La dépression du post-partum chez la primipare : prévalence,facteurs de risque et liens avec la douleur de l’accouchement

Childbirth of primiparous women is sometimes associated with severe pain that could predispose mothers to develop anxiety and depressive symptoms.ObjectiveTo assess the prevalence of postpartum depression among primiparous women, to determine risk factors that can contribute to this psychiatric disorder and to study the links between labor pain and postpartum depression.MethodsTo that end, we conducted a prospective and longitudinal study, including 183 primiparous women. In the first step, corresponding to the first 48 hours after delivery, we assessed pain experienced during childbirth using the “Saint-Antoine Pain Questionnaire”. In the second phase, 6 to 8 weeks after delivery, we used the Edinburgh Postnatal Depression Scale (EPDS) and the Hospital Anxiety and Depression Scale (HADS) to assess anxiety and depressive symptoms.ResultsThe average total score on the “Saint-Antoine Pain Questionnaire” was 74.44, with an average score of 45.01 for sensory pain and that of 29.44 for emotional pain. A depressive state was diagnosed in 18.7% of mothers. Edinburgh Postnatal Depression Scale scores were significantly higher among primiparous women in case of an unwanted pregnancy, vaginal delivery, instrumental delivery, complicated childbirth and when the marital relationship was considered to be conflictual. An anxiety state was objectified in 20% of women. Significantly higher anxiety scores were found in single mothers, those with a low socioeconomic level, those with a low level of education, in case of a vaginal delivery, when the sex of the baby was unwanted and when the quality of the marital bond and the contact with the healthcare team were judged to be of poor quality. Higher childbirth pain scores were associated with significantly higher scores of depression and anxiety. Moreover, Edinburgh Postnatal Depression Scale scores were significantly higher in primiparous mothers with higher scores of anxiety (P < 0.001).ConclusionIt seems judicious to assess the childbirth pain, to improve its management by support strategies and to make health professionals aware of postpartum anxiety and depression disorders.     

Pour une révision de la loi du 20 décembre 1988 relative à la protection des personnes qui se prêtent à des recherches biomédicales (dite loi Huriet)

In France, biomedical research is governed by the law on the protection of people who participate in biomedical research passed on December 20, 1988. Considering that this law is becoming an obstacle to some useful investigations, 50 scientific societies, organizations, and patients associations have written a memorandum asking for its revision. This memorandum contains propositions for alleged procedures while preserving the welfare of people who participate in biomedical research.     

Schizophrénie à début précoce chez un adolescent ayant une déficience intellectuelle et une agénésie du corps calleux : particularités cliniques, thérapeutiques et évolutives

IntroductionAgenesis of the corpus callosum (ACC) is a rare brain malformation characterized by a total or partial absence of formation of the corpus callosum during fetal development. ACC has been correlated with various neuropsychiatric manifestations, including schizophrenia. Here, we report a rare case of ACC revealed by neuropsychiatric disorders.VignetteMA was born of a first-degree consanguineous marriage. His early childhood was marked by a psychomotor development delay, school and extra-family relationship difficulties. Over the years, there has been a gradual worsening of social and school deficits, with isolation from peers. At the age of 15, MA brutally developed physical and verbal aggression, soliloquy with unmotivated laughter and bizarre behavior, as well as vague ideas of persecution towards his teachers and peers. He was thus referred to our psychiatric consultation. The general physical and systemic examination was normal. Neuropsychological tests indicated current low Intelligence Quotient (60) with impaired executive functions. The electroencephalogram was normal. Computed tomography and magnetic resonance imaging revealed ACC. He was diagnosed with schizophrenia according to the diagnostic criteria of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. The patient was put on Risperidone and then on Olanzapine at adequate doses and durations, with poor therapeutic response.ConclusionOur observation provides additional support for neurodevelopmental models of schizophrenia, and confirms literature data indicating that severe structural brain abnormalities would lead to early onset psychotic symptoms which are often refractory to pharmacological treatments.     

Décès et engagement du pronostic vital chez les enfants et les adolescents ayant un trouble psychiatrique : revue de la littérature et exemple dans un service universitaire d’hospitalisation pédopsychiatrique

BackgroundDeath is a rare event in child psychiatry and still not widely studied.MethodsHere, we report a review of literature concerning mortality in child psychiatry and a retrospective study (begun in 2007) of the implementation of “mortality and morbidity reviews” carried out in a university hospital within several inpatient units.ResultsThe review pulled together 73 studies, all of them confirming the excess mortality of children and adolescents in child psychiatry, whether in the general/non-specific populations (ex : hospitalized patients) or in specific populations (e.g. : autistic patients). The causes of excess mortality are undoubtedly suicide but also many natural causes (e.g. : complications due to addiction or anorexia nervosa). Our study includes 11 patients (mean average age = 15.5 years; 9 girls and 2 boys) and saw 5 deaths and 14 life-threatening situations. Again, suicides and serious suicide attempts were very common (n = 8 including 2 deaths), but the study also describes somatic causes, complications of pathological behaviour (n = 5 : undernutrition in the context of anorexia, water poisoning) or underlying somatic disease (n = 5, including 2 deaths related to Sanfilippo disease and infiltrative brain lymphoma).ConclusionAs with adult psychiatry, children and adolescents with mental disorders appear to have a lower life expectancy compared to the general population. Nevertheless, death in child psychiatry remains a rare phenomenon, especially when it happens in hospital care. Our study shows that cases of death or life-threatening situations in hospitalized child psychiatry are due to somatic diseases (that are more or less entangled with psychiatric disorders) or due to suicides.     

« Je ne veux pas aller à l’école » : perspectives actuelles sur le repérage du refus scolaire anxieux et présentation de la SChool REfusal EvaluatioN (SCREEN)

School refusal is an international topic of study and a major concern worldwide in the fields of education and health. This is a complex and multifaceted clinical reality that is misdiagnosed and not yet widely known phenomenon. This confusion delays the identification and, therefore, the clinical care of youth displaying school refusal. This article presents the latest scientific advances and consensus concerning the criteria, screening and assessment of school refusal. It focuses on the SChool REfusal EvaluatioN (SCREEN), a scale for assessing and diagnosing school refusal. Two examples of the use of SCREEN in the field (school and clinical settings) are presented. Finally, we discuss the place and role of the International Network for School Attendance (INSA) in this vital work towards improving the screening and management of school refusal at an international level.