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© Borgis - Nowa Medycyna 3/2019, s. 89-96 | DOI: 10.25121/NM.2019.26.3.89
*Katarzyna Martowska1, Małgorzata Kołodziejczak2, Anna Matczak1, Iwona Sudoł-Szopińska3
Psychological characteristics of 101 patients with benign proctological diseases
Psychologiczna charakterystyka grupy 101 pacjentów z łagodnymi chorobami proktologicznymi
1Institute of Psychology, Faculty of Christian Philosophy, Cardinal Stefan Wyszyński University in Warsaw
Head of Institute: Professor UKSW, Jan Cieciuch
2Warsaw Center of Proctology, St. Elizabeth’s Hospital, Mokotów Medical Centre, Warsaw
Head of Centre: Professor Małgorzata Kołodziejczak
3Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw Medical University
Head of Department: Professor Iwona Sudoł-Szopińska
Streszczenie
Wstęp. Łagodne choroby proktologiczne, takie jak: choroba hemoroidalna, szczelina odbytu, przetoka, ropień odbytu, dotykają znacznej części społeczeństwa. Mają one szczególnie stresogenny charakter, co wynika zarówno z silnego bólu, jaki im towarzyszy, jak i z lęku związanego z procesem leczenia i możliwymi komplikacjami (np. koniecznością stomii). Nie bez znaczenia jest też intymny charakter dolegliwości i ich niekorzystny wpływ na funkcjonowanie społeczne.
Cel pracy. Celem badań było określenie cech temperamentalno-osobowościowych osób chorujących na łagodne choroby proktologiczne.
Materiał i metody. Zbadano grupę 101 pacjentów hospitalizowanych z powodu łagodnych chorób proktologicznych, w tym 56 mężczyzn i 45 kobiet w wieku od 19 do 56 lat (M = 36,57; SD = 9,77) oraz grupę porównawczą osób zdrowych, 56 mężczyzn i 45 kobiet w wieku od 19 do 58 lat (M = 39,54; SD = 9,40). Pacjenci wypełniali kwestionariusze mierzące cechy temperamentu (KSR), częstość występowania symptomów depresyjnych (KSD), cechy osobowości typu D (DS14) oraz kwestionariusz mierzący strategie radzenia sobie ze stresem (Mini-COPE).
Wyniki. Chorzy mężczyźni charakteryzowali się wyższą perseweratywnością i regularnością. Chore kobiety nie różniły się pod względem cech temperamentu od zdrowych kobiet. Chorzy na łagodne choroby proktologiczne uzyskiwali wyższe wyniki niż osoby zdrowe w zakresie hamowania społecznego. Wykazano związek między osobowością stresową typu D a symptomami depresyjnymi.
Wnioski. Cechy temperamentu i osobowości pacjenta z łagodną chorobą proktologiczną mogą stanowić czynnik prognostyczny pojawienia się symptomów depresyjnych. Niekorzystne dla samopoczucia pacjentów jest wysokie nasilenie perseweratywności, reaktywności oraz hamowania społecznego.
Summary
Introduction. Benign proctological diseases, such as haemorrhoidal disease, anal fissure, fistula in ano and anal abscess, affect a large part of socjety. These diseases are stressogenic due to severe pain and anxiety associated with both treatment and potential complications, such as incontinence or the need for a stoma. The intimate nature of these conditions and their adverse effects on social functioning are also important. The intimate nature of these conditions and their adverse effects on social functioning are also important.
Aim. The aim of the study was to determine the temperamental and personality traits of individuals with mild proctological diseases.
Material and methods. A group of 101 patients (56 men and 45 women) aged between 19 and 56 years (M = 36.57; SD = 9.77) and a reference group of healthy individuals (56 men and 45 women) aged between 19 and 58 years (M = 39.54; SD = 9.40) were included. The patients were asked to complete questionnaires measuring temperament traits (RMQ), the incidence of depressive symptoms (DSQ), type D personality traits (DS14), and a questionnaire to evaluate stress coping strategies (Mini-COPE).
Results. The study showed that male patients were characterised by higher perseveration and regularity. Female patients did not differ in terms of temperamental traits from healthy women. Proctological patients scored higher for social inhibition compared to healthy individuals. A relationship was shown between type D personality and depressive symptoms.
Conclusions. Temperament and personality traits of patients with benign proctological diseases may be a prognostic factor for depressive symptoms. High perseveration, reactivity and social inhibition adversely affect the well-being of patients.
Introduction
Benign proctological diseases, such as haemorrhoidal disease, anal fissure, fistula in ano and anal abscess, affect a large part of society. The literature emphasises the need for a multidisciplinary approach to proctological patients. Although treatment involves mainly surgery, the psychological aspect of these conditions is particularly emphasised by researchers. These diseases are stressogenic due to severe pain and anxiety associated with both treatment and potential complications, such as incontinence or the need for a stoma. The intimate nature of these conditions and their adverse effects on social functioning are also important. Patients are often too embarrassed to speak about their symptoms with doctors or family members. All these factors may cause severe mental discomfort, a tendency to isolation and, consequently, depressive symptoms. For example, increased susceptibility to depression was found in a group of patients with proctalgia fugax and chronic pelvic pain (1, 2). The presence of psychological factor was also found in 65% of patients with impaired defecation and constipations (3). Other mental disorders observed in this group of patients included eating problems, rumination syndrome, pain disorder, anxiety/depression and a combination of depression and pain disorder or of eating disorders with anxiety-depression and pain disorder. It may be assumed based on the current data (3) that mental disorders not only increase the risk of proctological diseases, but they can also become aggravated secondary to disease-related stress. The awareness of psychological factors is all the more important as it also impacts the process of treatment, as concluded by many researchers (4-6). The use of relaxation techniques (mainly based on listening to music) in patients undergoing coloproctological surgeries was shown to positively influence postoperative pain levels and the quality of sleep (7).
Although there are some literature reports (8) on the psychological characteristics of patients with intestinal dysfunctions, no similar studies have been conducted in patients with benign proctological diseases so far. Therefore, we decided to focus on this group of patients. Our study evaluated temperament traits and distressed personality (type D personality), which were found to play a prognostic role in the aetiology of psychosomatic disorders.
The definition of temperament was based on the Theory of Temperament by Jan Strelau (9). According to this theory, temperament traits determine the ability to process stimulation and the need for stimulation, and thus have important regulatory functions, thereby affecting, among other things, the style of action, resistance to stress and stress coping strategies. Reactivity and activity are particularly important from the regulatory point of view. Reactivity is defined as a tendency to react intensively to emotional stimuli, i.e. high emotional excitability combined with low emotional resistance. This trait determines poor ability to cope with stimulation as it often contributes to agitation above the optimal level. Activity is described as a tendency to undertake behaviours with high stimulatory value and to seek highly stimulating situations. It may be interpreted as a sign of high demand for stimulation; therefore, high activity is usually accompanied by low reactivity and vice versa. Perseveration is another temperamental trait responsible for over-stimulation. This is a tendency of past experiences to reproduce themselves in a long-term manner (especially those intensely emotional) as well as a tendency to excessively focus on the past. As in the case of emotional reactivity, perseveration limits the ability to cope with stimulation as it leads to excessive accumulation of agitation. Regularity is a temperamental trait that may compensate the adverse (from the adaptational point of view) increase in reactivity and perseveration. It is described as a tendency to lead a regular lifestyle and may be interpreted as a tendency to limit stimulation by avoiding excitation resulting from the variability of events.
Distressed (type D) personality, which is regarded as an important risk factor for somatic diseases, has two dimensions which are regarded as constant personality traits: negative affectivity and social inhibition. Negative affectivity is described as a tendency to experience strong, negative emotions, such as anxiety or anger. Social inhibition is a tendency to refrain from expressing negative emotions and behaviours that correspond to these emotions, particularly in social situations (10). Although a number of studies on the relationship between temperament traits and type D personality and different diseases (cardiovascular diseases, ulcer, cancer) have been conducted, there is no corresponding data for patients with benign proctological diseases. Our preliminary study in 50 patients with mild proctological diseases indicated that these patients are characterised by higher perseveration and higher regularity than healthy individuals; and these features, along with reactivity, are predictors of the incidence of depressive disorders in patients with mild proctological diseases (11). The specificity of proctological diseases and their effects on the emotional and social functioning justify the need to continue research in this area as well as the need to additionally investigate the consequences of these conditions for the quality of life ? the wellbeing and stress coping styles.
Aim
The aim of the study was to determine temperament and personality traits in patients with mild proctological diseases to provide a basis for prophylactic methods to prevent depression in these patients.
Material and methods
Study subjects and the course of research
A group of 101 patients (56 men and 45 women) aged between 19 and 56 years (M = 36.57; SD = 9.77), hospitalised due to benign proctological diseases and a reference group of healthy individuals (56 men and 45 women) aged between 19 and 58 years (M = 39.54; SD = 9.40) were included in the study. The study was not anonymous. All participants were informed on the aim of the study, and the voluntary participation.
Research tools
A Reaction Mode Questionnaire (RMQ) by Anna Matczak and Katarzyna Martowska (11), based on the Regulative Theory of Temperament by Jan Strelau (9), was used for the measurement of temperamental traits.
The prevalence of depressive symptoms was measured with the use of a Depression Symptoms Questionnaire (DSQ) (11).

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Piśmiennictwo
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3. Nehra V, Bruce BK, Rath-Harvey DM et al.: Psychological disorders in patients with evacuation disorders and constipation in a tertiary practice. Am J Gastroenterol 2000; 95(7): 1755-1758.
4. Bharucha AE, Lee TH: Anorectal and pelvic pain. Mayo Clin Proc 2016; 91(10): 1471-1486.
5. Bharucha, AE Wald A, Enck P, Rao S: Functional anorectal disorders. Gastroenterology 2006; 130(5): 1510-1518.
6. Lee KH, Kim JY: Current Situation on the Diagnosis of Anismus-Discordances Between Imaging and a Physiologic Study. Ann Coloproctol 2016; 32(5): 159.
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8. Russo A, Pescatori M: Psychological assessment of patients with proctological disorders. [In:] Nasseri Y, Zbar AP, Pescatori M (eds.): Complex Anorectal Disorders. Investigation and Management. Springer-Verlag, London 2005: 747-760.
9. Strelau J: Temperament: A psychological perspective. Plenum Press, New York 1998.
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11. Martowska K, Kołodziejczak M, Matczak A: Temperamental characteristics and depressive symptoms in patients with mild proctological diseases based on research in 50 patients. A preliminary report. Nowa Medycyna 2017; 1: 5-13.
12. Ogińska-Bulik N, Juczyński Z, Denollet J: Skala do Pomiaru Typu D. [W:] Juczyński Z, Ogińska-Bulik N (red.): Narzędzia Pomiaru Stresu i Radzenia Sobie ze Stresem. Pracownia Testów Psychologicznych Polskiego Towarzystwa Psychologicznego, Warszawa 2009: 71-85.
13. Carver ChS, Scheier MF, Weintraub, JK: Assessing coping strategies: A theoretically based approach. J Pers Soc Psychol 1989; 56: 267-283.
14. Juczyński Z, Ogińska-Bulik N: Mini-COPE ? Inwentarz do Pomiaru Radzenia Sobie ze Stresem. [W:] Juczyński Z, Ogińska-Bulik N (red.): Narzędzia Pomiaru Stresu i Radzenia Sobie ze Stresem. Pracownia Testów Psychologicznych Polskiego Towarzystwa Psychologicznego, Warszawa 2009: 45-58.
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otrzymano: 2019-07-08
zaakceptowano do druku: 2019-07-29

Adres do korespondencji:
*Katarzyna Martowska
Instytut Psychologii Uniwersytet Kardynała Stefana Wyszyńskiego w Warszawie
ul. Wóycickiego1/3 bud. 14, 01-938 Warszawa
tel.: +48 (22) 569-96-12
k.martowska@uksw.edu.pl

Nowa Medycyna 3/2019
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