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.
- Publikační typ
- časopisecké články MeSH
Backround. Borderline personality disorder (BPD) is typically characterized by instability and impairmed behaviour,-affectivity, interpersonal relations and lifestyle. The most common condition comorbid with BPD is a depressive-episode. Depression is associated with severe disturbance of the circadian rhythms. This is apparent in depressive-patients with BPD. Both sleep and diurnal rhythms are disturbed and the symptoms fluctuate. Bright light may be an-effective in treatment of seasonal affective disorder, circadian sleep disorder and jet lag. It also improves sleep-wake-patterns and behavioural disorders in hospitalized patients with Alzheimer’s disease. Several studies have suggested-antidepressant effects of phototherapy in non-seasonal depressive episodes. The treatment of comorbid depressive-disorder and borderline personality disorder (BPD) is usually reported to be less successful than the treatment of-patients without personality disorder. Studies describing the use of bright light in depressed patients with comorbid-BPD have not been published so far. Method. The aim of this open study was to assess the effectiveness of a 6-week combined therapy with the application-of bright light (10,000 lux, 6:30 to 7:30 a.m. for 6 weeks) added to SSRIs in drug-resistant depressed patients-with comorbid BPD who did not respond with improvement to 6-week administration of antidepressants. The study-comprised 13 female patients who met the ICD-10 diagnostic criteria for research and the DSM-IV-TR diagnostic-criteria for major depression. The participants were regularly evaluated using the CGI, HAMD and MADRS scales-and the BDI and BDI self-report inventories. Results. According to all the assessment instruments, the application of bright white light leads to a significant-improvement. However, the results must be interpreted with caution due to the open nature of the study.
- MeSH
- antidepresiva terapeutické užití MeSH
- depresivní porucha unipolární epidemiologie terapie MeSH
- dospělí MeSH
- financování organizované MeSH
- fototerapie MeSH
- hraniční porucha osobnosti epidemiologie terapie MeSH
- komorbidita MeSH
- lidé MeSH
- selektivní inhibitory zpětného vychytávání serotoninu terapeutické užití MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
Backround. Suicide is the eighth leading cause of death in adults and the second leading cause of death in the 15- to 24-year-old age group. Suicidal impulses and suicidal behavior result from emotionally unbearable feeling of mental suffering and cognitive narrowing that prevent resolution to experienced stress, that is, in a situation when personal coping mechanisms have failed. Suicide attempts are a frequent cause of hospital admissions, in particular to anesthesiology and resuscitation departments. Risk factors. Women attempt suicide three times more often than men. Four times more men than women complete suicide. More than 90% of people who complete suicide are diagnosed with severe mental illness and 50% suffer from depression at the time of suicide. Assessment. Physicians should be aware of possible suicidal behavior in any patient with mental illness, especially if accompanied by depressive symptoms. The physician should approach the topic of suicide carefully and discreetly, only after a therapeutic relationship with the patient has been established. Management. Patient protection, usually in the setting of a closed psychiatric ward, is necessary if he or she has a clear plan and means to commit suicide. After the patient’s safety is secured, treatment may be initiated. If the patient is treated on an outpatient basis, his/her condition must be carefully monitored.
- Klíčová slova
- suicidal ideation,
- MeSH
- dospělí MeSH
- financování organizované MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- pokus o sebevraždu psychologie MeSH
- psychoterapie MeSH
- psychotropní léky terapeutické užití MeSH
- rizikové faktory MeSH
- sebevražda prevence a kontrola psychologie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
Background. Both patients and psychotherapists can experience strong emotional reactions towards each other in what are termed transference and countertransference within therapy. In the first part of this review, we discuss transference issues. Although not usually part of the obvious language of cognitive behavioral therapy (CBT), examination of the cognitions related to the therapist, is an integral part of CBT, especially in working with difficult patients. In the second part, we cover counter-transference issues. We describe schematic issues that give rise to therapist counter-transference and explain how this interacts in different types of patient therapist encounter. We also examine ways in which the therapist can use CBT to help him/her modify the countertransference and, in the process, assist the patient. Methods. PUBMED data base was searched for articles using the key words “therapeutic relations”, “transference“, “countertransference“, “cognitive behavioral therapy“, “cognitive therapy“, “schema therapy“, “dialectical behavioral therapy“. The search was repeated by changing the key word. No language or time constraints were applied. The lists of references of articles detected by this computer data base search were examined manually to find additional articles. We also used the original texts of A. T. Beck, J. Beck, M. Linehan, R. Leahy, J. Young and others. Basically this is a review with conclusions about how therapists can manage transference issues. Results. Transference. The therapist should pay attention to negative or positive reactions towards him/ her but should not deliberately provoke or ignore them. He/she should be vigilant for signs of strong negative emotions, such as a disappointment, anger, and frustration experienced in the therapeutic relationship by the patient. Similarly he/ she should be alert to exaggerated positive emotions such as love, excessive idealization, praise or attempts to divert the attention of therapy onto the therapist. These reactions open space for understanding the patient’s past and actual relations outside the therapy. Countertransference. The therapist should be aware of countertransference schemas as they apply to him/her. He/she should monitor his/her own feelings that indicate countertransference. Further, the assistance of and discussion with supervisors and colleagues is useful in regard to countertransference even in experienced therapists. Countertransference can be used as an open window into the interpersonal relations of the patient. Conclusions. Both the literature and our experience underscore the importance of careful and open examination of both transference and counter-transference issues in CBT and their necessary incorporation in the complete management of all patients undergoing CBT.
- MeSH
- financování organizované MeSH
- kognitivně behaviorální terapie MeSH
- lidé MeSH
- přenos (psychologie) MeSH
- protipřenos (psychologie) MeSH
- vztahy mezi lékařem a pacientem MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
- MeSH
- depresivní poruchy * MeSH
- disociační poruchy * MeSH
- emoce MeSH
- kognitivně behaviorální terapie * MeSH
- korespondence jako téma * MeSH
- lidé MeSH
- poruchy osobnosti * MeSH
- psychoterapeutické procesy MeSH
- psychoterapie * metody MeSH
- úzkostné poruchy * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
- MeSH
- lidé MeSH
- psychotické poruchy diagnóza farmakoterapie MeSH
- Check Tag
- lidé MeSH
