[Empty chairs - Dilemmas of artistic and emotional commintment].

Two paintings by the Dutch-born painter Vincent van Gogh of his own and his friend Paul Gauguin's chair in Arles have had a major impact on twentieth and twenty-first century art, in the visual and photographic arts, literature and film. The literature interpreting the paintings, particularly art history, art psychology and psychiatry, agrees that the two paintings, painted in a psychotic state, can be seen as a coping response to van Gogh's fear of death, a kind of mourning. There is, however, another interpretation of the paintings, which emerges when the two paintings are seen as a unified whole. In this case, the picture refers to the relationship between artistic and emotional commitment, and conveys the message that the painter's artistic mission does not tolerate a partner, and that he must sacrifice his private life for his art. This concept is in line with the basic idea of the poem "Choice" by the Nobel Prize-winning Irish poet Samuel Butler Yeats. In some examples from the history of art, such as Csontváry, Gulácsy and Cézanne, creative and private life are indeed mutually exclusive, but in others, such as Leonardo da Vinci, Bach, Woolf and Joyce, artistic and emotional commitment have proved compatible.

[Spontaneity and awareness in art In memory of Bertalan Petho].

The psychological characteristics of artistic activity emerge along the spontaneity-awareness dimension. Artistic development proceeds from spontaneous manifestations to conscious planning. At each step of this process, the effects of attractive and repulsive reference predecessors appear until the individual voice, style and creative inventions are formed. This development may be completed by the establishment of the artistic identity and conscious image creation. A certain group of artists - naive, autodidactic artists, psychiatric patients - stay in the state of spontaneity; or they get stuck halfway in the development, and thus their works of art have some self-healing nature as among the confessional poets. Regressive states (emerging due to effects of chemicals or old-age dementia etc.) might re-call spontaneity. The spontaneous manifestations of some artists might be overwritten by conscious image building. Based on the characteristic features of artistic socialization, the following categories of artists can be set up: experienceoriented, ability-oriented, child, citizen/scholar, and psychiatric patient artist types.

[Anna Karenina-effect, the impact of art].

No abstract available.

[The oeuvre, life history and illness of Sylvia Plath].

The roots of confessionalism reach back to the early Middle Ages and to the Confessions of Rousseau. Confessional literature gained a theoretical foundation in the age of Romanticism, then in the 20th century the genre underwent a revival and late modernisation in the works of the "confessional poets" (Lowell, Sexton, Plath etc.). The literary studies and psychobiographical examination of these authors threw light on the psychiatric aspects of confessionalism; most of them suffered from psychiatric or addictive disorders and committed suicide. Confessional poetry takes repetition of the (fragmented) psychological process of the individual life history as its almost sole theme. The poet builds up, demolishes, then again builds up his or her own life history, blurring the boundaries of reality and fiction. Interrupted personality development and the failure to work through traumatic experiences can be observed in the psychological background, to which Vladimir Nabokov also referred in his personal notes. In this collection of Psychiatria Hungarica about Sylvia Plath, titled The Broken-necked Deer the studies in three parts under the headings oeuvre, life history, illness are imbued with considerations of literary psychology and literary psychiatry that expand and enrich both literary studies and the psychiatric field of vision.

[The risk of imagination, or orgy of anger. Trying to reconstruct and understand the Sylvia Plath-phenomenon].

To clarify the relationship between literature and psychiatry we can call on the help of the American-English writer Sylvia Plath, who was given electroconvulsive therapy and psychotherapy on a number of occasions for psychiatric illness and later took her own life. This study seeks an answer to five questions. Did Sylvia Plath suffer from psychiatric illness? Did she show signs of the bipolar triad (bipolar affective disorder, trait aggression, substance or behavioural dependence)? Did her activity as a writer have a therapeutic effect? What was the nature of her "confessionalism"? To what extent does her oeuvre reflect her life? Sylvia Plath very probably suffered from a psychiatric illness, namely bipolar 2 affective disorder. The unsuitable treatment of her illness and the interruption of intensive psychotherapy could have contributed to her early death. Together with the bipolar affective disorder, she was also characterised by serious dispositional aggression and emotional dependence. For her, writing was both a source of stress, because her dysthymia intensified her inhibitions, and at the same time self-healing and a self-fulfilling prophecy. The roots of her confessionalism can be found in her personality development suspended in the stage of becoming an adult, and the failure to work through her traumas. Unlike Goethe and Salinger who killed their heroes, having them commit suicide in The Sorrows of Young Werther and A Perfect Day for Bananafish, while both writers recovered from their crisis, Sylvia Plath described a positive development in The Bell Jar and in Ariel, her verse cycle, then put her head in the gas oven. Would she have stayed alive if she had followed the patterns of Goethe and Salinger?

[Facilitating role of traumatic experiences in art]. / A traumatikus élmények facilitáló szerepe a muvészetben.

Traumatic experiences can not only have unfavourable consequences, they can also contribute, with a kind of creative twist, to the development of the person affected by the trauma. The artistic responses to traumas can be examined on the basis of the different types of trauma. This study reports on an investigation focusing on six types of trauma: emotional deprivation/neglect; near-death experience; becoming the victim of violence; war; accident/sickness and emotional frustration. Examples taken from the history of art indicate that works of art can draw attention to the traumatic experiences of the artists with frequently repeated motifs and portrayal techniques (sun, mother image, objects referring to the person lost, motifs of violence or symbols of violence, artistic manifestations of an exaggerated self-image, surreal visions, dry irony, substituting other objects for the beloved person), or a sudden change of style and subject that can express a heightened interest in human suffering (Lovis Corinth). An emphasis placed on self-portrayal can indicate the artist's increased self-examination, in cases of sickness, or continuous monitoring of the state of mind (Frida Kahlo, Otto Dix, Lovis Corinth, Edvard Munch). In some cases artistic activity can help to work through the trauma (Hans Bellmer, Oskar Kokoschka, Max Ernst, René Magritte), in other cases it is not able to prevent the development of psychological/psychiatric consequences of the trauma (Artemisia Gentileschi, Edvard Munch, Lajos Gulácsy). Traumas can be the sources of motivation and provide themes for works of art; and, although not in all cases, artistic creativity can contribute to effectively working through traumatic experiences. Orv Hetil. 2017; 158(17): 668-677.

The description of the litigious querulant: Heinrich von Kleist's Novella Michael Kohlhaas.

OBJECTIVE: To illustrate the use of fiction in understanding psychiatric disorders and refocus attention towards fiction as a valuable source of psychopathology, thereby contributing to the restoration of the narrative in psychiatry. METHOD: A psychopathological analysis of the novella Michael Kohlhaas written by Heinrich von Kleist, one of the outstanding literary figures of the German romantic movement of the early 19th century. RESULTS: The protagonist of Kleist's novella, Michael Kohlhaas, a querulant horse trader, carries out an armed uprising disproportionate to the minor injustice of the unlawful seizure of his horses. Following unsuccessful attempts at legal recourse, Kohlhaas takes up arms against the authorities, and in the course of his uncompromising pursuit of justice eventually sacrifices his own and his family's lives. Kleist accurately portrays Kohlhaas' psychopathological development from a psychologically balanced, emotionally warm family man to one who causes utter destruction, mayhem and the loss of innocent lives. This literary work is a remarkably authentic, insightful and rich representation of litigious/querulant behaviour, described by classical authors as litigious paranoia, a diagnostic category currently subsumed under 'delusional disorder, persecutory type', in DSM-5 and 'persistent delusional disorder' in ICD-10. CONCLUSIONS: Kleist's novella offers important clues to better understand the development of litigious-querulant behaviour and the inner world of its sufferers. An analysis of the novella also illustrates the contribution that fiction could make to resuscitate the narrative as a complement to criterion-based diagnostic practice prevailing in contemporary psychiatry. © 2014 S. Karger AG, Basel.

[Associations between concurrent use of tobacco and alcohol and symptoms of attention-deficit hyperactivity disorder among ninth grader students]. / A dohányzás és az alkoholfogyasztás együttes elofordulásának összefüggései a figyelemhiányos hiperaktivitás-zavar tüneteivel kilencedik osztályos tanulók körében.

INTRODUCTION: Attention-deficit hyperactivity disorder is a risk factor of smoking and alcohol drinking in adolescence. Since attention-deficit hyperactivity disorder and smoking and alcohol drinking in adolescence are predictors for the development of substance use disorders in adulthood, it is important to understand the nature of these associations. AIM: The aim of the authors was to investigate associations between attention-deficit hyperactivity disorder symptoms and the joint use of alcohol and nicotine among 9th graders. METHOD: A representative sample of 944 pupils attending state-run secondary schools in Budapest were recruited. Generalized Linear Mixed Model and logistic regression analyses have been conducted. RESULTS: The prevalence was 29.6% and 41.4% for current smoking and current alcohol drinking, respectively. The prevalence of their concurrent-use was 21.7%. Alcohol drinking and smoking showed a significant positive association with the total scores of Attention-Deficit Hyperactivity Disorder Scale and with the Attention Deficit and Hyperactivity/Impulsivity subscales. CONCLUSIONS: The findings highlight the potential importance of attention-deficit hyperactivity disorder in the development of the joint use of these substances.

[Personal motif in art]. / Személyes motívum a müvészetben.

One of the basic questions of the art psychology is whether a personal motif is to be found behind works of art and if so, how openly or indirectly it appears in the work itself. Analysis of examples and documents from the fine arts and literature allow us to conclude that the personal motif that can be identified by the viewer through symbols, at times easily at others with more difficulty, gives an emotional plus to the artistic product. The personal motif may be found in traumatic experiences, in communication to the model or with other emotionally important persons (mourning, disappointment, revenge, hatred, rivalry, revolt etc.), in self-searching, or self-analysis. The emotions are expressed in artistic activity either directly or indirectly. The intention nourished by the artist's identity (Kunstwollen) may stand in the way of spontaneous self-expression, channelling it into hidden paths. Under the influence of certain circumstances, the artist may arouse in the viewer, consciously or unconsciously, an illusionary, misleading image of himself. An examination of the personal motif is one of the important research areas of art therapy.

[Trait-aggression and suicide of Vincent van Gogh]. / Vincent van Gogh vonás-agressziója és öngyilkossága.

Although in recent decades the literature has paid special attention to Vincent van Gogh's life, work and illness, there has still not been an examination of the connections between his trait aggression and his suicide. The present study traces, in the light of this trait aggression, the predictive factors that can be observed on the path leading to the artist's suicide. Biographical documents, case history data, as well as letters and the findings of earlier research have been used in the course of the analysis. Among the distal suicide risk factors we find a positive family anamnesis, childhood traumas (emotional deprivation, identity problems associated with the name Vincent), a vagrant, homeless way of life, failures in relationships with women, and psychotic episodes appearing in rushes. The proximal factors include the tragic friendship with Gauguin (frustrated love), his brother Theo's marriage (experienced as a loss), and a tendency to self-destruction. Both factor groups on the one hand determined the course of development of the trait aggression and on the other can also be regarded as a manifestation of that trait aggression. It can be said that the trait aggression played an important role in Van Gogh's suicide.

[Trait-aggression and conscious poetic attitude in the background of Attila József's suicide]. / A vonás-agresszió és a költoi tudatosság szerepe József Attila öngyilkosságában.

Although recently many studies have indicated close connection between aggressive behaviour and suicide, and we can infer at Attila Jozsef's high trait-aggression from several cases, there is no research so far that would analyse the topic of the poet's aggression. We examine in this study the high trait-aggression and conscious poetic attitude of Attila Jozsef and put the question how could those two contribute to his suicide. Recollections of Attila Jozsef's contemporaries reveal that the poet's life was accompanied along with auto- and heteroaggression. By analysing his Rorschach-test, we can also conclude on the weakness of his aggression-control. During his psychoanalytic treatment from 1931 on, some difficult memories and unacceptable desires became revoked, and his aggressive outbreaks became unmanageable, first of all against some females in his life. His free-association works from this period are full of rude, incestuous, aggressive expressions. In spite of these, there is no trace of aggression in his poems - he masks his aggression in them by keeping precisely to formal criteria. We suppose that behind the masking there are unconscious processes, such as a very strong desire to get attached and fear of solitude that led to his aspiration to consciously form "the myth of the good poet". Art's healing power could not prevail as the spontaneous creative process has been turned into a conscious one. His impulses that came to light in the analytic process and were only partly sublime may have returned thus and became urgent and pressing again. We suppose that his high trait-aggression and his conscious poetic attitude together contributed to his life's tragic ending.

Psychometric characteristics of the Drug Use Disorders Identification Test (DUDIT) and the Drug Use Disorders Identification Test-Extended (DUDIT-E) among young drug users in Hungary.

BACKGROUND: The Drug Use Disorders Identification Test (DUDIT) was developed for problematic substance use screening, and for a more detailed assessment of problematic use, the Drug Use Disorders Identification Test-Extended (DUDIT-E) was additionally developed. PURPOSE: Examining the psychometric properties of DUDIT and DUIT-E across diverse settings in populations of young drug users. METHODS: We examined the psychometric characteristics of these instruments across various settings in populations of young substance users differing in substance use severity and treatment status. Data were collected from three clinically relevant groups (n = 259) as well as a control sample of college students (n = 109). RESULTS: Reliability analyses indicated good internal consistency for both instruments; high intraclass correlations further indicated good test-retest reliability. Differences among study groups were significant on the DUDIT scale and all DUDIT-E subscales (p < 0.01), with the target groups exhibiting higher scores compared to controls. A two-factor solution was identified for the factor structure of DUDIT. CONCLUSION: The Hungarian version of DUDIT and DUDIT-E can effectively identify substance use problems among young users.

[Teenage and adult pregnancy: different correlations between socio-economic status and smoking]. / A dohányzás és az anyagi helyzet összefüggése serdülokori és felnottkori terhesség esetén.

INTRODUCTION: Smoking occurs frequently during pregnancy, thereby putting mother and child at health risks. Low socio-economic status is a risk factor for smoking. AIM: To investigate the relationship between smoking and low income in teenage and adult pregnancy, which is an important measure of poor socioeconomic status. METHOD: The authors used subject-level data from the US NSDUH database, which contains information on pregnancies and smoking. RESULTS: Teenage pregnancy is associated with higher, whereas adult pregnancy with lower prevalence of smoking, compared to the age-matched female population. The association between income and smoking is age-dependent. Among adults there is an inverse relationship (high income -- low-risk of smoking), while in teenage pregnancy smoking increases with income. CONCLUSIONS: To investigate in teenage and adult pregnancy the relationship between smoking and low income, which is an important measure of poor socio-economic status. Higher socioeconomic status may be associated with risky behaviour, thereby increasing both the risk of smoking and early pregnancy.

[Empirical data regarding the relationship between religiosity and substance abuse]. / Empirikus adatok a vallasossag es droghasznalat kapcsolatanak kerdeskorehez.

Research concerning the topic of possible association of religiosity and substance use has already brought forth a significant amount of data, identifying strong belief in a religion as a protective factor in most cases. However, as in all other subject areas dealing with correlations between religion and health components, the issue of religiosity and substance (ab)use also produced some conflicting findings, hindering the formulation of a clear and stable consensus interpretation of this relationship. The aim of our examination was to provide empirical data for clarifying uncertainties about the possible effects of religiosity on substance use by examining a sample which is remarkable in Hungary: 1337 clinically diagnosed drug abuser patients and 205 normal controls. Based on our results we suggest some changes on the general approach of the effect of religiosity on substance use.

[The psychiatric aspects of animal assisted therapy]. / Az állatok által asszisztált terápiák pszichiátriai vonatkozásai.

Animal assisted therapy is a known preventive and interventive method which is held by the contribution of specially trained animals and professionals. One of its main indication fields is psychiatry. The purpose of this summary is to give an overview on the animal assisted therapy's background, possible uses and effectiveness with literature. It looks for the answer if this therapeutic method can be used for effectively easing the symptoms of specific psychiatric diseases and on which fields can it be used most effectively. Due to the data provided by literature it can be determined that the therapy supported by animals is able to give an effective help on the fields of various psychiatric supports, preventions, interventions and rehabilitations regardless of the age. It is mostly used in the case of depression, anxiety, addiction, schizophrenia and autism spectrum disorder. Aside from these it could also be used effectively in the rehabilitation of victims of sexual abuse especially in the case of children. It can also play a role in the re-socialization of inadapted adolescences and adults, even with farmtherapy. Due to experiences the therapies supported by animals are effective on the following fields: improving social and communication skills, easing anxiety, improving mood, helping independent living, improving emphatic skills.

The European Adolescent Assessment Dialogue (EuroADAD): a psychometric evaluation.

BACKGROUND: The Adolescent Drug Abuse Diagnosis (ADAD) has been a gold standard for assessing drug use and associated problems in adolescents. Criticism of the instrument has been increasing. A new instrument, the European Adolescent Assessment Dialogue (EuroADAD) that builds on ADAD's strengths but seeks to address its limitations is now available, but has not been subjected to comprehensive psychometric evaluation. OBJECTIVE: To examine the psychometric properties of the EuroADAD across various settings in adolescent populations who developed or were at a high risk of developing substance use and psychosocial adaptation problems. PARTICIPANTS AND SETTINGS: Three of the samples were collected in Hungary, including: institutionalized youths from juvenile residential facility (n = 295); adolescents from outpatient psychiatry facility (n = 278), and controls (n = 59). An additional sample was collected in the Netherlands, and consisted of adolescent boys from an independent residential institution for youth with severe behavioral problems (n = 51). PROCEDURE: The EuroADAD was administered by trained interviewers. Data were collected through face-to-face interviews and self-report questionnaires. RESULTS: Reliability: the intraclass correlation was high for all domains of the EuroADAD; reliability analyses indicated good test-retest reliability, and internal consistency. VALIDITY: difference among study samples was significant (p < 0.05) for the majority of the domains, with juvenile institution and psychiatric outpatient subjects exhibiting higher severity in most areas compared to controls. The Hungarian and Dutch samples were comparable, expect for the legal domain, due to the higher severity of behavioral problems in the Dutch sample. Several domains of the instrument, including 'alcohol', 'drugs' and 'legal' showed an association with trait aggression as measured by the Buss-Perry Aggression Questionnaire and with Novelty Seeking on the Cloninger Temperament and Character Inventory. CONCLUSION: Based on the pattern and significance of group differences, and correlations with other measures, the scale has good criterion, and convergent and discriminant construct validity. The EuroADAD is a reliable and valid tool for the assessment of alcohol and drug use, and related psychosocial problems in adolescents.

Substance use in Roma and non-Roma adolescents.

Little data have been published on specific health indicators for Roma, especially on substance use and related problems, and to our knowledge no data are available for Roma adolescents. The objective was to assess substance use of Roma as compared with non-Roma adolescents. Prevalence of tobacco and illicit drug use, and alcohol intoxication were examined in 225 Roma and 182 non-Roma adolescents. Relationship between substance use and potential risk factors, and ethnicity, was investigated by logistic regression analyses. A matched sample of Roma and non-Roma subjects was also used for additional confirmatory conditional regression analyses. Results indicated a significant association between Roma ethnicity and higher lifetime prevalence of tobacco use, alcohol intoxication, and illicit drugs use. Roma girls as compared with non-Roma girls evidenced a disproportionately higher prevalence of smoking as compared with the difference between Roma and non-Roma boys. Chi square analyses showed for both Roma parents a higher level of tolerant attitude to smoking. The inequalities of the health status in substance use behaviors of the Roma versus non-Roma population, expressed in a more pronounced way in the female Roma population, emerge at an early age, based on our data; they are observable already in the early adolescent and adolescent age groups.

[Biological and social predictors of smoking and perception of health]. / A dohányzás biológiai, szociális prediktorjellemzoi és az általános egészség percepciója.

While many studies focused on the serious inequalities in the biological (sex, age) and social (education, occupation, place of residence) predictors of smoking in the world, there is a scarcity of such studies with regard to Hungary. Despite increasing evidence for smoking-related morbidity and mortality, health perception of the Hungarian population is unreasonably optimistic. This study investigated biological and social predictors of smoking in relation to the smoking prevalence, as well as health perception in relation to current smoking and to age of onset of smoking. The study period lasted from 1990 to 2008. Individual data bases from 15 representative population based studies, collected in the above study period, served as empirical data for the investigation. The entire sample included 30,352 individuals. After pooling the databases, a meta-analysis was performed using GLIMMIX, GLM and logistic regression models. Our results revealed an increase in the prevalence of daily smoking between 1990 and 2008; the increase was substantially higher among women than men. Low education, unemployment and a high number of residents per households increased the likelihood of daily smoking; current smoking and early age of onset of smoking increased the likelihood of perceiving the health situation as poor. These smoking trends draw attention to the inefficiency of the previous tobacco policies and prevention practices; they also urge prompt professional and policy interventions in the global national tobacco strategy in Hungary.

[The Hungarian adaptation of Anxiety disorder module in the SCID-I/NP research version]. / A SCID-I/NP kutatási változata szorongásos zavarok fejezetének magyarországi adaptációja.

BACKGROUND: The SCID-I structured clinical interview based on the DSM-IV-TR criteria is widely used in internationally, but the reliability and validity of its Hungarian version has not been investigated. This paper presents the results of the first validity and reliability study of the Hungarian version of the SCID-I/NP's (Structured Clinical Interview for DSM-IV-TR Axis I Disorders Non-patient Edition) Anxiety Disorders module. METHODS: The language adaptation of the diagnostic interview and of the user's guide was conducted in accordance with the WHO recommendations. MEASURES: SCID-I/NP Overview and Screening module; SCID-I/NP Module F: Anxiety Disorders; Tests providing external validity: Beck Anxiety Inventory (BAI), Adult ADHD Self-Report Scale (ASRS), Buss-Perry Aggression Questionnaire (AQ), Alcohol Use Disorders Identification Test (AUDIT). The study sample consisted of 741 patients attended at three GP's offices. The trial's duration was two months. STATISTICAL ANALYSES: GLM analysis, Chi-square test, Fisher's exact test, Kappa and weighted Kappa statistics. RESULTS: Results showed a significant interrater-agreement between the rater pairs. For screening modules yealding negative results, the false-negative analysis indicated a subthreshold positive diagnosis in one case. External validity analyses showed significant discrepancies in terms of gender, marital status and past psychiatric treatments among the three sample groups including those with diagnosis present, subthreshold diagnosis, diagnosis absent. In terms of the psychometric scales, we found significant differences on the BAI and the ASRS in these groups. In the case of AQ we found significant differences in total score and in the factors of hostility and anger: the diagnosis present group showed significantly elevated severity values compared to the other two groups. CONCLUSIONS: The Anxiety Disorders Module of the SCID-I/NP is suitable for detecting anxiety disorders in non-psychiatric population, and hence enables the early admission for treatment.

Schizophrenia with prominent catatonic features ('catatonic schizophrenia') III. Latent class analysis of the catatonic syndrome.

No reports have yet been published on catatonia using latent class analysis (LCA). This study applied LCA to a large, diagnostically homogenous sample of patients with chronic schizophrenia who also presented with catatonic symptoms. A random sample of 225 Chinese inpatients with DSM-IV schizophrenia was selected from the long-stay wards of a psychiatric hospital. Their psychopathology, extrapyramidal motor status and level of functioning were evaluated with standardized rating scales. Catatonia was rated using a modified version of the Bush-Francis Catatonia Rating Scale. LCA was then applied to the 178 patients who presented with at least one catatonic sign. In LCA a four-class solution was found to fit best the statistical model. Classes 1, 2, 3 and 4 constituted 18%, 39.4%, 20.1% and 22.5% of the whole catatonic sample, respectively. Class 1 included patients with symptoms of 'automatic' phenomena (automatic obedience, Mitgehen, waxy flexibility). Class 2 comprised patients with 'repetitive/echo' phenomena (perseveration, stereotypy, verbigeration, mannerisms and grimacing). Class 3 contained patients with symptoms of 'withdrawal' (immobility, mutism, posturing, staring and withdrawal). Class 4 consisted of 'agitated/resistive' patients, who displayed symptoms of excitement, impulsivity, negativism and combativeness. The symptom composition of these 4 classes was nearly identical with that of the four factors identified by factor analysis in the same cohort of subjects in an earlier study. In multivariate regression analysis, the 'withdrawn' class was associated with higher scores on the Scale of Assessment of Negative Symptoms and lower and higher scores for negative and positive items respectively on the Nurses' Observation Scale for Inpatient Evaluation's (NOSIE). The 'automatic' class was associated with lower values on the Simpson-Angus Extrapyramidal Side Effects Scale, and the 'repetitive/echo' class with higher scores on the NOSIE positive items. These results provide preliminary support for the notion that chronic schizophrenia patients with catatonic features can be classified into 4 distinct syndromal groups on the basis of their motor symptoms. Identifying distinct catatonic syndromes would help to find their biological substrates and to develop specific therapeutic measures.