Impact of Panel Gene Testing for Hereditary Breast and Ovarian Cancer on Patients

Recent advances in next generation sequencing have enabled panel gene testing, or simultaneous testing for mutations in multiple genes for a clinical condition. With more extensive and widespread genetic testing, there will be increased detection of genes with moderate penetrance without established clinical guidelines and of variants of uncertain significance (VUS), or genetic variants unknown to either be disease-causing or benign. This study surveyed 232 patients who underwent genetic counseling for hereditary breast and ovarian cancer to examine the impact of panel gene testing on psychological outcomes, patient understanding, and utilization of genetic information. The survey used standardized instruments including the Impact of Event Scale (IES), Multidimensional Impact of Cancer Risk Assessment (MICRA), Satisfaction with Decision Instrument (SWD), Ambiguity Tolerance Scale (AT-20), genetics knowledge, and utilization of genetic test results. Study results suggested that unaffected individuals with a family history of breast or ovarian cancer who received positive results were most significantly impacted by intrusive thoughts, avoidance, and distress. However, scores were also modestly elevated among unaffected patients with a family history of breast and ovarian cancer who received VUS, highlighting the impact of ambiguous results that are frequent among patients undergoing genetic testing with large panels of genes. Potential risk factors for increased genetic testing-specific distress in this study included younger age, black or African American race, Hispanic origin, lower education level, and lower genetic knowledge and highlight the need for developing strategies to provide effective counseling and education to these communities, particularly when genetic testing utilizes gene panels that more commonly return VUS. More detailed pre-test education and counseling may help patients appreciate the probability of various types of test results and how results would be used clinically, and allow them to make more informed decisions about the type of genetic testing to select.     

Does psi exist? Comments on Milton and Wiseman's (1999) meta-analysis of ganzfeld research

J. Milton and R. Wiseman (1999) attempted to replicate D. Bem and C. Honorton's (1994) meta-analysis, which yielded evidence that the ganzfeld is a suitable method for demonstrating anomalous communication. Using a database of 30 ganzfeld and autoganzfeld studies, Milton and Wiseman's meta-analysis yielded an effect size (ES) of only 0.013 (Stouffer Z = 0.70, p = .24, one-tailed). Thus they failed to replicate Bem and Honorton's finding (ES = 0.162, Stouffer Z = 2.52, p = 5.90 x 10(-3), one-tailed). The authors conducted stepwise performance comparisons between all available databases of ganzfeld research, which were argued not to be lacking in quality. Larger aggregates of such studies were formed, including a database comprising 79 ganzfeld-autoganzfeld studies (ES = 0.138, Stouffer Z = 5.66, p = 7.78 x 10(-9)). Thus Bem and Honorton's positive conclusion was confirmed. More accurate population parameters for the ganzfeld and autoganzfeld domains were calculated. Significant bidirectional psi effects were also found in all databases. The ganzfeld appears to be a replicable technique for producing psi effects in the laboratory.     

Severe Mental Illness: A Bridge between Neurochemistry and the Collective Unconscious

This article builds a relationship between neurochemistry and Jung's a priori construct of the collective unconscious through an exploration of the psychotic delusions present in severe mental illness and the psychopharmacological drugs used to treat them. Jung's postulations of a collective unconscious were rooted in his clinical work with severely mentally ill patients, and he was aware, early on, that severe mental illness offered an example of the interplay between human biology and our psychological lives. Current post-Jungian discourse has moved away from addressing severe mental illness as a means of understanding the continued relevance of Jungian theory amidst advances in the fields of neuroscience. Narrative analysis of qualitative data on severe mental illness adds psychic dimension to medical research and offers evidence that the rise and fall of delusional content, replete with archetypal patterns of expression, are related to the presence or absence of psychopharmacological drugs used for the treatment of bipolar disorder.     

Further analysis of modifications to the three-step guided compliance procedure to enhance compliance among children with autism

Three-step guided compliance (vocal prompt, vocal plus model prompt, vocal prompt plus physical guidance) is a commonly used procedure to increase compliance among children with intellectual disabilities. Previous research has suggested that under some conditions, slight modifications to the three-step procedure may enhance its effectiveness. These modifications include omitting the model prompt and decreasing the interprompt interval. In the current study, we evaluated another modification to the procedure: the delivery of a high-preference item contingent upon compliance with the first vocal prompt (i.e., differential reinforcement). For 2 participants with autism, compliance remained low when we implemented differential reinforcement and the guided compliance procedure in isolation. However, compliance improved when we combined differential reinforcement and the three-step guided procedure, suggesting that for at least some children, the combination of contingent access to a high-preference item and the guided compliance procedure is more effective than either intervention alone.     

The use of auditory feedback and edible reinforcement to decrease toe walking among children with autism

We replicated and extended previous research on the use of auditory feedback to decrease toe walking exhibited by 3 children with autism. After pretreatment screening analyses suggested that toe walking occurred independent of social consequences, we attached squeakers to the heels of each participants' shoes. The squeakers provided auditory feedback when participants walked appropriately (i.e., with a heel-to-toe gait). For all participants, the auditory feedback itself produced increases in appropriate walking. For 1 participant, this feedback was sufficient to reduce toe walking to clinically acceptable levels; however, for 2 other participants, delivery of edible items paired with the auditory feedback was necessary. Intervention effects maintained when the schedule for edible delivery was thinned for all participants. In addition, for 2 participants, effects maintained when the intervention was implemented in a different setting and with a different person with no edibles or a thin schedule of edibles.