Generalized Anxiety Disorder in Older Medical Patients: Diagnostic Recognition, Mental Health Management and Service Utilization

Background Primary care physicians often treat older adults with Generalized Anxiety Disorder. Objective To estimate physician diagnosis and recognition of anxiety and compare health service use among older adults with GAD with two comparison samples with and without other DSM diagnoses. Methods Participants were 60+ patients of a multi-specialty medical organization. Administrative database and medical records were reviewed for a year. Differences in frequency of health service use were analyzed with logistic regression and between-subjects analysis of covariance. Results Physician diagnosis of GAD was 1.5% and any anxiety was 9%, and recognition of anxiety symptoms was 34% in older adults with GAD. After controlling for medical comorbidity, radiology appointments were increased in the GAD group relative to those with and without other psychiatric diagnoses, χ² (2, N = 225) = 4.75, p < .05. Conclusions Most patients with anxiety do not have anxiety or symptoms documented in their medical records.     

ACACIA: an agent-based program for simulating behavior to reach long-term goals

We present ACACIA, an agent-based program implemented in Java StarLogo 2.0 that simulates a two-dimensional microworld populated by agents, obstacles and goals. Our program simulates how agents can reach long-term goals by following sensorial-motor couplings (SMCs) that control how the agents interact with their environment and other agents through a process of local categorization. Thus, while acting in accordance with this set of SMCs, the agents reach their goals through the emergence of global behaviors. This agent-based simulation program would allow us to understand some psychological processes such as planning behavior from the point of view that the complexity of these processes is the result of agent–environment interaction.     

A qualitative exploratory study on gender identity and the health risks and barriers to care for transgender women living in a U.S.–Mexico border city

This exploratory, qualitative study examined the health risks and barriers to care for transgender women who live in a U.S.–Mexico border city. Individual in-depth interviews were conducted with 13 self-identified transgender women in El Paso, Texas, seven of whom identified as Latina. The interviews were recorded, transcribed, and coded for analysis of emerging themes, using the qualitative analysis software Atlas.ti (v.7.0). The themes that emerged are (1) self-acceptance of transgender identity; (2) acceptance of transgender identity within social networks; and (3) health risks, including body modifications and barriers to health care. The findings reveal phases of self-acceptance of transgender identity, a high level of health risks, scarce health services resources, and low levels of acceptance from family, friends, and partners. This study provides an important contribution to the health disparities literature on gender identity and health risks and the needs of transgender women, particularly in a U.S.–Mexico border context.     

Authenticity as a eudaimonic construct: The relationships among authenticity,values, and valence

The construct of authenticity is thought of as an expression of individuality and eudaimonic well-being. Yet, previous research has related state authenticity more to positive affect and pleasant behavior. We examine the extent to which feeling authentic is a reflection of personally held standards of worth (values) and authenticity’s relationship with affective states. We also examine whether feelings of authenticity are facilitated by dispositional authenticity. Study 1 had participants debate benevolent behavior (N = 199). In study two (N = 124) and three (N = 146), participants described memories where they acted in concordance or against their values, in both pleasant and unpleasant contexts. We found a relationship between acting in accordance with one’s values and experiencing authenticity, thus demonstrating that authenticity is a form of eudaimonic well-being, which is closely related to, but distinct from, affective states. We found less consistent associations between dispositional authenticity and momentary authentic feelings.     

The MCMI-III personality disorders scores predicted by the NEO-FFI-R and the ZKPQ-50-CC: a comparative study

This study was designed to compare the NEO-FFI-R versus the ZKPQ-50-CC in their relationships with the fourteen MCMI-III personality disorder scales in a Spanish non-clinical sample (N = 674). Previous studies showed consistent relationships between the Five Factor Model and the DSM-IV personality disorders (PD), but there is no comparative study between both Five Factor and Zuckerman's personality models. The aim was to replicate previous results about relationships between the Big-Five and PDs using the revised short version of the NEO-PI-R, and to compare the NEO-FFI-R versus the ZKPQ-50-CC regarding the relationships with MCMI-III personality disorder scales. Results showed no sharp differences between the NEO-FFI-R and ZKPQ-50-CC scales. Each instrument explained around 30% of the PDs MCMI-III scales variance. Using conjointly the 10 personality scales from the NEO-FFI-R and ZKPQ-50-CC, the PDs accounted variance rose to 38%. Differences and similarities between both short personality questionnaires are discussed.     

Visual problem solving in the absence of lexical semantics: Evidence from dementia

A case of dissociation between visual and praxic skills and linguistic, referential, and semantic skills is described in a case of dementia. Testing revealed that her visual processing was intact and that she was capable of a wide range of visually based tasks. These included copying geometric figures and block designs; matching items on the basis of number, color, or relative size, matching upper and lower case letters, sequencing numerals, orienting pictures, coins, and letters appropriately, and solving problems based on the identification of geometric patterns or on the identification of logical sequences based on pattern alternation, number, and size increases. In contrast, she was completely incapable of matching pictures on the basis of their semantic or referential meaning; similarly she had lost all comprehension of language. It was argued that this case demonstrates the capacities of a visual system cut off from all symbolic and semantic processes. When examined with other case studies this case provides information about the nature of and interaction between modality-specific perceptual processing and semantic processing, and information about the various cognitive factors involved in visual gnosis. The CT scan indicated frontal atrophy and marked anterior temporal atrophy, a pattern that is consistent with Pick's disease. The case was discussed in terms of the correlation between the pattern of observed strengths and deficits and the neurological pattern of atrophy.     

Predicting whether multiculturalism positively or negatively influences White Americans' intergroup attitudes: the role of ethnic identification

Multiculturalism, or the belief that racial and ethnic differences should be acknowledged and appreciated, has been met with both positive reactions (e.g., decreased prejudice) and negative reactions (e.g., perceptions of threat) from dominant group members. The present research proposes that multiculturalism can either positively or negatively influence White Americans' intergroup attitudes depending on their degree of ethnic identification. In Studies 1 and 2, White Americans primed with multiculturalism exhibited higher social dominance orientation (Study 1) and greater prejudice (Study 2), especially when they identified strongly with their ethnicity. In Study 3, perceptions of threat to group values were found to mediate the relation between multiculturalism, ethnic identification, and prejudice among White Americans. The results are discussed in terms of their implications for threat perceptions, ethnic identification, and conceptions of diversity.     

Evaluation of Breast Cancer Patients with Genetic Risk in a University Hospital: Before and After the Implementation of a Heredofamilial Cancer Unit

The identification of patients at risk for breast cancer by genetic testing has proven to reduce breast cancer mortality. In 2010, due to a lack of systematization in hereditary cancer assistance in our center, we implemented a multidisciplinary Heredofamilial Cancer Unit (HFCU). We analyze if the HFCU improved the rates of referrals and preventive management of breast cancer patients with genetic risk. We retrospectively compared family history records, referrals of high-risk patients to genetic counseling, and detection and management of patients with BRCA1/2 mutations in two cohorts of breast cancer patients diagnosed before (first period: 2007–2010) and after the creation of the HFCU (second period: 2010–2013). In the first period, 893 patients were included, and 902 were included in the second. Due to the inability to establish their genetic risk, 142 patients (15.9%) vs. 70 (7.8%) were excluded from analysis (p?<?0.001). Among the evaluable patients, 194 (25.8%) vs. 223 (26.8%) fulfilled one or more risk criteria (p?=?0.65). Family history documentation in patient’s medical records (92.4 vs. 97.8%, p?<?0.001) and referral rate (26.3 vs. 52%, p?<?0.0001) significantly increased in the second period. Eight BRCA1/2 mutations were detected among patients referred in the first period and 17 among those referred to the HFCU. The rate of preventive surgeries in patients with BRCA mutations significantly increased in the second period (25 vs. 76.5%, p?=?0.03). In conclusion, there was a clear improvement in family history records, referrals, and preventive surgeries in breast cancer patients with genetic risk after the implementation of the HFCU.