Genetic Counseling as a Tool for Type 2 Diabetes Prevention: A Genetic Counseling Framework for Common Polygenetic Disorders

Advances in genetic epidemiology have increased understanding of common, polygenic preventable diseases such as type 2 diabetes. As genetic risk testing based on this knowledge moves into clinical practice, we propose that genetic counselors will need to expand their roles and adapt traditional counseling techniques for this new patient set. In this paper, we present a genetic counseling intervention developed for a clinical trial [Genetic Counseling/Lifestyle Change for Diabetes Prevention, ClinicalTrials.gov identifier: NCT01034319] designed to motivate behavioral changes for diabetes prevention. Seventy-two phenotypically high-risk participants received counseling that included their diabetes genetic risk score, general education about diabetes risk factors, and encouragement to participate in a diabetes prevention program. Using two validated genetic counseling scales, participants reported favorable perceived control and satisfaction with the counseling session. Our intervention represents one model for applying traditional genetic counseling principles to risk testing for polygenetic, preventable diseases, such as type 2 diabetes.     

PTSD,comorbid depression,and the cortisol waking response in victims of intimate partner violence: preliminary evidence

Posttraumatic Stress Disorder (PTSD) and Major Depressive Disorder (MDD) are two highly comorbid and debilitating disorders experienced by more than half of intimate partner violence victims (IPV). Hypothalamic–pituitary–adrenal (HPA) abnormalities are common in both disorders, though the direction of abnormalities often differs. The present study examined the relationship between comorbid PTSD and MDD, and the (salivary) cortisol waking response in 104 recently abused IPV victims. Waking cortisol levels, area under the waking curve with respect to ground (AUCg), and AUC with respect to increase (AUCi) were examined to determine the relation of HPA dynamics to comorbidity for basal versus more dynamic measures. Prior to accounting for comorbidity, women with PTSD or MDD showed significantly greater AUCi than women without the respective disorder. Accounting for comorbidity, PTSD only did not differ from other groups, while MDD only and PTSD + MDD showed greater AUCi than women with neither disorder. Results were nonsignificant for waking cortisol levels or AUCg. Results suggest that MDD drives elevated waking cortisol response, but not basal cortisol activity in recently abused IPV victims. Results demonstrate the importance of examining comorbid diagnoses and HPA activity from a dynamic perspective. Therapeutic implications are discussed.     

Correlation between Changes in Stress-Induced Corticosterone Secretion and GR mRNA Levels

The current study was conducted to determine the potential relationship between stress-induced corticosterone secretion and corticosteroid receptor mRNA levels after 5 days of intermittent stress. In particular, we were interested in the rate at which animals terminate a stress response, and how this termination may be altered by repeated stress. Adult male Sprague-Dawley rats were subjected to either 5 days of restraint stress or 5 days of an unpredictable stress paradigm. Restraint-stress induced corticosterone secretion was measured on Days 1 and 5 in both groups, and animals were killed on Day 6. Glucocorticoid receptor (GR), and mineralocorticoid (MR) mRNA levels were determined using in-situ hybridization techniques. Five days of restraint stress caused an habituation of the plasma corticosterone response to stress measured 60 and 90 min post-stress initiation; this pattern of corticosterone secretion was not observed in the animals subjected to unpredictable stress. Five days of either stress paradigm did not alter MR mRNA levels measured within the hippocampus or GR mRNA levels within the hippocampus or the medial parvocellular division of the paraventricular nucleus of the hypothalamus (mpPVN). However, an individual's GR mRNA levels measured within the CA1/2 region of the hippocampus and the mpPVN were significantly correlated with the degree of habituation of the corticosterone response to stress measured on Day 5. This suggests that an increase in the rate of termination of the stress response and levels of GR within the hippocampus and mpPVN may be functionally related.     

Time-of-day effects on response of natural killer cells to acute stress in men and women.

Diurnal influences on natural killer (NK) cell changes to acute stress were assessed in 21 men and 21 women assigned to either an acute stress (mental arithmetic) or control task condition. Sessions began at either 8 a.m. or 2 p.m. Number of NK (CD3-CD56+) cells and NK activity were measured at baseline, during the 5-min task, and 60 and 90 min after the task. Both morning and afternoon stress participants had elevated NK cell numbers during the task. After the task, number of NK cells decreased in morning stress participants but remained significantly above baseline levels 60 and 90 min posttask. NK cell numbers in afternoon stress participants decreased to below baseline levels 60 and 90 min after the task. Changes in NK activity were driven primarily by diurnal influences. NK activity increased in all morning participants and stayed increased 60 and 90 min posttask. NK activity of all afternoon participants also increased during the task but dropped below baseline 60 and 90 min later. Greater increases in NK levels and activity during the task were associated with greater heart rate changes.     

Posttraumatic Stress Following Acute Medical Trauma in Children: A Proposed Model of Bio-Psycho-Social Processes During the Peri-Trauma Period

Millions of children worldwide experience acute medical events. Children’s responses to these events range from transient distress to significant posttraumatic stress disorder symptoms (PTSS). While many models suggest explanations for the development and maintenance of PTSS in adults, very few have focused on children. Current models of child PTSS are primarily restricted to the post-trauma period, thus neglecting the critical peri-trauma period when screening and preventive interventions may be most easily implemented. Research on PTSS in response to pediatric medical trauma typically examines predictors in isolation, often overlooking potentially important interactions. This paper proposes a new model utilizing the bio-psycho-social framework and focusing on peri-trauma processes of acute medical events. Understanding the relationships among bio-psycho-social factors during peri-trauma can inform early identification of at-risk children, preventive interventions and clinical care. Recommendations for future research, including the need to examine PTSS in the context of multiple influences, are discussed.     

Initial Evidence for the Reliability and Validity of the Sexual Experiences Survey-Short Form Perpetration (SES-SFP) in College Men

This study provides psychometric data on the Sexual Experiences Survey—Short Form Perpetration (SES-SFP), a revision of one of the most widely used measures of sexual perpetration, in a sample of college men. Participants (n = 402) completed a web survey containing the study measures; a subset of 66 participants completed the SES-SFP again 2 weeks later. Our results provide initial evidence of internal consistency and convergent evidence of validity for the SES-SFP in college men but question the measure’s test-retest reliability. The severity of tactics used to coerce sexually aggressive behaviors was more strongly associated with rape empathy than sexual outcome severity scores, indicating utility of assessing coercive tactics. Additional research is needed regarding the psychometric properties of the SES-SFP and other measures of sexual perpetration in order to accurately assess rates of these behaviors and inform preventive interventions.     

Trauma history as a resilience factor for patients recovering from total knee replacement surgery

Research concerning the impact of trauma history on individuals' ability to cope with subsequent events is mixed. While many studies find that trauma history increases vulnerability for conditions such as post-traumatic stress disorder and chronic pain, others reveal that there are benefits associated with moderate levels of stress (e.g. development of coping skills).

Objective: The present study investigated whether the experience of prior traumatic stressors would serve as a risk or resilience factor based on physical and emotional outcomes among patients recovering from total knee replacement surgery (TKR).

Design: 110 patients undergoing unilateral, TKR completed surveys before surgery, as well as one and three months following the procedure.

Results: Contrary to hypotheses, patients who reported more prior traumas experienced less severe pain and functional limitations at one- (β = ?.259, p = .006) and three-month follow-up assessments (β = ?.187, p = .04). A similar pattern emerged when specific types of traumas (e.g. interpersonal) were examined in relation to physical recovery. Further, patients’ trauma history was negatively related to symptoms of post-traumatic stress three-months following surgery (e.g. Avoidance: β = ?.200, p = .037).

Conclusion: Trauma history represents a source of resilience, rather than vulnerability, within the context of arthroplastic surgery.     

The Impact of Social Support on the Relationship between Trauma History and PTSD Symptoms in Motor Vehicle Accident Victims

The present study examined how different types of social support differentially moderated the relationship between trauma history characteristics and the development of posttraumatic stress disorder symptoms (PTSS) following a motor vehicle accident (MVA). Two hundred thirty-five MVA victims self-reported levels of social support and trauma history, and were evaluated for PTSS 6- and 12-months post-MVA. Results indicated that after controlling for gender, injury severity and income, number of prior trauma types and subjective responses to prior traumatization predicted subsequent PTSS (ps < .05). Appraisal social support was a significant moderator of the total number of types of trauma (appraisal: 6-months β = -.16, p < .05; 12-months β = -.17, p < .05) and subjective physical injury during the prior trauma (appraisal: 6-months β = -.14, p < .05; 12-months β = -.19, p < .05) in predicting PTSS. Results underscore the importance of examining both trauma history and social support as multi-dimensional constructs and suggest merit to addressing social support in trauma victims with a prior trauma history.     

Conceptually driven pharmacologic approaches to acute trauma

Secondary prevention of posttraumatic stress disorder (PTSD) entails intervening in the aftermath of a traumatic event to forestall the development of PTSD. There has been little psychopharmacologic research in this area. This is surprising, given that PTSD is the mental disorder with the most clearly identified cause and onset. In a translational model of PTSD's pathogenesis presented herein: A traumatic event (unconditioned stimulus) overstimulates endogenous stress hormones (unconditioned response); these mediate an overconsolidation of the event's memory trace; recall of the event in response to reminders (conditioned stimulus); releases further stress hormones (conditioned response); these cause further overconsolidation; and the overconsolidated memory generates PTSD symptoms. Noradrenergic hyperactivity in the basolateral amygdala is hypothesized to mediate this cycle. Preventing pre-synaptic norepinephrine release with alpha2-adrenergic agonists or opioids, or blocking post-synaptic norepinephrine receptors with beta-adrenergic antagonists such as propranolol, reduces hormonally enhanced memories and fear conditioning. Two controlled studies of trauma victims presenting to emergency rooms suggest that posttrauma propranolol reduces subsequent PTSD, as does one naturalistic clinical study of morphine treatment of burned children. Cortisol both enhances memory consolidation and reduces memory retrieval, leading to mixed predictions. Two controlled studies of intensive care unit patients found that cortisol reduced PTSD. One study did not find benzodiazepines effective in preventing PTSD. Selective serotonin reuptake inhibitors, antiepileptics, and alpha2-adrenergic agonists have yet to be tried.