Introduction and objectives: Orthorexia nervosa is a new type of disordered eating, characterized by an unhealthy fixation on healthy food. Those who suffer from it are showing compulsive behaviors and increasing dietary restrictions, that can lead to anxiety and physical health problems. Measuring tools for estimating the severity of its symptoms are available in Hungary only to a limited extent. The aim of this study was to adapt the Eating Habits Questionnaire’s revised version (EHQ-R) to Hungarian, and to perform a psychometric analysis, moreover, to explore the demographic features of orthorexic tendencies.
Methods: The cross-sectional online questionnaire included adults who perform physical exercize regularly (n = 175, 29% male; mean age 35.4 [SD = 7.59] years). Measurements: sociodemographic data, anthropometric data (bodyweight, height), EHQ-R, ORTO-11-Hu questionnaires.
Results: Confirmatory factor analysis supported the EHQ-R’s five-factor theoretical structure (c2 (395) = 856.2; p < 0.001; CFI = 0.914; TLI = 0.906; RMSEA = 0.082 [CI 90: 0.074-0.089]). Both the internal reliability of the scales (Cronbach-a = 0.75–0.87) and its consistency over time (r / r = 0.67–0.86) were adequate. The construct validity of the questionnaire is supported by the close correlation of the scales with the ORTO-11-Hu questionnaire (r / r = | 0.63–0.68 |). Regarding gender differences, women scored higher than men on the EHQ-R’s Rigidity subscale (t [173] = -1.807; p = 0.073). Age showed a significant, weak, negative relationship with the Negative Emotionality (r = -0.18; p = 0.017) and Time Impairment (r = -0.21; p = 0.005) subscales.
Conclusion: The EHQ-R has proven to be a reliable and valid measurement tool, thus, we recommend utilizing it as it can provide a quick and valid assessment about the severity of orthorexia symptoms, enabling appropriate interventions.

Schizophrenia research in the last decades led to rapid development of our knowledge regarding the cognitive deficits in the disease. Presence of neurocognitive and social cognitive deficits in schizophrenia is widely confirmed by empirical studies. Metacognition is one of the most recent and relatively less studied field of schizophrenia. Our literature review aims to introduce the concept and characteristics of metacognition. Then we overview the relationship between schizophrenia associated neurocognitive and social cognitive impairments and metacognitive deficits. Associations between the metacognitive deficits and the symptomatology will also be discussed. Finally, a method for the treatment of metacognitive deficits in schizophrenia will be suggested. The results of the overviewed studies support, that the umbrella term of metacognition encompassing the neurocognitive and social cognitive deficits, may provide a comprehensive model to better understand how cognitive deficits contribute to the development and maintanance of symptoms, and schizophrenia-associated serious social dysfunctions.

Among patients with substance use disorders (SUD), adult attention deficit hyperactivity disorder (ADHD) is one of the most frequently co-occuring disorder. Those SUD patients with comorbid ADHD show earlier onset of substance use, more severe SUD and poor treatment outcomes. Therefore, early recognition of ADHD is highly relevant within this patient population. The results of available screening instruments may lay the foundation of timely ADHD diagnosis. Considering the integrated treatment of patients with a dual ADHD+SUD diagnosis, the application of combined pharmaco- and psychotherapy is recommended. Based on the evidence-and consensus-based suggestions, prescription of long-acting methylphenidate, extended-release amphetamines and atomoxetine with up-titration might be the best choice in the treatment of patients who are either unresponsive to standard dose or characterized by therapy resistance. The main purpose of this manuscript is to establish a standing-ground for the effective screening, diagnosis and treatment of ADHD+SUD patients.

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

Introduction: Pharmacotherapy supported by therapeutic drug monitoring (TDM) has a tradition in psychiatry. Novel diagnostic infrastructure based on mass spectrometry has been developed at Semmelweis University, allowing the renewal of psychiatric treatments supported by TDM. In a cooperation of the Department of Laboratory Medicine, and the Department of Psychiatry and Psychotherapy 13 drugs were assayed in a routine setting. Several drugs were determined with their pharmacologically active metabolites.
Methods: In 2019, 678 TDM tests were performed on samples taken from 465 patients receiving treatment at the Department of Psychiatry and Psychotherapy. No patient-related data were used for the presented evaluation. Analytical method performance was evaluated by method validation, using internal controls and participating in an international external quality assessment scheme. The assay results were compared to reference ranges recommended in the leading international consensus guideline.
Results: Tests of clozapine, olanzapine and miscellaneous drugs comprised 35.8%, 34.9% and 29.3% of all orders, respectively. A high proportion of results was outside the limits of the therapeutic ranges. Similarly, several concentration ratios of metabolites and parent drugs were outside the reference ranges.
Conclusions: The reference ranges related to drug and metabolite concentrations are useful indicators but do not present therapeutic goals or a basis for clinical decisions by themselves. The interpretation of TDM results should be based on the condition of the patient, the clinical goals and the therapeutic context (e.g. the coadministration of other drugs), handled as an element of more complex decision making, and should serve the individualization of therapy.

The COVID-19 epidemic was declared a pandemic by the World Health Organization on 11 March 2020. The outbreak and spread of the disease has caused fear, insecurity and anxiety in people around the world. The pandemic has both direct and indirect effects on mental health problems, as fear of the virus can trigger or exacerbate mental illness and influence the onset of symptoms. Case studies suggest that this emergency can affect the content of delusions and hallucinations, as well as contribute to psychotic relapse. In addition to a brief review of the literature, we describe the case of three psychotic patients of the Jahn Ferenc South Pest Hospital, Centre for Psychiatry and Addiction Medicine, whose delusions and hallucinations were affected by the COVID-19 pandemic. In two cases, the symptoms of a reactive, transient psychotic episode presumably provoked by psychosocial stressors were determined, and in one case, the positive symptoms of a patient suffering in a psychotic disorder were determined by COVID-19.

Background: The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders has included nonsuicidal self-injury (NSSI) as a proposed independent diagnostic category, emphasizing the nonsuicidal nature of the phenomenon. Nevertheless, this terminology and concept have provoked a still ongoing scientific debate among researchers and clinicians.
Aims: By extending a systematic search with a broader focus on the prevalence and psychopathological correlates of NSSI, the aim of the present study is to explore the relationships between NSSI and suicidal behavior.
Methods: A systematic literature search was conducted in five databases (PubMed, OVID Medline, OVID PsycINFO, Scopus, Web of Science) with the search terms „NSSI” and „prevalence” and „mental disorder” or „psychiatric disorder”. The results were completed by manual searches. Inclusion criteria were for each publication to be an empirical study in English language that does not focus on a specific population.
Results: A total of 25 papers examined the relationship between NSSI and suicidality explicitly. Among these papers, fifteen focused on children/adolescents, five on young adults, four on adults, and one on participants from heterogeneous age groups. According to the results reviewed, altogether 50-70% of those who engaged in NSSI also reported suicidal thoughts or attempts. Those who did not report suicidal ideation differed from those who reported both NSSI and suicidal ideation in certain intra- and interpersonal traits (e.g., less depressive and borderline personality disorder symptoms, fewer negative life events, more social support) and in some specific characteristics (e.g., higher frequency and higher number methods) of NSSI.
Discussion: Based on the publications reviewed, significant suicidal risk is associated with NSSI in both adolescence and adulthood. This risk may be even higher in the presence of certain comorbid disorders and other psychosocial factors as well as in the presence of certain NSSI patterns such as repetitiveness or multiple NSSI methods.

Tourette syndrome is a neurodevelopmental disorder that is characterized by motor and vocal tics and by alterations in the cortico-basal ganglia-thalamo-cortical (CBGTC) circuitry. The CBGTC circuitry plays an important role in procedural learning, in the acquisition of skills and habits. Tics and habits are similar phenomenologically since tics can be described as overlearned habits. Based on these characteristics, prior studies proposed enhanced procedural learning, i.e., procedural hyperfunctioning in Tourette syndrome. A growing body of evidence supports this notion. The focus of the present review article is to discuss procedural hyperfunctioning in Tourette syndrome. We aim to shed light on a cognitive advantage in Tourette syndrome and to draw attention to the notion that pathologies and developmental disorder can be characterized not only with impairments and cognitive dysfunctions but with enhanced functions as well.

The new psychiatry classification systems, despite long lasting preparation and broad consensus, do not provide an answer to the fundamental dilemmas of modern psychiatry. This is because categorical approaches are independent of the underlying neurobiological and genetic factors and cannot integrate the results of modern research, which is a big barrier of the neuroscientific development.
Recent neuroscience research, with revolutionary new methods and tools and the analysis of huge databases, provides more and more information about the normal and abnormal functioning of the central nervous system. It is an enormous challenge to interpret these new findings, so there is a growing need to develop theoretical models that help to better understand the complexity of mental disorders and the mechanism of their development.
In my paper, I summarize recent research methods related to the symptomatic heterogenity and etiological background of mental disorders and present the results of some new transdiagnostic studies, in order to illustrate the key aspects of the Research Domain Criteria (RDoC) system developed to integrate the new results.
The RDoC framework helps to interpret the results of neuroscience research in a complex way and facilitates the detection of differences in genotypes and (endo)phenotypes, as well as a better understanding of the pathophysiological mechanisms and developmental differences responsible for the development of mental disorders. This can mean significant progress not only in renewing psychiatric nosology, but also in identifying new preventive and therapeutic targets.