Case Report
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatr. Sep 22, 2016; 6(3): 381-390
Published online Sep 22, 2016. doi: 10.5498/wjp.v6.i3.381
Understanding the paranoid psychosis of James: Use of the repertory grid technique for case conceptualization
Helena García-Mieres, Susana Ochoa, Marta Salla, Raquel López-Carrilero, Guillem Feixas
Helena García-Mieres, Susana Ochoa, Raquel López-Carrilero, Development Unit of Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, 08330 Barcelona, Spain
Helena García-Mieres, Marta Salla, Guillem Feixas, Department of Personality, Assessment and Psychological Treatments, Faculty of Psychology, University of Barcelona, 08035 Barcelona, Spain
Author contributions: García-Mieres H, Ochoa S and Feixas G designed the report; García-Mieres H and López-Carrilero R collected the patient’s clinical data; García-Mieres H and Salla M wrote the first draft of the paper; and Feixas G and Ochoa S revised the paper to produce the final version.
Supported by The Departament d’ Educació i Universitats de la Generalitat de Catalunya and the European Social Fund by means of a fellowship given to the first author, and by the Instituto de Salud Carlos III (Spanish Ministry of Health), research grant number PI14/00044, from the Fondo Europeo de Desarrollo Regional (FEDER).
Institutional review board statement: The study was reviewed and approved by ParcSanitariSant Joan de Déu Institutional Review Board.
Informed consent statement: The case provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There is no conflict of interests.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Helena García-Mieres, MD, Department of Personality, Assessment and Psychological Treatments, Faculty of Psychology, University of Barcelona, Passeig de Valld’Hebrón 171, 08035 Barcelona, Spain.
Telephone: +34-93-3125100
Received: April 13, 2016
Peer-review started: April 15, 2016
First decision: May 19, 2016
Revised: May 28, 2016
Accepted: August 11, 2016
Article in press: August 13, 2016
Published online: September 22, 2016

In this paper we illustrate the potential of the repertory grid technique as an instrument for case formulation and understanding of the personal perception and meanings of people with a diagnosis of psychotic disorders. For this purpose, the case of James is presented: A young man diagnosed with schizophrenia and personality disorder, with severe persecutory delusions and other positive symptoms that have not responded to antipsychotic medication, as well with depressive symptomatology. His case was selected because of the way his symptoms are reflected in his personal perception of self and others, including his main persecutory figure, in the different measures that result from the analysis of his repertory grid. Some key clinical hypotheses and possible targets for therapy are discussed.

Keywords: Persecutory delusions, Personal constructs, Schizophrenia, Repertory grid technique, Case formulation

Core tip: The repertory grid measures indicated that the patient’s meaning system was strongly articulated around a very negative view of self, and by symptomatic constructs related to fear, anxiety, sense of loneliness, and perceived aggressiveness in others. Furthermore, constructs related to hostility dominated his perception of his persecutory figure and also of his parental figures. Based on this appraisal, the case formulation was suggested as a focus for psychotherapy to enhance his self-esteem and deal with family conflicts.