The Confluence of Psychiatric Symptoms and Neurodegenerative Disease: Impact on Genetic Counseling

Hereditary neurodegenerative diseases can present with a psychiatric prodrome that overlaps with psychiatric symptoms that are not primary to these diseases. When individuals present for predictive testing while experiencing such symptoms, clinicians including genetic counselors, must proceed with caution and evaluate each situation on a case-by-case basis. Legitimate reasons may exist for moving forward with testing. Additionally predicting the consequences of testing is unrealistic so that the clinicians must do their best to prepare patients for both positive and negative results. A multidisciplinary team following the Huntington disease protocol remains the gold standard care for predictive testing for such patients. We discuss 3 case histories that demonstrate the complex nature of genetic counseling and testing in the presence of psychiatric symptoms, whether emanating from the disease itself or the results of living in an affected family.     

Developmental changes in anger expression and attention focus: learning to wait

Being able to wait is an essential part of self-regulation. In the present study, the authors examined the developmental course of changes in the latency to and duration of target-waiting behaviors by following 65 boys and 55 girls from rural and semirural economically strained homes from ages 18 months to 48 months. Age-related changes in latency to and duration of children's anger expressions and attention focus (e.g., self-initiated distraction) during an 8-min wait for a gift were found. On average, at 18 and 24 months of age, children were quick to react angrily and slower to shift attention away from the desired object than they were at later ages. Over time, children were quicker to distract themselves. By 36 months, distractions occurred before children expressed anger, and anger expressions were briefer. At 48 months, children typically made a quick bid to their mothers about having to wait before distracting themselves; on average, they did not appear angry until the latter half of the wait. Unexpectedly, children bid to their mothers as much at age 48 months as they had at 18 months; however, bids became less angry as children got older. Developmental changes in distraction and bidding predicted age-related changes in the latency to anger. Findings are discussed in terms of the neurocognitive control of attention around age 30 months, the limitations of children's self-regulatory efforts at age 48 months, and the importance of fostering children's ability to forestall, as well as modulate, anger.     

Clarifying the role of defensive reactivity deficits in psychopathy and antisocial personality using startle reflex methodology

Prior research has demonstrated deficits in defensive reactivity (indexed by potentiation of the startle blink reflex) in psychopathic individuals. However, the basis of this association remains unclear, as diagnostic criteria for psychopathy encompass two distinct phenotypic components that may reflect differing neurobiological mechanisms-an affective-interpersonal component and an antisocial deviance component. Likewise, the role of defensive response deficits in antisocial personality disorder (APD), a related but distinct syndrome, remains to be clarified. In the current study, the authors examined affective priming deficits in relation to factors of psychopathy and symptoms of APD using startle reflex methods in 108 adult male prisoners. Deficits in blink reflex potentiation during aversive picture viewing were found in relation to the affective-interpersonal (Factor 1) component of psychopathy, and to a lesser extent in relation to the antisocial deviance (Factor 2) component of psychopathy and symptoms of APD-but only as a function of their overlap with affective-interpersonal features of psychopathy. These findings provide clear evidence that deficits in defensive reactivity are linked specifically to the affective-interpersonal features of psychopathy and not to the antisocial deviance features represented most strongly in APD.     

Motivational determinants of integrating positive and negative past identities

Five studies examined whether quality of motivation (as individual differences and primed) facilitates or thwarts integration of positive and negative past identities. Specifically, more autonomously motivated participants felt closer to, and were more accepting of, both negative and positive past characteristics and central life events, whereas more control-motivated participants were closer to and more accepting of positive, but not negative, past characteristics and events. Notably, controlled motivation hindered participants' acceptance of their own negative identities but not of others' negative identities, suggesting that control-motivated individuals' rejection of negative past identities was an attempt to distance from undesirable parts of themselves. Defensive processes, reflected in nonpersonal pronouns and escape motives, mediated interaction effects, indicating that lower defense allowed fuller integration. Integration of both positive and negative past identities predicted indicators of well-being, namely, vitality, meaning, and relatedness satisfaction.     

Caution: fragile! Regulating the interpersonal security of chronically insecure partners

The authors present and test a model of interpersonal insecurity compensation. According to this model, perceivers detect targets' chronic insecurities about interpersonal acceptance, become vigilant about upsetting targets, and respond with affective exaggeration, which involves cautiously inflating positive thoughts and feelings about targets and concealing negative sentiments. Results of 3 studies support this model across a variety of relationship types. Perceivers who detected targets' chronic insecurities concealed negative sentiments when they believed their sentiments would be observed by targets (Study 1), converged with other perceivers in their self-reported affective exaggeration to insecure targets (Study 2), and reported vigilance about upsetting targets, which predicted perceivers' enhanced cognitive processing of targets' daily insecurity and intensified their tendencies to exaggerate affections in response to that insecurity (Study 3). Perceivers' affective exaggeration appeared to enhance chronically insecure targets' perceptions of being valued by perceivers, but it also predicted perceivers' reduced relationship satisfaction (Studies 2 and 3). Results underscore the active, but perhaps dissatisfying, regulation of relationships with chronically insecure relationship partners.     

Development and validation of a brief self-report measure of agitation: the Brief Agitation Measure

Emerging evidence indicates that agitation is an ominous precursor to imminent death by suicide, yet measures of it are few, and to our knowledge, no self-report measure of agitation exists. To fill this gap, we have developed the Brief Agitation Measure (BAM), which is designed as a brief measure to assess agitation. In this article, we provide preliminary evidence from 2 studies examining the reliability and validity of the BAM in an undergraduate sample as well as a clinical sample. We close with a discussion of the limitations of the studies and implications of our findings.     

Evaluation of developmental surveillance by physicians at the two-month preventive care visit

We evaluated the effects of feedback and instruction on resident physician performance during developmental surveillance of infants at 2-month preventive care visits. Baseline data were obtained by videotaping 3 residents while they performed the physical and developmental exam components. Training consisted of individualized feedback and a brief instructional module, after which the residents were again videotaped while they performed preventive care visits. All 3 residents showed improved performance following training.     

Demographic and familial predictors of early executive function development: Contribution of a person-centered perspective

Executive function (EF) skills are integral components of young children’s growing competence, but little is known about the role of early family context and experiences in their development. We examined how demographic and familial risks during infancy predicted EF competence at 36 months of age in a large, predominantly low-income sample of nonurban families from Pennsylvania and North Carolina in the United States. Using latent class analysis, six ecological risk profiles best captured the diverse experiences of these families. Profiles with various combinations of family structure, income, and psychosocial risks were differentially related to EF. Much of the influence of early risks on later EF appears to be transmitted through quality of parent-child interactions during infancy. Findings suggest that early family environments may prove to be especially fruitful contexts for the promotion of EF development.     

Relational regulation theory: a new approach to explain the link between perceived social support and mental health

Perceived support is consistently linked to good mental health, which is typically explained as resulting from objectively supportive actions that buffer stress. Yet this explanation has difficulty accounting for the often-observed main effects between support and mental health. Relational regulation theory (RRT) hypothesizes that main effects occur when people regulate their affect, thought, and action through ordinary yet affectively consequential conversations and shared activities, rather than through conversations about how to cope with stress. This regulation is primarily relational in that the types of people and social interactions that regulate recipients are mostly a matter of personal taste. RRT operationally defines relationships quantitatively, permitting the clean distinction between relationships and recipient personality. RRT makes a number of new predictions about social support, including new approaches to intervention.