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This pilot study explores the effects of a brief individual psychoanalytic therapy on perinatal depressive symptoms. This intervention is based on the Geneva's mother-infant intervention model. A sample of 129 pregnant women was recruited in Geneva (Switzerland) and screened for depressive symptoms with two instruments: the 'Edinburgh postnatal depression scale' (EPDS) and the 'Dépistage anténatal de la dépression postnatale'. A group of 40 women presenting depressive symptoms (treatment group) participated in a four-session intervention called 'Psychotherapy centred on parenthood (PCP)'. It consists in two antenatal and two postnatal sessions and is focussed on changing problematic representations of parenthood. This treatment group was compared to a control group of 88 women without depressive symptoms and following the usual obstetrical care. The main outcome measure was EPDS at 3 and 6 months after delivery. The 'Global assessment functioning scale' was administered at the end of each therapeutic session. The 'Parent-infant relationship global assessment scale' was administered at the two postnatal sessions in order to explore if PCP was also effective in preventing the potential negative effects of depression on mother-infant relationship. Results show that in the treatment group (N = 31), EPDS scores dropped from 12.8 to 4.8; none of these women met the EPDS cut-off score of 12 at 3 and 6 months postpartum. Mother-infant relationship was well adapted for all 31 dyads at the end of the intervention. These results suggest that PCP is a promising intervention for treating perinatal depression and helping mothers engaging in parenting.

Until today postpartum depression (PPD) remains too often banalised or misknown by the population who is frequently badly informed. Actually it is an important public health problem because it concerns more than one new mother out of ten without this pathology being diagnosed nor treated. The consequences of this depression can be serious both for the mother and for the child with latter developmental difficulties. Since several years, a Genevian team of child psychiatrists has been working on this problem and developed a screening questionnaire to identify women at risk to develop PPD. A preventive method of dynamic psychotherapy is presently being developed and implemented to the at-risk women with the collaboration of the Genevian gynaecologists.

Prematurity is an important cause of perinatal mortality and morbidity. The incidence is not decreasing, despite the efforts of prevention. Few interventions were demonstrated effective to decrease the risk of preterm birth. We are currently conducting two randomized trials including women with preterm labor. The objective of one trial is to evaluate a psychotherapeutic intervention. The other trial is multicentric to evaluate vaginal progesterone. We hope that these two trials will provide us with valid evidence on the effectiveness of these interventions to decrease the risk of preterm delivery and of neonatal consequences.

Objective: To figure out features of autism before the age of one and to explore the pathways of early social and nonsocial attention in autism through home movies., Method: Home movies of 15 children later diagnosed with autism, are compared with home movies of 13 typical children. The films of the two groups have been mixed and rated by blind observers through a Grid composed of social and nonsocial item and applied to two age ranges: 0-6 months (T1) and 7-12 months (T2). Two MANOVAs, an ANOVA and discriminant analyses were applied., Results: Significant differences between the two groups were found only for the item in the Social area at T1 but not at T2, when groups did not differ in either social or nonsocial areas. At T2 children with autism had significantly higher scores in the nonsocial area while normal children did not show significant differences between areas. Discriminant analyses revealed that social attention can distinguish the two groups at T1 but not at T2., Conclusions: The fundamental impairment of joint attention in autism could be considered a consequence of the early atypical developmental gap and of a later disconnection between attention to people and objects. Abnormal developmental trajectories for social and nonsocial attention could help us in the future to understand relationships between adaptive capacities and symptoms, and set the stage for appropriate early screening instruments.

Objective: To study the quality of early attention in autism spectrum disorder (ASD) through home movies., Method: Fifteen home movies from the first 6 months of life of children who later received a diagnosis of ASD were compared with home movies of 15 normal children. The diagnosis was performed after the third year of life of children by two senior child and adolescent psychiatrists using a checklist of symptoms according to the. The films of the two groups were mixed and rated by blind observers through a Grid for the Assessment of Attentional Skills in Infants, composed of 13 items grouped into three developmental areas., Results: Using multivariate analysis of variance, the authors found significant differences between the two groups for the items in the social attention and the social behavior areas; on the contrary, there were no differences in nonsocial attention., Conclusions: The authors pose some hypotheses about a specific early-appearing impairment of attention in ASD in which children shift their spontaneous attention mainly toward nonsocial stimuli rather than toward social stimuli. The importance of this finding for early diagnosis and treatment is underlined.

Objective: The main aim of the research is to study the early behavioral development in autistic children through home movies., Methods: fifteen home movies, regarding the first 2 years of life of autistic children are compared with the home movies of 15 normal children. The films of the two groups were mixed and rated by blind ratings with the Grid for the Assessment of Normal Behavior in Infants and Toddlers. The grid is composed of 17 items grouped into three developmental areas: social competence, intersubjectivity and symbolic activity. For every area, we have identified specific children's behaviors., Results: Significant differences between the two groups are found both in the range of age 0-6 for intersubjectivity, and in the ranges of age 6-12 and 18-24 for symbolic activity., Conclusions: The authors pose some hypotheses about an early-appearing impairment of intersubjectivity, the ability to represent other's state of mind, in subjects with autistic disorder., (Copyright 2001 S. Karger AG, Basel)

This is the first clinical description of a detailed psychological, speech, and language phenotype of four young children (< 5 years) with Velo-Cardio-Facial syndrome (VCFS) due to a deletion on chromosome 22 (22q11.2). The reported elevated risk of developing schizophrenia or bipolar disorder in adolescence for individuals with this chromosomal deletion led us to examine the psychiatric and cognitive status of young children with VCFS. Our observations suggest a phenotype comprised of a borderline to mildly retarded level of intellectual functioning, a language delay, a general deficit in social initiation, difficulties with attention/concentration, and a perturbed train of thought.

The authors describe the natural history and the beginning of pervasive developmental disorders (PDD) by the observation of home movies. The sample is composed of 26 children aged 18 months to 5 or 6 years at the first consultation. The methodology used in the observation of home movies includes: (1) application of the ERC-A-III scale for recognizing the precocious symptoms of autism; (2) analysis of the coming out and coming off of social, emotional and cognitive competences. The authors, starting from the analysis of these data, describe three kinds of onset and courses of PDD: progressive, regressive and fluctuating. The authors present some conclusive considerations on the different age of PDD onset in home movies, in anamnestic reconstruction and in recall for diagnosis., (Copyright 1999 S. Karger AG, Basel)

The authors begin by pointing out that Freud always considered parent-child relations in terms of the child's psychic development and took little account of the parents' experience of the relationship and its psychic effects on them. They recall Freud's distinction between the anaclitic and narcissistic modes of relationship and show how these are unconsciously embodied and enacted in varying proportions in the cases observed in their own clinical practice of therapeutic consultations with parents and young children. After a review of the relevant psychoanalytic literature, the authors present their concept of the narcissistic scenarios of parenthood, which include parental projection on to the child, parental counter-identification, a specific aim and a relational dynamic that is acted out. Depending on the individual situation, the effects may help to structure the developing psyche or, if the narcissistic element is excessive, they may be pathological. The authors consider the literature on the application of psychoanalysis to therapeutic interventions with parents and children, stressing the technical importance of establishing a therapeutic focus. These ideas are illustrated by a detailed case history showing the interaction between a mother and a 4-year-old girl and how it was modified by a short therapy. The differences between interpretation in this situation and in the classical psychoanalytic setting are explained, and the paper ends with some comments on the transmission of psychic elements from generation to generation.

On the basis of clinical cases in which brief therapeutic parent-child interventions were indicated, the author treats the problem of the involvement of the parents and of the family in child psychiatry. The clinical and dynamic characteristics of the parent-child interaction (that of the mother with her child in particular) as well as the relation with the examiner (positive pre-transference) are studied. Cases of counter-indication of this type of approach are also taken up. The author suggests using these clinical-dynamic criteria and the pre-transference in order to determine which members of the family could lend themselves to the most efficient, and economical preventive and therapeutic approaches.

We define the term "para-neurotic organization" as a particular form of the mental organization of the young child, intermediate between a neurotic structure and a personality disorder. The para-neurosis has little chance of spontaneous improvement, but there is good indication for psychotherapeutic treatment for these children and its results are satisfactory. Although the fantasmatic life of this type of children is often related to oedipal problems and their capacity to symbolise is rich, there are nevertheless frequent regressive mouvements leading to blocking (inhibitions of symbolisation) or to manic behaviors (flight of ideas). The persistance of this functioning could prevent the establishment of a true neurotic organization. We shall present this clinical entity on the basis of clinical examples (dynamic profiles). In order to illustrate the principal caracteristics, a standard-scale has been constructed. Psychodynamic considerations support our various findings.