Specific Psychopathology Factors Research Articles

Associations between general and specific psychopathology factors in parents and psychiatric, behavioral, and psychosocial outcomes in offspring: a Swedish population-based register study

IntroductionPsychiatric conditions in parents are associated not only with the same condition in offspring, but also with virtually all other psychiatric conditions. However, it remains unknown whether this intergenerational transmission of psychiatric conditions was attributable to broader psychopathology comorbidity or to specific conditions.ObjectivesTo estimate associations between general and specific factors of psychopathology in parents, and a wide range of register-based outcomes in their offspring.MethodsBased on Swedish national registers, we linked 2 947 703 individuals born in Sweden between 1970 and 2000 to their biological parents (1 705 780 pairs of parents) and followed them to December 31, 2013. First, we estimated one general and three unrelated (specific) psychopathology factors (capturing internalizing, externalizing, and psychotic problems, respectively, independently of general psychopathology) based on nine parental register-based psychiatric diagnoses and violent criminal court convictions. Second, we regressed each offspring outcome on the latent general and three specific factors simultaneously.ResultsThe general psychopathology factor in parents was significantly associated with all 31 offspring outcomes (mean Odds Ratio (OR) = 1.22; range: 1.08–1.40), which means that children whose parents scored one standard deviation above the mean on general psychopathology had, on average, a 23% higher probability of all outcomes. The specific psychotic factor in parents was primarily associated with psychotic-like outcomes (mean OR = 1.17; range: 1.05–1.25), and the specific internalizing factor in parents was primarily associated with offspring internalizing (mean OR = 1.11; range: 1.11–1.13) and neurodevelopmental outcomes (mean OR = 1.07; range: 1.02–1.10). The specific externalizing factor in parents was associated with externalizing (mean OR = 1.27; range: 1.21–1.32) and internalizing outcomes (mean OR = 1.10; range: 1.01–1.13).ConclusionsThe intergenerational transmission of psychiatric conditions across different types of spectra appeared largely attributable to a parental general factor of psychopathology, whereas specific factors were primarily responsible for within-spectrum associations between parents and their offspring. Service providers (e.g., child psychologists, psychiatrists, teachers, and social workers) might benefit from taking the total number of parental mental health problems into account, regardless of type, when forecasting child mental health and social functions.Disclosure of InterestNone Declared

Distal-to-proximal etiologically relevant variables associated with the general (p) and specific factors of psychopathology.

The general factor of psychopathology, often denoted as p, captures the common variance among a broad range of psychiatric symptoms. Specific factors are co-modeled based on subsets of closely related symptoms. This paper investigated the extent to which wide-ranging genetic, personal, and environmental etiologically relevant variables are associated with p and specific psychopathology factors. Using data from four waves (ages 11-19) of TRAILS, we modeled a bifactor model of p and four specific factors [internalizing, externalizing, ADHD, Autism Spectrum Disorder (ASD)]. Next, we examined the associations of 19 etiologically relevant variables with these psychology factors using path models that organized the variables according to the distal-to-proximal risk principle. Collectively, the etiologically relevant factors, including temperament traits, accounted for 55% of p's variance, 46% in ADHD, 35% in externalizing, 19% in internalizing, and 7% in ASD. The low 7% is due to insufficient unique variance in ASD indicators that load more strongly on p. Excluding temperament, variables accounted for 29% variance in p, 9% ADHD, 14% EXT, 7% INT, and 4% ASD. Most etiologically relevant factors were generic, predicting p. In addition, we identified effects on specific factors in addition to effects on p (e.g., parental SES, executive functioning); only effects on specific factors (e.g., parental rejection); opposite effects on different factors [e.g., diurnal cortisol (high INT but low EXT, p); developmental delay (high ASD and p but low EXT)]. Frustration, family functioning, parental psychopathology, executive functioning, and fearfulness had strong effects on p. (1) Strong generic effects on p suggest that etiologically relevant factors and psychopathology tend to cluster in persons. (2) While many factors predict p, additional as well as opposite effects on specific factors indicate the relevance of specific psychopathology factors in understanding mental disorder. (3) High frustration, neurodevelopmental problems, and a disadvantaged family environment primarily characterize p.

Intergenerational Transmission of Psychiatric Conditions and Psychiatric, Behavioral, and Psychosocial Outcomes in Offspring

Psychiatric conditions in parents are associated with many psychiatric and nonpsychiatric outcomes in offspring. However, it remains unknown whether this intergenerational transmission is attributable to broader psychopathology comorbidity or to specific conditions. To estimate associations between general and specific psychopathology factors in parents and a wide range of register-based outcomes in their offspring. This Swedish national register-based cohort study included 2 947 703 individuals born between 1970 and 2000 and followed up with participants through December 31, 2013. Statistical analysis was performed from October 2022 to October 2023. Hierarchical factor model consisting of 1 general and 3 specific psychopathology factors fit to 9 parental psychiatric diagnoses and violent criminal court convictions. A total of 31 outcomes were measured in offspring and sorted into 6 broad clusters: psychotic-like outcomes, neurodevelopmental outcomes, internalizing outcomes, externalizing outcomes, behavior and accidents, and psychosocial outcomes. Of 2 947 703 individuals, 1 518 252 (51.5%) were male, and the mean (SD) age at the end of follow-up was 28.7 (8.9) years. The general psychopathology factor in parents was significantly associated with all 31 offspring outcomes (range: odds ratio [OR] for accidents, 1.08 [95% CI, 1.07-1.08] to OR for social welfare recipiency, 1.40 [95% CI, 1.39-1.40]), which means that children whose parents scored 1 SD above the mean on the general psychopathology factor had an 8% to 40% higher odds of different studied outcomes. The specific psychotic factor in parents was primarily associated with all 5 psychotic-like outcomes (range: OR for prescription of antiepileptics, 1.05 [95% CI, 1.04-1.06] to OR for schizophrenia, 1.25 [95% CI, 1.23-1.28]) and the specific internalizing factor in parents was primarily associated with all 6 internalizing outcomes (range: OR for prescription of anxiolytics, 1.10 [95% CI, 1.09-1.10] to OR for depression, 1.13 [95% CI, 1.12-1.13]) and all 6 neurodevelopmental outcomes (range: OR for intellectual disability, 1.02 [95% CI, 1.01-1.03] to OR for autism spectrum disorder, 1.10 [95% CI, 1.09-1.11]) in offspring. The specific externalizing factor in parents was associated with all 6 externalizing outcomes (range: OR for violent crimes, 1.21 [95% CI, 1.19-1.23] to OR for oppositional defiant disorder, 1.32 [95% CI, 1.32-1.33]) and all 6 internalizing outcomes (range: OR for obsessive-compulsive disorder, 1.01 [95% CI, 1.00-1.02] to OR for posttraumatic stress disorder, 1.13 [95% CI, 1.12-1.13]) in offspring. This cohort study of the Swedish population suggests that the intergenerational transmission of psychiatric conditions across different types of spectra may largely be attributable to a parental general psychopathology factor, whereas specific factors appeared to be primarily responsible for within-spectrum associations between parents and their offspring. Professionals who work with children (eg, child psychologists, psychiatrists, teachers, and social workers) might benefit from taking the total number of parental psychiatric conditions into account, regardless of type, when forecasting child mental health and social functions.

Associations Between General and Specific Psychopathology Factors and 10-Year Clinically Relevant Outcomes in Adult Swedish Twins and Siblings

General and specific factors of psychopathology are associated with future adverse outcomes, indicating that they might be useful for identifying individuals at greatest risk. However, it remains unknown if these associations are attributable to confounders that may influence both the psychopathology factors and later outcomes. To analyze associations between psychopathology factors and clinically relevant outcomes within family pairs, adjusting for unmeasured confounds by applying co-twin control and sibling comparison designs. This longitudinal cohort study with a follow-up range of 9 to 13 years included all Swedish twins born from 1959 to 1985 who participated in the Study of Twin Adults: Genes and Environment (60% response rate) and the oldest pair of all Swedish siblings born from 1959 to 1985 per the Multi-Generation Register. Twins were evaluated based on responses to a hierarchical factor model derived using multivariate statistics. Sibling pairs were evaluated based on psychiatric diagnoses per the Swedish National Patient Register. Information on outcome events and prescriptions were derived from the National Patient Register, Prescribed Drug Register, and Crime Register. Baseline assessment was in August 2005, and data were analyzed from January 2022 to February 2023. Hierarchical factor model consisting of 1 general and 4 specific factors fit to 48 psychiatric symptoms on which twin participants self-reported in 2005 and 1 general and 3 specific factors fit to 9 register-based psychiatric diagnoses assigned to sibling participants prior to 2005. Outcomes consisted of 7 register-based events occurring after 2005, including suicidal behavior, substance overdoses, and criminal suspicion or convictions (data available until the end of 2013), and prescription of antidepressants, antialcohol or antiopioid medication, antipsychotics, and stimulants (data available until the end of 2017). The study included 32 328 twins (mean [SD] age, 34 [8] years; 16 076 [49.73%] male) and 1 942 106 siblings (mean [SD] age, 34 [7] years; 991 500 [51.05%] male). General psychopathology was significantly associated with all 7 outcomes within sibling pairs (mean within-pair odds ratio [OR], 2.28; 95% CI, 2.19-2.37) and dizygotic twin pairs (within-pairs OR, 1.65; 95% CI, 1.38-1.98) and with 3 outcomes within monozygotic twin pairs (mean within-pairs OR, 1.77; 95% CI, 1.35-2.36). Within sibling pairs, the specific internalizing factor was associated with antidepressant prescriptions (within-pairs OR, 1.65; 95% CI, 1.59-1.71), the specific substance misuse factor was associated prescription of antialcohol and antiopioid medication (within-pairs OR, 2.36; 95% CI, 2.20-2.54), and the specific psychotic factor was associated with antipsychotic medications (within-pairs OR, 1.61; 95% CI, 1.51-1.72). Similar results emerged within twin pairs. In this cohort study, general psychopathology was significantly associated with all 7 outcomes within sibling and dizygotic twin pairs and 3 outcomes within monozygotic twin pairs at 10 years. Within twin and sibling pairs, the specific factors were primarily associated with related outcomes. Several of the associations in this cohort study could not be attributed to unmeasured confounds shared by family members, suggesting that interventions toward broad psychopathology dimensions might help reduce the risk of future clinically relevant events.

"Three recommendations based on a comparison of the reliability and validity of the predominant models used in research on the empirical structure of psychopathology": Correction to Forbes et al. (2021).

Reports an error in "Three recommendations based on a comparison of the reliability and validity of the predominant models used in research on the empirical structure of psychopathology" by Miriam K. Forbes, Ashley L. Greene, Holly F. Levin-Aspenson, Ashley L. Watts, Michael Hallquist, Benjamin B. Lahey, Kristian E. Markon, Christopher J. Patrick, Jennifer L. Tackett, Irwin D. Waldman, Aidan G. C. Wright, Avshalom Caspi, Masha Ivanova, Roman Kotov, Douglas B. Samuel, Nicholas R. Eaton and Robert F. Krueger (Journal of Abnormal Psychology, 2021[Apr], Vol 130[3], 297-317). In the article, Figure 1 had an error in the latent variable labels for Models 1, 2, and 3 whereby "Fear" and "Distress" had been inverted. The online version of this article has been corrected. (The following abstract of the original article appeared in record 2021-13650-001.) The present study compared the primary models used in research on the structure of psychopathology (i.e., correlated factor, higher-order, and bifactor models) in terms of structural validity (model fit and factor reliability), longitudinal measurement invariance, concurrent and prospective predictive validity in relation to important outcomes, and longitudinal consistency in individuals' factor score profiles. Two simpler operationalizations of a general factor of psychopathology were also examined-a single-factor model and a count of diagnoses. Models were estimated based on structured clinical interview diagnoses in two longitudinal waves of nationally representative data from the United States (n = 43,093 and n = 34,653). Models that included narrower factors (fear, distress, and externalizing) were needed to capture the observed multidimensionality of the data. In the correlated factor and higher-order models these narrower factors were reliable, largely invariant over time, had consistent associations with indicators of adaptive functioning, and had moderate stability within individuals over time. By contrast, the fear- and distress-specific factors in the bifactor model did not show good reliability or validity throughout the analyses. Notably, the general factor of psychopathology (p factor) performed similarly well across tests of reliability and validity regardless of whether the higher-order or bifactor model was used; the simplest (single factor) model was also comparable across most tests, with the exception of model fit. Given the limitations of categorical diagnoses, it will be important to repeat these analyses using dimensional measures. We conclude that when aiming to understand the structure and correlates of psychopathology it is important to (a) look beyond model fit indices to choose between different models, (b) examine the reliability of latent variables directly, and (c) be cautious when isolating and interpreting the unique effects of specific psychopathology factors, regardless of which model is used. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Investigating general and specific psychopathology factors with nuance-level personality traits.

Mental health disorders share substantial variance, prompting researchers to develop structural models that can capture both generalised psychopathology risk and disorder/symptom-specific variation. This study investigated the associations of the general and specific psychopathology factors with multiple personality trait hierarchy levels: broad domains, their facets and nuances (N = 1839 Estonian adults). A bi-factor model with a general 'p' factor and specific factors for internalising problems, thought disorders and substance use best represented psychopathology structure. Although traits' predictive accuracy varied across psychopathology factors, nuances (the lowest level personality units) provided higher predictive accuracy and higher discriminant validity than domains. For example, traits related to high vulnerability, depression and immoderation and low friendliness and achievement striving were most strongly associated with the p factor. Nuances may prove useful for predicting and understanding general and specific psychopathology forms.

Combined polygenic risk scores of different psychiatric traits predict general and specific psychopathology in childhood.

BackgroundPolygenic risk scores (PRSs) operationalize genetic propensity toward a particular mental disorder and hold promise as early predictors of psychopathology, but before a PRS can be used clinically, explanatory power must be increased and the specificity for a psychiatric domain established. To enable early detection, it is crucial to study these psychometric properties in childhood. We examined whether PRSs associate more with general or with specific psychopathology in school‐aged children. Additionally, we tested whether psychiatric PRSs can be combined into a multi‐PRS score for improved performance.MethodsWe computed 16 PRSs based on GWASs of psychiatric phenotypes, but also neuroticism and cognitive ability, in mostly adult populations. Study participants were 9,247 school‐aged children from three population‐based cohorts of the DREAM‐BIG consortium: ALSPAC (UK), The Generation R Study (Netherlands), and MAVAN (Canada). We associated each PRS with general and specific psychopathology factors, derived from a bifactor model based on self‐report and parental, teacher, and observer reports. After fitting each PRS in separate models, we also tested a multi‐PRS model, in which all PRSs are entered simultaneously as predictors of the general psychopathology factor.ResultsSeven PRSs were associated with the general psychopathology factor after multiple testing adjustment, two with specific externalizing and five with specific internalizing psychopathology. PRSs predicted general psychopathology independently of each other, with the exception of depression and depressive symptom PRSs. Most PRSs associated with a specific psychopathology domain, were also associated with general child psychopathology.ConclusionsThe results suggest that PRSs based on current GWASs of psychiatric phenotypes tend to be associated with general psychopathology, or both general and specific psychiatric domains, but not with one specific psychopathology domain only. Furthermore, PRSs can be combined to improve predictive ability. PRS users should therefore be conscious of nonspecificity and consider using multiple PRSs simultaneously, when predicting psychiatric disorders.

Infant temperament prospectively predicts general psychopathology in childhood.

Recent models of psychopathology suggest the presence of a general factor capturing the shared variance among all symptoms along with specific psychopathology factors (e.g., internalizing and externalizing). However, few studies have examined predictors that may serve as transdiagnostic risk factors for general psychopathology from early development. In the current study we examine, for the first time, whether observed and parent-reported infant temperament dimensions prospectively predict general psychopathology as well as specific psychopathology dimensions (e.g., internalizing and externalizing) across childhood. In a longitudinal cohort (N = 291), temperament dimensions were assessed at 4 months of age. Psychopathology symptoms were assessed at 7, 9, and 12 years of age. A bifactor model was used to estimate general, internalizing, and externalizing psychopathology factors. Across behavioral observations and parent-reports, higher motor activity in infancy significantly predicted greater general psychopathology in mid to late childhood. Moreover, low positive affect was predictive of the internalizing-specific factor. Other temperament dimensions were not related with any of the psychopathology factors after accounting for the general psychopathology factor. The results of this study suggest that infant motor activity may act as an early indicator of transdiagnostic risk. Our findings inform the etiology of general psychopathology and have implications for the early identification for children at risk for psychopathology.

White Matter Microstructure and the General Psychopathology Factor in Children

Co-occurrence of behavioral and emotional problems in childhood is widespread, and previous studies have suggested that this reflects vulnerability to experience a range of psychiatric problems, often termed a general psychopathology factor. However, the neurobiological substrate of this general factor is not well understood. We tested the hypothesis that lower overall white matter microstructure is associated with higher levels of the general psychopathology factor in children and less with specific factors. Global white matter microstructure at age 10 years was related to general and specific psychopathology factors. These factors were estimated using a latent bifactor model with multiple informants and instruments between ages 6 and 10 years in 3,030 children from the population-based birth cohort Generation R. The association of global white matter microstructure and the psychopathology factors was examined with a structural equation model adjusted for sex, age at scan, age at psychopathology assessment, parental education/income, and genetic ancestry. A 1-SD increase of the global white matter factor was associated with a β=-0.07SD (standard error [SE]= 0.02, p< .01) decrease in general psychopathology. In contrast, a 1-SD increase of white matter microstructure predicted an increase of β=+0.07 SD (SE= 0.03, p< .01) specific externalizing factor levels. No association was found with the specific internalizing and specific attention factor. The results suggest that general psychopathology in childhood is related to white matter structure across the brain and not only to specific tracts. Taking into account general psychopathology may also help reveal neurobiological mechanisms behind specific symptoms that are otherwise obscured by comorbidity.

Toward precision therapeutics: general and specific factors differentiate symptom change in depressed adolescents

BackgroundThe longitudinal course of multiple symptom domains in adolescents treated for major depression is not known. Revealing the temporal course of general and specific psychopathology factors, including potential differences between psychotherapies, may aid therapeutic decision‐making.MethodsParticipants were adolescents with major depressive disorder (aged 11–17; 75% female; N = 465) who were part of the IMPACT trial, a randomized controlled trial comparing cognitive behavioral therapy, short‐term psychoanalytic psychotherapy, and brief psychosocial intervention. Self‐reported symptoms at baseline and 6, 12, 36, 52, and 86 weeks postrandomization were analyzed with bifactor modeling.ResultsGeneral psychopathology factor scores decreased across treatment and one‐year follow‐up. Specific melancholic features and depressive cognitions factors decreased from baseline to 6 weeks. Conduct problems decreased across treatment and follow‐up. Anxiety increased by 6 weeks and then reverted to baseline levels. Obsessions–compulsions did not change. Changes in general and specific factors were not significantly different between the three psychotherapies during treatment. During follow‐up, however, conduct problems decreased more in brief psychosocial intervention versus cognitive behavioral therapy (1.02, 95% Bayes credible interval 0.25, 1.96), but not versus short‐term psychoanalytic psychotherapy.ConclusionsThe clinical response signature in this trial is best revealed by rapid reductions in depression symptoms and general psychopathology. Protracted improvements in general psychopathology and conduct problems subsequently occur. Psychosocial treatments for adolescent depression have comparable effects on general and specific psychopathology, although a psychoeducational, goal‐focused approach may be indicated for youth with comorbid conduct problems.

Riskier Tests of the Validity of the Bifactor Model of Psychopathology

We advanced several “riskier tests” of the validity of bifactor models of psychopathology, which included that the general and specific psychopathology factors should be reliable and well represented by their respective indicators and that including a general factor should improve on the correlated factor model’s external validity. We compared bifactor and correlated factors models of psychopathology using data from a community sample of youth ( N = 2,498) whose parents provided ratings on psychopathology and theoretically relevant external criteria (i.e., personality, aggression, antisociality). Bifactor models tended to yield either general or specific factors that were unstable and difficult to interpret. The general factor appeared to reflect a differentially weighted amalgam of psychopathology rather than a liability for psychopathology broadly construed. With rare exceptions, bifactor models did not explain additional variance in first-order psychopathology symptom dimensions or external criteria compared with correlated factors models. Together, our findings call into question the validity of bifactor models of psychopathology and the p factor more broadly.

Distribution and age of onset of psychopathological risk in a cohort of children with Down syndrome in developmental age

BackgroundAim of the study is to intercept specific characteristics and psychiatric comorbidity in Down Syndrome (DS). The study describes the distribution and the age of specific aspects of behavioral phenotype in a sample of subjects with DS.MethodsPsychopathological risk has been evaluated in a 97 DS patient cohort, aged 1 to 18 years, during regular follow-up neuropsychiatric visit and through administration of Child Behavior Checklist (CBCL); Childhood Autism Rating Scale (CARS-T) was assessed to verify the presence of autistic behaviors.ResultsThe results show the presence of specific psychopathological risk factors in 90% of the sample. 7% of sample presents autistic features. The risk of psychopathology is independent of the degree of intellectual disability.ConclusionThe high frequency of psychopathological risk factors indicates the need for accurate monitoring to intercept specific characteristics, such as in the case of comorbidity for autism. The search for specific psychopathological factors is a little explored aspect to date, as evidenced by the literature. Despite the studies available to date highlight the presence of psychopathological vulnerability in DS, so far there are only few reports that explore this issue systematically.

Changes in General and Specific Psychopathology Factors Over a Psychosocial Intervention.

Recent research suggests that comorbidity in child and adolescent psychiatric symptoms can be summarized by a single latent dimension known as the p factor and more specific factors summarizing clusters of symptoms. This study investigated within- and between-person changes in general and specific psychopathology factors over a psychosocial intervention. A secondary analysis was conducted of the Systemic Therapy for At-Risk Teens study, a pragmatic randomized controlled trial that compared the effects of multisystemic therapy with those of management as usual for decreasing antisocial behavior in 684 adolescents (82% boys; 11-18 years old at baseline) over an 18-month period. The general p factor and specific antisocial, attention, anxiety, and mood factors were estimated from a symptom-level analysis of a set of narrowband symptom scales measured repeatedly during the study. General and specific psychopathology factors were assessed for reliability, validity, and within- and between-person change using a parallel process multilevel growth model. A revised bi-factor model that included a general p factor and specific anxiety, mood, antisocial, and attention factors with cross-loadings fit the data best. Although the factor structure was multidimensional, the p factor accounted for most of the variance in total scores. The p factor, anxiety, and antisocial factors predicted within-person variation in external outcomes. Furthermore, the p factor and antisocial factors showed within-person declines, whereas anxiety showed within-person increases, over time. Despite individual variation in baseline factor scores, adolescents showed similar rates of change. The bi-factor model is useful for teasing apart general and specific therapeutic changes that are conflated in standard analyses of symptom scores. START (Systemic Therapy for At Risk Teens): A National Randomised Controlled Trial to Evaluate Multisystemic Therapy in the UK Context; http://www.isrctn.com; ISRCTN77132214.

Brief Intervention with Adolescents Having Inhalant Use Disorder: a Case Series

Introduction The prevalence of substance use is among adolescents is on rise. In India, inhalant is one of the common drugs of use and acts as a gateway for illicit substance use. The mainstay of treatment for inhalant use among this population is psychosocial interventions. In India, we largely rely on western models to guide intervention programs, however, there is a need to develop and test the psychosocial interventions which are culturally relevant and effective. Objective The present study aims to highlight the culture specific psychopathological factors associated with inhalant use among adolescents. The paper aims at studying the effectiveness of a psychosocial intervention in reducing the frequency and quantity of inhalant use among adolescent clinic population. Methodology Four adolescents reporting to the Adolescent Clinic at the National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi were recruited for the study. A single-case design was adopted. The pre-, and post- intervention assessment were carried out. Results and Discussion There was a significant reduction in frequency and quantity of inhalant use in the cases. The findings of the study are discussed in the light of available research work, implications, limitations of the study and suggestions for future research. The psychpathological factors and challenges to intervention are discussed.

Are child and adolescent responses to placebo higher in major depression than in anxiety disorders? A systematic review of placebo-controlled trials.

BackgroundIn a previous report, we hypothesized that responses to placebo were high in child and adolescent depression because of specific psychopathological factors associated with youth major depression. The purpose of this study was to compare the placebo response rates in pharmacological trials for major depressive disorder (MDD), obsessive compulsive disorder (OCD) and other anxiety disorders (AD-non-OCD).Methodology and Principal FindingsWe reviewed the literature relevant to the use of psychotropic medication in children and adolescents with internalized disorders, restricting our review to double-blind studies including a placebo arm. Placebo response rates were pooled and compared according to diagnosis (MDD vs. OCD vs. AD-non-OCD), age (adolescent vs. child), and date of publication. From 1972 to 2007, we found 23 trials that evaluated the efficacy of psychotropic medication (mainly non-tricyclic antidepressants) involving youth with MDD, 7 pertaining to youth with OCD, and 10 pertaining to youth with other anxiety disorders (N = 2533 patients in placebo arms). As hypothesized, the placebo response rate was significantly higher in studies on MDD, than in those examining OCD and AD-non-OCD (49.6% [range: 17–90%] vs. 31% [range: 4–41%] vs. 39.6% [range: 9–53], respectively, ANOVA F = 7.1, p = 0.002). Children showed a higher stable placebo response within all three diagnoses than adolescents, though this difference was not significant. Finally, no significant effects were found with respect to the year of publication.ConclusionMDD in children and adolescents appears to be more responsive to placebo than other internalized conditions, which highlights differential psychopathology.

Different Forms of Migraine in Childhood and Adolescence: Notes on Personality Traits

SYNOPSISThe present study was proposed to explore the association between specific psychopathological factors and the different types of migraine.15 subjects with classic migraine (7 males and 8 females; avg. age 14.9), 15 subjects with common migraine (5 males and 10 females; avg. age 10.5) and 15 subjects with chronic daily headache (8 males and 7 females; avg. age 11.3) were examined.The psychological study of each of them was performed through individual interviews, psychodynamic testing and parental conferences in order to study the individual's personality in a dynamic fashion.With the same modalities 29 normal subjects were also studied (11 males and 18 females; avg. age 11.3).In the remote clinical histories of migrainous subjects the authors found: psychosomatic disturbances in a high percentage of cases (70% in classic and common migraine; 72% in chronic daily headache; 27% in control subjects: F = 7.3 p&lt; 0.01); the presence of a psychologically important event directly associated with the onset of the disease (55% for chronic daily headache, 31% for classic migraine, 27% for common migraine}.As regards the results of statistical analysis of some of the most objective parameters of the Rorschach the authors found: the number of responses of human movement (M) were significantly lower in headache patients, while popular responses (P%), spaces response (S%) and Dr % responses worn in higher percentage in comparison with control. The headache patients also showed significant deceases of F+% and extended F+% while kinesthetic shock and K‐type responses were significantly present.The authors conclude that in migrainous subjects there is a contact with reality which is uninvolved emotionally, and detached, with prevalently rationalized and intellectualized modalities that correspond to the need of blocking the emergence of emotional phantoms.