IntroductionSelf-stigma plays a role in many areas of the patient’s life. Furthermore, it also discourages therapy. The aim of our study was to examine associations between self-stigma and adherence to treatment and discontinuation of medication in patients from various diagnostic groups.MethodsThis cross-sectional study involved outpatients attending the Department of Psychiatry, University Hospital Olomouc, Czech Republic. The level of self-stigma was measured with the Internalized Stigma of Mental Illness and adherence with the Drug Attitude Inventory. The patients also anonymously filled out a demographic questionnaire which included a question asking whether they had discontinued their medication in the past.ResultsWe examined data from 332 patients from six basic diagnostic categories (substance abuse disorders, schizophrenia, bipolar disorders, depressive disorders, anxiety disorders, and personality disorders). The study showed a statistically significant negative correlation between self-stigma and adherence to treatment in all diagnostic groups. Self-stigma correlated positively and adherence negatively with the severity of disorders. Another important factor affecting both variables was partnership. Self-stigma positively correlated with doses of antidepressants and adherence with doses of anxiolytics. Self-stigma also negatively correlated with education, and positively with a number of hospitalizations and number of psychiatrists visited. Adherence was further positively correlated with age and age of onset of disorders. Regression analysis showed that self-stigma was an important factor negatively influencing adherence to treatment and significantly contributing to voluntary discontinuation of drugs. The level of self-stigma did not differ between diagnostic categories. Patients suffering from schizophrenia had the lowest adherence to treatment.ConclusionThe study showed a significant correlation between self-stigma and adherence to treatment. High levels of self-stigma are associated with discontinuation of medications without a psychiatrist’s recommendation. This connection was present in all diagnostic groups.

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Manypsychiatric patients stigmatize themselves because of their mental disorder. Itis necessary to focus on both research and therapeutic options to alleviate theirburden resulting from self-stigma. The goal of this paper was to evaluate theCzech translation of the ISMI scale (the Internalized Stigma of Mental Illnessscale). The scale measures the level of self-stigma in psychiatric patients andconsists of 29 items divided in 5 subscales-Alienation, Stereotypeendorsement, Perceived discrimination, Social Withdrawal, and StigmaResistance. The research sample included 369 psychiatric patients. Theiraverage age was 41,5 + 13,3 years, and the majority were women (N = 210;56,6 %). The most common diagnoses were neurotic disorders (46,1 %), followedby mood disorders (18,4 %), substance use disorders (13,3 %), psychoses (10,8%), personality disorders (9,5 %), and organic disorders (1,6 %). Reliabilitywas assessed by Cronbach alpha (α = 0,91), split-half (Spearman-BrownCoefficient = 0,93), and test-retest with the second measurement 3 weeks afterthe first one (N = 17; r = 0,90, p < 0,05). We also performed exploratory factor analysisand the evaluation of validity based on correlations with two scales presentingphenomena connected to the concept of self-stigma (Beck Depression Scale-II andClinical Global Impression). Lastly, we created norms based on T-scores andstens for the overall scale and its subscales. The results showed that theCzech version of the ISMI scale has satisfactory psychometric properties.

IntroductionAdherence to treatment of mental disorders is one of the key factors influencing its success and, secondarily, the patients’ quality of life and social adaptation.AimsThe cross-sectional study of 90 outpatients diagnosed with psychotic disorders aimed at determining if there was a relationship between discontinuation of medication in the past, current adherence to treatment and self-stigma.MethodsThe assessment was made with the objective and subjective Clinical Global Impression – Severity scale, Drug Attitude Inventory, Internalized Stigma of Mental Illness (ISMI) scale and demographic data.ResultsThe questionnaires were filled out by 79 patients, of whom 5 handed in incomplete questionnaires. Complete sets of data were obtained from 74 patients. The data analysis showed that the levels of self-stigma as assessed by the total ISMI scores was not statistically significantly correlated with most of the demographic factors (age, age of illness onset, gender, education, marital status, employment, duration of the illness, number of hospitalizations and antipsychotic dosage). However, there was a significant negative correlation with current adherence to treatment.ConclusionsAdherence to treatment is one of the most important prerequisites for successful therapy. Adherence may be enhanced through better motivation and education of patients on the necessity of adhering to treatment recommendations and the consequences of non-adherent behavior. Important factors in adherence also seem to be patients’ stigmatization and self-stigma. Adherence may be increased by promising self-stigma-reducing strategies performed by systematic psychoeducation of patients or as a part of psychotherapeutic counseling.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Introduction. According to recent findings, certain clinical symptoms of patients suffering from affective and anxiety disorder can be related to dissociation. The aim of our study was to examine if the level of dissociation in bipolar affective disorder differed from the level of dissociation in healthy volunteers.Methods. 41 patients suffering from bipolar disorder (51.2% females), and 198 healthy controls ( 71.2% females) were included in the study. The patients with bipolar affective disorder in remission were recruited from the Outpatient department of the Department of Psychiatry of the University Hospital Olomouc. They were psychiatrically assessed and the state of the disorder was evaluated by an experienced psychiatrist. Only patients in remission, evaluated as 1 or 2 points of clinical global impression -severity scale, were included in the study. All participants were assessed with the Dissociative Experiences Scale (DES).Results. There were no differences in the two groups in demographic variables like age, gender and education. Patients had a significantly higher mean score on the DES and pathological DES than healthy controls.Conclusion. Our results suggest that the level of psychological dissociation in bipolar affective patients is higher than in healthy controls.

BackgroundBipolar disorder (BD) is a serious mental illness with adverse impact on the lives of the patients and their caregivers. BD is associated with many limitations in personal and interpersonal functioning and restricts the patients’ ability to use their potential capabilities fully. Bipolar patients long to live meaningful lives, but this goal is hard to achieve for those with poor insight. With progress and humanization of society, the issue of patients’ needs became an important topic. The objective of the paper is to provide the up-to-date data on the unmet needs of BD patients and their caregivers.MethodsA systematic computerized examination of MEDLINE publications from 1970 to 2015, via the keywords “bipolar disorder”, “mania”, “bipolar depression”, and “unmet needs”, was performed.ResultsPatients’ needs may differ in various stages of the disorder and may have different origin and goals. Thus, we divided them into five groups relating to their nature: those connected with symptoms, treatment, quality of life, family, and pharmacotherapy. We suggested several implications of these needs for pharmacotherapy and psychotherapy.ConclusionTrying to follow patients’ needs may be a crucial point in the treatment of BD patients. However, many needs remain unmet due to both medical and social factors.

Background. Psychoeducation programs have been shown in the last two decades to significantly improve the post-hospital discharge care of individuals with schizophrenia by demonstrated effects on rehospitalization rates, compliance with medication and knowledge. The benefits of psychoeducation can be sustained for up to seven years although most studies have not shown such enduring benefit. Psychoeducation is a type of psychotherapeutic support that aims to provide broad and adequate information on psychotic disorders for both patients and their families.Method. The purpose of the group psychoeducational program at the Psychiatric clinic in Olomouc is to familiarize patients with the core of the disorder, explain the part played by pharmacotherapy, teach recognition of the warning signs of relapse, to advise on communication problems within families, and finally the training of social skills.Results. Patients perceive the program as meaningful and helpful in better understanding their lives. INTRODUCTIONSchizophrenia is a chronic psychiatric illness affecting 1% to 2% of the population. Unfortunately, suboptimal follow-through with treatment too often leads to a classic revolving-door pattern of relapse and rehospitalization. While the core intervention in schizophrenia remains antipsychotic medication; the limitations of medication alone in symptomatic, relapse prevention, and satisfaction/quality of life terms have long prompted interest in wider forms of management. This aside, in the CATIE study 1 , a naturalistic randomized-controlled trial comparing five antipsychotic compounds, 74% of all patients discontinued their original medication before the end of the 18 months of the first phase of the trial.One inherent deficit in schizophrenicia is an inability to engage appropriately in social and occupational activities. The debilitating effect of this is often a lasting feature of the illness, despite adequate psychopharmacological intervention, often isolating them and making it difficult for them to advocate appropriate social support or community services. Further, studies have found that there is a correlation between poor social functioning and relapse. One of the challenges of this area, is also wide interindividual variability although standardized measures have been developed to rate the social deficits. These assessments have become important tools in the determination of effective non-pharmacological treatment strategies. In addition to long-term pharmacotherapy, quality education is considered an additional important form of assistanc.Family caregivers report high levels of burden related to caring for their mentally ill family members 2 . They may not have the knowledge and skills necessary to take on the caring responsibilities. As a result, patient relapse and readmission are common 3 .Although no evidence of a definitive cause of schizophrenia is yet available, it can be reasonably controlled though the use of pharmacotherapy and psychosocial interventions. Relapse rates (measured by number of h...

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.