RORSCHACH RESPONSES IN SCHIZOPHRENIA AND BIPOLAR AFFECTIVE DISORDER
ABSTRACT
Rorschach Inkblot Test is a popular projective test used in clinical settings for differential diagnosis of psychological disorders. Paranoid schizophrenia and bipolar mania are presented in confusing and similar clinical presentation. For this purpose, this study was undertaken with the aim of comparing Rorschach responses of these two disorders. The study followed an exploratory design. Purposive sampling of thirty paranoid schizophrenia patients and thirty bipolar affective disorder patients (current state mania) diagnosed by consultant psychiatrists at inpatient and outpatient facility in Tribhuvan University Teaching Hospital were selected. Semi-Structured Interview Schedule, Brief Psychiatric Rating Scale, Young Mania Rating Scale, and Rorschach Inkblot Test were used. The Rorschach responses of the patients were scored using the Beck system. In location category, the findings showed higher major detail responses in patients with mania while higher space response in patients with paranoid schizophrenia. In determinants category, the results showed good form and movement responses to be higher in patients with mania. In content category, the findings indicated higher responses of fire, botany, landscape, and religion response in mania. In qualitative factors, different responses like total number of responses, affective ratio, texture, shading shock response were high in patients with mania while reaction time and color shock were high in paranoid schizophrenia. In pathognomic signs in Rorschach responses, mutilation, response impotence, confabulation, perplexity, position response, contamination, and self reference was higher among patients with mania while perseveration response was higher in paranoid schizophrenia. There was absence of perseveration and color shock response in mania while absence of perplexity, shading shock, and self reference response in paranoid schizophrenia.
Different symptoms were seen to be related to Rorschach responses. Irritability in patients with BPAD, mania was seen to be positively correlated with response time, movement response, human response, mythological response, texture, vista, flat gray responses, mutilation, and confabulation. Similarly, grandiosity in patients with BPAD, mania was positively correlated with the insect response while negatively correlated with the response time. Suspiciousness in patients with paranoid schizophrenia was positively correlated with whole response and architecture response. There was high correlation between vista response with flat gray and texture response.
Findings indicate that there are distinguishing presentation in Rorschach responses that can be supportive in differential diagnosis of paranoid schizophrenia and bipolar affective disorder, current state mania.
Keywords: schizophrenia, paranoid schizophrenia, Rorschach test, mania, BPAD, projective tests.
Author: Sujita Baniya