Communication of Information about Genetic Risks: Putting Families at the Center

Genetic information is a family affair. With the expansion of genomic technologies, many new causal genes and variants have been established and the potential for molecular diagnoses increased, with implications not only for patients but also their relatives. The need for genetic counseling and intrafamilial circulation of information on genetic risks grew accordingly. Also, the amount and, particularly, the complexity of the information to convey multiplied. Sharing information about genetic risks with family members, however, has never been an easy matter and often becomes a source of personal and familial conflicts and distress. Ethical requisites generally prevent healthcare professionals from directly contacting their consultands' relatives (affected or still at risk), who often feel unsupported throughout that process. We discuss here the communication of genetic risks to family members. We first consider genomic testing as a basis for family‐centered health care, as opposed to a predominant focus on the individual. We reviewed the literature on sharing genetic risk information with family members, and the associated ethical issues for professionals. Some clinical cases are presented and discussed, and key issues for meeting the needs of individuals and families are addressed. We argue that genetic information is inextricably linked to the family and that communicating about genetic risks is a process grounded within the broader milieu of family relationships and functioning. We conclude for the need for a more family‐centered approach and interventions that can promote sensitive attitudes to the provision of genetic information to and within the family, as well as its inclusion in educational and training programmes for genetic healthcare professionals.     

Comparing instructor-led,video-model,and no-instruction control tutorials for creating single-subject graphs in Microsoft Excel: A systematic replication and extension

Visual inspection of single-subject data is the primary method for behavior analysts to interpret the effect of an independent variable on a dependent variable; however, there is no consensus on the most suitable method for teaching graph construction for single-subject designs. We systematically replicated and extended Tyner and Fienup (2015) using a repeated-measures between-subjects design to compare the effects of instructor-led, video-model, and no-instruction control tutorials on the graphing performance of 81 master's students with some reported Microsoft Excel experience. Our mixed-design analysis revealed a statistically significant main effect of pretest, tutorial, and posttest submissions for each tutorial group and a nonsignificant main effect of tutorial group. Tutorial group significantly interacted with submissions, suggesting that both instructor-led and video-model tutorials may be superior to providing graduate students with a written list of graphing conventions (i.e., control condition). Finally, training influenced performance on an untrained graph type (multielement) for all tutorial groups.     

A preliminary exploration of predictors of outcome and cognitive mechanisms of change in cognitive behaviour therapy for psychosis in people not taking antipsychotic medication

BackgroundCognitive behaviour therapy (CBT) has been shown to be effective in an open trial for people with psychotic disorders who have not been taking antipsychotic medication. There is little known about predictors of outcome in CBT for psychosis and even less about hypothesised mechanisms of change.Method20 participants with schizophrenia spectrum disorders received CBT in an exploratory trial. Our primary outcome was psychiatric symptoms measured using the PANSS. Secondary outcomes were dimensions of hallucinations and delusions, self-rated recovery and social functioning, and hypothesised mechanisms of change included appraisals of psychotic experiences, dysfunctional attitudes and cognitive insight. We also measured patient characteristics that may be associated with outcome.ResultsT-tests revealed that several of the hypothesised mechanisms did significantly change over the treatment and follow-up periods. Correlational analyses showed that reductions in negative appraisals of psychotic experiences were related to improvements on outcome measures and that shorter duration of psychosis and younger age were associated with greater changes in symptoms.ConclusionsCBT based on a specific cognitive model appears to change the hypothesised cognitive mechanisms, and these changes are associated with good outcomes. CBT may be more effective for those who are younger with shorter histories of psychosis.     

EFFECTS OF AND PREFERENCE FOR PAY FOR PERFORMANCE: AN ANALOGUE ANALYSIS

We examined the effects of 2 payment systems on the rate of check processing and time spent on task by participants in a simulated work setting. Three participants experienced individual pay‐for‐performance (PFP) without base pay and pay‐for‐time (PFT) conditions. In the last phase, we asked participants to choose which system they preferred. For all participants, the PFP condition produced higher rates of check processing and more time spent on task than did the PFT condition, but choice of payment system varied both within and across participants.     

Investigating the Factor Structure of the Kessler Psychological Distress Scale in Community and Clinical Samples of the Australian Population

The Kessler 10 Psychological Distress Scale (K10) is a brief dimensional scale designed to measure and monitor trends of psychological distress. Recently the scale has been utilised by general practitioners and clinicians to screen for common mental disorders and measure treatment outcomes. Despite the K10 demonstrating a sound one dimensional structure in the general population, the scale??s structure has yet to be comprehensively tested in clinical samples. The current study aimed to use confirmatory factor analysis to test three theoretical structure models of the K10 and one model for the K6 (a six item variant) in a sample from a tertiary referral clinic for mood and anxiety disorders and compare those results with a population sample from the Australian National Survey of Mental Health and Wellbeing. The results demonstrated that a two factor model with correlated latent factors representing depression and anxiety fit the clinical sample the best whilst a one factor model with correlated errors between several items fit the population sample the best. The results are discussed further in relation to scoring and interpreting the Kessler scales.     

Using game theory to examine incentives in influenza vaccination behavior

The social good often depends on the altruistic behavior of specific individuals. For example, epidemiological studies of influenza indicate that elderly individuals, who face the highest mortality risk, are best protected by vaccination of young individuals, who contribute most to disease transmission. To examine the conditions under which young people would get vaccinated to protect elderly people, we conducted a game-theory experiment that mirrored real-world influenza transmission, with "young" players contributing more than "elderly" players to herd immunity. Participants could spend points to get vaccinated and reduce the risk of influenza. When players were paid according to individual point totals, more elderly than young players got vaccinated, a finding consistent with the Nash equilibrium predicting self-interested behavior. When players were paid according to group point totals, however, more young than elderly players got vaccinated-a finding consistent with the utilitarian equilibrium predicting group-optimal behavior-which resulted in higher point totals than when players were paid for their individual totals. Thus, payout structure affected whether individuals got vaccinated for self-interest or group benefit.     

Social deviance activates the brain’s error-monitoring system

Social psychologists have long noted the tendency for human behavior to conform to social group norms. This study examined whether feedback indicating that participants had deviated from group norms would elicit a neural signal previously shown to be elicited by errors and monetary losses. While electroencephalograms were recorded, participants (N = 30) rated the attractiveness of 120 faces and received feedback giving the purported average rating made by a group of peers. The feedback was manipulated so that group ratings either were the same as a participant’s rating or deviated by 1, 2, or 3 points. Feedback indicating deviance from the group norm elicited a feedback-related negativity, a brainwave signal known to be elicited by objective performance errors and losses. The results imply that the brain treats deviance from social norms as an error.     

Trait versus situation-specific intolerance of uncertainty in a clinical sample with anxiety and depressive disorders

Intolerance of uncertainty (IU) has been most heavily implicated in the development and maintenance of generalised anxiety disorder; however, recent research has supported the transdiagnostic conceptualisation of IU by demonstrating that IU contributes to a broad array of symptoms associated with multiple anxiety and depressive disorders. The aim of this study was to examine IU firstly as a trait variable and secondly in reference to a regularly occurring, diagnostically relevant situation in a large clinical sample (N = 218). A measure of situation-specific IU (the Intolerance of Uncertainty Scale-Situation-Specific Version; IUS-SS) is presented. The IUS-SS was found to have a unitary factor structure and high internal consistency. Participants reported significantly more situation-specific IU compared to trait IU. Discriminant validity was indicated by lack of significant relationships with measures of extraversion and alcohol use. Supporting the convergent validity and transdiagnostic nature of the scale, the IUS-SS was positively associated with neuroticism and symptoms of generalised anxiety disorder and social phobia, and explained unique variance in symptoms of depression and panic disorder above and beyond trait IU. Theoretical and clinical implications are discussed.     

Hostility,oral contraceptive use,and cardiovascular reactivity in women

Abstract

Hostility, task instructions, social desirability and cardiovascular reactivity were investigated in a exploratory study of 70 female college students and employees. Women were administered the Videotaped Clinical Interview (VC1), the Marlowe-Crowne Social Desirability Scale (MC), the Cook-Medley Hostility Scale (CM), the Buss-Durkee Hostility Index (BD) and the Personal Attributes Questionnaire (PAQ) before undergoing a stressful discussion. Oral contraceptive users had significantly higher DBP at baseline. Based on PAQ scores, women were given instructions for the discussion task consistent or inconsistent with their gender-relevant styles. Instruction type predicted heart rate changes, and interacted with hostility to predict DBP reactivity. Interview-based hostility (VCI-H) was associated with increased DBP during the discussion task, as was being high hostile (low MC/high VCI-H). The CM and the BD had less association with heart rate and blood pressure changes. Oral contraceptive (OC) use was associated with higher SBP reactivity under stress, with highest SBP increases in the OC users concerned with social desirability. The complex interaction between trait dimensions like hostility, social desirability, and oral contraceptive use requires further investigation.     

Attention and social functioning in children with malformations of cortical development and stroke

Attention and social functioning and their interrelationships have not been routinely examined in children with early brain insult (EBI). This study aimed to describe attention and social functioning in children with two types of EBI: malformations of cortical development (MCD) and stroke. Children diagnosed with MCD (n?=?14, 6 males) or stroke (n?=?14, 8 males) aged 8 to 14 years (M?=?12 years 11 months) completed neuropsychological assessments to examine attention processes. Primary caregivers completed a questionnaire to assess executive components of children's attention and teachers completed a questionnaire to measure children's social functioning. Brain scans (MRI or CT) were coded by a pediatric neuroradiologist. Higher rates of impairments in attention and social function were found in children with EBI compared with normative expectations. Children with MCD experienced more global and clinically significant levels of impairment than children with stroke; though impairments were present in both groups. A strong association between executive components of attention and social function was observed. In addition, complex attention processes were associated with social function. The findings emphasize the reciprocity between attention, behavior and social outcomes, and the vulnerability of social function following EBI.