Dynamic infant–parent affect coupling during the face-to-face/still-face.

We examined dynamic infant-parent affect coupling using the Face-to-Face/Still-Face (FFSF) paradigm. The sample included 20 infants whose older siblings had been diagnosed with Autism Spectrum Disorders (ASD-sibs), and 18 infants with comparison siblings (COMP-sibs). A series of extended autoregressive models was used to represent the self-regulation and interactive dynamics of infants and parents during FFSF. Significant bidirectional affective coupling was found between infants and parents, with the former serving as the “leading members” of the dyads. Further analysis of within-dyad dynamics revealed ongoing changes in concurrent infant-parent linkages both within and across different FFSF episodes. The importance of considering both inter- and intra-dyad differences is discussed

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

BACKGROUND: The 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. METHODS: Participants 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. RESULTS: General 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. CONCLUSIONS: The 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

Early Psychosis Intervention-Spreading Evidence-based Treatment (EPI-SET) : Protocol for an effectiveness-implementation study of a structured model of care for psychosis in youth and emerging adults

Introduction While early psychosis intervention (EPI) has proliferated in recent years amid evidence of its effectiveness, programmes often struggle to deliver consistent, recovery-based care. NAVIGATE is a manualised model of EPI with demonstrated effectiveness consisting of four components: individualised medication management, individual resiliency training, supported employment and education and family education. We aim to implement NAVIGATE in geographically diverse EPI programmes in Ontario, Canada, evaluating implementation and its effect on fidelity to the EPI model, as well as individual-level outcomes (patient/family member-reported and interviewer-rated), system-level outcomes (captured in provincial administrative databases) and engagement of participants with lived experience. Methods and analysis This is a multisite, non-randomised pragmatic hybrid effectiveness-implementation type III mixed methods study coordinated at the Centre for Addiction and Mental Health (CAMH) in Toronto. Implementation is supported by the Provincial System Support Program, a CAMH-based programme with provincial offices across Ontario, and Extension of Community Healthcare Outcomes Ontario Mental Health at CAMH and the University of Toronto. The primary outcome is fidelity to the EPI model as measured using the First Episode Psychosis Services-Fidelity Scale. Four hundred participants in the EPI programmes will be recruited and followed using both individual-level assessments and health administrative data for 2 years following NAVIGATE initiation. People with lived experience will be engaged in all aspects of the project, including through youth and family advisory committees. Ethics and dissemination Research ethics board approval has been obtained from CAMH and institutions overseeing the local EPI programmes. Study findings will be reported in scientific journal articles and shared with key stakeholders including youth, family members, programme staff and policymakers. Trial registration number NCT03919760; Pre-results

Integrating the Hierarchical Taxonomy of Psychopathology (HiTOP) Into Clinical Practice

Objective: Diagnosis is a cornerstone of clinical practice for mental health care providers, yet traditional diagnostic systems have well-known shortcomings, including inadequate reliability, high comorbidity, and marked within-diagnosis heterogeneity. The Hierarchical Taxonomy of Psychopathology (HiTOP) is a data-driven, hierarchically based alternative to traditional classifications that conceptualizes psychopathology as a set of dimensions organized into increasingly broad, transdiagnostic spectra. Prior work has shown that using a dimensional approach improves reliability and validity, but translating a model like HiTOP into a workable system that is useful for health care providers remains a major challenge. / Method: The present work outlines the HiTOP model and describes the core principles to guide its integration into clinical practice. Results: Potential advantages and limitations of the HiTOP model for clinical utility are reviewed, including with respect to case conceptualization and treatment planning. A HiTOP approach to practice is illustrated and contrasted with an approach based on traditional nosology. Common barriers to using HiTOP in real-world health care settings and solutions to these barriers are discussed. / Conclusions: HiTOP represents a viable alternative to classifying mental illness that can be integrated into practice today, although research is needed to further establish its utility

Criterion A of the AMPD in HiTOP

The categorical model of personality disorder classification in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (5th ed. [DSM-5]; American Psychiatric Association, 2013) is highly and fundamentally problematic. Proposed for DSM-5 and provided within Section III (for Emerging Measures and Models) was the Alternative Model of Personality Disorder (AMPD) classification, consisting of Criterion A (self-interpersonal deficits) and Criterion B (maladaptive personality traits). A proposed alternative to the DSM-5 more generally is an empirically based dimensional organization of psychopathology identified as the Hierarchical Taxonomy of Psychopathology (HiTOP; Kotov etal., 2017). HiTOP currently includes, at the highest level, a general factor of psychopathology. Further down are the five domains of detachment, antagonistic externalizing, disinhibited externalizing, thought disorder, and internalizing (along with a provisional sixth somatoform dimension) that align with Criterion B. The purpose of this article is to discuss the potential inclusion and placement of the self-interpersonal deficits of the DSM-5 Section III Criterion A within HiTOP

Early caregiving predicts attachment representations in adolescence: Findings from two longitudinal studies

Background: A growing research base demonstrates that adolescents’ construction of secure attachment relationships may underlie successful social and personal relationships and healthy behavioral adjustment. Little is known about the early caregiving origins of adolescent attachment security; this study provides some of the first data on this topic. Method: The relative contribution of early and current caregiving quality to attachment security in adolescence was assessed in two longitudinal studies of a clinic-referred and an at-risk community sample using identical measures (n=209). Quality of early parent-child relationships at age 3-7 years of age and parent-adolescent relationship quality at approximately 12 years were assessed using observational methods; psychosocial risk was derived from extensive interview and questionnaire assessments; adolescent attachment quality was assessed using a standard attachment interview. Results: Analyses indicated moderate stability in observed parent-child interaction quality from early childhood to adolescence. Observational ratings of both early childhood and current caregiving quality were significantly associated with adolescent attachment security; however, early caregiver sensitivity was more strongly associated with adolescent attachment security and predicted later attachment security independently from current caregiving quality. Follow-up analyses indicated that this longitudinal prediction was significantly weaker in the clinic than in the at-risk community sample. Conclusion: Parental sensitive responding in childhood has enduring effects on attachment representation in adolescence, independent of current parenting relationship quality. These findings provide important new evidence supporting early parenting interventions for promoting youth well-being and adjustment

Progress in achieving quantitative classification of psychopathology

Résumé: Les lacunes des classifications de la psychopathologie fondées sur des consensus d’experts ont conduit à de nombreuses tentatives actuelles pour classer la psychopathologie de manière quantitative. Dans cet article, nous passons en revue les progrès accomplis dans la réalisation d’une classification quantitative et empirique de la psychopathologie. Une littérature empirique substantielle montre que la psychopathologie est généralement plus dimensionnelle que catégorielle. Et lorsque la distinction entre une psychopathologie discrète et une psychopathologie continue est traitée comme une question de recherche, par opposition à une distinction basée sur un argument d’autorité, alors les preuves scientifiques soutiennent clairement l’hypothèse d’une psychopathologie continue. En outre, un corpus de littérature connexe montre comment les dimensions de la psychopathologie peuvent être organisées selon une hiérarchie qui va de dimensions très larges d’un niveau de type « spectre » à des groupes spécifiques et étroits de symptômes. De cette manière, une approche quantitative résout le « problème de la comorbidité » en modélisant explicitement la cooccurrence entre les signes et les symptômes au sein d’une hiérarchie détaillée et variée, maniant des concepts dimensionnels qui ont une utilité clinique directe. De nombreuses preuves concernant la structure dimensionnelle et hiérarchique de la psychopathologie ont conduit à la formation du consortium Hierarchical Taxonomy of Psychopathology (HiTOP, taxonomie hiérarchique de la psychopathologie). Il s’agit d’un groupe de 70 chercheurs travaillant ensemble pour étudier la classification empirique de la psychopathologie. Dans cet article, nous décrivons les objectifs et les axes de recherches actuels du consortium HiTOP. Ces objectifs concernent la poursuite des recherches sur l’organisation empirique de la psychopathologie ; le lien entre la personnalité et la psychopathologie ; l’utilité des construits empiriques de la psychopathologie, à la fois pour la recherche et pour la clinique ; et enfin, le développement de nouveaux modèles exhaustifs et d’instruments d’évaluation correspondant aux construits psychopathologiques dérivés d’une approche empirique. / Abstract: Shortcomings of approaches to classifying psychopathology based on expert consensus have given rise to contemporary efforts to classify psychopathology quantitatively. In this paper, we review progress in achieving a quantitative and empirical classification of psychopathology. A substantial empirical literature indicates that psychopathology is generally more dimensional than categorical. When the discreteness versus continuity of psychopathology is treated as a research question, as opposed to being decided as a matter of tradition, the evidence clearly supports the hypothesis of continuity. In addition, a related body of literature shows how psychopathology dimensions can be arranged in a hierarchy, ranging from very broad “spectrum level” dimensions, to specific and narrow clusters of symptoms. In this way, a quantitative approach solves the “problem of comorbidity” by explicitly modeling patterns of co-occurrence among signs and symptoms within a detailed and variegated hierarchy of dimensional concepts with direct clinical utility. Indeed, extensive evidence pertaining to the dimensional and hierarchical structure of psychopathology has led to the formation of the Hierarchical Taxonomy of Psychopathology (HiTOP) Consortium. This is a group of 70 investigators working together to study empirical classification of psychopathology. In this paper, we describe the aims and current foci of the HiTOP Consortium. These aims pertain to continued research on the empirical organization of psychopathology; the connection between personality and psychopathology; the utility of empirically based psychopathology constructs in both research and the clinic; and the development of novel and comprehensive models and corresponding assessment instruments for psychopathology constructs derived from an empirical approach

Les progrès dans la réalisation de la classification quantitative de la psychopathologie

Shortcomings of approaches to classifying psychopathology based on expert consensus have given rise to contemporary efforts to classify psychopathology quantitatively. In this paper, we review progress in achieving a quantitative and empirical classification of psychopathology. A substantial empirical literature indicates that psychopathology is generally more dimensional than categorical. When the discreteness versus continuity of psychopathology is treated as a research question, as opposed to being decided as a matter of tradition, the evidence clearly supports the hypothesis of continuity. In addition, a related body of literature shows how psychopathology dimensions can be arranged in a hierarchy, ranging from very broad "spectrum level'' dimensions, to specific and narrow clusters of symptoms. In this way, a quantitative approach solves the "problem of comorbidity'' by explicitly modeling patterns of co-occurrence among signs and symptoms within a detailed and variegated hierarchy of dimensional concepts with direct clinical utility. Indeed, extensive evidence pertaining to the dimensional and hierarchical structure of psychopathology has led to the formation of the Hierarchical Taxonomy of Psychopathology (HiTOP) Consortium. This is a group of 70 investigators working together to study empirical classification of psychopathology. In this paper, we describe the aims and current foci of the HiTOP Consortium. These aims pertain to continued research on the empirical organization of psychopathology; the connection between personality and psychopathology; the utility of empirically based psychopathology constructs in both research and the clinic; and the development of novel and comprehensive models and corresponding assessment instruments for psychopathology constructs derived from an empirical approach. (C) 2020 Published by Elsevier Masson SAS