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This study aimed to estimate the frequency of maladaptive daydreaming, and to explore the pathological personality traits of probable maladaptive daydreamers. Our sample consisted of 239 psychiatric patients. After screening, 42 persons were probable maladaptive, while 197 participants prove to be normal daydreamers. Two pathological domains and three facets measured by the Personality Inventory for DSM-5 showed a moderate significant correlation with the Maladaptive Daydreaming Scale. The score of nearly every domain and facet was slightly higher among probable maladaptive daydreamers. To quantify the difference between the groups, effect sizes were calculated: significant difference was found on the domain level in Antagonism, while on the facet level in Hostility, Grandiosity, Attention Seeking, Unusual Beliefs and Experiences, Cognitive and Perceptual Dysregulation. The group of probable maladaptive daydreamers was further examined to identify potential subgroups. Cluster analysis revealed heterogeneity in the severeness and patterns of pathological personality domains. Cluster 1 showed higher mean scores on the PID domains and on the MDS compared to Cluster 2. Cluster 1 and Cluster 2 broke further down into two subclusters: Cluster 1a and Cluster 1b differed in their mean scores on the domains of Antagonism and Detachment; the mean scores of Cluster 2a were uniformly low on each domain, while the mean values of Cluster 2b were scattered in a mixed way on the domains. Our results suggest that maladaptive daydreaming might manifest with differently pathological personality profiles in the background. This aspect might worth considering in planning treatment.

The high risk of mental health problems among medical students has been compounded by the COVID-19 pandemic, which greatly reduced social contact. The mental health support service of the medical school of one Hungarian university was transferred to the online learning management system and was expanded by self-help materials in three domains: Improving study skills, stress management techniques, and reducing stress related to the COVID-19 pandemic. We wanted to understand the preferences of medical students for psychological self-help techniques by investigating the pattern of access to online self-help materials and the characteristics of the users. Access to the online materials between April 2020 and April 2021 among Hungarian and international medical students was analyzed using the logging data of the system. Of all the students who logged in during the examination period (n = 458), 36.6–40.4% viewed materials to improve study skills and 23–29% viewed stress management materials, of which short-duration audio format techniques were preferred. The access rate of content targeting coping with the mental health effects of COVID-19 was 9.5–24%. Support to improve study skills is significantly more preferred than interventions targeting distress-reduction. The pattern of access can be used for the development of interventions that are of most interest to medical students.

Background: Evidence of the effect of metacognitive and social cognitive impairment on the symptoms and functioning of patients diagnosed with schizophrenia led to the development of the Metacognit...

The high risk of mental health problems among medical students has been compounded by the COVID-19 pandemic, which greatly reduced social contact. The mental health support service of the medical school of one Hungarian university was transferred to the online learning management system and was expanded by self-help materials in three domains: Improving study skills, stress management techniques, and reducing stress related to the COVID-19 pandemic. We wanted to understand the preferences of medical students for psychological self-help techniques by investigating the pattern of access to online self-help materials and the characteristics of the users. Access to the online materials between April 2020 and April 2021 among Hungarian and international medical students was analyzed using the logging data of the system. Of all the students who logged in during the examination period (

BACKGROUND The high risk for mental health problems among medical students has been compounded by the Covid-19 pandemic which greatly reduced formal and informal social contacts. In order to help students, the mental health support service of the medical school of one Hungarian university was not only transferred to the online learning management system but was expanded by self-help materials in three domains: improving study skills, stress management techniques, and reducing stress related to the Covid-19 pandemic. Separate portals were developed for medical students at Hungarian and English courses. OBJECTIVE Our objective was to investigate the pattern of access to the online self-help materials among medical students and the characteristics of those who used the portals. METHODS Access to the online materials between April 2020-April 2021 among Hungarian and international medical students was analyzed using the logging data of the system. RESULTS 15% (n=458) of medical students entered the portal. Women were more likely to visit the site than men among both Hungarian (female: 72%) and international students (female: 59%). Fifth-year students (27%) among Hungarians and first-year students (24%) among internationals comprised the largest proportion of visitors. Of all students who logged in at any time during the examined period, 36.6– 40.4% viewed materials for improving study skills, 23-29% viewed stress management materials of which short-duration techniques in audio format were preferred. The access rate of content targeting coping with mental health effects of Covid-19 was 9.5-24%. CONCLUSIONS The pattern of access can be used for the development of interventions that are of most interest to medical students. Support to improve study skills and brief stress management techniques were the most preferred types of self-help materials.

The DSM-5 describes two types of classification of personality disorders: a categorical and a dimensional classification. The alternative model of personality disorders in the DSM-5 determines new diagnostic criteria for personality disorders with a criterion B describing the presence of pathological personality facets. For the assessment of these domains and facets, the Personality Inventory for DSM-5 (PID-5) was created.A sample of patients receiving psychiatric care (n=239) and a normal sample (n=226) were involved in the study. The two samples did not differ significantly regarding gender, age, and the levels of education. The PID-5 was applied to assess the pathological domains and facets.Psychiatric patients scored significantly higher on four out of five PID domains compared to the members of the general population. Regarding the PID facets, the two study groups differed significantly in 18 out of 25 facets. Regarding the PID domains and facets, gender differences were found in the clinical sample: Negative Affectivity was more typical for women, while Antagonism was more dominant for men. Women receiving psychiatric care were cha - rac terized by Emotional Lability and Anxiousness, while Manipulativeness, Deceitfulness, Callousness and Risk Taking were more dominant for men of the clinical sample.Our results confirmed the applicability of the dimensional personality model. The PID-5 can discriminate between psychiatric and normal samples. Our findings suggested that in the case of the general population, traditional gender characteristics disappeared, while psychiatric patients seemed to preserve the traditional gender roles.

Schizophrenia research in the last decades led to rapid development of our knowledge regarding the cogni - tive deficits in the disease. Presence of neurocognitive and social cognitive deficits in schizophrenia is widely confirmed by empirical studies. Metacognition is one of the most recent and relatively less studied field of schizophrenia. Our lite rature review aims to introduce the concept and characteristics of metacognition. Then we overview the relation - ship between schizophrenia associated neurocognitive and social cognitive impairments and metacognitive deficits. Associations between the metacognitive deficits and the symptomatology will also be discussed. Finally, a method for the treatment of metacognitive deficits in schizophrenia will be suggested. The results of the overviewed studies sup - port, that the umbrella term of metacognition encompassing the neurocognitive and social cognitive deficits, may provide a comprehensive model to better understand how cognitive deficits contribute to the development and main - tanance of symptoms, and schizophrenia-associated serious social dysfunctions.

Abstract: Introduction: Oscillometric devices in contrast to the traditional Doppler based method for ankle-brachial index measurements have promising advantages like no need for special training, faster performance, and operator independence. Aim: Comparative assessment of the oscillometric and Doppler-based ankle-brachial index measurement. Method: Ankle-brachial index measurements were performed by continuous wave Doppler and an automatic oscillometric device (BOSO ABI-system 100) in consecutive subjects. The comparative assessment was performed by Bland−Altman and ROC analysis. Results: The two kinds of measurements (734 measurements) showed a good agreement in the ankle-brachial index spectrum close to the cut-off value of 0.9. The agreement diminished below or above this value. The optimal oscillometric ankle-brachial index diagnostic cut-off value was 0.96. Conclusions: The oscillometric device is not interchangeable for Doppler devices in the whole ankle-brachial index spectrum. Nevertheless, owing to its discriminative power, the oscillometric measurement potentially has an efficient role in the screening of asymptomatic patients. Orv Hetil. 2018; 159(5): 176–182.

Background: Arterial stiffness is the characteristic of early vascular damage that can be measured by several methods. Sphygmocor determines the carotid-femoral pulse wave velocity (PWV). Cardio-ankle vascular index (CAVI) also measures PWV between heart and ankle, independently of blood pressure. According to results of several studies using these methods is a well-recognized predictor of adverse cardiovascular outcomes. Objectives: We compared these different methods of measuring early vascular damage in asymptomatic population with increased cardiovascular risk. Methods: Database contained 40–95 years-old patients without cardiovascular diseases. Anamnestic and clinical data were collected, arterial stiffness was measured by Sphygmocor and CAVI. Atrial fibrillation, carotid atherosclerosis, and peripheral arterial disease were excluded. Results: We included 100 patients (male/female–19/81; mean age–60.3 ± 10.7), 40% of patients had diabetes, 89% were obese, 70% had metabolic syndrome, 83% had hypertension and 63% had dyslipidemia. 29% of patients had abnormal (>10 m/s) PWV. CAVI above the reference value was detected 19% on the left and 23% on the right side of patients. Results of two different methods correlated significantly (p < 0.05, Pearson correlation). However, the coefficient of determination was low, 8.5%. In half of the abnormal values, both results were above the reference values. Conclusion: Because of a few patients numbers, we can not draw far-reaching conclusions. However, we found more than 20% of asymptomatic patients with abnormal arterial stiffness. Relationship between two methods of arterial stiffness measurements was weak, which draws attention that these methods are not interchangeable. Role of these two methods in cardiovascular prognosis should be evaluated separately.

Background: Nonsuicidal self-injury (NSSI) is a key feature of borderline personality disorder (BPD), which is strongly associated with childhood traumatization. To the best of our knowledge, there has been a lack of studies investigating extensively the characteristics of borderline patients who engage in extremely high numbers of NSSI, and their features of NSSI, trauma history and psychopathology. The aim of this study is to identify groups of borderline inpatients on the basis of the lifetime number of NSSI, and to explore the characteristics of these groups regarding the onset, reasons and methods of NSSI, history of childhood traumatization, and severity of psychopathology. Subjects and methods: 80 psychiatric inpatients with BPD were included in the study, of whom 63 had a history of NSSI and 17 had not. The frequency and characteristics of NSSI were assessed by the Ottawa Self-Injury Inventory and the childhood traumatization were assessed by the Traumatic Antecedents Questionnaire and the Early Trauma Inventory. Results: In this study among self-injuring borderline inpatients a super self-injuring group was identified, who engaged in extremely high numbers of NSSI (75.0±28.4 acts/lifetime). Compared to moderate self-injurers, super self-injurers began harming themselves at a younger age (p=0.008), used more severe forms of NSSI, and all of them reported an anti-dissociation function of NSSI. Adverse childhood experiences were more prevalent in the super self-injuring group. The strongest predictors of the lifetime number of NSSI were early sexual abuse (p

In the recent years plenty of therapeutic treatment methods have been developed, aimed at neurocognitive impairments in schizophrenia. These trainingprograms can hold up promising results in the improvement of neurocognitive functions. Nevertheless the generalisation on the daily life is not perspicuous. A reason for it might be the supposition, that further factors such as metacognition and social cognition may play a mediator role between neurocognition and functional outcomes. As a result, many socialcognitive remediation methods and programs have emerged targeting the impairment of deficits both in the field of neuro- and social cognition and deficits of metacognition. We review the specific impairments in schizophrenia (e.g. deficits of Theory of Mind, disorder of emotional perception, specific cognitive biases or impairment of metamemory), the construction and speciality of the Metacognitive Training, and the findings of studies aimed at the efficacy of the method. In addition to the socialcognitive remediation, the goal of Metacognitive Training is the correction of the cognitive biases playing an important role in the emergence and subsistence of delusions.

Hereditary paraganglioma/pheochromocytoma syndrome is an autosomal dominantly inherited disease caused by germline mutation of the genes encoding subunits of the mitochondrial succinate dehydrogenase (SDH) enzyme involved in the mitochondrial respiratory chain. The pathogenetic role of SDH gene mutations was first recognized in 2000. Authors present the history of a patient with extra-adrenal pheochromocytoma who represents in Hungary the first genetically confirmed case of hereditary paraganglioma/pheochromocytoma syndrome due to disease-causing mutation of the SDHD gene. Also, the authors review the progress of our knowledge about this syndrome.A 33 years-old man was observed with hypertension, increased perspiration and palpitation. Laboratory analysis showed increased urinary catecholamine metabolite excretion, abdominal radiologic imaging revealed a retroperitoneal tumor with 3.5 cm extension located close to the abdominal aorta. After tumor resection the clinical symptoms disappeared. Histological examination of the tumor proved extra-adrenal pheochromocytoma. Although family history was unremarkable, the young age of the patient raised the possibility of a hereditary syndrome. Mutation screening using peripheral blood DNA samples of the patient indicated the presence of c.148-149 insA frameshift mutation of the SDHD gene. Genetic analysis of family members revealed the presence of the same mutation in his asymptomatic father while the mutation was not present in his mother and brother.The presented patient represents the first case with hereditary paraganglioma/pheochromocytoma syndrome from Hungary, in whom genetic analysis identified a disease-causing mutation of the SDHD gene. Pedigree analysis was compatible with genomic imprinting which has been demonstrated in many families with this syndrome.

The purpose of this study is to assess the internal consistency of the subscales of the Hungarian Version of the Codependent Questionnaire (CdQ, RoehlingGaumond, 1996). Thus, a reliable measurement of codependency for professionals become available in Hungary. The Hungarian Version of the Codependent Questionnaire enables professionals to identify codependent individuals.Our sample (N=137) was recruited from the general population and from self-help groups (82 individuals); and patients with borderline personality disorder (55 individuals) were recruited as clinical control group. The reliability of the questionnaire was assessed by Cronbach's alfa and principal component analysis. In addition, in order to investigate the latent structure, factors analyses and hierarchical cluster analysis were used.Based on our results, the Cronbach's alfa values of the subscales of 'control', 'reliability' and 'intimacy' indicate appropriate reliability, however, the subscale of 'enmeshment' indicates poor reliability. The originally assumed factor structure is not supported by the results of the statistical analyses. The subscales are not separate from each other, which is also indicated by the correlations of the total scores of the subscales.The reliability of the Hungarian Version of the Codependent Questionnaire is nearly identical to the original data, except for one subscale ('enmeshment subscale'). Based on these results the Hungarian Version of the Codependent Questionnaire is considered to be reliable. Besides the Hungarian adaptation, the strength of this study is the investigation of a clinical sample. The use of the questionnaire is recommended without the subscale of 'enmeshment' and further 5 items, and it is suggested to use as one scale.

Background and Objectives: There is a growing body of evidence suggesting the role of childhood abuse in the etiology of borderline personality disorder (BPD). Studies found that complex traumatization related to BPD include emotional/physical/sexual abuse and neglect. This study examines self-reported experiences of childhood traumatization in Hungarian inpatients with a diagnosis of borderline personality disorder and reveal which etiological factors are most strongly associated with the development of BPD. Methods: Traumatic childhood experiences of 80 borderline inpatients, 73 depressed inpatients and 51 healthy controls were assessed with the Traumatic Antecedents Questionnaire and the Sexual Abuse Scale of Early Trauma Inventory. Results: Adverse childhood experiences (neglect, emotional abuse, physical abuse, sexual abuse, witnessing trauma) were more prevalent among borderline patients than among depressed and healthy controls. Borderline patients reported severe sexual abuse, characterized by incest, penetration and repetitive abuse. Sexually abused borderline patients experienced more physical and emotional abuse than borderlines who were not sexually abused. The strongest predictors of borderline diagnosis were sexual abuse, intrafamilial physical abuse and neglect by the caretakers. Conclusions: Overall, our results suggest that a reported childhood history of abuse and neglect are both common and highly discriminating for borderline patients in Hungary as well.

The concept of codependency stems from the field of chemical dependency. Initially, codependent individuals meant women who dominated their partners and took care of them, while women actually were dependent upon their husbands. Nowadays, it has been recognized that men can become codependent as well, and its presence is not limited only to the relationship. This paper reviews the various interpretations of codependency and the empirical researches on the etiological factors of codependency. The explanatory models of codependency can be placed on a continuum of severity: psychopathology on the level of personality disorder, behavioural addiction, or excessive feminine behaviour. The etiology is mutifactorical: biological, psychological and social elements are also listed among etiology factors. The individual variability of the predisposition to care, failure of prefrontal cortex to inhibit empathic responses, a multitude of aversive experiences in a dysfunctional family (e.g. parental conflicts, emotional abuse, neglect and parentification), changes in the perception of women's role, and the emergence of substance abuse in the family could play a role in the development of codependency. Codependency is often unrecognized. Codependent individuals visit the health care system with stress-related or depressive symptoms which can mask the underlying causes, thus, it is possible that they will only receive symptomatic treatment. Through its trans-generational nature, codependency endangers children growing up in the family.

Significant changes are proposed in the personality disorders section of the 5th. edition of the DSM. The article summarizes the historical background of the personality disorder classification, including personality-types theory, trait-theory, and clinical concepts based upon psychiatric and psychoanalytical traditions. After briefly summarizing concerns on current approach to diagnosing personality disorders in DSM-IV, we summarise the most important features of the newly developed personality disorders classification, including concepts have been modified during long years of investigation. The new system will have modified less than was originally intended, and will be a hybrid model of dimensional categorical approach to diagnosing personality disorders. The ten personality disorder types are reduced to six, and they will have new criteria based on maladaptive trait dimensions. The trait structure model was derived from existing personality and personality disorder trait models, and includes five broad higher-order trait domains, which are negative affectivity, detachment, antagonism, disinhibition, and psychoticism. A new set of general criteria are developed for defining personality disorder. Self and interpersonal functioning represent the core impairment in personality functioning central to personality disorder, and the presence of maladaptive personality traits is also required. Severity continuum of personality pathology can be rated on the Levels of Personality Functioning Scale.

In the last 20 years six psychotherapy methods have been developed specifically for borderline personality disorder. Solid RCT evidences suggests the efficacy of all the methods. Roughly equivalent improvement was obtained from the different types of psychotherapies. Today we have reached a new phase of the borderline "psychotherapy boom", the integrative approach. According to the integrative treatment advocates we should not choose among these effective treatments but we can incorporate in the therapy all the components that work. The integrative approach uses general factors common to all effective therapies, combined with specific treatment techniques taken from different therapies in order to treat the given patient's psychopathology. These common factors are: coherent framework; attention to strategies for building strong positive alliance and maintaining patient motivation; creating a safe and structured therapeutic environment; clear treatment frame; transparency of the goals and roles; focus upon presenting problems; higher level therapeutic activity; here-and-now focus; and facilitating self-reflection. Treatment focuses on change while maintaining a validating and supportive stance. General strategies can be supplemented by more specific techniques such as cognitive-behavioral interventions for reducing maladaptive behavior, training for developing emotion regulation skills and interpersonal skills coming from dialectical behavior therapy. Methods drawn from psychodynamic approaches can be used for the modification of underlying interpersonal cognitive-emotional schemas.