Sensitivity of Exner's Comprehensive Scoring System in Detecting Specific Delusions in Psychotic Patients: Preliminary Observations

Satya Dhar Dwivedi

The present study was an attempt to gather preliminary observations to explore if Exner's Comprehensive Scoring System is sensitive enough to tap and discriminate various kinds of disorders of content of thought, specifically, delusion of infidelity in persons with psychotic illness. The sample comprised of 5 patients having delusion of infidelity and 5 patients having other delusions drawn from inpatients of Institute of Mental Health and Hospital, Agra. Psychotic Symptom Rating Scale (Haddock et al. 1999) was used for understanding of severity of delusions. Rorschach Inkblot Test was administered and scored in accordance with the Exner's Scoring System. The findings revealed that none of the scoring variables of Exner scoring system could differentiate the groups.

Schizophrenia is a clinical syndrome of variable, but profoundly disruptive, psychopathology that involves cognition, emotion, perception, and other aspects of behavior. The expression of these manifest-ations varies across patients and over time, but the effect of the illness is always severe and is usually long-lasting. The disorder usually begins before age 25, persists throughout life, and affects persons of all social classes. The life time prevalence of schizophrenia is about 1 percent, which means that about 1 person in

100 will develop schizophrenia during their lifetime. Schizo-phrenia is equally prevalent in men and women. The two genders differ, however, in the onset and course of illness. Onset is earlier in men than women (Kaplan & Sadock, 2007) (p.467)

Disorder of content of thought:

It is customary to define a delusion as a false unshakeable belief that is out of keeping with the patient's social and cultural background. The content of delusions in schizophrenia is dependent, to a greater or lesser extent, on the social and cultural background of the patient. Common general themes include persecution,

jealousy, love, grandiosity, ill health, guilt, nihilism and poverty.

The commonly used term 'delusion of jealousy' is generally a misnomer as patients tend to have morbid jealousy with delusions of infidelity, rather than delusions of jealousy (Munro, 1999). Delusions of infidelity may occur in both organic and functional disorders. Often the patient has been suspicious, sensitive and mildly jealous before the onset of the illness. Delusions of marital infidelity are not uncommon in individuals with schizophrenia and have been reported in many different varieties of organic brain disorders, but are especially associated with alcohol dependency syndrome. Delusions of infidelity are also seen in the affective psychosis, where they may again represent a morbid exaggeration of a premorbid mildly jealous attitude (Casey and Kelly 1978) (p.44)

The Rorschach Inkblot Test assesses broad personality characteristics and their behaviour proclivities (Blatt, 1990; Exner,1988; Weiner, 1997) by evaluating cognitive processing via the examination of what the individual has

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Satyadhar Dwivedi, Assistant Professor in Clinical Psychology, Institute of Mental Health and Hospital, Agra, Email: satyadhardwivedi@gmail.com

Key words: Delusion of Infidelity, Delusion, Rorschach Inkblot Test, PSYRATS

assigned to his perceptual experiences (Exner et al,1978; Weiner, 1997). The perceptual cognitive processes that invoke subjects in formulating and articulating their responses provide clues to their characteristic ways of dealing with life experiences and their psychological state and traits. It also helps to understand how they process information and how they prefer to cope with problem solving situation (Weiner, 1997). According to Garber and Kaminski (2002), the responses on the Rorschach protocol conceptualize different types of shortcoming in individual cognitive perceptual processing. Kleinger (1999) has pointed out that delusional disorder and obsessional thinking share some important structural features. Auslander et al, (2002) compared 27 medically stable out patients with paranoid schizophrenia to 17 outpatients with non-paranoid schizophrenia and 45 normal comparison participants. The paranoid patients showed significantly less impairment on Rorschach measures of perceptual inaccuracy and cognitive slippage. Belyi (1991) found that the responses on Rorschach protocols of patients with systematized delusions were similar to those of normal controls and were distinguished only by greater attention to detail.

Kleinger (1991) reported a case of frankly delusional woman whose Rorschach protocol had no indication of perceptual inaccuracy or cognitive distortion.

The present study was an attempt to gather preliminary observations to explore if Exner's Comprehensive Scoring System is sensitive enough to tap and discriminate various kinds of disorders of content of thought specifically, delusion of infidelity, in persons with psychotic illness?

Method:

The sample was collected from the Inpatient Department (IPD) of the Institute of Mental Health and Hospital, Agra. 10 persons with psychotic illness were taken for the study. Five of them had a prominent delusion of infidelity and the other five had delusions other than infidelity. Following tools were administered –

(a) Psychotic Symptom Rating Scale (Haddock et al. 1999) for mapping severity levels of psychotic symptoms. (b) Rorschach Inkblot Test as per Exner Scoring System. 83 variables were scored in each Rorschach Protocol and processed through Kolmogrove-Smirnov Test for group comparisons to identify the scoring variables that could discriminate the groups.

Table 1

Scoring Variables and Kolmogrove-Smirnov Test Values