Faculty Bibliography

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. Personality traits were assessed with the Karolinska Psychodynamic Profile (KAPP). Surgical functional outcome scales and the Psychosocial Adjustment to Illness Scale (PAIS) were used. RESULTS: Problems with sexual satisfaction, perfectionistic body ideals, lack of alexithymia, and poor frustration tolerance predicted poor postoperative adjustment in various areas, beyond what was predicted by surgical functional outcome alone. Moreover, moderate preoperative levels of alexithymia were beneficial to postoperative adjustment in the area of psychological distress. CONCLUSIONS: The findings suggest that the preoperative assessment of the patient's long-term sexual functioning and satisfaction, the importance attached to his or her appearance, level of alexithymia, and general capacity to tolerate frustration and set-backs in life, might alert both the surgeon and the patient to potential risk factors for poor postsurgical adjustment.

The Karolinska Psychodynamic Profile (KAPP) is a rating instrument that consists of 18 subscales for assessing different aspects of character from clinical interviews. The psychometric properties of the instrument, including reliability, stability, and some earlier validity studies, are reviewed. The present validity study of the KAPP examines aspects of affect control and its relation to other state and trait measures as well as to psychopathology in 65 ulcerative colitis patients. Cluster analysis was used to classify individuals according to aspects of affect control. Our results suggest that patients with excessive impulse control also have problems coping with aggressive affects, that this co-occurring difficulty is a stable mode of mental functioning in the individual, and that these patients manage quite well emotionally. Our findings also suggest that frustration tolerance is an important factor in psychopathology; poor frustration tolerance is associated with more problems on most measures.

The present study investigated the psychometric properties of the NEO Five-Factor Inventory (NEO-FFI) Observer form of the five-factor model of personality by examining agreement between self- and observer ratings. Both partners of 49 young, adult couples rated themselves and their partners on the NEO-FFI. The results provide preliminary evidence of the measurement utility of the NEO-FFI Observer form. Specifically, (a) each personality scale possessed acceptable levels of internal reliability, (b) five factors consistent with the five-factor model of personality emerged in both ratings forms, and (c) there was significant self-observer agreement for all five personality scales. Self-observer agreement was assessed by correlations as well as analyses that test a more stringent definition of agreement. Overall, there is consensus across analyses that points to a substantial amount of concordance between partners' self- and observer ratings.

Paroxysmal nocturnal hemoglobinuria (PNH) is a clonal hematopoietic stem cell disorder resulting from mutations in an X-linked gene, PIG-A, that encodes an enzyme required for the first step in the biosynthesis of glycosylphosphatidylinositol (GPI) anchors. PIG-A mutations result in absent or decreased cell surface expression of all GPI-anchored proteins. Although many of the clinical manifestations (e.g., hemolytic anemia) of the disease can be explained by a deficiency of GPI-anchored complement regulatory proteins such as CD59 and CD55, it is unclear why the PNH clone dominates hematopoiesis and why it is prone to evolve into acute leukemia. We found that PIG-A mutations confer a survival advantage by making cells relatively resistant to apoptotic death. When placed in serum-free medium, granulocytes and affected CD34(+) (CD59(-)) cells from PNH patients survived longer than their normal counterparts. PNH cells were also relatively resistant to apoptosis induced by ionizing irradiation. Replacement of the normal PIG-A gene in PNH cell lines reversed the cellular resistance to apoptosis. Inhibited apoptosis resulting from PIG-A mutations appears to be the principle mechanism by which PNH cells maintain a growth advantage over normal progenitors and could play a role in the propensity of this disease to transform into more aggressive hematologic disorders. These data also suggest that GPI anchors are important in regulating apoptosis.

The National Institute on Drug Abuse Collaborative Cocaine Treatment Study is a large, multisite psychotherapy clinical trial for outpatients who meet the DSM-IV criteria for cocaine dependence. For 480 randomized patients, the outcomes of 4 treatments are compared for an 18-month period. All treatments include group drug counseling. One treatment also adds cognitive therapy, one adds supportive-expressive psychodynamic therapy, and one adds individual drug counseling; one consists of group drug counseling alone. In addition, 2 specific interaction hypotheses, one involving psychiatric severity and the other involving degree of antisocial personality characteristics, are being tested. This article describes the main aims of the project, the background and rationale for the study design, the rationale for the choice of treatments and patient population, and a brief description of the research plan.

Twenty-four patients with a DSM-III-R diagnosis of Avoidant Personality Disorder (AVPD) and 14 patients with a diagnosis of Obsessive-Compulsive Personality Disorder (OCPD) were assigned to 52 sessions of time-limited Supportive-Expressive (SE) dynamic psychotherapy. At intake, most patients had at least one concurrent Depressive and/or Anxiety disorder. OCPD patients lost their personality disorder diagnoses significantly faster than did AVPD patients. By the end of treatment, 39 percent of AVPD still retained their diagnosis while only 15 percent of OCPD did so. Using hierarchical linear modeling, both patient groups improved significantly across time on measures of personality disorders, depression, anxiety, general functioning, and interpersonal problems. OCPD patients remained in treatment significantly longer and tended to improve (nonsignificantly) more than did AVPD patients. Alliance ratings from both patients and therapists increased significantly over time, except for those of OCPD patients who remained constant.

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. Some psychodynamically defined character traits, particularly poor frustration tolerance, were related to symptomatic suffering.