[Problems in prevention of mental disorders in preschool children]

In primary prevention, we meet many methodological difficulties: the promotion of mental health requires the transmission of specialized knowledge: this is in fact very difficult to realise. Validation of such programs is impossible. Moreover, primary prevention remains generally unspecific, often helpless--as in the case of psychosis. Problems of prediction are so important that we are not even able to predict--and then to prevent--the development of depression, one of the most common forms of psychiatric disturbance. Early diagnosis (secondary prevention) is also still inadequate: in most cases, we do not know how symptoms detected in early childhood will develop. In view of the poor state of etiopathogenic theories, 2 concepts are being used preferentially in prevention: high risk groups, and the notion of crisis. Large segments of population can be evaluated from these points of view and provided with preventive interventions. Prevention programs can address themselves to either the child himself, his family, or his larger environment. Most successful prevention programs organised by psychiatrists have addressed themselves to the early mother-child interaction. This is one of the most valuable targets for high risk or crisis interventions. Now that various preventive programs have been active for years, one can start evaluating the first results of primary prevention: while difficulties are enormous, one should not regress to comfortable isolationism of clinical work only. On the other hand, utopian dreams of eradication of psychic troubles through environmental manipulation are not valid any longer.