Inflammatory bowel disease (Crohn's disease and colitis ulcerosa) is a chronic, long-term condition that causes chronic inflammation in the digestive tract, and shows an increasing incidence and prevalence worldwide. Changes in disease activity over time affect psychological distress which increases the risk of exacerbations. Beside somatic symptoms (such as abdominal pain, diarrhoea and weight loss), psychiatric comorbidity (in particular major depression, anxiety, social phobia) is common in patients with Crohn's disease. This case study illustrates the management and stabilization of a 21-year-old adult male patient with active Crohn's disease and with severe psychiatric comorbidity. The patient was diagnosed with avoidant personality disorder and dysruptive mood dysregulation disorder based on the results of psychodiagnostics (SCID-II structured clinical interview, MMPI personality inventory and disease-specific clinical questionnaires such as Beck Depression Inventory, Beck Hopelessness Scale, Social Cognition Questionnaire, Anger Expression Scale, Cognitive Emotion Regulation Questionnaire, Rosenberg Self-Esteem Scale). The main aim of psychotherapy is to increase the adherence to pharmacotherapy, to promote psychosocial functioning, to improve well-being and to enhance adaptive coping strategies. Low-intensity cognitive-behavioural psychotherapy was used which included psychoeducation, motivational interview, behavioural activation, patient diary, cognitive restructuring, problem-solving training, and family consulting. Twenty-five sessions were held weekly in outpatient form and 3 sessions of crisis intervention after the surgery at the hospital. The efficacy of the treatment was measured by self-reported questionnaires at baseline and at two follow-up sessions which corroborated a very significant decrease in the severity of depression, hopelessness, while emotional regulation and self-esteem became more adaptive. The remission of the above-mentioned psychiatric symptoms resulted in the improvement of the pharmacotherapy adherence and the quality of life. Low-intensity psychosocial interventions are proven to be an effective way of delivering evidence-based psychotherapy. Orv Hetil. 2018; 159(9): 363-369.

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Background: Current research on suicide prevention revealed that deficits in problem solving skills belong to the most important cognitive risk factors of suicide vulnerability. Poor problem solving skills are associated with depression, hopelessness, maladaptive coping and an increased risk of suicidality. Evidence suggests that good problem solving protects against depression or hopelessness and improvements in problem solving skills can contribute to the prevention of suicide attempts. Problem solving training (PST) as a low intensity brief cognitive-behavioural intervention can be effective in suicide prevention also.Aims: our main aim was to accomplish the cultural adaptation of the PST in group format to improve access to evidence based low intensity psychosocial interventions for patients with attempted suicide in order to prevent further attempts. The second aim was to assess changes in problem solving skills, depression, hopelessness and negative thinking style after the intervention.Methods: Subjects were outpatients with major depression (N=90) with attempted suicide in their psychiatric history. The procedure included a manual-based 12-week outpatient problem solving training in group format (G-PST). Measure administered before and after the intervention: Beck Depression Inventory, Beck Hopelessness Scale, Paykel Life Events Scale, Ways of Coping Questionnaire and Mean-Ends Problem Solving Test.Results: patients showed very significant improvements in problem-solving skills, including planful problem solving, problem analysis and seeking social support. The level of depression and hopelessness as well as the negative evaluation of stressful life events were found to decrease significantly after the G-PST.Conclusions: the findings indicate that G-PST is an effective low-intensity brief intervention which contributes significantly to the improvements of modifiable risk factors of suicide.

Theoretical background: The Dysfunctional Attitude Scale (DAS) is a measurement tool that is commonly used to detect dysfunctional beliefs contributing to the emergence and onset of depressive symptoms. Although it has been primarily used for testing clinical populations, and various forms of the scale have been created, only a small body of literature has proved its psychometric adequacy on a clinical sample. Goals: Therefore, the current study aims to construct an updated, reliable and brief version of the DAS. Methods: For this purpose, besides the normal samples of adolescents (n = 195) and adults (n = 270), a heterogeneous clinical sample (n = 1077) was involved in cross-sectional research. Results: The overall results of parallel analysis and exploratory factor analysis suggested a bifactor structure with a general factor and three extracted subfactors (Dependence, Perfectionism and Entitlement), comprising 14 items altogether (χ2 = 157.26, DF = 63, p < 0.001, CFI = 0.970, TLI = 0.957, RMSEA = 0.036, RMSEA CI90 = 0.029–0.044). Convergent validity was tested by correlations with Beck Depression Inventory (r = 0.36, p < 0.001). Conclusion: Our study was based on the largest clinical sample in the field of psychometric analysis of the DAS so far. The findings suggest that DAS14 as a brief version of the original DAS has good psychometric properties, and it can be widely used as a measurement tool in the assessment of mood disorders.Elméleti háttér: A Diszfunkcionális Attitűd Skála (DAS) egy olyan pszichológiai kérdőíves eljárás, amely azon diszfunkcionális hiedelmek mérésére alkalmas, amelyek hozzájárulnak a depresszív tünetek kialakulásához és fennmaradásához. Annak ellenére, hogy már számos változata létezik és elsődleges használati területét a klinikai populáció jelenti, pszichometriai mutatóit klinikai mintán a kutatások szűk köre vizsgálta. Cél: Jelen tanulmány célja a DAS aktualizálása, rövidítése, megbízhatóságának és validitásának vizsgálata. Módszer: Keresztmetszeti kérdőíves vizsgálatunk keretében egészséges serdülő (n = 195) és felnőtt (n = 270) minta mellett heterogén klinikai mintát (n = 1077) alkalmaztunk. Eredmények: A parallelelemzés és a feltáró faktoranalízis eredményei a bifaktoros struktúrát igazolják. A 14 itemre egy általános és három alfaktor (Dependencia, Perfekcionizmus és Elvárások) illeszthető (χ2 = 157,26, DF = 63, p < 0.001; CFI = 0,970; TLI = 0,957; RMSEA = 0,036, RMSEA 90% CI = 0.029 – 0.044). A skála konvergens validitását a Beck Depresszió Kérdőívvel való korrelációja alátámasztja (r = 0,36;p < 0,001). Konklúzió: A DAS pszichometriai vizsgálatai közül ez idáig alkalmazott legnagyobb klinikai elemszámú vizsgálatát mutatja be a ta nulmány. Az eredmények alapján a DAS rövidített változata, a DAS-14 megfelelő pszicho metriai tulajdonságokkal rendelkezik alkalmazható a hangulatzavarok diagnosz tikájában.