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PubMed1987

Prognostic scale for chronic schizophrenia.

Although prognostic scales are available for schizophrenia, these focus on acute or subacute populations where premorbid functioning and established chronicity are the best predictors of outcome. Their usefulness in chronic schizophrenia is limited. The authors describe a simple and reliable 5-item, 12-point prognostic scale for chronic schizophrenia independent of chronicity. It measures prognosis as the product of a dynamic interplay between the highest level of adaptive occupational and social functioning ever achieved by the individual and the "invasiveness" of the Axis I disorder as manifest by genetic loading (family history of schizophrenia), erosion of reality testing (psychotic assaultiveness), and preservation of affect in psychopathology (depressed mood). Among chronic schizophrenic patients in the Chestnut Lodge Followup Study (n = 163), the prognostic score (based on history and admission clinical picture) allowed strong probabilistic statements to be made about long-term outcome. Tables present the conditional probability or risk of specific outcomes in the domains of institutionalization, work functioning, social relations, and global outcome for patients at varying levels along the prognostic spectrum. Close examination of these predictor-outcome relationships suggests that prognosis in chronic schizophrenia may be thought of as the variability (as opposed to fixedness) remaining in the individual's future life course, and poor outcome can be predicted with greater sensitivity than good outcome.

Adaptation, Psychological↗
PubMed1982

Pretreatment behavioral profiles associated with subsequent psychosocial adjustment in radiation therapy patients: a prospective study.

A clinically derived system of judging cancer patients' engagement, reality testing and degree of arousal during a pretreatment consultation was found predictive of psychosocial problems or no problems reported by sixty cancer patients one month after starting radiation therapy. Independent ratings of psychosocial problems by the treating oncologists, nurses and radiation therapists three months after starting treatment were also found significantly associated with the pretreatment composite. Disease, treatment and demographic factors were not predictive of psychosocial problems and were not associated with the pretreatment clinical composite. Follow-up observations at six months and eighteen to twenty-four months of forty-four and twenty-four of the original patients available for study revealed there was no continuing association between their pretreatment clinical composites and psychosocial problem ratings.

Adult↗
PubMed1993

Rorschach adaptive fantasy images and coping in children under severe environmental stress.

We measured the relationship between the capacity of a group of inner-city, homeless children to produce adaptive fantasy images, as assessed by the Rorschach M+ score and their performance on the Fruit Distraction Test of selective attention and Rorschach measures of reality testing (extended F+ percentage) and object relations (Mutuality of Autonomy [MOA] Scale, Urist, 1977). The sample included 46 Black and Hispanic children (24 boys and 22 girls) who ranged in age from 5 to 13 years. Results from multiple regression analyses that also included age, intelligence, and gender as independent variables indicated that the M+ score accounted for the largest portion of the variance in the Fruit Distraction and MOA scores. The M+ score was also significantly positively correlated with the extended F+ percentage. The results suggest that children's capacity to withstand severe environmental stressors is linked to their ability to produce adaptive fantasy images on the Rorschach.

Adaptation, Psychological↗
PubMed1995

[Psychological problem due to long-term organic solvent abuse].

Organic solvent abuse in adolescents has become a serious social problem. One of the reasons for this is the relationship to juvenile delinquency, and another is that it leads to various clinical symptoms including disturbance of consciousness, hallucinations, fantasia and apathy. In this study, using a health questionnaire that is composed of 33 psychiatric and 29 physical items and the Rorschach Test, we investigated these symptoms and the psychodynamics of personality respectively. The principal component analysis obtained for the health questionnaire extracted four factors as follows: 1) feelings of general fatigue and somatic symptoms, 2) feelings of guilt and self blame, 3) low self esteem and withdrawal adaptation, and 4) unreasonable anxiety and sleeping disturbance. The results of Rorschach Test supported the loss of libido, disability of reality testing and ego vulnerability in organic solvent abusers. This research strongly suggests that apathetic or depressive mood in chronic organic solvent abusers relates with loss of drive.

Adolescent↗
PubMed1984

[Value testing in psychoanalysis--reflections on an ego psychologic concept coined by Heinz Hartmann].

We have attempted to demonstrate the importance of the concept of value testing set forth by Hartmann in 1960 in terms of both clinical practice and the theory of psychoanalysis. We use a case study to illustrate the way in which this subfunction of the inner reality testing ties in with the subfunction of signal guilt (the function of affect differentiation as one of the subfunctions of the perception of internal reality) and with the anticipation of the interpersonal effect of one's own behavior and the appropriateness of this behavior as subfunctions of judgment. In conclusion we discuss the suitability of the concept of value testing as a way of relating the psychoanalytic idea of the moral organization of action to the ethics of utilitarianism.

Ego↗
PubMed1991

Object relations and self-reported AIDS self-care behavior.

This study examined the relationship between object relations and AIDS self-care behavior among 509 urban college students. The literature indicates that maturity of object relations is related to comfort in interpersonal relations and to taking responsibility for self-care. These concepts are widely accepted by psychoanalytic psychologists but have rarely been tested empirically. Object relations, measured by the Bell Object Relations and Reality Testing Inventory, was significantly related to AIDS knowledge as measured by the AIDS Prevention Survey of Thomas and to self-reported safer sex behavior, measured by Bassman's HIV Infection Prevention Scale. Knowledge about AIDS correlated with self-reported sexual risk behavior, and with a low level of self-reported social behavior aimed at preventing AIDS. Implications of these findings for public health education policy are discussed.

Acquired Immunodeficiency Syndrome↗
PubMed2002

Psychophysiological correlates of narcissistic traits in women during active coping.

Two dimensions of narcissism were related to psychophysiological responses to stress in 50 young women. Cardiovascular, electrodermal, task performance, and stress appraisal measures were recorded during rest, mental arithmetic, and a computerized Thematic Apperception Test (Murray, 1943). The Egocentricity and Alienation scales of the Bell Object Relations and Reality Testing Inventory (Bell, 1995) served as measures of overt/inflated and covert/deflated narcissism. Egocentricity correlated consistently with heightened preejection period reactivity, whereas Alienation correlated consistently with diminished electrodermal reactivity (all p < .05). Multivariate analyses supported specific relationships between Egocentricity and preejection period hyperreactivity, and between Alienation and electrodermal hyporeactivity. These results have implications for narcissism, cardiovascular disease risk, and a variety of psychiatric disorders.

Adaptation, Psychological↗
PubMed2003

Psychological measures as predictors of military training performance.

The predictive validity of 7 ability tests, the Big Five, and the Rorschach method administered to 71 male applicants at the Naval Special Forces (NSF) of Norway was evaluated based on pass/fail results in training. The findings showed: (a) small correlations between the ability tests, the Big Five scales, and the success criterion; (b) Rorschach variables measuring stress tolerance, reality testing, cognition, and social adjustment correlated significantly (r =.25 to.48) with pass/fail results in training, and (c) logistic regression analysis revealed that 3 of the Rorschach variables accumulated incrementally in the prediction of training completion when entered after the ability tests and the Big Five scales, thus supporting the merit of using Rorschach variables for predicting NSF training performance

Adaptation, Psychological↗
PubMed2000

A preliminary understanding of mania: roles for melatonin, vasotocin and rapid-eye-movement sleep.

Speculation about mania links melatonin, vasotocin and rapid-eye-movement (REM) sleep. Normal REM sleep can have the loss of reality testing and this feature intruding into the wake period could be the cause of the distorted reality present in manic delusions. REM sleep has a role in memory formation. Abnormal levels and/or rhythms of melatonin are thought to be involved in mania. Decreased melatonin production with malfunction of REM sleep is proposed to be a cause of sudden infant death syndrome and Alzheimer's disease, because the loss of the antioxidant function of melatonin allows brain injury to occur.

Bipolar Disorder↗
PubMed1993

Using a conceptual model for practice in a nursing wellness centre for seniors.

The use of a conceptual model to guide practice is critical to the maturation of the profession. Distinguishing between nursing and other health care professions rests, in part, on nursing's ability to articulate what it offers to clients. The nursing paradigm, comprising the essential components of the individual (client), health, environment, and nursing, provides general rules of thumb for the profession (Fawcett, 1984). Selecting a nursing model for a practice setting contributes to theory development: clinical questions generated from the model can be formulated as testable hypotheses. The Wellness Centre offers a unique opportunity for use of a conceptual model in a nurse-managed practice setting serving seniors. If conceptual models are to be useful, they need to be tested in the settings where nurses practise and for the roles that comprise nursing. Use of the crisis model, in this setting provides reality testing of the model which has evolved to a higher level of internal consistency and external validity as a direct result of practice.

Aged↗
PubMed1999

[A case report of organic solvent abuse with amotivational syndrome].

We investigated an organic solvent abuser who developed amotivational syndrome employing neuropsychological examination (Rorschach test, Bender Gestalt test and Benton visual retention test), electroencephalography, magnetic resonance imaging (MRI) and single photon emission computed tomography (SPECT). The patient manifested a disability to maintain a goal-orient mental activity, immature reality testing and poor set shifting, which suggest frontal lobe dysfunction, as we have reported before in neuropsychological examination. In this case, single photon emission computed tomography (SPECT) also revealed a decrease of regional cerebral blood flow (rCBF) in the medial frontal lobe. These results may suggest a contribution of frontal lobe (especially medial frontal lobe) dysfunction to the pathogenesis of amotivational syndrome due to organic solvent abuse.

Adult↗
PubMed1985

Identification of borderline personality disorders among substance abuse inpatients.

By means of a structured interview procedure, individuals with borderline personality disorders were identified among a sample of 50 patients admitted to an inpatient substance abuse treatment program. When given a series of psychological tests, borderline patients were shown to be more pathological than a nonborderline group of substance abusers in a number of areas including depression, impulse control, antisocial tendencies and reality testing. Time spent in treatment was also shorter for the borderline group. Implications for substance abuse treatment programs and the potential impact of these patients on such programs is discussed.

Adult↗
PubMed1998

Inflationary tendencies in judging the yield of depression research.

The mood around mood disorders is one of optimism. Progress in diagnosis and treatment is generally felt to be considerable. Zeitgeist rests on convictions. In this case the main supporting convictions are the following: depression is a very frequent disorder and its diagnosis has improved greatly; we dispose of more or less specific agents to control depression: biological psychiatric research made great strides, particularly in the field of affective disorders; new antidepressants are properly tested before being clinically introduced. Each of these convictions is critically analysed. It is concluded that each of these claims is either a half-truth or not true. Apparently reality awareness and reality testing are out of balance. This harms the prospects of research, particularly biological research. Ways to avoid the stalemate are discussed.

Antidepressive Agents↗
PubMed1995

The Rorschach Ego Impairment Index in heterogeneous psychiatric patients.

There is a need for test measures of ego functioning that identify treatment needs and predict treatment response. Perry and Viglione's Rorschach Ego Impairment Index (EII; Perry & Viglione, 1991) is a composite measure assessing reality testing, thought process, defensive regulation, and object relations. It has been shown to correlate with Minnesota Multiphastic Personality Inventory (MMPI; Hathaway & McKinley, 1943) scales and subscales and other measures of psychosis in a schizophrenic sample and to predict antidepressant treatment of outcome in a depressed sample. This investigation examined the EII as a measure of ego impairment in a sample of 85 heterogeneous psychiatric inpatients and outpatients. In this sample, the EII did discriminate between inpatients and outpatients; it did not discriminate between psychotic and nonpsychotic patients, though there was a trend in this direction and one of the EII's object relations variables (Good H) did so. The EII did not generally show significant relations with MMPI indices of ego impairment (Ex or Scale 8), though there were some significant patterns of relation with with Scale 8 subscales. The study provides some, though not unequivocal, support for the EII as measure of ego impairment and for its utility compared to other measures and adds credence to earlier suggestions of the importance of object relations measures to ego functioning assessment.

Adolescent↗
PubMed2000

The alcohol tests for drunken criminals using psychological tests.

In the alcohol test for drunken criminals, we introduced Bender-Gestalt test and Rorschach test for the assessment, and examined their usefulness for the evaluation of intoxication patterns according to Binder's classification. The subjects were 24 drunken criminals who were examined by Mental Hygiene Group, Tsukuba University, for psychiatric evidences. The subjects were divided into the ordinary intoxication group (OI group) and the complicated intoxication group (CI group) on the basis of the behavioral assessment, and the psychological tests were performed before and after drinking. The following results were obtained. 1) Alcohol intoxication induced decrease in R1T, W and VIII + IX + X/R and increase of BGT scores and P%, which indicates that subjects become unable to make comprehensive and delicate responses to the external stimuli. 2) When we classified subjects into increasing and decreasing type on the pattern of changes in the BGT score from before to immediately after drinking in each subject, we found the ratio of increasing type in complicated intoxication is more than in ordinary intoxication significantly. And we found significant group x drinking interaction in F+% and At% of Rorschach test. The F+% significantly decreased only in CI group. The At% in CI group tended upward, but downward in OI group. These findings indicated that complicated intoxication reduced the subject's reality testing, while not in ordinary intoxication. 3) Comparing the effects of personality and intoxication factors in complicated intoxication, intoxication factors were considered to play primary roles. 4) We found association between high BAL and reduction of ego function and imagination, which is represented as significant peak of BALx drinking interaction in the BGT scores, M and FM + m. These observations suggest that the psychological tests as part of the alcohol tests are useful for the evaluation and research of intoxication.

Adult↗
PubMed1984

A methodology for the use of the Rorschach in clinical research.

Traditional approaches to the Rorschach produce a myriad of isolated but overlapping variables and ratios which limit the utilization of the Rorschach in research. Several new conceptual approaches to the Rorschach provide the basis for integrating the multitude of Rorschach scores into more molar variables that can be scored reliably and that measure central dimensions of personality organization. These new approaches assess dimensions of explicit personality theories rather than being derived from the test alone. Factor analysis of variables derived from several of these new approaches along with several more traditional scores, indicate seven basic factors which assess important dimensions on the Rorschach: degree of reality testing, primary experiential mode (action or ideation), degree of access to primitive modes of thought and the extent to which these modes are integrated effectively, degree of the investment in appropriate and inappropriate interpersonal relationships, and severity of pathological thinking. These seven empirically independent, orthogonal factors can be assessed by single variables that significantly differentiate opiate addicts and psychiatric patients and significantly correlate with independent estimates of ego functioning and development as evaluated in the Bellak clinical interview and on the Loevinger Sentence Completion Test.

Adult↗
PubMed1985

On direct patient participation in the cost of their psychiatric care. Part I. A review of the empirical and experimental evidence.

In the midst of a sociopolitical debate regarding access to health services, an evaluation is required of the therapeutic impact of the direct participation by some patients in the cost of their psychiatric treatment. Empirical clinical concepts regarding the need for a direct payment of treatment by the patient have evolved. Initial rigorous practice systems have lead to more flexible methods allowing for the recognition of third-party financing. Psychoanalytic theory has addressed the issue most extensively, but other conceptual frameworks have reached similar conclusions as well. The experimental evidence to either support or refute the position that the direct payment of a fee has a beneficial effect on therapeutic outcome remains limited. The focus has been on studying the impact of fee manipulation, but a tested correlation of other motivators such as patient's insight, therapist's attitudes and behaviour and social pressures is mostly lacking. Two patient populations appear to be delineated. Fee participation is of particular value to the financially secure and to the educated while patients in need of less intensive involvement, with reality testing disturbance and limited insight benefit particularly from third party insurance. Different patient populations should have the right to choose different payment options.

Canada↗