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.

Black & white relations: Intimate relationships of patients with borderline personality disorder.

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.

Different hosts in different lakes: prevalence and population genetic structure of plerocercoids of Ligula intestinalis (Cestoda) in Czech water bodies.

Ligula intestinalis (Linnaeus, 1758) is a tapeworm parasite with a worldwide distribution that uses a wide variety of fish species as its second intermediate host. In the present study, we investigated the prevalence and population genetic structure of plerocercoids of L. intestinalis in five common cyprinoid species, roach Rutilus rutilus (Linnaeus), freshwater bream Abramis brama (Linnaeus), white bream Blicca bjoerkna (Linnaeus), bleak Alburnus alburnus (Linnaeus), and rudd Scardinius erythrophthalmus (Linnaeus), collected in six water bodies of the Czech Republic (Milada, Most, Medard, Jordán, Rímov and Lipno). Of the six study sites, the highest frequency of parasitism was recorded in Lake Medard (15%). The overall prevalence rate among the species was as follows: roach > rudd ≥ freshwater bream > bleak > white bream. Two mitochondrial genes (cytb and COI) were used to compare the population genetic structure of parasite populations using selected samples from the five fish species. The results of the phylogenetic analysis indicated that all populations of L. intestinalis were placed in Clade A, previously identified as the most common in Europe. At a finer scale, haplotype network and PCoA analyses indicated the possible emergence of host specificity of several mtDNA haplotypes to the freshwater bream. Moreover, pairwise Fixation indices (FST) revealed a significant genetic structure between the parasite population in freshwater bream and other host species. Parasite populations in roach not only showed the highest rate of prevalence but also depicted a maximum number of shared haplotypes with populations from bleak and rudd. Our results suggest that recent ecological differentiation might have influenced tapeworm populations at a fine evolutionary scale. Thus, the differences in prevalence between fish host species in different lakes might be influenced not only by the parasite's ecology, but also by its genetic diversity.

Unmet emotional, interpersonal, and treatment needs in patients with borderline personality disorder.

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.

Hallucinations and Other Psychotic Symptoms in Patients with Borderline Personality Disorder.

Background: Psychotic symptoms in BPD are not uncommon, and they are diverse and phenomenologically similar to those in schizophrenia spectrum disorders. Despite their prevalence in BPD patients, knowledge about the characteristics and severity of hallucinations is limited, especially in modalities other than auditory. Aim: This review summarises the causes, phenomenology, severity, and treatment options of hallucinations and other psychotic symptoms in BPD. Methods: The PubMed database was used with the following key terms: "borderline personality disorder" and 'hallucinations' and "psychotic symptoms". Articles were selected between January 1990 and May 2021. The primary keyword search yielded a total of 545 papers, of which 102 articles met the inclusion criteria and were fully screened. Papers from the primary source reference lists were also screened, assessed for eligibility, and then added to the primary documents where appropriate (n = 143). After the relevance assessment, 102 papers were included in the review. We included adult and adolescent studies to gather more recent reviews on this topic. Results: Hallucinations are significantly prevalent in BPD, mainly auditory, similar to schizophrenia spectrum disorders. The relationship between hallucinations and depression, anxiety, suicidality, schizotypy, and loneliness in BPD has been discovered but requires more research. Studies for treatment options for hallucinations in BPD are lacking. Conclusion: Recognition of psychotic symptoms in patients with BPD as distinguished psychopathological phenomena instead of diminishing and overlooking them is essential in the clinical assessment and can be useful in predicting complications during treatment. More focused research in this area is needed.

Schema Therapy for Patients with Bipolar Disorder: Theoretical Framework and Application.

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.

Contrasting structural complexity differentiate hunting strategy in an ambush apex predator.

Structural complexity is known to influence prey behaviour, mortality and population structure, but the effects on predators have received less attention. We tested whether contrasting structural complexity in two newly colonised lakes (low structural complexity lake-LSC; high structural complexity-HSC) was associated with contrasting behaviour in an aquatic apex predator, Northern pike (Esox lucius; hereafter pike) present in the lakes. Behaviour of pike was studied with whole-lake acoustic telemetry tracking, supplemented by stable isotope analysis of pike prey utilization and survey fishing data on the prey fish community. Pike displayed increased activity, space use, individual growth as well as behavioural differentiation and spent more time in open waters in the LSC lake. Despite observed differences between lakes, stable isotopes analyses indicated a high dependency on littoral food sources in both lakes. We concluded that pike in the HSC lake displayed a behaviour consistent with a prevalent ambush predation behaviour, whereas the higher activity and larger space use in the LSC lake indicated a transition to more active search behaviour. It could lead to increased prey encounter and cause better growth in the LSC lake. Our study demonstrated how differences in structural complexity mediated prominent changes in the foraging behaviour of an apex predator, which in turn may have effects on the prey community.

Attachment in patients with an obsessive compulsive disorder.

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.

Nightmares in obstructive sleep apnoea.

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.

Self-stigma, severity of psychopatology, dissociation, parental style and comorbid personality disorder in patient with neurotic spectrum disorders Part 2: Therapeutic efficacy of intensive psychotherapeutic inpatients program.

OBJECTIVES: The effect of short-term psychodynamic psychotherapy in patients with neurotic spectrum disorders may be related with predictive factors such as the severity of the disorder, diagnosis, self-stigma level, personality characteristics, comorbidity with depression and personality disorder, dissociation, and traumatic childhood experience. This study focuses on finding factors related to the effect of short-term psychodynamic psychotherapy in patients with neurotic spectrum disorders. METHOD: The study was conducted at the Psychotherapeutic ward of the Psychiatric Department in Regional Hospital Liberec from October 2015 to March 2019. The assessment method used at the beginning was the objective and subjective Clinical global impression (objCGI, subjCGI), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI-II), Dissociative Experience Scale (DES), Liebowitz Social Anxiety Scale (LSAS), Internalized Stigma of Mental Illness (ISMI), Temperament and Character Inventory (TCI), Parental Bonding Style (PBI), Childhood Trauma Questionnaire (CTQ). The 6-week therapeutic program combines group dynamic psychotherapy (4 times a week for 1.5 hours), pharmacotherapy and other therapeutic activities. The primary criterium of therapeutic outcome was the change in objCGI severity, and the secondary criteria were changes in subjCGI, BAI and BDI-II. RESULTS: A total of 96 hospitalized patients with neurotic spectrum disorder diagnosed according to ICD-10, confirmed with the MINI (MINI-International Neuropsychiatric Interview) were included in the study and filled out the questionnaires' battery. There was a statistically significant decrease in the anxiety and depression symptoms and an overall decrease in the disorder's severity during the treatment. At the beginning of the treatment, a higher self-stigma rate was associated with a smaller decrease in anxiety symptoms (BAI) and depression (BDI-II). However, self-stigma is not a factor associated with the change in primary outcome criteria (objCGI change). Initial assessment of objective severity of the disorder (objCGI) and personality factor Novelty Seeking predict the change in objCGI severity. CONCLUSIONS: Self-stigma predicted the change in anxiety and depressive symptom but not the change of the disorder's global severity in short-term psychodynamic psychotherapy of patients with a neurotic spectrum disorder.

Self-stigma, severity of psychopatology, dissociation, parental style and comorbid personality disorder in patient with neurotic spectrum disorders Part 1: Relationships between self-stigma and clinical, psychosocial and demograph.

OBJECTIVES: Self-stigma represents a process of accepting negative social prejudices with a consequent negative impact on many areas of the patient's life (self-concept, social and work functioning, relationships, cooperation in treatment, quality of life, willingness to strive for something). The study was aimed to examine the level of self-stigma and other significant variables potentially related to self-stigma (personality characteristics, childhood traumatisation, anxiety, depression, personality disorder, dissociation, parental styles, attachment). METHOD: The study was conducted at the Psychotherapeutic section of the Psychiatric Department in Regional Hospital Liberec from October 2015 to March 2019. A total of 96 hospitalised patients with neurotic spectrum disorders diagnosed by an experienced psychiatrist according to ICD-10 (panic disorder and/or agoraphobia, social phobia, generalised anxiety disorder, mixed anxiety depressive disorder, somatoform disorder, obsessive-compulsive disorder, adjustment disorders) were included into the study and filled in the test battery. RESULTS: The main finding is that self-stigma is related to the severity of the disorder, anxiety and depression, social anxiety, the comorbid occurrence of other anxiety disorders or personality disorders, dissociation, personality temperamental traits Harm Avoidance, Reward Dependence and Self-Directedness. We have not established a connection between attachment in close relationships and self-stigma. The most important predictors of self-stigma are the disorder's duration, reduced Self-Directedness, a higher rate of depression and social anxiety, which together explain 58% of severity if self-stigma. CONCLUSIONS: Self-stigma is a contemporary topic in research and clinical practice. The results can be used as a basis for the development of targeted intervention strategies aimed at reducing self-stigma or for further research studies in the field of self-stigma.

Borderline personality disorder and recovery.

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.

Insomnia in Patients with Borderline Personality Disorder.

OBJECTIVE: Both sleep disorders and BPD are prevalent in the population, and one is often a comorbidity of the other. This narrative review aims to assess contemporary literature and scientific databases to provide the current state of knowledge about sleep disorders in patients with borderline personality disorder (BPD) and clinical suggestions for managing sleep disorders in BPD patients and future research direction. METHODS: Articles were acquired via PubMed and Web of Science, and papers published between January 1980 and October 2020 were extracted. Authors made a series of literature searches using the keywords: Sleep problems, Insomnia, Nightmares, Obstructive sleep apnea, Borderline personality disorder. The inclusion criteria were: published in peer-reviewed journals; studies in humans; or reviews on the related topic; English language. The exclusion criteria were: abstracts from conferences; commentaries; subjects younger than 18 years. After an inspection of the full texts, 42 papers from 101 were selected. Secondary documents from the reference lists of the primary designated papers were searched, assessed for suitability, and included. In total, 71 papers were included in the review process. RESULTS: Sleep disturbance is common among patients with BPD. Nevertheless, the number of investigations is limited, and the prevalence differs between 5-45%. Studies assessing objective changes in sleep architecture in BPD show inconsistent results. Some of them identify REM sleep changes and a decrease in slow-wave sleep, while other studies found no objective sleep architecture changes. There is also a higher prevalence of nightmares in patients with BPD. Untreated insomnia can worsen BPD symptoms via interference with emotional regulation. BPD itself seems to influence the subjective quality of sleep significantly. Proper diagnosis and treatment of sleep disorders in patients with BPD could lead to better results in therapy. Psychotherapeutic approaches can improve both sleep disorders and BPD symptoms. CONCLUSION: Recognising and managing sleep disorders in patients with BPD may help alleviate the disorder's symptoms. Treatment of people with BPD may be more effective if the treatment plan explicitly addresses sleep problems. Further research is needed to reach reliable conclusions.

Sleep Disturbances in Patients with Nonepileptic Seizures.

OBJECTIVE: Up to 20% of patients treated for epileptic seizures experience psychogenic nonepileptic paroxysms (PNES). These patients present a significant burden for the health care systems because of poor treatment outcomes. The presented review aims to summarize the current state of knowledge on sleep disturbances in patients with nonepileptic seizures. METHODS: Articles were acquired via PubMed and Web of Science, and papers between January 1990 and March 2020 were extracted. Inclusion criteria were (1) published in a peer-reviewed journal: (2) studies in humans only; or (3) reviews on a related topic; (4) English language. The exclusion criteria were: (1) abstracts from conferences; (2) commentaries; (3) subjects younger than 18 years. From primary assessment, 122 articles were extracted; after obtaining full texts and secondary articles from reference lists, 45 papers were used in this review. RESULTS: Limited data are available regarding sleep disorders in PNES patients, over the last 30 years only nine original research papers addressed sleep problems in patients with PNES with only six studies assessing objectively measured changes in sleep. Current literature supports the subjective perception of the sleep disturbances with mixed results in objective pathophysiological findings. Conflicting results regarding the REM phase can be found, and studies reported both shortening and prolonging of the REM phase with methodological limitations. Poor sleep quality and shortened duration have been consistently described in most of the studies. CONCLUSION: Further research on a broader spectrum of patients with PNES is needed, primarily focusing on objective neurophysiological findings. Quality of life in patients suffering from PNES can be increased by good sleep habits and treatment of comorbid sleep disorders.

Self-Stigma and Treatment Effectiveness in Patients with SSRI Non-Responsive Obsessive-Compulsive Disorder.

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.

Fluctuations in pelagic fish density linked to ambient conditions.

Animal behaviour has been broadly studied for its social or functional aspects but less often for understanding the interactions between organisms and their ambient conditions. A pilot observational study was performed by means of underwater camera to investigate the correlation between environmental factors and the density of fish in the epipelagic habitat of a European temperate reservoir. Explored factors confirmed a positive correlation between water temperature and all observed categories: nonpredatory, predatory, single nonpredatory and schooling fish, as well as freshwater bream and roach. On the other hand, de-trended solar irradiance was found to be negatively correlated with density of nonpredatory fish, freshwater bream and European perch. Sunshine duration was negatively correlated with the density of predatory fish. Precipitation a showed positive relationship with single nonpredatory fish and European perch, whereas wind strength had a negative relationship with density of schooling fish. Furthermore, density of predatory fish was positively correlated with density of single nonpredatory fish and counts of observed clusters. Altogether, findings indicate that fish density is correlated with abiotic factors and the occurrence of predators. This suggests that more ecologically complex studies should be encouraged for better understanding of ecological interactions that drive the structure of aquatic ecosystems.

Diel changes in vertical and horizontal distribution of cladocerans in two deep lakes during early and late summer.

Temporal and spatial heterogeneity in the distribution of cladocerans in lakes could be caused by abiotic (wind, water currents) and biotic factors (reproduction, food resources, predation). Diel horizontal and vertical distribution of cladoceran assemblages was studied in two deep lakes (Milada and Most Lakes, Czech Republic) in early (June) and late (September) summer. The objective was to study diel vertical migration (DVM) and diel horizontal migration (DHM) of cladocerans under conditions of different macrophyte cover in littoral areas (rich in Milada Lake, poor in Most Lake) and fish assemblages (non-specialised planktivorous species in Milada Lake, and abundant planktivorous fish - maraena whitefish, Coregonus maraena - in open water habitats in Most Lake). Temporal variations in cladoceran assemblages were reported in both lakes in the two sampling periods. DVM was observed in the two lakes, performed by the most vulnerable species to fish predation (the larger Daphnia spp.), but with different patterns (direct and reverse) probably linked with the local fish community and other biotic and abiotic factors in each lake. Horizontal movements were only observed in Most Lake: D. longispina increase its abundance in open waters at night compared to the littoral points; while Ceriodaphnia spp. showed the inverse pattern. In both lakes, higher densities were often found at night in surface layers, producing a great "diurnal deficit": cladocerans remain undetected in some zones during the day (especially in the littoral areas) moving to surface layers at night.

Marriage in a panic: Panic disorder and intimate relationships.

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.

Insomnia and emotion regulation.

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.

Nightmares and their treatment.

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.