Predictive Genetic Testing for Hereditary Breast and Ovarian Cancer: Psychological Distress and Illness Representations 1 Year Following Disclosure

This prospective study evaluates emotional functioning and illness representations in 68 unaffected women (34 carriers/34 noncarriers) 1 year after predictive testing for BRCA1/2 mutations when offered within a multidisciplinary approach. Carriers had higher subjective risk perception of breast cancer than noncarriers. Carriers who did not have prophylactic oophorectomy had the highest risk perception of ovarian cancer. No differences were found between carriers and noncarriers regarding perceived seriousness and perceived control of breast and ovarian cancer. Mean levels of distress were within normal ranges. Only few women showed an overall pattern of clinically elevated distress. Cancer-specific distress and state-anxiety significantly decreased in noncarriers from pre- to posttest while general distress remained about the same. There were no significant changes in distress in the group of carriers except for ovarian cancer distress which significantly decreased from pre- to posttest. Our study did not reveal adverse effects of predictive testing when offered in the context of a multidisciplinary approach.     

Racial Differences in Responses to the Caregiver Strain Questionnaire

The aim of this study was to examine differences in responses to the Caregiver Strain Questionnaire (CGSQ) between African American and White caregivers of children with emotional and behavioral challenges. Significant item- and scale-level differences were detected across groups with African Americans consistently reporting less strain. We examined whether these differences were more likely due to nonequivalent measurement than to real differences in the experience of caregiver strain. Confirmatory factor analysis showed that the model fit the data well for both racial groups, but there were some differences in structural components. Internal consistency was equivalent across the groups. In an examination of criterion validity, regression analyses showed that African American caregivers experienced a slower rate of increase in objective caregiver strain at a given increase in child internalizing problems. No other race differences were found in the regression analyses. In general, we conclude that the CGSQ can be useful for detecting caregiver strain and identifying family support needs for both White and African American caregivers. Differences across groups in reports of caregiver strain, however, call for more research on racial differences in the impact on the family of caring for a child with emotional and behavioral disorders.     

Developmental Differences in Metacognition and their Connections with Cognitive Development in Adulthood

This study investigated developmental differences in some metacognitive variables in ill-defined problem solving and their possible connections with cognitive development in adulthood. Participants were 57 individuals of different ages (adolescents, young adults, mature adults and older adults). They solved one well-defined and six ill-defined problems while their thinking-aloud was taped. They then answered a metacognitive statements questionnaire. Differences in performance were statistically significant in all problems: the best results in interpolation and divergent production problems were achieved by the younger adult group and the best performance on most dialectical everyday problems was found in the mature adults' group. We found no significant differences between age groups in the on-line monitoring of the solving process. Accuracy in metacognitive statements was however significantly better in the mature adult and the younger adult groups. Awareness of and reflection on one's own mental processes showed a similar developmental pattern to relativistic/dialectical thought: low expression in adolescence, an increase in early adulthood, a peak in mature adulthood and a minor decline in later years.     

The Role of Temperament in the Etiology of Child Psychopathology

A substantial proportion of children and adolescents come to suffer from psychological disorders. This article focuses on the temperament factors that are involved in the pathogenesis of child psychopathology. It is argued that besides the reactive temperament factor of emotionality/neuroticism, the regulative process of effortful control also plays an important role in the etiology and maintenance of internalizing and externalizing problems in youths. More specifically, vulnerability to child psychopathology is determined by a temperament that is characterized by high levels of emotionality/neuroticism and low levels of effortful control. Models are hypothesized in which reactive and regulative temperament factors either have interactive or additive effects on the development of psychological disorders in children, and conceptualized in terms of a developmental psychopathology perspective. Directions for future research and clinical implications of this temperamental view on psychopathology are discussed.     

A call to restructure the drug development process: Government over-regulation and non-innovative late stage (Phase III) clinical trials are major obstacles to advances in health care

The history of drug/vaccine development has included major advances guided primarily by risk/benefit analyses concerning the innovative agent, not by evidence-based clinical trials (Phase I–IV). Because the approval for new drugs is hindered under the present process, the system requires restructuring. The Phase I/II study period should be more flexible, using the “environment of knowledge” about the new agent, plus risk/benefit assessments. Phase III, as presently constructed, does not add new adverse events data, it provides a narrower profile of drug efficacy than properly done Phase II studies, and placebo-controlled trials continue to raise unresolved ethical and social issues. Phase III studies should be abandoned for most drugs, and substituted with properly powered Phase II doseranging studies plus careful post-marketing surveillance. Phase III should be a penalty for poor drug development, not a regulatory requirement. To accomplish efficient drug development, greater cooperation between pharmaceutical companies and governments in developing clinical trials is needed rather than over-regulation. These changes will synchronize the drug development and regulatory process with the current rapid drug discovery process, reduce drug development time and cost, and improve patient care. The author is Adjunct Professor of Medicine, Weill Medical College of Cornell University, New York, New York, USA.     

Child Maltreatment and Emergent Personality Organization: Perspectives from the Five-Factor Model

The Five-Factor Model was used to examine personality organization in 211 six-year-old children (135 maltreated and 76 nonmaltreated). Longitudinal assessments were conducted at ages 7, 8, and 9. Six-year-old maltreated children exhibited lower agreeableness, conscientiousness, and openness to experience and higher neuroticism than did nonmaltreated children. Maltreated children also were more frequently represented in less adaptive personality clusters than were their nonmaltreated counterparts. A particularly vulnerable profile occurred predominantly among maltreated children and was related to experiencing both abuse and neglect. Child maltreatment and personality clusters were related to individual differences perceived by peers. Longitudinal stability of the personality dimensions also was assessed. At age nine, evidence was found for maintenance of the organization of the personality clusters obtained at age six and for continuity of maltreated children's personality liabilities.     

The Decades of Life: Relocating Erikson's Stages

Erik H. Erikson's life cycle schema consists of eight stages. Three are located in infancy and early childhood (ages 1–5), one in childhood (5–12), one in adolescence, and three in adulthood. This essay proposes a relocation of the stages in terms of decades. The eight psychosocial crises in Erikson's model are retained, but each crisis and its resolution is the central theme of a decade of life. This relocation of Erikson's stages orients the life cycle schema more toward adulthood than to early childhood, as six of the stages now occur in the adult years. It also reflects Erikson's theoretical shift in emphasis from the ego to the sense of I in his later writings. A proposal for how the ninth and tenth decades fit into the schema is also offered.     

“Seeing Conversion Whole”: Testing a Model of Religious Conversion

Rambo (1993) theorized that religious conversion consists of a process involving seven dimensions, labeled context, crisis, quest, encounter, interaction, commitment, and consequences. To test the Rambo model, a new measure, the 97-item Adult Religious Conversion Experiences Questionnaire (ARCEQ), was developed, revised on the basis of feedback from a focus group, and administered by mail to 110 adult volunteers who self-identified as having experienced conversion. Reliability analysis of the subscales of the ARCEQ resulted in five (crisis, quest, encounter, commitment, and consequences) meeting the criterion ( > .80). A sixth (interaction) achieved a reliability of .76 and was retained, but the seventh (context) was dropped. Principal components factor analysis with Varimax rotation produced factors labeled Redemptive Love, Zealous Dedication, Dysphoric Need, Openness to Uncertainty, Extrinsic Crisis, and Experiential Learning, which could readily be interpreted in relation to Rambo's model. Subsidiary analyses showed a number of significant correlations between demographic characteristics of the sample and differences in religious conversion experience.     

语篇理解中背景信息的激活: 情景限制的共振过程

该研究采用双人物线索语篇材料,对语篇理解中背景信息激活过程的共振模型与剧景模型进行检验。实验一发现,如果主角和配角一直同时在故事情景中成为主线索,则目标句中主角的行为可以激活那些经过屏蔽的、与这一行为相关的配角特征。在实验二中,配角只是在特征描述段落中出现,而后通过适当的描述使其在故事情景中消失,使主角成为故事的主线索,结果发现,此时目标句中主角的行为并不会激活经过屏蔽的配角的特征描述。这些结果表明,背景信息的激活虽然具有共振的特点,但共振并不是无范围限制的,而是一种情景限制下的共振。