François Poinso

Inpatient mother-and-child postpartum psychiatric care: Factors associated with improvement in maternal mental health.

PURPOSEnThis study assessed the underexplored factors associated with significant improvement in mothers mental health during postpartum inpatient psychiatric care.nnnMETHODSnThis study analyzed clinical improvement in a prospective cohort of 869 women jointly admitted with their infant to 13 psychiatric Mother-Baby Units (MBUs) in France between 2001 and 2007. Predictive variables tested were: maternal mental illness (ICD-10), sociodemographic characteristics, mental illness and childhood abuse history, acute or chronic disorder, pregnancy and birth data, characteristics and mental health of the mothers partner, and MBU characteristics.nnnRESULTSnTwo thirds of the women improved significantly by discharge. Admission for 25% was for a first acute episode very early after childbirth. Independent factors associated with marked improvement at discharge were bipolar or depressive disorder, a first acute episode or relapse of such an episode. Schizophrenia, a personality disorder, and poor social integration (as measured by occupational status) were all related to poor clinical outcomes.nnnDISCUSSIONnMost women improved significantly while under care in MBUs. Our results emphasize the importance of the type of disease but also its chronicity and the social integration when providing postpartum psychiatric care.

Care in a mother-baby psychiatric unit: analysis of separation at discharge.

SummaryJoint psychiatric admission to a Mother-Baby Unit (MBU) enables a mother to obtain care for psychiatric disorders and simultaneously receive support in developing her identity as a mother. This care is meant to prevent attachment disorders and mother-baby separation. Outcome at discharge, however, may differ according to the mothers admission diagnosis. Demographic data, clinical features of parent and child, and clinical outcome of 92 consecutive admissions of mothers and their children to a MBU in Marseille were collected over a period of eight years (1991–1998). Separations occurred in 23% of the joint admissions. Women with acute postpartum psychoses and major depressive disorders had better outcomes than those with chronic psychoses: at discharge, the latter were more often separated from their children. In those cases, however, MBU admission provided time to arrange the best placement for the child. Outcome was less predictable for non-psychotic personality disorders and depended not only on the mothers disease but also on her family and social context.

The Impact of Weight Normalization on Quality of Recovery in Anorexia Nervosa

Background: There is little agreement on what constitutes remission in anorexia nervosa. Objective: This study compared the medical, psychological, and social status of 2 female populations previously treated for anorexia nervosa and differing in their achievement of normal weight. Design: One hundred forty-one patients responded to a questionnaire documenting morphometric parameters, subjective perception of outcome, concerns about body shape and diet, and quality of familial, emotional, and professional life. Two groups were defined according to body mass index (BMI): normal (n u200a=u200a 69) with BMI ≥ 18.5 kg/m2, and subnormal (n u200a=u200a 72) with BMI < 18.5 kg/m2. In addition, subgroups (21 in each category) were interviewed. An age-matched control population composed of 156 women, either students or Health Services employees, responded to a similar questionnaire. Results: Only a minority of patients assessed themselves as recovered, and there was no statistically significant difference in perception of recovery between normal BMI and subnormal BMI groups (27.5% and 15.3%, respectively). As expected, underweight patients reported significantly more frequent purging behaviors, amenorrhea, recent hospitalization, and prolonged student status. In contrast, there were no significant differences in terms of pregnancy rate, psychiatric comorbidities, social integration, sexual activity, and self-assessment of professional and familial life. In comparison to control subjects, former anorexia patients with normalized BMI more frequently reported vomiting, fear of high-calorie foods, and treatment for depression. Conclusions: These few long-term advantages observed after BMI normalization suggest that normalization of nutritional status remains an important target in anorexia nervosa. However, the persistence of psychological distress after nutritional recovery confirms that more effective treatments are needed that target long-term psychological recovery.

Predictors of infant foster care in cases of maternal psychiatric disorders.

PurposeOur aim was to investigate the factors associated with mother–child separation at discharge, after joint hospitalization in psychiatric mother–baby units (MBUs) in France and Belgium. Because parents with postpartum psychiatric disorders are at risk of disturbed parent–infant interactions, their infants have an increased risk of an unstable early foundation. They may be particularly vulnerable to environmental stress and have a higher risk of developing some psychiatric disorders in adulthood.MethodsThis prospective longitudinal study of 1,018 women with postpartum psychiatric disorders, jointly admitted with their infant to 16 French and Belgian psychiatric mother–baby units (MBUs), used multifactorial logistic regression models to assess the risk factors for mother–child separation at discharge from MBUs. Those factors include some infant characteristics associated with personal vulnerability, parents’ pathology and psychosocial context.ResultsMost children were discharged with their mothers, but 151 (15xa0%) were separated from their mothers at discharge. Risk factors independently associated with separation were: (1) neonatal or infant medical problems or complications; (2) maternal psychiatric disorder; (3) paternal psychiatric disorder; (4) maternal lack of good relationship with others; (5) mother receipt of disability benefits; (6) low social class.ConclusionsThis study highlights the existence of factors other than maternal pathology that lead to decisions to separate mother and child for the child’s protection in a population of mentally ill mothers jointly hospitalized with the baby in the postpartum period.

Impact of an implicit social skills training group in children with autism spectrum disorder without intellectual disability: A before-and-after study

Introduction Children with Autism Spectrum Disorders (ASDs) have problems with social skills. Social skills training groups are among the proposed therapeutic strategies, but their efficacy still needs to be evaluated. Objective To evaluate the efficacy of an implicit social skills training group in children with ASDs without intellectual disability. Methods A before-and-after study of children with ASD without intellectual disability was conducted in a child psychiatry day hospital, where they participated in an implicit group with cooperative games. Their social skills were assessed using the Social-Emotional Profile (SEP), the Childhood Autism Rating Scale (CARS), and the empathy quotient (EQ) before and after 22 weeks. Results Six patients aged 9 to 10 years old were evaluated. A significant increase in overall adaptation and social skills (median 8 and 7.7 points) in the SEP was demonstrated in addition to a significant reduction in the CARS score (median: 4 points), including in the field of social relationships. The EQ increased two-fold. Discussion—Conclusion This implicit group improved the children’s social skills. It would be interesting to evaluate the maintenance of these skills over time, examine more widespread results, and compare implicit and explicit groups.

Infant psychomotor development in cases of maternal postpartum depression: Observation of a mother and baby unit

Studies of the first year of infant psychomotor development in cases of maternal postpartum depression are lacking. The mother and baby unit (MBU) is a healthcare system available to infants and their mothers during the postpartum period in a psychiatric hospital, which provides support and preserves the parent’s role in the child’s daily care. The aim of the paper is to describe the developmental profile of babies of mothers with severe postpartum depression treated in an MBU through the developmental quotients. Using the Brunet-Lézine scale, we studied six-month-old infants whose mothers were hospitalized. The study population consisted of 15 infants. The mean global developmental quotient score was 96.7. A developmental quotient lower than 80 was not observed for any of the children. We found no global psychomotor developmental delays. Despite this, the posture subscore was the area in which we observed the most difficulties. It is possible that the tonic dialogue between the mother and infant is disrupted by maternal depression.

An atypical autistic phenotype associated with a 2q13 microdeletion: a case report

BackgroundAutism spectrum disorders are serious neurodevelopmental disorders that affect approximately 1% of the population. These disorders are substantially influenced by genetics. Several recent linkage analyses have examined copy number variations associated with autism risk. Microdeletion of the 2q13 region is considered a pathogenic copy number variation. This microdeletion is involved in developmental delays, congenital heart defects, dysmorphism, and various psychiatric disorders, including autism spectrum disorders. There are only 34 reported cases with this chromosomal deletion, and five cases of autism spectrum disorders have been identified among them. The autistic phenotype associated with this microdeletion has never been described.Case presentationWe describe the case of a 44-month-old Caucasianxa0girl with the 2q13 microdeletion and autism spectrum disorders with global development delay but no associated organ anomalies. We examined the autistic phenotype using different workups and observed an atypical phenotype defined by relatively preserved relational competency and imitation abilities.ConclusionsThe main contribution of this case report is the precise description of the autistic phenotype in the case of this deletion. We observed some atypical clinical features that could be markers of this genetic anomaly. We have discussed the pathophysiology of autism associated with this microdeletion and its incomplete penetrance and variable expressivity.

Exploration and characterisation of the phenotypic and genetic profiles of patients with early onset schizophrenia associated with autism spectrum disorder and their first-degree relatives: a French multicentre case series study protocol (GenAuDiss)

Introduction Early-onset schizophrenia (EOS) is a rare and severe condition. A higher rate of neurodevelopmental abnormalities, such as intellectual or communication impairments as well as attention deficit hyperactivity disorder, is observed in EOS compared with adult-onset schizophrenia. Early signs of autism spectrum disorders (ASD) are present in about 30% of patients. Genetic abnormalities, including copy number variations, are frequent in neurodevelopmental disorders and have been associated to ASD physiopathology. Implicated genes encode proteins involved in brain development, synapses morphology and plasticity and neurogenesis. In addition, an increasing number of genetic abnormalities are shared by EOS and ASD, underlying the neurodevelopmental hypothesis of EOS. The main objective of our study is to identify disease-causing genetic mutations in a cohort of patients affected by both EOS and ASD. Special attention will be paid to genes involved in neurodevelopmental pathways. Methods and analysis We describe a multicentric study in a paediatric population. The study started in April 2014. Inclusion criteria are: age 7–22 years, diagnosis of EOS with comorbid ASD and IQ >50; Parents and siblings are also enrolled. We perform psychiatric assessments (Mini International Neuropsychiatric Interview, Kiddie Schedule for Affective Disorders and Schizophrenia -Present and Lifetime Version, Positive and Negative Syndrome Scale and Scale for the Assessment of Negative Symptoms) together with neurocognitive evaluations (IQ, Trail Making Test A/B and verbal fluency). Then, we study variants of the coding part of DNA (exome), using next-generation sequencing process on trio (mother, father and child). Bioinformatics tools (RVIS and PolyPhen-2) are used to prioritise disease-causing mutations in candidate genes. The inclusion period will end in November 2019. Ethics and dissemination The study protocol was approved by the Local Ethic Committee and by the French National Agency for Medicines and Health Products Safety. All patients signed informed consent on enrolment in the study. Results of the present study should help to unravel the molecular pathology of EOS, paving the way for an early therapeutic intervention. Trial registration number NCT0256552; Pre-results.

Inpatient Mother and Baby Psychiatric Units (MBUs) and Day Cares

MBUs can assess and deal with difficult perinatal disorders that may compromise both the mother’s physical and mental health and the baby’s safety and development, in the short or long term. Suffering associated with separation, sometimes necessary for child’s safety, requires a complete assessment of risks and resources. n n nIn multidisciplinary MBUs, well-trained teams provide comprehensive care including drug therapy, psychotherapy for the mother, and constant care and protection for the child. They also care for the parent–infant relationship. n n nMBUs have gradually learned to work with and help babies’ fathers (despite their frequent personal difficulties) and the family as the natural environment so important for the future of these children (and these families). n n nThe cost of this inpatient intensive care is high, but it must be considered in the light of the later disastrous consequences (and costs) that will follow in the absence of appropriate early postpartum care. The MBU, with all its expertise, is part of a perinatal network involving many partners.

1948 – Chilhood onset schizophrenia: Epidemiological and clinical preliminary findings from a french population-based study

Introduction Childhood-onset schizophrenia (COS) is a rare but severe psychiatric disorder with important individual, family and societal consequences. Its prevalence is approximately 2 per 10.000 in the general population and the incidence of COS increases with age. Objectives The main objective of our study was to evaluate the prevalence of COS in French medical-social institutions or psychiatric day hospitals for children and adolescents in the PACA region. The secondary objectives were: (1) to estimate the prevalence of children with both COS and autism diagnosis, (2) to characterize clinical and neurocognitive presentation of COS using the evaluation of intensity of positive and negative symptoms (PANSS, SANS), of thought disorganization (TLC), of cognitive functioning, and of attention and executive functions (verbal fluency, TMT A, TMT B). Methods Subjects were patients from medical-social and psychiatric care centers for children and adolescents in three PACA sub-regions in the south-east of France. The study included French speaking girls and boys between 7 and 18 years old, registered in a partner structure of the study, and presenting an IQ > 35 (WISC-IV). The study design was constituted by two phases: the first one was the categorical diagnostic phase using the psychosis section of the Kiddie-SADS Present and Lifetime Version. The second phase consisted of the dimensional COS diagnosis and neurocognitive exploration for the subjects fulfilling the DSM-IV diagnostic criteria for schizophrenia. Results The diagnosis of COS was not exceptional in this population. Most subjects diagnosed with COS also presented autism diagnosis and mental retardation.