Provision of Genetics Services on Guam

Guam’s geographic isolation and lack of community resources have resulted in unique healthcare needs. In 2006, the Western States Genetic Services Collaborative (WSGSC) conducted a genetics needs assessment and found that professional development is limited, families lack access to genetic services, and improved coverage of genetic testing is needed. With funding from the WSGSC, a Guam genetics outreach clinic was established and staffed by genetic counselors and a medical geneticist from Hawaii. Four clinics have been held to date. Although several challenges have been encountered, including minimal coverage of genetic testing by Guam insurance companies, limited referrals for families with private insurance, and inappropriate referral indications, the outreach clinic has been successful at increasing access to genetic services and improving professional development. With more collaborative work by staff from Guam, Hawaii, and the WSGSC, provision and reimbursement of genetic services and testing will continue to improve.     

Action preferences and the anticipation of action outcomes

Skilled performers of time-constrained motor actions acquire information about the action preferences of their opponents in an effort to better anticipate the outcome of that opponent's actions. However, there is reason to doubt that knowledge of an opponent's action preferences would unequivocally influence anticipatory responses in a positive way. It is possible that overt information about an opponent's actions could distract skilled performers from using the advance kinematic information they would usually rely on to anticipate actions, particularly when the opponent performs an ‘unexpected’ action that is not in accordance with his or her previous behaviour. The aim of this study was to examine how the ability to anticipate the outcome of an opponent's actions can be influenced by exposure to the action preferences of that opponent. Two groups of skilled handball goalkeepers anticipated the direction of penalty throws performed by opponents before and after a training intervention that provided situational probability information in the form of action preferences (AP). During the training phase participants in an AP-training group anticipated the action outcomes of two throwers who had a strong preference to throw in one particular direction, whilst participants in a NP-training group viewed players who threw equally to all directions. Exposure to opponents who did have an action preference during the training phase resulted in improved anticipatory performance if the opponent continued to bias their throws towards their preferred direction, but decreased performance if the opponent did not. These findings highlight that skilled observers use information about action preferences to enhance their anticipatory ability, but that doing so can be disadvantageous when the outcomes are no longer consistent with their generated expectations.     

Humour in psychotherapy

This paper examines some of the uses of humour in psychotherapy. Literature is reviewed and clinical examples given to illustrate how patients and therapists may be affected by humour. The conclusion reached is that using humour does not make our work less serious, but may in fact help the patient to become more integrated and more spontaneous in his relationships.     

The formation and development of individual and ethnic identity: insights from psychiatry and psychoanalytic theory

This paper describes the concept of identity formation, examining the historical development of identity, particularly ethnic identity. The author distinguishes the normative developmental achievement of self and group identity with pathological identity diffusion due to an earlier attachment disorder. The clinical case of a young male’s experience of his Persian family’s immigration to a new host country details the challenges encountered in ethnic identity formation and its interference in consolidating this ongoing process. The complicated task of self identity formation during this phase of development in the face of parental unresolved and ambivalent attitudes toward their own sense of threatened self and group identity diffusion is discussed. Parental intrapsychic conflict combined with environmental conflict such as racism, prejudice, and more recent paranoia toward Middle Eastern immigrant families interferes further with the normal identity formation process. The paper elaborates the compromised bicultural identity of a youngster who struggles through his developmental life phases.Mali A. Mann, M. D., is Adjunct Associate Professor of Psychiatry and Behavioral Science, Department of Psychiatry and Behavioral Science, School of Medicine, Stanford University, Stanford, CA and Faculty Member, San Francisco Psychoanalytic Institute.     

The impact of borderline personality disorder and anxiety on neuropsychological performance in major depression

Previous studies of neuropsychological performance in borderline personality disorder (BPD) have exhibited mixed results. The high rate of co-occurring major depressive disorder (MDD) in BPD makes it difficult to specify whether neuropsychological deficits in BPD predominantly reflect co-occurring MDD or unique aspects of their psychopathology. To address this issue, 22 participants with borderline personality disorder and concurrent major depressive disorder (BPD-MDD) and 33 participants with MDD and no concurrent personality disorder were compared on a neuropsychological battery that assessed seven domains of performance: general intellectual functioning, motor skill, psychomotor speed, attention, memory, working memory, and executive function. Neuropsychological performance did not differ between BPD-MDD and MDD. However, BPD-MDD participants reported higher levels of anger, anxiety, and of overall emotional distress compared to MDD. When levels of anxiety were controlled, BPD-MDD participants exhibited superior general intellectual performance, psychomotor speed, and attention. Deficits found in previous BPD samples may reflect their susceptibility to co-occurring MDD. The impact of anxiety on neuropsychological performance in BPD, though, indicates a need for future experimental studies of the effects of mood on cognitive function to determine whether mood dysregulation, rather than core depressive symptoms, underlie cognition impairments in BPD.     

Better the Devil You Know? High-Risk Individuals’ Anticipated Psychological Responses to Genetic Testing for Melanoma Susceptibility

Purpose: The psychological consequences of genetic testing for mutations among individuals at increased risk of developing melanoma remain unexamined. The present study aimed to explore anticipated emotional, behavioral, cognitive, and familial responses to hypothetical genetic testing for melanoma susceptibility. Methods: Forty semi-structured interviews were undertaken with affected (n=20) and unaffected (n=20) individuals at either high or average risk of developing melanoma due to family history. Results: In-depth thematic analysis revealed that, in response to being identified as a mutation carrier, most participants with a family history anticipated calmly accepting their increased risk; either increasing precaution adoption or maintaining already vigilant behavioral practices; perceiving such information as important and valuable; and communicating genetic test results to family members, despite the acknowledgement of potential difficulties. In response to being identified as a non-carrier, the majority of participants expected to feel relieved; to maintain current precautionary health practices; to still perceive themselves at some risk of developing melanoma; and to be wary of the potential negative behavioral consequences of disclosing such information to family members. Women appeared more likely than men to acknowledge the potential for depression and worry following genetic testing. In contrast, more males than females expected to carry a gene mutation, and viewed their current preventive practices as optimum. Conclusion: Genetic testing for melanoma risk is likely to elicit a complex array of emotional, behavioral, cognitive, and familial responses for both testees and their family members, and these responses are likely to bear subtle differences for males and females.     

Individual differences in anxiety trait are related to spatial learning abilities and hippocampal expression of mineralocorticoid receptors

Although high levels of anxiety might be expected to negatively influence learning and memory, it remains to be shown whether individual differences in anxiety may influence spatial learning and memory in outbred rat populations. We have studied this possibility in male Wistar rats whose levels of anxiety were first characterized as either high (HA) or low (LA) according to their behavior in the elevated plus maze or in the open field test. Subsequently, their performance in the Morris water maze was studied, a task dependent on hippocampal activity. Interestingly, LA rats showed a faster acquisition and better memory in the water maze when compared to HA rats. Indeed, this difference in performance could mainly be attributed to the increase in thigmotactic behavior (swimming in circles close to the maze walls) displayed by HA rats during spatial navigation. Glucocorticoids are known to affect the state of anxiety and the hippocampus is the main target of glucocorticoids in the brain. Hence, we investigated whether the hippocampal expression of the two classical corticosteroid receptors, mineralocorticoid (MR) and glucocorticoid (GR) differed in the two groups of rats. We found that LA rats displayed higher hippocampal expression of MR but not GR than HA rats. Indeed, the expression levels for these receptors were positively correlated with the amount of time spent by the animals in the open arms of the elevated plus maze. Moreover, we present evidence that the levels of anxiety quantified in the first stages of our study constitute a trait rather than a state. Taken together, this study has generated evidence of a close interaction between the anxiety trait, hippocampal MR expression and the learning abilities of individuals in stressful spatial orientation tasks.     

Effects of parent education on knowledge and attitudes

This study evaluated 42 pregnant and parenting adolescents (aged 13 to 20 years) and adults (who began parenting as adolescents) enrolled in parenting classes. The Parent as a Teacher Inventory and the Adult-Adolescent Parenting Inventory were used to measure change in knowledge and attitudes following participation in the classes. The findings indicated significant improvement as a result of parent education.