Postpartum Psychosis and Beyond: Exploring Mothers’ Experiences of Postpartum Psychosis and Recovery.

The aim of this thesis is to provide an understanding of motherhood and the mother-infant relationship within the context of postnatal distress. To facilitate this, it is necessary to understand universal experiences of motherhood as well as mental health difficulties following childbirth. Part of this understanding includes mothers’ experiences and management of distressing, repetitive thoughts of infant harm. Therefore, paper one consists of a literature review in which 10 empirical studies regarding thoughts of intentional infant harm (TIIHs) were critically appraised and synthesised. These thoughts were experienced in clinical and non-clinical samples. Common themes were found in terms of cognitive, emotional and behavioural responses to TIIHs and understood within the context of the parenting role. This review differentiated TIIHs between psychotic and non-psychotic difficulties and identified the need to understand such thoughts within mothers’ experiences of postpartum psychosis (PP). Paper two is a qualitative study exploring mothers’ experiences of PP and recovery. Purposive sampling was used to interview eight women across the United Kingdom. Transcripts were analysed using Interpretative Phenomenological Analysis (Smith, Flowers, & Larkin, 2009) and four super-ordinate themes were identified: ‘becoming unrecognisable’, ‘mourning losses’, ‘recovery as an ongoing process’ and ‘post-traumatic growth’. These themes demonstrated the need for physical and psychological space to facilitate recovery following childbirth. Paper three provides a personal reflective account of completing this thesis. The dynamic process of transitioning to a qualified psychologist is likened to the transformative process of motherhood. Ethical issues and the recent surge in perinatal mental health awareness are presented

Searching compassion in a crowd: Evaluation of a novel compassion visual search task to reduce self-criticism

Background: The ability to appropriately process social stimuli such as facial expressions is crucial to emotion regulation and the maintenance of supportive interpersonal relationships. Cognitive Bias Modification Tasks (CBMTs) are being investigated as potential interventions for those who struggle to appropriately process social stimuli. Aims: Two studies aimed to assess the effectiveness of a novel computerised ‘Compassion Game’ CBMT compared with a validated ‘Self-Esteem Game’ (Study 1, n=66) and a Neutral Control Game (Study 2, n=59). Method: In each study, baseline, post-task, and one-month follow-up measures of 3 self-reported forms of self-criticism (inadequate self, hated self, and self-reassurance) were used to examine the benefits of two weeks’ attentional training. Results: Analyses show that the novel Compassion Game significantly reduced inadequate self-criticism at post and one-month follow-up (Studies 1 and 2) and increased self-reassurance (Study 1). Results also show that the Self-Esteem (Study 1) and the Neutral Control Game (Study 2), which also used social stimuli, produced reductions in inadequate self-criticism. Conclusions: Results suggest that training one’s attention toward social stimuli can improve inadequate self-criticism. Implications for the use of compassionate stimuli in such CBMTs are discussed.Leverhulme Trus

Comparison of diagnoses of early-onset sepsis associated with use of Sepsis Risk Calculator versus NICE CG149: a prospective, population-wide cohort study in London, UK, 2020–2021

Objective We sought to compare the incidence of early-onset sepsis (EOS) in infants ≥34 weeks’ gestation identified >24 hours after birth, in hospitals using the Kaiser Permanente Sepsis Risk Calculator (SRC) with hospitals using the National Institute for Health and Care Excellence (NICE) guidance.Design and setting Prospective observational population-wide cohort study involving all 26 hospitals with neonatal units colocated with maternity services across London (10 using SRC, 16 using NICE).Participants All live births ≥34 weeks’ gestation between September 2020 and August 2021.Outcome measures EOS was defined as isolation of a bacterial pathogen in the blood or cerebrospinal fluid (CSF) culture from birth to 7 days of age. We evaluated the incidence of EOS identified by culture obtained >24 hours to 7 days after birth. We also evaluated the rate empiric antibiotics were commenced >24 hours to 7 days after birth, for a duration of ≥5 days, with negative blood or CSF cultures.Results Of 99 683 live births, 42 952 (43%) were born in SRC hospitals and 56 731 (57%) in NICE hospitals. The overall incidence of EOS (<72 hours) was 0.64/1000 live births. The incidence of EOS identified >24 hours was 2.3/100 000 (n=1) for SRC vs 7.1/100 000 (n=4) for NICE (OR 0.5, 95% CI (0.1 to 2.7)). This corresponded to (1/20) 5% (SRC) vs (4/45) 8.9% (NICE) of EOS cases (χ=0.3, p=0.59). Empiric antibiotics were commenced >24 hours to 7 days after birth in 4.4/1000 (n=187) for SRC vs 2.9/1000 (n=158) for NICE (OR 1.5, 95% CI (1.2 to 1.9)). 3111 (7%) infants received antibiotics in the first 24 hours in SRC hospitals vs 8428 (15%) in NICE hospitals.Conclusion There was no significant difference in the incidence of EOS identified >24 hours after birth between SRC and NICE hospitals. SRC use was associated with 50% fewer infants receiving antibiotics in the first 24 hours of life