Psychological distress and functional impairment in patients with personality disorders.

The study is aimed at investigating the impact of a personality disorder (PD) diagnosis, in terms of functional impairment and subjective distress, in order to better understand the burden of this diagnosis and its implications. Among the 462 consecutive psychiatric patients diagnosed with the DSM structured interview for Axis I, II and V diagnoses, almost 60% had PD. Patients with PD displayed considerable vulnerability and suffering in many domains, including finances and interpersonal relationships.

Unstable identity and prefrontal injury.

Introduction: In neuropsychological research, "organic personality disorder", lack of social insight, and executive dysfunctions have been identified in patients with prefrontal brain injury. The assessment of personality change has, in particular, been a methodological challenge in this field of research. The aim of the present pilot study was to examine personality aspects in patients with prefrontal brain injury from a neuropsychological as well as a psychodynamic point of view.

Manualized supportive-expressive psychotherapy versus nonmanualized community-delivered psychodynamic therapy for patients with personality disorders: bridging efficacy and effectiveness.

Objective: Time-limited manualized dynamic psychotherapy was compared with community-delivered psychodynamic therapy for outpatients with personality disorders.

Method: In a stratified randomized clinical trial, 156 patients with any personality disorder diagnosis were randomly assigned either to 40 sessions of supportive-expressive psychotherapy (N=80) or to community-delivered psychodynamic therapy (N=76). Assessments were made at intake and 1 and 2 years after intake.

The development of depression during psychodynamic group psychotherapy among subjects in substance abuse remission.

The aim of the present study was to examine the development of self-reported depression during psychodynamic group therapy among patients manifesting a history of substance use-related problems between 1993-2000. Subjects (n = 100) were prospectively followed with respects to depression levels at intake and after 6, 12, and 18 month in therapy. Depression was measured with the Beck Depression Inventory.

Change after long-term psychoanalytic psychotherapy.

Psychoanalytic psychotherapy in clinical practice is traditionally a long-term treatment conducted by well-trained psychotherapists. However, very few studies have been published that evaluate the effects of such treatment. To redress this lack of studies, 55 individuals selected for long-term psychoanalytic psychotherapy (average, 3 years) were invited to participate in a naturalistic study.

Change in the core conflictual relationship theme after long-term dynamic psychotherapy.

This naturalistic study focuses on changes in central relationship patterns after long-term dynamic psychotherapy (mean duration = 3 years) with experienced psychotherapists. Relationship patterns before and after treatment were assessed according to the core conflictual relationship theme (CCRT) method, which includes 3 components: most frequent wish, response from others, and response of the self. Overall, the main CCRT did not change substantially after therapy.

Personality traits predicting long-term adjustment after surgery for ulcerative colitis.

Very few studies have examined the relationship between personality traits and long-term postoperative psychosocial adjustment. In a sample of 46 patients, we examined the relation between personality traits before pelvic pouch surgery for ulcerative colitis and psychosocial adjustment seven years postoperatively, controlling for the effects of surgical functional outcome. The Karolinska Psychodynamic Profile (KAPP) was used for personality assessment.

Psychological factors in irritable bowel syndrome: a population-based study of patients, non-patients and controls.

Background: It has been suggested that psychopathology in irritable bowel syndrome (IBS) patients is a function of patient status rather than of the disease. Although there are many studies comparing IBS patients, IBS non-patients, and controls with each other, no previous study has recruited all three groups from a representative community sample and had all subjects diagnosed by a physician. In the present study we aimed to compare psychological factors in IBS patients, IBS non-patients, and normal controls in a sample recruited from the population.

A longitudinal study of long-term quality of life after ileal pouch-anal anastomosis.

Background: There is a lack of longitudinal long-term studies of quality of life (QOL) after surgery with ileal pouch-anal anastomosis (IPAA) for ulcerative colitis, where cohorts of patients are used as their own controls.

Methods: Forty ulcerative colitis patients who had undergone IPAA were prospectively assessed while they had a temporary ileostomy, and at a median of 18 months and 7 years after ileostomy closure. QOL was measured with the Psychosocial Adjustment to Illness Scale and the Well-Being Profile.

Psychological Factors in Irritable Bowel Syndrome: a Population-based Study of Patients, Non-patients and Controls.

Background: It has been suggested that psychopathology in irritable bowel syndrome (IBS) patients is a function of patient status rather than of the disease. Although there are many studies comparing IBS patients, IBS non-patients, and controls with each other, no previous study has recruited all three groups from a representative community sample and had all subjects diagnosed by a physician. In the present study we aimed to compare psychological factors in IBS patients, IBS non-patients, and normal controls in a sample recruited from the population.

Patient factors predicting dropout from supportive-expressive psychotherapy for patients with personality disorders.

In this prospective study of psychiatric outpatients with personality disorders, the authors examined patient factors that predicted dropout from supportive-expressive (SE) psychotherapy. Eighty patients were randomized to 40 sessions of time-limited SE psychotherapy. The dropout rate was 35%; 50% of dropouts terminated psychotherapy before Session 7, and 10% were nonengagers.

The central relationship questionnaire (CRQ): psychometric properties in a Swedish sample and cross-cultural studies.

The Core Conflictual Relationship Theme (CCRT) method is one of the most widely used and tested instruments developed within a psychoanalytic context for assessing central relationship patterns or characteristic patterns of relating to others. The Swedish version of the Central Relationship Questionnaire (CRQ), a recently developed self-report instrument based on the CCRT, was tested in a sample of Swedish psychology students (31 men, 60 women) and compared with responses of Swedish outpatients (15 men, 15 women) and North American students (49 men, 49 women). The subscales of the Swedish CRQ showed acceptable internal consistency and correlated with each other in a predictable fashion, displaying a pattern of intercorrelations similar to the English version.

A population study on irritable bowel syndrome and mental health.

Background: Irritable bowel syndrome (IBS) is commonly thought to be associated with psychologic distress. However, in some studies only persons who had sought medical care for IBS (IBS patients) showed an increased frequency of psychiatric symptoms, and nonpatients did not differ significantly from normal subjects. Our aims were 1) to estimate the prevalence of IBS in the population aged 18-45 years, 2) to find the proportion seeking medical care for IBS, and 3) to compare IBS subjects with normals, and IBS patients with IBS nonpatients with regard to mental health.

What patient characteristics make therapists recommend psychodynamic psychotherapy or other treatment forms?

In order to study factors that psychodynamic therapists considered to be important for recommendation of treatment, psychiatric diagnoses (DSM-III-R Axes I and II and the GAF) as well as character traits assessed by the Karolinska Psychodynamic Profile (KAPP) were retrospectively assessed in interview case-notes of patients applying for psychodynamic psychotherapy. Recommendation of psychotherapy was predicted by the absence of a personality disorder and high GAF scores, but not by the presence of a psychiatric syndrome. The KAPP differentiated between patients with and without disorders on Axis II, but not on Axis I.

Reliability of the Karolinska Psychodynamic Profile (KAPP) among patients with and without psychoactive substance abuse disorders.

Background: The Karolinska Psychodynamic Profile (KAPP) is a rating instrument, based on psychoanalytic theory, that assesses different aspects of character from clinical interviews. The aim of the present study was to examine interrater reliability of the KAPP in a sample of patients with and without psychoactive substance abuse disorders, using interviewers and a reliability judge who had not been trained by the developers of the instrument.

Methods: The sample comprised 47 consecutive patients with and without psychoactive substance abuse disorders, who were referred to an outpatient psychotherapy unit specializing in the treatment of substance abuse and dependence.

Personality predictors of dimensions of psychosocial adjustment after surgery.

Objective: Although many studies have examined the relationship between personality factors and adjustment after surgery, most of them have had very short follow-up periods. The present prospective study examines whether preoperative psychodynamic assessment of personality traits enhances prediction of various areas of psychosocial adjustment assessed at least 1 year after surgery.

Methods: In 53 patients undergoing pelvic pouch surgery for ulcerative colitis, we examined the relationship between personality traits measured before surgery, and postoperative psychosocial adjustment assessed at a median of 17 months postoperatively, controlling for the effect of surgical functional outcome.

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.

Symptoms and character traits in patients selected for long-term psychodynamic psychotherapy.

In this naturalistic study of 55 outpatients selected for long-term psychodynamic psychotherapy, two Swedish assessment instruments are presented (the Karolinska Psychodynamic Profile and the Karolinska Scales of Personality), and the significance of psychodynamic criteria for the selection of patients is discussed. Thirty patients (55%) fulfilled criteria for a DSM-III-R diagnosis. The most prominent psychodynamically defined character pathology was found in the areas of coping with aggressive affects; dependency and separation; frustration tolerance; and impulse control.

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.

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.

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.

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.

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 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 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.