M. Cerna

1222 – The quality of life of patients suffering from schizophrenia - a comparison with healthy controls

Background In 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 patients 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. Aims The purpose of the present study was to compare the QoL in patients suffering from schizophrenia in clinical remission with healthy controls and examine the extent of the effects of subjective cognitive functioning on QoL in these patients. Methods Data were obtained using the quality of life questionnaire (Quality of Life Enjoyment and Satisfaction - Q-LES-Q), and subjective questionnaire for cognitive dysfunction (Cognitive Failures Questionnaire - CFQ) for 40 schizophrenia patients in clinical remission and 40 healthy controls. Results Cognitive function correlates negatively with subjective QoL in patients with schizophrenia. Supported by grant IGA MZ CR NT11047.

840 – Heart rate variability in panic disorder patients before and after the therapy

We assessed HRV (heart rate variability) in 31 patients with panic disorder before and after 6-weeks treatment with antidepressants and CBT and 18 controls. Patients were regularly assessed weekly on the CGI, BAI and BDI. HRV was assessed during 3 positions. Thirty one pharmacoresistant panic disorder patients entered a 6-week open-label treatment study. A combination of CBT and pharmacotherapy proved to be the effective treatment. Patients significantly improved in all rating scales. There were highly statistical significant differences between panic patients and control group in all components of power spectral analysis in 2nd (VLF, LF and H in supine) and in two component of 3rd (LF and HF in standing) positions. There was also statistically significant difference between these two groups in LF/HF ratio in supine position (2nd). We have found statistically significant differences in HRV frequencies between before and after CBT program in VLF in standing position. We have also found statistically significant differences in HRV frequency ratios in the third position in case of decrease VLF + LF / HF ratio. We can also see decreasing activity in VLF and LF band in standing position in1st measurement and an increase in VLF and LF band in standing position in 2nd measurement. Conclusions These findings demonstrate a lower autonomic power in panic disorder patients and tendency to increase it during the treatment. Supported by: Project IGA MZ CR NS10301-3/2009

1226 – Changing the emotional schemas using writing letters to significant caregivers

The letter writing is a psychoterapeutic strategy, which can help to the patients to cope with the relationship to the significant people from their childhood. Method The purpose of writing letters is to experience and to understand their own feelings, to cope with strong emotional experiences, which are related to the injuries in the childhood. We present specific examples of the letters from our patients in last 15 years of our experience, when this technique is mainly used in patients with personality disorders, affective and anxiety disorders in the therapy and also using internet. Results The result is a profound change in beliefs about themselves and others. The basic types of therapeutic letters are these four: not censured letter, emphatic letter from the “other side”, the letter to the “inner child” of the significant person and the letter “visit-card”. In not censured letter the patients primarily reflect the negative feelings that hurt them in childhood. The emphatic letter from the “other side” is the ideal answer the patients would have wanted to get away from the significant person; patients formulate the particular wishes and expectations, which meet in a fictional response (encouraging selfconfidence, assurance of love, respect). The “visit-card” letter is the censured letter in “adult to adult” mode, written with respect for oneself and significant person, directed towards reconciliation. Fonetický přepis Supported by IGA MZ CR NT 11047-4/2010.

832 – Predictors of outcome of complex in-patient therapeutic program for pharmacoresitant obsessive compulsive patients

The aim of the study was to assess the efficacy of the in-patients therapeutic program for in patients suffering with pharmacoresistant OCD patients. The therapy was conducted in a group setting and systematic CBT steps were adapted to each individual patient in the group. Pharmacological treatment underwent no or minimal changes during the trial period. Outcome measures included the Yale-Brown Obsessive Compulsive Scale, subjective version (S-Y-BOCS), the Clinical Global Impressions-Severity of Illness scale (CGI-S), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and Dissociative Experience Scale (DES). The primary outcome measure for treatment response was a rating of 35% improvement in Y-BOCS. A remission was defined by S-Y-BOCS score 12 and lower or by CGI-S scores 1 or 2. Results 66 patients completed trial. Three patients refused the protocol. All patients finished minimum of 6 weeks of CBT and showed statistically significant improvement on S-Y-BOCS, CGI-S and BDI scales. The main predictors of achieving the response or remission were scores in S-Y-BOCS lower than 24, good insight, high resistance against symptoms, low level of dissociation, and aggressive character of obsessions. The negative predictors of achieving the response or remission were control/symmetry obsession and compulsions, and obsessive slowness/ambivalence. Supported by IGA MZ CR NT 11047-4/2010

1232 – Psychoeducation for patients with bipolar affective disorder

Structured psychological interventions should be considered for patients with bipolar disorder once they are past the acute phase or a relapse, with the aim of reducing the likelihood of future relapses. Method The PubMed, Web of Science and Scopus databases were searched for articles containing the following keywords: “bipolar disorder” and “psychoeducation”. The resources were confronted with our own experiences with psychoeducation in bipolar patients and only most relevant information was included in the text. Results The most important target of the psychoeducation is to prevent a relapse by increasing compliance with medication usage, increasing social rhythms, reducing emotional expressivity in the family and increasing coping skills against stress. Studies on psychoeducation in bipolar disorder demonstrate significant effects on rehospitalization rates, compliance and knowledge. Compared with mood stabilizer treatment alone, combination treatment of CBT and mood stabilizers has been shown to reduce the number of bipolar episodes, reduce the duration of episodes that do occur, and reduce the number of hospital admissions due to episodes. The aim of the group psychoeducational program of the Psychiatric clinic in Olomouc is to familiarize patients with the essence of bipolar disorder, the part and principles of pharmacotherapy, the recognition of the warning signs of relapse, to advice about improper and stressful stereotypes in communication within families, and finally the training of social skills. Patients consider this program as a meaningful and helping them to better understanding what happened in their life. Supported by grant IGA MZ CR NT 11047-4/2010.

843 – Group cognitive behavioral therapy for patients with panic disorder

Panic disorder is a severe and often disabling condition with a lifetime prevalence rate of 4.1% to 8.8%. The treatment of choice is cognitive behavioral therapy (CBT). Over past 20 years, behavioral, cognitive, and cognitive behavioral procedures (primarily exposure and cognitive reconstruction based treatments) were found to be effective in the treatment of panic disorder. CBT is the best studied non-pharmacological approach and can be applied to many patients, depending on its availability. CBT of panic disorder was most studied in individual setting, but group format of treatment could be also effective. Method We describe step by step the cognitive-behavioral group therapy of patients with panic disorder. We are explaning the concept of cognitive model of panic disorder, vicious circle, cognitive reconstruction, control of breathing and exposure. We also present personal experience with group cognitive-behavioral therapy and possible complications that may occur. Results The results of our research in this group concerning the efficacy of the program, changes in the heart rate variability during program and EEG changes (using sLORETA) are presented. We also try to point on possible complications that may occur during the therapy and coping with them. Supported by: Project IGA MZ CR NS 10301-3/2009

1263 – Internet based psychoeducative CBT program for bipolar patients treated with thymostabilisers

Objective Internet-based therapy typically involves the interaction between a consumer and therapist via the Internet and incorporates the use of a structured Web-based treatment program for consumers to access in conjunction with therapist assistance (usually by email. Over the past decade, Internet-based treatments have been found effective for a variety of physical health conditions and mental health disorders, such as headache, encopresis, tinnitus, depression, panic disorder, social phobia, GAD and posttraumatic stress disorder. Aims The purpose of this open study will be to test the efficacy of therapist-assisted internet 12 module 4 month long selfhelp program based on cognitive behavioral approach (IB-CBT) with the treatment as usual (TAU) for bipolar affective disorder patients who are medicated with thymostabilisers. Method Participants who recruit from the patients of the Psychiatric clinic Olomouc at time of start the maintenance pharmacological phase of the treatment of bipolar affective disorder will be randomized to the TAU (treatment as usual) and IB-CBT (12 modules of internet based CBT+ TAU). All participants will complete a clinical diagnostic interview, and a set of questionnaires to assess affective symptoms at four time periods (start of the maintenance treatment period and at follow up: 6 month, 12 month and 24 month. The study will be done in open conditions. Results The results from the start of the maintenance treatment period will be present.

850 – Panic disorder with and without personality disorders-therapeutic outcome of pharmacoresistant in-patients

Most clinicians tend to believe that the occurrence of the anxiety disorder in tandem with a personality disorder often leads to longer treatment, worsens the prognosis, and thus increasing treatment costs. The study is designed to compare the shortterm effectiveness of combination of cognitive behavioral therapy and pharmacotherapy in patient suffering with panic disorder with and without personality disorder. Method We compared the efficacy of 6 week therapeutic program in pharmacoresistant patients suffering with panic disorder and comorbid personality disorder (19 patients) and panic disorder and/or agoraphobia without comorbid personality disorder (43 patients). Patients were treated with CBT and psychopharmacs. They were regularly assessed every week on the CGI, BAI, BDI. Before and after treatment were used also Sheehan anxiety scale, Dissociative experience scale, Quality of Life. Results A combination of CBT and pharmacotherapy proved to be the effective treatment of patients suffering with panic disorder and/or agoraphobia with or without comorbid personality disorder. The treatment effect between groups did not differ in rating scales, but there are more remitted patients in group without personality disorder. Supported by: Project IGA MZ CR NS 10301-3/2009

926 – Emotional processing in patients with affective, borderline and dissociative disorders

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 childs 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

839 – Sloreta findings in patients with panic disorder, changes after combined therapy - pilot study

Introduction Panic disorder is frequent psychiatric disorder characterized by sudden and unexpected onset of a panic attack, characterized by terror or impending doom, and associated with many somatic symptoms. Panic is considered as a state of hyperarousal, the EEG has had a prominent place in anxiety studies. sLORETA (standardized low resolution brain electromagnetic tomography) is now widely used research method investigating the electrical activity of the brain with zero localization error and ability to reconstruct multiple resources. Objectives EEG may be useful toll in looking for predictors to therapeutic response. Aims The study aimed at finding electrotomographic differences between patients with panic disorder who respond to combined therapy. Method We measured patients with Panic disorder. Diagnosis was confirmed by M.I.N.I. (MINI-international neuropsychiatric interview). Patients were treated both by psychotropics and CBT (cognitive behavioral therapy) for six week. The symptoms intensity was assessed using BAI (Beck Anxiety Inventory) and BDI (Beck Depression Inventory). They were also examined by EEG. It was measured in rest state with closed eyes, using standard 10-20 montage with 19 electrodes. Measurements were carried out at the beginning and after 6 weeks of therapy. Results We found decreased absolute power in alfa-2 (10.5 - 12 Hz) activity in anterior cingulated, and increased absolute power in beta-3 (21.5 - 30 Hz) activity in superior frontal gyrus. Conclusions Our findings suggest that cognitive behavioural psychotherapy can cause changes in brain activity. Supported by IGA MZ CR NT 11047-4/2010