Preliminary validation of the Mental Health Test in a psychiatric sample.

To assist psychiatrists and clinical psychologists to assess their patients' psychological immune competence-based capacities and resources, depending on the mental health disorder diagnosis and the severity of the symptoms, the present study examined the psychometric properties of the Mental Health Test in a psychiatric sample. The research was carried out in four Hungarian healthcare facilities using a cross-sectional design. A total of 331 patients (140 male, 188 female, and 3 who preferred not to disclose their gender) completed the Mental Health Test, six well-being and mental health measures, and the Symptom Checklist-90. Psychiatrists and clinical psychologists reported the mental disorder status of each participant. Confirmatory factor analysis showed a good fit of the five-factor model to the data for the clinical version of the Mental Health Test (CFI = 0.972, RMSEA = 0.034). High internal consistency coefficients (α: 0.70-0.84; ω: 0.71-0.85) and excellent external and content validity were reported. The test is not sensitive to sociodemographic indicators but is sensitive to the correlates of well-being and to the symptoms of different types of mental disorders. Our preliminary findings suggest that the Mental Health Test is a suitable measure for assessing mental health capacities and resources in psychiatric samples.

Motion and Form Perception in Childhood-Onset Schizophrenia.

(1) Background: Childhood-onset schizophrenia (COS) is a rare type of psychotic disorder characterized by delusions, hallucinations, grossly disorganized behavior, and poor psychosocial functioning. The etiology of COS is unknown, but neurodevelopmental factors are likely to play a critical role. A potential neurodevelopmental anomaly marker is the dorsal visual system dysfunction, which is implicated in motion perception, spatial functions, and attention. (2) Methods: To elucidate the role of the dorsal visual system in COS, we investigated 21 patients with COS and 21 control participants matched for age, sex, education, IQ, and parental socioeconomic status. Participants completed a motion and form coherence task, during which one assesses an individual's ability to detect the direction of motion within a field of moving elements or dots and to recognize a meaningful form or object from a set of fragmented or disconnected visual elements, respectively. (3) Results: The patients with COS were impaired in both visual tasks compared to the control participants, but the evidence for the deficit was more substantial for motion perception than for form perception (form: BF10 = 27.22; motion: BF10 = 6.97 × 106). (4) Conclusions: These results highlight the importance of dorsal visual stream vulnerability in COS, a potential marker of neurodevelopmental anomalies.

Can you believe your eyes? Positive schizotypy is associated with increased susceptibility to the Müller-Lyer illusion.

BACKGROUND AND HYPOTHESIS: Visual illusions provide a unique opportunity to understand cognitive and perceptual alterations in schizophrenia-spectrum conditions. Schizophrenia patients often exhibit increased susceptibility to the Müller-Lyer illusion. Here, we investigate susceptibility to the Müller-Lyer visual illusion in the general population with different levels of schizotypy. STUDY DESIGN: We assessed a population-based convenience sample (N = 263) on an online platform. In addition to basic demographics, participants completed the Müller-Lyer illusion, the Cardiff Anomalous Perceptions Scale (CAPS) to measure perceptual anomalies, and the Multidimensional Schizotypy Scale - Brief (MSS-B) for schizotypic traits. To evaluate what predicts susceptibility to the illusion, we fitted a large set of multilevel logistic regression models and performed model averaging over the coefficients. STUDY RESULTS: We found support for increased illusion susceptibility among individuals with high positive schizotypy. However, we did not find a comparable effect for anomalous perceptions alone, or for negative or disorganized schizotypy. CONCLUSIONS: The increased Müller-Lyer effect in positive schizotypy might be specific to delusion-like beliefs and magical ideation. Further research is needed to clarify how a hierarchical Bayesian formulation of brain function (e.g. imbalances between bottom-up perceptual processing and substantial reliance on prior expectations) can account for the Müller-Lyer effect in schizophrenia-spectrum conditions.

Stress Responses Among Individuals with Spiritual Struggles in Hungary: An Experimental Study.

Individuals with a Religious or Spiritual Problem (RSP), as defined in the DSM-5, experience distress associated with faith-related moral dilemmas, existential meaning, and transpersonal attitudes toward other people. It is unclear whether a RSP reflects a generally heightened stress reactivity or whether the stress response is confined to religious and spiritual contexts. To elucidate this issue, we measured behavioral and physiological responses during social-evaluative stress (public speaking-Trier Social Stress Test) and in religious/spiritual contexts (Bible reading and listening to sacred music) in 35 individuals with RSP and 35 matched participants. We found no stress reduction in the religious/spiritual context in RSP, as indicated by increased heart rate, saliva cortisol, and relatively higher left than right frontal activity. Religious stimuli evoked physiological stress responses in RSP. Contrary to the physiological parameters, participants with RSP reported less anxiety in the religious/spiritual context. Religious individuals with and without RSP showed similar stress responses during public speaking. Religious individuals without RSP displayed reduced stress responses in the religious/spiritual context. These results indicate that specific physiological distress in religious/spiritual contexts should be considered in the psychological care of RSP.

Emotions under control? Better cognitive control is associated with reduced negative emotionality but increased negative emotional reactivity within individuals.

Associations between impaired cognitive control and maladaptive emotion regulation have been extensively studied between individuals. However, it remains unclear if this relationship holds within individuals. In this study, we tested the assumption that momentary within-person fluctuation in cognitive control (working memory updating and response inhibition) is associated with emotional reactivity in everyday life. We conducted an experience sampling study (eight two-hourly prompts daily) where participants repeatedly performed short 2-back and Go/no-go tasks in daily life. We assessed negative and positive affective states, and unpleasantness of a recent event to capture emotional reactivity. We analyzed two overlapping samples: a Go/no-go and a 2-back dataset (N = 161/158). Our results showed that better momentary working memory updating was associated with decreased negative affect if the recent event was on average unpleasant for the given individual. However, better-than-average working memory updating in interaction with higher event-unpleasantness predicted higher negative affect levels (i.e., higher negative emotional reactivity). These findings may challenge the account of better cognitive control being universally related to adaptive emotion regulation. Although it is unlikely that emotional reactivity boosts working memory, future studies should establish the direction of causality.

Autism and Religion.

The disease burden of autism spectrum disorder (ASD) is a definitive public health challenge. The quality of life of children with ASD depends on how the cultural environment fits their special needs, including religious and spiritual factors. Does ASD predict low religiosity, and if not, what is the significance for clinical care? To answer this question, we reviewed the literature on the cognitive models of ASD and religious beliefs. We found that the cognitive models of ASD and religious beliefs substantially overlap, which is particularly important from a developmental psychological perspective. These models include Theory of Mind and intentionality, the "broken mirror" hypothesis, central coherence, and the intense world theory. We dispute the assumption that individuals with ASD are inherently less religious and spiritual than the neurotypical population. Religiosity is possibly expressed differently in ASD with unique spiritual experiences and beliefs ("gifted, visionary, and truth-seeker"). In some circumstances, a religious background can be helpful for both children with ASD and their caregivers. These circumstances should not be neglected, and clinicians are encouraged to consider patients' religious context, resources, and needs.

[The immune hypothesis of major depressive disorder in the light of cognitive functions]. / A major depresszív zavar immunológiai elmélete a kognitív funkciók tükrében.

The immunological-inflammatory theory of major depressive disorder originated in the 1980s, yet it has become the focus of mainstream research today. Nevertheless, the results are controversial: postmortem immunohistochemical detection of central neuronal and glial markers has not led to a clear conclusion, the relationship with the therapeutic response is questionable, and the correlation between peripheral and central markers is poor. A possible solution is detecting inflammatory changes in vivo by positron emission tomography (PET) (e.g., TSPO binding). The importance of this method lies in its direct correlation with clinical changes and in the monitoring of the therapeutic response and its neurological correlates. Of particular importance is the link with cognitive symptoms and cognitive-behavioral therapy. In the present paper, we will highlight some critical results on this issue, showing that the presumed variation in microglia is associated with the cognitive symptoms accompanying mood disorders and provides an appropriate tool for the follow-up of clinical responses to cognitive therapy. We will also address the limitations of currently available methods (e.g., PET ligands' binding specificity, spatial resolution problems, and the possibility of monitoring immunological changes in vivo).

Mentalization, Oxytocin, and Cortisol in the General Population.

Although evidence suggests the role of oxytocin and cortisol in social cognition and emotion regulation, it is less known how their peripheral levels are related to social perception (biological motion detection) and mentalization (self-reflection, emotional awareness, and affect regulation) in the general population. We assessed 150 healthy individuals from the general community on a mentalization questionnaire, a scale measuring the intensity of positive and negative emotions, and measured oxytocin and cortisol levels in the saliva. Oxytocin but not cortisol level and biological motion detection predicted mentalization abilities. There was a positive correlation between mentalization and positive emotions and between mentalization and biological motion detection. These results suggest that oxytocin, but not cortisol, plays a role in low-level perceptual and self-reflective aspects of social cognition.

[How can subjects be objectified? - or a critical overwiev of the concept of personality disorders appearing in the new classificational systems].

The development of the new diagnostic systems (DSM-5; ICD-11) once again generated an interesting discussion around the personality disorders. In this paper we first review the historical traditions, than we examine and compare the new diagnostic suggestions appearing in DSM-5 and ICD-11. Our main goal is to help with the under standing of the new dimensional models and to clarify the questions that arose during the creation of these models. Although the DSM-5 keeps the classic categorical system, it also proposes a hybrid dimensional-categorical diagnostic alternative. Within the hybrid model, the first step is to investigate the impairment of the personality by evaluating the damages to the self and the interpersonal functions. The next step is to form categories along the Big-Five traits. The constellation of the impaired traits dimensions creates the final categories. ICD-11 broke up with the category approach and moved on with the hybrid proposal of DSM-5. Here the first step is to determine the severity of the personality disorder. After that the personality disorder can be specified by a new code. This system does not use the dimensions of the intact personality traits (Big-Five), but the dimensions emerging from the factor analysis of personality disorders. Since in ICD-11 the borderline diagnostic possibility appears in addition to the dimensions, in the last part of the study we review the critical, scientific data of this specific borderline syndrome and its therapy.

Seeds that bloom on stony ground - Concept paper of the future perspectives of the unexploited capacities of positive clinical psychology in Hungary.

Positive psychology has fully examined the flourishing among healthy people but neglected to understand how "optimal human functioning" can apply to the life experiences of a vulnerable person. Considering methodological issues, this article gives a brief overview on how the conceptualization of mental health and mental disorders affects the consideration of strengths along with the presence of dysfunction with the emergence of positive psychology. First, we summarize the shortcomings of the applicability of clinical positive psychology, focusing especially on Hungarian clinical practice. Second, we discuss the problems with the conceptualization of mental health in positive psychological framework. Third, we propose a model, the Maintainable Positive Mental Health Theory based on capacities and competences. Finally, we conclude with methodological questions and present a research protocol. The key finding of our review is that the opportunity exists for psychiatrists and psychologists to embrace disability as part of human experiences and to show how people with vulnerabilities can be supported to recover. (Neuropsychopharmacol Hung 2022; 24(3): 113-119).

Trauma and Remembering: From Neuronal Circuits to Molecules.

Individuals with posttraumatic stress disorder (PTSD) experience intrusions of vivid traumatic memories, heightened arousal, and display avoidance behavior. Disorders in identity, emotion regulation, and interpersonal relationships are also common. The cornerstone of PTSD is altered learning, memory, and remembering, regulated by a complex neuronal and molecular network. We propose that the essential feature of successful treatment is the modification of engrams in their unstable state during retrieval. During psychedelic psychotherapy, engrams may show a pronounced instability, which enhances modification. In this narrative review, we outline the clinical characteristics of PTSD, its multifaceted neuroanatomy, and the molecular pathways that regulate memory destabilization and reconsolidation. We propose that psychedelics, acting by serotonin-glutamate interactions, destabilize trauma-related engrams and open the door to change them during psychotherapy.

Visually guided equivalence learning in borderline personality disorder.

The hallmark symptoms of borderline personality disorder are maladaptive behavior and impulsive emotional reactions. However, the condition is occasionally associated with cognitive alterations. Recently, it has been found that the function of the basal ganglia and the hippocampi might also be affected. Hence, deterioration in learning and memory processes associated with these structures is expected. Thus, we sought to investigate visually guided associative learning, a type of conditioning associated with the basal ganglia and the hippocampi, in patients suffering from borderline personality disorder. In this study, the modified Rutgers Acquired Equivalence Test was used to assess associative learning in 23 patients and age-, sex-, and educational level-matched controls. The acquisition phase of the test, which is associated primarily with the frontostriatal loops, was altered in patients with borderline personality disorder: the patients exhibited poor performance in terms of building associations. However, the retrieval and generalization functions, which are primarily associated with the hippocampi and the medial temporal lobes, were not affected. These results corroborate that the basal ganglia are affected in borderline personality disorder. However, maintained retrieval and generalization do not support the assumption that the hippocampi are affected too.

Visual consequent stimulus complexity affects performance in audiovisual associative learning.

In associative learning (AL), cues and/or outcome events are coupled together. AL is typically tested in visual learning paradigms. Recently, our group developed various AL tests based on the Rutgers Acquired Equivalence Test (RAET), both visual and audiovisual, keeping the structure and logic of RAET but with different stimuli. In this study, 55 volunteers were tested in two of our audiovisual tests, SoundFace (SF) and SoundPolygon (SP). The antecedent stimuli in both tests are sounds, and the consequent stimuli are images. The consequents in SF are cartoon faces, while in SP, they are simple geometric shapes. The aim was to test how the complexity of the applied consequent stimuli influences performance regarding the various aspects of learning the tests assess (stimulus pair learning, retrieval, and generalization of the previously learned associations to new but predictable stimulus pairs). In SP, behavioral performance was significantly poorer than in SF, and the reaction times were significantly longer, for all phases of the test. The results suggest that audiovisual associative learning is significantly influenced by the complexity of the consequent stimuli.

Multisensory stimuli enhance the effectiveness of equivalence learning in healthy children and adolescents.

It has been demonstrated earlier in healthy adult volunteers that visually and multisensory (audiovisual) guided equivalence learning are similarly effective. Thus, these processes seem to be independent of stimulus modality. The question arises as to whether this phenomenon can be observed also healthy children and adolescents. To assess this, visual and audiovisual equivalence learning was tested in 157 healthy participants younger than 18 years of age, in both a visual and an audiovisual paradigm consisting of acquisition, retrieval and generalization phases. Performance during the acquisition phase (building of associations), was significantly better in the multisensory paradigm, but there was no difference between the reaction times (RTs). Performance during the retrieval phase (where the previously learned associations are tested) was also significantly better in the multisensory paradigm, and RTs were significantly shorter. On the other hand, transfer (generalization) performance (where hitherto not learned but predictable associations are tested) was not significantly enhanced in the multisensory paradigm, while RTs were somewhat shorter. Linear regression analysis revealed that all the studied psychophysical parameters in both paradigms showed significant correlation with the age of the participants. Audiovisual stimulation enhanced acquisition and retrieval as compared to visual stimulation only, regardless of whether the subjects were above or below 12 years of age. Our results demonstrate that multisensory stimuli significantly enhance association learning and retrieval in the context of sensory guided equivalence learning in healthy children and adolescents. However, the audiovisual gain was significantly higher in the cohort below 12 years of age, which suggests that audiovisually guided equivalence learning is still in development in childhood.

Postdiction in Visual Awareness in Schizophrenia.

BACKGROUND: The mistiming of predictive thought and real perception leads to postdiction in awareness. Individuals with high delusive thinking confuse prediction and perception, which results in impaired reality testing. The present observational study investigated how antipsychotic medications and cognitive-behavioral therapy (CBT) modulate postdiction in schizophrenia. We hypothesized that treatment reduces postdiction, especially when antipsychotics and CBT are combined. METHODS: We enrolled patients with schizophrenia treated in a natural clinical setting and not in a randomized controlled trial. We followed up two schizophrenia groups matched for age, sex, education, and illness duration: patients on antipsychotics (n = 25) or antipsychotics plus CBT (n = 25). The treating clinician assigned the patients to the two groups. Participants completed a postdiction and a temporal discrimination task at weeks 0 and 12. RESULTS: At week 0, postdiction was enhanced in patients relative to controls at a short prediction-perception time interval, which correlated with PANSS positive symptoms and delusional conviction. At week 12, postdiction was reduced in schizophrenia, especially when they received antipsychotics plus CBT. Patients with schizophrenia were also impaired on the temporal discrimination task, which did not change during the treatment. During the 12-week observational period, all PANSS scores were significantly reduced in both clinical groups, but the positive symptoms and emotional distress exhibited a more pronounced response in the antipsychotics plus CBT group. CONCLUSION: Perceptual postdiction is a putative neurocognitive marker of delusive thinking. Combined treatment with antipsychotics and CBT significantly ameliorates abnormally elevated postdiction in schizophrenia.

Postdiction in Visual Awareness and Intrinsic Religiosity.

The mistiming and fusion of predictive thought and actual perception result in postdiction in awareness, a critical factor in the emergence of nonrational beliefs. Individuals with delusive thinking tend to experience a temporal reversal of prediction ("I guess the rain will fall.") and real perception ("I feel the rain falling."), incorrectly showing conviction that their predictions are correct. It is unknown how postdiction is related to religious cognition with a particular reference to intrinsic religiosity when religious beliefs and values are master motives and fundamental frameworks of life. Using a temporal decision-making task, we investigated a group of religiously committed individuals, atheists, and people from the general community. Results revealed higher postdiction at short thought-precept time intervals in the intrinsic religious group relative to the atheists. Intrinsic religiosity, but not delusive thinking, was predicted by postdiction in both religious individuals and the general population. These results indicate that people who display pronounced thought-percept reversal and fusion feel that they are close to a higher power and the sacred.

The Relationship Among Mentalization, Mindfulness, Working Memory, and Schizotypal Personality Traits in the General Population.

Individuals with high schizotypal traits are less able to observe, describe, and monitor inner feelings, thoughts, and experiences, commonly referred to as mindfulness and mentalization. High schizotypy is also associated with impaired working memory (WM). However, the relationship among mindfulness, mentalization, WM, and schizotypal traits is unknown. Three hundred individuals from the community (mean age: 38.0 years, SD = 10.5; 49.3% women) completed questionnaires examining schizotypal traits, mindfulness, and mentalization and performed working memory tasks. Results revealed that mentalization was a general predictor of schizotypal traits, including unusual experiences, cognitive disorganization, introverted anhedonia, and impulsive nonconformity, when the effect of mindfulness and working memory was controlled. We also found a positive correlation between mindfulness and mentalization. Low mindfulness and mentalization performances were associated with high schizotypy. However, poor working memory was only weakly linked to cognitive disorganization and introverted anhedonia. These findings suggest that weak mentalization is a core feature of schizotypy independent of mindfulness and working memory.

The Influence of Stimulus Complexity on the Effectiveness of Visual Associative Learning.

Visually guided equivalence learning is a special type of associative learning, which can be evaluated using the Rutgers Acquired Equivalence Test (RAET) among other tests. RAET applies complex stimuli (faces and colored fish) between which the test subjects build associations. The complexity of these stimuli offers the test subject several clues that might ease association learning. To reduce the number of such clues, we developed an equivalence learning test (Polygon), which is structured as RAET but uses simple grayscale geometric shapes instead of faces and colored fish. In this study, we compared the psychophysical performances of the same healthy volunteers in both RAET and Polygon test. Equivalence learning, which is a basal ganglia-associated form of learning, appears to be strongly influenced by the complexity of the visual stimuli. The simple geometric shapes were associated with poor performance as compared to faces and fish. However, the difference in stimulus complexity did not affect performance in the retrieval and transfer parts of the test phase, which are assumed to be mediated by the hippocampi.

The key to superior memory encoding under stress: the relationship between cortisol response and mnemonic discrimination.

Some previous studies have shown that increased stress hormone levels have beneficial effects on memory encoding; however, there is no clear consensus on which encoding-related processes are affected by stress hormones. In the present study, we investigated the relationship between interindividual differences in neuroendocrine response to acute stress and interference resolution (i.e., mnemonic discrimination). Participants were healthy young adults who were exposed to physical and psychological stressors (Socially Evaluated Cold Pressor Test). Then participants completed the modified version of the Mnemonic Similarity Task. Specifically, they were presented with photographs of emotionally arousing (negative and positive) and nonarousing (neutral) scenes followed by a recognition memory test where they saw a mixture of old and new stimuli. Crucially, participants were also presented with critical lure items, that is, visually similar stimuli to ones presented at encoding. We found that participants who had higher cortisol response to the stressors were better in discriminating between the studied items and their visually similar lures. This effect was present for the arousing and nonarousing materials as well. These findings suggest that increased hormonal response to acute stress has a beneficial impact on the formation of distinct, nonoverlapping, unique memory representations, and consequently, on episodic memory encoding processes.

Mental Health Profiles in Clinical and Non-clinical Samples in Light of the Maintainable Positive Mental Health Theory: Protocol Paper.

Clinical psychology has invested a lot of energy in the thorough examination of the characteristics of mental disorders, but less in the implication of the accessible mental health capacities in the recovery phase. Our aim in the present study is to verify the two-continuum mental health model in clinical and non-clinical samples in the light of the Maintainable Positive Mental Health Theory. A further aim is to investigate the interrelationship between positive mental health and mental disorder by examining various groups of mental disorders with different levels of severity. We also examine the prevalence of the diagnostic categories of the Complete Mental Health Model. Furthermore, we aim to identify mental health profiles and their correlates. In the present paper, we introduce the protocol for the ongoing research. A cross-sectional, case-control design is employed to investigate the two-continuum model of mental health. The clinical sample (n = 400) is recruited from four Hungarian hospitals. The non-clinical sample (n = 400) is collected using an online self-report survey-based research design. The two-continuum model of mental health will be tested using exploratory factor analysis and confirmatory factor analysis, with the symptoms of mental disorders and mental health as outcome variables. We will then separate groups of mental disorders according to the leading symptoms. Analysis of variance will be used to examine mental health as the dependent variable at a certain severity level in different mental disorder groups. Analysis of covariance will be used to identify the effect of different sociodemographic indicators.The prevalence of the diagnostic categories of the Complete Mental Health Model will be calculated and compared using chi-square tests. Finally, mental health profiles will be identified using latent profile analysis. Our study draws attention to the fact that "optimal human functioning" can be understood in ways that includes, and not excludes, people living with mental disorder.