The importance of examining early maladaptive schemas in the diagnosis and treatment of obsessive-compulsive disorder.

Introduction: The aim of the study was twofolded: to identify the early maladaptive schemas characteristic of obsessive-compulsive disorder in a Hungarian sample and, to examine the presence and severity of comorbid anxiety and depressive symptoms in the light of early maladaptive schemas. Methods: 112 participants (58 men and 54 women) diagnosed with OCD were involved in the study. The questionnaire package consisted of the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the State-Trait Anxiety Inventory (STAI), the Beck Depression Inventory (BDI), the Penn State Worry Questionnaire (PSWQ) and the Schema Questionnaire (SQ). Results: We identified five early maladaptive schemas with a direct effect on the manifestation of obsessive-compulsive symptoms: Mistrust-Abuse, Inferiority/Shame, Dependence/Incompetence, Insufficient Self-Control/Self-Discipline and Entitlement/Grandiosity (reversed effect). Based on the severity of the early maladaptive schemas, three significantly different groups could be identified in our sample: patients with mild, moderate and high schema-values. Among the groups significant differences can be found in the appearance and severity of compulsive symptoms, as well as in the presence of anxiety and depressive symptoms. But contrary to our expectations, not the severity, but the numberof the early maladaptive schemas showed a stronger correlation with the symptom variables. An additional result of our study derives from canonical correlation, addressing the relationship among early maladaptive schemas, OCD symptoms, anxiety and depressive symptoms from a new perspective. The results highlight that OCD is only one and not the most serious consequence of personality damage, indicated by early maladaptive schemas. Discussion: The results of our study suggest that obsessive-compulsive disorder can be divided into several subgroups, which can be separated in terms of symptom severity, comorbid psychiatric symptoms and personality impairment patterns. The relationship between OCD symptom severity and personality impairment seems to be not directly proportional. Our results strengthen the new dimensional view of OCD, which can determine the selection of the appropriate therapeutic treatment method beyond the diagnostic process.

[Investigation of visuospatial memory in obsessive-compulsive disorder using the Rey-Osterrieth Complex Figure Test].

Based on previous results the cognitive profile of patients with obsessive-compulsive disorder (OCD) is determined by the impairment of executive and visual-spatial memory functions. The Rey-Osterrieth Complex Figure (ROCF) is a widely used tool for examining visual-spatial memory disorders. Several scoring systems can be used to evaluate the ROCF and the most widespread is the original Osterrieth evaluation system. The Boston Qualitative Scoring System (BQSS) is a new, much more detailed scoring system than the Osterrieth, which allows both quantitative and a more detailed qualitative analysis of ROCF. In our study, we analyzed the copying and immediate recall performance of 24 OCD and 24 age- and education-matched healthy control subjects using the Osterrieth and BQSS scoring systems. Our research had two main goals, (1) to examine the diff erences in visualspatial memory performance shown by the OCD group compared to the control group, and (2) to compare the Osterrieth and BQSS scoring systems in one clinical sample. Based on both the Osterrieth and BQSS scoring systems, our results show that the OCD group performed significantly worse in the recall phase, but not in the copy phase. According to our results both scoring systems can be effectively used to examine the functioning of visual-spatial memory in OCD patients. While the Osterrieth evaluation system is faster and more widespread, the BQSS scoring system examines detailed qualitative aspects in addition to quantitative indicators.

[Effectiveness of psychotherapeutic interventions: the potentials of professional guidelines - a methodological consensus proposal].

Psychotherapeutic interventions diff er from other health care interventions in many ways, thus the indicators of evidence-based medicine should be used with modifications when necessary. Implementation of a unified evaluation and quality assurance framework would aid the psychotherapy scene in having their intervention methods acknowledged by other medical specialties as an equal healthcare intervention. Professional recommendations regarding the interventions and methods used in clinical care in the field of psychotherapy can be laid down in specific professional guidelines of the domestic healthcare regulatory practice. A professional guideline is both a starting point and a practical guide for (planning to train, in training, or trained) professionals, as well as for the healthcare funder(s). In addition, a fixed professional framework would provide a consistent and accountable reference for quality assurance for patients who wish to recover and for those consider receiving psychotherapy. Evidence-based recommendations for the practice of the profession 1) can validate the applied care practice through findings supported from a scientific point of view, 2) can consensually resolve the specific contradictions of the field through definitions 3) can also provide a basis for transparent training, administrative and financing aspects. Consistent professional decision-making must be carried out according to a uniform ranking system. The reliability of the evidence is also very important in terms of clinical applicability of a psychotherapy method.

19 pandemic and obsessive compulsive disorder. How does the COVID-19 pandemic influence symptoms in obsessive compulsive disorder patients?

The COVID-19 pandemic had a significant psychological impact on the mental state of both healthy and psychiatric patients. The authors involved 34 obsessive-compulsive patients in their study. The patient group included both patients with and without symptoms of contamination, patients with and without COVID-19 infection, and patients with and without continuous, available therapy. Changes in general condition as a result of the pandemic that had existed for nearly two years, adherence to health standards, and changes in compulsive symptoms were assessed. The results show that the non-specific stress effect of the pandemic significantly less affected those patients who are under care compared to those who did not receive therapy. However, the characteristics of the symptomatic picture and the fact of COVID infection did not significantly affect the general condition of the patients, their adherence to the health regulations, and the change in compulsive symptoms. The main finding of the study is that psychiatric, psychotherapeutic patient follow-up is the most important factor in the prevention of deterioration, and neither the symptomatic dimension (symptomatic subgroup) nor COVID infection played a significant role. The results support that in such an acute and persistent stress situation as a pandemic, the continuous availability of professional help and the appropriate therapeutic relationship is one of the most important protective factors in relapse prevention.

Pareidolia in Schizophrenia and Bipolar Disorder.

While there are many studies on pareidolia in healthy individuals and patients with schizophrenia, to our knowledge, there are no prior studies on pareidolia in patients with bipolar disorder. Accordingly, in this study, we, for the first time, measured pareidolia in patients with bipolar disorder (N = 50), and compared that to patients with schizophrenia (N = 50) and healthy controls (N = 50). We have used (a) the scene test, which consists of 10 blurred images of natural scenes that was previously found to produce illusory face responses and (b) the noise test which had 32 black and white images consisting of visual noise and 8 images depicting human faces; participants indicated whether a face was present on these images and to point to the location where they saw the face. Illusory responses were defined as answers when observers falsely identified objects that were not on the images in the scene task (maximum illusory score: 10), and the number of noise images in which they reported the presence of a face (maximum illusory score: 32). Further, we also calculated the total pareidolia score for each task (the sum number of images with illusory responses in the scene and noise tests). The responses were scored by two independent raters with an excellent congruence (kappa > 0.9). Our results show that schizophrenia patients scored higher on pareidolia measures than both healthy controls and patients with bipolar disorder. Our findings are agreement with prior findings on more impaired cognitive processes in schizophrenia than in bipolar patients.

First Reactions and Attitudes of Psychiatric Workers in Budapest Psychiatric Care Units Regarding the COVID-19 Pandemic.

OBJECTIVE: To focus on the first feelings, attitudes, and planned reactions of psychiatric workers in Hungary to the news of the appearance of coronavirus disease 2019 (COVID-19) and to examine any differences between psychiatrists/psychologists and nurses/other professionals regarding these attitudes. METHODS: Hungarian psychiatric workers (N = 119) including psychiatrists/psychologists (n = 78) and nurses/other professionals (n = 41) participated in the study. To measure attitudes, a questionnaire was designed consisting of 7 questions and filled out within 1-3 days after the declaration of emergency in response to COVID-19 in Hungary on March 11, 2020. RESULTS: Psychiatric workers, especially psychiatrists/psychologists, regarded information gathering from valid sources as important. When examining the first feelings, we found that the psychiatrists/psychologists group tended to feel higher extent of anxiety, while the nurses/other professionals group showed higher extent of hope. When investigating willingness to work in the pandemic situation, a lower percentage of Hungarian psychiatric workers (58%) would choose to continue working compared to previous research. Answers to open-ended questions revealed that denial was the most frequent coping reaction. CONCLUSIONS: These differences could be attributed to the finding that psychiatrists/psychologists, who had faced the reality of the virus situation via the news, tended to have more realistic attitudes toward the virus, while nurses/other professionals, who had avoided valid information, tended to have less realistic attitudes.

[Telephone information service for psychiatric patients during the COVID-19 pandemic: Experience with a direct phone line in the Nyíro Gyula National Institute of Psychiatry and Addictions in Hungary]. / Beteginformációs telefonvonal a COVID-19-járvány idején: a Nyíro Gyula-OPAI-ban muködtetett közvetlen vonallal szerzett tapasztalataink.

The COVID-19 epidemic has had an extraordinary impact on mental health. In addition to the direct effect of the virus, we must take into account increasing disease anxiety due to the risk of infection, insecurity, confusing media activity, social isolation due to quarantine, socioeconomic impact, and the reduced capacity of the health-care system. In this paper, we present our experiences with the patient information telephone service operated by the psychotherapy department of the Nyíro Gyula National Institute of Psychiatry and Addiction (Nyíro-OPAI). Clinical psychologists and psychotherapists received the calls. The vast majority of the 264 phone calls registered during the two months of the pandemic (62%) were initiated by treated patients (availability of a doctor, questions related to the operation of the health-care system, prescribing medications). Still, we could also help patients and their families in potentially dangerous situations (21%): suicidal intentions, alcohol- and drug-related crises, severe neurocognitive disorders (dementias) with acute behavioural and psychological symptoms. In all cases, the telephone consultation led to the successful resolution of the crisis (low-threshold psychological intervention, counselling, assistance in admission to the institution). A relatively small number of calls (7%) were related to more complex psychotherapeutic needs. In summary, our experience shows that in extreme social situations, direct telephone assistance is suitable for supporting registered patients in the mental health system. This type of service also provides an opportunity to address acute crises and cases requiring more complex psychotherapeutic interventions.

Enhanced Verbal Statistical Learning in Glossolalia.

Glossolalia ("speaking in tongues") is a rhythmic utterance of word-like strings of sounds, regularly occurring in religious mass gatherings or various forms of private religious practices (e.g., prayer and meditation). Although specific verbal learning capacities may characterize glossolalists, empirical evidence is lacking. We administered three statistical learning tasks (artificial grammar, phoneme sequence, and visual-response sequence) to 30 glossolalists and 30 matched control volunteers. In artificial grammar, participants decide whether pseudowords and sentences follow previously acquired implicit rules or not. In sequence learning, they gradually draw out rules from repeating regularities in sequences of speech sounds or motor responses. Results revealed enhanced artificial grammar and phoneme sequence learning performances in glossolalists compared to control volunteers. There were significant positive correlations between daily glossolalia activity and artificial grammar learning. These results indicate that glossolalists exhibit enhanced abilities to extract the statistical regularities of verbal information, which may be related to their unusual language abilities.

Attribution of Mental States in Glossolalia: A Direct Comparison With Schizophrenia.

Glossolalia ("speaking in tongues") is a rhythmic utterance of pseudo-words without consistent semantic meaning and syntactic regularities. Although glossolalia is a culturally embedded religious activity, its connection with psychopathology (e.g., psychotic thought disorder and altered mental state attribution/mentalization) is still a matter of debate. To elucidate this issue, we investigated 32 glossolalists, 32 matched control participants, and 32 patients with schizophrenia using the Animated Triangle Test (ATT) and the Reading the Mind in the Eyes Test (RMET). The ATT can detect hypo- and hypermentalization using animations of two moving triangles. Healthy adults describe these as random movements (e.g., bouncing), willed actions (e.g., playing), or they mentalize (e.g., tricking). We found that glossolalists provided more mentalizing descriptions in the ATT random and intentional movement animations relative to the control participants. They also recognized more mental states in the RMET than the controls. None of them had a diagnosis of mental disorders. In contrast, patients with schizophrenia hypermentalized only in the ATT random movement condition, whereas they showed hypomentalization in the ATT intentional movement condition and in the RMET relative the control subjects. Hypermentalization in the ATT positively correlated with intrinsic religiosity in the glossolalia group. In conclusion, our results demonstrated a substantial difference in the mentalizing ability of glossolalists (generalized hypermentalization) and patients with schizophrenia (both hypo- and hypermentalization).

Early-Stage Vision and Perceptual Imagery in Autism Spectrum Conditions.

Autism spectrum conditions (ASC) are characterized by multifaceted alterations in visual perception and mental imagery. However, the interaction between early-stage visual perception and imagery has not been explored. We recruited 40 individuals with ASC and 20 neurotypical control volunteers to participate in a lateral masking task. Participants detected a luminance-contrast target pattern (Gabor patch) flanked by two collinear masks. The flanking masks inhibit target detection at small target-mask distances and facilitate target detection at intermediate target-mask distances. In the perceptual task, the masks appeared adjacent to the target. In the imagery task, participants imagined the masks immediately after seeing them. Results revealed that individuals with ASC characterized by exceptional visuoconstructional abilities (enhanced Block Design performance; n = 20) showed weaker inhibition at small target-mask distances and stronger facilitation at intermediate target-mask distances relative to the controls. Visual imagery was markedly dampened in ASC regardless of the visuoconstructional abilities. At the behavioral level, these results indicate increased facilitation via lateral connections in the primary visual cortex (V1) of individuals with ASC who exhibit exceptional visuoconstructional abilities, together with less efficient mental imagery.

[Dimensions of mentalization in psychotic disorders]. / A mentalizáció dimenziói pszichotikus zavarokban.

The clinical assessment of mentalization became one of the most important issues in clinical psychology and psychiatry. Despite extensive research efforts, the exact definition, classification, and evaluation of mentalization is unresolved, especially in psychotic disorders. The primary purpose of the present study was to investigate the factor structure of the Mentalization Questionnaire. In addition, we investigated the relationship between the dimensions of mentalization and the positive, negative, and general symptoms of psychotic disorders, as well as potential associations with antipsychotic medications. We recruited two independent samples: the first consisted of 94 individuals (schizophrenia, n=63; schizoaffective disorder, n=21; psychotic bipolar disorder, n=10), and the second included 75 patients (schizophrenia, n=60; schizoaffective disorder, n=10; psychotic bipolar disorder, n=5). Exploratory and confirmatory factor analyses revealed four dimensions in both samples: self-reflection, emotional awareness, psychic equivalence, and affective regulation. The two samples did not differ in Mentalization Questionnaire scores. The severity of negative symptoms significantly correlated with weak self-reflection. The dose of first- and second-generation antipsychotics was not associated with mentalization. In summary, the questionnaire is suitable for the measurement of mentalization in psychotic disorders. Mentalization is not a unitary phenomenon: its four psychometric components were differentially associated with clinical symptoms, but not with antipsychotic medications.

Obsessed not to forget: lack of retrieval-induced suppression effect in obsessive-compulsive disorder.

The aim of the present study was to investigate the role of executive functions in resolving memory interference in a clinical sample of patients with obsessive-compulsive disorder (OCD). Retrieval of memories has been shown to involve some form of executive act that diminishes the accessibility of rival memory traces, leading to retrieval-induced forgetting (RIF). These executive control processes might suppress unwanted thoughts and irrelevant memories during competitive retrieval. We assessed RIF with the retrieval practice paradigm among 25 OCD patients and 25 healthy controls matched for age and education. Retrieval of target memories led to enhancement of target memory recall in both groups, but suppression of related memories (RIF) occurred only among controls. Our results suggest that suppression of irrelevant, interfering memories during competitive recall is impaired in OCD.

Two types of impairments in OCD: obsessions, as problems of thought suppression; compulsions, as behavioral-executive impairment.

Impairments in executive functioning have been identified as an underlying cause of Obsessive-Compulsive Disorder (OCD). Obsessive patients attempt to suppress certain unwanted thoughts through a mechanism that Wegner referred to as 'chronic thought suppression', whereas compulsive patients are unable to inhibit their rituals. We tested 51 OCD patients using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the White Bear Suppression Inventory (WBSI) and the Dysexecutive Questionnaire (DEX). Executive functions were tested using a cognitive test battery. We found that the total WBSI score was correlated with the Y-BOCS obsessive score but not with the Y-BOCS compulsive score. A stronger correlation was observed between the Y-BOCS obsessive score and the 'unwanted intrusive thoughts' factor based on Blumberg's 3-factor model of the WBSI. The total WBSI score was not correlated with the cognitive test results. The DEX score was significantly correlated with the Y-BOCS compulsive score; however, no correlation was found between the DEX score and the Y-BOCS obsessive score. A stronger correlation was observed between the Y-BOCS compulsive score and the 'inhibition' component of the DEX score, as defined by Burgess's 5-factor model. The DEX scores were correlated with cognitive test results measuring attention, cognitive flexibility and inhibitory processes. We conclude that obsessions indicate a failure of cognitive inhibition but do not involve significant impairment of executive functions, whereas compulsions indicate ineffective behavior inhibition and impaired executive functions.

Intact short-term memory and impaired executive functions in obsessive compulsive disorder.

BACKGROUND AND PURPOSE: Previous neuropsychological studies produced inconsistent results with tasks tapping short-term verbal and visual-spatial memory and executive functions in obsessive compulsive disorder (OCD). The aim of this study was to investigate the presence of deficits in these cognitive domains. A further goal was to describe the distribution of patients in different impairment ranges for all functions, and clarify the relationship between symptom severity and cognitive impairments. METHODS: Thirty patients with OCD (DSM-IV) and 30 healthy volunteers were compared using well-known neuropsychological tasks. We assessed short-term verbal memory with the Digit Span Forward and Digit Span Backward Tasks, short-term visual-spatial memory with the Corsi Block Tapping Task, while we measured the level of executive functions with the StroopTask and the Wisconsin Card Sorting Test (WCST). RESULTS: Compared with a matched healthy control group, the performance of OCD patients was in the impaired range only in the two executive tasks. We find a significant positive correlations between the Y-BOCS (Yale-Brown Obsessive Compulsive Scale) total scores and the number of perseverative responses (r(28) = 0.409, p < 0.05) and perseverative errors (r(28) = 0.385, p < 0.05) in the WCST. CONCLUSION: Our results gave evidence that executive functions are impaired while short-term memory is intact in OCD. This is in line with neuropsychological model of OCD that the deficit of cognitive and behavioral inhibition are responsible for the main cognitive findings of this disorder, most prevalently the deficit in set shifting and prepotent response inhibition.

The validation of the Hungarian version of the dimensional Yale-Brown obsessive-compulsive scale.

BACKGROUND: The Obsessive-Compulsive disorder (OCD) has a complex phenotype, which can be summarized by using a few consistent and temporally stable symptom dimensions. The dimensional approach derived from the systematic factor analytic studies of OCD symptoms. In 2006, a new psychometric scale was created by M.C. Rosario-Campos and her colleague, the Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS). This scale measures the presence and severity of obsessive-compulsive (OC) symptoms within six distinct dimensions. The Hungarian translation of the test and preliminary results were published in 2009. PURPOSE: The objective of this recent study was two folded: on one hand, our goal was to validate the Hungarian version of the DY-BOCS on a larger sample size. On the other hand, we wanted to publish our results gained by the Hungarian version of the test in English. METHODS: We assessed 30 Hungarian patients diagnosed with OCD by DSM-IV. Reliability and validity of the expert and of the self-report were estimated. RESULTS: Self-report and expert ratings were highly correlated. The global DY-BOCS score was well correlated with the total Yale-Brown Obsessive-Compulsive Scale score. The internal validity of the symptom dimensions and the global severity score were high. Divergent validity was also good. CONCLUSION: These results indicate that the Hungarian version of the DY-BOCS is a reliable and valid clinical tool.

An experimental study of prospective memory in obsessive-compulsive disorder.

The aim of the present study was to investigate prospective memory (PM) function in patients with obsessive-compulsive disorder (OCD). An event-based PM task was administered to 30 OCD patients and 30 healthy adult participants. For OCD patients, PM instruction produced significantly more cost in terms of reaction time (RT) during the ongoing task. A significant group-experimental condition interaction in ongoing task RTs was found, which suggests that PM instruction loaded an extra cost onto OCD patients' ongoing activities, and this was independent of the execution of the PM intention. Comparing the PM task RTs between patients and healthy adults also revealed a significant group difference. These results suggest that OCD patients experience difficulties during PM tasks, and these difficulties originate from overmonitoring the stimuli for PM cues.

Deep brain stimulation for treatment refractory obsessive-compulsive disorder--a case report.

In the past 30 years it has been a great development in the unders-anding and therapy of obsessive-compulsive disorder. Adequate pharmaco- and cognitive-behavior therapies reduce the symptoms in 40-60% of patients, so a remarkable portion of patients still remains refractory to conventional treatment. Neurosurgery--with it's reversible and irreversible techniques--brought a breakthrough in the therapy of treatment refractory patients. In the present case, we represent a 3 months follow-up of an obsessive-compulsive pctient treated by deep brain stimulation. In our case, the stimulation target was the anterior limb of internal capsule. The clinical symptoms were measured by Y-BOCS. In addition various neuropsychological tests were used to monitor patient's executive functions before and 3 months after the deep brain stimulation. We found that obsessive-compu sive symptoms improved after three months of the stimulation. The neuropsychological tests showed improvement in some executive functions (e.g. fluency, set-shifting, decision making). On the other hand our results revealed severe neurocognitive--mainly attention skill--deficits in a treatment refractory obsessive-compulsive patient.

[Hungarian translation of the Dimensional Yale-Brown Obsessive-Compulsive Scale and our first experiences with the test]. / A dimenzionális Yale-Brown obszesszív-kompulzív teszt (DY-BOCS) magyar fordítása, és a teszttel szerzett elsö tapasztalataink.

According to the dimensional approach of the obsessive-compulsive disorder (OCD), it is possible to identify phenotypic subtypes--so called dimensions--within the heterogeneous clinical manifestations of OCD by statistical techniques (principal component analysis). The Dimensional Yale-Brown Obsessive Compulsive Scale (DY-BOCS) measures the presence of the obsessive-compulsive symptoms within the phenotype. The scale is a semi-structured instrument, which includes a symptom list divided into six dimensions for the patients and a part reserved for the clinician. The authors gave their written permission for the translation of the DY-BOCS test into Hungarian, revised the back-translation of the Hungarian version and the final, revised version is published for the first time, in Hungary. The Hungarian DY-BOCS was administered to seventeen OCD patients at 2nd Department of Psychiatry, Nyírô Gyula Hospital. The reliability analysis produced strong correlation coefficients. The internal consistency (Cronbach alpha) scores were high, ranging from 0.97 to 0.99. The scores of the validity scales were also good. There was a strong convergent validity between the gold standard, Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) global severity scores and the DY-BOCS global severity scores (p=0.001 / r=0.744). The examination of the internal validity showed that the DY-BOCS global score and the aggressive and miscellaneous dimension severity rating scores are strongly correlated. We also experienced strong correlation between the DY-BOCS global score and the component scores of the global severity ratings (time, distress, interference, and impairment), the Pearson's r ranged from 0.815 to 0.960. There was no significant inter-correlation between the dimensions, which supports the assumption that these dimensions are independent constructs. In the divergent validity measures, we used the Hamilton Depression Scale (HAM-D) to compare OCD dimensions with the most common comorbid disorder (depression) symptoms. The severity scores of the HAM-D were correlated with the severity scores of the DY-BOCS dimensions. In this latter validity test, we found only one significant correlation between the aggressive dimension and the severity of the depression. In the case of the remaining dimensions, there was no significant correlation between the dimensions and the severity of depression; thus, it seems that the two tests examine widely different psychological phenomena . The evaluating scores of the Hungarian version of the DY-BOCS are very close to the original published scores. These results indicate that the Hungarian version of the DY-BOCS is a reliable and a valid clinical tool and we hope that by using the test, Hungarian professionals will become familiar with and accept the dimensional approach of OCD.