Schizophrenic, depressive, and nonpatient personality organizations described by Rorschach factor structures

Rorschachs of 155 schizophrenics, 102 depressives, and 186 nonpatients were collected and scored using the Comprehensive System. Twenty-seven Rorschach variables considered central to interpretation were selected for study. Factor analyses and partial correlations controlling for number of responses, R, were generated in order to investigate the personality organization of each of the three groups. A three factor solution was found to be optimal for each group. Patterns of personality organization were discussed within the three groups and factor structures were compared and contrasted. While similarities occur between the three groups, each group also manifests a unique personality organization. These findings support the hypothesis that schizophrenics and depressives differ from nonpatients in kind, rather than degree of disorder.     

The paranoid person: cognitive motivations and personality traits

The purpose was to contribute to a better understanding of the personality structure and dynamics of paranoia. In study 1, 29 paranoid patients and three control groups (30 schizophrenics, 27 depressives, and 64 healthy subjects) were administered the Cognitive Orientation (CO) Questionnaire of Paranoia, which included beliefs of four types (goals, norms, about self, and general) referring to 44 themes (e.g. masculinity, strength). Discriminant analyses (based on longer and shorter versions of the questionnaire) showed that the four belief types enabled significant discrimination among the four groups and that there is a CO based on themes and conflicts characteristic for paranoia. In Study 2, 31 paranoids and 31 healthy controls were administered the Meaning Test which yielded prevalidated scores for 124 personality traits. The results showed that paranoids have a clear-cut personality profile, with traits in clinical (e.g. obsessive), interpersonal (e.g. extravert, leadership), emotional, cognitive, and other domains. The findings are integrated and the convergences between the behavioral tendencies and personality traits specified, in an attempt to identify the major features of the paranoid, including potential dangers and therapeutic chances. © 1997 by John Wiley & Sons, Ltd.     

Cognitive and attentional deficits in children vulnerable to psychopathology

Cognitive and attentional deficits were assessed in children with either a schizophrenic, an affectively disordered or a normal parent. The children were grouped both by their parents' DSM-II diagnoses (broadly defined group of schizophrenics and heterogeneous group of depressives)and by a new set of diagnoses (narrowly defined group of schizophrenics, unipolar depressive group and bipolar group). Children whose parents met the more stringent criteria for schizoprhenia performed somewhat more deviantly than children whose parents met only DSM-II criteria. In addition, the importance of splitting the heterogeneous depressive group into more homogeneous subgroups is indicated by the findings that children of unipolar parents generally could not be distinguished from children whose parents are schizophrenic. On the other hand, children of bipolar parents performed reliably better than children of schizophrenics. These findings are viewed within the context of current high-risk studies and psychological deficit literature and suggest that diagnostic issues require more attention by researchers in these areas.This research was supported by Grant MH 21145 from the National Institute of Mental Health. The authors are indebted to Lina Jandorf for assistance in testing the children and with the data analyses.     

Differing lateralized perceptual-motor patterns in schizophrenic and non-psychotic children

A neuropsychological assessment stressing lateralized perceptual-motor and cognitive abilities was administered to two groups of hospitalized child and adolescent psychiatric patients, 25 schizophrenics and 25 non-psychotics. The findings included an increased incidence of crossed eye-hand dominance in schizophrenics, poorer tactile sensory function in the right hands of schizophrenics than in the left hands, and lower Vocabulary and Similarities WISC subtest scores than Block Design and Object Assembly scores for schizophrenics. Right-left confusion was associated with finger agnosia for schizophrenics. The results supported the hypothesis that there may be left-hemisphere dysfunction in schizophrenia; however, no single pattern of dysfunction was apparent.     

Emotional disturbances and their interaction with neuropsychological deficits

The interaction and relationships between neuropsychological tests (which are principally oriented to intellectual and cognitive abilities) and tests of personality and emotional status are complex, but nevertheless important in the clinical assessment of brain-damaged persons. Are indications of emotional disturbances to be expected as a direct consequence of brain damage? If so, how can the indications of emotional disturbances be differentiated from results obtained with psychiatrically disturbed (non-brain-damaged) subjects? Some authors have presumed that emotional disturbances, such as depression, acute anxiety, etc., in their own right cause impaired performances on neuropsychological tests, whereas other authors have proposed that brain damage predisposes the individual to demonstrate evidence of emotional disturbances. If emotional disturbances cause impairment on neuropsychological tests, why is it that so many emotionally disturbed persons without brain damage tend to perform normally on neuropsychological tests? This review of relevant publications considers (1) different general approaches to these questions and their implications for neuropsychology, (2) evidence of differential sensitivity to brain damage of neuropsychological and emotional instruments, (3) the sensitivity and specificity of self-assessments and complaints of head-injured subjects, (4) MMPI findings among head-injured subjects and in interaction with neuropsychological measurements, and (5) principles and guidelines that may be of value in clinical application of findings reported in the literature.     

Interhemispheric transfer in schizophrenics, depressives, and normals with schizoid tendencies

Although several studies suggest that schizophrenics suffer from an impairment in the interhemispheric transfer (IHT) of information, methodological weaknesses in these studies preclude clear interpretation of their results. This study addresses these criticisms in order to provide a clearer test of the IHT theory. Schizophrenics, depressives, normal controls, and normals with schizoid tendencies were assessed on five measures of IHT (verbal and nonverbal dichotic listening, intermanual transfer, bimanual block design, finger sequence repetition) and two measures of unilateral hemispheric processing (lateral eye movements, auditory thresholds). Results consistently failed to support an IHT deficit interpretation of schizophrenia. Schizoid normals had a significantly greater right-ear advantage on verbal dichotic listening than both psychiatric groups, a result suggesting enhanced left-hemisphere activation in schizoid normals. It is concluded that the IHT theory requires stronger empirical substantiation than has been obtained to date to warrant further consideration as a central theory of schizophrenia.     

Efficiency and automaticity of self-schema processing in clinical depressives

In this study, female clinical depressives and nondepressed control subjects made a series of self-referent personality judgments concerning depressed and nondepressed content personal adjectives. Employing rating times (RTs) for the personality decisions as a dependent measure, it was found that both clinical depressives and nondepressed psychiatric controls processed self-schema congruent content more efficiently (with quicker RTs), than incongruent content. To further test for the automaticity of self-schema processing, half the depressed and nondepressed adjectives were rated while subjects held six digits in memory (a concurrent memory load). Here it was found that the independent variable of memory load (zero vs. six digits) did not interact significantly with the remaining independent variables of groups (clinical depressives, psychiatric nondepressives, normal nondepressives), decision type (yes, no), and adjective content (depressed, nondepressed). The lack of any interactions involving the memory load factor provides initial evidence for self-schema processing as an automatic process, rather than as a process that demands attentional capacity.This research was supported, in part, by a Social Sciences and Humanities Research Council Doctoral Fellowship to Michael R. MacDonald.     

Schizophrenia and automatic processing: an exploratory study

This study deals with the schizophrenic deficit as one of automatic processing. To test the idea, a special experimental task was designed on which 21 schizophrenics, 21 depressives, and 21 normal subjects had to complete a series of simple geometric figures. When the subjects had thoroughly learned this activity, another information source, a brief story, was introduced, and the subjects had to pay attention to the story while they did the task. Two dependent variables were considered, execution time and performance. There were no differences among the three groups in the first experimental condition; but in the second condition, when the distractor was introduced, schizophrenics needed more time to do the task and their performance was noticeably worse than those of both normals and depressives. This outcome is explained in terms of a failure in the internal mechanisms which regulate the automatic, parallel, and unconscious processing.     

Neurobehavioral deficit and computed tomographic abnormalities in three samples of schizophrenic patients

Recent reports have suggested that schizophrenics show brain abnormalities as reflected on computed tomography (CT Scan). We present data on three groups of schizophrenic patients which replicate our original report of this phenomenon with associated neuropsychological test results. The over-all evidence for an increased rate of neuropsychological abnormalities and related CT structural anomalies in groups of schizophrenics in several studies is robust. The biological dynamics, cause-effect relationships, and clinical applicability of this phenomenon in the individual case, however, are far from clear. Diagnostic agreements between behavioral and structural abnormalities should simultaneously sound a note of clinical caution and stimulate further study.     

Some aspects of verbal conditioning in psychiatric patients

Using a modification of a verbal conditioning technique reported by Tafiel (1955) it was found that only schizophrenics and normals showed evidence of conditioning, neurotics and depressives showing changes not differing from chance. There was greater evidence of conditioning among Ss aware of the contingency between response and reinforcement, and some tentative evidence for relationships of anxiety and extraversion with verbal conditioning.     

Cattell 16 personality profiles of patients following closed-head injuries

The personality scores from Cattell's 16 PF for 188 patients who had been referred for neuropsychological assessment following motor vehicle incidents were analyzed as a function of the severity of neuropsychological impairment (Halstead-Reitan Index) and time since the injury. Patients who were impaired (Index > 0.4) exhibited lower scores on Factor B (moe concrete thinking), Factor E (more submissive), and Factor F (more cautious) than patients who were not impaired. The presence of impairment accommodated only 10% of the variance in Factor E scores, associated with the largest group difference. There were no significant differences between scores on any of the personality factors, verbal intelligence, or standardized reading ability as a function of time since the injury.     

Differential diagnosis of steroid-dependent nephrotic syndrome with psychosis: Practical and ethical issues

The present case illustrates practical and ethical issues that can be encountered by clinical psychologists providing consultation services in medical settings. The neuropsychological consultation service was asked to evaluate a 22-year-old male with psychosis, steroid-dependent nephrotic syndrome, and a family history of schizophrenia. MRI revealedmarked cortical atrophy. Clinical findings were consistent with (1) steroid inducedapparent atrophy, which has been shown to be reversible with withdrawal of steroids; (2) uremia secondary to steroid withdrawal; (3) cortical atrophy, found in some schizophrenics; or (4) an atypical, diffuse degenerative disorder. Clinical interview and psychological testing revealed significant thought disorder, prominent delusions, somatic hallucinations, and mood disturbance. Deterioration in social and academic functioning was also present. Except for impaired attention and concentration, neuropsychological evaluation showed no clear evidence of brain-based dysfunction. Further, neuropsychological results effectively ruled out a degenerative process and were not consistent with a steroid effects profile. A conclusive differential diagnosis of steroid induced psychosis versus severe psychopathology would require withdrawal from steroids and antipsychotics. In addition to the practical and ethical issues of withholding antipsychotics, steroid withdrawal would require either dialysis or renal transplant surgery. Decision making regarding dialysis dependency and the possibility of postsurgical psychosis secondary to true psychopathology were salient issues to both the patient and the treatment team.     

Comprehensive driving assessment: neuropsychological testing and on-road evaluation of brain injured patients

The study investigates the correspondence between neuropsychological test results and on-road driving performance among 55 patients with a CT-verified brain damage or documented neurological disorder (cerebrovascular accident: 43, traumatic brain injury: 5, multiple sclerosis: 4, other: 3). 5 patients showed unimpaired test profiles and passed the on-road evaluation. 18 patients showed severe neuropsychological deficits contrary to driving and were not recommended for on-road evaluation. Of the remaining 32 patients with some neuropsychological deficits, all 100% in the minor impaired group (n = 8) passed the driving evaluation, compared to 69% in the mildly impaired (n = 16) and 38% in the moderately impaired group (n = 8). Measures of reduced visuoconstructive ability, reaction time, visual attention, and awareness of cognitive impairments, were found to discriminate between groups. It is concluded that neuropsychological assessment of targeted functions provide an ecological valid prediction of driving skill after brain damage, but that on-road evaluation is needed as supplement in cases with ambiguous test findings.     

Neuropsychological profile in patients with schizotypal personality disorder or schizophrenia

Neuropsychological impairments have been consistently reported in patients with schizophrenia. As little is known whether subjects with schizotypal personality disorder exhibit neurocognitive dysfunction similar to that in schizophrenia, we assessed the neuropsychological profile of 15 subjects with schizotypal personality disorder and compared it with that for 15 patients with schizophrenia and for 15 psychiatrically normal volunteers. All participants were administered a standard neuropsychological battery assessing language ability, spatial ability, visuomotor function, verbal memory, visual memory, auditory attention, visual attention, and executive function. Performance on most of the cognitive domains was impaired in patients with schizotypal personality disorder but less than patients with schizophrenia. Specifically, impairment in verbal memory and visuomotor ability in patients with schizotypal personality disorder and patients with schizophrenia were comparable, while patients with schizophrenia performed worse on the test of executive function than did patients with schizotypal personality disorder. As a whole, cognitive deficits in patients with schizotypal personality disorder were qualitatively similar to, but quantitatively milder than, those for patients with schizophrenia. The results suggest that cognitive abilities related to frontotemporal lobe function are disturbed across these schizophrenia-spectrum disorders.     

Frontal lobe dysfunctions in borderline personality disorder? Neuropsychological findings

This study aims to determine whether specific neuropsychological performance impairments in borderline patients can be objectified and whether these findings indicate frontal dysfunctions. Twenty-three patients with borderline personality disorder and 23 normal controls were examined using a neuropsychological test battery to assess intelligence, attentiveness, proneness to interference, learning and memory, as well as planning and problem solving. All subjects filled out standardized questionnaires to assess aggressiveness and impulsiveness in the context of these cognitive performance areas. The neuropsychological test results of the borderline patients were comparable to those of the controls. Although there were no indications of frontal dysfunction of cognitive information processing, inverse correlations were found between the severity of borderline-related personality traits regarding impulsiveness and various areas of cognitive performance. Borderline personality patients show no indications of frontal cognitive dysfunction. Further research is needed to clarify the relationship between impulsiveness and cognitive information processing in borderline personality disorder, including a dimensional approach to personality and personality disorder.     

Depression,Alexithymia, and Pain Prone Disorder: A Rorschach Study

The relationship between depression and chronic low back pain (LBP) is controversial. Theorists differ in the emphasis they place on predisposing versus reactive factors in LBP disability and depression. Alexithymia has been suggested as a predisposing factor in psychosomatic disorders, including chronic LBP. This study addresses the association between depression, alexithymia, and LBP using the Rorschach comprehensive system. LBP patients were hypothesized to be distinguishable from Research Diagnostic Criteria-diagnosed inpatient depressives, to exhibit features of alexithymia, and to resemble a group of DSM-III personality disorders. Subjects were 33 chronic LBP patients. Results supported the hypotheses. On depression measures, LBP patients differed significantly from depressives (p < .001). LBP patients exhibited Rorschach features consistent with alexithymia. They also exhibited a number of similarities to the personality disorders group. The role of alexithymia as a cognitive-mediating factor in coping and adaptation is discussed.     

Depression, alexithymia, and pain prone disorder: a Rorschach study

The relationship between depression and chronic low back pain (LBP) is controversial. Theorists differ in the emphasis they place on predisposing versus reactive factors in LBP disability and depression. Alexithymia has been suggested as a predisposing factor in psychosomatic disorders, including chronic LBP. This study addresses the association between depression, alexithymia, and LBP using the Rorschach comprehensive system. LBP patients were hypothesized to be distinguishable from Research Diagnostic Criteria-diagnosed inpatient depressives, to exhibit features of alexithymia, and to resemble a group of DSM-III personality disorders. Subjects were 33 chronic LBP patients. Results supported the hypotheses. On depression measures, LBP patients differed significantly from depressives (p less than .001). LBP patients exhibited Rorschach features consistent with alexithymia. They also exhibited a number of similarities to the personality disorders group. The role of alexithymia as a cognitive-mediating factor in coping and adaptation is discussed.     

A data-driven approach to neuropsychological features in isolated REM behaviour disorder: A latent class analysis

Recent evidence demonstrated that neuropsychological assessment may be considered a valid marker of neurodegeneration in idiopathic REM sleep behaviour disorder (iRBD). However, little is known about the possible neuropsychological heterogeneity within the iRBD population. This retrospective study aimed to identify and describe different neuropsychological phenotypes in iRBD patients by means of a data-driven approach using latent class analysis. A total of 289 iRBD patients underwent a neuropsychological assessment evaluating cognitive domains: global cognition, language, short- and long-term memory, executive functions and visuospatial abilities. The presence of mild cognitive impairment (MCI) was also assessed. Latent class analysis was carried out to identify iRBD subtypes according to neuropsychological scores. The most parsimonious model identified three latent classes. Groups were labelled as follows: Class 2 “severely impaired” (n = 83/289): mean pathological scores in different tests, a high percentage of MCI multiple-domain and impairment in all neuropsychological domains. Class 1 “moderately impaired” (n = 44/289): mean neuropsychological score within the normal value, a high percentage of MCI (high risk to phenoconversion) and great impairment in the visuospatial domain. Class 3 “slightly impaired” (n = 162/289): no deficit worthy of attention except for short- and long-term memory. Our results suggest three different clinical phenotypes within the iRBD population. These findings may be relevant in the future for predicting the clinical trajectories of phenoconversion in iRBD.     

Clinical syndromes, personality disorders, and neurocognitive differences in male and female inmates

This study examined clinical syndromes, personality disorders, and neurocognitive problems in adult male (n = 523) and female inmates (n = 523) and a sample of unincarcerated adult women (n = 523). Inmates were administered the Coolidge Correctional Inventory (CCI), and the unincarcerated sample was given an identical test, the Coolidge Axis II Inventory. Although there were significant differences between the two inmate groups on a majority of the 32 CCI scales, only two scales achieved a medium effect size. The two inmate groups were found to be highly similar in a comparison of ranked personality disorder prevalence rates. Consistent with previous literature, male inmates had a significantly higher prevalence of antisocial personality disorder than female inmates (24% vs. 18%). Female inmates had double the prevalence of male inmates on the borderline and histrionic personality disorder scales. Female inmates also reported significantly more general neuropsychological dysfunction, specifically memory problems and neurosomatic symptoms, than male inmates. Female inmates also reported significantly higher levels of anxiety, depression, symptoms of schizophrenia, post-traumatic stress disorder, attention deficit hyperactivity disorder, and depersonalization than male inmates. Overall, the findings support previous research of high levels of psychological and neuropsychological problems in inmates, regardless of gender, and reinforces the need for comprehensive mental health screening of offender populations. Copyright © 2011 John Wiley & Sons, Ltd.