[Intrusive touch of borderline parenting and risk of disorganized attachment of children]. / Toucher intrusif de la parentalité borderline et risque d'attachement désorganisé des enfants.

The development of attachment in toddlers is linked to the quality of their early interactions with their mother and father. The impact of interactive dysfunctions, in relation to different parental circumstances, constitutes an important risk for the development of disorganized attachment. Although this aspect is fairly well known, few studies have been done on the children of people with borderline personality disorder.

[Supporting the encounter of mothers suffering from borderline conditions with their baby]. / Accompagner la rencontre des mères souffrant d'états limites avec leur bébé.

Mothers suffering from borderline conditions are overwhelmed by emotions. Their interactions are tainted with qualitative discontinuities, unpredictable for infants. These high-risk situations must not be trivialised. They are characterised by the importance of providing rapid support to the baby and by the existence of maternal suffering. The infant's basic needs guide the professionals working with these families.

Update on Mental Health of Infants and Children of Parents Affected With Mental Health Issues.

This paper highlights the most recent publications, in the field of psychiatry, on offspring of patients with psychiatric illnesses such as schizophrenia and bipolar disorder, and then summarizes what we know about the progeny of adults with mood disorders, the most prevalent of parental disorders. Studies examining personality disorders and contextual factors such as stress and trauma are examined with a focus on the crucial question of development and attachment status in children. Findings converge to reveal that offspring of parents (generally mothers) with most major psychiatric disorders present a higher risk for all mental disorders, and a wide range of disorders are also found in children, adolescent, and finally adult offspring of mothers with mood and anxiety disorders. Developmental psychopathology and infant and child psychiatry have focused on early relationship formation through social interaction and attachment patterns as pathways affected by vulnerability or resilience factors. First year of life longitudinal studies following mothers and infants has shown that maternal psychopathology is positively correlated with higher risk of attachment issues. It would seem that pathology appears when adaptation to real-life contexts becomes difficult in association with an accumulation of negative individual characteristics and environmental circumstances. We suggest that in order to move forward psychiatry should embrace a developmental cascade model, which posits a cumulative pathway for the emergence of psychopathology in the developing child. We propose that we have sufficient knowledge today to start implementing multilevel approaches to enhance the health and mental health of the next generation.

[Supporting the establishment of the parent-child bond in cases of prematurity]. / Soutenir l'élaboration de la relation parent-enfant en cas de prématurité.

The evolution of the care of premature babies is having an effect on a particular difficulty, that of the development of parenthood and the parent-baby relationship hampered by an early birth. The short- and long-term consequences of any disruption to these two dimensions can be considerable and the hospital must take into account the issue when caring for parents and their premature baby.

Panda Unit, a Mother-Baby Unit Nested in a Neonatal Care Service.

The PANDA unit is a full-time mother-baby hospitalization unit based on an original model of care for vulnerable dyads. It is located within a neonatal unit allowing tripartite care (perinatal psychiatry, neonatology and post-natal care). It thus differs from traditional mother-baby units in its close links with the other perinatal care actors, allowing comprehensive health and mental health care in the immediate post-partum period. Patients admitted to the Panda Unit may have been referred during the antenatal period or taken into care in an emergency if the mother's clinical condition requires it, in the aftermath of childbirth. During their stay, the dyads are evaluated daily by a perinatal psychiatrist. This includes assessment of maternal clinical state, the newborn's development and the quality of mother-infant interactions. During the first 6 months of use, 24 dyads have benefited from PANDA care. Three women among 5 were admitted during the antenatal period and almost one-third were aged under 21. The first primary diagnosis during the antepartum was major depressive disorder, two-fold that of personality disorder or bipolar disorder alone. At the end of PANDA stay, close to 3 women among 4 were back to their home with their child, and an out-of-home placement was mandated for 4 infants. PANDA unit is a step toward continuous and comprehensive integrative care. The mother and baby do not leave the maternity ward, and management of mother, baby, and their interactions can start immediately after birth. Considering the importance of the first months of life in the establishment of fundamental links and bonding, PANDA offers an innovative opportunity for what we hope will be both therapeutic and preventive for at-risk dyads. The detection, and ultimately prevention and management of risk of abuse and neglect is another major challenge that this unit hopes to address from the very beginning.

Pregnancy, somatic complaints and depression: a French population-based study.

OBJECTIVE: Depression during pregnancy is today one of the greatest medical risks for expectant mothers and newborns. It is associated with numerous morbid conditions and with postnatal depression. Identifying depression during pregnancy is therefore a major public health concern, but screening for depression is not routinely carried out in somatic settings. We hypothesized that the presence of numerous somatic complaints contributes to the detection of an increased risk of depression during pregnancy. STUDY DESIGN: A cross-sectional study was conducted on 1000 consecutive pregnant women approached during OB/GYN visits at a general maternity hospital. They were asked to fill out a questionnaire, which contained the Edinburgh Postnatal Depression Scale (EPDS) and a checklist of 18 somatic complaints. RESULTS: The median number of somatic complaints was 5 (interquartile range 3-7). The risk of depression during the 2nd and 3rd trimesters was 18.3% (EPDS score > 10.5). Logistic regression revealed that when the somatic complaints total score moved from 3 to 7, the odds of moving from not-at-risk to at-risk for antenatal depression were multiplied by 2.91. CONCLUSION: Our results call for further research exploring somatic complaints and their link to depression during pregnancy. Until more knowledge is available, we suggest considering that women with a high number of somatic complaints during pregnancy are at high risk for depression and should be referred for further diagnostic clinical assessment and care.