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Table 5 Clinical implications for managing postpartum psychosis and facilitating recovery

From: Psychological interventions for managing postpartum psychosis: a qualitative analysis of women’s and family members’ experiences and preferences

SubthemeWhat is needed?How should this be delivered?
1. Seeking safety and containment
“What is wrong?”Prompt assessment and recognition of postpartum psychosis (PP)Support to boost their understanding of PP, signposted to credible information, such as APP literatureComplete timely assessment and provide factual information regarding prognosis once diagnosis is madeSpecialist training for staff in how to respond and manage PP and increased awareness e.g., through antenatal classes and midwife
“My greatest hour of need”Emphasis on feeling safe and supported. Ideally inpatient care provided in an MBUTo be involved in decision making and informed of treatment planEmphasis on building a relationship and devising a care planNeed for local MBU provision and specialist community mental health team input
“Ploughing through fog” - Need for hope and reassuranceTo be given optimistic and realistic messages about the futureExisting strength and resource recognised and utilised within the familyNeed to promote hope, drawing on prognosis literatureClear clinical pathways. Clarity about how to involve family
2. Recognising and responding to the psychological impact
“It wasn’t me” - Externalising the experienceSupport to develop a balanced understanding of PPTo enhance women’s understanding e.g., through own reading and involvement in acute phaseDevelop psychoeducation with woman and family. Help to externalise experience and reduce self-blameEnsure provision of specialist knowledge available in services e.g., through perinatal team
“Somebody else has got through this”Connecting with peer networks to help normalise experiencesLinking to other family/partners, share experiences and copingHelp to build up confidence and address potential barriers to peer connectionDevelop links with wider peer networks e.g., APP
Validation – Recognising and responding to the emotional impactEmotional impact of PP recognised, utilise both formal and informal supportFamily consider their own emotional needs e.g., liaising with MBU staff, GP and personal networksComplete a flexible and holistic assessment, drawing on biological, psychological and social aspectsEnsuring streamlined clinical pathways, including increased access to psychological therapies
Making sense and processingHave someone who is knowledgeable about PP to talk to and to make sense with. Allow time to do thisBe guided by the woman e.g., if they want to create a timeline, fill in gaps, then support this processRecognise long term impact. Promote techniques to enhance coping skills, self-care, self-compassion and acceptanceEnsure pathways consider all areas of need, including access to psychological therapies
Responding to changes in the relationshipOpportunity for joint input to talk through any concernsProfessional guidance, including best ways to support, when to withdrawProvide guidance to family, help allay their fears and anxietiesConsider family intervention, drawing on evidence-based approaches
3. Planning for the future
“Too good to be true”Information regarding symptoms to monitor and how to manageSupport how to respond, e.g., when experiencing increased stressProvide relapse prevention planning – identify triggers and early warning signsFuture plan for when perinatal team withdraws one year postpartum
“It lives with you”Opportunity for pre-conception counsellingTo be involved in counselling, opportunity to share own concernsPro-actively offer advice to inform decision makingFurther develop clinical guidelines re: pre-conception counselling
Contributing and giving backWhen appropriate, utilise opportunities to ‘give back’ and share storyFacilitate involvement and incorporate into service development, e.g., developing peer support networks
Recognising internal resource and seeking acceptanceStrengthening resource, facilitated in earlier stagesUtilise therapeutic approaches that draw upon pre-existing strengths – acceptance and compassion based approaches could be considered.