The role of psychological flexibility in birth experience for first-time mothers: a mixed methods study

Background: Childbirth is a momentous event for a woman where they can feel empowered and transformed. Negative experiences of birth are linked to development of perinatal mental health difficulties including postnatal depression and birth trauma (Ayers et al., 2016; Bell & Anderson, 2016). Birth can be experienced as negative when birth expectations are not met (Goodman et al., 2004; Hauck et al., 2007). Psychological Flexibility (PF) is a concept adopted within the Acceptance and Commitment Therapy (ACT) model (Hayes et al., 1999). PF could illustrate how a woman adapts to situational demands of birth, shifts perspective or expectations and balances competing wishes and values that encompass expectations of birth. This study aimed to 1) explore the relationships between PF, birth satisfaction and birth expectations, 2) explore whether women report PF-related skills as playing a role in sense-making of birth, and 3) explore what aspects women describe as helping and/or hindering sense-making of birth. Methods: A sequential explanatory design following two phase, mixed methods design was used. Phase One involved collection of data pre- and post-birth (N = 68) to explore whether level of PF moderated appraisal of birth. Phase Two involved semi-structured interviews (N = 11) exploring what aspects played a role in sense-making of birth to further explain Phase One findings. Phase One analysis involved nonparametric correlations, independent samples t-test and a Content Analysis. Phase Two involved a deductive-inductive Thematic Analysis (TA). Results: For Phase One, nonparametric correlations indicated no significant relationship between PF and Birth Satisfaction or Birth Expectations. A significant negative relationship was found between Birth Satisfaction and Birth Expectations (p < .001). An independent samples t-test indicated a significant relationship between Birth Satisfaction and Birth Type (p < .001). A Content Analysis indicated the most common reasons for unmet birth expectations: intervention needed, length of labour and medical complications. For Phase Two, the deductive TA considered two themes: Psychological Flexibility and Psychological Rigidity. The theme Psychological Flexibility captured aspects that resembled the six core therapeutic processes of PF (Hayes et al., 2006). The theme Psychological Rigidity captured aspects resembling the six core pathological processes of psychological rigidity (Hayes et al., 2006). The inductive TA constructed five themes: Support & Care, Choice/Control, Personal Processes, Preparedness and Birth Processes. The first theme Support & Care involved four subthemes: communication, influence of others, healthcare and talking. The third theme Personal Processes involved three subthemes: mindset, attributes and internal processes. The fifth theme Birth Processes involved two subthemes: labour and medical challenges. Discussion: Current conceptualisations of birth satisfaction are potentially not capturing important nuances. Discrepancies between Phase One rand Phase Two could be explained by interviews enabling reflective capacity. PF appears to play an important role in sense-making of birth but sense-making also involves other complex processes. Findings could suggest changes to maternity care e.g., antenatal education and providing opportunities for sense-making. Future research could explore the function of acceptance in birth satisfaction and its relationship with perinatal mental health

The role of psychological flexibility in birth experience for first-time mothers: a mixed methods study

Background: Childbirth is a momentous event for a woman where they can feel empowered and transformed. Negative experiences of birth are linked to development of perinatal mental health difficulties including postnatal depression and birth trauma (Ayers et al., 2016; Bell & Anderson, 2016). Birth can be experienced as negative when birth expectations are not met (Goodman et al., 2004; Hauck et al., 2007). Psychological Flexibility (PF) is a concept adopted within the Acceptance and Commitment Therapy (ACT) model (Hayes et al., 1999). PF could illustrate how a woman adapts to situational demands of birth, shifts perspective or expectations and balances competing wishes and values that encompass expectations of birth. This study aimed to 1) explore the relationships between PF, birth satisfaction and birth expectations, 2) explore whether women report PF-related skills as playing a role in sense-making of birth, and 3) explore what aspects women describe as helping and/or hindering sense-making of birth. Methods: A sequential explanatory design following two phase, mixed methods design was used. Phase One involved collection of data pre- and post-birth (N = 68) to explore whether level of PF moderated appraisal of birth. Phase Two involved semi-structured interviews (N = 11) exploring what aspects played a role in sense-making of birth to further explain Phase One findings. Phase One analysis involved nonparametric correlations, independent samples t-test and a Content Analysis. Phase Two involved a deductive-inductive Thematic Analysis (TA). Results: For Phase One, nonparametric correlations indicated no significant relationship between PF and Birth Satisfaction or Birth Expectations. A significant negative relationship was found between Birth Satisfaction and Birth Expectations (p < .001). An independent samples t-test indicated a significant relationship between Birth Satisfaction and Birth Type (p < .001). A Content Analysis indicated the most common reasons for unmet birth expectations: intervention needed, length of labour and medical complications. For Phase Two, the deductive TA considered two themes: Psychological Flexibility and Psychological Rigidity. The theme Psychological Flexibility captured aspects that resembled the six core therapeutic processes of PF (Hayes et al., 2006). The theme Psychological Rigidity captured aspects resembling the six core pathological processes of psychological rigidity (Hayes et al., 2006). The inductive TA constructed five themes: Support & Care, Choice/Control, Personal Processes, Preparedness and Birth Processes. The first theme Support & Care involved four subthemes: communication, influence of others, healthcare and talking. The third theme Personal Processes involved three subthemes: mindset, attributes and internal processes. The fifth theme Birth Processes involved two subthemes: labour and medical challenges. Discussion: Current conceptualisations of birth satisfaction are potentially not capturing important nuances. Discrepancies between Phase One rand Phase Two could be explained by interviews enabling reflective capacity. PF appears to play an important role in sense-making of birth but sense-making also involves other complex processes. Findings could suggest changes to maternity care e.g., antenatal education and providing opportunities for sense-making. Future research could explore the function of acceptance in birth satisfaction and its relationship with perinatal mental health

Peripheral neuropathy secondary to a ‘domino’ liver transplant: a case report

Background: Peripheral neuropathy caused by amyloidosis is one of the well-recognised sequelae of mutations in the transthyretin gene (TTR).// Case presentation: We describe a case of peripheral neuropathy in a White British 74 year old man with wild-type TTR, 8 years following receipt of a ‘domino’ liver transplant (from a donor with a TTR mutation). The clinical phenotype and neurophysiology, coupled with presence of ATTR amyloid deposits on fat biopsy, established the diagnosis of ATTR amyloid neuropathy, as a consequence of receipt of a variant-TTR secreting liver. A nerve biopsy was not clinically appropriate for this patient. Such cases are rare since recipients of such livers are typically restricted to people whose natural lifespan is unlikely to stretch into the anticipated symptomatic period of ATTR amyloidosis. However, novel “gene silencing” therapeutics are now available which can dramatically alter the course of this disorder, by reducing the proportion of abnormal proteins.// Conclusions: This represents a rare but predictable iatrogenic side effect, and doctors should be aware of this eventuality occurring in a shorter time span than previously anticipated

Peripheral neuropathy secondary to a ‘domino’ liver transplant:a case report

Abstract Background Peripheral neuropathy caused by amyloidosis is one of the well-recognised sequelae of mutations in the transthyretin gene (TTR). Case presentation We describe a case of peripheral neuropathy in a White British 74 year old man with wild-type TTR, 8 years following receipt of a ‘domino’ liver transplant (from a donor with a TTR mutation). The clinical phenotype and neurophysiology, coupled with presence of ATTR amyloid deposits on fat biopsy, established the diagnosis of ATTR amyloid neuropathy, as a consequence of receipt of a variant-TTR secreting liver. A nerve biopsy was not clinically appropriate for this patient. Such cases are rare since recipients of such livers are typically restricted to people whose natural lifespan is unlikely to stretch into the anticipated symptomatic period of ATTR amyloidosis. However, novel “gene silencing” therapeutics are now available which can dramatically alter the course of this disorder, by reducing the proportion of abnormal proteins. Conclusions This represents a rare but predictable iatrogenic side effect, and doctors should be aware of this eventuality occurring in a shorter time span than previously anticipated

Interpretation of vaccine associated neurological adverse events:a methodological and historical review

As a result of significant recent scientific investment, the range of vaccines available for COVID-19 prevention continues to expand and uptake is increasing globally. Although initial trial safety data have been generally reassuring, a number of adverse events, including vaccine induced thrombosis and thrombocytopenia (VITT), have come to light which have the potential to undermine the success of the vaccination program. However, it can be difficult to interpret available data and put these into context and to communicate this effectively. In this review, we discuss contemporary methodologies employed to investigate possible associations between vaccination and adverse neurological outcomes and why determining causality can be challenging. We demonstrate these issues by discussing relevant historical exemplars and explore the relevance for the current pandemic and vaccination program. We also discuss challenges in understanding and communicating such risks to clinicians and the general population within the context of the ‘infodemic’ facilitated by the Internet and other media

Functional Cognitive Disorder: Diagnostic Challenges and Future Directions

Functional cognitive disorder describes patients with persistent, troublesome subjective cognitive complaints that are inconsistent with a recognized disease process, and where significant discrepancies are found between subjective and objectively observed cognitive functioning. The etiology is heterogeneous and potentially related to underlying psychological factors. Making a diagnosis of functional cognitive disorder can be challenging and there is the potential for misdiagnosis of early-stage neurodegeneration. We compared neuropsychological findings in three groups: functional cognitive disorder (FCD), mild cognitive impairment (MCI), and healthy controls. Participants were recruited from the ReMemBr Group Clinic, North Bristol NHS Trust, and via Join Dementia Research. Both the FCD and MCI groups showed elevated prospective and retrospective memory symptom scores. Performance on the Montreal cognitive assessment was equivalent in the FCD and MCI groups, both being impaired compared with the controls. The FCD group was younger than those with MCI. We discuss challenges and controversies in the diagnosis of functional cognitive disorder, alongside illustrative cases and proposals for areas of research priority

Differentiating Functional Cognitive Disorder from Early Neurodegeneration: A Clinic-Based Study

Functional cognitive disorder (FCD) is a relatively common cause of cognitive symptoms, characterised by inconsistency between symptoms and observed or self-reported cognitive functioning. We aimed to improve the clinical characterisation of FCD, in particular its differentiation from early neurodegeneration. Two patient cohorts were recruited from a UK-based tertiary cognitive clinic, diagnosed following clinical assessment, investigation and expert multidisciplinary team review: FCD, (n = 21), and neurodegenerative Mild Cognitive Impairment (nMCI, n = 17). We separately recruited a healthy control group (n = 25). All participants completed an assessment battery including: Hopkins Verbal Learning Test-Revised (HVLT-R), Trail Making Test Part B (TMT-B); Depression Anxiety and Stress Scale (DASS) and Minnesota Multiphasic Personality Inventory (MMPI-2RF). In comparison to healthy controls, the FCD and nMCI groups were equally impaired on trail making, immediate recall, and recognition tasks; had equally elevated mood symptoms; showed similar aberration on a range of personality measures; and had similar difficulties on inbuilt performance validity tests. However, participants with FCD performed significantly better than nMCI on HVLT-R delayed free recall and retention (regression coefficient −10.34, p = 0.01). Mood, personality and certain cognitive abilities were similarly altered across nMCI and FCD groups. However, those with FCD displayed spared delayed recall and retention, in comparison to impaired immediate recall and recognition. This pattern, which is distinct from that seen in prodromal neurodegeneration, is a marker of internal inconsistency. Differentiating FCD from nMCI is challenging, and the identification of positive neuropsychometric features of FCD is an important contribution to this emerging area of cognitive neurology

Predictors and prognosis of population-based subjective cognitive decline: longitudinal evidence from the Caerphilly Prospective Study (CaPS)

Objectives: To understand associations between the subjective experience of cognitive decline and objective cognition. This subjective experience is often conceptualised as an early step towards neurodegeneration, but this has not been scrutinised at the population level. An alternative explanation is poor meta-cognition, the extreme of which is seen in functional cognitive disorder (FCD). Design: Prospective cohort (Caerphilly Prospective Study). Setting: Population-based, South Wales, UK. Participants: This men-only study began in 1979; 1225 men participated at an average age of 73 in 2002–2004, including assessments of simple subjective cognitive decline (sSCD, defined as a subjective report of worsening memory or concentration). Dementia outcomes were followed up to 2012–2014. Data on non-completers was additionally obtained from death certificates and local health records. Primary and secondary outcome measures: The primary outcome measure was incident dementia over 10 years. Secondary outcome measures included prospective change in objective cognition and cross-sectional cognitive internal inconsistency (the existence of a cognitive ability at some times, and its absence at other times, with no intervening explanatory factors except for focus of attention). Results: sSCD was common (30%) and only weakly associated with prior objective cognitive decline (sensitivity 36% (95% CI 30 to 42) and specificity 72% (95% CI 68 to 75)). Independent predictors of sSCD were older age, poor sleep quality and higher trait anxiety. Those with sSCD did not have excess cognitive internal inconsistency, but results suggested a mild attentional deficit. sSCD did not predict objective cognitive change (linear regression coefficient −0.01 (95% CI −0.13 to 0.15)) nor dementia (odds ratio 1.35 (0.61 to 2.99)) 10 years later. Conclusions: sSCD is weakly associated with prior objective cognitive decline and does not predict future cognition. Prior sleep difficulties and anxiety were the most robust predictors of sSCD. sSCD in the absence of objective decline appears to be a highly prevalent example of poor meta-cognition (ie, poor self-awareness of cognitive performance), which could be a driver for later FCD