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Background Consistent with the contemporary literature that psychosis constructs are best represented as continuous syndromes, this study aims to determine if dimensional psychosis measures outperform traditional categorical measures, thereby improving detection of symptom severity. The Rorschach Performance Assessment System (R-PAS) contains meta-analytically supported internationally normed scales for assessing disordered thinking and reality testing that have been replicated in many countries. Given the literature trend of utilizing a dimensional approach when assessing psychosis, a dimensional R-PAS scale for assessing disordered thinking was recently developed. Therefore, it is important to determine if this new measure outperforms the traditional measure. We also attempt to replicate recent research by deconstructing the key components of psychosis (e.g., disorganized thinking, hallucinations, and negative symptoms) and evaluating the validity of the R-PAS measures designed to assess these constructs. Methods Our study uses an archival clinical sample of 70 male inpatients with schizophrenia, schizoaffective, and major depressive disorder (Mean age = 41.9, Range 20 to 63) that were collected as part of an IRB-approved research project. Two trained diagnosticians independently interviewed the patients using the Structured Clinical Interview for DSM (SCID) and blindly assigned diagnoses as well as Brief Psychiatric Rating Scale (BPRS) ratings. Interrater reliability of their ratings using ICCs will be computed. The Rorschach was administered and relevant R-PAS variables were scored by trained research assistants. The new R-PAS dimensional measure of disorganized thinking (SPCT) will be coded by the first author, and a subset of protocols will be blindly coded by the third author. Interrater reliability will be computed for all variables. Results First, we will conduct correlational analyses to test the relationship between clinician ratings of disorganized thinking (on the BPRS Conceptual Disorganization and relevant SCID criteria) and the traditional measure of disorganized thinking on R-PAS (WSumCog). We will then use hierarchical regression analyses to determine whether the new dimensionalized measure of disorganized thinking (SPCT) provides incremental prediction of the clinician ratings of disorganized thinking on the BPRS and SCID-P over the traditional R-PAS measure (WSumCog). To replicate previous research, we will test the relationship between negative symptom ratings (on the BPRS and SCID) and R-PAS measures of behavioral, perceptual, and emotional task engagement (Complexity & FQ-%). Further, we anticipate that clinician ratings of delusions (on the BPRS and the SCID) will correlate with R-PAS measures of inaccurate understanding of human intention and action (M-) and illogical thinking (SPCT Illogical Thinking subscale). Lastly, we use correlational analyses to test the relationship between clinician ratings of hallucinations (on the BPRS and SCID) and an R-PAS measure of visual misperceptions (FQ-%). Discussion Implications of this research provide additional validation for assessing key components of psychosis with a standardized internationally normed measure. Psychosis components (e.g., poor reality testing) limit the accuracy of patients’ self-reported symptoms and inflate rates of misdiagnosis; these R-PAS measures provide a framework for clinicians to behaviorally assess symptoms on a continuum ranging from nonclinical to severe psychosis-level disturbance. This research will aid in more accurate symptom assessment, thereby improving prognosis and treatment planning.

The Social Cognition and Object Relations Scale-Global Rating Method (SCORS-G) examines narrative data on eight dimensions of personality functioning. Research has demonstrated reliability and validity of the SCORS-G, but clinical utility is limited by the lack of data from nonclinical samples to provide a normative basis for interpreation. Bram (2014) introduced data from 63 college students, and the present study sought to extend this normative perspective with data from 140 nonpatient adults from the Eugene-Springfield Community Sample (ESCS). Narrative data obtained using five stimulus pictures from the Picture Story Exercise (PSE; Smith, 1992) demonstrated good to excellent inter-rater reliability across three raters. Median scores for the eight dimensions are generally near the midpoint, and the factor structure replicates that reported by Siefert et al. (2018). Suggestions are offered for establishing formal norms for the SCORS-G.

Background Research is increasingly pointing toward the need for a dimensional, rather than categorical, conceptualization of psychopathology. This is particularly true within the literature on psychosis and related disorders. Taking a dimensional approach to conceptualizing psychosis requires deconstructing its components in assessment. The Rorschach Performance Assessment System (R-PAS) contains meta-analytically supported scales with international norms that are used to categorically rate signs of disordered thinking and perceptions in individuals’ responses to the Rorschach inkblots. Recently, a new dimensionalized set of scales called the Scales of Problematic Communication and Thinking (SPCT) have been developed for R-PAS with three main components: Disturbed and Confusing Communication, Illogical Verbal Justification, and Incongruous Perceptual Combinations. Research also suggests that linguistic measures of speech cohesion can be used to successfully predict conversion to psychosis in clinical high-risk patients and may be more related to stable neurocognitive deficits than clinical measures of disorganized speech. Coh-Metrix, an automated speech analysis software, provides over 100 specific measures of linguistic cohesion, such as connectivity, syntax simplicity, and referential cohesion. The purpose of this presentation is twofold: (a) to report recent findings showing the SPCT provides incremental validity over the traditional R-PAS measure of disordered thinking in predicting clinician ratings of disorganized thinking on the PANSS and (b) to determine if Coh-Metrix measures of linguistic cohesion provide incremental validity to SPCT ratings in predicting these PANSS ratings. Methods R-PAS protocols from a maximum-security inpatient forensic hospital (N = 91) aged 19 to 80 years (M=40) and predominantly male (89%) were coded for thinking and perceptual disturbances using the R-PAS traditional measure of disordered thinking and the 6-point dimensional SPCT measure. The patients’ primary clinician provided PANSS ratings. Protocols will be coded for speech cohesion using 15 indices from the automated speech analysis software Coh-Metrix, which were chosen based on a literature review. Results Interrater reliability was excellent for the SPCT ratings (ICC = 0.97) and good for the PANSS clinician ratings (ICC = 0.71). In a previous study, SPCT ratings showed significant associations with the clinician ratings of disorganized thinking on the PANSS (r = 0.42, p < 0.01, N = 90); hierarchical regression analyses demonstrated incremental validity over the traditional R-PAS measure of disordered thinking (ΔR = 0.28, p < 0.01). Using hierarchical regression analyses, the Coh-Metrix indices of cohesion are predicted to provide incremental validity to the SPCT ratings. Discussion The SPCT shows promise as a reliable and valid dimensionalized measure for assessing the continuum of clear thinking to psychosis-level disturbances. The measures of linguistic cohesion provided by Coh-Metrix have the potential to offer clinicians a quick, efficient, and objective method for assessing disorganized thinking. The R-PAS international norms are currently being coded for SPCT and, if Coh-Metrix measures provide incremental validity, will be coded for these measures as well. Using these measures in combination with SPCT ratings can provide clinicians with a clearer understanding of this significant component of psychosis.