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Introduction

The RT was made available for use in 1920 when it

was published along with the manual named

psychodiagnostic.1 Test consists of ten page-sized

inkblots that represent the stimulus plates of the

technique. Number of surveys has been conducted in

the USA, India and other countries to find out the

psychological test to be highly accepted and widely

used by the clinicians2 among the entire test the RT has

always been found to have first place in USA, India

and other countries.3

The interpretation of Rorschach protocol in most

of the symptoms is based on the number of responses

given by the subjects. The test has psychometric

qualities and is useful for personality assessment. It has

also been used in many countries. In India extensive

work has been done at Central Institute of Psychiatry,

Ranchi.4 Indian researchers have carried out normative

studies on Indian subjects. The norms, in the form of

the Rorschach indices, established by different Indian

researchers have been followed.

In clinical setup, the RT is frequently and even

regularly administered to resolve the diagnosis. These

diagnostic indicators are generally called for the

following major psychiatric illnesses or conditions:

Schizophrenia, psychosis, depression, hypomania,

anxiety, obsession and organicity.

Apart from these psychiatric categories, many a

times, the RT is advised to understand and study the

personality structure of an individual or patient.5 Patients
Correspondence: Dr. B. Yengkokpam

E-mail: babkokpam@yahoo.com

Comparative study of consultant psychiatrist and clinical psychologist among

psychiatric patients, using rorschach test

B. Yengkokpam1, S. K. Shah1, G.R. Bhantana1, P. Giri 2

1 Lecturer, 2 Medical Officer, Department of Psychiatry, College of Medical Sciences, Bharatpur, Nepal.

Abstract

This comparative study among psychiatric patients attending College of Medical Sciences, teaching

hospital, Bharatpur, Nepal was carried out to determine responses on Rorschach test (RT). A total of 65

diagnosed psychiatric patients as per international classification of diseases (ICD-10) criteria attending

psychiatric OPD between ages of 15 to 65 years, both male and female in the period of January 2009 to

July 2009 were selected. RT was administered and results were tabulated as per diagnosis by clinical

psychologist. Out of total 65 patients who underwent RT, 41 were male and 24 were female in the ratio of

63:37. In clinical psychologist diagnosis- 38 were schizophrenia, 7 were psychotic depression, 6 were

depression, 3 were mania, 1 was organic psychosis and 10 were underlying psychosis and in consultant

psychiatrist diagnosis- 36 were schizophrenia, 5 were psychotic depression, 12 were depression, 8 were

mania, 3 were organic psychosis, 1 was underlying psychosis.

Key words: Rorschach test, international classification of diseases, psychotic depression, organic psychosis,

underlying psychosis.

, 14-17 Original ArticleJournal of College of Medical Sciences-Nepal, 2010, Vol. 6, No. 1

14



are diagnosed as per ICD-10 classification of mental

and behavioral disorders by a consultant psychiatrist.6

Materials and methods
All the cases in this study have been selected from

psychiatry outpatient department of College of Medical

Sciences, teaching hospital, Bharatpur, Nepal, between

January to July 2009. A total of 65 diagnosed

psychiatric patients as per ICD-10 criteria by a

consultant psychiatrist between the ages of 15 to 65

years, both male and female were selected. Patients

were analyzed according to age, sex and symptoms.

RT was administered by clinical psychologist and

results were tabulated as per diagnosis.

Statistical analysis
In the present research study obtained data have been

scored by using standard scoring procedure of the tests.

Chi-square test has been computed to evaluate the

difference between clinical psychologist and consultant

psychiatrist.

Results
       Table-1 shows that out of total 65 patients, who

underwent RT, 41 were males and 24 were females in

the ratio of 63:37, their age ranged from 15 to 65 years

but they are divided into three age groups of 15 to 30,

31 to 46, 47 to 65 years. In the first age group from

15 to 30 years, 42 cases in which 28 were males and

14 were females, in the second age group 31 to 46

years, 20 cases in which 13 were males and 7 were

females and in the third age group of 47 to 65 years

and all the 3 cases of them were females. In Table-2

comparison between clinical psychologist and consultant

psychiatrist, symptom wise distribution: Clinical psychologist

diagnosis: A 38 were schizophrenia, 7 were psychotic

depression, 6 were depression, 3 were mania, 1 was

organic psychosis and 10 were underlying psychosis.

Consultant psychiatrist diagnosis: A 36 were schizophrenia,

5 were psychotic depression, 12 were depression, 8 were

mania, 3 were organic psychosis and 1 was underlying

psychosis. The difference between clinical psychologist

B. Yengkokpam et al. Comparative study of consultant psychiatrist and clinical .............. using rorschach test

15

Table- 1: Age group of patients included in the study

Ages Male % Female % Total %

15-30 28 43 14 21.5 42 64.5

31-46 13 20 7 10.5 20 30.5

47-65 0 0 3 5.0 3 5.0

TOTAL 41 63 24 37 65 100

Table- 2: Clinical psychologist diagnosis and consultant psychiatrist diagnosis

        DiagnosisSymptoms Clinical Consultant df χχχχχ 2 Level of
psychologist psychiatrist (degrees of (Chi significance

freedom) square)

Schizophrenia 38 (55.5%) 36 (55%)

Psychotic depression 7 (10.5%) 5 (7.5%)

Depression 6 (10%) 12 (18.5%) 5 29.11 0.01

Mania 3 (5%)  8 (12.5%)

Organic psychosis 1 (1.5%) 3 (5%)

Underlying psychosis 10 (14.5%) 1 (1.5%)

Total 65 65



and consultant psychiatrist was found to be statistically

significant at 0.01 levels (x2 = 29.11, P < 0.01).

Discussion

Psychiatric diagnoses were based on ICD-10

criteria. Recent research has revealed that norms cannot

be used from one country to another and differences

within the same cultural group are also to be found.7, 8

The Rorschach norms were established by

researchers in India differ considerably.9 Most of these

studies had a number of shortcomings the most

important being the relatively small sample size from

one center, which was not representative of the service.

In the absence of reliable norms, mental health

professionals in India are left with no alternative but to

interpret. Our aim in this study was to divide the patients

in subgroups based on the age, sex and symptoms wise

distribution. General background information and

behavioral data that are generally considered to be of

importance in finding symptoms could be illuminating

for this purpose. Differences in terms of such additional

data would support the meaningfulness and validity of

the suggested sub groupings.

Our results suggest that these patients display a

rather complex pattern of psychological functioning,

with emotional encumbrance and also a more complex

psychological relation to symptoms itself. Although

psychological resources were higher in this group, there

were also more psychological factors possibly

counteracting. Out of the sample of total 65 patients,

who underwent RT, 41 were males and 24 were females

in the ratio of 63:37. There are differences between

Clinical psychologist diagnosis and Consultant

psychiatrist diagnosis as shown in table-2. In Clinical

psychologist diagnosis 38 were schizophrenia, 7 were

psychotic depression, 6 were depression, 3 were mania, 1

was organic psychosis and 10 were underlying psychosis.

But in Consultant psychiatrist diagnosis: A 36 were

schizophrenia, 5 were psychotic depression, 12 were

depression, 8 were mania, 3 were organic psychosis and

1 was underlying psychosis. The results of this study

indicate that there were clinically meaningful in the

diagnosis of a psychiatric disorder.

Acute schizophrenics are quick and impulsive as

the normal inhibition is lifted in them. This trend is in

agreement with some studies though one study

observed longer RT in schizophrenics which may be

attributed to differences in the sample characteristics.

A chronic schizophrenic is likely to have a longer RT

as compared to an acute schizophrenic. The RT of

head injury and epilepsy patients was significantly more

than the RT of the psychotic subjects, which is in

agreement. In this study, we investigate the reliability,

and diagnostic efficiency of the RT in relation to the

accurate identification of patients diagnosed with ICD-

10 criteria, schizophrenia or other psychotic disorder.

Finally, this variable could be employed for classification

purposes in ways that were clinically meaningful in the

diagnosis of a Psychotic disorder. Conceptual and

methodological issues are discussed in relation to the

assessment of psychosis.10

Ilonen et al. reported out of twenty-seven patients

with first-episode schizophrenia, 13 with bipolar I

disorder, 28 with psychotic depression, 29 with non-

psychotic depression, and 60 healthy controls were

recruited for the study. The schizophrenic was highly

specific with a very low false positive rate. The lowest

positive value of 4, however, may yield false positives,

especially among manic patients. The depressive

disorder patients identified severe non-psychotic

depression but not psychotic depression, suggesting

that these patient groups invoke different perceptual-

Journal of College of Medical Sciences-Nepal, 2010, Vol. 6, No. 1

16



cognitive processes in formulating and articulating their

Rorschach responses. Anyway, both the schizophrenic

and the depressive disorder patients based on the

psychological organization and functioning that are

known to play a clearly formulated role in schizophrenia

and depression, respectively, provide a valuable

addition for diagnostics characterized by overt

symptoms.11

Finally, it is important to consider that this research

opens an area of interest for the study of human behavior

in the definition of conduct. The present findings

although preliminary, shed some light into this matter.

Furthermore, these results are concordant with

diagnostic and semiologic instruments such are those

suggested by Kandel12 and Kaplan13, among others.

In the genesis of these clinical conditions we must

consider genetic factors as well as environmental issues

such as parental relations, social stressors, work-

related stressors, familiar stressors.14

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Bircher, Bern 1921:12.

2. Dubey BL. Rorschach analysis of importance cases and

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3. Fiske DW, Baughman EE. Relationship between

Rorschach scoring categories and total number of

responses. J.Abnor Soc Psychol 1953; 48: 25-32.

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5. Asthana HS. Some aspects of personality structuring

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