Positive and negative symptoms in schizophrenia and their relation to depression, anxiety, hope, self-stigma and personality traits - a cross-sectional study.

OBJECTIVE: The purpose of the investigation was to explore the relationship between positive or negative symptoms, social anxiety, hope, personality, and self-stigma in patients with schizophrenia spectrum disorders. METHOD: 57 outpatients took part in this cross-sectional study. The structured interview M.I.N.I. International Neuropsychiatric Interview was used to confirm the diagnosis. All patients completed the Liebowitz Social Anxiety Scale, Internalized Stigma of Mental Illness Scale, Beck Depression Inventory-II, Beck Anxiety Inventory, Adult Dispositional Hope Scale, and Temperament and Character Inventory - Revised. The disorder severity was evaluated by Clinical Global Impression - Severity scale, and Positive and Negative Syndrome Scale. The patients were in a stabilized state that did not require hospitalization or modifications in the treatment. RESULTS: Both positive and negative symptoms of schizophrenia positively correlated with the length of the disorder, global severity of the disorder, the severity of the general and social anxiety symptoms, the severity of self-stigma, and negatively with personality traits Self-directedness and Cooperativeness. Only negative symptoms significantly positively correlated with the severity of depressive symptoms and personality trait Harm-avoidance and negatively with the hope and personality trait Persistence. Comorbidity with social phobia is associated with statistically significantly higher mean scores on the total score of schizophrenic symptomatology, negative subscale average rating, and general psychopathological items measured by PANSS. Patient with comorbid depression would experience a higher level of negative symptomatology than patients without such comorbidity.

Anxiety disorders and marital satisfaction.

OBJECTIVES: Anxiety disorders can be a burden for the patient and his family. They affect the family everyday functioning, require greater demands on adaptation and re-evaluation of the existing habits of family members and consequently may result in family dysfunction due to anxiety disorders, especially in marital relationship or partnership. However, the knowledge about the impact of anxiety disorders on one or both partners in marital or partner life is still limited. METHOD: The relevant studies were identified through the Web of Science, PubMed, and Scopus databases, within the period 1990-2017. Additional references were found using reviews of relevant articles. The search terms included "anxiety disorders,""marital problems," "marital conflicts," "partnership," "family functioning," and "communication." RESULTS: Dissatisfaction in a relationship can act as a trigger for the development of anxiety disorders and could also be responsible for the modulation and maintenance of these disorders. However, this dissatisfaction may also be the consequence of manifestation of the anxiety disorders. The individuals with the anxiety may feel guilty about their partners because of the tolerance and help (does not matter what kind and quality of the help he/she provides), sometimes they are submissively grateful because of the support, they may feel inferior, tend to serve him /her. On the other hand, he/she begins to rebuke partner's supposed negative attitudes; the patient may start to use his psychological problems as an excuse and expects others to help him and solve the situation. Consequently, he /she starts to check and criticize the partner and this tense situation may lead to problems in marriage and disturbs family functioning. CONCLUSION: Distress elements that contribute to the development of anxiety disorders can be diverse and sometimes it is not easy to identify so-called precipitating factors. The link between anxiety disorders and family relationships is bi-directional: psychological problems adversely affect patient relationships and attitudes of the partner towards the patient significantly affect his/her anxiety.

Three diagnostic psychiatric subgroups in comparison to self-stigma, quality of life, disorder severity and coping management cross-sectional outpatient study.

BACKGROUND: Much attention has been paid to psychological factors influencing characteristics, severity, and course of mental disorders. The objective of our investigation was to examine the interrelations among quality of life (QoL), self-stigma, and coping strategies, demographics and severity of the disorder in neurotic spectrum disorders, schizophrenia, and depressive spectrum disorders. METHODS: A total of 343 clinically stable Czech outpatients with different mental disorders (153 with neurotic spectrum disorders; 81 with depression, and 109 with schizophrenia spectrum disorders) were included. The patients were examined by their outpatient psychiatrists during regular psychiatric checkup and completed a sociodemographic questionnaire, the Quality of Life Satisfaction and the Enjoyment Questionnaire (Q-LES-Q), the Internalized Stigma of Mental Illness Scale (ISMI), the Stress Coping Style Questionnaire (SVF-78), and the Clinical Global Impression scale (CGI). RESULTS: The study demonstrates that the self-stigma and coping strategies are significant factors linked to the QoL in all diagnostic groups of patients. Patients with schizophrenia spectrum disorders had lower scores in QoL compared to the other two groups. The patients with depression or neurotic spectrum disorders had a lesser degree of self-stigma than the patients with schizophrenia spectrum disorders. The severity of the illness significantly correlated with the QoL, self-stigma, and coping strategies. CONCLUSIONS: The investigation confirmed the connection between the quality of life, self-stigma, coping strategies, and the severity of the illness, in outpatients with schizophrenia spectrum disorders, depressive, and neurotic spectrum disorders. A further longitudinal study would be useful to determine the causative relationships of these variables.

Personality disorder in marriage and partnership - a narrative review.

BACKGROUND: Partner conflicts are the most common precipitating factors of decompensation of psychiatric disorders, including personality disorders. Personal characteristics play a fundamental role in both the prediction of marital satisfaction of the individual as well as the satisfaction of the couple as a whole. METHOD: Narrative Review of the articles, books and book chapters within the period 1956 - 2016 using PubMed, Web of Science, and Scopus databases with keywords "personality disorder," "partnership," marital problems," "marital conflicts." Additional references were found using reviews of relevant articles. RESULTS: It is evident that patients with personality disorders can have problems with meeting the criteria that contribute to the marital satisfaction and, on the other hand, easily fulfill the criteria that are related to the causes of the relationship breakups. People with personality disorders have substantial problems with starting and continuing a relationship with a partner. They have an unintentional ability to create and maintain problematic relationships. The association between the dysfunctional marriage and personality problems of the partners may have the basis in the insufficient understanding of the behavior of one or both partners. People with personality disorder experience numerous misunderstandings, misinterpretations, communicate poorly, and they are more alert to verbal and physical aggression in the interpersonal relations. They do not recognize that the basis of experienced struggles has a source in their intrapersonal processes and their relationship with the world. Persons with certain personality disorders tend to seek and create a pathologically stable partnership. To understand the dynamics of such relationships, examining personality traits first should be essential. Understanding the maladaptive personality patterns in the context of the relationship should be beneficial for both partners.

Discrepancy between readiness to change, insight and motivation in alcohol-dependent inpatients.

BACKGROUND: Poland, Czech Republic, and the Slovak Republic are countries with high alcohol consumption, and alcohol-induced disorders are in the ten leading causes of Years Lost due to Disability. Therefore it is necessary to study factors as insight, motivation, and readiness to change for the better understanding the variables which are in probably connected with therapeutic effectiveness. AIM: The purpose of the study was to examine the state of readiness to change at the beginning and the end of inpatient short (six weeks) and long (12 weeks) therapeutic program in the Slovak Republic, Poland, and the Czech Republic, and look for the relationship between readiness to change, insight, and motivation in alcohol-dependent persons. METHODS: We studied a sample of 380 alcohol-dependent inpatients (282 men and 98 women) by Alcohol Use Disorders Identification Test (AUDIT), The Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES), Readiness to Change Questionnaire (RCQ), and Demographic Questionnaire. RESULTS: The unmarried patients declare a higher severity of alcohol dependence than married or divorced ones in AUDIT questionnaire. At the beginning of the treatment, the majority of patients declared Action (68.5%) or Preparation (26.3%) motivation stage according to RCQ questionnaire. At the end of the treatment, married patients showed higher readiness to change in domain Taking steps of SOCRATES questionnaire. The unmarried patients displayed the decrease of domain Ambivalence. The duration of the completed therapeutic program may not be crucial for improvement in preparedness to change. CONCLUSIONS: The intention and motivation to alcohol dependence treatment seem to be high at the beginning of the treatment, but recognition of the alcohol problems were low in highly dependent patients. Marital status was connected with an increased active component for readiness to change. The passive component (decreasing the ambivalence) was observed in the unmarried patients.

Measuring hope: Standardization of the Czech version of the Adult Dispositional Hope Scale in healthy adults.

OBJECTIVES: Hope is an important factor that influences mental state of individuals and efficacy of systematic and supportive psychotherapy. The goal of the study was to translate the Adult Dispositional Hope Scale (ADHS) to Czech, evaluate its psychometric properties and create norms to interpret the scale scores. METHODS: The scale consists of twelve items. Four items assess the ability of pathway thinking, four items measure agency, and the remaining four items are fillers that are not interpreted. There were 394 adult participants with negative psychiatric history who completed the ADHS and BDI-II. Their mean age was 27.1±11.7 years, most of them were women (n=303; 76.9%). RESULTS: There was no significant relationship between age or sex and hope. Reliability was analyzed by Cronbach alpha (α=0.82) and the split-half method (Spearman-Brown coefficient = 0.81). The factor structure of the scale was approved by the results of exploratory and confirmatory factor analysis, except the ninth item that similarly saturated both subscales. The ADHS moderately negatively correlated with BDI-II. Norms were created for the scores of the entire scale and both subscales. CONCLUSION: The Czech version of the Adult Dispositional Hope Scale shows adequate psychometric properties.

Cognitive function and depressivity before and after cpap treatment in obstructive sleep apnea patients.

OBJECTIVE: The target of the investigation was to find if there is any improvement of depressive symptoms and cognitive functioning after continuous positive airway pressure (CPAP) treatment in the severe obstructive apnea (OSA) patients. METHOD: The study included 59 patients treated with CPAP for OSA in the Sleep Laboratory of the Department of Respiratory Medicine. Thirty-eight patients were treated with CPAP for one month, and twenty-one patients were in a control group. We used the following methods: Test of Visual Memory (ViMe), Numeric Rectangle, d2 (test of attention), and the Beck Depression Inventory-II, respectively. RESULTS: Among the OSA patients, there were statistically significant improvements in all parameters: attention, working memory, and depressive symptoms after the treatment with CPAP. We found a statistically significant positive connection between the decrease in depressive symptoms and the improvement in attention. In the control group, there were no improvements in the investigated factors. CONCLUSIONS: According to our results, the patients with sleep apnoea improved their mood and cognitive functions during the treatment by the CPAP device.

Insight in schizophrenia - a double-edged sword?

Lack of insight is defined as a loss of ability to distinguish that one's unusual and unreal experiences should be the symptoms of the psychiatric disorder requiring treatment. Lack of insight may be considered as a core symptom of schizophrenia. The concept of insight has been regarded for a long time as necessary for treatment, which improves adherence and makes a better prognosis. Increased insight in schizophrenia has been associated not only with benefits, but also bring trouble in the form of self-stigma, low self-esteem, reduced patient's hope, diminished quality of life, and increased suicidality. Therefore, insight should be managed with sensitive monitoring of the risk factors, and be gradual, carefully supported by the encouragement of hope and confidence to managing everyday life.

Minimal role of comorbid personality disorder on the quality of life in patients with anxiety spectrum disorders.

OBJECTIVES: There is no consensus on the definition of Quality of life (QoL). It is considered to be comprised of both psychological and somatical well-being. A variety of tools has been developed to measure subjective and objective (QoL). A number of factors, including demographical and medical may have an impact on QoL. The aim of our study was to compare the QoL in selected anxiety disorders and evaluate the influence of comorbid personality disorder. METHOD: We evaluated data from 278 patients suffering from social phobia, panic disorder and/or agoraphobia, adjustment disorder, generalized anxiety disorder and obsessive-compulsive disorder. Personality disorders were diagnosed in 90 probands. The Quality of Life Enjoyment and Satisfaction (Q-LES-Q) was used to assess patients´perceived QoL. RESULTS: Up to our data there was no statistical difference in overall score of quality of life in selected anxiety disorders. The only significant difference between patients was found in subscale "household." Comorbid personality disorder had no influence on the overall score or any domain of Q-LES-Q. CONCLUSION: Our study proved that presence of anxiety disorder means a decrease in QoL. Particular anxiety disorders did not differ in overall scores of Q-LES-Q. Furthermore, comorbid personality disorder had no impact on quality of life of patients.

Borderline personality disorder and unmet needs.

BACKGROUND: Borderline personality disorder (BPD) is a disabling psychiatric condition with a chronic and challenging course. BPD is reflected as a disorder of self-regulation" and is associated with both psychological vulnerabilities and social relations that fail to support basic emotional needs. The objective of the paper is to provide the up-to-date data on the unmet needs of BPD patients and their families. METHOD: A computerized search of the literature printed between January 1990 and May 2017 was conducted in PubMed, and additional papers were extracted using keywords "borderline personality disorder,"needs," "pharmacotherapy," "psychotherapy," "CBT," and "family" in various combinations. According to the eligibility criteria, 57 articles were chosen. Secondary articles from the reference lists of primarily identified papers have been selected for the eligibility and added to the first list (N=151). RESULTS: The results were divided into three categories: the needs connected with (1) the symptom control; (2) the treatment; (3) the quality of life. The needs connected with symptoms were described issues such as emotional needs, social interactions, self-harm, parasuicide, suicidality, comorbidity, mentalization, identity disturbance, moreover, barriers to treatment. The needs connected with the treatment described are focused on needs for early diagnosis, early intervention, holding environment, therapeutic relation, assertive community treatment, destigmatization, hospitalization, and primary care. The needs connected with the quality of life involve family needs, physical health, spiritual needs, advocacy needs, and needs for the separation-individuation. The part focused on implications for the treatment presented several treatment approaches, focusing mostly on the their basics and efficacy. CONCLUSION: Observing the patients' needs may be essential to the treatment of the individuals suffering from BPD. However, many needs remain unmet in the areas linked to medical, personal, and social factors. A bigger focus on the patients' needs could be beneficial and should be targeted in the treatment.

Depression and obstructive sleep apnea.

OBJECTIVE: Obstructive sleep apnea (OSA), is described as intermittent interruptions or reductions in airflow which are initiated by an incomplete or complete collapse of the upper airways despite respiratory effort. When left untreated, OSA is connected with comorbid conditions, such as cardiovascular and metabolic illnesses. METHOD: The PubMed database was used to examine papers published until April 2017 using the subsequent terms: "obstructive sleep apnea" or "obstructive sleep apnoea" and "depression" in successive combination with "CPAP (continuous positive airway pressure)", "therapy", "pharmacotherapy", "psychotherapy", "cognitive behavioral therapy" or "quality of life". RESULTS: After assessment for the suitability, 126 articles were chosen. The numerous evidence of a connection between OSA and depressive symptoms, as well as depressive disorder, were found. This connection may be directly or indirectly linked due to the participation of some OSA mediators consequences such as obesity, hypertension, and the decreased quality of life. Patients with the comorbid major depression and OSA reported more severe and longer episodes of depression. Nevertheless, the information on the effect of the treatment of OSA using CPAP on the depressive symptoms was limited. Still, the current state of the art suggests that this treatment decreases the severity of the comorbid depressive symptoms. CONCLUSIONS: It is important to evaluate the symptoms of depression in the patients with OSA. On the other side, a psychiatrist should not just treat the depression, as it is also important to screen individuals at high risk of OSA when assessing patients for depressive disorder, especially those with depression resistant to treatment.

Adherence, self-stigma and discontinuation of pharmacotherapy in patients with anxiety disorders - cross-sectional study.

INTRODUCTION: Treatment adherence is one of the main factors affecting the success of treatment and, secondarily, the quality of life and social adaptation of the patients. The aim of this study was to investigate the association between self-stigmatization, treatment adherence and history of discontinuation of drug treatment. METHODS: The cross-sectional study was conducted on 120 (98 completed all the questionnaires) neurotic outpatients treated in the University Hospital Olomouc. The following variables were evaluated: the objective and subjective Clinical Global Impression (CGI) scale, Drug Attitude Inventory (DAI-10) questionnaire measuring adherence, Internalized Stigma of Mental Illness (ISMI) scale measuring self-stigma, and a demographic data questionnaire. RESULTS: Data analysis showed no correlation between self-stigmatization and age, age of onset or length of the post-hospitalization phase. However, there were significant correlations between self-stigmatization and the severity of the disorder (assessed by both objective and subjective CGI), number of previous hospitalizations, total number of psychiatrists visited by the patient, the arbitrary discontinuation of medication in the past, and the dose of an antidepressant. Furthermore, self-stigma was significantly negatively correlated with the current treatment adherence. The rate of adherence was negatively correlated with both objective and subjective CGI only. CONCLUSIONS: Self-stigma significantly affects the current adherence to the treatment of neurotic spectrum disorders.

Psychometric evaluation of the Czech Beck Depression Inventory-II in a sample of depressed patients and healthy controls.

OBJECTIVE: The goal of this study was to explore reliability and validity of the Czech revised Beck Depression Inventory (BDI-II) and to identify the best cut-off for a correct identification of a potentially depressed individual. METHOD: Two groups of adult participants entered the study. The first group consisted of 177 patients with depression (F32x or F33x according to the ICD-10). Furthermore, there were 767 healthy controls. Each participant filled in BDI-II. A part of the patients also completed the Beck Anxiety Inventory (BAI), the Dissociative Experiences Scale (DES), and the subjective Clinical Global Impression scale (CGI). A part of the controls filled in the Adult Dispositional Hope Scale (ADHS) and the Satisfaction with Life Scale (SWLS). RESULT: The average patients' BDI-II score was 30.8±10.3, the mean controls' score was 7.2±6.8. The internal consistency of the inventory was excellent (the ordinal alpha coefficient was 0.90 for the patients and 0.93 for the controls). The stability in time, measured two weeks apart, was also good (intra-class correlation coefficient r=0.83 for the patients and 0.77 for the controls). The exploratory factor analysis of the patients showed a three-factor solution, while the analysis of the controls' data identified two factors. As expected, BDI-II significantly positively correlated with BAI, DES, and CGI and was negatively connected to ADHS and SWLS. The cut-off score with the best sensitivity and specificity was 17. CONCLUSION: The Czech BDI-II shows adequate psychometric characteristics.

Can gut microbes play a role in mental disorders and their treatment?

The gut microbes, collectively called microbiota, are linked to the brain through a bidirectional system that involves the vagus nerve, the immune system, and various neurotransmitters. Stress response, memory functions, social behavior, and mood are modulated by microbiota. Furthermore, microbiota play a role in the development of the central nervous system. These features, established largely in rodent studies, have informed hypotheses about the role of microbiota in human psychiatric disorders. Microbiota affect phenomena that are known to be parts of the depression phenotype, such as exaggerated response to stress and inflammatory features. Furthermore, the role of microbiota in neurodevelopment and in the modulation of social behavior suggests the possibility of its role in autism spectrum disorder and in schizophrenia. If altered, microbiota play a role in psychiatric disorders, then efforts to normalize the gut microbial population by the ingestion of probiotics (live bacteria) could have antidepresssant or antipsychotic effects. Testing such hypotheses in translational human studies is a matter of future research.

Evaluation of the psychometric properties of the brief Internalized Stigma of Mental Illness Scale (ISMI-10).

OBJECTIVES: A significant number of psychiatric patients stigmatize themselves because of their mental struggles. Such self-stigmatization has an adverse impact on patients' well-being and effectiveness of the treatment of mental disorders. The goal of this study was to standardize the brief Internalized Stigma of Mental Illness Scale (ISMI-10), which could be used in studies targeting the self-stigma among the psychiatric patients. METHOD: 354 psychiatric patients participated in the study between the years 2012 and 2014. All individuals were undergoing treatment in the outpatient care or the psychotherapeutic ward of the Department of Psychiatry, University Hospital Olomouc. The mean age of the participants was 41.5±13.3 years. The majority of them were women (n=195). The patients suffered from various mental disorders - neurotic disorders (n=166), mood disorders (n=65), substance use disorders (n=47), psychoses (n=40), personality disorders (n=32), and organic mental illness (n=4). Each patient completed a demographic questionnaire and the ISMI-10. RESULTS: The ordinal alpha of the scale was 0.86, indicating its good internal consistency. The overall scores of the full and abbreviated version of the scale were almost perfectly correlated (r=0.95, p<0.001). The factor analysis confirmed a good internal structure of the scale. The created norms for the scale score were based on stens. CONCLUSION: The ISMI-10 may be a useful method for measuring the self-stigma among adults with a mental disorder. The area of its use lies mainly in research.

The impact of childhood adversities on anxiety and depressive disorders in adulthood.

OBJECTIVES: The childhood adversities model is generally accepted as a predictor of adult psychopathology vulnerability. It stems from child development theories, but the question remains as of how well solid research supports it. The aim of this article is to give a review of the studies concerning childhood adversities and their impact on the development of anxiety disorders and major depressive disorder in adulthood. METHOD: A computerized search of the MEDLINE database of publications up to 31 March 2016 was done, using the keywords "childhood adversities, abuse, maltreatment, bullying" and "anxiety disorders, depressive disorder". No backward time constraints were used. Non-original studies, conference abstracts, books and book chapters, commentaries, and dissertations were excluded. RESULTS: The influence of childhood adversities on later age psychopathology is examined in five categories: the negative family atmosphere, abuse, loss of a close person, the social difficulties, and problems at school (including, most importantly bullying). The majority of studies confirmed the connection between childhood adversities and anxiety and depression disorders in adulthood. The character of the adversities is not, apparently, a specific predictor for a concrete psychopathology. Multiple adversities are more frequently connected with depressive and anxiety disorders in adulthood, cumulating together in broader adverse context. CONCLUSION: Childhood adversities were found to increase vulnerability to the distress, depression, fear and anxiety later in the life. However, specific correlations between a given childhood adversity and a specific form of depression or anxiety disorder were either not found or weak. This is in line with the generally accepted view considering each of these factors a non-specific stressor increasing vulnerability to mood and affect disorders later in life.

Unmet needs of the patients with obsessive-compulsive disorder.

BACKGROUND: Obsessive compulsive disorder (OCD) is a disabling mental disorder with the chronic and difficult course. The disorder is accompanied by numerous limitations in personal and interpersonal functioning. OCD decreases the quality of life and the chance to maintain relationships and professional status. The patients with OCD often experience a severe disabling course of the disorder. Even the individuals, who follow treatment advice, are often still highly symptomatic. In the last decade, the concept of the needs has been assessed as an extent of the traditional outcome evaluation in order to focus on the identification of the specific needs of the patients and their relatives, improve the patients´ overall mental condition and quality of life, and also to increase the treatment effectiveness of the mental disorders. The objective of the article was to review the current literature about unmet needs of the OCD patients and their caregivers. METHOD: A computerized search of the literature published between January 2000 and June 2016 was conducted in MEDLINE, and additional papers were extracted using keywords "obsessive compulsive disorder","needs", "pharmacotherapy", "CBT", and "family" in various combinations. Primary selection selected the total of 449 articles. According to the established criteria, 168 articles were chosen. After a detailed examination of the full texts, 53 articles remained. Secondary articles from the reference lists of primarily selected papers were read and evaluated for the eligibility and added to the final list of the articles (n = 107). RESULTS: The needs of the OCD patients might differ at various stages and severity of the disorder. Four sets of the needs were identified: the needs connected with the symptoms, the treatment, the quality of life, and the family. The patients suffering from OCD often experience many limitations in the fulfillment of their fundamental human needs such as disturbed patients´ functioning in the common life, family, at work, in the ability to realize their goals, skills, potential, capacity to follow prescribed treatment, take medication, cooperate in addressing the root causes of their problems, reduce obsessive thoughts and compulsive behavior, as well as their willingness to realize exposures with the desire to resolve the situation. CONCLUSION: Monitoring the patients´ needs may be relevant for the treatment of the individuals suffering from OCD. A bigger focus on the patients´ needs could be beneficial and should be targeted in the treatment.

Unmet psychosocial needs in adolescents with inflammatory bowel disease.

BACKGROUND: Inflammatory bowel diseases (IBD) are severe medical conditions with adverse impact on the quality of life of both children and their caregivers. IBD are associated with many limitations in personal and interpersonal functioning, and it also restricts the patients' ability to use the full potential (extent) of their capabilities. With the progress and humanization in society, the issue of patients' needs became an important topic; however, the psychosocial functioning and quality of life of adolescents suffering from IBD and their caregivers have been understudied. The aim of this article is to provide a comprehensive, up-to-date literature review of the unmet needs of patients with IBD and their caregivers. METHOD: A computerized search of MEDLINE publications from 1990 to 2016 using the keywords "inflammatory bowel disease", "Crohn disease", "ulcerative colitis" and "unmet needs". In the period 1990-2016, the MEDLINE searches identified 54 publications. Articles cited in the papers from these searches were also used. The total number of 132 particular articles were collected, sorted by their relevance and key articles (n=72) listed in reference lists were searched. RESULTS: Patients' needs differ at various stages of the illness and may have different origins and goals. Thus, we divided the needs into five groups according to their nature; i.e. needs to be connected with symptoms, treatment, quality of life, family and age-related challenges. We provide implications of the patients' needs for pharmacotherapy and psychotherapy. CONCLUSION: Following the needs of patients with IBD may be a crucial part of the therapeutic process. Due to the better understanding and cooperation, the impact of disease could be reduced, and the physical and mental condition of the patient could be improved. However, many needs remain unmet due to both medical and social factors.

The circadian system of patients with bipolar disorder differs in episodes of mania and depression.

OBJECTIVES: Bipolar disorder is a common psychiatric disease characterized by mood disturbances with alternating episodes of mania and depression. Moreover, disturbances in the sleep/wake cycle are prevalent. We tested a hypothesis that the function of the circadian system, which drives the sleep/wake cycle, may differ in patients with bipolar disorder depending on whether they are experiencing an episode of mania or depression. METHODS: To assess the functional state of the central circadian clock, daily profiles of melatonin levels in saliva were determined. The functional state of the peripheral clocks was assessed by determining daily profiles of Per1 and Nr1d1 clock gene expression in buccal mucosa cells. Sixteen patients with bipolar disorder in a manic episode, 22 patients in a depressive episode, and 19 healthy control subjects provided samples at regular intervals during a 24-hour cycle. RESULTS: During episodes of mania, the daily profiles of melatonin differed compared with healthy controls and patients in an episode of depression, mainly due to elevated melatonin levels during the daytime. No difference was found between melatonin profiles of control subjects and patients in depression. The Per1 and Nr1d1 profiles were advanced in patients in mania compared with those in depression. Compared with controls, a trend toward an advance was apparent in the profiles of patients during an episode of mania but not depression. The amplitude of the Nr1d1 expression profile was higher in mania than in depression. CONCLUSIONS: The data revealed differences in the functional state of the circadian system in patients with bipolar disorder depending on whether they were experiencing a manic or a depressive episode.

What fMRI can tell as about panic disorder: bridging the gap between neurobiology and psychotherapy.

Fifty years ago, when the effect of antidepressants on panic disorder was described, a significant progress in understanding this anxiety disorder has been made. Theoretical mechanisms and models of fear and panic disorder were proposed and tested in animal models and humans. With growing possibilities of non-invasive neuroimaging techniques, there is an increasing amount of information on the panic disorder. Unfortunately, a number of circumstances lead to inconsistent findings and its interpretations. In our review, we focused on functional MRI in panic disorder, limitations of current studies, possible interpretations and proposals for future direction. In our opinion, the current findings support the neuroanatomical model of panic disorder at the level of group data analysis. But at the same time, the results suggest significant inter-individual differences across the patients, which may be related to each patient's individual history, woven into their neural network and affecting the individual symptoms and response to therapy.