Psychometric properties of the Hungarian childhood trauma questionnaire short form and its validity in patients with adult attention-deficit hyperactivity disorder or borderline personality disorder.

BACKGROUND: Compelling evidence supports the role of childhood traumatization in the etiology of psychiatric disorders, including adult attention-deficit hyperactivity disorder (aADHD) and borderline personality disorder (BPD). The aim of this study was to examine the psychometric properties of the Hungarian version of the Childhood Trauma Questionnaire Short Form (H-CTQ-SF) and to investigate the differences between patients diagnosed with aADHD and BPD in terms of early traumatization. METHODS: Altogether 765 (mean age = 32.8 years, 67.7% women) patients and control subjects were enrolled from different areas of Hungary. Principal component analysis and confirmatory factor analysis were carried out to explore the factor structure of H-CTQ-SF and test the validity of the five-factor structure. Discriminative validity was assessed by comparing clinical and non-clinical samples. Subsequently, aADHD and BPD subgroups were compared with healthy controls to test for the role of early trauma in aADHD without comorbid BPD. Convergent validity was explored by measuring correlations with subscales of the Personality Inventory for DSM-5 (PID-5). RESULTS: The five scales of the H-CTQ-SF demonstrated adequate internal consistency and reliability values. The five-factor model fitted the Hungarian version well after exclusion of one item from the physical neglect scale because of its cross-loading onto the emotional neglect subscale. The H-CTQ-SF effectively differentiated between the clinical and non-clinical samples. The BPD, but not the aADHD group showed significant differences in each CTQ domain compared with the healthy control group. All CTQ domains, except for physical abuse, demonstrated medium to high correlations with PID-5 emotional lability, anxiousness, separation insecurity, withdrawal, intimacy avoidance, anhedonia, depressivity, suspiciousness, and hostility subscales. CONCLUSIONS: Our study confirmed the psychometric properties of the H-CTQ-SF, an easy-to-administer, non-invasive, ethically sound questionnaire. In aADHD patients without comorbid BPD, low levels of traumatization in every CTQ domain were comparable to those of healthy control individuals. Thus, the increased level of traumatization found in previous studies of aADHD might be associated with the presence of comorbid BPD. Our findings also support the role of emotional neglect, emotional abuse and sexual abuse in the development of BPD.

Disturbed body schema, perceptual body image, and attitudinal body image in patients with borderline personality disorder.

Background: Borderline personality disorder (BPD) is a severe mental disorder that affects attitudes toward the body. However, whether this condition also affects body schema and perceptual body image remains unclear. Previous questionnaire-based studies found dissatisfaction with one's body in patients with BPD. In addition to attitudinal body image, our study investigates whether body schema and perceptual body image are disturbed in patients with BPD. Method: Our study included 31 patients diagnosed with BPD (25 women) and 30 healthy individuals (19 women) (Mage = 29 for both groups). The SCID-5-PD interview was used to determine personality disorder. Attitudinal body image was measured using the Body Attitude Test (BAT) factors. Body schema and perceptual body image were measured by two conditions of a body representation task, the body portraying method (BPM). Results: BPD patients achieved higher scores in all three BAT factors and were more susceptible to misinformation in both conditions of BPM. Based on the results, BPD patients appear to have more negative attitudes toward their bodies and worse perceptual body image and body schema. Conclusion: The novel finding of our study is that, besides the previously found attitudinal dissatisfaction with the body, individuals with BPD also show disturbances at the levels of body schema and perceptual body image. Our findings concerning disturbances in body schema and perceptual body need further research into their etiological factors and provide new therapeutic targets for the treatment of BPD.

Moral Injury and Shame Mediate the Relationship Between Childhood Trauma and Borderline Personality Disorder, PTSD, and Complex PTSD Symptoms in Psychiatric Inpatients.

Moral injury (MI) has received increased research attention in the past decades. However, despite its detrimental mental health consequences, MI has not been studied in psychiatric patients. We aimed to establish the relationship between childhood trauma, MI, and borderline personality disorder (BPD), posttraumatic stress disorder (PTSD), and disturbances in self-organization symptoms (DSO), a core diagnostic criterion of complex PTSD besides PTSD symptoms, and shame as a moral emotion in an inpatient psychiatric sample (N = 240). We found that the impact of childhood trauma on present BPD, PTSD, and DSO symptoms was mediated by MI and shame; the models accounted for up to 31% of variance in symptomatology. To our knowledge, this study is the first to investigate MI in a psychiatric sample, and our results highlight the importance of considering MI as a critical factor of patient experiences in relation to childhood trauma that potentially contributes to the development of psychiatric symptoms.

Impaired decision-making in borderline personality disorder.

Introduction: Borderline personality disorder (BPD) is a complex mental disorder with core symptoms like interpersonal instability, emotion dysregulation, self-harm, and impulsive decision-making. Previous neuropsychological studies have found impairment in the decision-making of patients with BPD related to impulsivity. In our study, we focus on a better, more nuanced understanding of impulsive decision-making in BPD with the help of Rogers' decision-making test that simulates a gambling situation. Methods: A novelty of our study is that we excluded from further analysis non-compliant participants based on their performance. Outlier participants on the measures proportion of good choices and average of wager choice number were filtered out to represent the population that understood the basic premise of the task and showed minimal motivation to gain rewards. Thus participants often choosing the less likely color or frequently choosing the first bet amount available (to probably speed up the test) were omitted from further analysis. Another novelty is that we assessed and reported six variables that examine Deliberation Time, Quality of Decision, Risk-taking, Overall proportion bet, Delay aversion, and Risk adjustment. Forty-three women with BPD participated in the study, and 16 non-compliant were excluded. As for the healthy control group, 42 women participated in the study, and four non-compliant were excluded. Thus, we compared the data of 27 patients with BPD with 38 healthy controls. Results: Our results show that there are significant differences amongst the groups regarding the Quality of Decision Making (F (1,63) = 5.801, p = 0.019) and Risk Adjustment (F (1,63) = 6.522, p = 0.013). We also found significant interactions between group and winning probability regarding Risk Taking (F (4,252) = 4.765 p = 0.001) and Overall proportion of bets, i.e., the average proportion of bets relative to the total score of the subject (F (4,252) = 4.505, p = 0.002). Discussion: Our results show that the two groups use different decision-making strategies that can have various associations with everyday life situations.

Moral injury in psychiatric patients with personality and other clinical disorders: development, psychometric properties, and validity of the Moral Injury Events Scale-Civilian Version.

Background: Moral injury emerges when someone perpetrates, fails to prevent, or witnesses acts that violate their own moral or ethical code. Nash et al. [(2013). Psychometric evaluation of the moral injury events scale. Military Medicine, 178(6), 646-652] developed a short measure, the Moral Injury Events Scale (MIES) to facilitate the empirical study of moral injury in the military. Our study aimed to develop a civilian version of the measure (MIES-CV) and examine its psychometric properties in a sample of psychiatric inpatients .Methods: In this cross-sectional study, the sample comprised 240 adult patients (71.7% female) with a mean age of 31.57 (SD = 11.69). The most common diagnoses in the sample were anxiety disorders (58.3%), depressive disorders (53.8%), and borderline personality disorder (39.6%). Participants were diagnosed using structured clinical interviews and filled out psychological questionnaires.Results: Exploratory factor analysis suggested that Nash et al.'s model (Perceived Transgressions, Perceived Betrayals) represents the data well. This two-factor solution showed an excellent fit in the confirmatory factor analysis, as well. Meaningful associations were observed between moral injury and psychopathology dimensions, shame, reflective functioning, well-being, and resilience. The Perceived Betrayals factor was a significant predictor of bipolar disorders, PTSD, paranoid personality disorder, borderline personality disorder, and avoidant personality disorder.Conclusions: Our study demonstrated that this broad version of the MIES is a valid measure of moral injury that can be applied to psychiatric patients.

The Moral Injury Events Scale­Civilian Version is a reliable and valid instrument.The original 2-factor solution (Perceived Transgressions, Perceived Betrayals) yielded a good fit to the data.Moral injury's Perceived Betrayals factor predicted bipolar disorders, PTSD, and three personality disorders (paranoid PD, borderline PD, avoidant PD).

m-RESIST, a Mobile Therapeutic Intervention for Treatment-Resistant Schizophrenia: Feasibility, Acceptability, and Usability Study.

BACKGROUND: In the European Union, around 5 million people are affected by psychotic disorders, and approximately 30%-50% of people with schizophrenia have treatment-resistant schizophrenia (TRS). Mobile health (mHealth) interventions may be effective in preventing relapses, increasing treatment adherence, and managing some of the symptoms of schizophrenia. People with schizophrenia seem willing and able to use smartphones to monitor their symptoms and engage in therapeutic interventions. mHealth studies have been performed with other clinical populations but not in populations with TRS. OBJECTIVE: The purpose of this study was to present the 3-month prospective results of the m-RESIST intervention. This study aims to assess the feasibility, acceptability, and usability of the m-RESIST intervention and the satisfaction among patients with TRS after using this intervention. METHODS: A prospective multicenter feasibility study without a control group was undertaken with patients with TRS. This study was performed at 3 sites: Sant Pau Hospital (Barcelona, Spain), Semmelweis University (Budapest, Hungary), and Sheba Medical Center and Gertner Institute of Epidemiology and Health Policy Research (Ramat-Gan, Israel). The m-RESIST intervention consisted of a smartwatch, a mobile app, a web-based platform, and a tailored therapeutic program. The m-RESIST intervention was delivered to patients with TRS and assisted by mental health care providers (psychiatrists and psychologists). Feasibility, usability, acceptability, and user satisfaction were measured. RESULTS: This study was performed with 39 patients with TRS. The dropout rate was 18% (7/39), the main reasons being as follows: loss to follow-up, clinical worsening, physical discomfort of the smartwatch, and social stigma. Patients' acceptance of m-RESIST ranged from moderate to high. The m-RESIST intervention could provide better control of the illness and appropriate care, together with offering user-friendly and easy-to-use technology. In terms of user experience, patients indicated that m-RESIST enabled easier and quicker communication with clinicians and made them feel more protected and safer. Patients' satisfaction was generally good: 78% (25/32) considered the quality of service as good or excellent, 84% (27/32) reported that they would use it again, and 94% (30/32) reported that they were mostly satisfied. CONCLUSIONS: The m-RESIST project has provided the basis for a new modular program based on novel technology: the m-RESIST intervention. This program was well-accepted by patients in terms of acceptability, usability, and satisfaction. Our results offer an encouraging starting point regarding mHealth technologies for patients with TRS. TRIAL REGISTRATION: ClinicalTrials.gov NCT03064776; https://clinicaltrials.gov/ct2/show/record/NCT03064776. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1136/bmjopen-2017-021346.

Measuring post-traumatic stress disorder and complex post-traumatic stress disorder using the International Trauma Questionnaire: results from a Hungarian clinical and non-clinical sample.

Background: The 11th revision of the International Classification of Diseases (ICD-11) simplified the description of post-traumatic stress disorder (PTSD) and also introduced a new trauma-related diagnosis called complex post-traumatic stress disorder (CPTSD). CPTSD is linked to earlier, prolonged interpersonal trauma, and is characterized by a broader range of symptoms, in addition to the core PTSD symptoms. The International Trauma Questionnaire (ITQ) has been developed to assess the new diagnostic criteria.Objectives: The primary aim of our study was to test the factor structure of the ITQ in a clinical and a non-clinical Hungarian sample. We also examined whether the degree of traumatization or the type of trauma experienced was associated with meeting the criteria for PTSD or CPTSD, or with the severity of PTSD or disturbances in self-organization (DSO) symptoms, in both samples.Method: A trauma-exposed heterogeneous clinical sample (N = 176) and a non-clinical sample (N = 229) filled out the ITQ and a modified version of the Life Events Checklist (LEC-5). The factor structure of the ITQ was tested by examining the model fit of seven competing confirmatory factor analysis models.Results: A two-factor second-order model with a second-order PTSD factor (measured by three first-order factors) and a DSO factor (measured directly by six symptoms) had the best fit to the data in both samples if an error correlation was allowed between negative self-concept items. Those in the clinical group who reported more interpersonal and childhood trauma experienced more PTSD and DSO symptoms. Also, there were significant, positive, and weak associations between the total number of different traumas and PTSD and DSO factor scores in both samples.Conclusion: ITQ was found to be a reliable tool to differentiate between PTSD and CPTSD, two related but distinct constructs in a clinical and a non-clinical trauma-exposed sample in Hungary.

The distinction between PTSD and DSO as related but separate constructs was validated using the ITQ in a Hungarian clinical and non-clinical sample.CPTSD was more frequent than PTSD among general help-seeking clinical clients, while in the non-clinical sample PTSD had a higher prevalence rate.Interpersonal trauma in childhood and adulthood was associated with more PTSD and DSO symptoms.

Stronger coupling of emotional instability with reward processing in borderline personality disorder is predicted by schema modes.

BACKGROUND: Mood instability and risk-taking are hallmarks of borderline personality disorder (BPD). Schema modes are combinations of self-reflective evaluations, negative emotional states, and destructive coping strategies common in BPD. When activated, they can push patients with BPD into emotional turmoil and a dissociative state of mind. Our knowledge of the underlying neurocognitive mechanisms driving these changes is incomplete. We hypothesized that in patients with BPD, affective instability is more influenced by reward expectation, outcomes, and reward prediction errors (RPEs) during risky decision-making than in healthy controls. Additionally, we expected that these alterations would be related to schema modes. METHODS: Thirty-two patients with BPD and thirty-one healthy controls were recruited. We used an established behavioral paradigm to measure mood fluctuations during risky decision-making. The impact of expectations and RPEs on momentary mood was quantified by a computational model, and its parameters were estimated with hierarchical Bayesian analysis. Model parameters were compared using High-Density Intervals. RESULTS: We found that model parameters capturing the influence of RPE and Certain Rewards on mood were significantly higher in patients with BPD than in controls. These model parameters correlated significantly with schema modes, but not with depression severity. CONCLUSIONS: BPD is coupled with altered associations between mood fluctuation and reward processing under uncertainty. Our findings seem to be BPD-specific, as they stand in contrast with the correlates of depressive symptoms. Future studies should establish the clinical utility of these alterations, such as predicting or assessing therapeutic response in BPD.

The Reflective Functioning Questionnaire-Revised- 7 (RFQ-R-7): A new measurement model assessing hypomentalization.

Although it is a widely used questionnaire, limitations regarding the scoring procedure and the structural validity of the eight-item Reflective Functioning Questionnaire (RFQ-8) were raised. The present study aimed to examine further the latent dimensionality of the RFQ-8 and to examine linear and non-linear associations between mentalization difficulties and maladaptive psychological characteristics. Data from two separate representative samples of young adults (N = 3890; females: 51.68%; mean age: 27.06 years [SD = 4.76]) and adults (N = 1385; females: 53.20%; mean age: 41.77 years [SD = 13.08]) were used. In addition to the RFQ-8, standardized questionnaires measured the levels of impulsivity, sensation seeking, rumination, worry and well-being. Confirmatory factor analysis (CFA) was used to test the model fit of competing measurement models. CFA revealed that a revised, seven-item version of the RFQ (RFQ-R-7) with a unidimensional structure showed the most optimal levels of model fit in both samples. Impulsivity, sensation seeking, rumination and worry consistently presented significant, positive, linear associations with general mentalization difficulties in both samples. Significant quadratic associations were also identified, but these relationships closely followed the linear associations between the variables and increased only marginally the explained variance. The supported unidimensional measurement model and the associations between the general mentalization difficulties factor and maladaptive psychological characteristics indicated that the RFQ-R-7 captures a dimension of hypomentalization ranging between low and high levels of uncertainty. Increasing levels of hypomentalization can indicate a risk for less adaptive psychological functioning. Further revisions of the RFQ-8 might be warranted in the future to ensure adequate measurement for hypermentalization.

The Inventory of Personality Organization: A valid instrument to detect the severity of personality dysfunction.

Background and aims: In the eleventh revision of the International Classification of Diseases (ICD-11), the severity of personality dysfunction became the central dimension of personality disorder's (PDs) definition, besides the trait domain qualifiers. Personality functioning, also known as personality organization (PO), is becoming an increasingly important concept in administering, predicting, and measuring severity and nature of personality disturbance. Otto Kernberg and his team developed several tools to measure personality impairment. The Inventory of Personality Organization (IPO) is a self-report rating scale for the measurement of PO. Aim of this study was to identify severity groups according to the level of PO and to explore their validity. Materials and methods: A clinical sample of 118 patients was recruited from a 4-weeks in-patient cognitive psychotherapy program. Beside the IPO, Structured Clinical Interview for the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, (DSM-IV.) Axis I and II, Symptom Check List-90 (SCL-90), State-Trait Anger Expression Inventory and Dissociative Experience scale (DES). Two types of analyses were conducted: a person-centered (latent profile) analysis and various variable-centered tests to confirm the factor structure of IPO and calculate group differences. Results: The three-factor (CFI = 0.990, TLI = 0.990, RMSEA = 0.022, SRMR = 0.089) and the five-factor (CFI = 0.995, TLI = 0.995, RMSEA = 0.014, SRMR = 0.090) models of the IPO was supported. Latent class analysis identified three subgroups of PO: "Well-integrated," "Moderately integrated," and "Disintegrated" classes. There were no significant differences between the three classes in the number of Axis 1 diagnoses (p = 0.354; η2 = 0.01). Group differences in the number of PDs, the number of PD symptoms as well as in the presence of borderline and depressive PD were significant (all p < 0.001; V = 0.35-0.42; η2 = 0.15-0.26). Persons with more severe PO problem level had higher rates of psychopathological symptoms, state and trait anger, and dissociative characteristics (all p < 0.001; η2 = 0.13-0.36). Conclusion: The IPO can be an appropriate instrument to measure the severity of personality disorganization and to classify participants along a continuum of severity in this regard. Our results present further evidence that the severity of personality dysfunction, the central dimension of the ICD-11 and the Alternative Model for PDs is detectable with an instrument, the IPO, that was initially developed to detect the disturbances in PO.

Rumination in Borderline Personality Disorder: A Meta-analytic Review.

Borderline personality disorder (BPD) is characterized by deficits in emotion regulation and affective liability, specifically rumination. Despite this, inconsistencies have existed in the literature regarding which rumination type is most prominent in BPD. Taking this into consideration, a meta-analysis was performed to look at how BPD symptoms correlate with rumination, while also considering clinical moderator variables (i.e., BPD symptom domain, comorbidities, GAF score) and demographic moderator variables (i.e., age, gender, sample type, and education level). Analysis of rumination domains for the entire sample revealed a medium correlation between BPD symptoms and rumination. When types of rumination were assessed, the largest correlation was among pain rumination followed by anger, depressive, and anxious rumination. Among BPD symptom domain, affective instability had the strongest correlation with increased rumination, followed by unstable relationships, identity disturbance, and self-harm/impulsivity. Demographic variables showed no significance. Clinical implications and further therapeutic interventions are discussed considering rumination.

Reliability and validity of the Hungarian version of the Personality Inventory for DSM-5 (PID-5).

OBJECTIVES AND METHODS: In order to assess the internal consistency, fit indexes, test-retest reliability, and validity of the Personality Inventory for the DSM-5 (PID-5) and its associations with age, gender, and education, 471 non-clinical (69,6% female; mean age: 37,63) and 314 clinical participants (69,7% female, mean age: 37,41) were administered the Hungarian translation of the PID-5, as well as the SCL-90-R and the SCID-II Personality Questionnaire. RESULTS: We found that; (a) temporal consistency of the Hungarian PID-5 was confirmed by one-month test-retest reliability analysis, (b) validity of the PID-5 instrument is acceptable in the clinical and the non-clinical sample as well, based on significant correlations with SCID-II and SCL-90-R, (c) PID-5 facets' and domains' associations with gender, age, and level of education are in accordance with previous findings. CONCLUSION: These findings support that the Hungarian PID-5 is a reliable and valid instrument for both clinical and non-clinical populations.

Alternative female and male developmental trajectories in the dynamic balance of human visual perception.

The numerous multistable phenomena in vision, hearing and touch attest that the inner workings of perception are prone to instability. We investigated a visual example-binocular rivalry-with an accurate no-report paradigm, and uncovered developmental and maturational lifespan trajectories that were specific for age and sex. To interpret these trajectories, we hypothesized that conflicting objectives of visual perception-such as stability of appearance, sensitivity to visual detail, and exploration of fundamental alternatives-change in relative importance over the lifespan. Computational modelling of our empirical results allowed us to estimate this putative development of stability, sensitivity, and exploration over the lifespan. Our results confirmed prior findings of developmental psychology and appear to quantify important aspects of neurocognitive phenotype. Additionally, we report atypical function of binocular rivalry in autism spectrum disorder and borderline personality disorder. Our computational approach offers new ways of quantifying neurocognitive phenotypes both in development and in dysfunction.

Expectation of Selfishness From Others in Borderline Personality Disorder.

Social difficulties are apparent in borderline personality disorder (BPD). Behavior in BPD is characterized by mistrust and expectations of malevolence from others. We examined whether there is an asymmetry between their social behavior and their belief about other people's social motivations. Subjects completed a task where they had to allocate money between themselves and an imagined other they will not meet and interact with. In addition they also had to report their expectations about how the imagined other would solve the task. We hypothesized that even though BPD patients will act in a prosocial way, they will expect selfish behavior from the other. We used the Slider Measure of social value orientation (SVO) and also created a modified version of the measure to examine the discrepancy between the subjects' own SVO and their expectations from other people. We compared the results of thirty clinically diagnosed BPD patients to a matched sample of healthy participants. Our results show that the BPD group's selfishness expectations significantly outweigh the expectations of selfishness in the HC group (U = 269, p = 0.007). This result further supports the mistrust and negativity bias observed in various aspects of social interactions in BPD.

Schema modes and their associations with emotion regulation, mindfulness, and self-compassion among patients with personality disorders.

BACKGROUND: The current study's goal was to examine the multivariate patterns of associations between schema modes and emotion regulation mechanisms in personality disorders. Schema modes are either integrated or dissociative states of mind, including intense emotional states, efforts to regulate emotions, or self-reflective evaluative thought processes. Exploring the multivariate patterns of a shared relationship between schema modes and emotion regulation strategies may lead to a better understanding of their associations and a deeper understanding of the latent personality profiles that organize their associations in a mixed personality disorder sample. METHODS: Patients who have personality disorders (N = 263) filled out five different self-report questionnaires, out of which four measured adaptive and maladaptive emotion-regulation strategies (Cognitive Emotion Regulation Questionnaire, Difficulty of Emotion Regulation Scale, Five Factor Mindfulness Questionnaire, Self-Compassion Scale), and the fifth one assessed schema modes (Schema Mode Inventory). We conducted canonical correlation analysis in order to measure the multivariate patterns of associations between the 26 emotion regulation and the 14 schema mode subscales. RESULTS: We found strong multivariate associations between schema modes and emotion regulation strategies. Collectively, the full model based on all canonical variate pairs was statistically significant using the Wilks's Λ = .01 criterion, F (364,2804.4) = 3.5, p < .001. The first two canonical variate pairs yielded interpretable squared canonical correlation (Rc2) effect sizes of 74.7% and 55.8%, respectively. The first canonical variate pair represents a general personality pathology variable with a stronger weight on internalization than externalization, and bipolarity in terms of adaptive vs. non-adaptive characteristics. We labeled this variate pair "Adaptive/Non-Adaptive." The second canonical variate pair, labeled "Externalizing", represents externalizing schema modes and emotion regulation strategies. CONCLUSION: Using a multivariate approach (CCA), we identified two independent patterns of multivariate associations between maladaptive schema modes and emotion regulation strategies. The Adaptive/Non-Adaptive general personality pathology profile and the Externalizing personality pathology profile may lead to a deeper understanding of personality disorders and help psychotherapists in their conceptualization in order to design the most appropriate interventions.

Emotion regulation, mindfulness, and self-compassion among patients with borderline personality disorder, compared to healthy control subjects.

OBJECTIVES: Emotion regulation difficulties are a major characteristic of personality disorders. Our study investigated emotion regulation difficulties that are characteristic of borderline personality disorder (BPD), compared to a healthy control group. METHODS: Patients with BPD (N = 59) and healthy participants (N = 70) filled out four self-report questionnaires (Cognitive Emotion Regulation Questionnaire, Difficulties in Emotion Regulation Scale, Five Facet Mindfulness Questionnaire, Self-Compassion Scale) that measured the presence or lack of different emotion-regulation strategies. Differences between the BPD and the healthy control group were investigated by Multivariate Analysis of Variance (MANOVA) and univariate post-hoc F-test statistics. RESULTS: People suffering from BPD had statistically significantly (p<0.05) higher levels of emotional dysregulation and used more maladaptive emotion-regulation strategies, as well as lower levels of mindfulness and self-compassion compared to the HC group. CONCLUSION: In comparison to a healthy control group, BPD patients show deficits in the following areas: mindfulness, self-compassion and adaptive emotion-regulation strategies. Based on these results, we suggest that teaching emotion-regulation, mindfulness, and self-compassion skills to patients can be crucial in the treatment of borderline personality disorder.

Shame in Borderline Personality Disorder: Meta-Analysis.

Shame has been found to be a core feature of borderline personality disorder (BPD). To date, there is no existing systematic review or meta-analysis examining shame in individuals with BPD as compared to healthy controls (HCs). A meta-analysis of 10 studies comparing reported shame in BPD patients to HCs was carried out. Demographic and clinical moderator variables were included to see if they have a relationship with the effect size. Results showed that those with BPD had more reported shame than healthy controls. In addition, in BPD patients and HCs, higher education level was related to lower reported shame. In HCs, it was found that those who were younger reported a higher level of shame. Finally, among BPD patients, there was a relationship between levels of reported shame and elevated PTSD symptomatology. These findings emphasize the clinical relevance of shame in individuals with BPD and the need to formulate psychotherapeutic strategies that target and decrease shame.

A Method to Compare the Delivery of Psychiatric Care for People with Treatment-Resistant Schizophrenia.

INTRODUCTION: Community services are gaining ground when it comes to attention to patients with psychiatric diseases. Regarding patients with treatment-resistant schizophrenia (TRS), the use of information and communication technology (ICT) could help to shift the focus from hospital-centered attention to community services. This study compares the differences in mental health services provided for patients with TRS in Budapest (Hungary), Tel-Aviv (Israel) and Catalonia (Spain) by means of a method for the quick appraisal of gaps among the three places, for a potential implementation of the same ICT tool in these regions. METHODS: An adapted version of the Description and Standardised Evaluation of Services and Directories in Europe for Long Term Care (DESDE-LTC) instrument was made by researchers in Semmelweis University (Budapest, Hungary), Gertner Institute (Tel-Aviv, Israel) and Hospital de la Santa Creu I Sant Pau and Parc Sanitari Sant Joan de Déu (Catalonia, Spain). RESULTS: Two types of outpatient care services were available in the three regions. Only one type of day-care facility was common in the whole study area. Two residential care services, one for acute and the other for non-acute patients were available in every region. Finally, two self-care and volunteer-care facilities were available in the three places. CONCLUSION: Although the availability of services was different in each region, most of the services provided were sufficiently similar to allow the implementation of the same ICT solution in the three places.

[Transdiagnostic study of impulsivity dimensions. Comparative analysis of impulsivity profiles in adult Attention Deficit Hyperactivity Disorder and Borderline Personality Disorder].

INTRODUCTION: High levels of impulsivity represent a core feature of various psychiatric conditions, such as Attention Deficit Hyperactivity Disorder (ADHD), Borderline Personality Disorder (BPD), Impulse Control and Conduct Disorders, Bulimia Nervosa, Substance Use Disorders, and other maladaptive behaviors, like non-suicidal self-harm and suicidal behavior. The overall aim of our research is to carry out a trans-diagnostic study of impulsivity as a common behavioral risk factor, taking into consideration the different dimensions of impulsivity (motor, attentional, non-planning). The project investigates inhibitory neurocognitive deficits, electrophysiological correlates, childhood adversities and genetic vulnerability factors in the background of impulsivity. METHODS: In this report, we describe the results of our pilot study which aims to compare impulsivity profiles, personality traits, and levels of aggression in patients with adult ADHD (aADHD) and BPD primary diagnoses, and healthy control subjects, based on self report questionnaires (Barratt Impulivity Scale, Cloninger Temperament and Character Inventory). We have also carried out analyses on the role of childhood adverse events in the background of impulsivity. Because of the predominance of female participants in the BPD group, we restrict our analyses to only female subjects (N=111 out of 152 patients overall). RESULTS: Comparing the three groups significant differences were observed in each impulsivity domain: higher levels of attentional and motor impulsivity were present in aADHD, while non-planning impulsivity was more characteristic to BPD (p<0.001). Using the Cloninger Temperament and Character Inventory aADHD patients reached significant higher levels on six subscales (novelty seeking, harm avoidance, reward dependency, perseverance, selfdirection, cooperation) than BPD patients (p<001). Childhood emotional neglect results in higher levels of impulsivity in adulthood (R=0.54, p<0.001) regardless of diagnosis. CONCLUSION: Impulsivity, as a diagnostic criterion of different psychiatric disorders is a heterogenous construct. Different characteristics of impulsivity are pronounced with respect to the condition it is part of. Studying impulsivity can improve our understanding of the etiology of different psychiatric conditions, which can result in more specific and effective therapeutic interventions.

[When the seed sprouts: The first thirty years of the VIKOTE].

The Hungarian Association for Behavioural, Cognitive and Schema Therapies (HABCT) has continuously been developing since its foundation 30 years ago. László Tringer was the first to teach Cognitive and Behavioural Therapy (CBT) in Hungary and to establish the first educational team. Their goal was to familiarise doctors and other professionals with CBT's methodology in psychotherapy. They conducted research in the field using CBT and supported other research projects as well. Today, HABCT has its own Psychotherapy Center running various programs from multilevel psychotherapy and individual training, to patient care and other health related programs. The leaders of the association were present and assisted the works of the Hungarian Psychiatric Association, Hungarian Psychological Association, Psychotherapeutic Gremium, Psychotherapeutic Co-ordination Committee and international cognitive behavioural associations.