Rammouz I, Tahiri D A, Aalouane R, Kjiri S, Belhous A, Ktiouet J E, Sekkat F Z
Clinique universitaire de psychiatrie Ar-razi, CHU Ibn-Sina, Rabat-Salé, Morocco.
Encephale. 2008 Jun;34(3):284-8. doi: 10.1016/j.encep.2007.06.003. Epub 2007 Nov 7.
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.
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.
杀婴是一种极其创伤性的犯罪行为，具有精神病理学影响和严重的社会家庭后果。其特点是形式多样、方面各异且隐性案例频发。杀婴行为的实施情况和方式因作案者的性质以及社会文化背景而异。杀婴行为常发生在急性和慢性结构性精神病理学（产褥期精神病、躁狂抑郁症、精神分裂症、癫痫、药物滥用等）的框架内。有时，它与社会文化限制以及产后阶段适应方面的困惑有关。精神病理学上的解释涉及母婴互动的严重功能失调、对分裂的恐惧以及母亲的幼稚和退行特征。杀婴作案者的法医学责任问题很复杂。治疗取决于作案者的精神病理学状况；除药物治疗外，还需要进行心理治疗。精神科医生在预防杀婴行为方面的作用至关重要。这包括识别高危人群、确定产后阶段的精神并发症以及确保产科团队和社会服务之间的充分协调。
文献中报道的杀婴行为发生在不同背景下，由各种情况引发。我们报告一例年轻女性，她没有个人或家族精神病史；已婚且婚姻生活稳定。她在一次自杀未遂后住院，随后勒死了自己的孩子；这发生在分娩十天后。谋杀发生在产后一周突然出现的首次精神病发作期间，主要症状包括被害妄想、言语紊乱、幻听、冷漠和情绪冷淡。这种症状持续了四个月，使用抗精神病药物后完全消退。最初考虑诊断为产褥期精神病，已排除重度抑郁发作和任何器质性病变。
我们临床病例的说明表明，精神科医生在预防和确保治疗产后阶段出现的此类精神障碍方面的作用至关重要，否则这些精神障碍随时可能使杀婴行为复杂化。
