Improving Service Evaluation in Clinical Genetics: Identifying Effects of Genetic Diseases on Individuals and Families

Outcome measurement in clinical genetics is challenging. Outcome attributes used currently have been developed by service providers or adapted from measures used in other areas of healthcare. Many of the ‘patients’ in clinical genetics are healthy but at risk of developing or transmitting a condition. Usually no pharmacological or surgical treatment is offered, although information-giving is an objective of most consultations. We argue that services should be evaluated on the basis of how well they alleviate the effects of disease, from a patient perspective. This paper describes a qualitative study using seven focus groups with health professionals, patients and patient representatives. Social and emotional effects of genetics diseases were identified. Some differences emerged between the effects identified by health professionals and those identified by patients. These findings will be used to inform the evaluation of existing outcome measures and develop robust measures of outcome for clinical genetics services.     

Stress administered prior to encoding impairs neutral but enhances emotional long-term episodic memories

Stressful events frequently comprise both neutral and emotionally arousing information, yet the impact of stress on emotional and neutral events is still not fully understood. The hippocampus and frontal cortex have dense concentrations of receptors for stress hormones, such as cortisol, which at high levels can impair performance on hippocampally dependent memory tasks. Yet, the same stress hormones can facilitate memory for emotional information, which involves interactions between the hippocampus and amygdala. Here, we induced psychosocial stress prior to encoding and examined its long-term effects on memory for emotional and neutral episodes. The stress manipulation disrupted long-term memory for a neutral episode, but facilitated long-term memory for an equivalent emotional episode compared with a control condition. The stress manipulation also increased salivary cortisol, catecholamines as indicated by the presence of alpha-amylase, heart rate, and subjectively reported stress. Stressed subjects reported more false memories than nonstressed control subjects, and these false memories correlated positively with cortisol levels, providing evidence for a relationship between stress and false memory formation. Our results demonstrate that stress, when administered prior to encoding, produces different patterns of long-term remembering for neutral and emotional episodes. These differences likely emerge from differential actions of stress hormones on memory-relevant regions of the brain.     

Cognitive vulnerability to depression in individuals with borderline personality disorder

The goal of the current study was to examine whether individuals with comorbid Major Depressive Disorder (MDD) and Borderline Personality Disorder (BPD) exhibit greater severity of depressive symptoms than (1) individuals with MDD without BPD and (2) individuals with neither MDD nor BPD. One hundred and forty-one individuals participated in a semi-structured clinical interview assessing MDD and BPD. They also completed measures assessing depressive symptoms, depressogenic attributional style, hopelessness, self-esteem, rumination, and dysfunctional attitudes. In line with hypotheses, individuals with BPD and MDD exhibited higher levels of depressive symptoms and cognitive vulnerability than individuals in the other two groups. In addition, after controlling for the effects of cognitive vulnerability, the effect of group membership on depressive symptoms was reduced, suggesting that the increased severity of depressive symptoms experienced by those with BPD is partially due to their possessing higher levels of cognitive vulnerability to depression.     

Enhanced perceptual priming for neutral stimuli in a traumatic context: A pathway to intrusive memories?

Clinical observations suggest that re-experiencing symptoms are triggered by stimuli that are perceptually similar to those present shortly before the trauma or its worst moments. Two experiments investigated the possible role of perceptual priming in this phenomenon. Volunteers (N = 28, N = 62) watched a series of "traumatic" and neutral picture stories, and completed blurred object identification (priming) and recognition memory tasks. Neutral objects that immediately preceded the "traumatic" stories were more strongly primed, but not better recognised, than objects from neutral stories. Enhanced priming predicted subsequent re-experiencing symptoms. The results support the role of perceptual priming in re-experiencing.     

An inkblot for attitudes: affect misattribution as implicit measurement

Misattributions people make about their own affective reactions can be used to measure attitudes implicitly. Combining the logic of projective tests with advances in priming research, the affect misattribution procedure (AMP) was sensitive to normatively favorable and unfavorable evaluations (Experiments 1-4), and the misattribution effect was strong at both fast and slow presentation rates (Experiments 3 and 4). Providing further evidence of validity, the AMP was strongly related to individual differences in self-reported political attitudes and voting intentions (Experiment 5). In the socially sensitive domain of racial attitudes, the AMP showed in-group bias for Black and White participants. AMP performance correlated with explicit racial attitudes, a relationship that was moderated by motivations to control prejudice (Experiment 6). Across studies, the task was unaffected by direct warnings to avoid bias. Advantages of the AMP include large effect sizes, high reliability, ease of use, and resistance to correction attempts.     

Investigating the mechanisms fuelling reduced false recall of emotional material

Addictive behaviour has qualities that make it ideal for study using implicit techniques. Addictive behaviours are mediated in part by automatic responses to drug cues, and there is sometimes social pressure to distort self-reports. However, relationships between implicit attitudes and addictive behaviours have been inconsistent. Using a new implicit measure, the affect misattribution procedure (AMP), we found consistent evidence that drinking-related behaviours are systematically related to implicit attitudes. The procedure predicted a behavioural choice to drink beer and self-reported typical drinking tendencies, including hazardous drinking and alcohol-related problems. The AMP showed larger relationships with drinking behaviour than other implicit measures, and explained unique variance in drinking beyond those measures and beyond explicit measures. Though self-presentation distorted self-reports, it did not affect AMP scores. These studies highlight the importance of automatic affective responses in addictive behaviour and suggest a useful means for measuring those responses.     

Comparison selection: An approach to the study of consumer judgment and choice

We introduce an alternative perspective on the study of consumer judgment and decision making, which is based on the notion that judgment and choice problems consist of comparisons that decision makers might select. Our new perspective proposes that if we can predict the likelihood that particular comparisons will become focal in a judgment or choice task, we will be able to gain a better understanding of and anticipate the resulting effect. Building on related literatures, we propose that comparison selection is driven by the task's latitude of acceptance (LOA) and comparison fluency (i.e., the overall ease of making that comparison). The task's LOA curve represents the range and concentration of potentially acceptable comparisons, whereas comparison fluency refers to the salience and ease of making the comparison. We illustrate our approach using previously studied problems (e.g., choice, variety seeking, the “jacket and calculator” problem, and contingent valuation) as well as new empirical tests.     

Effect of Thermal Need on Responses to Pictorial Stimuli

In order to provide more rigorous experimental evidence on the question of need projection in thematic materials, 72 U. S. Army enlistee volunteers were subjected to systematically varying degrees of body cooling and confronted with pictorial stimuli, varying in relevance, to which they could make quantifiable vicarious heat-seeking responses. Thermal need was independently assessed as a negatively accelerated inverse function of ambient temperature, and responses to the most relevant stimuli provided conclusive evidence of need projection as a similarly accelerated function. Scenes which differentiated significantly between thermal conditions were those which suggested the more immediate and thorough reduction of thermal discomfort. The relevance of results to studies of motivated perception was discussed.     

Memory and comprehension for health information among older adults: Distinguishing the effects of domain-general and domain-specific knowledge

While there is evidence that knowledge influences understanding of health information, less is known about the processing mechanisms underlying this effect and its impact on memory. We used the moving window paradigm to examine how older adults varying in domain-general crystallised ability (verbal ability) and health knowledge allocate attention to understand health and domain-general texts. Participants (n = 107, age: 60–88 years) read and recalled single sentences about hypertension and about non-health topics. Mixed-effects modelling of word-by-word reading times suggested that domain-general crystallised ability increased conceptual integration regardless of text domain, while health knowledge selectively increased resource allocation to conceptual integration at clause boundaries in health texts. These patterns of attentional allocation were related to subsequent recall performance. Although older adults with lower levels of crystallised ability were less likely to engage in integrative processing, when they did, this strategy had a compensatory effect in improving recall. These findings suggest that semantic integration during reading is an important comprehension process that supports the construction of the memory representation and is engendered by knowledge. Implications of the findings for theories of text processing and memory as well as for designing patient education materials are discussed.     

Mental time travel for self and other in three- and four-year-old children

Humans possess the unique ability to mentally travel backward in time to re-experience past events (i.e., episodic memory) and forward in time to pre-experience future events (i.e., episodic foresight). Although originally viewed as different cognitive skills, they are now both viewed as components of the episodic memory system. Recently, it has been suggested that the episodic system may allow us to not only pre-experience and predict our own future but also that of another person. In the current study, we investigate this possibility by examining the ability of three- and four-year-old children to plan for their own future and for that of another person. We found that both three- and four-year-old children performed equally, when planning for their own future or when planning for the experimenter's future. These data are consistent with the finding that planning for someone else's future recruits the same neural structures that are used when planning for one's own future.