Psychiatric Disorders in Clinical Genetics I: Addressing Family Histories of Psychiatric Illness

This is the first article of a two-part professional development series addressing genetic counseling for personal and family histories of psychiatric disorders. It is based on an Educational Breakout Session presented by the Psychiatric Special Interest Group of the National Society of Genetic Counselors at the 2006 Annual Education Conference. This article examines issues that arise in addressing family histories of psychiatric illness, while the second article in the series considers the generation and provision of individualized recurrence risks for psychiatric disorders. In this article we discuss the importance of managing uncertainty for affected individuals and their close family members who have been referred to genetics for a number of different indications. We then use four simulated cases to make recommendations about the scope and timing of discussions related to the psychiatric family history.     

Systemic administration of a nitric oxide synthase inhibitor impairs fear sensitization in the plus-maze

The aim of the present study was to evaluate the occurrence of fear sensitization in rats previously treated with an inhibitor of the NO syntheses and submitted to Trial1/Trial2 plus-maze (PM) procedure. Male Wistar rats received a systemic treatment with N(omega)-nitro-L-Arginine-methyl ester (L-NAME; 5, 10 or 50 mg kg(-1)) and were submitted to PM Trial1. In the following day the animals were re-exposed to the PM with no drug administration (Trial2). Some standards spatial-temporal measures, such as the percentage of entries (% Open arm entries) and time spent (% Open arm time) in the open arms and risk assessment frequency were recorded and used to estimate the animal level of fear sensitization in PM Trial2. The results showed that animals receiving L-NAME (50 mg kg(-1)) displayed increased % Open arm entries and % Open arm time in Trial2 in relation to the group receiving 0.9% saline, which is compatible with impaired fear/anxiety acquisition during Trial1/Trial2 PM procedure. In addition, rats treated with L-NAME (50 mg kg(-1)) exhibited low level of risk assessment in Trial2 in relation to the group treated with 0.9% saline, which indicates low level of fear/anxiety during PM re-exposure. The number of entries into the enclosed arms was not changed by any L-NAME treatment, which suggests no bias of the drug treatments on animal locomotor activity. The data suggest that NO synthesis may mediate the fear sensitization process in the PM.     

Randomized clinical trial of local anesthetic versus a combination of local anesthetic with self-hypnosis in the management of pediatric procedure-related pain.

A prospective controlled trial was conducted to compare the efficacy of an analgesic cream (eutectic mixture of local anesthetics, or EMLA) with a combination of EMLA with hypnosis in the relief of lumbar puncture-induced pain and anxiety in 45 pediatric cancer patients (age 6-16 years). The study also explored whether young patients can be taught and can use hypnosis independently as well as whether the therapeutic benefit depends on hypnotizability. Patients were randomized to 1 of 3 groups: local anesthetic, local anesthetic plus hypnosis, and local anesthetic plus attention. Results confirmed that patients in the local anesthetic plus hypnosis group reported less anticipatory anxiety and less procedure-related pain and anxiety and that they were rated as demonstrating less behavioral distress during the procedure. The level of hypnotizability was significantly associated with the magnitude of treatment benefit, and this benefit was maintained when patients used hypnosis independently.     

Use of Functional Magnetic Resonance Imaging in the Early Identification of Alzheimer's Disease

A growing body of evidence suggests that a preclinical phase of Alzheimer's disease (AD) exists several years or more prior to the overt manifestation of clinical symptoms and is characterized by subtle neuropsychological and brain changes. Identification of individuals prior to the development of significant clinical symptoms is imperative in order to have the greatest treatment impact by maintaining cognitive abilities and preserving quality of life. Functional magnetic resonance imaging (fMRI) offers considerable promise as a non-invasive tool for detecting early functional brain changes in asymptomatic adults. In fact, evidence to date indicates that functional brain decline precedes structural decline in preclinical samples. Therefore, fMRI may offer the unique ability to capture the dynamic state of change in the degenerating brain. This review examines the clinical utility of blood oxygen level dependent (BOLD) fMRI in those at risk for AD as well as in early AD. We provide an overview of fMRI findings in at-risk groups by virtue of genetic susceptibility or mild cognitive decline followed by an appraisal of the methodological issues concerning the diagnostic usefulness of fMRI in early AD. We conclude with a discussion of future directions and propose that BOLD-fMRI in combination with cerebral blood flow or diffusion techniques will provide a more complete accounting of the neurovascular changes that occur in preclinical AD and thus improve our ability to reliably detect early brain changes prior to disease onset.     

The hidden persuaders break into the tired brain

There is a long-lasting debate on whether subliminal advertising actually works. In this context there are some studies suggesting that subjects’ motivation is a crucial point. Karremans et al. [Karremans, J. C., Stroebe, W., & Claus, J. (2006). Beyond Vicary’s fantasies: The impact of subliminal priming and brand choice. Journal of Experimental Social Psychology, 42, 792-798] showed that subjects were influenced in their intention to drink a specific brand of soft drink by a subliminally presented brand prime, but only if they were thirsty. In the present study, we adapted their paradigm to the concept of ‘concentration’ and embedded the subliminal presentation of a brand logo into a computer game. Actual subsequent consumption of dextrose pills (of the presented or a not presented brand) was measured dependent on the level of participants’ tiredness and the subliminally presented logo. We found the same pattern as Karremans et al. (2006): only tired participants consumed more of the subliminally presented than the not presented brand. Therefore, the findings confirm that subjects are influenced by subliminally presented stimuli if these stimuli are need-related and if subjects are in the matching motivational state.     

Maternal correlates of 2‐year‐old American Indian children's social‐emotional development in a Northern Plains tribe

The developmental experiences of very young American Indian children today are not well documented in the current literature. The present study sought to explore the social‐emotional development of American Indian toddlers living on a Northern Plains reservation, as a function of maternal variables. Mothers completed self‐report questionnaires about their experiences and their children's development. Observer ratings of children's development also were conducted. Maternal stress, substance use/abuse, perceptions of stress in the mother–child relationship, social support, and American Indian cultural identity were significantly related to children's social‐emotional development. This study is the first to explore these relationships in a Northern Plains American Indian sample of young children and their mothers. Results suggest possible points of intervention for improving the developmental outcomes of very young American Indian children.     

The neighbor and the infinite: Marion and Levinas on the encounter between self,human other,and God

In this article I examine Jean-Luc Marion's two-fold criticism of Emmanuel Levinas’ philosophy of other and self, namely that Levinas remains unable to overcome ontological difference in Totality and Infinity and does so successfully only with the notion of the appeal in Otherwise than Being and that his account of alterity is ambiguous in failing to distinguish clearly between human and divine other. I outline Levinas’ response to this criticism and then critically examine Marion's own account of subjectivity that attempts to go beyond Levinas in its emphasis on a pure or anonymous appeal. I criticize this move as rather problematic and turn instead back to Levinas for a more convincing account of the relations between self, human other, and God. In this context, I also show that Levinas in fact draws quite careful distinctions between human and divine others.     

Resilience in the Face of Maternal Psychopathology and Adverse Life Events

Maternal psychopathology has long been recognized as a risk factor for psychopathology in offspring; however, some resilient youth achieve a favorable outcome in the presence of maternal psychopathology. We identified factors that predicted resilience among youth who were exposed to adverse life events, and also examined whether the same factors protected youth against maternal psychopathology and adverse life events. Main and interaction effects of child and family factors were examined employing cross-sectional data from a household probability sample of 1285 youth aged 9 through 17 collected at four sites. On average, children exhibited a greater degree of resilience when they had higher IQ, closer parental monitoring, better family functioning, higher educational aspiration, and were female. Interaction between maternal psychopathology and IQ was significant, and there was a trend between maternal psychopathology and gender. A higher IQ is a protective factor against both maternal psychopathology and adverse life events; whereas being a girl seems to be a protective factor against maternal psychopathology, but not adverse life events.     

Maltreated Children's Emotional and Behavioral Problems: Do Teachers and Parents See the Same Things?

We examined whether parent/caregivers and teacher/therapists differ in their perceptions of the behavior problems of young maltreated children. The sample consisted of 33 maltreated preschoolers (58% neglected, 24% sexually abused, 18% physically abused, 59% African American, 41% Caucasian) enrolled in a metropolitan-area treatment center providing an educational/intervention program for maltreated children and their families. Most (82%) of the participant families had an annual income of $10,000 or less. Parent/caregivers and teacher/ therapists provided data about the children, employing the Colorado Child Temperament Inventory, Child Behavior Checklist, and Preschool Behavior Questionnaire. The results indicate that the teacher/therapists and the parent/caregivers perceived the same child as behaving differently. Implications concerning how teachers and parents might communicate are discussed, as well as possible reasons for the two different perceptions of the same child. Three potential reasons for the differences are that they are due to the different perspectives of parents and teachers in assessing child behaviors, to situational variation in child behavior (e.g., home versus school), or to some combination of both effects.