Development and Evaluation of a Telephone Communication Protocol for the Delivery of Personalized Melanoma Genomic Risk to the General Population

Communicating personalized genomic risk results for common diseases to the general population as a form of tailored prevention is novel and may require alternative genetic counseling service delivery models. We describe the development and evaluation of a communication protocol for disclosing melanoma genomic risk information to the asymptomatic general population and assess participants’ satisfaction and acceptability. Participants (n?=?117) were aged 22–69 years, living in New South Wales, Australia and unselected for family history. They provided a saliva sample and had genomic testing for melanoma for low to moderate penetrant melanoma susceptibility variants in 21 genes. Participants could choose to receive their results from a genetic counselor via telephone, followed by a mailed booklet or to receive their risk result via mailed booklet only with a follow-up call for those at high risk. A follow-up questionnaire was completed by 85% of participants 3-months later. Most participants (80%) elected to receive their result via telephone. Participants were highly satisfied with the delivery of results (mean 3.4 out of 4, standard deviation 0.5), and this did not differ by delivery mode, risk category, age or sex. On follow-up, 75% accurately recalled their risk category, 6% indicated a preference for a different delivery mode, either electronic or face-to-face. The process of disclosing genomic risk results to the general population over the telephone with accompanying written material was feasible and acceptable, and may be useful for communicating polygenic risk for common diseases in the context of increasing demands for genomic testing.     

Better the Devil You Know? High-Risk Individuals’ Anticipated Psychological Responses to Genetic Testing for Melanoma Susceptibility

Purpose: The psychological consequences of genetic testing for mutations among individuals at increased risk of developing melanoma remain unexamined. The present study aimed to explore anticipated emotional, behavioral, cognitive, and familial responses to hypothetical genetic testing for melanoma susceptibility. Methods: Forty semi-structured interviews were undertaken with affected (n=20) and unaffected (n=20) individuals at either high or average risk of developing melanoma due to family history. Results: In-depth thematic analysis revealed that, in response to being identified as a mutation carrier, most participants with a family history anticipated calmly accepting their increased risk; either increasing precaution adoption or maintaining already vigilant behavioral practices; perceiving such information as important and valuable; and communicating genetic test results to family members, despite the acknowledgement of potential difficulties. In response to being identified as a non-carrier, the majority of participants expected to feel relieved; to maintain current precautionary health practices; to still perceive themselves at some risk of developing melanoma; and to be wary of the potential negative behavioral consequences of disclosing such information to family members. Women appeared more likely than men to acknowledge the potential for depression and worry following genetic testing. In contrast, more males than females expected to carry a gene mutation, and viewed their current preventive practices as optimum. Conclusion: Genetic testing for melanoma risk is likely to elicit a complex array of emotional, behavioral, cognitive, and familial responses for both testees and their family members, and these responses are likely to bear subtle differences for males and females.     

Emotion Regulation and Parenting in AD/HD and Comparison Boys: Linkages with Social Behaviors and Peer Preference

Children's emotion regulation strategies and parenting responses in a family task that elicited frustration are investigated by, comparing core attention-deficit/hyperactivity disorder (AD/HD) symptomatology, emotional reactivity, and emotional regulation in the prediction of social behaviors and peer social preference. Participants were boys, ages 6–12 years, either with AD/HD (n = 45) or without problem behaviors (comparison; n = 34). A high-aggressive subgroup of AD/HD boys showed a significantly less constructive pattern of emotional coping than did both a low-aggressive AD/HD subgroup of boys and nondiagnosed comparison boys, who did not differ. With statistical control of core AD/HD symptomatology, noncompliance in a naturalistic summer camp was predicted by boys' overall emotion regulation and three specific strategies (emotional accommodation, problem solving, negative responses) during the parent–child interaction. Emotional accommodation and negative responses to the frustration task also marginally predicted social preference at the camp. These emotion regulation variables outperformed emotional reactivity in predicting such outcomes. Some emotion-related parenting behaviors were associated with child coping in the task. We discuss the relationship of emotion regulation to core AD/HD symptomatology and emotional reactivity, and the role of parents' behaviors in influencing children's emotional responses.     

"I know what I like": stability of aesthetic preference in Alzheimer's patients

Two studies explored the stability of art preference in patients with Alzheimer's disease and age-matched control participants. Preferences for three different styles of paintings, displayed on art postcards, were examined over two sessions. Preference for specific paintings differed among individuals but AD and non-AD groups maintained about the same stability in terms of preference judgments across two weeks, even though the AD patients did not have explicit memory for the paintings. We conclude that aesthetic responses can be preserved in the face of cognitive decline. This should encourage caregivers and family to engage in arts appreciation activities with patients, and reinforces the validity of a preference response as a dependent measure in testing paradigms.     

First Year Post-Katrina: Changes in Occupational Performance and Emotional Responses

The purpose of this retrospective study was to determine whether Hurricane Katrina affected the occupational performance and emotional states of New Orleans area residents affected by the hurricane over the first year post-Katrina. A purposeful sample of 143 adults who lived in the New Orleans area just prior to Katrina completed a questionnaire one year after Katrina. Participants were asked to rate their satisfaction with their occupational performance and emotional states at four time periods: August 2005, before Katrina; September 2005, one month after Katrina; March 2006, six months post-Katrina; and September 2006, one year post-Katrina. The most notable findings were that both satisfaction with occupational performance and emotional states showed marked declines during the month immediately following Katrina, with some recovery six months post-Katrina, and further recovery a year after Katrina. At one year post-Katrina however, the recovery of satisfaction with occupational performance and emotional states approached, but did not quite reach pre-Katrina baseline responses. Further, women did not fare as well as men post-Katrina, on both variables. Limitations of the study, implications of findings for the theory and practice of occupational therapy in the area of disaster responses, and possible future research are discussed.     

Family interaction and child outcome in a high-risk sample

This study hypothesized that the quality of family interaction would predict longitudinally children's follow-up functioning. The subjects were 97 boys, functioning on the average within the normal range but considered to be at risk for psychopathology because one parent had previously been hospitalized for psychiatric illness. Family measures of deviant and healthy communication and of activity, balance, and warmth related significantly to children's competent social/emotional/cognitive functioning at a 3-yr. follow-up. The findings suggest the importance of considering multiple predictors of outcome for children and of employing clinical interventions that attend to more than one aspect of family functioning.     

Declining medical decision-making capacity in mild AD: a two-year longitudinal study

This is a report of a two-year longitudinal study comparing healthy older adult subjects (n = 15) and mild Alzheimer's disease (AD) patients (n = 20) using an objective performance measure of medical decision-making capacity (MDC). Capacity to consent to medical treatment was measured using the Capacity to Consent to Treatment Instrument (CCTI). The CCTI is a psychometric measure that tests MDC using a series of four core capacity standards: S1 (evidencing/communicating choice), S3 (appreciating consequences), S4 (providing rational reasons), and S5 (understanding treatment situation), and one experimental standard [S2] (making the reasonable treatment choice). For each standard, mild AD patients were assigned one of three capacity outcomes (capable, marginally capable, or incapable) based on cut-off scores derived from control group performance.At baseline, mild AD patients performed equivalently with controls on simple standards of evidencing a choice (S1) and making the reasonable choice ([S2]), but significantly below controls on complex standards of appreciation, reasoning, and understanding (S3, S4, and S5) (p < 0.02). Control performance was stable over time on all capacity standards. At one-year follow-up, the mild AD group did not show significant decline from baseline on any capacity standard. However, at two-year follow-up the mild AD group showed significant declines from baseline on the three complex standards (S3, S4, and S5) (p < 0.02), and a trend on one of the simple standards (S1). Over the two-year period, the proportion of marginally capable and incapable outcomes in the AD group increased substantially for four of the five standards (S1, S3, S4, and S5). Performance on [S2] remained stable over time in the AD group.We conclude that mild AD patients have impaired MDC at baseline, and demonstrate significant additional decline on complex consent abilities of appreciation, reasoning, and understanding over a two-year period. AD patients also show emerging impairment on the simple consent ability of evidencing choice at two-year follow-up. Capacity outcome data reflect similar declines over time for these four consent standards. The findings suggest the value of early assessment and regular monitoring at two-year intervals of MDC in patients with mild AD.     

Emotional experience and expression in schizophrenia and depression.

The emotional responses of schizophrenic, depressed, and normal subjects and whether differences in the emotional responding of these groups depended on how emotional responses were elicited or measured were examined. Twenty-three blunted and 20 nonblunted schizophrenics, 17 unipolar depressed subjects, and 20 normal subjects were exposed to a series of affect-eliciting stimuli. The stimuli varied in valence (positive vs. negative) and in level of cognitive demand. Subjects reported their subjective experiences, and their facial expressions were videotaped. Blunted schizophrenics were the least facially expressive, although their reported subjective experiences did not differ from those of the other groups. The nonblunted schizophrenics were more responsive than the depressed subjects to the positive stimuli, although the two groups did not differ in their clinical ratings of affective flatness.     

Adolescents' reactions to the evacuation of the Sinai settlements: a longitudinal study

This study investigated psychological reactions of adolescents to a severe stress situation--the evacuation of the Sinai settlements. The research focused on emotional reactions of anxiety and anger to this stress situation. Two central problems were investigated: The intensity of the emotional responses of anxiety and anger of the adolescents to the stress situation, before and after the evacuation, and the impact of three intervening variables on these emotional reactions--cognitive perception of the political situation, family functioning, and personality characteristics. Data for this study were collected in a regional high school in Israel from 418 pupils in 9th through 12th grades. Seventy-eight of the pupils lived in the Yamit area. Measurements were obtained at three points in time: 6 weeks and 1 week before the evacuation and 2 months after it. The results supported the predicted trend that adolescents in the Yamit group before the evacuation would score higher on state anxiety and state anger than would those in the comparison group. Two months after the evacuation there was a significant drop in those scores. The trait measures remained stable in both groups and no significant differences were found between the two groups on these scores. Concerning the impact of the three intervening variables on the intensity of the state emotional responses, the results did not support any of the hypotheses.     

Panic-Related fears in persons reporting a family history of panic disorder

Abstract We administered the Body Sensations Questionnaire, Health Hardiness Index, Panic Attack Questionnaire, and the Symptom Checklist 90-R to college students (n=71) who either reported or did not report a family history of panic disorder. Participants who reported a family history of panic disorder reported significantly less perceived control over their health status, a greater fear of bodily arousal, and greater frequency of unexpected panic attacks compared to participants without such a history, although no significant group differences were detected for Symptom Checklist-90-R scales that measure negative emotional experiences. After controlling for personal history of panic, differences between the positive family history group remained only for the control over health measure. We discuss the results as preliminary evidence that certain cognitive responses are overrepresented in self-classified first-degree relatives of persons with panic disorder.     

Affiliation and self disclosure in a specific ego threat situation

This study presents findings about affiliative reactions to a specific ego threat in a real life situation. Subjects exposed to a personal and cognitive evaluation were asked about their preference for sharing this experience with others or experiencing it individually. They were compared with subjects offered the same choice in a neutral non-evaluative situation. The actual self disclosure of the subjects was also evaluated. As hypothesized, the subjects in the evaluative condition reacted with higher levels of emotional arousal and preferred isolation rather than affiliation. The hypothesis that emotional arousal due to a specific ego threat would restrict self disclosing behavior was only partly confirmed.     

Family socioeconomic status and emotional adaptation among rural‐to‐urban migrant adolescents in China: The moderating roles of adolescent's resilience and parental positive emotion

Low family socioeconomic status (SES) is closely related to increased risk of emotional maladaptation among adolescents. Although previous studies have found that low family SES is a significant and common experience for most rural‐to‐urban migrant adolescents in China, little research has examined the association between family SES and emotional adaptation or identified the protective factors that may minimise emotional maladaptation among these adolescents. The present study examined the associations between family SES and three indices of emotional adaptation (emotion regulation, life satisfaction and depression) and the moderating effects of adolescents' resilience and parental positive emotion (PE) among 486 Chinese rural‐to‐urban migrant adolescents. The results suggest that family SES was significantly associated with migrant adolescents' emotional outcomes, to varying degrees. Moreover, both adolescents' resilience and PE moderated the associations between family SES and emotional outcomes, although the protective effects of the two moderators differed on the three emotional outcomes. These findings shed light into designing intervention and prevention programs to reduce emotional maladaptation among migrant adolescents.     

Adolescents' Reactions to the Evacuation of the Sinai Settlements: A Longitudinal Study

This study investigated psychological reactions of adolescents to a severe stress situation—the evacuation of the Sinai settlements. The research focused on emotional reactions of anxiety and anger to this stress situation. Two central problems were investigated: (a) The intensity of the emotional responses of anxiety and anger of the adolescents to the stress situation, before and after the evacuation, and (b) the impact of three intervening variables on these emotional reactions—cognitive perception of the political situation, family functioning, and personality characteristics. Data for this study were collected in a regional high school in Israel from 418 pupils in 9th through 12th grades. Seventy-eight of the pupils lived in the Yamit area. Measurements were obtained at three points in time: 6 weeks and 1 week before the evacuation and 2 months after it. The results supported the predicted trend that adolescents in the Yamit group before the evacuation would score higher on state anxiety and state anger than would those in the comparison group. Two months after the evacuation there was a significant drop in those scores. The trait measures remained stable in both groups and no significant differences were found between the two groups on these scores. Concerning the impact of the three intervening variables on the intensity of the state emotional responses, the results did not support any of the hypotheses.     

Adolescents’ reactions to the world trade center destruction: A study of political trauma in metropolitan New York

This study examined the emotional response of 110 adolescents living in the New York metropolitan area one month and five months after the destruction of the World Trade Center (WTC) by terrorists. The purpose of the study was to assess emerging hypotheses in political psychology that suggest that there are differential emotional responses to a national trauma that recede in predictable directions. The results followed predictions and indicate that adolescents experienced a higher level of emotions related to the Crisis and Bereavement dimension than affect associated with Vulnerability and that the emotional response decreased during the four-month follow-up period. There was no effect on emotional response from the biological sex or political orientation of the respondents, which is inconsistent with other studies in the literature. The absence of a political orientation effect is explained in terms of the lack of a domestic ideological difference in response to the terrorist attack.     

Maternal depressive history, teen 5HTTLPR genotype, and the processing of emotional faces: Exploring mechanisms of risk

Variations in the serotonin transporter gene (5HTTLPR) and biased processing of face-emotion displays both have been implicated in the transmission of depression risk, but little is known about developmental influences on these relationships. Within a community sample of adolescents, we examine whether 5HTTLPR genotype moderates the link between maternal depressive history and errors in face-emotion labeling. When controlling for current levels of depression and anxiety among youth, a two-way interaction between maternal depressive history and 5HTTLPR genotype was detected. Specifically, adolescents whose mothers reported a depressive history and who had a low expressing genotype made more errors in classifying emotional faces when compared with adolescents with an intermediate or high expressing genotype, with or without maternal depression history. These findings highlight the complex manner in which maternal depression and genetic risk may interact to predict individual differences in social information processing.     

A randomised controlled trial of the effectiveness of writing as a self-help intervention for traumatic injury patients at risk of developing post-traumatic stress disorder

The study investigated the effects of writing and self-help information on severity of psychological symptoms in traumatic injury patients at risk for developing post-traumatic stress disorder (PTSD). Patients attending Accident and Emergency (A & E), were screened for Acute Stress Disorder and randomised to an information control group (n = 36) or a writing and information group (n = 31). Participants in both groups received an information booklet one-month post-injury. Participants in the writing group also wrote about emotional aspects of their trauma during three 20-min sessions, five to six weeks post-injury. Psychological assessments were completed within one month and at three and six months post-injury. There were significant improvements on measures of anxiety, depression and PTSD over time. Differences between groups on these measures were not statistically significant. However, subjective ratings of the usefulness of writing were high. In conclusion, the results do not currently support the use of writing as a targeted early intervention technique for traumatic injury patients at risk of developing PTSD.     

Determinants and Predictive Value of Clinician Assessment of Short‐Term Suicide Risk

We examine the interrelations among clinicians' judgment of patients' suicide risk, clinicians' emotional responses, and standard risk factors in the short‐term prediction of suicidal thoughts and behaviors. Psychiatric outpatients (n = 153) with a lifetime history of suicide ideation/attempt and their treating clinicians (n = 67) were evaluated at intake. Clinicians completed a standard suicide risk instrument (modified SAD PERSONS scale), a 10‐point Likert scale assessment of judgment of patient suicide risk (Clinician Prediction Scale), and a measure of their emotional responses to the patient (Therapist Response Questionnaire‐Suicide Form). The Columbia Suicide Severity Rating Scale and the Beck Scale for Suicide Ideation were administered at a one‐month follow‐up assessment (n = 114, 74.5%). Clinician judgment of risk significantly predicted suicidal thoughts and behaviors at follow‐up. Both the standard suicide risk instrument and clinician emotional responses contributed independently to the clinician assessment of risk, which, in turn, mediated their relationships with suicidal thoughts and behaviors. Our findings validate the importance of clinical judgment in assessing suicide risk. Clinical judgment appears to be informed both by concrete risk factors and clinicians' emotional responses to suicidal patients, highlighting emotional awareness as a promising area for research and training.     

Posture affects emotional responses: A Head Down Bed Rest and ERP study

Body posture, mainly represented by horizontal bed rest, has been found to be associated with cortical inhibition, altered perceptual and cognitive processing. In the present research, the influence of Head Down Bed Rest (HDBR) – a condition also termed simulated microgravity – on emotional responses has been studied. Twenty-two male subjects were randomly assigned to either Sitting Control or HDBR group. After 3-h, subjects attended to a passive viewing emotional task in which 75 IAPS slides, divided into 25 pleasant, 25 neutral and 25 unpleasant, were presented in random order for 6 s each, while EEG was recorded from F7, F8 and Pz locations. Results showed in Sitting Controls the expected greater P300 and Late Positive Potential (LPP) to pleasant and unpleasant compared with neutral slides, an effect which indicates greater processing of emotional arousing stimuli. The HDBR group showed smaller non-significant differences among all emotional conditions in both ERP components. Arousal and valence subjective evaluations, typically less sensitive to experimental manipulation, did not differentiate groups. The observed ability of HDBR to inhibit cortical emotional responses raises an important issue on the risk that astronauts underestimate a dangerous/threatening situation or that long-term bedridden inpatients develop depressive symptoms.     

Imaging Brain Effects of APOE4 in Cognitively Normal Individuals Across the Lifespan

The ε4 allele of the apolipoprotein E (APOE4) is associated with an increased risk of developing Alzheimer’s disease (AD). Hence, several studies have compared the brain characteristics of APOE4 carriers versus non-carriers in presymptomatic stages to determine early AD biomarkers. The present review provides an overview on APOE4-related brain changes in cognitively normal individuals, focusing on the main neuroimaging biomarkers for AD, i.e. cortical beta-amyloid (Aβ) deposition, hypometabolism and atrophy. The most consistent findings are observed with Aβ deposition as most studies report significantly higher cortical Aβ load in APOE4 carriers compared with non-carriers. Fluorodeoxyglucose-positron emission tomography studies are rare and tend to show hypometabolism in brain regions typically impaired in AD. Structural magnetic resonance imaging findings are the most numerous and also the most discrepant, showing atrophy in AD-sensitive regions in some studies but contradicting results as well. Altogether, this suggests a graded effect of APOE4, with a predominant effect on Aβ over brain structure and metabolism. Multimodal studies confirm this view and also suggest that APOE4 effects on brain structure and function are mediated by both Aβ-dependent and Aβ-independent pathological processes. Neuroimaging studies on asymptomatic APOE4 carriers offer relevant information to the understanding of early pathological mechanisms of the disease, although caution is needed as to whether APOE4 effects reflect AD pathological processes, and are representative of these effects in non-carriers.