Introduction

The diagnosis of’ functional psychosis’ does not appear in recent infanto-juvenile literature. In our conception, we have deliberately decided to consider as a psychosis a psychic and behavioural mechanism elaborated against a primitive and existential anxiety. From this angle, every psychotic behaviour in childhood or adolescence (whatever its aetiology) can be considered as a functional psychosis. Infanto-juvenile psychosis can be considered from an analytical and intrapsychical, or a systemical and relational, or an organical and pharmacological point of view.

For psychoanalysts the crucial problem depends on the quality of the primitive relation between mother and child during his first year of life. Anxiety appears between 6 and 12 months of age; the resolution of this crucial phase in the personal development is essential. A lack of resolution may lead to severe behavioural troubles. The goal of therapy is to reach, through different media (like drawings, handling, games, body, words), those primitive problems.

From the systemic point of view, the patient is considered as the symptom of a dysfunctional family. The psychogenic family is centripetal; roles, limits are hidden and changing. Communications are chaotic or characterized by the double bind. Each tendency to attain a certain autonomy or a certain identity by one member of the family system provokes the elaboration of strategies to impede it and to preserve the homeostatic role of madness. Systemic psychotherapy consists of the clarification of the roles, limits and relations of every member of the family.

From the organic point of view, psychosis is considered as a genetically transmitted illness or as a congenital disease which stems from a defect in the metabolism of 3,4-dihydroxyphenylalanine (DOPA). During the last 5 years, research in this area in terms of the way in which it relates to children, has begun. In this context, treatment consists of the administration of drugs, associated (or not) with behavioural psychotherapy or pedagogic techniques. Literature concerning those approaches is relatively abundant although it is difficult to find comparative studies.

It is obvious that whatever the kind of psychotherapy, the result depends almost entirely on the relation between the therapist and his patient. Prognosis of the infanto-juvenile psychosis generally is not good: in the best conditions, psychosocial adaptation is relatively good but the fundamental problem remains intact.