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What psychological testing and neuroimaging tell us about the treatment of Posttraumatic Stress Disorder by Eye Movement Desensitization and Reprocessing.

To better understand the pathophysiology and treatment of Posttraumatic Stress Disorder (PTSD), standard psychological testing, Rorschach Ink Blot testing, and neuroimaging using Single Photon Emission Computed Tomography (SPECT) were administered to subjects with PTSD prior to and following three sessions of Eye Movement Desensitization and Reprocessing (EMDR). Using this within-subject design, data from one of six subjects in our series is presented as a case report. Following EMDR, the subject experienced improvement in his level of distress, which correlated with decrements in PTSD and depressive symptomatology on psychological testing. Analysis of the Rorschach data corroborated these changes. Among other findings, the Hypervigilance Index went from positive to negative, indicating that the subject was spending less time scanning the environment for threats, and available ego resources also increased, as measured by the Experience Actual variable. Upon recall of the traumatic memory during SPECT scanning, two areas of the brain were hyperactive post-EMDR treatment relative to pretreatment: the anterior cingulate gyrus and the left frontal lobe. These changes were consistent with summed data from four out of six subjects in the ongoing study. An important implication of these findings is that successful treatment of PTSD does not reduce arousal at the limbic level, but instead, enhances the ability to differentiate real from imagined threat. The psychology and neurophysiology of PTSD are discussed in greater detail.

Adult↗

Methylphenidate hydrochloride effects on psychological tests in acute schizophrenic and nonpsychotic patients.

Actively psychotic schizophrenic and nonpsychotic psychiatric inpatients received intravenous methylphenidate hydrochlroide (0.5 mg/kg). Each patient was rated for level of psychosis and talkativeness, and each received the Holtzman projective ink blot tests and the Kent-Rosanoff word-association tests before, during, and after methylphenidate infusion. Minnesota Multiphasic Personality Inventory Goldberg Index scores were also obtained as a general measure of psychosis. For the entire patient group, methylphenidate infusion was followed by a significant increase in talkativeness and psychosis ratings and in pathological responses to the Holtzman ink blot test. There was a significant decrease in common word associations. Since neither of the psychological tests allow more than one response per item, it appears that methylphenidate truly effects pathological thought processes and decreases common word associations as such, rather than merely making these processes more evident by increasing verbalization.

Acute Disease↗

Rorschach predictors of therapeutic outcome for inpatient treatment of children: a proactive study.

The present study tested the hypothesis that Rorschach measures of psychological instability and perceptual sensitivity (i.e., es, es-EA, Lambda, Blends, Zf, & Zsum) would be sensitive to therapeutic change after inpatient treatment of children. Twelve male children were administered the Rorschach Ink Blot test in accordance with Exner's (1986) procedures and comprehensive system, pretreatment and posttreatment. The 12 children received inpatient treatment an average of 12 months, and all children showed improved functioning after treatment. Pre- to posttreatment Rorschach performance changes provided a partial confirmation of the hypothesis. Specifically, significant changes in es and Lambda were found posttreatment. As such, these Rorschach variables appear to be sensitive to therapeutic change in children.

Adolescent↗

[Value of the study of contingent negative variation in migraine and tension headache].

The aim of this study was to display the result obtained by the contingent negative variation (CNV) recording in patients suffering from headache. Eighty-five patients were taken into account: 59 with migraines (M) and 26 with tension headache (TH). A typical CNV pattern (high CNV amplitude with no habituation) differentiated M from TH. Moreover, psychological data were collected through Rorschach ink blot test among 42 headache sufferers (31 M and 11 TH). The typical Rorschach repressive pattern of alexithymia was found as well in M as in TH while CNV amplitude was significantly higher in the 31 M (-25 microV) than in the 11 TH (-19 microV FP less than 0.04). Biochemical data collected among 28 patients (17 M and 11 TH) revealed a positive correlation between CNV amplitude and plasma level of noradrenaline, regardless of the type of headache (r = 0.58; P less than 0.01). Thus, besides psychological factors, catecholaminergic mechanisms seem implicated in the determination of the CNV pattern in migraine. CNV may help the clinician both to specify diagnosis and to decide between the many therapeutic strategies available.

Adult↗

Coping with disability and the surgical experience: body image of scoliotic female adolescents.

Twenty-five adolescent girls undergoing surgery for correction of idiopathic scoliosis (curvature of the spine) were administered the Rorschach Ink Blot Test preoperatively, and the House-Tree-Person Test preoperatively, postoperatively, and at one year follow-up. In the figure drawing test younger girls scored significantly higher than older girls in both the preoperative and postoperative periods. The older adolescent's sensitivity of issues of physical attractiveness and bodily functioning increased her painful awareness of the deformity. With other measures, girls who denied their deformity significantly differed from nondenyers in their ability to cope with the stress of surgery; they had greater feelings of vulnerability and perception of the self as the object of an aggressive attack. Such denying, highly anxious patients need greater psychologic preparation prior to surgery. The limited motility of the postoperative scoliotic patient distorts body image perception and promotes feelings of passivity and helplessness.

Adolescent↗

[Was Snow White a transsexual?].

The Rorschach Ink Blot test is considered to be an essential analytical instrument when studying the personalities of individuals presenting identity disorders, in particular, in the context of a sex change request. Nevertheless, there exist less than 20 studies of transsexualism utilising the Rorschach since the creation of this diagnostic category in 1953. This research has mostly concerned itself with relations between psychopathology and transsexualism. Practically non-existent are studies investigating the psychological conditions that permit, shape or induce sex change requests in individuals. Transsexuals request the removal of their genitals through mutilation surgery, which can be seen as subjects literally crying out to be castrated. This request is all the more surprising given that castration, in psychoanalytic terms, is considered to be the most severe punishment that an individual (woman or man) can be threatened with. Therefore, we asked ourselves which psychic conditions could motivate such as request. Based on any earlier study where answers (some explicit, others symbolic) given by sex-change applicants tested on the Rorschach were analysed, results seemed to suggest a counter-phobic attitude underlying sex-reassignment requests (28). According to these hypotheses, the fear of castration (banal as such) can only be overcome through the active search for castration itself. In opting for castration, the transsexual puts an end to the states of anxious waiting that are dominated by feelings of the incertitude and unpredictability of an eventual castration. Once obtained, the threat it constituted disappears, and with it so does the fear. Thus, by taking this active and voluntary step, the subject is no longer exposed to an imminent danger in a passive manner. This in itself creates a great feeling of relief, if not of actual pleasure in the subject (28). In this article, we postulated in a purely speculative manner, the existence of one or several modalities in the transsexual dynamics. Nevertheless, one can ask oneself about the possibility of a request based on a desire rather than on a defense, or even on the existence of a defensive process diametrically opposed to the counter-phobic attitude and which, instead of actively provoking the dreaded reality, would privilege its avoidance and the search of passivity. This latter hypothesis has the advantage of being rather easy to explore with the Rorschach because, according to Exner, the predominance of passive compared to active human movement responses (which he terms the Snow White Syndrome) indicates the propensity to escape into passive fantasies and the tendency to avoid the initiative for behaviour or decision-making, if other people can do it in the subject's place (12). Our results largely confirmed the hypothesis of the existence of an opposite mechanism, as a third of subjects (n = 26) presented Snow White Syndrome. According to Exner, these transsexuals are typically characterized by hiding into a world of make believe, avoiding all responsibility, as well as any decision-making. This passivity in our Snow White Syndrome group was all the more remarkable in that, on the whole, it infiltrated into all the movement responses and seemed to define a rigid style of thinking and mental elaboration, in addition to a suggestive content of passivity. However, this condition cannot be associated with a general lack of dynamism or energy. In fact, the treatment of information, which provides data concerning the motivation to treat a stimulus field of the stimulus--whether this concerns the capture (L) of the stimulus or the elaboration (DQ+) of the response--displayed a sufficient amount of motivation. Furthermore, internal resources (EA) were considerable and were brought into play whenever it was necessary to adopt a behaviour or make a decision. Furthermore, based on these Rorschach findings, we note that in transsexuals with Snow White Syndrome, there is a stereotyped tendency to shy away from difficulties by seeking refuge in realistic representations (but that lack in variety), which could be materialized by actions, but where the initiative is delegated to others. These transsexuals appear to shy away from the difficulties of life by seeking refuge into a world of fantasy, which they fill with the representations borrowed from reality (rather than fantasy) and consequently that are liable to be transposed, if necessary, back into reality. Therefore, one can better understand why they shun away from the deceiving reality that their physical sex represents, into the satisfying dream where they possess the genitals of the opposite sex, that is, a perfectly real organ, no longer the result of the subject's fantasy world.

Adult↗