Drawings reflect a new dimension of the psychological impact of long-term remission of Cushing's syndrome.
OBJECTIVE
Drawings can be used to assess perceptions of patients about their disease. We aimed to explore the utility of the drawing test and its relation to illness perceptions, quality of life (QoL), and clinical disease severity in patients after long-term remission of Cushing's syndrome.


METHODS
We conducted a cross-sectional study including 47 patients with long-term remission of Cushing's syndrome. Patients completed the drawing test, the Illness Perception Questionnaire-Revised, the Short-Form 36, the EuroQoL-5D, and the Cushing QoL. The Cushing's syndrome severity index was scored based on medical records.


RESULTS
Characteristics of the drawings were strongly associated with the Cushing's syndrome severity index and severity ratings of health professionals (all P < 0.02). In addition, patients perceived a dramatic change in body size during the active state of the disease compared to the healthy state before disease. Patients reported that their body does not completely return to the original size (i.e. before disease) after treatment. There were no clear associations between characteristics of the drawings and QoL or illness perceptions. This indicates that drawings and QoL or illness perceptions do not share multiple common properties and measure different aspects/dimensions of the disease process.


CONCLUSIONS
Drawings reflect a new dimension of the psychological impact of long-term remission of Cushing's syndrome because drawings do not share common properties with parameters of QoL or illness perceptions, but do represent the clinical severity of the disease. The assessment of drawings may enable doctors to appreciate the perceptions of patients with long-term remission of Cushing's syndrome and will lead the way in dispelling idiosyncratic beliefs.
Leiden University Medical Center, Department of Endocrinology and Metabolism, 2300 RC Leiden, The Netherlands. J.Tiemensma@lumc.nl
Jitske
J
Tiemensma
Nikolaos P
NP
Daskalakis
Else M
EM
van der Veen
Steven
S
Ramondt
Stephanie K
SK
Richardson
Elizabeth
E
Broadbent
Johannes A
JA
Romijn
Alberto M
AM
Pereira
Nienke R
NR
Biermasz
Adrian A
AA
Kaptein
D050154:Adiposity; D003430:Cross-Sectional Studies; D003480:Cushing Syndrome / Q000523:psychology* / Q000601:surgery; D003627:Data Interpretation, Statistical; D004644:Emotions / Q000502:physiology; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010901:Pituitary Function Tests; D011788:Quality of Life; D012649:Self Concept; D012720:Severity of Illness Index; D012867:Skin / Q000473:pathology; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires