Mental health competencies are stronger determinants of well-being than mental disorder symptoms in both psychiatric and non-clinical samples.

The present study aimed to investigate whether the strength of mental health competencies and the severity of mental disorder symptoms, and their interaction, differ in the strength of their associations with several dimensions of well-being in Hungarian adult psychiatric and non-clinical samples. All respondent in the psychiatric sample (129 patients (44 male, 85 female)) and in the non-clinical community sample (253 adults (43 male, 210 female)) completed the Mental Health Test, six measures of well-being and mental health, and the Symptom Checklist-90-Revised. Including both mental health competencies and mental disorder symptoms in a regression model in both samples can predict patients' well-being even more accurately. Mental health competencies were positively related; mental disorder symptoms were negatively related to subjective well-being. In all models and in both samples, mental health competencies were found to be stronger determinants of well-being than mental disorder symptoms. The interaction of mental health competencies and mental disorder symptoms is no more predictive of well-being in either psychiatric or non-clinical samples than when the effects of each are considered separately. The assessment of mental health competencies has an important predictive value for well-being in the presence of psychopathological symptoms and/or mental disorders.

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.

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).

[Comment to the article of Gábor Kapócs and Dániel Bacsák].

No abstract available.

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.

The Journey from Mental Disorder Towards Recovery.

No abstract available.

[On Postpsychiatry].

The fruitless fights and battles among biological psychiatry, social psychiatry and antipsychiatry represented obstacles on the road towards development in psychiatry. Psychiatry came into existence as part of medicine, although its best practices often looked over the fence of natural sciences and embraced various approaches and viewpoints from both human sciences and existentialist philosophy. In our review paper, we analyse the philosophy of sciences background of psychiatry and the latest trends such as critical psychiatry and postpsychiatry. Then, under a critical psychiatry angle, we touch on some callenges psychiatry is compelled to face today, namely:(1) limits of the validity of diagnostics and of the research of evidence-based practices; (2) the various drawbacks of the state of being a psychiatric patient; (3) the intertwining of psychiatry and marketing interests; (4) the professional challenges linked to the therapeutic effectiveness of certain illegal drugs. Finally, we will display the benefits of the postmodern approach and postpsychiatry which stem from the various viewpoints and approaches and provide positive and practical answers to challenges in psychiatry. All this together offers us, professionals, new vistas for development and changes. Similarly, postpsychiatry offers a solid theoretical basis to a number of existing good practices.

Thinking of psychiatric disorders as "normal" illness. Data from a questionnaire on social stigma: a multicenter study.

Prejudice and stigma about mental illness is still present in society. Patients suffer both from the disease, and from the marginalization behavior exhibited by others towards them and their families. Psychiatric professionals may also become ill and suffer for the same reason. The authors of this international multicenter study have set themselves the question of whether there may be prejudice and/or stigma among psychiatric professionals towards their suffering colleagues, among patients towards nursing staff affected by the same disease and between patients themselves. Using two standardized questionnaires which have been tested, but have not been used before they have studied 207 mental health professionals and 407 patients, of Italian, Belgian, Hungarian and Croatian nationalities. The results show that there are in fact prejudices among Mental Health Professionals about colleagues suffering from mental illness because they responded that such persons cannot treat well patients with their own pathology. However Mental Health Professionals do not demonstrate behaviors which are not frankly marginalizing or stigmatizing towards colleagues suffering from mental illness. On the other hand, among patients the prevailing view was that psychiatric professionals who suffer from mental illness, can better understand the sick, because they are also suffering. This is in analogy with the Jungian theory of the "wounded healer" in the myth of the centaur Chiron. Patients did not demonstate rejection or marginalization behavior towards other sick patients. Finally both the professionals and the patients tend to be cautious in relating to healthy persons and tend not to disclose their suffering for fear of being misjudged or marginalized.

Social capital and reported discrimination among people with depression in 15 European countries.

PURPOSE: Social capital is a protective factor for mental health. People with depression are vulnerable to discrimination and its damaging impact. No previous studies have explored the link between social capital and experienced or anticipated discrimination in people with depression. This study aims to test the hypothesis that levels of self-reported discrimination in people with depression are inversely associated with social capital levels. METHOD: A total of 434 people with major depression recruited in outpatient settings across 15 European countries participated in the study. Multivariable regression was used to analyse relationships between discrimination and interpersonal and institutional trust, social support and social network. RESULTS: Significant inverse association was found between discrimination and social capital in people with major depression. Specifically, people with higher levels of social capital were less likely to have elevated or substantially elevated levels of experienced discrimination. CONCLUSIONS: Higher level of social capital may be closely associated with lower level of experienced discrimination among patients with major depression. It is important to explore these associations more deeply and to establish possible directions of causality in order to identify interventions that may promote social capital and reduce discrimination. This may permit greater integration in society and more access to important life opportunities for people with depression.

[Health related quality of life and disease burden of patients with schizophrenia in Hungary]. / A szkizofreniaval elo betegek egeszseggel osszefuggo eletminosege es betegseg-terhe Magyarorszagon.

INTRODUCTION: According to the international literature disease burden of schizophrenia is substantial, however data from Eastern Central Europe is scarce. Our aim was to assess the quality of life and costs of patients with schizophrenia in Hungary. METHODS: A cross sectional questionnaire survey was performed in 3 hospital based psychiatry centres involving patients with schizophrenia. Demographics, disease severity (Clinical Global Impression, CGI), functional ability (Global Assessment of Functioning, GAF) and general health status (EQ-5D) was assessed. Health care utilisation and aids were surveyed for the past 12 months. Costing was performed from the societal perspective and human capital approach was applied. RESULTS: Altogether 78 patients (female 43.6%) were involved with a mean age of 44.2 (SD=13.1) years, disease duration was >10 years at 49 (62.8%) cases, 66 (84.6%) patients were disability pensioners. Distribution between CGI 3-4-5-6 levels were 12 (16%), 33 (43%), 21 (28%), 10 (13%) patients, respectively, mean GAF was 52.6 (SD=13.9). The average EQ-5D score was 0.64 (SD=0.3) and it was significantly worse than the age-matched general population's score in Hungary (p < 0.01). Mean yearly cost was 13 878 Euros/patient (conversion 1 Euro=280.6 HUF), the rate of direct medical,direct non-medical and indirect costs was 28.5%, 5.4% and 66.1%, respectively. Among direct costs hospitalisation and drug costs were dominant. Total cost correlates with disease severity (CGI). CONCLUSION: Schizophrenia leads to notable deterioration in health related quality of life and induce high costs to society, mainly due to the productivity loss of the patients. Nevertheless disease related costs in Hungary are lower than in economically more developed European countries. Our study offers basic data about disease burden of schizophrenia in Hungary to support clinical and health policy decision making.

[Costs of treatment in patients with schizophrenia switched to amisulpride--one-year follow-up]. / Az amisulpridre történô átállítás hatása a szkizofréniával kapcsolatos költségekre egyéves követés során.

OBJECTIVES: In our present research we have studied the costs associated with switching schizophrenia patients to amisulpride as well as the efficacy of amisulpride treatment. We wanted to explore whether the relatively higher costs of amisulpride can be recovered under the current Hungarian economic and financing conditions. METHODS: From 2002, we analysed clinical improvement with a 6 months follow-up measured by CGI and also compared the costs that were incurred before and after switching in 76 patients suffering from schizophrenia who received amisulpride instead of their previous treatment with typical or atypical antipsychotics. In a second, retrospective phase of the study which lasted for 6 months, we studied the willingness of investigators and patients to continue amisulpride treatment. During this period of treatment both the investigators and the patients were unaware of the fact that the circumstances of treatment would be investigated later; thus, we could determine the number of investigators and patients who decided on the continuation of amisulpride in this phase, and how costs changed later on. In our analysis we followed the cost evaluation methodology introduced earlier by Agnes Rupp. RESULTS: 68 patients were available for the second phase of the study, 65 continued the treatment with amisulpride. Amisulpride has demonstrated cost neutrality in both phases of the study. Higher costs of this medicine have been compensated by an increase in productivity and the resulting cost reduction. Amisulpride treatment was associated with a significant improvement of CGI-measures. CONCLUSIONS: In an open, non-controlled study, modelling a field study in its second phase, amisulpride has been shown to be an effective antipsychotic which is readily accepted by patients and clinicians and which can be prescribed without increasing costs.

[Costs related to change to amisulpride in patients suffering from schizophrenia]. / Az amisulpridre történõ átállítás hatása a szkizofréniával kapcsolatos költségekre.

OBJECTIVES: The present research studied the cost effects of converting patients suffering from schizophrenia to the use of amisulpride, in order to learn whether the relatively higher medicine costs were compensated for under the Hungarian economic and financing conditions. METHODS: We analysed and compared costs having occurred before and after conversion in the case of 76 patients suffering from schizophrenia who got amisulpride instead of other typical or atypical antipsychotics in hospital. The analysis adhered to the methodology introduced by Agnes Rupp. RESULTS: In conformity with earlier investigations in Hungary performed with atypical antipsychotics, amisulpride has also proved its cost neutrality under local economic and financing conditions. Namely, higher disbursements for medicaments are compensated for by productivity increase, indicative of amisulpride's effectiveness, implying decreased economic (and other) burdens to family members. Te remarkable cost ratio improvement in case of patients defined as therapy resistant has played an important role in cost neutrality. CONCLUSIONS: Amisulpride is an effective antipsychotic which can be prescribed without increasing costs, and in case of therapy resistant patients, it appears to have significant cost sparing effects.

Implementation of evidence-based treatment for schizophrenic disorders: two-year outcome of an international field trial of optimal treatment.

According to clinical trials literature, every person with a schizophrenic disorder should be provided with the combination of optimal dose antipsychotics, strategies to educate himself and his carers to cope more efficiently with environmental stresses, cognitive-behavioural strategies to enhance work and social goals and reducing residual symptoms, and assertive home-based management to help prevent and resolve major social needs and crises, including recurrent episodes of symptoms. Despite strong scientific support for the routine implementation of these 'evidence-based' strategies, few services provide more than the pharmacotherapy component, and even this is seldom applied in the manner associated with the best results in the clinical trials. An international collaborative group, the Optimal Treatment Project (OTP), has been developed to promote the routine use of evidence-based strategies for schizophrenic disorders. A field trial was started to evaluate the benefits and costs of applying evidence-based strategies over a 5-year period. Centres have been set up in 18 countries. This paper summarises the outcome after 24 months of 'optimal' treatment in 603 cases who had reached this stage in their treatment by the end of 2002. On all measures the evidence-based OTP approach achieved more than double the benefits associated with current best practices. One half of recent cases had achieved full recovery from clinical and social morbidity. These advantages were even more striking in centres where a random-control design was used.