Jan Prasko
Palacky University, Olomouc, Psychiatry, Faculty Member
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Many of patients suffering with affective, dissociative and dissociative disorders experienced significant stressful or traumatic events from childhood or later in their life. Many of them suffer as children with unsatisfactory fulfilled... more
Many of patients suffering with affective, dissociative and dissociative disorders experienced significant stressful or traumatic events from childhood or later in their life. Many of them suffer as children with unsatisfactory fulfilled basic child's needs, such as security, acceptance or approbation. Without the systematic processing these traumatic experiences the treatment is unsuccessful and their problems persist. Although CBT stresses the importance of cognitions or thoughts in activating or maintaining negative affects, there has been increasing emphasis on considering the role of emotional processing. Many of our patients believe that one should be rational and logical all the time, never have conflicting feelings, and should ruminate in order to figure things out. Meaningful cognitive and simultaneously experiential technique for working with deep emotional schemas, formatted in childhood, is imaginal rescripting of the traumatic events, role playing and writing the therapeutic letters. Inclusions of emotion regulation skills in the treatment especially for patients with dissociative disorders enhance the efficacy of CBT. Several examples of emotional processing and trauma rescripting will be presented. Supported by the project IGA MZ CR NT 11047-4/2010
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www.meduca.sk / PSYCHIATRIA PRE PRAX 4 / 2004 Úvod Vyhýbavá porucha osobnosti se projevuje relativně trvalými vzorci přecitlivělosti, napětí a inhibice v sociálních situacích. Člověk s vyhýbavou poruchou osobnosti prožívá neustálé napětí... more
www.meduca.sk / PSYCHIATRIA PRE PRAX 4 / 2004 Úvod Vyhýbavá porucha osobnosti se projevuje relativně trvalými vzorci přecitlivělosti, napětí a inhibice v sociálních situacích. Člověk s vyhýbavou poruchou osobnosti prožívá neustálé napětí a obavy, podceňuje sám sebe, předpokládá neúspěch ve svém jednání, bojí se druhých lidí, protože očekává v mezilidském kontaktu zásadně zranění, kritiku nebo odmítnutí. Vyhýbá se proto sociálním situacím, kde by mohl být druhými odmítnutý, ačkoliv po mezilidském kontaktu a po blízkých vztazích velmi touží. Vůči druhým se cítí méněcenný a neschopný, obává se nových činností ze strachu, že se před druhými ztrapní. Přitom velmi touží po vytvoření blízkého osobního vztahu, ale cítí se velmi nejistý s druhými setkat a vyjádřit jim svoje pocity (35).
Celoživotni prevalence schizofrenie se pohybuje podle epidemiologických studii mezi 1–1,5 %. I když moderni farmakoterapie vedla k významnemu sniženi utrpeni nemocných, kolem 25 % schizofrennich pacientů je oznacovano za „farmakologicky... more
Celoživotni prevalence schizofrenie se pohybuje podle epidemiologických studii mezi 1–1,5 %. I když moderni farmakoterapie vedla k významnemu sniženi utrpeni nemocných, kolem 25 % schizofrennich pacientů je oznacovano za „farmakologicky rezistentni“ a 20–60 % přerusi uživani doporucene medikace. Kromě přiznaků odolavajicich lecbě býva průběh nemoci negativně ovlivňovan dalsimi faktory, jako je premorbidni osobnost, kognitivni deficit, rodinne a interpersonalni problemy, abuzus navykových latek a stigmatizace. Vsechny tyto okolnosti poukazuji na potřebu doplnit biologickou lecbu systematickými psychoterapeutickými intervencemi. Halucinace jsou projevem poruchy vnimani. U schizofrenie se nejcastěji vyskytuji halucinace sluchove, při kterých nemocný slysi domněle hlasy. Pacient si obsah halucinatornich prožitků interpretuje, casto bludně, což nasledně vede k negativnim emocnim reakcim a zjevnemu maladaptivnimu chovani. Cilem KBT je pomoci nemocnemu zaujmout k halucinacim kritictějsi po...
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Disociativni poruchy tvoři skupinu onemocněni s heterogennimi a mnohdy dramatickými projevy. Disociativni stavy jsou přitomny u řady jiných psychických poruch a disociativni poruchy bývaji nezřidka doprovazeny jinými komorbidnimi... more
Disociativni poruchy tvoři skupinu onemocněni s heterogennimi a mnohdy dramatickými projevy. Disociativni stavy jsou přitomny u řady jiných psychických poruch a disociativni poruchy bývaji nezřidka doprovazeny jinými komorbidnimi psychiatrickými poruchami. Existuje shoda na psychogenni etiologii onemocněni, ve větsině připadů nalezneme souvislost mezi traumatickými zažitky předchazejicimi rozvoj poruchy. Pohotovost reagovat na zatěž disociaci vznika dřive, casto v obdobi disharmonickeho dětstvi. Větsina disociativnich poruch vznika v kratkem casovem horizontu a maji tendenci ke spontanni remisi. Pokud onemocněni trva roky, casto chronifikuje a je rezistentni vůci terapii. Terapii volby jsou předevsim psychoterapeuticke intervence. Farmakologicke postupy se doporucuji u komorbidnich psychických symptomů. Specificka farmakoterapeuticka intervence pro disociativni stavy neni znama. Zkouman je efekt transkranialni magneticke stimulace mozku.
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... more
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.
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V nasi praci jsme hledali klinicke a elektrofyziologicke rozdily mezi pacienty s panickou poruchou, kteři dobře reagovali na lecbu, a kteři nereagovali dostatecně. Zkoumani pacienti byli leceni pomoci standardizovane KBT a větsina... more
V nasi praci jsme hledali klinicke a elektrofyziologicke rozdily mezi pacienty s panickou poruchou, kteři dobře reagovali na lecbu, a kteři nereagovali dostatecně. Zkoumani pacienti byli leceni pomoci standardizovane KBT a větsina pacientů zaroveň dostavala antidepresiva. Odpověď na lecbu byla definovana jako pokles v Beckově inventaři uzkosti o 25 %. Skupina responderů se od non-responderů na pocatku nelisila v elektricke aktivitě. U responderů doslo po lecbě ke statisticky významnemu (p < 0,05) sniženi alfa-2 aktivity (10,5–12 Hz) v oblasti okcipitalniho laloku a dale byl zaznamenan trend ke zvysovani beta-3 aktivity (21,5 – 30 Hz) v zadnim cingulu. U non-responderů nedoslo po terapii k žadne statisticky významne změně v sLORETA nalezu.
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U pacientů trpicich hranicni poruchou osobnosti (HPO) je lecbou volby dle větsiny doporucených postupů psychoterapie. Farmakoterapie je teoreticky považovana za adjuvantni a casto kontroverzni soucast komplexni lecby emocni nestability, v... more
U pacientů trpicich hranicni poruchou osobnosti (HPO) je lecbou volby dle větsiny doporucených postupů psychoterapie. Farmakoterapie je teoreticky považovana za adjuvantni a casto kontroverzni soucast komplexni lecby emocni nestability, v praxi býva aplikovana hojně. Cilem sděleni je referovat o farmakologicke lecbě uživane u pacientů v peci Kliniky psychiatrie FN Olomouc, zamyslet se nad důvody teto lecby a srovnat ji s doporucenými postupy v lecbě HPO. Byli zařazeni pacienti s diagnozou emocně nestabilni porucha osobnosti – hranicni typ, leceni ambulantně nebo hospitalizovani v roce 2011. Uživana medikace se nelisila od větsiny doporucených postupů, ale s přihlednutim k nedostatecným důkazům o jejim efektu se jevi jako vhodne směřovat k jeji redukci.
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ObjectiveGoal of the study was to analyze the impact of dissociation on the treatment of the patients with anxiety/neurotic spectrum and depressive disorders, and with or without personality disorders.MethodsThe sample consisted of... more
ObjectiveGoal of the study was to analyze the impact of dissociation on the treatment of the patients with anxiety/neurotic spectrum and depressive disorders, and with or without personality disorders.MethodsThe sample consisted of inpatients who met the ICD-10 criteria for the Depressive disorder, Panic disorder, GAD, Mixed anxiety-depressive disorder, Agoraphobia, Social phobia, OCD, PTSD, Adjustment disorders, dissociative/conversion disorders, Somatoform disorder or other anxiety/neurotic spectrum disorder. The participants completed Beck Depression Inventory, Beck Anxiety Inventory, subjective version of clinical global impression-severity, Sheehan Patient-Related Anxiety Scale, and Dissociative Experience Scale, at the start and the end of the therapeutic program.ResultsThe total of 840 patients with anxiety or depressive spectrum disorders, who were resistant to pharmacological treatment in outpatients basis and were referred for hospitalization for the six-week complex thera...
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Chronic fatigue syndrome (CFS) is a specific clinical condition that characterises unex-plained disabling fatigue and a combination of non-specific accompanying symptoms for at least 6 months, in the absence of a medical diagnosis that... more
Chronic fatigue syndrome (CFS) is a specific clinical condition that characterises unex-plained disabling fatigue and a combination of non-specific accompanying symptoms for at least 6 months, in the absence of a medical diagnosis that would otherwise explain the clinical presentation. Consequences of CFS found include social isolation and stigmatiza-tion, physical inactivity, psychological disturbances and a reduced quality of life. Plausible mechanism for the development of CFS is based on loss of immunological tolerance to the vasoactive neuropeptides following infection, significant physical exercise or de novo. Considerable evidence points towards a prominent role for central nervous system (CNS) mechanisms in the pathogenesis of CFS. Patients with CFS are described as perfectionist, conscientious, hardworking, somewhat neurotic and introverted individuals with high personal standards, a great desire to be socially accepted and with a history of continu-ously pushing themselves...
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Through treatment of BPD is complicated, many CBT therapist can learn schema therapy (ST) principles and strategies to used them as an additional tool. ST began as an extension of Beck's cognitive therapy model and has grown to become... more
Through treatment of BPD is complicated, many CBT therapist can learn schema therapy (ST) principles and strategies to used them as an additional tool. ST began as an extension of Beck's cognitive therapy model and has grown to become a unique integrative treatment for the personality disorders. A schema is a extremely stable, constant negative pattern which develops during childhood and is elaborated during person's life. There are two main schema operations: healing of schema and schema maintenance. ST devotes considerable attention to modes, the predominant emotions, schemas, or coping reactions working for an individual at a particular time. The aim of the therapy is to engage in schema healing processes, which are intended to reduce the early maladaptive schemas and coping styles, and build up the person's healthy side. The history of the schemas, modes and coping strategies are systematically discussed, their origin are explored, they are linked to current problems, and the opportunity of modifying is explored. In treatment phase, the therapist flexibly uses cognitive, emotional/experiential, behavioral, and relational/interpersonal strategies to change schemas and change maladaptive coping styles with healthier forms of behavior. Schema therapists use the relationship itself quite extensively, in two main ways. First, it is a area in which behaviors modes, and schemas can be observed, assessed, and modified. Second, the relationship is used as a ‘corrective emotional experience’. Through what schema therapy terms ‘limited reparenting,’ the therapist acts in ways that supply as an cure to early unmet needs.
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The training of cognitive behavioral (CBT) supervision is organized in accordance with the basic principles of CBT. The trainees learn how to develop adequate conceptualization of the supervision, improve self-reflection of supervisory... more
The training of cognitive behavioral (CBT) supervision is organized in accordance with the basic principles of CBT. The trainees learn how to develop adequate conceptualization of the supervision, improve self-reflection of supervisory process and how to help supervisee to better selfreflection into the therapy. The training of using CBT strategies in supervision like mapping of thoughts, challenge them, emotional processing, using experiential techniques, role playing, imagination are significant part of the supervision training. Trainees learn to appreciate their fundamental attitudes that they enter into the supervision process. The core work in supervision training is the direct supervision of trainees of the cognitive behavioral training. The supervisions are recorded and supervised by trainers of supervision training and during the peer supervision of supervisors. The theoretical part of the supervision training consist of 50 hours of lectures about supervision models, approaches, conceptualization, measurements of competencies, and 100 hour of self-study of literature and preparation of 3 lectures for the peers about supervision, ethics and related topics. The practical part includes 200 hours of direct training (role playing, supervision under supervision, supervision of video tapes of supervision). The requirement for the completion of the supervision training is presentation of the continuous supervision (minimum 10 sessions) of 4 trainees of CBT. For the final examination the videos of 4 individual supervision sessions and 2 from group supervision is required; the opponency of the thesis with personal self-reflection of the supervisory training is needed.
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Introduction Panic disorder is common disease characterized by spontaneous attacks of massive anxiety and fear. Anxiety is generally considered to be a condition in which the organism is increasingly aroused and EEG may therefore play an... more
Introduction Panic disorder is common disease characterized by spontaneous attacks of massive anxiety and fear. Anxiety is generally considered to be a condition in which the organism is increasingly aroused and EEG may therefore play an important role in the study of the biological basis of anxiety disorders. Standardized low-resolution electromagnetic tomography (sLORETA) is a new quantitative EEG method for determining distribution of neuronal electrical activity in the form of three- dimensional images of current density of the cerebral cortex. Objectives EEG may be usefull method in searching for predictors to the pharmaco and cognitive-behavioral therapy (CBT). Aims The study aimed at finding electrotomographic differences between patients with panic disorder who respond to combined CBT and pharmacotherapy. Methods The study comprised 24 patients diagnosed with panic disorder with or without agoraphobia. The severity of symptoms was measured with the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Sheehan Anxiety Scale, subjective and objective Clinical Global Impression (CGI) and Dissociative Experiences Scale (DES). Based on final BAI score decreases by 25%, the patients were classified into two groups - responders and non-responders. 21-channel EEGs were recorded at baseline and after completion of therapy. Results In non-responders, there were no statistically significant changes in sLORETA findings following therapy. Responders showed a significant decrease of alpha-2 sources (p< 0.05) in the occipital lobes and cuneus and a statistical trend for increased beta-3 sources (p< 0.10) in the posterior cingulate. Conclusion Only treatment response was associated with significant changes of electric neuronal activity.
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Although several studies have assessed the relationships between stigmatization and treatment outcome of psychotic patients, relative little is known about the role of self-stigmatization and treatment outcome in patients suffering with... more
Although several studies have assessed the relationships between stigmatization and treatment outcome of psychotic patients, relative little is known about the role of self-stigmatization and treatment outcome in patients suffering with anxiety disorders. Our study is designed to search for the relation between self-stigmatization and treatment outcome of pharmacotherapy resistant patients suffering with panic disorder, generalized anxiety disorder, social phobia, OCD and PTSD treated in complex program (cognitive behavioral therapy and pharmacotherapy) for anxiety disorders. Method: Sixty patients with pharmacoresistant anxiety disorder recommended for in-patient complex therapeutic program (combination of cognitive-behavioral therapy and pharmacotherapy) were evaluated during structured interview focusing on self-stigmatization with clinical psychologist. There were divided into 3 groups according level of self-stigmatization. the patients were treated in intensive 6 weeks cognitive behavioral therapy program combined with treatment of antidepressants. Results: Preliminary results show, that patients with high level of self-stigmatization improved less in complex therapeutic program than patients with low level of self-stigmatization. Supported by: IGA MZ CR NT 11047-4/2010
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BackgroundIn the past, the first goal of schizophrenia treatment was to reduce psychotic symptoms, mainly positive symptoms. Recently, as a result of an emphasis on patient needs, the concept of quality of life (QoL) has been brought into... more
BackgroundIn the past, the first goal of schizophrenia treatment was to reduce psychotic symptoms, mainly positive symptoms. Recently, as a result of an emphasis on patient needs, the concept of quality of life (QoL) has been brought into the treatment. The goal has therefore changed from the alleviation of symptoms to improvement of the patient's satisfaction with social activities. Self-evaluations by people with schizophrenia were previously thought to lack reliability because of the presence of psychopathological symptoms and poor awareness of the disease. Recently the importance of evaluating the satisfaction of patients themselves, however, has been recognized in schizophrenia. Studies on this field showed us, that QoL data from patients with chronic mental illness were reliable and concluded that subjective QoL evaluation was applicable to such patients.AimsThe purpose of the present study was to compare the QoL in patients suffering from schizophrenia in clinical remissi...
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Adherence k léčbě psychických poruch je jedním z hlavních faktorů ovlivňujících její úspěšnost a druhotně také kvalitu života a sociální adaptaci. Průřezová studie ambulantních pacientů s diagnózou neurotického spektra, do které bylo... more
Adherence k léčbě psychických poruch je jedním z hlavních faktorů ovlivňujících její úspěšnost a druhotně také kvalitu života a sociální adaptaci. Průřezová studie ambulantních pacientů s diagnózou neurotického spektra, do které bylo zařazeno 120 pacientů, měla za cíl zjistit, zda existuje souvislost mezi vysazováním psychofarmak v minulosti, adherencí k léčbě a sebestigmatizaci. K hodnocení bylo použito objektivní i subjektivní CGI-S (Clinical GlobalImpression – Severity), dotazník adherence DAI-10 (Drug Attitude Inventory), míra sebestigmatizace dotazníkem ISMI (Internalized Stigma of Mental Illness Scale) a demografická data. Všechny metody vyplnilo 98 pacientů. 22 pacientů odevzdalo nedostatečně vyplněné dotazníky nebo dodatečně z různých důvodů nespolupracovalo. Analýza dat ukázala, že míra sebestigmatizace hodnocená celkovým skórem ISMI nekoreluje významně s věkem, věkem počátku nemoci ani s časem od poslední hospitalizace. Statisticky významně pozitivně však koreluje se závaž...
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Introduction Many of patients suffering with psychiatric disorder describe significant stressful experiences from childhood. Many of them suffer as children with unsatisfactory fulfilled basic child's needs, such as security,... more
Introduction Many of patients suffering with psychiatric disorder describe significant stressful experiences from childhood. Many of them suffer as children with unsatisfactory fulfilled basic child's needs, such as security, acceptance or approbation. Method We describe approach in processing these painful events during the therapy. Among basic principles in the treatment of the patients who developed psychiatric disorder and have stressful events in childhood or adolescence belongs the creation of collaborative therapeutic relation, explanation and psychoeducation what happens with the patient and reducing or correct stigmatization and guilt feelings. Therapist helps the patient to understand, how symptoms connected with the events from childhood and how they are interconnected with actual problems in life. The transcription of traumatic or stressful events follows after cognitive restructuralization of core schemas and conditional assumptions. Therapeutic process can be divided into of several steps:(a) creation of therapeutic atmospheres (with feelings of security and control, acceptance, approbation);(b) exposition to the painful memories in imagination;(c) expression of negative emotion to the aggressors, or persons that the didn’t guard against stress or trauma;(d) formulation the needs of the child to significant adult person;(e) experience better end in imagination - transcription of the story;(f) general calm down. The aim of therapist is to help the patient memorizing the stressful events and expressing affective experience and then help him/her to rescript experience to less painful. Results There are some case examples of traumatic rescription in the article. Supported by IGA MZ CR NT 11047-4/2010.
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In the Czech Republic people with mental illness are still stigmatized and exposed to various forms of discrimination not only from the community but also from the professional society. The most stigmatized patients are those suffering... more
In the Czech Republic people with mental illness are still stigmatized and exposed to various forms of discrimination not only from the community but also from the professional society. The most stigmatized patients are those suffering from schizophrenia and bipolar disorder, and highly affected are also patients with personality disorders, eating disorders, anxiety and OCD. There can also be a stigma in the psychiatric therapy; psychiatric medication can be labeled as toxins that alter the psyche, psychotherapy as a brainwashing. Stigma of mental disorder is connected with a lack of knowledge about psychiatric disorder, fear, prejudice and discrimination of the patients. Czech mass media significantly contribute to the stigmatization of patients with mental disorder.There are already programs with destigmatization message in the Czech Republic. These programs are in charge of organizations focused on patients with mental disorders, as well as individual professionals or even nonspe...
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Borderline personality disorder (BPD) is typically characterized by instability and impairmed behaviour, affectivity, interpersonal relations and lifestyle. The most common condition comorbid with BPD is a depressive episode. Depression... more
Borderline personality disorder (BPD) is typically characterized by instability and impairmed behaviour, affectivity, interpersonal relations and lifestyle. The most common condition comorbid with BPD is a depressive episode. Depression is associated with severe disturbance of the circadian rhythms. This is apparent in depressive patients with BPD. Bright light may be an effective in treatment of seasonal affective disorder. Several studies have suggested antidepressant effects of phototherapy in non-seasonal depressive episodes. The treatment of comorbid depressive disorder and borderline personality disorder (BPD) is usually reported to be less successful than the treatment of patients without personality disorder. Studies describing the use of bright light in depressed patients with comorbid BPD have not been published so far. Method The aim of this open study was to assess the effectiveness of a 6-week combined therapy with the application of bright light (10,000 lux, 6:30 to 7:30 a.m. for 6 weeks) added to SSRIs in drug-resistant depressed patients with comorbid BPD who did not respond with improvement to 6-week administration of antidepressants. The study comprised 13 female patients who met the ICD-10 diagnostic criteria for research and the DSM-IV-TR diagnostic criteria for major depression. The participants were regularly evaluated using the CGI, HAMD and MADRS scales and the BDI and BDI self-report inventories. Results According to all the assessment instruments, the application of bright white light leads to a significant improvement. However, the results must be interpreted with caution due to the open nature of the study. Supported By IGA MZ CR NT 11047-4/2010
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ABSTRACT Anxiety disorders are chronic psychiatric conditions with a low rate of natural remission, producing substantial decreases in the quality of life and numerous specific social role impairment and disabilities. Over past 15 years,... more
ABSTRACT Anxiety disorders are chronic psychiatric conditions with a low rate of natural remission, producing substantial decreases in the quality of life and numerous specific social role impairment and disabilities. Over past 15 years, behavioral, cognitive, and cognitive behavioral procedures (primarily exposure and cognitive reconstruction based treatments) were found to be effective in the treatment of anxiety disorders.The purpose of this mini workshop is to present the main principals and techniques of a short-term group cognitive behavioral therapy for these patients. In our work, we combine education, cognitive reconstruction, behavioural experiments, exposure therapy, social skills training and problem solving approach. This program will demonstrate how to provide significant improvement even for those with the most severe anxiety disorders.Participants will learn theoretically and practically in exercises:(1) The cognitive and behavioral models of anxiety disorders(2) The main principles of group cognitive behavioral therapy for anxiety disorders(3) How to use CBT techniques useful for anxiety disorders in group:(4) Cognitive reconstruction; - social skills training with role playing; - behavioral experiments and exposure (including imaginal exposure); - problem solving.SupportedBy the project IGA, MZ CR NT 11047-4/2010.
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This study examined whether repetitive transcranial magnetic stimulation applied over the left dorsolateral prefrontal cortex (DLPFC) affected cognition or mood in poststroke patients. The study was a single-center, prospective,... more
This study examined whether repetitive transcranial magnetic stimulation applied over the left dorsolateral prefrontal cortex (DLPFC) affected cognition or mood in poststroke patients. The study was a single-center, prospective, double-blind, sham-controlled preliminary study. Eighteen patients (10 males and 8 females; average age, 62.9 yrs) were enrolled. All participants were randomly assigned to one of three treatment groups: low-frequency (1 Hz) stimulation, high-frequency (10 Hz) stimulation, and sham stimulation (control). Each patient underwent 10 consecutive treatment sessions (five times per week for 2 wks). A Computerized Neuropsychological Test was used to evaluate cognitive function, the Tower of London test was used to assess executive function, the Modified Barthel Index score was used to assess activity of daily living function, and the Beck Depression Inventory was used to assess mood status. These evaluations were conducted in all patients before and after treatment. Treatment had no significant effect on any cognitive function parameter, including the Tower of London scores, in any of the three groups. In contrast, high-frequency repetitive transcranial magnetic stimulation resulted in significantly lower Beck Depression Inventory scores compared with baseline and compared with the other two groups. The Modified Barthel Index scores significantly increased in all three groups. These preliminary data suggest that there was a positive effect on mood, but the study was not powered to detect any measurable effect on cognition.
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Bright light is a treatment of choice for seasonal affective disorder. Other indications for bright light therapy have also been tested. These include non-seasonal depression, bipolar depression, chronic depressive disorder, ante- and... more
Bright light is a treatment of choice for seasonal affective disorder. Other indications for bright light therapy have also been tested. These include non-seasonal depression, bipolar depression, chronic depressive disorder, ante- and postpartum depression, late luteal phase dysphoric disorder, circadian phase sleep disorders, jet lag, shift work problems, and behavioral disturbance and insomnia in organic dementia. Future studies should focus on exploring the use of light therapy in combination with sleep deprivation, other classes of antidepressants, and with psychotherapy and their possible combined effect on subtypes of depression or other mentioned diagnoses, light treatment duration, and the applicability and efficacy of adjunct light treatment for in-patients.
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BACKGROUND: Numerous myths and prejudices about mental disorders are still present in society. Psychiatric patients are stereotypically seen as irrational, dangerous, and hostile which leads to social distance and limited life chances.... more
BACKGROUND: Numerous myths and prejudices about mental disorders are still present in society. Psychiatric patients are stereotypically seen as irrational, dangerous, and hostile which leads to social distance and limited life chances. METHOD: The literature about stigma and self-stigmatization from 1977 to 2012 was reviewed. Articles were found in Pubmed and PsychInfo when using the key words: anxiety disorder, stigma, self-stigmatization. The top ic was also searched in psychiatric textbooks. The aim of review was to find the information about impact of the stigma and self-stigma on the diagnosis, help-seeking, and treatment of patients with anxiety disorders. RESULTS: The unequal approach negatively affe cts diagnostics, treatment, and reintegra
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Although treatment of BPD is complicated, CBT therapists can learn schema therapy (ST) principles and strategies used as an additional tool in the therapy. ST originally began as an extension of Beck’s cognitive therapy model and has... more
Although treatment of BPD is complicated, CBT therapists can learn schema therapy (ST) principles and strategies used as an additional tool in the therapy. ST originally began as an extension of Beck’s cognitive therapy model and has developed into an unique integrative treatment for the personality disorders. According to the ST principles, schemas provide in-depth understanding of personality disorders. People perceive their own self, others and world in the lenses of their schemas. A schema is an extremely stable, constant pattern which developed during childhood or adolescence and now is elaborated in individual ́s life. ST also devotes considerable attention to modes, the predominant emotions, schemas, and coping reactions used by an individual at a particular time. The aim of the therapy is to engage in schema healing processes. These methods are intended to reduce the early maladaptive schemas and coping styles, and build up more adaptive and healthy approaches. A conceptuali...
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Beck anxiety inventory (BAI) is widely used self-rating questionnaire evaluating the severity of anxiety symptoms. The aim of our study was to confirm validity and reliability of Czech version of BAI, identify cut-off points and prove... more
Beck anxiety inventory (BAI) is widely used self-rating questionnaire evaluating the severity of anxiety symptoms. The aim of our study was to confirm validity and reliability of Czech version of BAI, identify cut-off points and prove sensitivity to measure improvement after therapy. The patients selected for the study were treated in the department of psychiatry, University Hospital Olomouc between January 2008 and 2014. Patients meeting criteria for anxiety, or depressive disorder were involved. 789 patients and 284 healthy controls agreed to participate in the study. Czech version of Beck anxiety inventory proved high internal consistency (α=0.92) and good test-retest reliability over one week (BAI seems to be independent of other used scales - Beck depression inventory and the Clinical Global Impression. BAI is also sensitive to measure change after therapy. Czech version of BAI was found to have enough internal stability and test-retest reliability same as the original version....
Research Interests: Psychology and Medicine
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Research Interests: Cognitive Science, Psychiatry, Medicine, Humans, Female, and 13 moreBrainstem, Male, Panic Disorder, Depressive Disorder, Substantia nigra, Clinical Sciences, Middle Aged, Adult, Sensitivity and Specificity, Neurosciences, Brain stem, Psychology and Cognitive Sciences, and Medical and Health Sciences
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... more
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. 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. During episodes of mania, the daily profiles of melatonin differed compared with healthy controls and patien...
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Many authors suggest that there is low reactivity of autonomic nervous system and reduced heart rate variability in patients with panic disorder. The patients are therefore exposed to increased cardiac mortality. Power spectral analysis... more
Many authors suggest that there is low reactivity of autonomic nervous system and reduced heart rate variability in patients with panic disorder. The patients are therefore exposed to increased cardiac mortality. Power spectral analysis is a successful tool in detecting autonomic instabilities in many disorders. The aim of our study is to monitor the activity of the autonomic nervous system through heart rate variability measured in the beginning and end of a therapeutic cognitive behavioral therapy (CBT) program in patients with panic disorder. We measured 31 patients with panic disorder in the beginning (1st measurement) and end of a therapeutic CBT program (2nd measurement). The autonomic nervous system (ANS) has been evaluated in three positions (supine - standing - supine). The evaluated parameters of the HRV linear analysis were: RR interval, HF, LF, VLF band and VLF + LF / HF ratio. Spectral activity in the very low frequency band was significantly higher in the 2nd measureme...
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The purpose of this qualitative review is to examine prodromes, precipitants, and risk factors for repeated episodes of mania and depression in bipolar disorder. PubMed, EMBASE, and PsychInfo were searched for "bipolar disorder"... more
The purpose of this qualitative review is to examine prodromes, precipitants, and risk factors for repeated episodes of mania and depression in bipolar disorder. PubMed, EMBASE, and PsychInfo were searched for "bipolar disorder" in conjunction with: "prodromes", "triggers", and "life change events". Phenomenology and prevalence of prodromes, precipitants, and risk factors are described, and their therapeutic implications are outlined. Most patients with bipolar disorder are able to recognize their prodromes. This ability depends largely on insight. Psychoeducation focused on improving various aspects of insight, including treatment adherence, reduces incidence of relapses in bipolar disorder.
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Alarming somatic symptoms and in particular the cardiovascular symptoms, are the characteristic features of panic attacks. Increased cardiac mortality and morbidity have been proposed in these patients. Power spectral analysis of... more
Alarming somatic symptoms and in particular the cardiovascular symptoms, are the characteristic features of panic attacks. Increased cardiac mortality and morbidity have been proposed in these patients. Power spectral analysis of electrocardiogram R-R intervals is known to be a particularly successful tool in the detection of autonomic instabilities in various clinical disorders. Heart rate variability (HRV) has been found to be the outcome of rapidly reacting cardiovascular control systems. The aim of our study is to measure very low frequency band (VLF), low frequency band (LF) and high frequency band (HF) components of R-R interval during orthostatic experiment in patients with panic disorder before and after treatment and compares it with healthy controls. We assessed heart rate variability in 19 patients with panic disorder before and after 6-weeks treatment with antidepressants combined with cognitive behavioral therapy (CBT) and in 18 healthy controls. Diagnosis was done acco...
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In the past, the first goal of bipolar disorder treatment was the reduction of symptoms of mania or depression, rather than the recovery of social functioning. Recently, as a result of an increased emphasis on patient needs, the concept... more
In the past, the first goal of bipolar disorder treatment was the reduction of symptoms of mania or depression, rather than the recovery of social functioning. Recently, as a result of an increased emphasis on patient needs, the concept of quality of life (QoL) has been brought into the treatment of physical illnesses. The purpose of the present study was to examine QoL data in patients with bipolar disorder in clinical remission and to determine the extent of the effects of demographic and clinical data on QoL in these patients. The second aim was to compare the QoL data of these patients to that of patients with schizophrenia in clinical remission and to that of healthy controls. Data were obtained using a QoL questionnaire (Quality of Life Enjoyment and Satisfaction Questionnaire, or Q-LES-Q) for 41 bipolar patients in clinical remission. The data were then compared with the data of 40 schizophrenic patients in clinical remission and with 40 healthy controls. There were higher me...
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Transcranial magnetic stimulation (rTMS) can modulate cortical activity. The goal of our study was to assess whether rTMS would facilitate effect of serotonin reuptake inhibitors in patients with panic disorder. Fifteen patients suffering... more
Transcranial magnetic stimulation (rTMS) can modulate cortical activity. The goal of our study was to assess whether rTMS would facilitate effect of serotonin reuptake inhibitors in patients with panic disorder. Fifteen patients suffering from panic disorder resistant to serotonin reuptake inhibitor (SRI) therapy were randomly assigned to either active or to sham rTMS. The aim of the study was to compare the 2 and 4 weeks efficacy of the 10 sessions 1 Hz rTMS with sham rTMS add on SRI therapy. We use 1 Hz, 30 minutes rTMS, 110% of motor threshold administered over the right dorso-lateral prefrontal cortex (DLPFC). The same time schedule was used for sham administration. Fifteen patients finished the study,. Psychopathology was assessed using the rating scales CGI, HAMA, PDSS and BAI before the treatment, immediately after the experimental treatment and 2 weeks after the experimental treatment by an independent reviewer. Both groups improved during the study period but the treatment ...