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Abstract: With the deinstitutionalization and the evolution of antipsychotic therapeutics, the life of psychotic women has changed. If issues related to desire, questioning and sexual life are globally similar to those of general population, this sexuality is more active with multiple sexual partners, with more unwanted and unplanned pregnancies, abortion, and sexual abuses. A review of literature reveals that limited published research exists on the subjective experiences of mothers with a psychotic illness and their desire for child. Furthermore, pregnancy of mentally-ill patients raises ethical questions for professionals who look after these women because of the illness, their environment, the social conditions of life, and their isolation. The desire of pregnancy does not fully coincide with the desire of a child. Some psychotic women want to be pregnant but do not want a child. Other women cannot establish a mother–child link because the imaginary child overrides the real baby. But, on the contrary, some are very good mothers, especially in the first months of life of the baby. How must we work with this desire of pregnancy with our psychotic patients to understand and to help them, and in order to ameliorate the preventive strategies of protection for the child in case of pregnancy? [Copyright &y& Elsevier]

Abstract: More than 50% of suicides are by patients who have been or are still followed-up. The prevalence of suicidal crises is high (32%) and stable in populations of chronic psychiatric patients. Suicidal risk factors are well known, nevertheless they are more particularly high during acute crises and are lower when the psychiatric illness is chronic. Five percent of the suicides are committed during hospitalization. Most of them occur on the first month following admission, in the first week of an acute psychotic crisis, within the year after hospitalization, prior to the hospital discharge. The rate of suicide is particularly important in psychiatric institutions because most of their patients are suffering from schizophrenia and/or depression, two diseases with high rates of suicide. Some suicidal risk factors specific to schizophrenia have been identified such as the schizoid-affective form of the disease, patient care that has been delayed, a chronic disease with numerous acute episodes, short and frequent admissions in a hospital, involuntary hospitalisations, extrapyramidal side effects and disruption of treatment. The vulnerability appears to be maximum during the first week and/or the three months after discharge from the hospital, during the first year following the diagnosis and during acute episodes, especially the first one. In the second part of this work, we will examine the legal aspects, based on the main recent court cases relative to hospital liability. The fault usually consists in lack of surveillance and involves the liability of the hospital. The assessment of the adequacy of the measures taken for the medical care of a patient and in particular his/her supervision depends on the predictability of the suicidal act; the severity of the psychiatric illness and more particularly on previous suicidal attempts; previous fugues from the hospital and previous violent acting out especially on the occasion of previous hospitalisations. To avoid reciprocal projections when there is a suicidal act it is essential to work with family and attendants, to obtain clear and exact information about the psychiatric illness and to ensure both medical and administrative care. [Copyright &y& Elsevier]

Abstract: Post-partum psychosis occurs in one to two cases out of 1000 deliveries. Studies in prenatal psychiatry have improved our understanding of the symptoms. If the prognosis of the acute state is generally positive, the rate of recidivism remains important due to the risk of becoming chronic. Analysis of the data allows preventative work with mothers-to-be. From a psychodynamic perspective, pregnancy is a time of important psychological conflicts, identity crisis and awakening of infantile conflicts. The understanding of those psycho-emotional mechanisms related to pregnancy and the multidimensional approach appears to be indispensable in taking care of acute psychiatric post-partum states. The case of Mrs. O, hospitalised in adult psychiatrics for a post-partum manic episode shows how those theoretical models become relevant in order to elaborate intra-psychological conflicts. The anamnesis and the history of the patient revealed the existence of several risk factors for triggering the psychosis. The identification of the patient to her maternal lineage in association with revisiting her infantile past grounded the psychosis. We worked the issue of her place within her maternal lineage, with her husband and her place as a mother. The confusion about her own identity added to the patient''s generational confusion was gradually amended and a work of separation/individuation could then be undertaken. [Copyright &y& Elsevier]

Objective: The objective of this systematic review was to investigate which specific and especially neurocognitive factors related to schizophrenia, were associated with homicide risk. Methods: A systematic English-French Medline literature search of cohort studies, case-control studies and transversal studies published from January 1999 to December 2009 was performed combining the MeSH terms “schizophrenia”, “homicide”, “violence”, “mental process”, “cognition”, “risk”, “risk factors”,. Abstract selection was based on the STROBE checklist for observational studies and on the consort statement for clinical trials. Results: Of the 366 selected studies, 65 observational or prospective studies, 10 systematic reviews and meta-analysis and 2 interventional studies met the selection criteria and were included in the final analysis. Firstly, we highlighted that historical (past violence, juvenile detention, physical abuse, parental arrest record), dispositional (male gender, young age, low socioeconomic status) and contextual (recent divorce, unemployment, victimisation) factors could be considered as general homicide-related factors. Clinical factors (clinical paranoid, delusions of persecution or thought insertion, substance abuse, disorganized thinking, long duration of untreated psychosis, stopped monitoring or treatment) were more schizophrenia-specific factors for homicide. Most of the excess risk appears to be mediated by substance abuse. Secondly, our results suggested that schizophrenics with a history of aggressive behaviour compared to those without such history, had better performances on global neuropsychological tests exploring executive functions but performed more poorly as considering orbitofrontal functions. Conclusions: We suggest that every comprehensive psychiatric assessment should explore the risk of homicide, including historical, dispositional, contextual, clinical and neurocognitive (low insight capacity, impaired frontal functions) factors of violence. [Copyright &y& Elsevier]

Three common missense variants of the Disrupted in Schizophrenia 1 (DISC1) gene, rs3738401 (Q264R), rs6675281 (L607F) and rs821616 (S704C), have been variably associated with the risk of schizophrenia. In a case-control study, we examine whether these gene variants are associated with schizophrenia and ultra-resistant schizophrenia (URS) in a population of French Caucasian patients. The URS phenotype is characterized according to stringent criteria as patients who experience no clinical, social and/or occupational remission in spite of treatment with clozapine and at least two periods of treatment with distinct conventional or atypical antipsychotic drugs. We find a significant association between DISC1 missense variants and URS. The association with rs3738401 remains significant after appropriate correction for multiple testing. These results suggest that the DISC1 rs3738401 missense variant is statistically linked with ultra-resistance to antipsychotic treatment. [ABSTRACT FROM AUTHOR]