The 'Draw-the-Family Test' in the preoperative assessment of patients with anorectal diseases and psychological distress: a prospective controlled study.
OBJECTIVE
Some benign anorectal diseases may have psychosomatic aetiology, but patients often refuse direct psychological counselling. The Draw-the-Family Test (DFT) is a simple indirect investigation. The aim of this study was to evaluate the DFT in patients with psychological problems undergoing surgery for benign anorectal disease and to correlate the results with surgical outcome.


METHODS
DFT was administered prior to surgery to 62 patients with benign anorectal disease who admitted psychological problems at the time of the outpatient visit. Of these 18 (29%) had functional disease, mainly obstructed defecation (OD) while 44 (71%) had organic disease (haemorrhoids, fissures, pilonidal sinus or fistula). DFT was also administered to 40 healthy control subjects. Each DFT was judged as normal or pathological according to 10 parameters. Patients were followed up for a median of 12 months (range 3-64) and divided into two outcome groups, success (n = 58) and failure (n = 12) according to the results of a questionnaire. The DFT of all patients was then correlated with the outcome.


RESULTS
None of the patients refused DFT. All DFT parameters but one (animal/things instead of human beings) were more frequent in patients compared with controls (P < 0.05). When comparing separately organic or functional disease patients with controls, one parameter (absence of patient in the drawing) was only pathological in the organic disease group (P < 0.05). Another parameter (schematic figures) was more frequently altered in the organic disease group compared with the functional disease group (P = 0.01). Eight out of 10 parameters were more frequently pathological in patients who failed after treatment, but none reached statistical significance.


CONCLUSIONS
Results of DFT in patients with anorectal disease admitting to psychological problems are markedly different from healthy controls. Patients with organic disease and those with functional bowel disease have different DFT profiles. In our study group, DFT had an excellent compliance but could not predict the outcome of surgery.
Miliacca
C
C
Coloproctology Unit, Ars Medica Hospital, Rome, Italy.
Gagliardi
G
G
Pescatori
M
M
D000328:Adult; D001003:Anal Canal / Q000503:physiopathology; D003672:Defecation / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010864:Pilonidal Sinus / Q000523:psychology / Q000601:surgery; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000523:psychology*; D011446:Prospective Studies; D011580:Psychological Techniques; D011581:Psychological Tests; D011602:Psychophysiologic Disorders / Q000503:physiopathology / Q000523:psychology*; D012002:Rectal Diseases / Q000523:psychology* / Q000601:surgery*; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D055815:Young Adult