How do Physicians Decide to Refer Their Patients for Psychiatric Genetic Counseling? A Qualitative Study of Physicians’ Practice

Psychiatric genetic counseling (PGC) is an emerging specialty discipline within the genetic counseling profession. A specialist PGC service was founded in 2012 in Vancouver, Canada, and though patient benefits have been demonstrated, many physicians do not regularly refer patients to the service despite awareness of its availability. We conducted a qualitative study involving semi-structured telephone interviews with Vancouver-based physicians who were aware of the PGC service to explore this phenomenon. Interviews were audio-recorded, transcribed verbatim, coded, and analysed for emergent themes. Consistent with a grounded theory approach, constant comparison was employed throughout data collection and analysis. Analyses of interviews conducted with 12 physicians revealed that referral practices were informed by perceptions about the purpose of PGC and interpretation of patient cues. Physicians perceived PGC as an information-focused intervention, and considered referral when patients explicitly expressed desire for information about recurrence risk or etiology that they felt unable to adequately address themselves. Even when physicians identified psychotherapeutic benefits of PGC, patient needs of this nature were not perceived as cues prompting referral to PGC. These data suggest that further work is necessary to position PGC in physicians’ minds as a service that could potentially benefit most individuals with psychiatric disorders and their families, and that it encompasses more than information provision. It is important to increase physicians’ awareness of the complementary role that genetic counselors can play to that of the physician in providing psychotherapeutically oriented counselling about illness etiology.     

Social cognition is not associated with cognitive reserve in older adults

Social and general cognitive abilities decline in late life. Those with high cognitive reserve display better general cognitive performance in old age; however, it is unknown whether this is also the case for social cognition. A total of 115 healthy older adults, aged 60–85 years (m = 44, f = 71) were assessed using The Awareness of Social Inference Test (TASIT-R; social cognition), the Lifetime of Experiences Questionnaire (LEQ; cognitive reserve), and the Wechsler Abbreviated Scale of Intelligence (WASI-II; general cognitive ability). The LEQ did not predict performance on any TASIT-R subtest: Emotion Evaluation Test (β = -.097, p = .325), Social Inference – Minimal (β = -.004, p = .972), or Social Inference – Enriched (β = -.016, p = .878). Sensitivity analyses using two alternative cognitive reserve measures, years of education and the National Adult Reading Test, supported these effects. Cognitive reserve was strongly related to WASI-II performance. Unlike general cognitive ability, social cognition appears unaffected by cognitive reserve. Findings contribute to the emerging understanding that cognitive reserve differentially affects individual cognitive domains, which has implications for the theoretical understanding of cognitive reserve and its brain correlates. Cognitive measures unbiased by cognitive reserve may serve as best indicators of brain health, free of compensatory mechanisms.     

Views of a good life and allostatic load: Physiological correlates of theories of a good life depend on the socioeconomic context

This research examines the relationship between one’s theory of a good life and allostatic load, a marker of cumulative biological risk, and how this relationship differs by socioeconomic status. Among adults with a bachelor’s degree or higher, those who saw individual characteristics (e.g. personal happiness, effort) as part of a good life had lower levels of allostatic load than those who did not. In contrast, among adults with less than a bachelor’s degree, those who saw supportive relationships as part of a good life had lower levels of allostatic load than those who did not. These findings extend past research on socioeconomic differences in the emphasis on individual or relational factors and suggest that one’s theory of a good life has health implications.     

Religious Commitment's Moderating Effect on Refugee Trauma and Growth

The authors assessed religious commitment's moderating effect on the relationship between posttraumatic stress disorder and posttraumatic growth (PTG) in adult Liberian refugees who experienced trauma from war (N = 444). Results indicated that religious commitment predicted PTG and had an interaction effect on the relationship between trauma and PTG, albeit a negative one. Counselors should therefore gauge clients’ worldviews in terms of religion or spirituality before integrating spiritual or religious issues in therapy.     

Depression and Cognitive Control across the Lifespan: a Systematic Review and Meta-Analysis

Neuropsychology Review - Depression has been shown to negatively impact neurocognitive functions, particularly those governed by fronto-subcortical networks, such as executive functions. Converging...     

Treatment of food selectivity: An evaluation of video modeling of contingencies

Many children with disabilities have feeding problems including, but not limited to, food selectivity and/or food refusal. The purpose of this study was to evaluate the effectiveness of video modeling of contingencies alone and combined with direct exposure to the contingencies in the treatment of food selectivity. Treatment procedures included sequentially introducing videos in which models consumed nonpreferred foods or were exposed to differential reinforcement or differential reinforcement plus escape extinction. In addition, during feeding sessions, participants were exposed to differential reinforcement. Results indicated that video modeling of differential reinforcement plus direct exposure to differential reinforcement may be effective at increasing consumption of some nonpreferred foods, but the results were not replicated across all foods. For one participant, consumption of one food increased with video modeling alone.     

Note on comparability of MicroCog test forms.

This study investigated the differences between the Standard and Short forms of MicroCog by comparing Domain scores for a clinical sample of 351 substance abusers which gave a significant difference between scores on the Spatial Processing Domain. Implications for research and clinical use are discussed.     

Why are you looking at me? It’s because I’m talking,but mostly because I’m staring or not doing much

Our attention is particularly driven toward faces, especially the eyes, and there is much debate over the factors that modulate this social attentional orienting. Most of the previous research has presented faces in isolation, and we tried to address this shortcoming by measuring people’s eye movements whilst they observe more naturalistic and varied social interactions. Participants’ eye movements were monitored whilst they watched three different types of social interactions (monologue, manual activity, active attentional misdirection), which were either accompanied by the corresponding audio as speech or by silence. Our results showed that (1) participants spent more time looking at the face when the person was giving a monologue, than when he/she was carrying out manual activities, and in the latter case they spent more time fixating on the person’s hands. (2) Hearing speech significantly increases the amount of time participants spent looking at the face (this effect was relatively small), although this was not accounted for by any increase in mouth-oriented gaze. (3) Participants spent significantly more time fixating on the face when direct eye contact was established, and this drive to establish eye contact was significantly stronger in the manual activities than during the monologue. These results highlight people’s strategic top-down control over when they attend to faces and the eyes, and support the view that we use our eyes to signal non-verbal information.     

Counsellors' experiences of changing their practice: Learning the psychodynamic‐interpersonal model of therapy

Seven counsellors were interviewed about their experiences of learning and applying a new approach to therapy: the psychodynamic‐interpersonal model. These interviews were analysed using grounded theory — a qualitative approach. Under the core category of ‘changing counselling practice: applying the PI model of therapy’, the material was organised into 10 major categories: difficult feelings; new awareness; therapeutic identity; identifying reasons for choosing how to work; experiencing difficulties in adherence; attributing causes of difficulties; ways through the difficulties; understanding how change in practice occurs; changing interventions; and specific other inputs. Examples from the interviews are used to cast light on the difficulties experienced by counsellors in the process of changing their practice.