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L'encéphale - Infanticide en post-partum : à propos d’un cas


Infanticide in the postpartum period: About a clinical case
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I. Rammouza, D.A. Tahiria, R. Aalouanea, S. Kjiria, A. Belhousb, J.E. Ktioueta, F.Z. Sekkata a Clinique universitaire de psychiatrie Ar-razi, CHU Ibn-Sina, Rabat-Salé, Maroc b Service de médecine légale, CHU Ibn-Rochd, Casablanca 20202, Maroc Résumé L’infanticide est un acte criminel hautement traumatique avec des répercussions psychopathologiques et sociofamiliales graves, marqué par la pluralité de ses formes, la diversité de ses aspects et la fréquence des cas dissimulés. Les actes d’infanticides qui ont été rapportés dans la littérature se situent dans divers contextes. Nous avons choisi de rapporter le cas d’une jeune femme de 28 ans sans antécédents psychiatriques et qui a présenté en post-partum un accès psychotique aigu avec un acte d’infanticide suivi par la suite d’une tentative de suicide. L’amélioration a eu lieu sous neuroleptiques au bout du quatrième mois. Cela montre que le rôle des psychiatres dans la prévention des actes d’infanticide est primordial en dépistant les populations à risque, en identifiant les complications psychiatriques du post-partum et en assurant une coordination adéquate avec les équipes de maternité et les services sociaux. Summary Background Infanticide is an extremely traumatic criminal act, which has psychopathologic repercussions and severe sociofamilial consequences. It is marked by its plurality of forms, the variety of its aspects and the frequency of its hidden cases. Circumstances and modes of completion of the infanticide act are variable according to the nature of the author and the sociocultural context. Infanticide is often situated within the framework of an acute and a chronic structured psychiatric pathology (puerperal psychosis, maniacodepressive psychosis, schizophrenia, epilepsy, substance abuse, etc.). Sometimes, it is connected to sociocultural constraints and confusions of adaptation of the postpartum stage. The psychopathologic justifications evoke a profound dysfunction of the mother–child interactions, fears of division and the infantile and regressive characteristics of the mother. The medicolegal issue of responsibility of the author of infanticide is complex. Treatment depends on the mental pathology of the author; psychotherapeutic efforts are required in parallel with pharmacological treatment. The role of psychiatrists in preventing the act of infanticide is crucial. This consists in detecting the populations at risk, identifying the psychiatric complications of the postpartum stage and ensuring an adequate coordination of the maternity team and the social services. Case-report The infanticide acts reported in the literature are situated in diverse contexts and are motivated by various circumstances. We report a case of a young woman without any personal or family psychiatric history; she is married and has a stable matrimonial life. She was hospitalised following a suicide attempt and subsequently killed her child by strangulation; this occurred ten days after giving birth. The murder took place during a first psychotic episode that arose brutally one week after delivery and essentially included persecution mania, inconsistent comments, auditive hallucinations, indifference and emotional coolness. This symptomatology lasted four months and totally regressed with antipsychotics. The diagnosis of a puerperal psychosis was evoked at first, having eliminated major melancholic depression and any organic affection. Conclusion The illustration of our clinical case shows to what extent the role of the psychiatrist is essential in preventing and ensuring the therapeutic stage of such psychiatric disorders arising during the postpartum stage, which would complicate infanticide acts at any time. Mots clés Infanticide; Post-partum; Psychose puerpérale; Tentative de suicide Keywords Infanticide; Postpartum; Puerperal psychosis; Suicide attempt


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