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Title: Mothers experiences of first onset postpartum psychosis
Author: Kelly, Siobhan
ISNI:       0000 0004 8500 3322
Awarding Body: Royal Holloway, University of London
Current Institution: Royal Holloway, University of London
Date of Award: 2018
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The mother-infant relationship and perinatal mental health: • The postpartum period covers the first year after birth and is when a mother learns to react to her baby's needs appropriately and develop a close and warm relationship with her infant (Perun, 2013). • There are a range of parental psychological features that influence the nature and shape of an infant's internal working model and attachment, such as maternal sensitivity and mind-mindedness (Meins, Fernyhough, Fradley, & Tuckey, 2001), where a mother makes accurate inferences about her child's mental state. • Perinatal mental disorders have been found to disrupt this process by mothers responding inappropriately to infant's needs (Bakermans-Kranenburg, van Ijzendoorn, & Juffer, 2003), not showing sufficient warmth and being unable to regulate infant distress (Murray, Halligan, Goodyer, & Herbert, 2010). • Perinatal mental disorders can compromise the quality of parenting which has been found to increase the risk of psychological and developmental disturbances in children (Stein et al., 2014). This supports the need for psychotherapeutic interventions in perinatal mental disorders that focus both on the mother's mental health and the mother-infant interaction (Murray et al., 2010). • NICE (2014) guidelines recommend specialist perinatal inpatient services for antenatal and postnatal mental health, where mothers and babies have access to specialist perinatal mental health staff and a full range of therapeutic services focused on the mother-infant relationship. Postpartum psychosis: • Postpartum psychosis is considered the most serious type of perinatal mental disorder that typically occurs in the days following childbirth and should be considered a psychiatric emergency (Heron et al., 2012). • Postpartum psychosis occurs in one to two in every thousand births (MunkOlsen, Laursen, Pedersen, Mors, & Mortensen, 2006) and more than 50% of women who develop postpartum psychosis have no mental health history (first onset postpartum psychosis; Blackmore et al., 2013). Women with bipolar disorder however have a 25% risk of developing postpartum psychosis (Jones & Craddock, 2005). • First onset postpartum psychosis has been associated with treatment delay due to misdiagnosis (Edwards & Timmons, 2005) and higher levels of confusion and disorientation (Kirpinar, CosLkun, Çayköylü, & Özer, 1999). This population however tend to have shorter hospital stays (Kirpinar et al., 1999), better treatment outcomes (Jones, Chandra, Dazzan, & Howard, 2014) and substantial improvement in mother-infant interaction at recovery (Thiels & Kumar, 1987). Current research does not differentiate outcomes between women at risk of postpartum psychosis and first onset (e.g. Hornstein et al., 2006; Noorlander, Bergink, & van den Berg, 2008). • Mothers with postpartum psychosis have been observed to show dysfunctional cognitions, poor insight and difficulties understanding their child's needs (Murray, Cooper, & Hipwell, 2003), as psychotic symptoms contribute to poor concentration, fatigue and agitation (Hornstein et al., 2006). These symptoms are likely to affect bonding between mother and baby, which the present study aims to explore. • Maternal responsiveness is also affected by how women experience motherhood, which has been described by women who have experienced postpartum psychosis as traumatic due to the disruption and confusion experienced by mothers (Heron et al., 2012). Systematic review • A systematic review was conducted to explore the impact of postpartum psychosis in the postpartum period on the mother-infant relationship, looking at both quantitative and qualitative articles. • Empirical studies investigating the mother-infant relationship in postpartum psychosis were included. Five online databases (PsycINFO, PsycARTICLES, Psychology and Behavioral Sciences Collection, PsycEXTRA, Medline) and references of included studies were searched. Study characteristics, participant demographics, methods and results were extracted for both quantitative and qualitative papers. Five studies were assessed for quality and narrative synthesis was conducted. • Findings showed that mother-infant bonding and interactions were not significantly impaired in mothers with postpartum psychosis compared to women with postnatal depression. • Qualitative findings on the other hand highlighted the difficulties women experience caring for and interacting with their baby due to their psychotic symptoms when experiencing postpartum psychosis. • Data gathered within this review is representative of mothers when they are acutely unwell and does not explore longer term relationships, which would provide further valuable information. • Women with longstanding mental health difficulties, such as bipolar disorder, are also grouped with women with no previous mental health difficulties. Separating these groups of women would be beneficial in future research to understand what these experiences are like for different populations of mothers.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (D.Clin.Psy.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available