(2012).Suicide  Prevention  (SUPRE) schizophrenia patients.  

Schizophrenia is heterogeneous group of disorders characterized in general by fundamental and characteristic disorders of thinking and perception, and by inappropriate or blunted affect, poor emotional control, and ineffective interpersonal relationship, positive symptoms, negative symptoms, and disorganized behaviors. The chronic schizophrenia is operationally defined when the duration of illness is more than two years. Patients may have more deficits symptoms such as social withdrawal, under activity, blunt affect, apathy and lack of initiative.  

Projective technique is a psychological assessment procedure which helps the respondents in projecting theirunconscious material and feelingson ambiguous stimuli. The somatic Inkblot Series (SIS-II) is a semistructured, projective, diagnostic procedure helps in understanding the psychopathology of the case. It further helps in the management of the case as therapeutic intervention tool (Cassell and Dubey, 2003). The SIS-II indices are used as measures of ego strength, interpersonal relationship, social isolation tendencies, imaginative capacity, functional intelligence, psychologically immaturity, self-image, sexual anxiety and thought process. The review of literature on SIS reveals that SIS- II (Booklet form) has been used in various psychiatric disorders (Cassell and Dubey, 1980,1980a, 1990, 2003, 2004, Dosajh, 1998, Vermaet al., 1994; 1996; Prasad et al., 1997; Rathee et al., 1995; 2002, Singh and Dubey, 1997; Singh et al., 1997; Kumari et al., 2009). It would be of interest to see if the chronicity of illness produces a different picture on inkblots perception. The present study was carried out to comparethe SIS-IIindices of non-chronic and chronic schizophrenia patients and to identify SIS-II indices that differentiate these two groups. 

Materials and Method: 

Sample: 

Thirty non-chronic and 30 chronic schizophrenia patients, using purposive sampling were selected from the LGBRIMH, Tezpur, Assam (India). The patients were diagnosed schizophrenia as per ICD – 10 diagnostic criteria.The patients with duration of illness two years or more were considered as chronic schizophrenia and with less than one year of duration were considered as nonchronic schizophrenia. They were in the age range of 20 to 50 years (with mean age 20.9 ± 7.27 years for non-chronic patients and 34 ± 4.38 years for chronic patients). The Mean duration of illness was 7.93 _± 2.59 months for non-chronic group and 78.4 _± 25.35 months for chronic patients. Majority of the patients were literate, employed and married.

Tools: 

Socio-demographic and Clinical Data Sheet was used to collect the information about patients. Brief Psychiatric Rating Scale (BPRS) was used to assess severity of symptoms of schizophrenia. Patients with severe level of psychopathology were excluded to ensure proper understanding of instructions. 

Procedure: 

SIS-II test was administered individually and the scoring of the responses was done as per given procedure (Cassell and Dubey, 1993). The consent of the patients was obtained.   

Statistical Analysis: 

Data was statistically analyzed using Chisquare for group comparison, Pearson’s product moment correlation to find out correlation between variables and SIS 

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indices, and Stepwise discriminant function analysis to identify discriminating variables. 

Result and Discussion: 

The mean and S.D. of SIS-II indices in two groups are given in Table1. The findings show non- significant difference between both the groups on Total no of responses (R), Animal responses (A), Anatomical responses (At), Movement responses (M), Most Typical responses (MT),Typical responses (T), Atypical responses (AT), and Rejection of images (Rej). It suggests that performance of both groups was similar on variables related to imaginative capacity, self- image, logical thinking, psychological or psychiatric disturbance and thought process. Similar response pattern have been observed in previous studies on schizophrenia patients (Verma et al., 1994; 1995; Kumari et al., 2009, Kandhari et al., 2010). 

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Chronic schizophrenia patients gave more Human responses (M=27.33 _± 7.48) in comparison to Non-chronic schizophrenia patients (M=25.26 _± 5.30). The difference of Human responses was statistically significant 

(χ²=25.60, p<.05) suggesting more psychological immaturity in non-chronic schizophrenia patients. Similar findings have been reported in comparison of acute and chronic schizophrenia patients (Vives, 1983; Gomila, 2011).

Analysis of sex responses (Sex) suggests that non-chronic schizophrenia patients gave significantly less number of sex responses (M= .66 _± .75) in comparison to chronic schizophrenia patients (M = 4.8 _± 2.87). The significantly difference (χ²=34.40, p< .001) on sex responses may suggests that chronic schizophrenia patients were more expressive about sexual content in comparison to nonchronic schizophrenia patients. More sex 

responses have been reported to be associated with sexual anxiety and/or dysfunction (Cassell, 1980,1980a).

To find out correlation between age at onset of illness and duration of illness with SIS-II indices, Pearson’s product moment correlation was computed (Table 3). No significant correlation was found between age at onset of illness and SIS indices. However, in non-chronic schizophrenia patients with increasing age at onset of illness the total number of responses increased. Duration of illness was significantly negatively correlated with animal response and positively correlated with sex and movement response. It shows that sex and movement responses increased with increasing duration of illness and animal responses decreased with increasing duration of illness.  

Stepwise Discriminant Function Analysis (Table 4) was performed to examine classification accuracy of SIS-II variables in discriminating the two group of patients.  

The results show that 30% of chronic schizophrenia patient showed similar response indices as non-chronic schizophrenia patients. Seventy percent chronic schizophrenia patient showed significantly different response indices as compared to non-chronic schizophrenia patients. Sex (Wilk’s Lamda value .955) and AT (Wilk’s Lamda value.492) responses were most discriminating variables with classification accuracy of 85% with a sensitivity of 100% and specificity of 70%. 

SIS Profile of Schizophrenic Patients: 105

High discriminant value suggests SIS indices of Sex and AT can discriminate between chronic and non-chronic schizophrenia patients. 

Conclusion: 

The findings suggest that non-chronic schizophrenia patients tend to have more social isolation tendencies and higher sexual anxiety in comparison to chronic schizophrenia patients. Duration of illness affects a few of the SIS-II indices. Sex and AT response are most discriminating variables for chronic and non-chronic schizophrenia patients. 

References: 

Cassell, W. A. (1980) Body Awareness and Somatic Delusions Involving Sexual Organs. American J.of Psychoanalysis, 40: 125-135. 

Cassell, W. A. (1980a) Somatic Inkblot Series- II Aurora communication, Inc. 

Cassell, W.A. and Dubey, B. L. (1990) Interpreting Inner world through Somatic Imagery: Manual or the somatic in Somatic Inkblot Series, SIS Centre, Anchorage, AK 99516 (USA). 

Cassell, W, A. and Dubey, B. L. (2003) Interpreting Inner World through Somatic Imagery: Manual of Somatic Inkblot Series. Anchorage (USA): SIS Center. 

Cassell, W, A. and Dubey, B. L. (2004) Somatic Inkblot Series: Historical Background and Earlier Projects, SIS Journal of Projective Psychology & Mental. Health, 11:11-18 

Dosajh, N. L. (1998)   Use of SIS-II and other Projective Tests in the Treatment of a Case of Schizophrenia. SIS Journal of Projective Psychology & Mental Health, 5: 46-50. 

Frank L.K. (1939) "Projective methods for the study of personality" The journal of psychology 8, 389-414 

Gomila, M. V., (2011) The Rorschach test in the differential diagnosis of 245 schizophrenic inpatients, Annuary of Clinical and Health Psychology, Volume 07 , Pages 79 to 93 

Kandhari, S., Sharma, J. and Kumar, R., (2010) Discriminating Power of the Comprehensive Scoring System for SIS-I, SIS J. Proj. Psy.& Ment. Health 17 : 16-22 

Kumari. D., Prakash, J., Singh. A. R., and Chaudhury. C. (2009) Personality prfile of Schizophrenia and Bipolar Affective Disorder (Mania on SIS- II, SIS J. Proj.Psy.&Ment. Health, 16: 134-137. 

Overall, J.E. and Gorhan, D. R. (1963) The BPRS Recent Development in ascertaining and scaling, Psycho-pharmacological Bulletin, 24(1), 93-97. 

Pershad, D., Verma, S. K. and Bhagat, K. (1997) Body Image Disturbance in Psychiatirc Cases, SIS J. Projective Psychology & Mental Health, 4 91) :6068. 

Rathee, S.P., Pande, V. and Singh, A. (1995) Diagnostic efficacy of Somatic Inkblot Series-II among Psychiatric Patient of Armed Forces.SIS journal of Projective psychology and Mental Health, 2(1), 6166. 

Singh,A.R., Dubey, B.L. and Banarjee K. R. ( 1997) Prognosis utility of Somatic Inkblot Series-II, SIS Journal of Projective Psychology and Mental Health 4( 2), 141-144. 

Verma, S. K., Pershad, D. and Nehra, R. (1994) CrossValidation of SIS-II in Psychiatric Population. SIS Journal of Projective Psychology & Mental Health, 1: 15-18. 

Verma, S. K., Pershad, D., Kaur, R. and Nehra, R. (1995) Diagnostic Significance of SIS-II. SIS Journal of Projective Psychology & Mental Health,  2: 72-76. 

Vives, M. (1983).Analisis of Rorschach data from acute andchronic Spanish schizophrenics.Estudio no. 291 (inedito) de la Rorschach Workshops.