Elements of maternal psychopathology and child psychosis

The chidren of parents with psychiatric disorders present high risks of dev eloping psychiatric pathological states. although these difficulties are be nign in most cases. a fortunately small but real risk exists for the childr en to develop a psychotic pathology. A strong association between the psych opathological elements, notably maternal, but more generally familial and c hild autism has long been established : clinical cases have been reported a nd epidemiological studies have supported these findings. BS means of a pre liminary case-control study, we proposed to verify the existence of such a link among a sample of psychotic but not autistic children. These children were taken from the population in diagnostic evaluation at the Dnr-unit of Saint Vincent de Paul hospital in Paris (Professor B. Golse). Sixteen mothe rs whose children were later hospitalized and sixteen mothers of control ch ildren, matched for age and sex, were interviewed with a structured intervi ew tin accordance with the DSM (IV). We looked for past psychopathological elements with particular attention devoted to the period of pregnancy and e arly post-partum in the course of the clinical interview. Thirteen children were diagnosed psychotic aut not autistic. In fact, over the life span, tw elve mothers of the hospitalized children (92.3 %) presented at least one p sychopathological disorder (principally depressive disorders) versus 5 (38. 5 %) in the control group (p = 0.01). It was also shown that before the pre gnancy, there were 9 (69.2 %) versus 1 (7.7 %) psychopathological disorders respectively diagnosed in, the two groups (p = 0.003). During the pregnanc y and the first year the child's life, the rates were 61.5 % (n = 8) versus 15.4 % (n = 2) (p = 0.04). Moreover, three manic-depressive disorders were found in the mothers of hospitalized children, but none in the control gro up. Our research therefore gives evidence of a large epidemiological relati onship between, on one hand maternal pathology (primarily affective disorde rs after and surprisingly even before the birth of the child) and, on the o ther hand, non autistic psychosis of the child. Several hypotheses are conf ronted in trying to explain this relationship, but first of all, we would l ike to propose a multifactorial model of pervasive developmental disorders. In this concept, there exist both a complex genetic vulnerability and also a disturbance of the interrelations between the child and his caregivers. This disturbance prevents compensation and may even perpetuate the difficul ties of a particularly vulnerable child. Finally, we would like to insist i mportance of identifying and beginning treatment of these maternal psychopa thological elements, particularly the ones manifested in the course of the pregnancy and at post-partum. This work is in a perspective of public healt h and prevention.