Visual form perception: a comparison of individuals at high risk for psychosis, recent onset schizophrenia and chronic schizophrenia.

Schizophrenia has been associated with deficits in visual perception and processing, but there is little information about their temporal development and stability. We assessed visual form perception using the Rorschach Comprehensive System (RCS) in 23 individuals at clinical high risk for psychosis, 15 individuals with recent onset schizophrenia (< or =2 years since onset), and 34 with chronic schizophrenia (> or =3 years since onset). All three groups demonstrated reduced conventional form perception (X+%), as compared with published norms, but did not differ significantly from one another. In contrast, the high-risk group had significantly better performance on an index of clarity of conceptual thinking (WSUM6) compared to the chronic schizophrenia patients, with the recent onset group scoring intermediate to the high-risk and chronic schizophrenia groups. The results suggest that individuals at clinical high risk for psychosis display substantial deficits in visual form perception prior to the onset of psychosis and that these deficits are comparable in severity to those observed in individuals with schizophrenia. Therefore, visual form perception deficits may constitute a trait-like risk factor for psychosis in high-risk individuals and may potentially serve as an endophenotype of risk for development of psychosis. Clarity of conceptual thinking was relatively preserved among high-risk patients, consistent with a relationship to disease expression, not risk. These deficits are discussed in the context of the putative neurobiological underpinnings of visual deficits and the developmental pathophysiology of psychosis in schizophrenia.

Achievement orientation and fear of success in Asian American college students.

One hundred eighty-five Asian American undergraduates participated in a study designed to examine the relationships among gender, acculturation, achievement orientation, and fear of academic success. Acculturation was modestly correlated with achievement orientation. Endorsement of Asian and Anglo values were significantly related to individual-oriented achievement. Marginal significance, however, was obtained for endorsement of Asian values and beliefs to social-oriented achievement. These findings suggest that persons with a bicultural identity tend to adopt a multifaceted achievement style. Achievement orientation, in turn, predicted fear of academic success, with gender and perceived discrepancies from parental achievement values contributing minimal additional variance. Social-oriented achievement was related to high fear of academic success, whereas an individualistic orientation buffered against such conflicts.

Relationship between cognitive style and defensive style.

This study examines psychoanalytic psychology, theories of cognitive style, and cognitive developmental psychology to examine the relationship between cognitive style and defensive style. A new set of cognitive styles of visual attention is formulated at the following developmental levels: (1) global, (2) local, (3) global-plus-local at the concrete operational level, and (4) global-plus-local at the formal operational level, 50 subjects were administered global-local sorting tasks, the Sentence Preference Test, the Embedded Figures Test, and the Defense Style Questionnaire. Analysis provided mixed support for the hypothesized cognition-defense relationship. Results suggested that the "pure" character types are not typical and that their styles of cognition and defense are positively correlated, not independent as expected. However, possible measurement problems preclude any firm conclusions at this time.

Putting your eggs in the content analysis basket: a response to Aronow, Reznikoff, and Moreland.

A response is made to the essay by Aronow, Reznikoff, and Moreland (this issue) on the superiority of the content analysis approach to the Rorschach. Their argument is seen as giving insufficient emphasis to the importance of information obtained from empirically based, quantified methods of Rorschach interpretation. Content analysis without score-based interpretation is not sufficiently reliable for clinical use. Also, the argument of Aronow and colleagues that the Rorschach is predominantly a projective technique is refuted. Rorschach interpretation that deemphasizes empirically based scores is as insufficient as interpretation that excludes content analysis.

Predictors of two-year outcome among psychiatric outpatients.

This study hypothesized that social competence and clinical factors previously associated with psychiatric outcome among inpatients would be effective predictors of outcome among outpatients (N = 77) as well. Intake and 2-year outcome status were assessed multidimensionally with absolute-level and residualized indices of functioning, overall clinical status, and symptomatology. Menninger health-sickness proved to be the best single predictor, although Phillips premorbid functioning, Strauss-Carpenter prognosis, social class, and diagnostic severity also predicted well to outcome. Patterns of associated predictor/outcome variable clusters were described. Results suggest that a general social competence factor predicts to psychiatric outcome across the entire range of disorders, but that life events stress does not.

Predictors of outcome among adult psychiatric first-admissions.

This study comparatively evaluated the prognostic potential of 10 demographic and clinical factors previously associated with psychiatric outcome. The longitudinal design employed intensive, structured, reliable interview techniques. One hundred forty-five subjects from a representative sample (N = 217) of community mental health catchment area first lifetime admissions were assessed at hospitalization and at 2-year follow-up. Predictors examined included premorbid functioning, overall health-sickness, diagnostic severity, social class, sex, age, IQ, race, and life events. Outcome was assessed multidimensionally with absolute-level and residualized indices of functioning and symptomatology. Phillips Premorbid Status and social class emerged from correlation and multiple regression analyses as the best predictors of functioning level and overall clinical status, while IQ was the most prominent indicator of symptomatology changes. Results support the notion that a general social competence factor predicts to psychiatric outcome across the entire spectrum of severe disorders.

The effect of inquiry on the Exner Comprehensive System.

The effect of inquiry on the Comprehensive System was tested by scoring 130 protocols of patients and normals with and without inquiry. The absence of inquiry significantly reduced the means for Developmental Quality-vague (DQv), Form Quality-unusual (FQu), the sum of color responses (SumC), the sum of shading responses (Sum Shading), and the weighted thought disorder measure (W Sum6 SP SC), but significantly increased pure form (F). The effect for W Sum6 SP SC was strongest for schizophrenic protocols. Liberalized scoring rules were established in an attempt to restore the interpretative validity of the scoring categories distorted by the lack of inquiry. The new rules significantly improved the accuracy of color and shading categories, but did not improve the special scores measure of thought disorder.

Life events and psychopathology severity: comparisons between psychiatric outpatients and inpatients.

Relationships between life events stress variables and seven indices of psychopathology severity for a group of 97 never-hospitalized outpatients were compared with those of a previously studied group of 217 first-admission functional disorder psychiatric inpatients from the same geographical catchment areas. The hypotheses tested were that degree of life events stress would be correlated positively with indices of psychopathological severity and that the magnitudes of association would be higher for the outpatients. Bivariate correlations and stepwise multiple regression with other potential demographic and prognostic moderator variables provided evidence for significant, but somewhat differing, patterns in outpatient vs. inpatient stress/pathology relationships. Contrary to prediction, the magnitudes of significant and near-significant associations between life events and pathology severity were not different in the two samples.

IQ as a prognostic indicator in adult psychiatric first-admissions.

This study used IQ, along with measures of premorbid adjustment, health-sickness, symptom level, diagnostic severity and demographic data, to predict to 2-year outcome measures of level of functioning, health-sickness, and symptoms for a sample of 145 adult psychiatric first-admissions. It was hypothesized that IQ as an indicator of cognitive ability, or of general ability to adapt, would predict positively to improvement over the 2-year period. Data analysis was conducted with bivariate correlations and multiple regressions, using both absolute-level and residualized outcome variables. IQ showed modest, significant relationships with all absolute outcome indices and six of seven residualized measures, especially for a subsample of those with non-average IQ scores. Regressions showed that IQ provided independent prediction of symptom outcomes.

Social class and psychiatric disorder. The examination of an extreme.

Relationships between social status and various aspects of mental disorder have been of long-standing interest to both clinicians and researchers, and a large body of literature exists attesting to the importance of social status in understanding psychiatric illness and disability. Reports examining social status and schizophrenia suggest that relationships between socioeconomic status and psychiatric illness may rest heavily upon differences between the lowest socioeconomic stratum and the remainder of society. To investigate the extent to which relationships between socioeconomic status and psychiatric illness and disability reflect differences between a deviant lowest socioeconomic stratum and the remainder of society, data from 217 patients hospitalized for psychiatric disorder and reassessed at a 2-year follow-up were examined. At initial assessment, 17 patient characteristics were found to be associated with socioeconomic status; for seven of these 17 characteristics, the largest difference between classes was found between the lowest and the adjacent (next-lowest) social class. At follow-up, for five of 15 characteristics found to be related to social class, the greatest interclass difference occurred between the lowest and the adjacent social class. Both initially and at follow-up, significant associations between patient characteristics and social class remained when the lowest social class patients were excluded from the analyses.

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.

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.

Social class and psychiatric outcome.

Although social status has been shown to relate to rates of certain types of psychiatric disorder and to treatment received, little information is available regarding social class and clinical improvement over time. This report presents findings from a prospective follow-up study of a representative sample of first-admission psychiatric patients. A variety of clinical characteristics were analyzed at hospital admission and 2-year follow-up. The social status of the individual patient, the social status of the patient's parents, and the social status associated with the patient's residential area were found to be correlated with improvement over the 2-year follow-up period.

Rorschach teaching in APA-approved clinical graduate programs: ten years later.

A questionnaire on teaching of the Rorschach technique was sent to all APA-approved graduate clinical psychology programs in the United States and Canada. The survey represents a 10-year update of a study conducted in 1974 and reported in 1976. The questionnaire asked for the degree of emphasis placed on the Rorschach in the curriculum; the Rorschach teaching experience of the Rorschach instructor; the instructor's evaluation of the technique as a clinical tool, a teaching aid, and a research instrument, and a list of the instructional material used to teach the Rorschach. Based on a 93% return of questionnaires, the major results show that 88% of the programs place major emphasis on the Rorschach in at least one assessment course (compared to 86% in 1974); in contrast to the results of the 1974 survey, there were no differences between the ratings of highly experienced and moderately experienced instructors; as in 1974, instructors as a group highly rated the Rorschach as a clinical tool and teaching aid, but gave it generally low ratings as a research instrument; and the results clearly indicate that the Exner Comprehensive System is widely used as an instructional method.

Sex and race of patients admitted for their first psychiatric hospitalization: correlates and prognostic power.

Much attention has been focused on the advantages enjoyed by white males in the general society. Are they similarly advantaged in a psychiatric population? Two hundred seventeen patients from two demographically heterogeneous catchment areas admitted to inpatient care during a 1-year period were interviewed using standardized procedures; 80% of the original sample was available for follow-up 2 years later. Race and sex showed no consistent pattern of relationships with psychiatric symptoms, disability, and outcome; being both white and male was not advantageous in terms of any of the characteristics examined.

Comparing diagnostic validity of the TAT and a new picture projective test.

Diagnostic validity of the TAT and a new picture projective test, the PPT, were compared for normal, depressed, and psychotic subjects. Generally, the PPT elicited more positive emotional tone, more activity, and fewer thematic deviations than the TAT. The PPT and TAT were essentially equal in the capacity to discriminate between stories of normal and depressed subjects; however, the PPT was superior in differentiating psychotics from normals and depressives. On the PPT, depressives told stories with gloomier emotional tone and psychotics made more perceptual distortions, thematic and interpretive deviations. None of these differences were apparent on the TAT. The PPT pictures seem to have more diagnostic validity than the TAT stimuli.

The Urist Rorschach Mutuality of Autonomy Scale as an indicator of psychopathology.

The Urist Rorschach Mutuality of Autonomy Scale (MAS), which assesses development along a self-object differentiation and mutuality dimension, has shown considerable promise as an index of interpersonal relationship capacities. As such, MAS scores were predicted to correlate significantly with three measures of psychological pathology/health. The reliability of the scale was investigated with non-S Rorschachs and found to be satisfactory. Four-card Rorschachs from 60 previously hospitalized adults comprised the data source for the hypothesis test. Results suggest that the Mutuality Scale accurately reflects observed pathology severity at time of hospitalization and over a lifetime, but not at the time of assessment. Hence, the Urist MAS may indicate potential for pathology.

Self-derogation and psychopathology.

To test empirically the oft-repeated clinical hypothesis of a relationship between the self-derogation component of low self-esteem and severity of psychopathology across the entire range of pathology, including nondepressive disorders, the present study examined this relationship in two samples of Ss. The first were 152 patients and expatients from two community mental health catchment areas followed up two years after their first functional-disorder psychiatric admission. The second group were 97 outpatients from the same catchment areas beginning therapy at a community mental health clinic. Within each sample self-derogation was related significantly to severity of diagnosis, overall health-sickness, numerous indices of symptomatology severity, and a measure of difficulty in social/employment functioning. These findings point to the need to recognize and treat self-derogation in psychopathological states other than depression. In addition, they raise the important question of direction of causality between self-derogation and observed psychopathology.

First-admission psychiatric ward milieu: treatment process and outcome.

A two-year, prospective study of 123 first-admission patients examined the impact of different inpatient treatment decision-making styles on patient outcome on a therapeutic community ward and a medically oriented psychiatric ward. Ward philosophy, programmatic and administrative structure, and ward atmosphere defined the ward milieus. Data on length of stay and the use of various therapeutic modalities provided comparisons of treatment process. Standardized ratings of psychopathologic condition and levels of function, readmissions, and illness attitudes were used to assess two-year outcomes. The major finding was the absence of outcome differences despite longer lengths of stay on the therapeutic community ward. Hence, differences in ward decision-making style may not influence outcome, but may affect the process of care among diagnostically heterogeneous, first-admission patients treated in a university setting.