Managing Alzheimer's Dementia with Homecare in an African American Family During the COVID Pandemic.

In the US, over 95 million people have been infected with COVID and over 1 million have died. 10% of Californians are infected with COVID with higher rates reported among Latinx, Pacific Islanders, and low-income people. Higher death rates have been reported among African Americans. People living with Alzheimer's Disease (AD) are also more likely to be infected with COVID. African Americans with AD have three times the COVID rate of Whites. Homecare workers who care for moderate to severe AD in home and community settings are frontline essential workers who manage complex AD-related problems like incontinence. Little is known about communication and problem-solving processes between homecare workers and families of people with AD to manage continence at home. This report describes the challenges facing homecare workers illustrated by an African American family caring for a relative with advanced AD during pandemic.

Clinical considerations in the psychological evaluation of gestational surrogates: uses of narrative assessment.

Potential risks and ethical considerations inherent in surrogacy arrangements place tremendous responsibility on mental health professionals performing the necessary assessments, yet there is little discussion and no consensus on the best testing protocol. In the U.S., the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and the Personality Assessment Inventory (PAI) are the most common psychological measures used to screen gestational surrogates (GSs), although these self-report symptom inventories reveal tendencies to underreport, deny problems and present positive impressions that may conceal important clinical information. This study examines the utility of a multi-method approach in the psychological evaluation of GS candidates. A total of 43 women cleared to be GSs completed the PAI and an abbreviated protocol of a narrative construction assessment measure (The Thematic Apperception Test (TAT)) as part of the psychological screening process. Findings of the study show that utilising a multi-method approach in the psychological consideration of a GS can address the limitations inherent in a single-measure assessment approach. Including a narrative measure such as the TAT that is less affected by defensiveness found on self-report scales may allow for more subtleties in interpretation, helping assessors to identify women who may have particular psychological vulnerabilities. These might then be addressed through implications counselling.

Interpersonal Decentering and Interpersonal Problems: Testing the Multi-Method Utility of Person-Situation Interactions in Thematic Apperception Tests.

Mature interpersonal decentering is a form of social cognitive role-taking involving reflective thought about one's interpersonal relationships. Previous research examining main effects for persons, card situation content, story content, and person-card interactions found more mature decentering in stories about heterosexual romantic-pull Thematic Apperception Test (TAT) cards (HRC) as compared with stories about nonromantic cards (NRC). To see whether differences in means corresponded to differential criterion validity, this multi-method study examined Inventory of Interpersonal Problems circumplex (IIP-C) scores associated with young adults' decentering maturity and deficits, comparing correlations with IIP-C scores of decentering scores calculated from HRC versus NRC. Similarly, to test the effect of story content, IIP-C scores were correlated with decentering scores calculated from stories having romantic versus nonromantic story content. Using circumplex statistical tests, decentering deficits were associated with domineering/vindictive interpersonal problems, and mature decentering with nonassertive/exploitable problems. Men who reported more exploitable problems decentered more maturely across all situations. Women who decentered more maturely in response to HRC reported more socially avoidant problems, whereas those who decentered more maturely to NRC reported more exploitable problems. Results for romantic versus nonromantic story content were largely uninterpretable (did not meet circumplexity assumption). Findings might assist clinicians' card selection.

Object relations assessment predicts outpatients' attrition, early working alliance and psychotherapy process.

This study investigated the predictive utility of assessing clients' object relations functioning to prognosticate therapy dropout, quality of the early working alliance and psychotherapy process events reported by clients after their first five sessions. Clients accepting a recruitment invitation were administered the thematic apperception test (TAT) shortly after intake, and those still in treatment three to four sessions later rated the working alliance and psychotherapy process events. Participants were 47 clients beginning psychotherapy with advanced doctoral practicum students at a university-based community-serving training clinic. The Social Cognition and Object Relations Scales (SCORS), an object relations scoring system for TAT stories, was used to assess object relations functioning. The California Psychotherapy Alliance Scales-Patient form measured four dimensions of the alliance. The Therapy Orientation Process Scales, created from the Psychotherapy Process Q-set, measured clients' perceptions of therapy process events as involving relatively more psychodynamic or cognitive behavioural techniques. The SCORS significantly predicted remaining in therapy, client ratings of stronger working alliance and typical therapy process as more psychodynamic than cognitive behavioural. SCORS complexity of representations and capacity for emotional investment in relationships scales were the strongest predictors, especially of the patient commitment facet of the alliance. The findings suggest that (1) beginning psychotherapy with object relations assessment can be useful for treatment planning and (2) the relationship between clients' object relations functioning, working alliance and greater sensitivity to psychodynamic than to cognitive behavioural interventions depends on the aspect of object relations that is being assessed.

Acculturation processes and mental health of Asian Indian women in the United States: A mixed-methods study.

Acculturation theories and research find that both new culture acquisition and heritage culture attachment are associated with positive outcomes. However, gender-related analyses are rare. In this mixed-method study of 73 Asian Indian American women who were first- or second-generation immigrants from Kerala, India, those classified as behaviorally bicultural, assimilated, separated, or marginalized did not differ significantly in well-being. Being older and married was related to higher self-esteem; unmarried women reported more Kerala attitudinal marginalization. With age, marital status, immigrant generation, and both cultural behavioral orientations controlled, Kerala attitudinal marginalization (but not Anglo attitudinal marginalization) correlated moderately with both lower self-esteem and more severe depressive symptoms. Content analysis of open-ended question data suggested associations among more intricate and multifaceted acculturation processes and psychological well-being via the rewards and challenges the women described. Attaining the "best of both worlds" that some mentioned meant selective adoption and rejection of facets of each culture: family connectedness and control, freedom and moral decline, opportunity, and discrimination. For these women, status-related characteristics (being younger and single representing lower status), discrimination experiences, and attitudinal rejection of their heritage culture (although it accords women lower status than men) had negative psychological outcomes. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Interpersonal Decentering and Person-Situation Interaction in the Thematic Apperception Test: Is It all in the Cards? What's the Story?

Assessors using storytelling assessment techniques have debated the relative importance of picture imagery (card pull) versus story content for interpreting clients' stories. This study used generalizability theory to compare sources of variance in scores for Feffer's Interpersonal Decentering as a function of persons, cards, raters, or interactions. Representing situational activation of mature role-taking (mentalizing of interpersonal processes), decentering activity should differ across interpersonal situations according to the social role norms involved, resulting in more variance due to card pull than for previously studied scoring systems. Decentering scores from stories told to heterosexual romantic-pull pictures were compared with those for other pictures and with scores from romantic versus nonromantic stories to identify score variance explained by card pull and story content. Considering cards as analogs for life situations, person-card interaction explained more decentering variance (53.7%) than did other effects. Heterosexual romantic-pull pictures stimulated more mature decentering than others; story content did not explain significant variance. Women told more mature decentering stories to heterosexual romantic-pull pictures than to other pictures, and more so than men did. Finding strong person-card interaction illuminates typically low internal consistency for content-based scoring systems. Recommendations for clinicians include implications for card selection and story content interpretation.

The Emotional Approach Coping Scales in Chinese: Validation, Psychometric Properties, and Measurement Invariance.

American and Chinese literatures on emotion-focused coping show inconsistent associations with distress, attributable to criterion contamination problems with measures. This problem was remedied by the American Emotional Approach Coping (EAC) scales, which are not confounded with distress; however, there is no Chinese counterpart. The EAC is of theoretical interest for exploring cross-cultural models of psychological and physical health since it allows one to measure emotion processing (theoretically lowering distress) without emotion expression (maintaining collectivist group harmony). In the present study, the EAC scales were translated into Chinese and their factorial, criterion, and discriminant validity as well as measurement invariance of the two versions were examined in 353 Chinese and 491 Americans. Previous validational findings for American EAC scales were replicated and configural and metric invariance demonstrated, supporting the comparable reliability and validity of the Chinese EAC scales. Chinese showed fewer gender differences than Americans.

Validating the Structure of the Depression and Somatic Symptoms Scale.

BACKGROUND: Depressed primary care patients may present with somatic symptoms first, complicating differential diagnosis. Clinicians have few instruments for assessing this comorbidity. OBJECTIVE: To evaluate the psychometrics of the translated Chinese Depression and Somatic Symptoms Scale (DSSS) in Americans. PROCEDURES: A total of 491 nonclinical but symptomatic ethnically-diverse individuals completed the DSSS and Center for Epidemiologic Studies Depression Scale (CES-D). RESULTS: Factor analysis yielded 2 distinct factors: depression and somatic symptoms. DSSS and subscales showed internal consistency, reliability, and convergent validity with CES-D and subscales. CONCLUSIONS: These results support DSSS's trustworthiness for US populations. Using DSSS for patient assessment may assist diagnosis and inform interventions.

Electrical and Structural Substrate of Arrhythmogenic Right Ventricular Cardiomyopathy Determined Using Noninvasive Electrocardiographic Imaging and Late Gadolinium Magnetic Resonance Imaging.

BACKGROUND: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a significant cause of sudden cardiac death in the young. Improved noninvasive assessment of ARVC and better understanding of the disease substrate are important for improving patient outcomes. METHODS AND RESULTS: We studied 20 genotyped ARVC patients with a broad spectrum of disease using electrocardiographic imaging (a method for noninvasive cardiac electrophysiology mapping) and advanced late gadolinium enhancement cardiac magnetic resonance scar imaging. Compared with 20 healthy controls, ARVC patients had longer ventricular activation duration (median, 52 versus 42 ms; P=0.007) and prolonged mean epicardial activation-recovery intervals (a surrogate for local action potential duration; median, 275 versus 241 ms; P=0.014). In these patients, we observed abnormal and varied epicardial activation breakthrough locations and regions of nonuniform conduction and fractionated electrograms. Nonuniform conduction and fractionated electrograms were present in the early concealed phase of ARVC. Electrophysiological abnormalities colocalized with late gadolinium enhancement scar, indicating a relationship with structural disease. Premature ventricular contractions were common in ARVC patients with variable initiation sites in both ventricles. Premature ventricular contraction rate increased with exercise, and within anatomic segments, it correlated with prolonged repolarization, electric markers of scar, and late gadolinium enhancement (all P<0.001). CONCLUSIONS: Electrocardiographic imaging reveals electrophysiological substrate properties that differ in ARVC patients compared with healthy controls. A novel mechanistic finding is the presence of repolarization abnormalities in regions where ventricular ectopy originates. The results suggest a potential role for electrocardiographic imaging and late gadolinium enhancement in early diagnosis and noninvasive follow-up of ARVC patients.

Desmoplakin missense and non-missense mutations in arrhythmogenic right ventricular cardiomyopathy: Genotype-phenotype correlation.

BACKGROUND: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is traditionally considered as primarily affecting the right ventricle. Mutations in genes encoding desmosomal proteins account for 40-60% of cases. Genotype-phenotype correlations are scant and mostly non gene-specific. Accordingly, we assessed the genotype-phenotype correlation for desmoplakin (DSP) missense and non-missense mutations causing ARVC. METHODS AND RESULTS: We analyzed 27 ARVC patients carrying a missense or a non-missense DSP mutation, with complete clinical assessment. The two groups were compared for clinical parameters, basic demographics such as sex, age at diagnosis, age at disease onset, as well as prevalence of symptoms and arrhythmic events. Missense DSP variants were present in 10 patients and non-missense in 17. Mean age at diagnosis and at first arrhythmic event did not differ between the two groups. Also the prevalence of symptoms, either major (60% vs 59%, p=1) or all (80% vs 88%, p=0.61), did not differ. By contrast, left ventricular (LV) dysfunction was significantly more prevalent among patients with non-missense mutations (76.5% vs 10%, p=0.001), who were also much more likely to have a structural LV involvement by Cardiac Magnetic Resonance (CMR) (92% vs 22%, p=0.001). CONCLUSIONS: For ARVC patients, both missense and non-missense DSP mutations carry a high arrhythmic risk. Non-missense mutations are specifically associated with left-dominant forms. The presence of DSP non-missense mutations should alert to the likely development of LV dysfunction. These findings highlight the clinical relevance of genetic testing even after the clinical diagnosis of ARVC and the growing clinical impact of genetics.

The Narrative Arc of TATs: Introduction to the JPA Special Section on Thematic Apperceptive Techniques.

The past decade has seen important developments in thematic apperceptive techniques (TATs), with the creation of new card sets having alternate pictures representing different cultures, new scoring systems becoming available, and increasing international communication of these achievements. However, continuing impediments to the development of a validational literature include lingering mistaken assumptions about the nature of story data, ongoing debates about appropriate psychometric evaluation, and continuing questions about how stimuli and scoring systems should be conceptualized and interpreted. Negotiating the publication system can impede some potential authors. Excellent work on TATs with children is not well known in the adult-focused journals. The labor burden of meeting increasingly sophisticated publication standards might be a barrier to assessors focused on clinical practice. Accumulating a focused evidence base is challenging given the diversity of criterion variables for which TATs have been used. Research on TATs by clinicians can span the science-practice gap, but the narrative arc can be a dramatic one. The articles in this special section on TATs represent important conceptual, methodological, and substantive innovations.

Not Your Same Old Story: New Rules for Thematic Apperceptive Techniques (TATs).

Stories told about pictures have been used for both research and clinical practice since the beginning of modern personality assessment. However, with the growing science-practice gap, these thematic apperceptive techniques (TATs) have been used differently in those 2 venues. Scientific validation is presumptively general, but clinical application is idiographic and situation-specific. A bridge is needed. The manualized human-scored narrative analysis systems discussed here are valuable scientist-practitioner tools, but they require a validation literature to support further research publication, maintain their role in clinical training, and justify clinicians' reimbursement by third-party payers. To facilitate wider understanding of manualized TAT methodologies, this article addresses long-standing criticisms of TAT reliability and proposes some strategic solutions to the measurement error problem for both researchers and clinicians, including analyzing person-situation interactions, purposeful situation sampling for within-storyteller comparisons, and uses of small samples. The new rules for TATs include conceptual and methodological standards that researchers should aim to meet and report, reviewers should apply to manuscripts, and clinical assessors can use to analyze their own data and justify third-party payment.

Development of a Scale to Measure Death Perspectives: Overcoming and Participating.

Kastenbaum and Aisenberg have suggested that persons can cope with the impact of death and dying by altering their understanding of what each means to them as well as by changing their behavioral responses to such experiences. The present study's purpose was to develop a reliable and valid measure to assess an individual's particular death perspective based on Kastenbaum and Aisenberg's distinctions between overcomers and participators. The Death Perspective Scale developed here assessed the extent to which individuals utilize either an overcoming or participating approach to (a) assigning meaning to dying and death and (b) behaviorally responding to death-related experiences. Based upon the data collected from 168 adults varying by age and gender, findings suggested that both overcoming and participating could be reliably assessed, correlated with measures of death anxiety and death attitudes, and varied reliably (p < .05) by age and gender, wherein such differences were for the most part consistent with predictions by Kastenbaum and Aisenberg espoused over 30 years ago. Findings here suggested that overcomers reported more fear of death and dying and were less accepting in this respect, while participators reported fewer death-related fears and were more accepting. Women and older adults were more participating, while men and younger adults were more overcoming, though such effects varied depending upon whether meaning versus response to death was considered. The consistency between the present findings and the predictions Kastenbaum and Aisenberg suggests that while person's orientations to death and dying seem to transcend sociocultural change, empirically based efforts to better understand how our death system impacts persons need to move forward.

Stabilization of Cu(I) for binding and calorimetric measurements in aqueous solution.

Conditions have been developed for the comproportionation reaction of Cu(2+) and copper metal to prepare aqueous solutions of Cu(+) that are stabilized from disproportionation by MeCN and other Cu(+)-stabilizing ligands. These solutions were then used in ITC measurements to quantify the thermodynamics of formation of a set of Cu(+) complexes (Cu(I)(MeCN)3(+), Cu(I)Me6Trien(+), Cu(I)(BCA)2(3-), Cu(I)(BCS)2(3-)), which have stabilities ranging over 15 orders of magnitude, for their use in binding and calorimetric measurements of Cu(+) interaction with proteins and other biological macromolecules. These complexes were then used to determine the stability and thermodynamics of formation of a 1 : 1 complex of Cu(+) with the biologically important tri-peptide glutathione, GSH. These results identify Me6Trien as an attractive Cu(+)-stabilizing ligand for calorimetric experiments, and suggest that caution should be used with MeCN to stabilize Cu(+) due to its potential for participating in unquantifiable ternary interactions.

Abnormal septal convexity into the left ventricle occurs in subclinical hypertrophic cardiomyopathy.

BACKGROUND: Sarcomeric gene mutations cause hypertrophic cardiomyopathy (HCM). In gene mutation carriers without left ventricular (LV) hypertrophy (G + LVH-), subclinical imaging biomarkers are recognized as predictors of overt HCM, consisting of anterior mitral valve leaflet elongation, myocardial crypts, hyperdynamic LV ejection fraction, and abnormal apical trabeculation. Reverse curvature of the interventricular septum (into the LV) is characteristic of overt HCM. We aimed to assess LV septal convexity in subclinical HCM. METHODS: Cardiovascular magnetic resonance was performed on 36 G + LVH- individuals (31 ± 14 years, 33 % males) with a pathogenic sarcomere mutation, and 36 sex and age-matched healthy controls (33 ± 12 years, 33 % males). Septal convexity (SCx) was measured in the apical four chamber view perpendicular to a reference line connecting the mid-septal wall at tricuspid valve insertion level and the apical right ventricular insertion point. RESULTS: Septal convexity was increased in G + LVH- compared to controls (maximal distance of endocardium to reference line: 5.0 ± 2.5 mm vs. 1.6 ± 2.4 mm, p ≤ 0.0001). Expected findings occurred in G + LVH- individuals: longer anterior mitral valve leaflet (23.5 ± 3.0 mm vs. 19.9 ± 3.1 mm, p ≤ 0.0001), higher relative wall thickness (0.31 ± 0.05 vs. 0.29 ± 0.04, p ≤ 0.05), higher LV ejection fraction (70.8 ± 4.3 % vs. 68.3 ± 4.4 %, p ≤ 0.05), and smaller LV end-systolic volume index (21.4 ± 4.4 ml/m(2) vs. 23.7 ± 5.8 ml/m(2), p ≤ 0.05). Other morphologic measurements (LV angles, sphericity index, and eccentricity index) were not different between G + LVH- and controls. CONCLUSIONS: Septal convexity is an additional previously undescribed feature of subclinical HCM.

Novel genotype-phenotype associations demonstrated by high-throughput sequencing in patients with hypertrophic cardiomyopathy.

OBJECTIVE: A predictable relation between genotype and disease expression is needed in order to use genetic testing for clinical decision-making in hypertrophic cardiomyopathy (HCM). The primary aims of this study were to examine the phenotypes associated with sarcomere protein (SP) gene mutations and test the hypothesis that variation in non-sarcomere genes modifies the phenotype. METHODS: Unrelated and consecutive patients were clinically evaluated and prospectively followed in a specialist clinic. High-throughput sequencing was used to analyse 41 genes implicated in inherited cardiac conditions. Variants in SP and non-SP genes were tested for associations with phenotype and survival. RESULTS: 874 patients (49.6±15.4 years, 67.8% men) were studied; likely disease-causing SP gene variants were detected in 383 (43.8%). Patients with SP variants were characterised by younger age and higher prevalence of family history of HCM, family history of sudden cardiac death, asymmetric septal hypertrophy, greater maximum LV wall thickness (all p values<0.0005) and an increased incidence of cardiovascular death (p=0.012). Similar associations were observed for individual SP genes. Patients with ANK2 variants had greater maximum wall thickness (p=0.0005). Associations at a lower level of significance were demonstrated with variation in other non-SP genes. CONCLUSIONS: Patients with HCM caused by rare SP variants differ with respect to age at presentation, family history of the disease, morphology and survival from patients without SP variants. Novel associations for SP genes are reported and, for the first time, we demonstrate possible influence of variation in non-SP genes associated with other forms of cardiomyopathy and arrhythmia syndromes on the clinical phenotype of HCM.

Cross-measure equivalence and communicability in the assessment of depression: a focus on factor-based scales.

All measures of depression yield a global summary scale indicating the severity of depressive symptoms, implicitly conceptualized as a homogeneous construct. However, depression is a heterogeneous construct, with different presentations, subtypes, correlates, and responses to interventions. In response, the National Institute of Mental Health (NIMH) has suggested changes in the way depression is assessed, moving the focus to specific factors, such as cognitive, somatic, or affective symptoms. Still, there is little factor overlap between measures, and shared factors are weighted differently. To help fulfill NIMH's strategic plan, this study used canonical correlation analysis (CCA) to explore shared latent variables and redundancy across the measures. It also analyzed the psychometric properties of factor-based subscales in the Beck Depression Inventory-2nd edition (BDI-II), Center for Epidemiologic Studies Depression scale (CES-D), Inventory for Depression and Anxiety Symptoms (IDAS), and Inventory of Depressive Symptomatology (IDS). Using a diverse sample of 218 students who reported at least mild depressive symptoms, this study found that the IDAS was best aligned with NIMH's strategic plan; it has complete DSM-IV/DSM-5 symptom coverage and content-valid, psychometrically sound subscales. The BDI-II, CES-D, and IDS did not have consistent subscales, nor had incomplete or incongruent coverage of DSM criteria. Furthermore, CCA revealed low redundancy across measures (23% to 41% shared variance). These results suggest that different measures of depression do not measure the same construct. As a partial solution, empirical conversion tables were provided for researchers and clinicians to empirically compare total scores from different measures.

Psychometrics and latent structure of the IDS and QIDS with young adult students.

BACKGROUND: Students and young adults have high rates of suicide and depression, thus are a population of interest. To date, there is no normative psychometric information on the IDS and QIDS in these populations. Furthermore, there is equivocal evidence on the factor structure and subscales of the IDS. METHODS: Two samples of young adult students (ns=475 and 1681) were given multiple measures to test the psychometrics and dimensionality of the IDS and QIDS. RESULTS: The IDS, its subscales, and QIDS had acceptable internal consistencies (αs=.79-90) and favorable convergent and divergent validity correlations. A three-factor structure and two Rasch-derived subscales best fit the IDS. LIMITATIONS: The samples were collected from one university, which may influence generalizability. CONCLUSIONS: The IDS and QIDS are desirable measures of depressive symptoms when studying young adult students.