Therapeutic approach to referential thinking in a case of schizotypal disorder

Abstract

This article has two different aims: first, to test whether the Rorschach Psychodiagnostic Test can confirm the psychiatric diagnosis of 245 schizophrenic inpatients when the initial diagnosis was based on the criteria of the RDC and DSM-IV for the differentiation of schizophrenia; and second, to determine whether there are statistically significant differences between two refined samples of 191 “acutely aggravated” and 54 chronic schizophrenic patients. The following tests were used: the Rorschach Psychodiagnostic Test (Comprehensive System), the Research Diagnostic Criteria, the DSM-IV and the Katz Adjustment Scale. A cross-sectional study design was used to compare the groups with the Mann Whitney U, in order to test for differences between the two refined acute and chronic samples. Analysis of the data confirmed the precision and efficacy of the Rorschach test for the differential diagnosis of schizophrenia and distinguishes it from borderline personality and bipolar disorder. Application of the Mann-Whitney U to the two refined samples of acute and chronic patients (refined due to the presence in their protocols of L>5; R<14; X+%>70%; few M, no M- and no level 2 special codes), confirmed the existence of statistically significant differences at three confidence levels (<0.01; 0.02 and 0.05). In the two refined acutely aggravated and chronic groups, the presence of the mechanisms of splitting, loss of perceptual accuracy, dissociated and delusional thought, isolation and deficient interpersonal relationships was confirmed in 100% of cases and all of them complied with the six criteria of the Schizophrenia Index and the five criteria of the Perceptual Thinking Index. These features were also observed in the 245 patients from the overall sample, including those who did not fully comply with these indexes. Analysis of the values of the Rorschach structural summary in the samples of acute and chronic patients studied revealed additional information about the personalities and behavior of these people and aided in focusing their treatment. However, the most important aspect of the Rorschach test is that it does not require a three-month, six-month or two-year period to perform a differential diagnosis of people with schizophrenia, as is the case with the RDC and the DSM-IV.