A prospective study of personality as a predictor of quality of life after pelvic pouch surgery.

BACKGROUND: Surgeons often "know" preoperatively which patients will achieve good postoperative quality of life (QOL). This intuition is probably based on impressions of the patient's personality. The present aim was to examine whether preoperative personality traits predict postoperative QOL. METHODS: In 53 patients undergoing pelvic pouch surgery for ulcerative colitis the relationship between preoperative personality traits, and surgical functional outcome and QOL was examined at a median of 17 months postoperatively. Personality assessment instruments (KAPP and KSP), and specific measures of alexithymia were used. Postoperatively, the Psychosocial Adjustment to Illness Scale (PAIS), and surgical functional outcome scales were used. RESULTS: Using multiple correlation/regression, analysis lack of alexithymia, poor frustration tolerance, anxiety proneness, and poor socialization (resentment over childhood and present life situation) were found to predict poor postoperative QOL. CONCLUSIONS: The findings suggest personality traits, in addition to surgical functional outcome, to be important for the patient's postoperative QOL.

A prospective study of the quality of life after pelvic pouch operation.

BACKGROUND: For surgeons familiar with pelvic pouch operation, it is disappointing that the patients, although very satisfied to have a pouch instead of an ileostomy, often have difficulty in specifying exactly how their quality of life really has improved. The present study is an attempt to examine this situation. STUDY DESIGN: In 48 patients with ulcerative colitis undergoing pelvic pouch operation, quality of life (QOL) was studied prospectively when the patients had an ileostomy, and at follow-up evaluation at least one year after restitution of anal defecation. The surgeons' evaluation of functional outcome was compared with those of three independent evaluators (the patient, a psychiatrist, and a psychologist). The Psychosocial Adjustment to Illness Scale, the Well-being Profile, the Global Assessment of Function Scale, and surgical evaluation scales were used. RESULTS: As assessed by surgeons using the surgical evaluation scales, functional outcome correlated significantly with most of the assessments of QOL done by the three independent evaluators (the patient, a psychiatrist, and a psychologist). Quality of life did not improve with increasing time, either with an ileostomy or with a functioning pelvic pouch. On most evaluations, there was no further significant improvement in QOL after restitution of anal defecation. CONCLUSIONS: The findings suggest that QOL is already satisfactory after "cure" of the disease, and restitution of normal defecation does not yield much further improvement.

Relationship between components of alexithymia as measured with psychodynamic ratings and subjective lack of well-being.

Two alexithymia-related characterological patterns, identified by means of psychodynamic assessments in a study of patients with ulcerative colitis, were further investigated regarding subjective lack of well-being. The multidisturbed group (with disturbances in interpersonal relations) was symptomatically characterized by more sadness and by less initiative, but manifested less anxiety, enjoyed sex and slept well at night. The inhibited group was characterized by the opposite. The groups could not be discriminated on the basis of their general adaptive level of functioning. Our results suggest that alexithymia may have several dimensions, associated with different characterological disturbances and symptoms.

Stability over time of character assessment using a psychodynamic instrument and personality inventories.

In a group of patients with a preoperative diagnosis of ulcerative colitis, the stability of character traits and modes of mental functioning were studied after a major life event, major abdominal surgery, using the Karolinska Psychodynamic Profile (KAPP), an interview-based assessment instrument founded upon psychoanalytic theory. In addition, different personality and temperamental variables were assessed with 2 self-report instruments. The patients were assessed before surgery, and follow-up was made at least 1 year after their final scheduled surgery. Although the patients had undergone major abdominal surgery and convalescence between the assessments, the correlations between the scores before and after surgery were very high, and the levels of the scores were very similar. This was true for all the instruments, indicating that they assessed stable characteristics in the patients. The changes that did occur were mainly in the predicted direction. The results of this study suggest that the KAPP can assess modes of mental functioning and character traits that are relatively stable and only slowly variable.

The concept of alexithymia: an empirical study using psychodynamic ratings and self-reports.

In patients with ulcerative colitis, alexithymia and related traits were studied using the Karolinska Psychodynamic Profile (KAPP), a recently constructed psychodynamic assessment instrument, and other measures of alexithymia (the Schalling-Sifneos Personality Scale (SSPS) and the Beth Israel Questionnaire (BIQ)), and other personality traits using the Karolinska Scales of Personality (KSP). The results of these measures were analyzed for correlation. The prevalence of mental disorder as defined by DSM-III was not above normal, and the KSP T-scores were within normal limits. As rated with the KAPP, alexithymia was uncorrelated with age or level of education, but was inversely correlated with proximity to a major life event (abdominal surgery), suggesting that alexithymia may have a defensive function. Cluster analysis, with Regression in the service of the ego (R), Alexithymia (A) and Normopathy (N) as clustering variables, yielded 3 groups: normal, multidisturbed (problems with R, A and N) and inhibited (problems with R and N). SSPS failed to distinguish between the multidisturbed and the inhibited groups, and BIQ between any groups. In the multidisturbed group, correlations were found with detachment and with disturbances in interpersonal relations. The results suggest that disturbances in object relations are of major importance in alexithymia.

Karolinska Psychodynamic Profile. KAPP.

The Karolinska Psychodynamic Profile, KAPP, is a rating instrument founded upon psychoanalytic theory. Its validity is satisfactory, and high interrater reliability can be attained with modest training of the raters in using the instrument. It enables relatively stable and only slowly variable modes of mental functioning and character traits to be assessed psychodynamically. The profile is based upon eighteen subscales, by means of which these modes of mental functioning and character traits can be represented. The subscales have been chosen with a view to obtaining a comprehensive assessment of modes of mental functioning and character traits, as reflected in the patient's self-image and relationships with others. The subscales and their scale steps have been provided with relatively detailed descriptions which are kept close to clinically observable phenomena. The information needed for making the assessments is obtained through a structural interview procedure. The manual, the subscales and their scale steps, and the assessment procedure is presented.

The Karolinska Psychodynamic Profile. I. Validity and dimensionality.

The Karolinska Psychodynamic Profile (KAPP) is a new rating instrument based on psychoanalytical theory that is intended to assess relatively stable modes of mental functioning, as they appear in self-perception and in interpersonal relations. The 18 subscales of the KAPP and their scale steps are described in detail. The information needed for assessment is obtained through a structural interview procedure. The KAPP can discriminate between patients with and without a DSM-III diagnosis. It does not appear to be sensitive to the strain of a major life event. Comparison between interview-based ratings and projective test-based ratings shows satisfactory agreement and similarities in factor structure. The KAPP appears to possess both discriminative and construct validity.

The Karolinska Psychodynamic Profile. II. Interdisciplinary and cross-cultural reliability.

The Karolinska Psychodynamic Profile (KAPP) is a rating instrument based on psychoanalytical theory, that is intended to assess relatively stable modes of mental functioning, as they appear in self-perception and in interpersonal relations. The 18 subscales of the KAPP and their scale steps are described in detail and kept close to clinically observable phenomena. The information needed for assessment is obtained through a structural interview procedure. The interrater reliability was tested with different Swedish raters with varying psychodynamic training and experience. It was also tested with a non-Swedish rater with psychoanalytic training. The interrater correlations were generally high, suggesting that the KAPP has interdisciplinary and cross-cultural reliability.