Weighing evidence for the Rorschach's validity: a response to Wood et al. (1999).

Wood, Nezworski, Stejskal, Garven, and West (1999) challenged Ganellen's (1996) characterization of the revised Rorschach Depression Index (DEPI; Exner, 1991) as a promising psychometric marker of depression that deserves serious attention by researchers and clinicians. To the contrary, however, a careful examination of existing studies indicates that no compelling empirical evidence exists indicating that Ganellen's conclusions should be modified at the present time, although no firm conclusions about the DEPI can be reached until further evidence accumulates. Furthermore, although Wood et al. (1999) suggested that evidence supporting the reliability and validity of the Rorschach in general is weak, ample evidence exists demonstrating that the Rorschach can be scored reliably (Meyer, 1997), that Rorschach variables in general have respectable levels of criterion-related validity (Bornstein, 1996; Hiller, Rosenthal, Bornstein, Berry, & Brunnel-Neuleib, 1999), and that the Minnesota Multiphasic Personality Inventory (MMPI; Hathaway & McKinley, 1943) and Rorschach have comparable levels of criterion-related validity, with the MMPI outperforming the Rorschach in certain respects and the Rorschach outperforming the MMPI in others (Bornstein, 1999; Hiller et al, 1999).

Exploring MMPI-Rorschach relationships.

Limitations exist in the current literature examining Minnesota Multiphasic Personality Inventory (MMPI)-Rorschach interrelationships. In this article I attempt to identify several issues to be addressed by researchers in this area. These include restricting conclusions about MMPI-Rorschach relationships to research using the Comprehensive System; considering the relative reliability and validity of these tests; comparing the predictive power of the Rorschach and MMPI; examining the effects extreme outliers have on statistical analyses; and determining the appropriate level of analysis for research, the level of individual test scores, or psychological constructs. The implications of these issues for research design, statistical analysis, and applied clinical work are discussed.

Comparing the diagnostic efficiency of the MMPI, MCMI-II, and Rorschach: a review.

The diagnostic efficiency of the Minnesota Multiphasic Personality Inventory (MMPI), Millon Clinical Multiaxial Inventory-II (MCMI-II), and Rorschach Comprehensive System for detecting depressive and psychotic disorders were compared. Studies examining the diagnostic performance of these measures published in the Journal of Clinical and Consulting Psychology, Psychological Assessment, and the Journal of Personality Assessment were included in this review. The methodological limitations of these studies are identified and suggestions for improving future research are offered. Although only limited conclusions can be reached because of the small number of existing studies and methodological problems, several preliminary observations were made. First, the MMPI, MCMI-II, and Rorschach are comparable in their sensitivity to detecting depression. However, high MMPI and MCMI-II scores are not specific to depression and misclassify a substantial percentage of nondepressed patients as being depressed. The Rorschach has a lower rate of false positives and higher specificity than the MMPI and the MCMI-II. Second, the Rorschach was more sensitive and specific to psychotic disorders than either the MMPI or MCMI-II. The MCMI-II did not detect psychosis at a rate above chance and frequently inaccurately classified psychotic patients as nonpsychotic. Overall, these preliminary findings suggest that Rorschach indices are promising psychometric markers for depression and psychotic disorders. The clinical implications of these preliminary findings are discussed.

Can psychosis be malingered on the Rorschach? An empirical study.

Can psychosis be faked on the Rorschach? We examined this question by comparing 2 groups of subjects with a high incentive to malinger, persons accused of serious crimes. All subjects were administered both the Minnesota Multiphasic Personality Inventory (MMPI) and the Rorschach and were assigned to honest (N = 35) and malingered (N = 13) groups on the basis of MMPI validity scales. The Rorschach protocols of these 2 groups were compared to assess how successfully malingerers could deliberately produce records that appeared psychotic on empirically derived Rorschach indices of psychosis. Despite an attempt to portray themselves as psychotic on the MMPI, subjects in the malingered group did not differ from honest responders on Rorschach variables that distinguish psychotic from nonpsychotic patients, but did differ in the number of dramatic responses produced. Our data suggest that the combination of the MMPI and Rorschach provides a powerful psychometric technique for detecting deliberate malingering of psychosis.

Impaired insight in Alzheimer's disease.

We studied insight into illness in 41 patients with probable Alzheimer's disease. An impaired insight score was developed by measuring discrepancies between patient report and caregiver report on standard instruments of activities of daily living. Insight was more impaired in subjects with greater dementia severity and subjects with paranoid delusions. In a multivariate analysis, the best neuropsychological predictors of impaired insight were the Continuous Performance Test and the Visual Reproduction Test. We speculate that the impaired insight of Alzheimer's disease has two components: confabulation reflecting prefrontal dysfunction and anosognosia reflecting right-hemisphere dysfunction.

Quantitative measurement of delta activity in Alzheimer's disease.

Quantitative measurements of delta activity were made in 10 healthy elderly controls and 31 subjects with Alzheimer's disease. Delta activity did not discriminate between the healthy elderly controls and the early mild Alzheimer's disease subjects. However, delta activity was a significantly greater percentage of total EEG power in the moderate-to-advanced Alzheimer's subjects when compared to either the healthy controls or mild Alzheimer subjects. In the T3 and T4 electrodes, delta activity in the moderate-to-advanced Alzheimer subjects was 78.3% and 47.6% higher, respectively, than in control subjects. Furthermore, delta activity was an excellent predictor of dementia severity within the 31 subjects with Alzheimer's disease.

Psychotic and behavioral symptoms in Alzheimer's disease: neuropsychological correlations

La aparición de sintomas psicóticos y conductales y el compromiso neuropsicológico fueron estudiados en 35 pacientes con diagnóstico de Enfermedad de Alzheimer Probable ( segun criterios del NINCDS-ADRDA) utilizando la Escala de Trastornos Conductales de Reisberg y cols. y una extensa batería de tests neuropsicológicos. Once pacientes, libres de trastornos psicológicos y conductales, presentaron puntajes más alto en el MMSE y en el Aphasia Screening Test, scores más bajos en la Escala de Demencia de Blessed y estadios más precoces en la Escala de Deterioro Global de Reisberg que los 24 pacientes con síntomas psicóticos o conductuales. Ambos grupos de pacientes no presentaron diferencias significativas en el Trailmaking Test, Span de dígitos y Construcciones. Delirios de robo, celotípicos, por falsos reconocimientos ( Sindrome de Capgras), agitación e intranquilidad motora son los trastornos que mostraron significativa correlación con baja performance cognitiva, especialmente en tests de memoria verbal, Token Test, Aphasia Screening Test, Trailmaking y Nominación por confrontación Visual. Por el contrario, la agresividad verbal (y/o física) y el delirio de abandono se correlacionan significativamente con evidencias de mejor performance cognitiva y menor pérdida de memoria. Se concluye que los síntomas sicóticos y conductuales asociados a la Enfermedad de Alzheimer pueden ser analizados en dos grupos: un grupo formado por agresividad verbal o física y delirios de abandono correlacionado con mejor performance neuropsicológica y menor duración de los síntomas cognitivos

Psychotic and behavioral symptoms in Alzheimers disease: neuropsychological correlations

La aparición de sintomas psicóticos y conductales y el compromiso neuropsicológico fueron estudiados en 35 pacientes con diagnóstico de Enfermedad de Alzheimer Probable ( segun criterios del NINCDS-ADRDA) utilizando la Escala de Trastornos Conductales de Reisberg y cols. y una extensa batería de tests neuropsicológicos. Once pacientes, libres de trastornos psicológicos y conductales, presentaron puntajes más alto en el MMSE y en el Aphasia Screening Test, scores más bajos en la Escala de Demencia de Blessed y estadios más precoces en la Escala de Deterioro Global de Reisberg que los 24 pacientes con síntomas psicóticos o conductuales. Ambos grupos de pacientes no presentaron diferencias significativas en el Trailmaking Test, Span de dígitos y Construcciones. Delirios de robo, celotípicos, por falsos reconocimientos ( Sindrome de Capgras), agitación e intranquilidad motora son los trastornos que mostraron significativa correlación con baja performance cognitiva, especialmente en tests de memoria verbal, Token Test, Aphasia Screening Test, Trailmaking y Nominación por confrontación Visual. Por el contrario, la agresividad verbal (y/o física) y el delirio de abandono se correlacionan significativamente con evidencias de mejor performance cognitiva y menor pérdida de memoria. Se concluye que los síntomas sicóticos y conductuales asociados a la Enfermedad de Alzheimer pueden ser analizados en dos grupos: un grupo formado por agresividad verbal o física y delirios de abandono correlacionado con mejor performance neuropsicológica y menor duración de los síntomas cognitivos

Transient global amnesia and thalamic infarction.

We describe the clinical and neuroradiologic features of a patient with two episodes of transient amnesia who later developed persistent amnesia and an acute infarction in the left thalamus. The neurobehavioral manifestations were strikingly similar in all three episodes. Cranial computed tomography was normal following the first two episodes. Thalamic ischemia could explain some cases of transient global amnesia.

Panic disorder, agoraphobia, and anxiety-relevant cognitive style.

We attempted to identify factors differentiating Agoraphobia with Panic Attacks (AG) from Panic Disorder (PD) patients. Twenty-three AG and 27 PD patients were compared. No significant difference in severity of illness was found. As predicted, the groups differed on a measure of anxiety-relevant cognitions developed for this study, the Anxious Thoughts and Tendencies scale (AT&T) (P less than 0.02). We suggest that differences in interpretation of panic attacks account for the development of of phobic avoidance behavior in some but not all PD patients. The intercorrelations among measures suggest that Panic Disorder may be conceptualized as having several independent although related components (panic attacks, general anxiety, phobic anxiety, and cognitive distortions).

Pessimistic self-preoccupation, performance deficits, and depression.

Three studies are presented testing a model of the cognitive performance deficits shown in depression. The model proposes that such deficits occur as an interaction of expectancy and focus of attention variables, that is, in the presence of both low expectancy of success and high self-focus. Study 1 was a pilot study which documented that depressed undergraduates evidence poorer anagram performance, greater self-focus, and lower pretask expectancies than do nondepressed subjects. Study 2 showed that nondepressed undergraduates evidence performance deficits only when both expectancy is lowered and self-focus is increased. Study 3 suggested that depressed undergraduates' performance deficits are overcome either by lowering self-focus or by raising expectancy. Discussed are discrepancies between self-report and performance data, the relevance of these studies to the test anxiety literature, the need to integrate literature concerning the effects of depression, anxiety, and self-esteem on performance, and how the interactive roles of positive expectancy and focus of attention may be related to effective coping in a variety of situations.

Depression and cognitive style: comparisons between measures.

Several instruments have been developed recently to measure cognitive styles associated with depression. At least four of them appear to have an underlying similarity. Each appears to reflect a tendency for respondents to infer a general lack of self-worth (or a continued likelihood of bad events) on the basis of a single discrete failure. The present research was a comparative test of one of these scales against the other three in terms of associations with Beck Depression Inventory (BDI) scores. Though all instruments were significantly correlated with BDI, partial correlations revealed that our generalization scale was a more robust predictor of BDI than were (a) a measure of characterological self-blame, (b) a measure of cognitive bias, and (c) a measure of attributional style.

Stress, externality, and depression.

Previous research has found mixed support for the possibility that locus of control moderates the effects of life stress on depression. Two methodological choices may have influenced previous findings: the use of a unidimensional rather than a multidimensional locus of control scale, and reliance on linear statistical methods using median splits. We attempted to correct these choices by using the Levenson IPC scale (1974) and multiple regression analyses in a female undergraduate population (N = 158). The results supported use of a multidimensional scale, since Stress, Internality, and Powerful Others were found to have main effects on depression whereas Chance interacted with life stress. The question of whether locus of control refers to responsibility for causing an event, i.e., self-blame, or belief in control over future events, i.e., coping behavior, was discussed.

Sex-role-related differences in self-concept and mental health.

Examined the differences in serf-concept and psychological health between androgynous, sex-typed, cross-sex-typed, and undifferentiated males and females. Two hundred forty-nine students who were enrolled in introductory psychology classes were classified according to sex type on the basis of their scores on the Bem Sex-Role Inventory. Nine aspects of self-concept and five aspects of psychological health, obtained, from the Tennessee Self-Concept Scale, were analyzed as a function of Sex and Sex Type. A series of analyses of variance and subsequent individual comparisons across groups revealed a clear pattern wherein androgynous subjects manifested more positive self-concepts and more positive psychological health than sex-typed subjects. Undifferentiated subjects manifested the poorest self-concepts, while results for sex-typed and cross-sex-typed subjects varied more as a function of the sex of the subject. The data are discussed as appearing to be consistent with Bem's hypothesis that androgynous people may represent a more appropriate societal definition of mental health than strongly sex-typed people. Qualifications of this support are also discussed.