PURPOSE: Child abuse and trauma are significant risk factors in the etiology of borderline personality disorder (BPD). Apart from affecting the risk of developing BPD, adverse childhood experiences seem to increase its symptoms and related disability. Self-stigma presents another common issue with equally prominent consequences for mental health. Despite being theoretically linked, the connections among childhood trauma, self-stigma, and mental health have not been explored in patients with BPD. This study aimed to provide first insights into this understudied topic. PATIENTS AND METHODS: This cross-sectional study included 283 inpatients diagnosed with BPD participating in a residential transdiagnostic psychotherapeutic program. The patients completed several measurements - the Internalized Stigma of Mental Illness Scale, the Childhood Trauma Questionnaire - Short Form, the Clinical Global Impression - Severity, the Beck Depression Inventory-II, the Beck Anxiety Inventory, the Dissociative Experiences Scale, the Sheehan Disability Scale, and a demographic questionnaire. The data was statistically analyzed using IBM SPSS and AMOS 26 programs, and bivariate correlation tests and structural equation modeling explored the hypotheses. RESULTS: Retrospectively reported childhood trauma positively correlated with current self-stigma. Both childhood trauma and self-stigma were also positively related to several indicators of general psychopathology and disability. The significance of these connections was subsequently confirmed by structural equation modeling, where self-stigma acted as a partial mediator of childhood trauma, general psychopathology, and disability. CONCLUSION: Self-stigma significantly mediates the relationship between childhood trauma and selected mental health symptoms among adult patients diagnosed with BPD. Longitudinal studies are necessary to explore the causality of the findings. Therapeutic and societal efforts to tackle childhood trauma or self-stigma might benefit from reflecting its broader psychosocial context.
- Publikační typ
- časopisecké články MeSH
Depresivní porucha patří mezi časté psychické poruchy. Podstatná část pacientů s touto poruchou se nedostává k adekvátní terapii. Mezi hlavní důvody patří snížená dostupnost péče a strach ze stigmatizace. V řadě západních zemí, jako jsou Švédsko, Austrálie, Německo, Velká Británie, Nizozemí, Švýcarsko nebo Spojené státy, tyto bariéry snižují internetové terapeutické programy, které představují účinnou a nízkonákladovou pomoc jedincům s lehkými až středně závažnými příznaky deprese. Tyto programy zpravidla vychází z principů kognitivně behaviorální terapie a psychoedukace, mají interaktivní obsah a sebezkušenostní cvičení. Většina nabízí i pomoc vyškoleného terapeuta. Programy bez podpory terapeuta jsou také účinné. Ukazuje se však, že intervence s intervencemi terapeuta vykazují vyšší efektivitu. Některé země, jako je Velká Británie, mají bohatou tradici výzkumu účinnosti těchto programů a zařadily je do krokové péče a doporučených postupů léčby. V České republice dosud tyto programy chyběly. Česká platforma Mindwell nabízí internetový KBT program pro jedince s lehkými a středně těžkými příznaky deprese. Tento program má 12 modulů, ve kterých se systematicky rozvíjejí jednotlivé internetové strategie účinné pro zmírňování deprese. V současnosti se dokončuje výzkum uživatelské přívětivosti programu, v blízké budoucnosti bude následovat analýza jeho účinnosti.
Depressive disorder is a common mental disorder. A considerable part of the patients does not receive adequate therapy. The main reasons are the low availability of treatment and fear of stigmatisation. Online therapeutic programs reduce these barriers in many Western countries, such as Sweden, Australia, Germany, the United Kingdom, the Netherlands, Switzerland, and the United States. These programs present efficacious and cost-effective help for individuals with mild and moderate symptoms of depression. They are usually based on principles of cognitive behavioural therapy and psychoeducation and offer interactive content and help from a trained therapist. Purely self-guided programs are also efficacious. However, the guided programs seem more effective. The United Kingdom and several other countries have a rich tradition of researching these programs and integrating them into the stepped care and the guidelines. Until recently, Czech patients did not have the option to access such programs in their mother tongue. The Czech platform Mindwell offers an online CBT program for individuals with mild and moderate symptoms of depression. This program has 12 modules that systematically develop individual online strategies effective for alleviating depressive symptoms. The team finishes a feasibility study, and an effective analysis will follow.
- Klíčová slova
- program Mindwell,
- MeSH
- deprese * prevence a kontrola terapie MeSH
- internetová intervence * MeSH
- kognitivně behaviorální terapie MeSH
- lidé MeSH
- směrnice pro lékařskou praxi jako téma MeSH
- telemedicína MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
- Publikační typ
- abstrakt z konference MeSH
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.
- MeSH
- kvalita života MeSH
- lidé MeSH
- psychoterapie MeSH
- psychotické poruchy * MeSH
- schizofrenie * terapie MeSH
- sebepojetí MeSH
- společenské stigma MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
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.
- MeSH
- hraniční porucha osobnosti * MeSH
- interpersonální vztahy MeSH
- konflikt v rodině MeSH
- lidé MeSH
- manželství MeSH
- sexuální chování MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
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.
- MeSH
- hraniční porucha osobnosti * terapie MeSH
- lidé MeSH
- poruchy osobnosti MeSH
- psychotické poruchy * MeSH
- společenské stigma MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
Bipolar disorder (BD) is a severe mood disorder characterized by episodes of depression and hypomania or mania. Despite its primarily biological roots, the onset and course of the disorder have also been related to psychosocial factors such as early adverse experiences and related maladaptive schemas. Several researchers proposed a schema therapeutic model to treat patients with BD. In this paper, we further develop the theoretical model and elaborate on seven elements that were found effective in the psychosocial interventions with individuals with BD: monitoring mood and early symptoms of relapse, recognizing and management of stressful situations and interpersonal conflicts, creating a relapse prevention plan, stabilizing the sleep/wake cycle and daily routine, encouraging the use of medication, and reducing self-stigma and substance use. Apart from that, we describe the elements of the schema work with patients who suffer from BD. Illustrative clinical cases accompany the theoretical framework. The research of the schema therapy with patients with severe mental illnesses has only recently started developing. The presented paper also aims to encourage further research in this area and highlight potentially beneficial research goals.
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
Porucha s bludy se zpravidla vyznačuje jediným bludným přesvědčením nebo systémem několika vzájemně propojených bludů. Bludná přesvědčení se mohou vytvořit na podkladu reálné, obvykle zraňující, ponižující či stresující události. Rozeznáváme několik podtypů: persekuční, žárlivecký, erotomanický, somatický, grandiózní, smíšený a nespecifický. Bludy mohou přetrvávat dlouhodobě, mnohdy mnoho let. Terapie pacientů s touto poruchou bývá obvykle náročná, protože se zpravidla nepovažují za nemocné a nemají sklony vyhledávat léčbu. Úspěch léčby výrazně závisí na kvalitě terapeutického vztahu. Jedním z terapeutických cílů je motivovat pacienta k užívání antipsychotik, která jsou léčbou volby. U bludů somatického podtypu může pomoci léčba antidepresivy. Kognitivně behaviorální terapie vyvinula strategie pro léčbu chronických bludů. Specifickou strategií pro změnu bludného přesvědčení je periferní dotazování.
Delusional disorder usually presents by a single delusional belief that gradually arises in time or by a system of several interconnected delusions. Delusions can develop from a misrepresentation of real, usually hurtful, degrading, or stressful events. There are several subtypes: persecutory, jealous, erotomaniac, somatic, grandiose, mixed, and non-specific. Delusions can persist for a long time, sometimes for many years. The treatment is usually challenging, as these patients generally do not consider themselves ill and tend to not seek treatment. The therapeutic success heavily relies on a safe and stable therapeutic relationship. One of the psychotherapeutic goals is to motivate the patient to use antipsychotics which are the treatment of choice. Antidepressants may then alleviate symptoms of somatic delusions. Cognitive behavioural therapy has developed strategies for the treatment of chronic delusions. The most specific strategy for changing delusional beliefs is peripheral questioning.
- MeSH
- antipsychotika terapeutické užití MeSH
- bludy * terapie MeSH
- kognitivně behaviorální terapie MeSH
- lidé MeSH
- psychoterapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
- Publikační typ
- abstrakt z konference MeSH
Purpose: Obsessive compulsive disorder (OCD) is a debilitating mental disorder that often takes a chronic course. One of the factors influencing the treatment effectiveness in anxiety and depressive disorders is the self-stigma. This study focused on the relationship between the self-stigma, symptomatology, and therapeutic outcomes in patients with OCD. Patients and Methods: Ninety-four inpatients with OCD, who did not sufficiently respond to at least one selective serotonin reuptake inhibitor trial, participated in the study. They attended a six-week therapeutic program consisting of exposure and response prevention, transdiagnostic group cognitive behavioral therapy, individual sessions, mental imagery, relaxation, sport, and ergotherapy. The participants completed several scales: the Internalized Stigma of Mental Illness Scale (ISMI), the self-report Yale-Brown Obsessive Compulsive Scale (Y-BOCS-SR), Beck Anxiety Scale (BAI), Beck Depression Scale-II (BDI-II), and Dissociative Experiences Scale (DES). A senior psychiatrist filled in the Clinical Global Impression (CGI-S). Results: The average scales' scores considerably declined in all measurements except for DES. The self-stigma positively correlated with all psychopathology scales. It was also higher in patients with a comorbid personality disorder (PD). The higher self-stigma predicted a lower change in compulsion, anxiety, and depressive symptoms but not the change of obsessions or the overall psychopathology. Conclusion: The self-stigma presents an important factor connected to higher severity of OCD. It is also a minor predictor of a lower change in symptomatology after combined treatment.
- Publikační typ
- časopisecké články MeSH
