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Introduction: Headache is a very common health problem worldwide and in our country due to the increasing environmental damage and daily stress. The proportion of patients with headache in general practice is 4-5%, in neurology up to 30%. Chronic headache as a persistent stressor exhausts the body through central sensitisation, which can lead to the consolidation of maladaptive coping strategies such as avoidance, feelings of loss of control, catastrophising pain. This can lead to a deterioration in quality of life and depression also. The effectiveness of pharmacotherapy in coping with chronic pain is limited, so attention should be paid to modifying maladaptive pain behaviour, as recommended by the NICE guidelines. The international literature shows that mindfulness-based cognitive therapy (MBCT) has been shown to be effective in the management of chronic headache, primarily in improving quality of life, increasing self-efficacy and reducing pain catastrophisation and depression (Hunt et al., 2022). Objectives: Our first objective was to introduce mindfulness-based cognitive therapy in Hungary to patients suffering from chronic headache. Secondly, we wanted to measure the impact of the method on quality of life, coping with pain and depression. Methods: N=28 patients, suffering from chronic headaches (tension headache and migraine) participated in the study at the Department of Clinical Psychology, Semmelweis University (BNO: G430, G431, G442). Selection criteria were: referral from a neurologist, age 18-65. The intervention was an 8-session mindfulness-based cognitive therapy for pain (Day, 2017) led by an MBCT teacher and a clinical psychology resident. Before the intervention, all patients had an individual first interview and filled in the questonnaires. Measures: Beck Depression Questionnaire, Pain Catastrophizing Scale, Comprehensive Headache-related Quality of life Questionnaire, Five Facet Mindfulness Questionnaire, Cognitive Emotion Regulation Questionnaire. Results: After the intervention, there was a significant reduction in the negative impact of pain on quality of life (p<0.05, Cohen's d=0.6), pain catastrophization (p<0.01, Cohen's d=0.74), and depression (p<0.001, Cohen's d=0.84). In addition, several sub-factors of mindfulness increased, including non-reactivity and being non-judgemental (p<0.05, Cohen's d=0.57), as well as adaptive cognitive emotion regulation strategies (p<0.05, Cohen's d=0.49). Conclusions: We can conclude, that in line with international findings, MBCT has been shown to be effective in reducing the negative impact of depressive symptoms, pain catastrophisation and headache on quality of life, and in helping people to cope with pain more adaptively, primarily through the acquisition of mindfulness skills. Disclosure of Interest: None Declared [ABSTRACT FROM AUTHOR]

Introduction: The behavioral addiction model posits that repetitive suicidal behaviors can serve as maladaptive strategies for managing stress and negative emotional states, akin to substance addiction. Both behaviors involve negative emotions, offer temporary psychological relief, and persist, indicating shared neurobiological mechanisms. This study explored psychometric differences among major repeaters, occasional attempters, and non-suicidal prisoners., Methods: A multi-centre cross-sectional survey of 363 inmates across four prisons assessed depression, cognitive-emotional regulation, impulsivity, perceived stress, lifetime non-suicidal self-injury and suicide attempts., Results: Mild depression, moderate suicidal ideation, and moderate impulsivity were common, with nearly half of the participants having attempted suicide at least once. Hierarchical multiple regression analyses revealed that repeated suicidal behavior in the past increases susceptibility to future suicidal thoughts, with suicide attempts serving as a maladaptive emotion regulation strategy among repeated attempters., Discussion: The results reveal differences in emotional dysregulation, impulsivity, and stress coping strategies among the studied groups, reinforcing the idea of suicidality as a form of behavioral addiction. The addiction approach helps explain the sensitivity to later suicidal thoughts in former attempters and self-harmers, offering valuable insights for tailored interventions within correctional settings., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Horváthné Pató, Kresznerits, Szekeres, Zinner-Gérecz and Perczel-Forintos.)

Introduction: Mindfulness based interventions belongs to the third wave of cognitive behavioural therapies, where the focus is shifted from restructuring negative automatic thoughts and dysfunctional attitudes to the awareness and acceptance of mental events. The effectiveness of mindfulness based interventions also encouraged researchers to explore more precisely the mechanism of mindfulness. One of the most common measuring instruments is the Five Facet Mindfulness Questionnaire (FFMQ). In recent years, several versions of the questionnaire have been developed, but so far no Hungarian sample has yet been used to assess which version is the most suitable for clinical and research use., Objective: Hungarian adaptation and internal / external validity testing of the short version of FFMQ., Method: In our cross-sectional, non-randomized study, we included 1413 patients from the psychotherapy outpatient clinic of our institution between 2018 and 2022., Results: Compared to the original 39 items, the 15-item version of the FFMQ has better validity indicators. Based on the confirmatory factor analysis, the five-factor model shows an excellent fit. The internal and external reliability of the five-factor structure proved to be better, than the one-factor model. The correlation coefficients also are indicating, that the direction and strength of the relationship are equivalent for the examined variables., Conclusions: The FFMQ-SF-15 version is a reliable and valid instrument for measuring mindfulness in a clinical sample.

Introduction: Panic disorder is one of the most commonly occurring emotional disorder, showing increased prevalence rates since the COVID-19 pandemic. The ever-growing number of patients in need of treatment is a heavy burden on the healthcare system, which draws attention to the importance of low-intensity, short and effective psychological interventions in the treatment of mental disorders, especially in the field of primary care. According to international guidelines, the recommended evidence-based treatment of panic disorder is cognitive behavioral therapy, which is based on the cognitive model of panic disorder. According to the model, a panic attack develops in those who catastrophize the symptoms of the normal stress reaction, i.e., consider them a sign of a serious physical illness such as heart-attack and react to this with intense anxiety., Objective: Based on Salkovskis and Clark (1986), we developed a 5 session, intensive cognitive behavioral group therapy protocol for panic patients., Method: Effectiveness of the short group therapy was assessed with questionnaires (Spielberger's State-Trait Anxiety Inventory, Beck Depression Inventory) and an additional subjective scale. Paired sample t-tests were conducted., Results: Our results suggest that the intensity of anxiety and depressive symptoms (t(36) = 5.497, p<0.0001; Z = -4.871, p<0.0001) as well as the frequency of panic attacks (Z= -5.190, p<0.0001) decreased significantly after the 5 session group therapy., Discussion and Conclusion: Our clinical study provides further evidence by the effectiveness of low-intensity psychological interventions, offering an evidence-based protocol for professionals working in primary as well as mental health care. Orv Hetil. 2023; 164(42): 1665-1672.

Background: The main aim of our study was to investigate the role of depression, stigmatization, body shame and self-compassion in the adherence of young Hungarian breast cancer patients aged between 18 and 45 years., Methods: In a cross-sectional online survey, data were collected from 99 young breast cancer patients (BC). Participants completed self-report questionnaires on socio-demographic and cancer-specific parameters as well as psychological factors (adherence: 12-item Medication Adherence Scale; depression: Hospital Anxiety and Depression Scale; stigmatization: Stigma Scale for Chronic Illnesses; body shame: Experience of Shame Scale; self-compassion: Self-Compassion Scale). We tested the predictors and mediators of adherence using hierarchical regression, mediation and moderation analysis among BC patients., Results: We found that adherence was significantly associated with body shame and stigmatization in our BC sample. In addition, stigmatization alone was a significant predictor of lower adherence. Finally, in mediation models, where body shame was a mediator, we found a significant direct effect between stigma and adherence, in other words body shame had a significant mediating effect between these variables. According to our moderation analysis, self-compassion as a significant moderator acts as a protective factor in the linear relationship between stigma and lower adherence., Conclusions: Our results highlight the importance of stigma and body shame in the development of adherence in oncological care among young Hungarian BC patients aged between 18 and 45 years. Assessment of stigma, body shame, self-compassion, and the improvement of the availability of evidence-based psychological interventions may increase the adherence of young Hungarian BC patients, leading to more favourable rates of survival., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Depression in old age is often underdiagnosed, although it is the leading mental health problem at this age. The significance of assessment and adequate treatment of depression among elderly patients cannot be overstated, since it significantly impairs the quality of life, increases morbidity and mortality in many of the chronic disease groups. In addition, it is a primary risk factor in completed suicide, which occurs up to three times more often among elderly than in other age groups. In our non-systematic (narrative) summary study, we briefly review the clinical picture and differential diagnosis of depression in elderly patients, as well as the main aspects of screening and treatment. The clinical characteristics and the pathology of the disease at this age raise a number of methodological questions that could be the subject of further empirical studies. Orv Hetil. 2023; 164(39): 1537-1543.

Introduction: Suicide attempts and their consequences have been the leading causes of death among prisoners. Meta-analyses suggest that the main risk factors are current suicidal ideation, the presence of a mental disorder, high perceived stress levels, previous suicidal attempts or self-harm, and institutional and criminogenic variables. Empirical evidence is consistent with the integrated motivational-volitional model of suicidality, which also emphasizes the role of impulsivity in suicidal behaviour. The main objectives of our research are: (a) factor analysis of the Barratt Impulsiveness Scale-Brief-8 (BIS-R-8); (b) examination of the mental health status of prisoners, and the suicidal risk factors in our sample; (c) modeling the effect of mindfulness skills on the main risk factors., Methods: In our cross-sectional survey, we matched a sample of inmates to a convenience sample according to gender and age (N=378). Based on our hypotheses, we examined the factor structure and reliability of the BIS-R-8. An independent sample t-test was used for comparison, and a two-step linear regression and mediation modeling were used to examine the risk of suicide., Results: Based on factor analysis, the BIS-R-8 can be used as a unidimensional scale. A two-factor structure with cognitive and behavioral impulsivity subscales has also been confirmed. However, the internal and external reliability of the one-factor structure proved to be better. Depression, hopelessness, perceived stress and impulsivity turned out to be of higher level in the prisoner sample; lower levels of coping skills, self-esteem, mindfulness skills and well-being were also confirmed. Depression and perceived stress level seems to be the main modifiable risk factors for suicidal thoughts in the total and prisoner's sample. Previous suicide attempts and non-suicidal self-harm are the main unmodifiable risk factors of suicidal thoughts. Low level of mindfulness skills directly and indirectly via perceived stress explains 50% of the heterogeneity in depression., Discussion: In correctional institutions BIS-8-R can be a suitable screening tool for measuring impulsivity as a suicide risk factor. Mindfulness-based interventions seem promising for improving the mental health status of prisoners and reducing the risk of suicide.

Introduction: Due to patients diagnosed with borderline personality disorder (BPD) can engage risky behaviors, it is necessary to develop evidence based interventions in healthcare that can help to reduce the most pressing problems. BPD-specific cognitive therapy-based mindfulness training (MBCT) can be a solution to this challange., Literature Review: Non-suicidal self-injury (NSSI) is a significant predictor of subsequent suicide attempts and occurs in 80% of BPD patients. It is related to impulse- and emotion-dysregulation (cognitive-emotional model), as well as the deficit of mindfulness skills, which are also key difficulties in BPD (emotional cascade model, mindfulness deficit theory). The cognitive-emotional reactivity model of NSSI based on the reactivity model in recurrent depression, the four-function model and theories above. The model differs situational, cognitive, emotional, physiological, and behavioral factors that can trigger or maintain NSSI, and it also helps to determine intervention points., Study Protocol: Our hypothesis is that the 8-week MBCT training is more effective in developing mindfulness skills, emotion- and impulse control, and in reducing self-harm also than waiting list or supportive therapy. Participants are BPD patients with NSSI, in a quasi-experimental repeated measure design, planned sample size is N=60 per group. Before the training there is a two-stage interview procedure, patients fill out a questionnaire survey and they have to sign a suicide prevention contract. The planned waiting time between the first interview and the start of the training is 8-12 weeks. The group sessions are based on the MBCT training protocol designed to reduce the risk of suicide, supplemented with BPD-specific elements (specific psychoeducation, loving-kindness meditation)., Discussion: Based on the effectiveness of small-sample research, our aim is to test the effectiveness of MBCT training among BPD patients based on the above protocol.

Cancer and the various medical treatments and tests are a major physical and psychological challenge for patients, their relatives and for the medical staff as well. Adherence and compliance become critical factors during prolonged oncological therapies. The mental health of people with malignant cancer, untreated psychological symptoms can affect survival by increasing distress and suffering, weakening quality of life and reducing adherence. Furthermore, they have a particularly high comorbidity with psychiatric disorders. The aim of this study is to introduce the tools of cognitive behavioural therapy and the therapeutic indications in the context of mental disorders associated with chronic somatic illness. Our study presents the case of a 66-year-old woman with breast cancer. She was diagnosed with mild depressive episodes and hypochondriasis based on psychodiagnostic assessment. Instead of interpreting the patient's symptoms as a serious organic illness, the goal of psychotherapy is to develop new, more adaptive attitudes and more comforting perspective of the symptoms, and to reduce secondary depression. The elements of the 16 -session cognitive behavioural therapy included behavioural activation, analysis of symptomatic behaviour, diary management, development of new alternatives and behavioural experiments, conceptualisation, and summarising learned techniques and future planning.

Background: Low self-esteem (LSE) has been associated with several psychiatric disorders, and is presumably influenced by transdiagnostic factors. Our study was based both on investigations of the relationship between depression and LSE (vulnerability, scar, reciprocal models) and on theories of cognitive factors contributing to the development and maintenance of LSE, such as Melanie Fennell's model, the catalyst model and the Self-Regulatory Executive Function model., Aims: Based on the theories above, in our cross-sectional study we aimed at understanding more specifically the transdiagnostic factors that can maintain LSE in a heterogeneous clinical sample., Method: Six hundred and eleven out-patients were assessed by SCID-I and self-report questionnaires. The model was tested by structural equation modelling., Results: Based on the fit indices, the hypothesis model did not fit the data; therefore, a modified transdiagnostic model was emerged. This model made a good fit to the data [χ2 (12, n=611)=76.471, p<.001; RMSEA=.080, CFI=.950, TLI=.913] with a strong explanatory power (adj R2=.636). Severe stressful life events and depressive symptoms lead to LSE indirectly. Self-blame, perfectionism, seeking love and hopelessness have been identified as mediating factors in the relationship between depressive symptoms and LSE. Although there was a significant correlation between state-anxiety and LSE, as well as LSE and rumination, these two factors did not fit into the model., Conclusions: The new transdiagnostic model of LSE has great potential in the treatment of various mental conditions and may serve as a guide to developing more focused and more effective therapeutic interventions.

Introduction: In the recent research and interpretation of the genetical-biological and environmental-social factors shaping psychosexual development, in addition to scientific arguments, more and more ideological and political aspect have received unfortunate emphasis., Objective: Since the literature investigating the development of gender identity and gender orientation has not only increased, but also polarized, it is timely to look at the scientific exchange of ideas and debates among the differing positions., Method: Exploring the significance of genetic, biological and social factors involved in the development of gender identity and gender orientation based on international literature data., Results: Based on the current state of science it can be concluded that, in addition to the indisputably marked genetic-biological factors, education and social patterns, as well as the extremely complex environmental and media-related influence with its variable intensity and diverse emotional content also play a significant role in the psychosexual development. This is supported, among other observations, by the data indicating that homoerotic behavior is more common in people raised by same-sex couples., Conclusion: As psychosexual development is determined jointly by both genetic-biological and social factors (like education, media etc), belonging to a sexual minority group is not a choice, not the result of a personal decision. Therefore, any kind of discrimination in this regard is unacceptable. Further scientific studies are necessary to answer a large number of questions that still remain open.

Összefoglaló. A szülés utáni időszakban megjelenő aggodalmak természetesnek tekinthetők, az anyák jelentős részénél azonban klinikai szintű szorongásos megbetegedés alakulhat ki. A postpartum időszakban a szorongásos tünetek gyakori előfordulása ronthatja az anya életminőségét, pszichés állapotát, s ezáltal kedvezőtlen hatást gyakorol az anya-gyermek kapcsolatra, a gyermek mentális fejlődésére, a párkapcsolatra, valamint a családi rendszer egyensúlyára. Kutatási eredmények igazolják, hogy a szorongásos zavar a későbbiekben megjelenő anyai depresszió előrejelzője lehet. A nemzetközi irányelvek (NICE) a peri- és postnatalis időszakban jelentkező szorongásos zavarok kezdeti kezelésében az alacsony intenzitású pszichoterápiás módszereket javasolják. Tanulmányunk elsődleges célja, hogy egy esetismertetésen keresztül, kérdőívekkel követve az állapot változását, bemutassuk a szülészet-nőgyógyászat területén alkalmazható, kis intenzitású pszichológiai intervenciók eszköztárát. Az utóbbi a kognitív viselkedésterápia alapmódszereit használja kórházi osztályos, illetve ambuláns keretek között. A pszichoedukációt, normalizálást és átkeretezést, problémafókuszú keresztmetszeti konceptualizálást, szisztematikus deszenzitizálást és problémamegoldó technikákat tartalmazó intervenciók hatására az anya jelentős szenvedést okozó szorongásos panaszai már négy pszichoterápiás találkozást követően csökkentek, az anya képessé vált arra, hogy gyermekét ellássa. A terápia hatékonyságát, a szorongás és a depresszió csökkenését a páciens szubjektív megélésén túlmenően az állapotkövető kérdőívek eredményei is teljesen mértékben alátámasztották. Eredményeink megerősítik, hogy az alacsony intenzitású pszichológiai intervenciók hatékonyan alkalmazhatók a kórházi osztályokon a szorongásos, depressziós panaszok csökkentésében és ezáltal költségkímélő módon a pszichés zavarok megelőzésében. Orv Hetil. 2021; 162(44): 1776-1782. Summary. The occurrence of postpartum worries is considered a normative phenomenon, although the threshold of anxiety reaches clinical level and can lead to the development of postpartum anxiety disorder for a significant number of new mothers. Frequent occurrence of anxiety-related symptoms can negatively influence the mother's quality of life, psychological status, the mother-child relationship, the newborn's mental development, the relationship of the couple as well as the balance of the family system as a whole. Studies show that postpartum anxiety disorder can lead to depression later on. International guidelines (NICE) suggest peri- and postnatal anxiety disorders to be treated using low intensity psychological interventions (LIPIs). The aim of this study is to present the different methods of LIPIs used in obstetrics and gynecology through a clinical case study, while monitoring the outcomes in the mothers' psychological status by the use of questionnaires. LIPIs contain the basics of cognitive behavioural therapy used in hospitals in both in- and outpatient care. After only four psychotherapy sessions using psychoeducation, normalizing and reframing, problem-centered cross-sectional conceptualisation, systematic desensitization and problem solving techniques, the mother's severe symptoms of anxiety decreased significantly, enabling her to take proper care of the newborn. The efficacy of the therapy was confirmed thoroughly not only by the subjective experience of the patient, but the results of the questionnaires used to follow the psychological status of the patient. Our results show that LIPIs can be effectively used as a cost-effective method to reduce symptoms of anxiety or depression, and to prevent the development of mental health problems among hospital patients. Orv Hetil. 2021; 162(44): 1776-1782.

Összefoglaló. Bevezetés: Az elhízás korunk egyik legnagyobb kihívása, hiszen a többletsúly számos krónikus betegség kockázati tényezője, és fontos pszichés és szociális következményei vannak. A kezelésben bizonyítottan hatékony a kognitív viselkedésterápiás testsúlycsökkentő program, amelynek során alapvető fontosságú a reális célsúly meghatározása, ugyanis az irreális elvárások megakadályozhatják a hosszú távú sikeres testsúlykontrollt. Célkitűzés: Prospektív kutatásunk kérdése, hogy az elérhető fogyást milyen mértékben befolyásolják a testsúlycélok a kognitív viselkedésterápiás testsúlycsökkentő program során. Feltételeztük, hogy a testsúlycsökkentő csoport résztvevői irreális fogyási elvárásokkal érkeznek, melyek azonban reálisabbá válnak a program végére, és megmaradnak az utánkövetés idejére. Emellett feltételeztük, hogy a testsúlycsökkentő program során az evési magatartás pozitív irányban fog változni. Módszer: A 24 hetes testsúlycsökkentő programban 63, az egyéves utánkövetésben pedig 49 felnőtt vett részt. A résztvevők antropometriai mutatói mellett (testtömeg, testmagasság) az evési magatartást és a testsúlycélokat a Háromfaktoros Evési Kérdőívvel, illetve a Célok és Relatív Testsúlyok Kérdőívvel mértük fel. Eredmények: A résztvevők közel 90%-a elérte a professzionális testsúlycsökkentő módszerek esetében elvárható legalább 5-10%-os fogyást, az evési magatartás pozitív irányban változott, testsúlycéljaik reálisabbak lettek. A fogyás szignifikáns, fordított kapcsolatban volt az aktuális és az álomsúly, az aktuális és a vágyott, valamint az aktuális és az elfogadható testsúly közötti eltéréssel. Következtetés: A kognitív viselkedésterápia széles körben alkalmazható, hatékony testsúlycsökkentő módszer, amelynek sikerében fontos szerepet játszanak a reálisan kitűzött testsúlycélok. Orv Hetil. 2021; 162(28): 1119-1128., Introduction: Obesity has become one of the most challenging issues, as the excess body-weight is a risk factor for numerous chronic diseases and has serious psychological and social consequences. The cognitive behavioral approach to weight loss had been shown an effective treatment, in which realistic weight target setting is essential, because unrealistic expectations can hinder the effort for a successful long-term weight management., Objective: The objective of our prospective study was to investigate as to how weight loss is influenced by realistic and unrealistic weight targets in a cognitive behavioral weight loss program. We hypothesized that the participants come with unrealistic weight loss expectations, which become more realistic by the end of the program and remain realistic for the follow-up. In addition, a positive change was expected in the eating behavior of the participants during the program., Method: The program was completed by 63 people, 49 subjects participated in the 1-year follow-up. Anthropometric data were obtained and the participants were asked to fill in the Three-Factor Eating Questionnaire - Revised 21 items and the Goals and Relative Weights Questionnaire., Results: According to the results, the program is effective, since nearly 90% of the participants reached at least 5-10% weight loss as expected by professional weight loss methods. Besides weight loss there were positive changes in the participants' eating behavior; weight targets became more realistic. Weight loss was inversely related to the difference between actual and dream, actual and desired as well as between actual and acceptable weight., Conclusion: Our results in accordance with previous studies show that cognitive behavioral weight loss programs can be effective; however, setting up realistic weight targets can be crucial in successful weight loss. Orv Hetil. 2021; 162(28): 1119-1128.

Introduction: About 25-30% of patients present themselves in general practice and specialized healthcare with medically unexplained somatic symptoms. The prevalence of these symptoms is the highest among the elderly, children and adolescents. Approximately 20% of patients in primary care and 47% of them in specialized clinics are children between the age of 7-12 who seem to have somatic symptom disorder (SSD). Somatization disorder most frequently occur with symptoms of headache, stomach ache or various kinds of pain in the limbs that show high comorbidity with other mental disorders, predominantly with anxiety. SSDs are always multicausal issues where biological, social-environmental and psychological factors are interconnected in a complex manner. According to our experience, somaziting patients are often drifting in the healthcare system for years, and instead of getting adequate treatment, they only receive medication, thus their symptoms may easily become chronic. Aim, method: Our aim was to review the current literature and guidelines concerning evidence-based treatments for SSD in childhood. Furthermore, to underline the importance of psychotherapy in SSD, we present the cognitive behavior therapy of a 16-year-old adolescent with vertigo, gastrointestinal symptoms and insomnia over a 8-month period., Discussion: The results of effectiveness studies unequivocally recommend cognitive behavioral therapy in the treatment of SSD patients, accompained by family therapy or family consultation. The therapy should focus on reducing psychosocial stressors, health anxiety and catastrophizing thinking style in the family, while developing adequate coping and communication skills as well as maintaining the patient's age-appropriate activity level., Conclusion: Cognitive behavior therapy is the treatment of choice in SSD for children and young people. Applying the biopsychosocial approach is a key issue in the assessment of predisposing and maintaining factors, ensuring that only methods based on scientific evidence will be applied to help these children. Orv Hetil. 2020; 161(25): 1050-1058.

The prevention of suicide and self-harm are of particular importance in psychiatric practice handling ade - quate diagnostic procedures. Despite its decreasing tendency, suicide risk is still a serious problem facing our health care system. From the second half of the 20th century, verbal or written agreements that were intended to forestall sui - ci dal behavior became part of suicide prevention protocol. Today, we refer to them as "suicide prevention contracts" or "no-suicide contracts". Despite the fact that these agreements are becoming more and more common in medical care, there is still no general agreement among health care providers on the indication, form or other aspects of these con - tracts. However, contracting in these situations requires delicate discretion. At the outpatient psychotherapy service of the Clinical Psychology Department, Semmelweis University we have been using this tool in the last 20 years in the management of patients in suicidal crisis. In this article the establishment of contracts in clinical use and its indica - tions are described as well as some special issues like suicidality in adolescence. We also discuss the presumed positive effects of contracting, and demonstrate the use of no-suicide contracts in clinical practice by presenting selected cases.

Introduction: Chronic obstructive pulmonary disease (COPD) is a health burden for the patient and the society. We have sought to find the optimal education content to alleviate this burden. Aim: (1) To create patient education content based on the pulmonologists' opinion; (2) to understand the pulmonologists' attitudes and perceptions; (3) to evaluate the options to improve patient adherence. Method: We have performed 20 interviews with pulmonologists working in inpatient, outpatient and rehabilitation settings. The structure of the interviews has been designed to determine the key elements of a patient education programme and to discover perception and therapeutic attitudes. Results: The average COPD patient is a smoker, male, under-socialized, coughs, has dyspnoea and is older than 40 years. He does not take his illness seriously, and seeks medical attention only in case of worsening of the disease, and improvement in adherence is only present in such cases. The latter phenomenon is frequently transient, and limited to worse periods. Three adherence groups can be defined: marginal good adherence (approx. 10%), the average is around 30-40%, and minimal adherence (60%). Correct inhaler use should be taught in maximum three steps, which should be easily reproduced and explained. Conclusion: The aspects defining the framework of the education programme are the adequate patient profile (tailor-making), on-the-spot education in the pulmonology centre, the relationship between the patient and the doctors, patient attitudes and lifestyle changes (smoking cessation), and choosing the adequate inhaler. Orv Hetil. 2020; 161(3): 95-102.

In this literature review the new trends of cognitive behavioural therapy (CBT), namely behavioural activation and rumination-focused cognitive behavioural therapy are introduced as new methods for the treatment of major depression. Component-analytical studies of CBT showed that besides cognitive restructuring, behavioural components play an important role as active treatment factors. Behavioural activation and rumination-focused CBT emphasize these processes. The central idea of behavioural activation is that negative experiences in depression result in secondary avoidant behaviour. Clients participating in such therapy learn to recognize and change avoidant behaviour. Rumination-focused CBT target repetitive negative thoughts that are considered a transdiagnostic maladaptive phenomenon. These conceptual and methodological can contribute substantially to the effectiveness of CBT for major depression.

Introduction: Different types of childhood trauma have been repeatedly shown to contribute to psychotic symptoms. Gender differences in schizophrenia are well known. Some studies argue that trauma history means a significantly higher risk of psychosis for women than men. However, there is evidence of early adverse life events to be associated with higher stress-sensitivity in men. Little is known about the connection of specific type of trauma and specific psychotic symptoms as well as the course of illness with explicit regard to gender differences., Methods: 102 men and women with schizophrenia spectrum disorder were tested using Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Scale for Assessing Positive Symptoms, Early Trauma Inventory-SR., Results: Although, women had a later age at onset without regarding trauma history (d = 0.74), this difference became non-significant when introducing trauma variables. Patients reporting physical abuse had a significantly earlier age at onset, regardless of their sex (V = 0.13, F = 3.11, p = 0.03. Physical abuse predicted an earlier age at onset only in women (R 2  = 0.23). History of general trauma predicted more frequent hospitalizations only in men (R 2  = 0.55)., Conclusions: Although women generally tend to have a more favorable course of illness including a later age at onset men, women with CPA seem to lose this "advantage". It is necessary to investigate the contribution of gender interacting with adverse life events in contribution to the phenomenology and etiology of schizophrenia., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Inflammatory bowel disease (Crohn's disease and colitis ulcerosa) is a chronic, long-term condition that causes chronic inflammation in the digestive tract, and shows an increasing incidence and prevalence worldwide. Changes in disease activity over time affect psychological distress which increases the risk of exacerbations. Beside somatic symptoms (such as abdominal pain, diarrhoea and weight loss), psychiatric comorbidity (in particular major depression, anxiety, social phobia) is common in patients with Crohn's disease. This case study illustrates the management and stabilization of a 21-year-old adult male patient with active Crohn's disease and with severe psychiatric comorbidity. The patient was diagnosed with avoidant personality disorder and dysruptive mood dysregulation disorder based on the results of psychodiagnostics (SCID-II structured clinical interview, MMPI personality inventory and disease-specific clinical questionnaires such as Beck Depression Inventory, Beck Hopelessness Scale, Social Cognition Questionnaire, Anger Expression Scale, Cognitive Emotion Regulation Questionnaire, Rosenberg Self-Esteem Scale). The main aim of psychotherapy is to increase the adherence to pharmacotherapy, to promote psychosocial functioning, to improve well-being and to enhance adaptive coping strategies. Low-intensity cognitive-behavioural psychotherapy was used which included psychoeducation, motivational interview, behavioural activation, patient diary, cognitive restructuring, problem-solving training, and family consulting. Twenty-five sessions were held weekly in outpatient form and 3 sessions of crisis intervention after the surgery at the hospital. The efficacy of the treatment was measured by self-reported questionnaires at baseline and at two follow-up sessions which corroborated a very significant decrease in the severity of depression, hopelessness, while emotional regulation and self-esteem became more adaptive. The remission of the above-mentioned psychiatric symptoms resulted in the improvement of the pharmacotherapy adherence and the quality of life. Low-intensity psychosocial interventions are proven to be an effective way of delivering evidence-based psychotherapy. Orv Hetil. 2018; 159(9): 363-369.

Introduction: Although social anxiety disorder (SAD) is the third most frequent emotional disorder with 13-15% prevalence rate, it remains unrecognized very often. Social phobia is associated with low self-esteem, high self-criticism and fear of negative evaluation by others. It shows high comorbidity with depression, alcoholism, drug addiction and eating disorders., Aim: To adapt the widely used "Fear of Negative Evaluation" (FNE) social phobia questionnaire., Method: Anxiety and mood disorder patients (n = 255) completed the Fear of Negative Evaluation Scale (30, 12 and 8 item-versions) as well as social cognition, anxiety and self-esteem questionnaires., Results: All the three versions of the FNE have strong internal validity (α>0.83) and moderate significant correlation with low self-esteem, negative social cognitions and anxiety. The short 8-item BFNE-S has the strongest disciminative value in differentiating patients with social phobia and with other emotional disorders., Conclusions: The Hungarian version of the BFNE-S is an effective tool for the quick recognition of social phobia. Orv Hetil. 2017; 158(22): 843-850.

Suicide is a major public health problem everywhere in the world and in the WHO European Region suicide accounts for over 120,000 deaths per year. 1. Recognition and diagnosis: An underlying psychiatric disorder is present in up to 90% of people who completed suicide. Comorbidity with depression, anxiety, substance abuse and personality disorders is high. In order to achieve successful prevention of suicidality, adequate diagnostic procedures and appropriate treatment for the underlying disorder are essential. 2. Treatment and care: Acute intervention should start immediately in order to keep the patient alive. Existing evidence supports the efficacy of pharmacological treatment and cognitive behavioural therapy (including dialectical behavior therapy and problem-solving therapy) in preventing suicidal behaviour. Some other psychological treatments are promising, but the supporting evidence is currently insufficient. Studies show that antidepressant and mood stabilizer treatments decrease the risk for suicidality among responders in mood disorder patients. However, the risk of suicidal behaviour in depressed patients treated with antidepressants exists during the first 10-14 days of treatment, which requires careful monitoring. Short-term supplementary medication with anxiolytics and hypnotics in the case of anxiety and insomnia is recommended. Treatment with antidepressants of children and adolescents should only be given under supervision of a specialist. Long-term treatment with lithium has been shown to be very effective in preventing both suicide and attempted suicide in patients with unipolar and bipolar depression. Treatment with clozapine is effective in reducing suicidal behaviour in patients with schizophrenia. Other atypical antipsychotics are promising but more evidence is required. 3. Family and social support: The suicidal person should always be motivated to involve family in the treatment. Psychosocial treatment and support is recommended, as the majority of suicidal patients have problems with relationships, work, school and lack functioning social networks. 4., Safety: A secure home, public and hospital environment, without access to suicidal means is a necessary strategy in suicide prevention. Each treatment option, prescription of medication and discharge of the patient from hospital should be carefully evaluated against the involved risks. 5. Education of treatment team: Training of general practitioners is effective in the prevention of suicide. It improves treatment of depression and anxiety, quality of the provided care and attitudes towards suicide. Continuous training including discussions about ethical and legal issues is necessary for psychiatrists and other mental health professionals. Multidisciplinary treatment teams including psychiatrist and other professionals such as psychologist, social worker, and occupational therapist are always preferable, as integration of pharmacological, psychological and social rehabilitation is recommended especially for patients with chronic suicidality. 6. Public aspects: Not only the health care workers are responsible for suicide prevention. All members of our society (including community/political leaders as well as religious and civil organizations) have their own task with more or less competence and responsibility.

Unlabelled: The aim of the present study was a systematic path-analytical investigation between the effects of life events, dysfunctional attitudes and coping strategies in relation with the exhibited depressive and anxiety symptoms in patients with mental disorders., Methods: Self-report data of 234 patients from our outpatient psychotherapy unit were analyzed. Life events, dysfunctional attitudes, coping strategies as well as symptoms of anxiety and depression were assessed by self-administerd questionnaires. Statistical methods included structural equation modelling, which enables the estimation of the magnitude and strength of individual variables within an overarching casual model, thus yielding a complex view on the possible processes underlying the development of the clinical symptoms of anxiety and depression., Results: Our findings indicate that both the number of negative life events and their subjectively experienced intensity contributed to the increase of dysfunctional attitudes. The presence of dysfunctional attitudes decreased the use of problem-focused coping strategies and increased the use of emotion-focused coping strategies. The use of problem-focused coping decreased symptom occurrence and emotion-focused coping strategies increased the frequency of symptoms of anxiety and depression. Our findings suggest that dysfunctional need for achievement and perfectionism directly increase the probability of depressive symptom manifestation. The attitude of external locus of control showed a significant relationship with anxiety symptoms through emotion-focused coping strategies and directly as well., Conclusion: Restructuring dysfunctional attitudes and developing problem-focused coping strategies are an important part of psychotherapeutic interventions aiming to decrease anxiety and depressive symptoms.

The central goal of this manuscript was to review literature about the interconnections of traumatic life events and symptoms of schizophrenia spectrum of the last 15 years. First of all, the stress-diathesis model and the traumagenic neurodevelopmental model are shortly presented. Psychological effects of traumas and specific psychotic symptoms in connection with traumatic events are discussed. The course of the disease in patients affected by previous traumas and possible mediating factors are also addressed. Studies of both clinical and community samples are cited. It was also our aim to review literature about the neurobiological and neurocognitive processes in people affected by schizophrenia and/or traumatic life events. The role of prefrontal and medial temporal regions are explored with a special emphasis on contextual memory and hippocampal functioning. Finally, the possible effects of exploring traumatic life events on the treatment of schizophrenia are discussed.

Introduction: Treatment of obesity has become one of the most challenging issues., Aim: The aims of the authors were to present the results of standard behavior therapy weight loss program combined with self-help and the results of one-year follow-up., Method: The 24-week program involved 41 participants of which 33 subjects participated in the follow-up. Anthropometric data were obtained and the participants were asked to fill questionnaires (the 21 items Three Factor Eating Questionnair Revised 21 items; Physical Exercise: Steps of change [Short Form]., Results: 87.8% of participants achieved a minimum weight loss of 5% which is the rate expected in professional therapies for obesity. Significant changes in maladaptive eating pattern and an increase in the rate of regular exercise were observed. Significant association was found between the increase of cognitive restraint and the rate of weight loss during treatment. At one-year follow-up the majority of participants (75.8%) did keep their minimum weight loss of 5% and they showed significant change in eating pattern., Conclusions: The results suggest that standard behavior therapy extended with self-help elements may be a cost-effective treatment of obesity.

Mutations in the mitochondrial genome can impair normal metabolic function in the central nervous system (CNS) where cellular energy demand is high. Primary mitochondrial DNA (mtDNA) mutations have been linked to several mitochondrial disorders that have comorbid psychiatric, neurologic, and cognitive sequelae. Here, we present a series of cases with primary mtDNA mutations who were genotyped and evaluated across a common neuropsychological battery. Nineteen patients with mtDNA mutations were genotyped and clinically and cognitively evaluated. Pronounced deficits in nonverbal/visuoperceptual reasoning, verbal recall, semantic word generativity, and processing speed were evident and consistent with a "mitochondrial dementia" that has been posited. However, variation in cognitive performance was noteworthy, suggesting that the phenotypic landscape of cognition linked to primary mtDNA mutations is heterogeneous. Our patients with mtDNA mutations evidenced cognitive deficits quite similar to those commonly seen in Alzheimer's disease and could have clinical relevance to the evaluation of dementia., (© The Author 2014. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

In our study we assessed the frequency of reported hopelessness and suicide attempts in the national representative survey Hungarostudy 2002. The randomly selected sample consisted of 14,000 individuals over the age of 18. We created a short version of the widely used Beck Hopelessness Scale for screening purposes in suicide prevention. The short version of the BHS consists of four items and has high internal consistency (Cronbach's alpha = 0.85). Moreover, we conducted an investigation into psychological, somatic, sociological and socio-economic as well as cultural variables that show a positive or negative correlation with hopelessness and important predictors of suicide. The following psychological variables showing a positive correlation with hopelessness were identified: dysfunctional attitudes, exhaustion, psychological distress, hostility, lack of life goals and inability to cope emotionally. Sense of coherence, social support, perceived self-efficiency, subjective well-being and problem-solving coping showed a negative correlation with hopelessness. Concerning the relationship between hopelessness and suicide attempts, we found that participants who attempted suicide in the last year scored higher (mean = 4.86) than participants who attempted suicide more than 3 years ago (mean = 3.57). These results indicate that applying the short version of the BHS could be very useful in general practice and in psychiatric care.

Background: The prevalence of depression and burnout among health care professionals is high in Hungary. However, there is limited empirical data on disease prevention among these populations., Aims: This study aims at evaluating the mediating role of coping mechanisms in preventing depression and burnout., Methods: Cross-sectional survey among 1333 health care professionals. Participants completed self-administered questionnaires about their perception of work stress, burnout and depressive symptoms, as well as their preferred coping strategies. Analyses were performed using structural equation modelling., Results: The prevalence of severe depression and lack of personal accomplishment was 5.6% and nearly 50%, respectively. Work stress predicted symptoms of burnout and depression both directly and indirectly through the mediation by coping strategies. Of the coping strategies, cognitive restructuring, which accentuates the realistic assessment of challenging situations, was found to reduce the probability of the development of burnout and depression symptoms., Conclusions: This study provides further data for the development of cognitive interventional strategies and highlights the significance of these strategies in the prevention of depression and burnout among Hungarian health care professionals.

Introduction: In the present study specific characteristics of PTSD patients were explored in a clinical sample with particular regard to dysfunctional attitudes and coping strategies. The purpose was to draw attention to this rarely investigated but presumably prevalent psychiatric disorder in the Hungarian population., Method: Twenty-two PTSD patients' retrospective data was analyzed who presented at our clinic for outpatient psychotherapy treatment. Patients were assessed on depressive, anxiety, hopelessness, and posttraumatic stress symptoms, as well as dysfunctional attitudes and coping strategies., Results: Thirty-two percent (n=7) of the sample is male and 68% (n=15) is female, the mean age is 34.77 years. Based on trauma type 40.9% (n=9) had a motor vehicle accident, 18.2% (n=4) lost a close relative, 18.2% (n=4) was a victim of sexual or physical assault. There is great variance in the duration since the trauma (2 months to 10 years). The results suggest that posttraumatic stress symptoms (PTSSs) are associated with the dysfunctional attitudes of need for achievement and external control, and with avoidant and conforming coping styles. Additionally, PTSSs were highly comorbid with depressive and anxiety symptoms., Conclusion: The results imply that PTSD patients in Hungary have similar characteristics as international findings indicate.

Being aware of the worldwide spread of diabetes and obesity as well as its economic effects, the authors discuss the complex, behavior remediational methods of the treatment and its current questions. They emphasize the role of chronic stress in the etiopatogenesis of insulin resistance, metabolic syndrome, and type 2 diabetes. All these require a shift of paradigm in the field of treatment too. Based on literature data and on their own practical experience, the authors consider that behavior remediational can integrate two, sometimes still opposing medical philosophical views in order to foster the efficiency of medical work. They review elements of behavior remediation of diabetes, underlining self-management, acceptance of the illness, and motivation which can be followed by teaching theoretical and practical knowledge, the ongoing diabetes education. Comorbid psychological disorders impede these processes; their early recognition and complex treatment are essential. The authors present a cognitive, behavior remediational programme of weight loss, that can be used in practise, both in prevention and treatment of diabetes.

Background: The Impact of Event Scale (IES, Horowitz, 1979) has been widely used to evaluate subjective stress following traumatic life events. Based on the theoretical reflections of the authors, it consists of two subscales: intrusion and avoidance. Although the empirical data of the past 30 years have supported the original two-factor model to a large extent, alternative models have also been published. Our aim was to evaluate the psychometric properties of the Impact of Event Scale Hungarian version., Methods: Data from 244 undergraduate students on the Hungarian version of Impact of Event Scale (Annus, Perczel Forintos, Kiss, 2005) were analyzed. Subjects were asked to fill in Beck Depression Inventory shortened version (Beck & Beck, 1972, Kopp & Forizs, 1993) and STAI-T (Spielberger, 1970, Sipos & Sipos, 1978) too., Results: Internal consistency of the whole IES (Cronbach's a=0,891) as well as of intrusion (Cronbach's a=0,874) and avoidance (Cronbach's a=0,818) was found to be very good. Test-retest reliability of the whole scale (r=0,491, p<0,001) as well as of subscales (for intrusion r=0,543 p<0,001, for avoidance r=0,523 p<0,001) was satisfactory. No association was found between gender and IES scores. Confirmatory and explanatory factor analysis supported the two factor model in our sample. IES had a moderate positive correlation with depression (r=0,273, p<0,001) and anxiety (r=0,381, p<0,001), indicating that it reflects a somewhat related but still independent construct., Conclusions: The Hungarian version of the Impact of Event Scale has been proved a valid and reliable measure of post-traumatic stress symptoms.

Objective: The Cognitive Emotion Regulation Questionnaire (CERQ) measures conscious attentional and thinking processes that people often use to regulate their emotions. The English version of the CERQ - consisting of nine subscales: self-blame, rumination, catastrophizing, other blame, acceptance, positive refocusing, planning, positive reappraisal and putting into perspective - showed excellent psychometric properties in previous investigations and is widely used in current research and clinical practice. The present study describes the psychometric properties of the Hungarian version of the CERQ., Method: The forward and back-translation method was used for the adaptation. 261 undergraduate and graduate students completed the Hungarian version of the CERQ, the Shortened Beck Depression Inventory (BDI-S), the 5-item version of the WHO Well-being Index (WBS-5) and a short demographical form., Results: CERQ subscales showed acceptable to very good internal consistency (Cronbach's alphas ranging from 0.68 to 0.88) and strong test-retest reliability (Pearson's correlations ranging from 0.58 to 0.85, p<0.001 ). No associations were found between the emotion regulation strategies and gender and socioeconomic status. Confirmatory and exploratory factor analysis supported the theoretical model with nine independent factors. Multiple linear regression analyses revealed significant relationships between BDI-S and self-blame, acceptance, planning, positive reappraisal and catastrophizing (F=14,28 p<0,001, adjusted R2=0,320), and WBI-5 and self-blame, rumination, positive refocusing and positive reappraisal (F=5,89 p<0,001; adjusted R2=0,26)., Conclusion: Results indicate that the Hungarian version of the CERQ is a reliable and useful instrument for assessment of cognitive emotion regulation strategies.

Obesity is a global epidemic with serious health consequences. Behavior therapy is one of the evidence based methods in the treatment of obesity. According to several studies these programs induce modest (cca. 10 %) weight reduction that is associated with statistically and clinically substantial improvements in weight-related health conditions and psychosocial outcomes. Reduced weight is usually maintained for a relatively long time, cca. 2-3 years. Cognitive and affective processes seem to play an important role in weight regain. This led to the development of cognitive behavioral treatment approaches. This paper describes the behavior therapy and cognitive-behavioral treatment of obesity.

In our recent article we attempt to sum up the circumstances of the closing-down of the National Psychiatric and Neurologic Institute (OPNI). We intend to summarize the values that may disappear by the liquidation of the institute and try to explore the possibilities how to keep them alive in the future. Most of the divisions can operate further under the umbrella of the Semmelweis University; the modus operandi and the role of the University are also covered in this article.

Some theories explaining the background of suicidal attempts emphasise the role of depression, while others emphasise the role of hopelessness in the case of different psychological states, like psychosis. According to researches negative emotions, namely hopelessness predicts suicidal intentions more precisely than depression itself. In our study we measured the suicidal risk of our psychotic patients with hopelessness, depression and life event scales. Our results have implied that suicidal psychotic patient groups showed significantly more serious level of depression and hopelessness and had more negative life events than the non-suicidal group. Indeed, a sub-group could also be distinguished among suicidal psychotic patients in which the level of hopelessness predicts suicidal risk and not depression.

According to our present knowledge depression and hopelessness play an important role in attempted suicide and the development of hopelessness seems to be closely associated with poor problem solving skills. In the present study we have used the internationally well-known MEPS (Means-Ends Problem Solving Test; a measure of social problem solving ability) in Hungary for the first time and combined with other tests. We intended to explore the cognitive risk factors that potentially play a role in the suicidal behavior in clinical population. In our study we compared a group of individuals who had attempted suicide to a nonsuicidal psychiatric control group and a normal control group (61 subjects in each group). Our results confirm the findings of others that psychiatric patients have difficulties in social problem solving compared to normal controls. Moreover, they generate less and poorer solutions. According to our data problem solving skills of the two clinical groups were similar. A strong positive correlation was found between poor problem solving skills, depression and hopelessness which may suggest that the development of problem solving skills could help to reduce negative mood.

Unlabelled: In order to reduce suicide rate in Hungary, it is essential to screen for and detect individuals with high suicide risk. For people with suicidal thoughts and intentions often visit their GP, our intention was to assess the potential suicide risk amongst patients going to the GP's. Based on a former study, we assumed the rate of depression to be about 30% amongst patients waiting at the GP's consulting room, and that there would be suicidal patients too. A randomised study of 158 patients together with 91 matched controls was conducted in GP's practices. Four different scales were applied: Beck Hopelessness Scale, Beck Depression Scale, Beck's Anxiety Scale and Paykel's Life Event Scale. Unfortunately, our results showed a more serious picture than expected: people visiting the GP were significantly more depressed, hopeless and anxious than controls, and one third of them proved to be at high suicide risk., Conclusion: GPs can play an important role in suicide prevention, and should do as well. Hopelessness Scale and Beck's Depression Scale are reliable test materials for local doctors.

Psychological studies have great importance in suicide prevention since psychological factors belong to the modifiable risk factors in suicide. These are the negative cognitive triad and hopelessness which are related to vague, over-generalized autobiographical memory and lead to poor problem solving abilities. In this paper we review the most relevant clinical psychology studies and models such as the cognitive model of suicide as well as the entrapment theory by Williams (2004). In the second part we describe the frequently used method of problem solving training/therapy which can be used in either individual or group format. We hope that the problem solving skill training will soon become a part of suicide prevention in Hungary also, since short,focused and evidence based interventions are much needed in psychiatric care.