The Rorschach Ego Impairment Index: prediction of treatment outcome in a child psychiatric population

In this study, we investigated the treatment utility of the revision of Perry and Viglione's (1991) Rorschach Ego Impairment Index (EII-2) in a sample of 53 child psychiatric inpatients. Parent ratings of symptomatic functioning on the Devereux Scales of Mental Disorders (DSMD; Naglieri, LeBuffe, & Pfeiffer, 1994) were obtained at admission, 30 days postdischarge, and 120 days postdischarge. EII-2 scores correlated with initial symptom elevations on the Critical Pathology at admission. EII-2 scores did not predict short-term response to treatment. However, EII-2 scores demonstrated moderate correlations with long-term outcome and relapse. EII-2 was related to prediction of worsening of symptoms between 30-day and 120-day follow-up as measured by Reliable Change Index scores that were computed for the Externalizing, Internalizing, Critical Pathology, and Total DSMD scales.     

Toward a synthetic approach to the Rorschach: the case of a psychotic child.

Much Rorschach research on case material focuses on the utility of a single scoring system, set of variables, or scale in isolation from other systems, scales, or perspectives. This approach fails to acknowledge the complexity of the Rorschach and to reflect the manner in which sophisticated clinicians select and synthesize various perspectives during the clinical inference and decision-making process. A case of a psychotic child is presented to illustrate the utility of a synthetic approach to the Rorschach. The strengths and weaknesses of various Rorschach perspectives in addressing specific diagnostic issues is explored through the case material.     

The diagnostic efficiency of the Rorschach Depression Index and the Schizophrenia Index: a review

This review focuses on the diagnostic efficiency of the new versions of the Rorschach Comprehensive System Depression Index (DEPI) and the Schizophrenia Index (SCZI). Clinical diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders was chosen as the external validation criteria. The sensitivity, specificity, and overall classification rates for the indices were presented from the studies or computed from the data when possible. The positive and negative predictive validity was estimated at three different base rates. As regards the DEPI the results showed a large variation in diagnostic performance as the index seemed to have relatively more success in identifying nonpsychotic and unipolar depression than psychotic and bipolar depression. The DEPI did not successfully identify depression among adolescent patients. As regards the SCZI the results more consistently indicated that the index effectively discriminates between psychotic and nonpsychotic patients and the predictive validity of both a positive and negative SCZI was found to be high.     

The Rorschach Comprehensive System Egocentricity Index in psychiatric inpatients

This paper reports an exploratory study of potential correlates of Exner's Rorschach Egocentricity Index, a measure of self-focusing, in a sample of 70 psychiatric inpatients. We examined the relationship of the Index of the MMPI Ego Strength scale and to other MMPI and Exner Comprehensive System Rorschach variables, using Pearson Product-Moment correlations with partialling of the number of Rorschach responses. There were seven meaningful significant correlations between the Index and Rorschach variables: M, FM, X +%, F +%, Lambda, D, and A%. The Index-MMPI correlations were not significant. Sex differences and differences between these intercorrelations and some reported by Exner (1983) are discussed.     

Rorschach predictors of therapeutic outcome in a child psychiatric inpatient service

This study tested the hypothesis that Rorschach indicators of psychological instability and perceptual sensitivity are predictive of therapeutic outcome in a child psychiatric inpatient service. Thirty-four children, matched for age, were divided into two groups, Improvers and Decliners, based on changes in behavioral problems over 60 days of hospitalization. The groups were not distinguishable by scores on intellectual tests, sex, or the initial quality or severity of psychological disturbance. Analyses of Rorschach protocols indicated that children who obtained higher ep, ep-EA, Blends, Zf, and Z sum and lower Lambda had improved in treatment. The results suggest that children who are less stabilized and manifest perceptual sensitivity do achieve the greatest gains.     

The relationship between personality traits and psychotic like experiences in a large non-clinical adolescent sample

ObjectiveThe relationship between personality and psychosis is well established. It has been suggested that this relationship may be partly accounted for by higher levels of depression in individuals with certain personality traits. We explored whether the link between personality and psychotic symptoms is already apparent in adolescence, and if this association would still hold when depression was controlled for.Method654 secondary school students were surveyed via self-report questionnaires measuring the Five-Factor model of personality (NEO-FFI), depression (CES-D) and psychotic-like experiences (CAPE).ResultsPositive associations were found between Neuroticism and all CAPE-subscales except Magical Thinking, which was in turn associated with all other personality traits when at high levels. Agreeableness was negatively associated with all CAPE-subscales, while Openness to Experience was only positively associated with Persecutory Ideas and Magical Thinking. After controlling for depression, many of the significant associations remained.ConclusionOur findings suggest that the chance of having psychotic like experiences is more likely for adolescents with certain personality traits. These associations are not fully explained by depression, especially when psychotic experiences are at higher levels. Future research is needed to investigate if these personality traits might put a person at risk for the development of full-blown psychosis.     

Being with a psychotic child a psycho-analytical approach to the problems of parents of psychotic children.

The reactive and adaptive responses of parents to their overtly psychotic children are described and an attempt is made to reconstruct the specific mother/infant interactions contributing to the development of different types of childhood psychosis. The concepts of 'maternal structure' and of 'delusional primary maternal preoccupation' are found to be relevant in this context. These considerations throw light on some aspects of countertransference encountered by workers in this field and of creative search in general. Whilst exploring parental psychology and psychopathology this paper attempts to outline the psychodynamic environment of the psychotic child at the various stages of his life and dis-ease. It emphasizes the value of the psychoanalytical approach as a guide in such an exploration and as a source of hope for better understanding and more effective interventions, both therapeutic and prophylactic.     

The concurrent validity of child Rorschach interpretations

Rorschach records were obtained by 10 examiners from 59 preschool children. These records were reliably scored and interpreted. Interpretation consisted of preparing a list of Rorschach concepts for each child. An additional number of Rorschach concepts of equal frequency in this sample were added to each child's list of concepts. Half of the concepts on each child's list were checked for agreement by school personnel. The children were described with consistency across judges and over time by the same judges. The school personnel were able to differentiate concepts that described each child from nonrelevant concepts. The Rorschach concepts provided data that was validated by teacher perception of these children. This methodology for Rorschach validation makes use of interpretive concepts derived directly from data rather than from reports.     

Three factors of the comprehensive system for the Rorschach and their relationship to Wechsler IQ scores in an adolescent sample

Principal axis factor analyses of the Rorschach Comprehensive System (CS) in a clinical sample of 152 adolescents yielded three clearly defined factors: Synthesized Complexity (defined by Zf, DQ+, and F%), Productivity (defined by R, D, and Dd), and Form Quality (defined by X+%, F+%, and X-%). Variables on the Synthesized Complexity and Form Quality factors were generally correlated with Wechsler Full Scale IQ, Verbal IQ, and Performance IQ scores. Overall, the factors in this adolescent sample replicated factors identified in earlier studies with adults. Implications for clinical practice are discussed.     

A Rorschach stability study in a nonpatient adult sample

The objective of this study was to provide new primary data on Rorschach Comprehensive System stability levels. To achieve this, we tested 75 French nonpatient adults twice on the Rorschach with a 3-month interval between the tests. Interrater reliability was in the excellent range for most of the variables studied. The overall stability level in a selected set of previously studied variables was below expectations (median r = .53). Personality, cognitive or self/relational variables yielded higher test-retest correlations than emotional and coping variables. Moderators of stability could be identified: (a) overall level of Task Engagement (TE) in F, m, FM + m, a, FC, Sum C', Sum V, Sum Shd, Fr + rF, INC + FAB, COP, es, Adj es, EGO, and Blends; (b) variations in TE in F, FM, and p; (c) state distress in Zd, m, FM + m, a, C, CF + C, WSumC, FD, and es; (d) variables derived from the number of responses impacted stability in P, Zf, m, FC, CF + C, Sum C', Sum V, MOR, EA, es, and Blends. These results provide further support for the reliability of several measures. Examiner effects as an influence on productivity and TE were identified as an important area for future research.     

The temporal stability of some Rorschach features

One hundred nonpatient adults, screened for evidence of personality disorganization, were retested after a three-year interval to study the temporal consistency of the Rorschach. In general, the correlational analysis for 19 basic variables studied, and a directionality analysis for five ratios, illustrate a considerable sturdiness over time. It is postulated that these variables can be separated into situational related indices (state variables), and more stable scores indicative of durable response styles (trait variables), based on the assumption that variables with lower correlations would identify state variables, while the higher correlations would signify the trait features. Nine of the 19 variables yield retest correlations in excess of.     

Correspondence between statistically derived behavior problem syndromes and child psychiatric diagnoses in a community sample

The correspondence between Diagnostic and Statistical Manual (3rd ed.) (DSM-III) diagnoses and statistically derived syndromes was examined within a community sample of children and adolescents in Puerto Rico. Specifically, the extent to which behavior dimensions, derived from the Child Behavior Checklist and the Youth Self-Report, corresponded to psychiatric diagnoses, derived from parent and child versions of the Diagnostic Interview Schedule for Children, was examined. The alternative approaches for assessing psychopathology in children and adolescents were compared against external validators. The results indicated a meaningful convergence between DSM-III diagnoses and statistical syndromes; however, a one-to-one correspondence did not emerge. Little evidence was found for diagnostic thresholds. There was no evidence of the superiority of either the statistically derived syndromes or the DSM-III diagnoses. The incorporation of a measure of impairment improved the validity of both approaches. Adding parental reports to the selfreports of adolescents yielded little gain in the validity of either the statistical or diagnostic approach. The implications for the definition and assessment of child and adolescent disorders are discussed.This research was supported by grant MH 38821 from the National Institute of Mental Health.The authors wish to acknowledge Glorisa Canino, Ph.D., and Maritza Rubio-Stipec, M.A., of the University of Puerto Rico, co-investigators in the epidemiologic project and to Barbara Bettes, Ph.D. for her contribution to preliminary analyses for this manuscripl. Portions of this paper were presented at the 38th Annual Meeting of the American Academy of Child and Adolescent Psychiatry, San Francisco, October 1991.     

The Last-Weiss Rorschach Ego-Strength Scale as a prognostic measure for psychiatric inpatients

This study tested the hypothesis that the Last-Weiss (Last & Weiss, 1976) Rorschach Ego-Strength Scale would predict outcome among a representative sample of first-lifetime psychiatric admissions. One hundred seventeen patients were assessed with structured symptom, psychiatric history, and social data interviews at hospital admission, and 2-year follow-up. Outcome measures included a multidimensional variable involving rehospitalization time, social and work functioning, and recent symptom level and symptom measures. Unexpectedly, the Last-Weiss Sum E variable correlated significantly with negative multidimensional outcome, a result that was strengthened when any possibly confounding effects of social class, IQ, and number of Rorschach responses were partialled out. It was found that Sum E's predictive value for poorer outcome was due to the space response (S+) component of the ego-strength variable. Possible explanations of the findings and implications for the previously validated Klopfer's Rorschach Prognostic Rating Scale are discussed.     

The Last-Weiss Rorschach Ego-Strength Scale as a prognostic measure for psychiatric outpatients

This study tested the hypothesis that the Last and Weiss (1976) Rorschach Ego-Strength Scale (sigma E) would predict outcome among a representative sample of never-hospitalized psychiatric outpatients. 78 patients were assessed with structured symptom, psychiatric history, and social data interviews at the time of initial clinic contact and at 2-yr. follow-up. Outcome measures included the Menninger Health-Sickness Scale, a multidimensional variable involving social and work functioning and recent symptom level, symptom measures, and an index of diagnostic severity. sigma E, controlled for number of responses, correlated significantly with Health-Sickness, neurotic symptoms, diagnostic severity, and psychotic symptomatology. Among the components of sigma E, M+, and FC+ had significant relationships or contributed to significant relations with outcome variables. Considered with an earlier study of inpatients, in which S+ sigma E component correlated inversely with outcome, this study suggested that sigma E components have differing prognostic significance, depending on adaptational level of the patient.