been linked with high rates of suicide, the potential connection with suicidality is crucial to address., Aims: To create an up-to-date review of current knowledge on nightmares in BPD and to explore the links between nightmares, insomnia, and suicidality or self-harm in BPD patients., Method: This narrative review was conducted using the PubMed, Web of Science, and Google Scholar databases to search for articles published between January 1990 and October 2022, using the following key terms: 'borderline personality disorder' and 'nightmares' or 'insomnia' and 'suicidality' or 'self-harm' or 'self-injuring'. The final list consisted of 99 publications., Results: Sleep disturbances often occur in BPD patients. The prevalence of nightmares in BPD is higher than in general or clinical populations. Nightmares influence borderline personality traits and vice versa through emotional dysregulation, poorer sleep quality, nightmare anxiety, higher arousal, and worsened self-control. A link between nightmares and suicidal behaviour was established in some psychiatric conditions (depression, insomnia); studies on BPD are lacking in this area. Studies comparing nightmares in BPD to other disorders are also missing. There are some suggestions for pharmaceuticals or psychotherapy in treating nightmares, but their application to BPD needs more research., Conclusion: Sleep disturbance and nightmares are common among individuals with BPD yet underrepresented in research. Nightmares have been linked with suicidality in other conditions (depression, PTSD) but only indirectly in BPD. More clinical studies are needed to explore the phenomenon further.

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

Objective: Both panic disorder (PD) and obstructive sleep apnea (OSA) are frequent conditions that can be comorbid. This article reviews the current state of knowledge about the comorbidity of PD and OSA and the effectiveness of therapy in patients with this comorbidity., Method: Articles obtained via PubMed and Web of Science search were selected; the publishing date was between January 1990 and December 2022. The applied search terms were: obstructive sleep apnea; panic disorder; CPAP; antidepressants; anxiolytics; antipsychotics. Eighty-one articles were chosen by primary search via keywords. After a complete assessment of the full texts, 60 papers were chosen. Secondary papers from the references of the primary documents were investigated, evaluated for suitability, and included in the list of documents (n = 18). Thus, seventy-eight papers were incorporated into the review article., Results: Studies describe a greater prevalence of panic disorder in OSA patients. So far, there is no data on the prevalence of OSA in PD patients. Limited evidence is found regarding the influence of CPAP treatment on PD, and this evidence suggests that CPAP can partially alleviate PD symptoms. Medication used in PD treatment can significantly impact comorbid OSA, as explored in several studies., Conclusions: The relationship between the two conditions seems bidirectional, and it is necessary to assess OSA patients for comorbid panic disorder and vice versa. Both disorders can worsen the other and must be treated with a complex approach to ensure improvement in patients' physical health and psychological well-being.

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

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

Objectives: Obsessive-compulsive disorder (OCD) is a chronic mental disorder that is often hard to treat with current treatment options. Therapeutic outcomes are predicted by many factors, ranging from biological to psychosocial. Early life experiences and adult attachment influence the effectiveness of the treatment. This study explores their predictive abilities in the combined treatment of adult inpatients with OCD., Methods: Seventy-seven patients with OCD, diagnosed according to the ICD-10 criteria, were included in the study, out of which 66 patients completed the treatment. All patients were previously unsuccessfully treated with a minimum of two antidepressants for three months each. They were evaluated with rating scales and questionnaires at the start and the end of a six-week hospitalization in a psychotherapeutic department. The treatment approach presented a combination of group cognitive-behavioural therapy and medication., Results: The average severity of OCD, anxiety and depressive symptoms significantly decreased during the inpatient treatment. The improvement in Y-BOCS negatively correlated with the age of onset. The history of emotional abuse and neglect and physical neglect predicted a lower change in anxiety evaluated by a psychologist and perceived maternal care positively correlated with a decrease in anxiety assessed with a rating scale. Adult attachment anxiety predicted a lower decrease in the anxiety measured by the clinician but not the OCD symptomatology. Dissociative symptoms did not significantly predict a change in any of the measures. Comorbid personality disorder did not have a significant impact on therapeutic change., Conclusions: The early onset of the disorder was the sole predictor of the treatment outcomes regarding specific OCD symptomatology. Selected early adverse experiences, maternal care, and adult attachment anxiety predicted a change in the anxiety symptoms. Future research should focus on mediation and moderation analyses that could help target specific treatment strategies to decrease the impact of these factors.

Objectives: Obsessive-compulsive disorder (OCD) has been connected to various psychosocial factors that might influence its onset and course. Developmental factors, such as parenting styles or early adverse experiences, and adult attachment have been listed as examples. However, the research on the interconnections of these factors brought mixed results. The study explores the relationship between demographic, clinical, and selected psychosocial factors and the severity of adult OCD., Method: Eighty-seven pharmacoresistant inpatients with OCD were admitted between October 2019 and August 2022 for a 6-week cognitive behavioural therapy inpatient program in the psychotherapeutic department. The participants completed the following scales at the start of the hospitalisation: the self-report Yale-Brown Obsessive-Compulsive Scale (Y-BOCS-SR), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI-II), Dissociative Experiences Scale (DES), Childhood Trauma Questionnaire-Short Form (CTQ-SF), PBI (Parental Bonding Instrument), ECR-R (Experiences in Close Relationships - Revised), and a demographic questionnaire. A skilled psychologist administered Mini International Neuropsychiatric Interview (MINI) to confirm the OCD diagnosis and Hamilton Anxiety Rating Scale (HAMA)., Results: OCD patients with more severe adverse childhood experiences (ACEs) showed earlier onset of the disorder and more pronounced attachment anxiety, depressive symptoms, and dissociation and subjectively rated the severity of the disorder as more severe. Physical abuse and physical neglect were related to the severity of specific OCD symptoms. Maternal care negatively correlates with clinician-rated anxiety, patient-rated depressive symptoms, and dissociation. The maternal and paternal control positively correlated with patient-rated anxiety and depression. Attachment anxiety negatively correlated with the age of onset and positively with the severity of the clinician-rated anxiety and the patient-rated anxiety, depressive symptoms, and dissociation., Conclusions: Early adverse experiences, perceived parental styles, and adult attachment anxiety could play a significant role in the symptoms of anxiety, depression, and dissociation. The connection with the specific obsessive-compulsive symptoms is less apparent. Still, adverse childhood events and adult attachment anxiety seem to influence the age of OCD onset.

Objective: Our study aimed to screen for obstructive sleep apnoea (OSA) in a clinical population of psychiatric patients with affective disorders and risk factors for OSA using screening devices in psychiatric clinical environments., Methods: Inpatients admitted with mood disorders in an inpatient psychiatric department were selected via inclusion and exclusion criteria and assessed for the risk factors of OSA. The inclusion criteria were: a diagnosis of an affective disorder confirmed by two independent psychiatrists, snoring or apnoeic pauses witnessed during regular night check-ups by nurses, and BMI > 25 kg/m2. The exclusion criteria were: a comorbid psychotic disorder, previously diagnosed OSA, intellectual disability, organic mental illness, acute coronary syndrome, acute or chronic heart failure, acute pulmonary diseases, a history of stroke, neuromuscular disorders, or a myorelaxant treatment. All included patients underwent overnight monitoring by a screening device SomnoCHECK Micro Cardio. A certified somnologist assessed obtained data., Results: A total of 32 subjects (23 women and nine men) were included in the study. The mean age was 49.8 ± 8.8 years. Most participants had major depressive disorder (n = 23); another nine individuals had bipolar disorder. Diagnostic criteria for OSA were found in 50% of the sample, specifically in 88% of men and 33% of women. The correlation analysis identified several risk factors and variables., Conclusions: This pilot study showed an increased risk of OSA in patients with mood disorders. Psychiatric patients with identified risk factors should be routinely screened for obstructive sleep apnoea and referred to proper treatment.

Objective: Needs of psychiatric patients may be to a various degree frustrated. A sole focus on treatment effectiveness can lead to the omission of other patient's needs. Patients with borderline personality disorder present high demands on health and social services that often remain unmet. The review aims to identify common unmet needs of patients with BPD, map the areas in which they appear, and identify ways to manage them., Method: The PubMed database was used by applying the following key terms: "borderline personality disorder" and "needs" supplemented by a combination of "borderline personality disorder" and "unmet needs"; "treatment"; "therapy"; "management", "quality of life", "pharmacotherapy", "psychotherapy". the Papers were selected from a period between Jan 1, 1990, and Nov 30 2020. Primary keyword search yielded a total of 502 articles, of which 225 articles met the inclusion criteria and were subjected to a complete inspection. Secondary contributions from reference lists of the primary sources were examined, evaluated for suitability, and added to the primary document list (n = 182). After an evaluation of the relevance, a total of 197 papers were included in the review process., Results: Recognizing patients' unmet needs with borderline personality disorder emphasises the importance of a comprehensive patient assessment. The diagnosis of comorbidities is also essential, especially with bipolar disorder and posttraumatic stress disorder, as comorbid conditions may require different therapeutic approaches. Traditional treatments of BPD tend to be demanding both in time and funding. However, alternatives are being developed to overcome these shortcomings by introducing methods focused on specific goals. Furthermore, supporting the patient's responsibility in the treatment choice can lead to better improvements., Conclusions: There is a need for further studies that will focus on the needs of this patient group and the possibilities of their treatment in psychotherapy, using psychotropic drugs, or social interventions. The development of step-by-step treatment models, adjunctive treatments, and technology-based interventions can bring greater access to care and reduce costs, especially for newly diagnosed patients or patients waiting for comprehensive treatment.

Introduction: This review aims to present the current state of knowledge about attachment and obsessive-compulsive disorder (OCD), the connection to the disorder's course, and the treatment effectiveness., Method: A literature search was performed using PubMed, Google Scholar, Web of Science, and ScienceDirect databases using the following search terms: obsessive compulsive disorder, attachment, therapy, treatment, and long-term outcome. The period of extraction was between January 1990 and October 2020., Results: Insecure attachment leads to the formation of dysfunctional beliefs about the world and self, which influences the dynamics of OCD. It is associated with maladaptive cognitive processes such as an inflated sense of responsibility, perfectionism, and mind control. With worse emotional regulation and reduced self-esteem (which can also result from insecure attachment), it can lead to maladaptive behaviour such as perfectionistic and compulsive behaviour to secure and stabilize self-worth and safety. Of the two dimensions that define insecure adulthood attachment (anxiety and avoidance), attachment anxiety is more closely related to OCD. While anxious attachment can lead to a worse response in acute treatment, secure attachment is a protective factor that can improve remission., Conclusions: Anxious attachment is common in patients with OCD and interconnects with primary OCD symptomatology. From this perspective, strategies that promote feelings of safety, acceptance, and appreciation within a therapeutic relationship may be essential in treating OCD.

Objective: Obstructive events in patients with obstructive sleep apnoea (OSA) cause recurrent sleep fragmentation and occasional desaturation, which can cause various parasomnias, including nightmares. Several lines of evidence suggest that OSA may be potentially associated with a higher frequency of nightmares., Method: We searched for studies published from January 2000 until November 2020 in PubMed, the Cochrane Library, Web of Science and Google Scholar. The keywords Obstructive Sleep Apnoea / OSA / Nightmares / CPAP / PTSD / Sleep Quality / Dream / were used in various combinations. The literature search identified 1361 articles which were eligible to more careful examination. Secondary texts were also examined, evaluated for suitability, and added to the primary document list. Finally, a total of 168 articles were included in the review., Results: According to current findings, OSA could affect emotional regulation via activation of limbic system during sympathetic activation and suppression of REM sleep essential to emotional regulation. The reviews also found an increased prevalence of nightmares in OSA patients. OSA is significantly associated with psychiatric morbidity, as was proved in several studies. There seems to be a strong link between nightmares, OSA, PTSD symptoms and other disorder such as unipolar depression., Conclusions: It is clear that therapy of OSA patients, especially those with psychiatric comorbidity, must be complex. In the case of nightmares, we should not forget to use psychotherapy as a first choice, particularly in patients with poor compliance to continuous positive airway pressure (CPAP) and poor sleep and overall life quality. In the same time, we should emphasise the healthy lifestyle and sleep hygiene.

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

Objectives: In the new millennium, a growing focus on human rights and preserving individual autonomy urges the promotion of needs of the psychiatric patients. The topic of human needs takes its place also in patients with panic disorder. This review intended to explore current facts concerning the needs of the patients and present a broader understanding of patients' needs, due to the complexity of problems of patients with panic disorder. The text also focuses on psychosocial well-being and the quality of life of patients with panic disorder., Methods: The PubMed was used to search for articles published between January 2000 and February 2020 using the following keywords: "panic disorder" or "agoraphobia" and "unmet needs" in combination with "pharmacotherapy" or "psychotherapy" or "cognitive behavioural therapy" or "family" or "quality of life." A total of 264 articles were selected by primary keyword picking in different combinations. Altogether 182 articles were reviewed., Results: We identified the most important unmet needs of patients with panic disorder connected to symptoms, treatment and help-seeking, stigma and self-stigma, family and quality of life. To help the patients to improve the unmet needs connected with: (1) symptoms is to increase the awareness of treatment steps for patients and their families, good cooperation with therapists, and management of persistent symptoms, alleviation or elimination of anxiety symptoms, avoidance and safety behaviour. (2) treatment is the quick approach, effective one, not too difficult, without side effects and harmless, not requiring hospitalization and not disturbing the daily routine, increasing treatment compliance, improving patient self-confidence and an active social network, affordable health and social services and more suitable information for families; (3) stigma is to change of public opinion about people with mental health problems and to create effective antistigma programs; (4) family is to include the support for a functional and independent life, helping to manage everyday tasks and stop excessive protection, while reducing the stigmatization of the whole family. (5) the quality of life is to help to integrate into the community and improve the factors that affect the quality of life; like esteem, self-acceptance, social acceptance etc. CONCLUSIONS: This review aimed to explore the unmet needs in patients with panic disorder or agoraphobia. In selected articles we identified 5 basic unmet needs and described the basic strategies to cope with them. It is essential for every clinician to understand those needs as it can substantially help to alleviate patients' symptoms and improve their quality of life. The importance of this understanding further highlights that unmet needs described for panic disorder overlap with unmet needs of other psychiatric disorder and thus have broader utility.

Objective: Insomnia and affective disorders are among the most common and disabling health problems of our society. Although there seems to be a clear link between poor sleep and problems in emotional regulation, it is still an area with many remaining questions. While the cognitive and behavioural consequences of poor sleep and insomnia have been studied in depth in recent decades, emotional experience empirical findings in this area still need to be replicated and confirmed., Method: Review article included studies published from January 1990 to March 2020 accessed via PubMed database. The keywords "Insomnia, Emotional regulation, Nightmares, Mental disorders, Sleep quality, Nightmares treatment" were used in various combinations. The total of 145 articles was found, and after their complete review, 42 papers were selected. Secondary texts from reference lists of primarily selected articles were examined and added to the primary document list. Finally, a total of 159 articles were included in the review., Results: Sleep is involved in emotion regulation both in the general population and individuals with various mental disorders. Several studies found that pre-sleep emotional activation of negative and positive emotions disturbs sleep by enhancing emotional excitement. On the other hand, many studies showed that poor sleep quality and sleep deprivation adversely affects the emotional functioning in adults. The results of the studies summarized in this review show that emotional regulation can mediate the effect of insomnia on various psychiatric disorders. Insomnia can be a significant risk factor that should be targeted in various psychiatric disorders., Conclusion: Targeted prevention of affective disorders in patients who have insomnia, as well as identification of transformation mechanisms, could be an advantageous approach to alleviating their burden. Complex treatment, including cognitive-behavioural therapy for insomnia, added to the primary treatment of these disorders, is recommended.

Background: Panic disorder and agoraphobia not only affect the patients themselves but also may have a detrimental effect on their intimate relationships. A problem arising in the intimate sphere could be a trigger, a modulator, a maintenance factor, or the result of the panic disorder and agoraphobia. The consequences of panic disorder include increased demands on the non-affected partner to adapt, which may prove to be too challenging for some to manage. Panic disorder and agoraphobia can also change earlier relationship patterns which may result in partnership dysfunction. This review explores the effect of panic disorder and agoraphobia upon partnership problems and satisfaction., Method: Relevant studies were identified via PubMed and Web of Science, published between January 1970 and April 2020. The search terms included "panic disorder", "agoraphobia", "marital problems", "marital conflicts" and "marital adjustment". Further references were found in reviews, books, and book chapters of the relevant papers. A total of 1154 articles were nominated by primary assortment using the keywords in different combinations. After selecting according to the inclusion and exclusion criteria, evaluating the complete texts and searching for secondary documents, 173 papers were finally chosen., Results: Problems in a relationship can act as a trigger for the development of the panic disorder and agoraphobia and could also function as modulating and maintenance factors. Panic disorder and agoraphobia often have a negative influence on the relationship and the non-affected partner. Partnership problems can be both a precursor and a consequence of panic disorder and agoraphobia.

Background: People who have an obsessive-compulsive disorder (OCD) tend to manifest a need for excessive control over their partners and other relatives, which then constitutes a principal problem in their relationships. This behaviour probably relates to an unmet need for safety in their childhood. This review article aims to explore the interpersonal dimension of OCD., Method: Sources used in this review were acquired via PubMed from January 1990 to January 2020. The search terms included "obsessive compulsive disorder", "OCD", "marital problems", "marital conflicts", "marital attachment", and "partnership". Primary search with keywords in various combinations yielded 242 articles. After applying inclusion and exclusion criteria, 68 articles were found eligible for further research, and a secondary search was performed by screening their reference lists for relevant articles. In total, 124 papers were included in the review., Results: OCD patients often have interpersonal problems that are related to symptomatology and the excessive need for control over the relationship. The patient is often addicted to his/her loved ones and transmits his excessive concerns to them. The studies describe increased marital distress, less satisfaction with their partner and couples experiencing less intimacy. The communication style of people suffering from OCD often shows a tendency to control others extensively, which is probably related to their exaggerated need for safety. Individuals with preoccupied or avoidant attachment styles are more likely to become jealous and to consider any rival as threatening than those people who have a safe attachment style., Conclusion: Participation of the partner in the therapy can have positive effects. Furthermore, family-based exposure and response prevention programs might be useful for reducing OCD symptoms.

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

Objective: This article describes the role of imagery in supervision which is a part of the work of both the supervisee and the supervisor. Imagination bears outstanding importance in psychotherapy and supervision., Method: The relevant texts for this narrative review were identified through the Web of Science and PubMed databases, within the period 1990-2019. The search terms included: Supervision, Cognitive behavioural therapy, Imagination, Imagery, Imagery rescripting, Therapeutic relationship, Supervisory relationship. The report also includes information from the books referred to by the articles. The supervisory experiences of the authors were also incorporated. The theoretical part is supplemented with case vignettes of strategies using imagination in CBT supervision., Results: Working with imagery can be used in transformative experiential learning. It can help to better map the situation with the patient, including its emotional components and basic psychological needs, to realise how the therapeutic relationship is set up, as well as to rework own therapist attitudes, schemas and emotional - behavioural responses, and plan future steps in the therapy. Many therapy steps could be learned during imagery exercises. Imagery also helps to understand and regulate the supervisory relationship., Conclusion: It is useful to integrate imagery to the supervision. Using imagery can help to understand the patient, the therapeutic relationship better, and to plan optimal therapeutic strategies, as well as reflect/self-reflect and train difficult skills which promote professional and personal growth.

Objectives: Little is known about the relation between severity of panic disorder, adverse events in childhood, dissociation, self-stigma and comorbid personality disorders. The aim of this study is to look for the intercorrelations between these factors., Method: The study explores the relation between clinical, demographic and social factors in panic disorder using cross sectional design. The inpatients with pharmacoresistant panic disorder with and without agoraphobia were included in the study. Participants were also assessed for comorbidity with other anxiety or personality disorder. The Clinical Global Impression (CGI), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI-II), Dissociative Experiences Scale (DES), Internalized Stigma of Mental Illness (ISMI), Childhood Trauma Questionnaire-Short Form (CTQ-SF), Panic Disorder Severity Scale (PDSS) and demographic data were used as measurement tools., Results: A total of 142 pharmacoresistant patients with panic disorder with or without agoraphobia were admitted for 6-week cognitive behavioral therapy inpatient program in psychotherapeutic department between November 2015 and July 2019. One hundred and five inpatients (33 males and 72 females) with mean age 37.8 + 12.1 years were included in the study. Sixty-nine patients suffer from additional comorbid anxiety disorder and 43 had comorbid personality disorder.

Objectives: A combination of antidepressants with the cognitive-behavioural therapy showed effectiveness in treatment-resistant patients with panic disorder. This prospective study intended to establish how childhood adverse experiences, self-stigma, dissociation, and severity of psychopathology influence the effectiveness of combined cognitive-behavioural therapy and pharmacotherapy in patients with treatment-resistant panic disorder., Methods: One hundred and ten patients were included into the study and one hundred five subjects finished the study. After admission, the subjects were assessed during the first two days of hospitalization. Rating scales were administered before the beginning of the cognitive behavioural therapy (measurement-1) and at the end of the treatment which was after six weeks (measurement-2). Patients with panic disorder were treated using a combination of group cognitive-behavioural therapy and antidepressants. The usual antidepressant dosage range was used. Before admission to intensive cognitive behavioural therapy program, the patients were unsuccessfully treated by antidepressants for minimum 3 months, which defined them as pharmacoresistant., Results: Hospitalized pharmacoresistant patients with panic disorder improved significantly throughout the 6-week intensive CBT program in all measurements that assessed the overall severity of the disorder, the degree of general anxiety and depression and the severity of specific symptoms of panic disorder and agoraphobia. The rate of improvement was negatively related to sexual abuse in childhood, presence of comorbid personality disorder, and positively with the severity of the disorder at the beginning, and the level of self-stigma at the beginning of treatment. Improvement in symptoms correlates significantly with decreasing of dissociation during the treatment.severity of depressive symptoms. The earlier development of the disorder is linked to higher score in childhood adverse events, higher level of dissociation and pathological dissociation, and higher level of self-stigma., Conclusions: Our prospective study discovers importance of the role of adverse childhood experiences, self-stigma, dissociation and comorbid personality disorder in effectiveness of combined cognitive-behavioural therapy and pharmacotherapy treatment in patients with treatment-resistant panic disorder.

Objective: Young schema questionnaire - short form (YSQ-S3) represents a useful method for the identification of early maladaptive schemas in clinical and non-clinical samples. The study aimed to examine the internal consistency and factorial structure of the recently adapted Slovak version of YSQ-S3 in a non-clinical sample., Methods: The sample consisted of 302 healthy participants from the general population in Slovakia. Slovak version of YSQ-S3 was used. Reliability analysis and confirmatory factor analysis were performed., Results: The results suggest an acceptable internal consistency of early maladaptive schemas (EMSs). The Cronbach's alpha coefficients of YSQ-S3 subscales ranged from 0.54 to 0.85. Confirmatory factor analysis supports the factor structures of 18 unifactorial EMSs. The results partially support Young's theoretical schema clusters and fail to support the second-order factor model., Conclusion: In conclusion, the Slovak version of the YSQ-S3 is a psychometrically sound questionnaire that can be utilized for assessing EMS, both for research and clinical purposes.

Background: Much attention has been paid to psychological factors influencing characteristics, severity, and course of mental disorders. The objective of our investigation was to examine the interrelations among quality of life (QoL), self-stigma, and coping strategies, demographics and severity of the disorder in neurotic spectrum disorders, schizophrenia, and depressive spectrum disorders., Methods: A total of 343 clinically stable Czech outpatients with different mental disorders (153 with neurotic spectrum disorders; 81 with depression, and 109 with schizophrenia spectrum disorders) were included. The patients were examined by their outpatient psychiatrists during regular psychiatric checkup and completed a sociodemographic questionnaire, the Quality of Life Satisfaction and the Enjoyment Questionnaire (Q-LES-Q), the Internalized Stigma of Mental Illness Scale (ISMI), the Stress Coping Style Questionnaire (SVF-78), and the Clinical Global Impression scale (CGI)., Results: The study demonstrates that the self-stigma and coping strategies are significant factors linked to the QoL in all diagnostic groups of patients. Patients with schizophrenia spectrum disorders had lower scores in QoL compared to the other two groups. The patients with depression or neurotic spectrum disorders had a lesser degree of self-stigma than the patients with schizophrenia spectrum disorders. The severity of the illness significantly correlated with the QoL, self-stigma, and coping strategies., Conclusions: The investigation confirmed the connection between the quality of life, self-stigma, coping strategies, and the severity of the illness, in outpatients with schizophrenia spectrum disorders, depressive, and neurotic spectrum disorders. A further longitudinal study would be useful to determine the causative relationships of these variables.

Objective: The purpose of the investigation was to explore the relationship between positive or negative symptoms, social anxiety, hope, personality, and self-stigma in patients with schizophrenia spectrum disorders., Method: 57 outpatients took part in this cross-sectional study. The structured interview M.I.N.I. International Neuropsychiatric Interview was used to confirm the diagnosis. All patients completed the Liebowitz Social Anxiety Scale, Internalized Stigma of Mental Illness Scale, Beck Depression Inventory-II, Beck Anxiety Inventory, Adult Dispositional Hope Scale, and Temperament and Character Inventory - Revised. The disorder severity was evaluated by Clinical Global Impression - Severity scale, and Positive and Negative Syndrome Scale. The patients were in a stabilized state that did not require hospitalization or modifications in the treatment., Results: Both positive and negative symptoms of schizophrenia positively correlated with the length of the disorder, global severity of the disorder, the severity of the general and social anxiety symptoms, the severity of self-stigma, and negatively with personality traits Self-directedness and Cooperativeness. Only negative symptoms significantly positively correlated with the severity of depressive symptoms and personality trait Harm-avoidance and negatively with the hope and personality trait Persistence. Comorbidity with social phobia is associated with statistically significantly higher mean scores on the total score of schizophrenic symptomatology, negative subscale average rating, and general psychopathological items measured by PANSS. Patient with comorbid depression would experience a higher level of negative symptomatology than patients without such comorbidity.

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

Introduction: Treatment adherence is one of the main factors affecting the success of treatment and, secondarily, the quality of life and social adaptation of the patients. The aim of this study was to investigate the association between self-stigmatization, treatment adherence and history of discontinuation of drug treatment., Methods: The cross-sectional study was conducted on 120 (98 completed all the questionnaires) neurotic outpatients treated in the University Hospital Olomouc. The following variables were evaluated: the objective and subjective Clinical Global Impression (CGI) scale, Drug Attitude Inventory (DAI-10) questionnaire measuring adherence, Internalized Stigma of Mental Illness (ISMI) scale measuring self-stigma, and a demographic data questionnaire., Results: Data analysis showed no correlation between self-stigmatization and age, age of onset or length of the post-hospitalization phase. However, there were significant correlations between self-stigmatization and the severity of the disorder (assessed by both objective and subjective CGI), number of previous hospitalizations, total number of psychiatrists visited by the patient, the arbitrary discontinuation of medication in the past, and the dose of an antidepressant. Furthermore, self-stigma was significantly negatively correlated with the current treatment adherence. The rate of adherence was negatively correlated with both objective and subjective CGI only., Conclusions: Self-stigma significantly affects the current adherence to the treatment of neurotic spectrum disorders.

Objective: Obstructive sleep apnea (OSA), is described as intermittent interruptions or reductions in airflow which are initiated by an incomplete or complete collapse of the upper airways despite respiratory effort. When left untreated, OSA is connected with comorbid conditions, such as cardiovascular and metabolic illnesses., Method: The PubMed database was used to examine papers published until April 2017 using the subsequent terms: "obstructive sleep apnea" or "obstructive sleep apnoea" and "depression" in successive combination with "CPAP (continuous positive airway pressure)", "therapy", "pharmacotherapy", "psychotherapy", "cognitive behavioral therapy" or "quality of life"., Results: After assessment for the suitability, 126 articles were chosen. The numerous evidence of a connection between OSA and depressive symptoms, as well as depressive disorder, were found. This connection may be directly or indirectly linked due to the participation of some OSA mediators consequences such as obesity, hypertension, and the decreased quality of life. Patients with the comorbid major depression and OSA reported more severe and longer episodes of depression. Nevertheless, the information on the effect of the treatment of OSA using CPAP on the depressive symptoms was limited. Still, the current state of the art suggests that this treatment decreases the severity of the comorbid depressive symptoms., Conclusions: It is important to evaluate the symptoms of depression in the patients with OSA. On the other side, a psychiatrist should not just treat the depression, as it is also important to screen individuals at high risk of OSA when assessing patients for depressive disorder, especially those with depression resistant to treatment.

Background: Borderline personality disorder (BPD) is a disabling psychiatric condition with a chronic and challenging course. BPD is reflected as a disorder of self-regulation" and is associated with both psychological vulnerabilities and social relations that fail to support basic emotional needs. The objective of the paper is to provide the up-to-date data on the unmet needs of BPD patients and their families., Method: A computerized search of the literature printed between January 1990 and May 2017 was conducted in PubMed, and additional papers were extracted using keywords "borderline personality disorder,"needs," "pharmacotherapy," "psychotherapy," "CBT," and "family" in various combinations. According to the eligibility criteria, 57 articles were chosen. Secondary articles from the reference lists of primarily identified papers have been selected for the eligibility and added to the first list (N=151)., Results: The results were divided into three categories: the needs connected with (1) the symptom control; (2) the treatment; (3) the quality of life. The needs connected with symptoms were described issues such as emotional needs, social interactions, self-harm, parasuicide, suicidality, comorbidity, mentalization, identity disturbance, moreover, barriers to treatment. The needs connected with the treatment described are focused on needs for early diagnosis, early intervention, holding environment, therapeutic relation, assertive community treatment, destigmatization, hospitalization, and primary care. The needs connected with the quality of life involve family needs, physical health, spiritual needs, advocacy needs, and needs for the separation-individuation. The part focused on implications for the treatment presented several treatment approaches, focusing mostly on the their basics and efficacy., Conclusion: Observing the patients' needs may be essential to the treatment of the individuals suffering from BPD. However, many needs remain unmet in the areas linked to medical, personal, and social factors. A bigger focus on the patients' needs could be beneficial and should be targeted in the treatment.

Objective: The target of the investigation was to find if there is any improvement of depressive symptoms and cognitive functioning after continuous positive airway pressure (CPAP) treatment in the severe obstructive apnea (OSA) patients., Method: The study included 59 patients treated with CPAP for OSA in the Sleep Laboratory of the Department of Respiratory Medicine. Thirty-eight patients were treated with CPAP for one month, and twenty-one patients were in a control group. We used the following methods: Test of Visual Memory (ViMe), Numeric Rectangle, d2 (test of attention), and the Beck Depression Inventory-II, respectively., Results: Among the OSA patients, there were statistically significant improvements in all parameters: attention, working memory, and depressive symptoms after the treatment with CPAP. We found a statistically significant positive connection between the decrease in depressive symptoms and the improvement in attention. In the control group, there were no improvements in the investigated factors., Conclusions: According to our results, the patients with sleep apnoea improved their mood and cognitive functions during the treatment by the CPAP device.

Objective: The goal of this study was to explore reliability and validity of the Czech revised Beck Depression Inventory (BDI-II) and to identify the best cut-off for a correct identification of a potentially depressed individual., Method: Two groups of adult participants entered the study. The first group consisted of 177 patients with depression (F32x or F33x according to the ICD-10). Furthermore, there were 767 healthy controls. Each participant filled in BDI-II. A part of the patients also completed the Beck Anxiety Inventory (BAI), the Dissociative Experiences Scale (DES), and the subjective Clinical Global Impression scale (CGI). A part of the controls filled in the Adult Dispositional Hope Scale (ADHS) and the Satisfaction with Life Scale (SWLS)., Result: The average patients' BDI-II score was 30.8±10.3, the mean controls' score was 7.2±6.8. The internal consistency of the inventory was excellent (the ordinal alpha coefficient was 0.90 for the patients and 0.93 for the controls). The stability in time, measured two weeks apart, was also good (intra-class correlation coefficient r=0.83 for the patients and 0.77 for the controls). The exploratory factor analysis of the patients showed a three-factor solution, while the analysis of the controls' data identified two factors. As expected, BDI-II significantly positively correlated with BAI, DES, and CGI and was negatively connected to ADHS and SWLS. The cut-off score with the best sensitivity and specificity was 17., Conclusion: The Czech BDI-II shows adequate psychometric characteristics.

Objectives: Hope is an important factor that influences mental state of individuals and efficacy of systematic and supportive psychotherapy. The goal of the study was to translate the Adult Dispositional Hope Scale (ADHS) to Czech, evaluate its psychometric properties and create norms to interpret the scale scores., Methods: The scale consists of twelve items. Four items assess the ability of pathway thinking, four items measure agency, and the remaining four items are fillers that are not interpreted. There were 394 adult participants with negative psychiatric history who completed the ADHS and BDI-II. Their mean age was 27.1±11.7 years, most of them were women (n=303; 76.9%)., Results: There was no significant relationship between age or sex and hope. Reliability was analyzed by Cronbach alpha (α=0.82) and the split-half method (Spearman-Brown coefficient = 0.81). The factor structure of the scale was approved by the results of exploratory and confirmatory factor analysis, except the ninth item that similarly saturated both subscales. The ADHS moderately negatively correlated with BDI-II. Norms were created for the scores of the entire scale and both subscales., Conclusion: The Czech version of the Adult Dispositional Hope Scale shows adequate psychometric properties.

Objectives: A significant number of psychiatric patients stigmatize themselves because of their mental struggles. Such self-stigmatization has an adverse impact on patients' well-being and effectiveness of the treatment of mental disorders. The goal of this study was to standardize the brief Internalized Stigma of Mental Illness Scale (ISMI-10), which could be used in studies targeting the self-stigma among the psychiatric patients., Method: 354 psychiatric patients participated in the study between the years 2012 and 2014. All individuals were undergoing treatment in the outpatient care or the psychotherapeutic ward of the Department of Psychiatry, University Hospital Olomouc. The mean age of the participants was 41.5±13.3 years. The majority of them were women (n=195). The patients suffered from various mental disorders - neurotic disorders (n=166), mood disorders (n=65), substance use disorders (n=47), psychoses (n=40), personality disorders (n=32), and organic mental illness (n=4). Each patient completed a demographic questionnaire and the ISMI-10., Results: The ordinal alpha of the scale was 0.86, indicating its good internal consistency. The overall scores of the full and abbreviated version of the scale were almost perfectly correlated (r=0.95, p<0.001). The factor analysis confirmed a good internal structure of the scale. The created norms for the scale score were based on stens., Conclusion: The ISMI-10 may be a useful method for measuring the self-stigma among adults with a mental disorder. The area of its use lies mainly in research.

Background: Obsessive compulsive disorder (OCD) is a disabling mental disorder with the chronic and difficult course. The disorder is accompanied by numerous limitations in personal and interpersonal functioning. OCD decreases the quality of life and the chance to maintain relationships and professional status. The patients with OCD often experience a severe disabling course of the disorder. Even the individuals, who follow treatment advice, are often still highly symptomatic. In the last decade, the concept of the needs has been assessed as an extent of the traditional outcome evaluation in order to focus on the identification of the specific needs of the patients and their relatives, improve the patients´ overall mental condition and quality of life, and also to increase the treatment effectiveness of the mental disorders. The objective of the article was to review the current literature about unmet needs of the OCD patients and their caregivers., Method: A computerized search of the literature published between January 2000 and June 2016 was conducted in MEDLINE, and additional papers were extracted using keywords "obsessive compulsive disorder","needs", "pharmacotherapy", "CBT", and "family" in various combinations. Primary selection selected the total of 449 articles. According to the established criteria, 168 articles were chosen. After a detailed examination of the full texts, 53 articles remained. Secondary articles from the reference lists of primarily selected papers were read and evaluated for the eligibility and added to the final list of the articles (n = 107)., Results: The needs of the OCD patients might differ at various stages and severity of the disorder. Four sets of the needs were identified: the needs connected with the symptoms, the treatment, the quality of life, and the family. The patients suffering from OCD often experience many limitations in the fulfillment of their fundamental human needs such as disturbed patients´ functioning in the common life, family, at work, in the ability to realize their goals, skills, potential, capacity to follow prescribed treatment, take medication, cooperate in addressing the root causes of their problems, reduce obsessive thoughts and compulsive behavior, as well as their willingness to realize exposures with the desire to resolve the situation., Conclusion: Monitoring the patients´ needs may be relevant for the treatment of the individuals suffering from OCD. A bigger focus on the patients´ needs could be beneficial and should be targeted in the treatment.

Objective: Beck anxiety inventory (BAI) is widely used self-rating questionnaire evaluating the severity of anxiety symptoms. The aim of our study was to confirm validity and reliability of Czech version of BAI, identify cut-off points and prove sensitivity to measure improvement after therapy., Methods: The patients selected for the study were treated in the department of psychiatry, University Hospital Olomouc between January 2008 and 2014. Patients meeting criteria for anxiety, or depressive disorder were involved., Results: 789 patients and 284 healthy controls agreed to participate in the study. Czech version of Beck anxiety inventory proved high internal consistency (α=0.92) and good test-retest reliability over one week (BAI seems to be independent of other used scales - Beck depression inventory and the Clinical Global Impression. BAI is also sensitive to measure change after therapy., Conclusion: Czech version of BAI was found to have enough internal stability and test-retest reliability same as the original version. It may also be useful to detect improvement after therapy.

Objective: Heart rate variability (HRV) oscillations are used in the detection of autonomic instabilities in various clinical disorders., Methods: We compared the HRV as a possible marker of chronic distress in children with inflammatory bowel disease (IBD) with HRV frequencies in the healthy controls. Participants were 29 children with IBD (19 Crohn's disease and 10 ulcerative colitis), 25 children were in remission and 4 presented mild disease activity. They were compared with the control group of 35 healthy children of the same age (13-16 years-old)., Results: In HRV assessment, adolescents with IBD had significantly lower levels of the spectral activity in an LF band in all three positions; lower levels of VLF in both supine positions; and the ratio of the spectral activity at LF/HF was significantly lower in the second post (standing)., Conclusion: These results indicate children with IBD have less adaptability to stress.

Objective: Inflammatory bowel diseases (IBD) are chronic diseases with a significant impact on quality of life (QoL). The aim of the study was to examine the QoL in children with IBD and their families, depression and anxiety for both the children and their parents., Methods: Participants were 29 adolescents with IBD (19 individuals suffered from the Crohn disease, another ten had ulcerative colitis) and 40 healthy controls of the same age (13-16 years). The probands and their parents completed questionnaires measuring the quality of life (KidScreen-10, PedsQL), depression (CDI, BDI-II), and anxiety (SAD, BAI)., Results: The QoL measured by questionnaires did not differ between the adolescent participants, but it was significantly lower in the parents of the children with IBD than in the parents of the healthy controls. The parents of the IBD children scored lower in the Family Impact Module Total Scale Score and the parental Health-Related QoL Summary Score. The fathers of the IBD children also had a lower level of the Family Functioning Summary Score. There wasn't any difference in the levels of anxiety and depressive symptoms among the IBD adolescents and the controls., Conclusions: The parents of the children with IBD experience lower QoL than the parents with the healthy children. The children with IBD show similar symptoms of depression, anxiety, and QoL as the healthy controls.

Objective: Treatment of major depressive disorder can be affected by a broad range of factors. In our study, we focused on the relationships of demographic, psychological, clinical and social factors to the course of treatment of depression., Method: The study included 151 patients (finally 140 patients were evaluated) hospitalized for major depressive disorder. They were assessed for demographic characteristics, the rates of depression and anxiety, quality of life, the rates of dissociation and insomnia, and subjective and objective disease severity at different times during treatment. Patients were treated with standard doses of antidepressants or other psychiatric medication. They also completed a 6-week long daily cognitive-behavioural therapy. Data were statistically analyzed., Results: There were significant decreases in the overall severity of the disorder, anxiety level and depression rate during treatment. Improvement measured by objective Clinical Global Impression (oCGI-I) at the end of treatment was not significantly correlated with any of the measured parameters (age of patient, onset of illness, duration of disease, doses of medication etc.). It only significantly positively correlated with the initial evaluation of the patient by oCGI. However, the improvement in subjective assessment (using sCGI-I) correlated with many parameters (increased age, later onset of the disease, greater disease severity at baseline in both overall and subjective evaluation of the severity, anxiety and depressive symptomatology). Furthermore, it was negatively correlated with most quality of life parameters, such as H (Home), F (Feelings), L (Leisure), Sr (Social relations) and G (General)., Conclusions: The results suggest that individual variables, such as the degree of psychopathology, particularly depression and anxiety, most quality of life parameters, higher patient age and age of disorder onset may be associated with poorer subjective response to complex treatment of patients with major depressive disorder.