A sample of 265 adolescents hospitalized between 1971 and 1980 in a psychiatric unit following a suicide attempt was studied to evaluate outcome. After an average of 11.5 years, 48% of the original sample, or 127 subjects, could be traced. Thirty-nine per cent of these subjects showed signs of improvement, 22% appeared to be unchanged and 33% were worse. Substantial dropout rates were found in postdischarge care, only 32% of the patients having been followed up for a sufficient amount of time. Fifteen subjects had died, only one of whom from a natural cause. Of the remaining 14, 5 had committed suicide and 9 had died from unnatural or violent causes other than suicide, the cause of death appearing in all cases to be closely linked to the subject's adolescent disorders. The implications of these findings for suicide prevention are discussed.

UN SUIVI THéRAPEUTIQUE ATYPIQUE : CO-CONSTRUCTIONS THéRAPEUTIQUES DE LA RELATION PRéCOCE D’UNE MèRE BORDERLINE ET SON BéBé Depuis les travaux originaux sur les consultations thérapeutiques et thérapies brèves parents/bébé, la réflexion sur l’intervention précoce s’est dirigée vers les situations cliniques complexes qui ne rentrent pas dans le cadre stricto sensu des psychothérapies conjointes. Il a fallu alors progressivement inventer d’autres formes d’intervention pour des situations que l’on définira volontiers comme atypiques. Il s’agit souvent de parents présentant des troubles graves de la personnalité de type narcissique ou borderline. Ces troubles exposent le bébé dès la naissance à des négligences graves de leurs besoins, à des distorsions relationnelles et à des violences psychologiques retentissant sur leur développement précoce. Si bien des cliniciens se sont penchés sur les conséquences du fonctionnement pathologique parental sur le bébé, on a décrit moins souvent le dispositif institutionnel thérapeutique que ces situations requièrent. La complexité du fonctionnement psychique de ces parents interroge à plusieurs niveaux les espaces thérapeutiques. Seul un cadre alliant souplesse et disponibilité, dans un travail de co-construction mené conjointement par plusieurs thérapeutes, peut permettre l’établissement du lien mère/enfant. Nous illustrerons ce travail à travers un cas clinique suivi de la grossesse jusqu’aux 3 ans et 5 mois de l’enfant. Nous en décrirons les moments significatifs en montrant comment le cadre thérapeutique institutionnel, espace à la fois contenant et organisateur, a pu accompagner cette dyade mère/enfant. Dans un deuxième temps, nous décrirons plus en détail les particularités d’une psychothérapie mère/enfant atypique. Notre pratique clinique nous a appris qu’un dispositif de soins et d’interventions thérapeutiques plurifocal est nécessaire face aux situations cliniques atypiques.

Infants ages 0 to 1 year consecutively referred for psychiatric treatment during the year 2005 were followed, and variables associated with diagnosis and short-term outcome were assessed. Infants were evaluated using the Psychiatric Infant Navigator Chart and Evaluation that includes nosological diagnoses [Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood, (DC 0-3), Zero to Three, 1994] as well as risk and protective factors, treatment procedure, and outcomes. Seventy-six percent of the infants had an Axis I diagnosis, with anxiety disorders and a mixed disorder of emotional expressiveness being the most frequent. Twenty-five percent had an Axis II diagnosis. Multiple correspondence analyses showed that two dimensions corresponding grossly to DC 0-3 Axes I and II emerged. They emphasized three clinical profiles characterized by (a) good infant functioning, parent's awareness of their own difficulties, and a good outcome; (b) moderate child symptoms, overinvolved relating, and a good/intermediate outcome; (c) severe child symptoms, underinvolved relating, and a less favorable short-term outcome, signaling the risk for developmental disorders. Among the associated risk factors were cumulative parental stress, maternal psychopathology, and family dysfunction. Clinical implications of these findings indicated that infants under the age of 1 year who are referred for mental health evaluation and intervention are a heterogeneous group in terms of both severity and prognosis. Clinicians should differentiate subgroups of young children to detect those infants at risk for persistent psychopathology.

Borderline personality disorder (BPD) is among the most severe and perplexing mental disorders. Adults with BPD appear particularly exposed to severe difficulties in the transition to parenthood, infant caregiving, and the establishment of healthy early interactions.Studies on the offspring of parents with BPD show a high prevalence of social and emotional symptoms, including BPD features. This article reviews the possible consequences of this mental disorder for women during the transition to parenthood, for the quality of early mother-infant relationships, and for infant development. A presentation of a clinical case illustrates these issues, and some features of the preventive/therapeutic approach of these dyads are discussed.

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