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.
- MeSH
- disociační poruchy * terapie psychologie MeSH
- dospělí MeSH
- hospitalizovaní pacienti MeSH
- hraniční porucha osobnosti * terapie psychologie MeSH
- kognitivně behaviorální terapie * metody MeSH
- kombinovaná terapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- obsedantně kompulzivní porucha * terapie psychologie MeSH
- panická porucha * terapie MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
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.
- MeSH
- disociační poruchy * psychologie epidemiologie MeSH
- dítě MeSH
- dospělí MeSH
- hraniční porucha osobnosti * psychologie epidemiologie MeSH
- komorbidita MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- nepříznivé zkušenosti z dětství psychologie MeSH
- obsedantně kompulzivní porucha * psychologie epidemiologie MeSH
- panická porucha * psychologie epidemiologie MeSH
- stupeň závažnosti nemoci MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Potíže spojené s emoční nestabilitou jsou v adolescenci časté a diagnostikování poruchy osobnosti už v tomto věku se stává běžnější. Jedná se o významnou skupinu pacientů, obzvlášť když uvážíme, že se tato porucha vyskytovala až u 76 % adolescentů, kteří vyhledali péči pro suicidální úvahy. Rodinné prostředí hraje roli při vzniku emočně nestabilní poruchy osobnosti a zároveň jsou blízcí těmito potížemi také významně zasaženi. Existuje několik terapeutických postupů, které byly adaptovány i pro emočně nestabilní adolescenty a vykazují efektivitu v jejich léčbě. Zapojení rodiny v léčbě je nezbytné. Tento článek se věnuje roli rodiny a možnostem zapojení rodinných příslušníků emočně nestabilních adolescentů v jejich léčbě
Difficulties associated with emotional instability are frequent in adolescence, and the diagnosis of personality disorders at this age is becoming common. The importance of this group of patients is evident, when we consider that this disorder was present in up to 76 % of adolescents who sought care for suicidal ideation. Family environment plays a role in the pathogenesis of emotionally unstable personality disorder, while on the other hand, relatives are also significantly affected by this disorder. There are several therapeutic procedures that have been adapted for emotionally unstable adolescents and show effectiveness in their treatment. Family involvement in the treatment is essential. This article explores the role of the family and the possibilities of involvement of family members of emotionally unstable adolescents in their 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.
- MeSH
- bipolární porucha * MeSH
- emoce MeSH
- hraniční porucha osobnosti * terapie MeSH
- komorbidita MeSH
- lidé MeSH
- psychoterapie metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Zánět je součást reakce imunitního systému na zevní i vnitřní podněty, především infekčního charakteru. V posledních letech se pozornost odborníků přenáší od akutní zánětlivé reakce k chronickému mírnému systémovému zánětu. Tento fenomén zřejmě hraje roli v etiopatogenezi řady chronických onemocnění, jako jsou kardiovaskulární onemocnění, diabetes či obezita. Z hlediska psychiatrie je mimo jiné zkoumána zejména souvislost zánětu a psychotických onemocnění.
Inflammation is part of immune reaction to external and internal stimuli, particularly infectious insults. In recent years, the attention of experts has shifted from acute inflammatory response to mild chronic systemic inflammation. This phenomenon appears to play a role in the etiopathogenesis of many chronic diseases, such as cardiovascular disease, diabetes and obesity. In psychiatry, connection between inflammation and psychotic disorders is one of the major study interests. There is multiple evidence, that inflammation plays a role in a certain group of patients with psychosis. Markers that can help recognize this state in both acute and chronic psychotic disorders have been identified. A specific phenotype of schizophrenia spectrum disorders in which inflammation plays a significant role is being recognized. Research leads to theories of inflammation being one of the factors in the neurodevelopmental hypothesis of schizophrenia. This article introduces theoretical and research backgrounds to the connection between psychotic diseases and the immune system and presents an insight into attempts at the practical implementation of this knowledge into clinical practice.
- MeSH
- imunitní systém MeSH
- lidé MeSH
- psychotické poruchy * etiologie imunologie MeSH
- schizofrenie etnologie imunologie MeSH
- zánět MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
Mezi komorbidní poruchy schizofrenie patří také obsedantně kompulzivní porucha. Ačkoliv tyto dvě poruchy tvoří nezávislé diagnostické kategorie, jejich charakteristiky vykazují vzájemnou podobnost a může také docházet k překryvu jejich symptomatiky. Výskyt obsedantně kompulzivní poruchy je předpokládán až u 12 % pacientů se schizofrenií. Tyto poznatky vedou k návrhům kategorie poruch schizoobsedantního spektra a vymezení schizoobsedantní poruchy jako samostatné jednotky vykazující rozdíly oproti schizofrenii i obsedantně kompulzivní poruše. Klinický význam schizoobsedantních příznaků lze popsat z 3 hledisek: Obsedantně kompulzivní symptomatika může předcházet psychóze a být vnímána jako její prodrom. Při současném průběhu může působit diagnostické komplikace a negativně ovlivňuje prognózu onemocnění. Obsedantně kompulzivní příznaky také mohou být indukovány antipsychotiky, a to zejména klozapinem, olanzapinem a risperidonem. Tento fakt také komplikuje léčebný přístup k schizoobsedantní poruše.
Obsessive compulsive disorder is among the comorbid disorders in schizophrenia. Although these two disorders form independent diagnostic categories, their characteristics show similarity to one another and their symptoms may also overlap. Obsessive compulsive disorder is expected to occur in up to 12 % of patients with schizophrenia. This knowledge leads to suggestions of the category of schizo-obsessive disorders and the definition of schizo-obsessive disorder as aseparate unit showing differences from both schizophrenia and obsessive compulsive disorder. The clinical significance of schizo-obsessive symptoms can be described from 3 perspectives: Obsessive-compulsive symptoms can precede psychosis and thus be seen as its prodroms. Obsessive-compulsive symptoms co-occuring with schizophrenia can cause diagnostic complications and negatively affect the prognosis of the disease. Obsessive compulsive symptoms may also be induced by antipsychotics, particularly clozapine, olanzapine and risperidone. This also complicates the therapeutic approach to schizoobsedant disorder.
