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.

Stigma and self-stigma in borderline personality disorder: A narrative review.

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.

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.

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.

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.

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.

Early life experiences and adult attachment in obsessive-compulsive disorder. Part 2: Therapeutic effectiveness of combined cognitive behavioural therapy and pharmacotherapy in treatment-resistant inpatients.

OBJECTIVES: Obsessive-compulsive disorder (OCD) is a chronic mental disorder that is often hard to treat with current treatment options. Therapeutic outcomes are predicted by many factors, ranging from biological to psychosocial. Early life experiences and adult attachment influence the effectiveness of the treatment. This study explores their predictive abilities in the combined treatment of adult inpatients with OCD. METHODS: Seventy-seven patients with OCD, diagnosed according to the ICD-10 criteria, were included in the study, out of which 66 patients completed the treatment. All patients were previously unsuccessfully treated with a minimum of two antidepressants for three months each. They were evaluated with rating scales and questionnaires at the start and the end of a six-week hospitalization in a psychotherapeutic department. The treatment approach presented a combination of group cognitive-behavioural therapy and medication. RESULTS: The average severity of OCD, anxiety and depressive symptoms significantly decreased during the inpatient treatment. The improvement in Y-BOCS negatively correlated with the age of onset. The history of emotional abuse and neglect and physical neglect predicted a lower change in anxiety evaluated by a psychologist and perceived maternal care positively correlated with a decrease in anxiety assessed with a rating scale. Adult attachment anxiety predicted a lower decrease in the anxiety measured by the clinician but not the OCD symptomatology. Dissociative symptoms did not significantly predict a change in any of the measures. Comorbid personality disorder did not have a significant impact on therapeutic change. CONCLUSIONS: The early onset of the disorder was the sole predictor of the treatment outcomes regarding specific OCD symptomatology. Selected early adverse experiences, maternal care, and adult attachment anxiety predicted a change in the anxiety symptoms. Future research should focus on mediation and moderation analyses that could help target specific treatment strategies to decrease the impact of these factors.

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 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.

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.

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.

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.

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.

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.

Obstructive sleep apnea, depression and cognitive impairment.

OBJECTIVE: Obstructive sleep apnea (OSA) is a severe disorder with a high prevalence. Psychiatric comorbidities, especially depressive symptoms and cognitive dysfunction, are often described in OSA patients. This narrative review aims to examine: (1) the relationship between obstructive sleep apnea syndrome (OSAS) and depressive and cognitive symptoms, and (2) the effect of OSAS treatment on psychiatric symptoms. METHOD: Articles that were published between January 1990 and August 2018 were searched and extracted via PubMed, and Web of Science databases. Authors analyzed the papers and its references using the following keywords: obstructive sleep apnea, depression, cognitive dysfunction, anxiety disorders, and continuous positive airway pressure (CPAP). A total of 632 articles were nominated. After the selection according to the inclusion and exclusion criteria, 172 articles were chosen. After complete inspection of the full texts, finally, 58 papers were selected. Secondary papers from the reference lists of the primarily designated papers were also searched, assessed for suitability, and added to the first list of the papers (n = 67). In total, 125 papers were included in this review. RESULTS: There is a significant overlap in depressive, anxious and OSA symptoms. Studies also show that attention, working memory, episodic memory, and executive functions are decreased in OSA. Conversely, most of verbal functions remain intact and variable results are found in psychomotor speed. Several studies implicated that in some fields of cognitive functions (eg, attention) deficit caused by untreated OSA can be irreversible and shows only partial recovery after a period of treatment with CPAP. CONCLUSIONS: Untreated OSA impacts affective disorders, and often leads to decline of cognitive functions or even leads to permanent brain damage. Further studies are needed to analyze the connection between OSA and affective disorders, anxiety disorders and its effect on cognitive functions more thoroughly, especially in the context of CPAP treatment.

Severity of panic disorder, adverse events in childhood, dissociation, self-stigma and comorbid personality disorders Part 1: Relationships between clinical, psychosocial and demographic factors in pharmacoresistant panic disorder patients.

OBJECTIVES: Little is known about the relation between severity of panic disorder, adverse events in childhood, dissociation, self-stigma and comorbid personality disorders. The aim of this study is to look for the intercorrelations between these factors. METHOD: The study explores the relation between clinical, demographic and social factors in panic disorder using cross sectional design. The inpatients with pharmacoresistant panic disorder with and without agoraphobia were included in the study. Participants were also assessed for comorbidity with other anxiety or personality disorder. The Clinical Global Impression (CGI), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI-II), Dissociative Experiences Scale (DES), Internalized Stigma of Mental Illness (ISMI), Childhood Trauma Questionnaire-Short Form (CTQ-SF), Panic Disorder Severity Scale (PDSS) and demographic data were used as measurement tools. RESULTS: A total of 142 pharmacoresistant patients with panic disorder with or without agoraphobia were admitted for 6-week cognitive behavioral therapy inpatient program in psychotherapeutic department between November 2015 and July 2019. One hundred and five inpatients (33 males and 72 females) with mean age 37.8 + 12.1 years were included in the study. Sixty-nine patients suffer from additional comorbid anxiety disorder and 43 had comorbid personality disorder.