Bayesian Risk Assessment in Genetic Testing for Autosomal Dominant Disorders with Age-Dependent Penetrance

Risk assessment is an essential component of genetic counseling and testing, and the accuracy of risk assessment is critical for decision making by consultands. However, it has been shown that genetic risk calculations may have high error rates in practice. Risk calculations for autosomal dominant disorders are frequently complicated by age-dependent penetrance and sensitivities of less than 100% in genetic testing. We provide methods of risk calculation for prototypical pedigrees of a family at risk for an autosomal dominant disorder with age-dependent penetrance. Our risk calculations include scenarios in which the sensitivity of genetic testing is less than 100%, and in which the sensitivity of genetic testing varies for different family members at risk. Our Bayesian methods permit autosomal dominant disease probabilities to be calculated accurately, taking into account all relevant information. Our methods are particularly useful for hereditary cancer syndromes, in which genetic testing can seldom achieve 100% sensitivity. Our methods can be applied to many different scenarios, including those where the sensitivity of genetic testing varies for different family members at risk. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government.     

The neurobiology of virtual reality pain attenuation.

During the past decade, virtual reality (VR) has gained recognition as a means of attenuating pain during medical procedures. However, while investigators have examined the effects of virtual environments on level of distraction, subjective pain intensity, and brain activity, there have been only a handful of investigations into the neurobiological mechanisms associated with VR's efficacy. In an effort to explain how VR may alter pain perception and produce analgesia, as well as to guide the development of novel and improved VR pain treatments, this review aims to link the wealth of empirical data examining the neurobiology of pain to the growing field of VR. This review is separated into three main sections: (a) a brief overview of the current literature on the use of VR for the treatment of pain; (b) a review of the basic neurobiology of how pain is detected, processed, and controlled by the brain; and (c) an exploration into how current VR pain treatments may impact the pain system to produce analgesia. In addition, the future of VR for pain treatment is discussed, including how current treatments might be improved and novel ways to use VR to treat pain might be developed. Speculation on future VR interventions is based on our current understanding of how the brain processes pain and how VR appears to alter this process and produce analgesia.     

Patients with schizophrenia demonstrate dissociation between affective experience and motivated behavior

Self-reported emotional experience does not differ between patients with schizophrenia and healthy individuals, suggesting that the anhedonia in schizophrenia instead reflects decoupling of affect from motivated behavior. In 2 behavioral conditions, participants with schizophrenia and healthy participants were able to prolong or decrease exposure to stimuli while stimuli were present or alter the likelihood of future exposure to stimuli on the basis of internal representations. They also provided self-reports of affective experience. Patients showed weaker correspondence between behavior and ratings than did comparison participants. The effect was amplified when patients responded on the basis of internal rather than evoked stimulus representations. These data suggest that the motivational deficits in schizophrenia reflect problems in the ability to translate experience into action.     

Resource Document on Access to Firearms by People with Mental Disorders

The American Psychiatric Association, (“APA”), with more than 36,000 members at present, is the Nation's leading organization of physicians who specialize in psychiatry. APA provides for education and advocacy and develops policy through Position Statements. It promotes enhanced knowledge of particular topics relevant to psychiatric practice and patient care through Resource Documents. Since 1993, the APA has developed various positions and resource materials related to firearms and mental illness, incorporating evolving themes as new issues emerge. This paper reflects the APA's 2014 Resource Document on “Access to Firearms by People with Mental Disorders.” This article is derived from work done on behalf of American Psychiatric Association and remains the property of APA. It has been altered only in response to the requirements of peer review. Copyright © 2015 American Psychiatric Association. Published with permission (original adopted by the American Psychiatric Association 2014).     

A Secondary Analysis of Integrated Pediatric Chronic Pain Services Related to Cost Savings

Youth with chronic pain have high healthcare utilization and associated costs. Research supports integrated treatment; though, it’s unclear which treatments are used and cost-effective. This study expands on work that found reduced service use and cost savings following participation in an outpatient integrated pediatric pain clinic. We explored which services were commonly used and which individual (psychotherapy, medication management, acupuncture, massage, biofeedback) and/or combinations of services were associated with service use reduction and cost savings. Medication management and psychotherapy were more common than complementary integrative medicine (CIM) services. Massage services were associated with reduced inpatient costs. There were trends of fewer emergency department visits for participants who received CIM services in addition to medication management and psychotherapy, and more visits for those with biofeedback. Findings suggest that a more detailed examination of service utilization is needed to better understand cost outcomes related to the integrated treatment of pediatric chronic pain.

     

Construction of a Hypercompetitive Attitude Scale

Theory testing in the area of hypercompetitiveness has been impeded by the lack of an adequate psychometric instrument. Four studies were conducted as part of an initial research program designed to remedy this deficiency by constructing an individual difference measure of general hypercompetitive attitude with satisfactory psychometric properties. In Studies 1 and 2, a 26-item scale was derived primarily through item-total correlational analysis; it demonstrated adequate internal and test-retest reliabilities. The remaining two studies were concerned with determining the construct validity of the scale. In line with theoretical expectations based on Horney's theory of neurosis, subjects who perceived themselves as hypercompetitive were less psychologically healthy. The potential usefulness of the scale in therapeutic, athletic, school, and business settings is discussed.     

Memory and learning for visual signals in time and space

Vision is often characterized as a spatial sense, but what does that characterization imply about the relative ease of processing visual information distributed over time rather than over space? Three experiments addressed this question, using stimuli comprising random luminances. For some stimuli, individual items were presented sequentially, at 8 Hz; for other stimuli, individual items were presented simultaneously, as horizontal spatial arrays. For temporal sequences, subjects judged whether each of the last four luminances matched the corresponding luminance in the first four; for spatial arrays, they judged whether each of the right-hand four luminances matched the corresponding left-hand luminance. Overall, performance was far better with spatial presentations, even when the entire spatial array was presented for just tens of milliseconds. Experiment 2 demonstrated that there was no gain in performance from combining spatial and temporal information within a single stimulus. In a final experiment, particular spatial arrays or temporal sequences were made to recur intermittently, interspersed among, non-recurring stimuli. Performance improved steadily as particular stimulus exemplars recurred, with spatial and temporal stimuli being learned at equivalent rates. Logistic regression identified several shortcut strategies that subjects may have exploited while performing our task.     

Trait valence and the better-than-average effect

People tend to regard themselves as having superior personality traits compared to their average peer. To test whether this "better-than-average effect" varies with trait valence, participants (N = 154 students) rated both themselves and the average student on traits constituting either positive or negative poles of five trait dimensions. In each case, the better-than-average effect was found, but trait valence had no effect. Results were discussed in terms of Kahneman and Tversky's prospect theory.