Patients with chronic bipolar disorder show impairments in interpreting literary fiction - A preliminary explorative study with the short story task.

INTRODUCTION: Theory of mind (ToM) is a crucial skill in navigating and functioning in the social world. Significant ToM impairment was consistently found in bipolar disorder; it can be both a state and trait marker of the disorder. However, most of the ToM tests are not sensitive enough to detect subtle individual differences, which would be necessary for an individualized treatment plan. The Short Story Task (SST) is a new way to sensitively assess individual differences in ToM performance. The aim of the study was to test the feasibility of SST in patients with bipolar disorder. METHOD: 31 persons (11 male, 20 female) with bipolar I disorder and 31 healthy individuals (15 males and 16 females) as a control group were recruited. SST was used to evaluate ToM performance. The SST uses a Hemingway novel, in which the patient is presented with a realistic social situation, where the motivations of the characters and the underlying relationships of events are not explicitly described. RESULTS: In the explicit mental state reasoning questions the CG (M = 8.06) had significantly higher (p < 0.001) scores than the persons with bipolar I disorder (M = 5.03). There was no ceiling effect for explicit ToM scores in either group. Participants in CG (M = 8.03) also significantly outperformed (p = 0.006) the BG participants (M = 6.55) in the comprehension questions. The spontaneous mental state inference question was performed equally (M = 0.23) in both groups. Group assignment (t = -3.503, p < 0.001), comprehension score (t = 2.864, p = 0.006), and spontaneous mentalization (t = 2.846, p = 0.006) significantly predicted the explicit ToM performance. CONCLUSIONS: Overall, we found that the Short Story Task is a promising tool for measuring ToM in patients with bipolar disorder without ceiling effect. Primarily explicit ToM was found to be deficient, which corresponds well with the ToM literature in bipolar disorder. Contrary to our hypothesis we could not detect impairment in spontaneous ToM and found that patients living with bipolar disorder also showed deficits in comprehension. The lack of assessment of neurocognitive skills is a significant limitation of the current study.

The effect of reading literary fiction on the theory of mind skills among persons with schizophrenia and normal controls.

Introduction: Recent research data suggest that theory of mind (ToM) skills may improve after reading literary fiction. However, beside this short term favorable effect, regular long-term reading of literary fiction may also support ToM development or may improve ToM performance. The presence of impaired ToM abilities is well-documented in schizophrenia; however, the role of reading in these deficits is unknown. In the present study our aim was to assess the effect of prior reading experiences on theory of mind performance in patients with schizophrenia, and in healthy controls. Materials and methods: ToM assessment was done with the Short Story Task, which is based on the interpretation of a Hemingway short story. After reading the short story, questions were asked in an interview format regarding comprehension, explicit and implicit ToM skills, then comparative analysis of schizophrenia patients was performed (n = 47) and matched to a normal control (n = 48) group concerning deficits of ToM abilities. Participants were also stratified according to their prior reading experiences. Results: Previous reading experience was associated with better comprehension and explicit ToM performance both in patients with schizophrenia, and in healthy controls. However, the explicit ToM performance of patients with prior reading was still weaker compared to healthy controls with reading experiences. Path model analysis revealed that reading had a direct positive effect on ToM, and an indirect effect through improving comprehension. Conclusions: Prior reading experience is associated with better ToM performance not just in healthy controls but also in patients living with schizophrenia. Previous reading experience also improves comprehension, which in turn has a favorable impact on ToM. Our results support the idea that literary fiction reading may have a therapeutic potential in the rehabilitation of schizophrenia.

[The potential role of improvisation training to optimize communication in emergency care]. / Az improvizációs tréningek lehetséges szerepe a kommunikáció optimalizálására a sürgosségi ellátásban.

INTRODUCTION: One of the most common challenges in acute care is the time- and space-limited communication with patients, relatives and colleagues. There is ample evidence, however, that the quality of care, patient and staff satisfaction can be improved, measured and researched using simple communication tools (e.g., training). OBJECTIVE: This improvement was what we focused on when carrying out voluntary participation surveys with the staff of the Department of Emergency Medicine of the Clinical Centre of the University of Pécs. METHOD: With the help of a trained psychologist-actor and a senior specialist in medical communication, we investigated the potential impact of applied improvisation on medical communication by testing the participants in various situations simulating communication challenges after having completed an improv-based communication training full of exercises, games and tasks. After warm-up games taken from improv, the participants completed pre-defined tasks and finished every session with discussion and self-reflective feedback. Questionnaire (Interpersonal Confidence Questionnaire - ICQ) was used to check the potentially positive impact of improvisation on emergency communication. RESULTS: Our studies confirmed that the applied elements of medical improvisation, developing communication skills through play not only make participants more assertive and empathic, but also - after preparation - lead to a smoother and more effective exchange of information. Positive feedback from participants in the training sessions also confirms this. DISCUSSION: Our aim is to develop an improvisation-based communication training focused specifically on acute care providers, which, based on our initial experience, could optimize communication with patients, relatives and also between professionals. CONCLUSION: Application of improvisational techniques in this segment of acute care studied by us might open new perspectives to improve communication. Orv Hetil. 2023; 164(19): 739-746.

What do patients think about the Hungarian health care system and medical students' learning outcomes? A cross-sectional study on the patients' perspective in Hungary.

BACKGROUND: The doctor-patient relationship has changed a lot in the 21st century and the varying expectations of the patients play an important role in future professional medical care. The knowledge of patients' needs is crucial in determining the learning outcomes in medical education. The objective of this study was to examine the expectations of the patients regarding professional and soft skills (e.g. communicational skills, empathy) of doctors and to get a deeper view. METHODS: Face-to face data collection through self-reported questionnaire in accredited health care institutions (GPs, hospitals, outpatient care) in Hungary was carried out in 2019. Descriptive statistics, independent sample t-tests, k-means cluster and gap matrices were performed to analyze the data. RESULTS: In total 1115 patients (male-female: 50-50%, age groups: between 18 and 30: 20%, between 31 and 60: 40% above 60: 40%) participated in the survey. They rated sixteen learning outcomes along with two dimensions: importance and satisfaction. Except for one learning outcome, patients rated the outcomes more important than they were satisfied with them (negative gap). Positive gap was registered only in the case of respecting individual specialty during patient care. CONCLUSIONS: The results suggest the importance of learning outcomes in relation to the rate of satisfaction from the patients' perspectives. In addition, the results support that patients' need are not met in medical care. Patients' ratings also make an emphasis on the fact that besides professional knowledge other learning outcomes are also important in health care which should have been emphasized as a basis in medical education.

[Text and behavior - analysis of farewell notes - pilot study].

Studying suicide notes, - last personal documents before a suicide act - as well as investigation of media and internet texts on self-destruction (including contents, "messages") can have a great significance. Individual and cultural valuations appear in the way farewell notes, media letters and other personal documents present self-destruction. These "messages", ideas about life, death and suicide are deeply embedded within the public context of culture too. In the present content analysis formal, syntactic and grammatical characteristic features, as well as speech patterns and verbal expressions of selected notes, samples have been investigated. Suicidal - fatal (n=49) and nonfatal group (n=31) of farewell letters were compared with the sample of a control group (n=33). Results have been discussed, interpreted and concluded. These appear to be useful and important not only in understanding of suicidal phenomenon and its psychodynamic background in clinical work or in suicide hotlines, but also in prevention, social-, and clinical intervention of self-destruction. The investigation of these new data may provide a much broader perspective in understanding suicidal process.

Accepting cultural differences in the integration of foreign medical students / Kulturális különbözoségek elfogadása a külföldi orvostanhallgatók beilleszkedésében.

Összefoglaló. Bevezetés: A 21. századra a multikulturális társadalmi közegben az interkulturális tudás, mint készség, fokozott mértékben válik kulcskompetenciává. E társadalmi kompetencia elsajátításának egyik lehetséges területe a nemzetközi hallgatói mobilitás, mely világszerte, így hazánkban is, egyre nagyobb jelentoségu. Célkituzés: Magyar és külföldi hallgatók körében folytatott vizsgálatunk fókuszában a beilleszkedési folyamatoknak, valamint az interkulturális kompetencia és érzékenység kialakulásának és fejlodésének vizsgálata állt, a Pécsre érkezo mintegy 60 különbözo kultúra, valamint a magyar befogadó közeg vonatkozásában egyaránt. Kutatásunk során többek között arra kerestünk választ, hogy az eredeti és a befogadó kultúra közötti különbségek mely területeken nyilvánulnak meg a leginkább, illetve egy másik kultúrához történo alkalmazkodás során milyen beilleszkedést lassító vagy támogató tényezok tárhatók fel. Módszer: Kutatásunkban kvantitatív és kvalitatív módszereket alkalmaztunk, önkitöltéses kérdoíves felmérés, valamint fókuszcsoportos interjúk formájában. A PTE ÁOK német, angol és magyar nyelvu általánosorvos-képzésében részt vevo hallgatókat a 2010 és 2018 közötti idoszak tavaszi szemesztereiben saját fejlesztésu, anonim, önkéntesen kitöltheto kérdoívvel kerestük meg (a kitöltött kérdoívek száma: n = 13 084 kérdoív). A kérdoíveket három tanévben hét, félig strukturált fókuszcsoportos interjúval egészítettük ki (n = 92 fo). Eredmények: A hazánkba érkezo külföldi orvostanhallgatók számára a befogadó közeghez való alkalmazkodást tekintve a kapcsolódás elsosorban a szocializációs, nyelvi, kommunikációs különbségek miatt bizonyult kihívásnak. Megállapítható azonban, hogy a képzési ido elorehaladtával a különbözoségekbol fakadó nehézségek csökkentek, így a hallgatók egyre inkább képessé váltak az etnorelatív irányba történo elmozdulásra, valamint a multikulturális közeg pozitív aspektusainak értékelésére. Következtetések: A multikulturális környezetben folytatott tanulmányok alatt a kultúraközi kapcsolódási pontok és együttmuködések kialakulása és fejlodése lehetové teszi és támogatja az interkulturális kompetencia elsajátítását, annak minden résztvevoje számára, akár az egyetemi képzésen túlmutatóan, a késobbi orvosi pályát tekintve is. Orv Hetil. 2021; 162(25): 978-987. INTRODUCTION: In the increasingly multicultural social environment of the 21st century, intercultural knowledge as a social skill is gradually becoming a key competence. One of the possible areas of acquiring this competence is international student mobility, which is of increasing importance worldwide, including Hungary. OBJECTIVE: The focus of our study was to examine integration processes and the development and improvement of intercultural competence and sensitivity among Hungarian and international students, both in relation to the approximately 60 different cultures arriving in Pécs and in relation to the Hungarian host environment. In the course of our research, we sought - among other factors - areas, in which the differences between the original and the host culture are the most prominent, and we aimed at identifying those factors that are slowing down or supporting the integration during the adaptation period to another culture. METHOD: In our research, we used both quantitative and qualitative methods, in the form of a self-administered questionnaire and focus group interviews. General medical students of the University of Pécs studying in the German-, English- and Hungarian-language programmes participated in the survey during the spring semesters of the academic years between 2010 and 2018. We used our self-developed questionnaires (number of completed questionnaires: n = 13 084), which were filled in on a voluntary basis and anonymity was ensured. The questionnaires were supplemented with seven semi-structured focus group interviews over three academic years (n = 92 students). RESULTS: Regarding the adaptation to the host environment of foreign medical students studying in Hungary, relationship building arising from socialization, language and communication differences, proved to be a challenge. However, it can be stated that as the training time progressed, the difficulties arising from the differences decreased, so that the students gradually became more able to move towards an ethno-relative direction and evaluated the positive aspects of the multicultural environment. CONCLUSION: During studies in a multicultural university environment, the emergence and development of intercultural connections and collaborations enable and support the acquisition of intercultural competence for all of the students, which will be of great benefit for them, even beyond the university, in their future medical career. Orv Hetil. 2021; 162(25): 978-987.

Do we need special pedagogy in medical schools? - Attitudes of teachers and students in Hungary: a cross-sectional study.

BACKGROUND: The quality of medical education is a key factor. The fact that mostly physicians teach tomorrow's physicians without acquiring pedagogical skills before becoming a teacher is a cause of concern. In Hungary, where traditional teaching methods are common, and teachers have not had pedagogical courses in medical education there has not been any research dealing with the issue. On the one hand, we aimed with this cross-sectional study to examine the attitudes of teachers towards learning outcomes of medical students to get a view about the opinions about their importance and rate of delivery. On the other hand, we analyzed the pedagogical skills of teachers from the students' and teachers' perspective in Hungary. METHODS: Data collection through self-reported questionnaires in online form in all the four Hungarian higher education institutions offering medical education was carried out among teachers and students with active student legal status in 2017. We validated the questionnaires of the two respondents' groups. We used gap matrices to represent the correspondences of the delivery and perceived importance of the learning outcomes. We calculated averages of the pedagogical skills and compared them with t-tests. RESULTS: The response rates are 11.18% in case of the students (1505) and 24.53% in case of the teachers (439). The results indicate the lack of concordance between the rates of the learning outcomes in terms of their importance and delivery - no positive gap can be observed -, and the need for pedagogical skills among teachers and students. The opinions of students compared to teachers' are all statistically higher according to the averages. CONCLUSIONS: The study results underline the necessity of a transition and paradigm shift in medical education from delivering solely professional knowledge towards pedagogically prepared practice and patient oriented teaching methods as well as acquiring pedagogical knowledge as part of the training of medical teachers in Hungary.

Persons With Schizophrenia Misread Hemingway: A New Approach to Study Theory of Mind in Schizophrenia.

INTRODUCTION: Theory of Mind (ToM) is a key component of social cognition. Recently the Short Story Task (SST) was developed as a new measurement of ToM. SST uses a short story of Ernest Hemingway to assess ToM skills. SST proved to be a suitable tool, and sensitive to individual differences among healthy subjects. Our aim was to test SST to evaluate the ToM skills of persons with schizophrenia. MATERIALS AND METHODS: SST was used to assess ToM skills. After reading the short story "The End of Something" a structured interview was done with 14 questions. Spontaneous mental state reasoning, explicit mental state inference and comprehension of nonmental aspects of the story were evaluated. 47 persons with schizophrenia in remission and 48 healthy controls were assessed and compared. RESULTS: Persons with schizophrenia performed significantly more poorly in the explicit mental state inference questions. Ceiling effect was not detectable in explicit ToM scores. Patients made less spontaneous mental state references as well, although the occurrence of spontaneous mental state terms was infrequent in both groups. Patients were also less accurate in answering comprehension questions, but the difference was not significant after Bonferroni correction. DISCUSSION: Our results lined up with the original findings and we found SST to be a sensitive tool to explore the individual differences in ToM performance, not only among healthy subjects, but also among persons with schizophrenia especially in explicit mental state inferences without observing the ceiling effect. We found, however, SST to be less sensitive to measure spontaneous mental state reasoning and also the lack of the use of another ToM test to assess convergent validity of SST for indicating ToM deficits in schizophrenia stands as a limitation of current study.

Bicycle injuries in children: an analysis based on demographic density.

INTRODUCTION: The purpose of this study was to investigate the characteristics and the outcome of bicycle injuries in paediatric patients according to the living environment, and to create guidelines for injury prevention. PATIENTS: The evaluation was performed in part based on hospital database of 1803 in- and out-patient children treated at the Paediatric Surgical Department of Pécs/Hungary between 2000 and 2006, and at the Department of Paediatric Surgery at the Heim Pal Hospital Budapest between 2004 and 2006. Additionally questionnaires were mailed to the patients' families to gain follow-up information. We analysed three groups according to demographic density (village, midsize town and large town). RESULTS: We found, that poor road quality played an important role as a contributing factor of injuries in villages. The number of bicycle spoke-injuries was higher in villages (13%), than in midsize towns (4.6%) and the large town (9.9%). In villages, 5% of children injured wore a helmet; this rate was 9% in midsize towns and 9.1% in the large town. Head injury was more common in villages, while in midsize towns and the large town arm injuries proved to be predominant. DISCUSSION: Prevention strategies targeting bicycle injuries in children should take into account the population density. This analysis revealed a substantial difference in the use of safety devices, and in the characteristics of injuries occurring in villages, indicating that there is a need for special attention regarding this higher risk population.