The Association of Rorschach Measures of Thought Disorder, Psychological Complexity and Interpersonal Representations with Everyday and Social Functioning in People with Schizophrenia

Research has demonstrated that cognitive impairment and negative symptoms are associated with impairments in everyday and social functioning in people with schizophrenia. However, research has not previously examined whether thought disorder, disturbances in thinking, psychological complexity, and interpersonal representations are also contributing to the everyday and social functioning impairments that are prevalent in this population. It was hypothesized that patients with greater thought disorder and less psychological complexity would exhibit greater 'real-world' functional impairment than patients with less thought disorder and greater psychological complexity. It was also hypothesized that a patient's interpersonal representations of self and others would impact their capacity to engage in appropriate social interactions. Seventy-two racially diverse middle-aged and older outpatients with schizophrenia (mean age 51.17 +/- 6.52 yrs) were administered the Rorschach Performance Assessment System (R-PAS) and two performance-based measures of functioning: the UCSD Performance-Based Skills Assessment (UPSA) and Social Skills Performance Assessment (SSPA). Assessment in the following domains was compared to UPSA and SSPA performance: (i) thought disorder and psychological complexity, as measured by the R-PAS Ego-Impairment Index-2 (EII-2) and Response Complexity Variable, respectively; and (ii) interpersonal representations, as measured by the R-PAS Human Representational Variable (HRV), Human Content (H: (H)+(Hd)+Hd), and Mutuality of Autonomy Scale (MAR). Relationships between these constructs and cognitive functioning, positive and negative symptoms, and depression were also explored. A significant correlation was found between psychological complexity and UPSA performance, but not between EII-2 and the UPSA. In a regression model, significant main effects were found of thought disorder for everyday functioning (beta = -0.28, p = 0.04) and of complexity for everyday The Association of Rorschach 4 functioning (beta = 0.42, p = 0.001), but the interaction between thought disorder and everyday functioning was not significant. No significant relationships were found between SSPA and HRV, Human Content, or MOA. However, subcomponent analyses revealed significant relationships between some of these variables (Scene 1 of SSPA and HRV, MOA Health Index (MAH), and Good Human Representations (GHR)). Exploratory analyses found significant relationships between (i) thought disorder, positive symptoms, and cognitive functioning, and (ii) psychological complexity, negative symptoms, everyday functioning, and social functioning. Lastly, regression analyses incorporating the impact cognitive status and negative symptoms together with psychological complexity showed that psychological complexity predicted everyday and social functioning in people with schizophrenia above and beyond the impact of cognitive status, but not negative symptoms. This data suggest that the constructs of thought disorder and psychological complexity, together, play a role in the functional limitations seen in schizophrenics. This data also suggests that psychological complexity and healthy object relations functioning are related to social functioning, with greater cognitive motivation, cognitive capacity for problem-solving and healthy mental schemas of the self and others as autonomous individuals positively associated with social competence. Clinical implications include novel information for future development of cognitive remediation treatment strategies based on a patient's developmental level of psychological capacity and interpersonal schemas.