Self-stigma in patients with schizophrenia: Impact and management.

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.

Nightmares in borderline personality disorder - narrative review.

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.

Cognitive Functions, Depressive and Anxiety Symptoms After One Year of CPAP Treatment in Obstructive Sleep Apnea.

Objective: The study worked with depressive symptoms, anxiety score and cognitive functions in obstructive sleep apnea (OSA) patients treated with CPAP. Methods: Eighty-one subjects with OSA and without psychiatric comorbidity were treated with CPAP for one year and completed the following scales and cognitive tests: Trail Making Test, Verbal Fluency Test, d2 Test, Beck Depression Inventory-II and Beck Anxiety Inventory. MINI ruled out psychiatric disorder. At the two months check-up, subjects were re-evaluated for depressive and anxiety symptoms, and after one year of CPAP treatment, subjects repeated cognitive tests and scales. Data about therapy adherence and effectiveness were obtained from the patient's CPAP machines. Results: The study was completed by 59 CPAP adherent patients and eight non-adherent patients. CPAP therapy effectiveness was verified in all patients by decreasing the apnea-hypopnoea index below 5 and/or 10% of baseline values. The adherent patients significantly improved depressive and anxiety symptoms. There was also an improvement in overall performance in the attention test; however, performance in many individual items did not change. The adherent patients also improved verbal fluency and in the Part B of the Trail making test. The non-adherent group significantly increased the number of mistakes made in the d2 test; other results were non-significant. Conclusion: According to our results, OSA patients' mood, anxiety and certain cognitive domains improved during the one-year therapy with CPAP. Trial Registration Number: NCT03866161.

Obstruction sleep apnoea and panic disorder.

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.

Sleep Disturbance and Immunological Consequences of COVID-19.

The overarching importance of sleep was further emphasized during the pandemic of COVID-19. The subjects infected by COVID-19 frequently experience sleep disturbances; some are long-lasting problems and decrease the quality of life. Insomnia is the most studied sleep disorder associated with COVID-19. Insomnia affects patients who have experienced an infection and the general population. Good sleep is important in maintaining mental and physical health, including immune system functions. The interconnections between insomnia, the immune system, and COVID-19 are complex. Insomnia triggers numerous immune system dysregulations and makes individuals more vulnerable to respiratory infections. This narrative review overviews the influence of the COVID-19 pandemic on the immune system through sleep disorders.

Screening for obstructive sleep apnoea in high-risk patients with mood disorders.

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.

Early life experiences and adult attachment in obsessive-compulsive disorder. Part 1: Relationships between demographic, clinical, and psychological factors in pharmacoresistant OCD.

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.