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Postpartum psychoses are a severe form of postnatal mood disorders, affecting 1–2 in every 1000 deliveries. These episodes typically present as acute mania or depression with psychosis within the first few weeks of childbirth, which, as life-threatening psychiatric emergencies, can have a significant adverse impact on the mother, baby and wider family. The nosological status of postpartum psychosis remains contentious; however, evidence indicates most episodes to be manifestations of bipolar disorder and a vulnerability to a puerperal trigger. While childbirth appears to be a potent trigger of severe mood disorders, the precise mechanisms by which postpartum psychosis occurs are poorly understood. This review examines the current evidence with respect to potential aetiology and childbirth-related triggers of postpartum psychosis. Findings to date have implicated neurobiological factors, such as hormones, immunological dysregulation, circadian rhythm disruption and genetics, to be important in the pathogenesis of this disorder. Prediction models, informed by prospective cohort studies of high-risk women, are required to identify those at greatest risk of postpartum psychosis.

Granular hydrogels are emerging as an important class of scaffolds for biomedical applications, due to their injectability and pore structure to support cellular infiltration. Past research has primarily focused on spherical microgels, which allows limited control over granular hydrogel pore size and void volume fraction; however, investigation into microgels with higher aspect ratios has allowed even higher porosity. This study explores the impact of hyaluronic acid microgel aspect ratio (ranging from 3 to 5) on granular hydrogel porosity and cellular interactions. Both simulations and experimental results show increased void volume fractions and pore sizes in granular hydrogels formed from rod‐like microgels when compared to volume‐matched spherical microgels, which results in increased cellular invasion with an endothelial cell spheroid migration assay. Injection of the hydrogels into a confined space alters particle packing and void space, but porosity is still higher when rod‐like microgels are used, which results in increased cellular invasion when injected subcutaneously. Finally, the highest aspect ratio microgels are used as injectable granular hydrogels to treat myocardial infarction in rats and show reduced infarct area and enhanced functional outcomes when compared to untreated controls. This work provides further insight into microgel shape considerations for engineered granular hydrogels. Granular hydrogels are being developed for the repair of tissues, mostly with the use of spherical microgels. Here, injectable granular hydrogels formed from anisotropic particles (i.e., rod‐like) are explored to improve cellular invasion by increasing scaffold void volume fraction. One formulation is then investigated for the repair of cardiac tissue after myocardial infarction.

Perry discusses how neoliberalism has had a dramatic impact on higher education in the UK. She traces the history of neoliberalism in broad strokes from the pre-Thatcher years to the post-Thatcher years and identifies three key trends in higher education: widening participation and the politics of aspiration, the emergence of the student entrepreneur-consumer, and the marketization of higher education. With specific reference to the third trend, she discusses the use of Internet-based education by higher education institutions and its potential impact on students. The coronavirus pandemic has posed major challenges for student recruitment and increased the precariousness of students in the instructional process.

Purpose The global ageing population places increased demands on the professional caregiver workforce. Literature reveals that although many in this workforce experience stress and fatigue, they also experience high levels of work satisfaction. These findings seem contradictory and therefore warrant further qualitative exploration. The purpose of this paper is to explore how professional caregivers describe their health and well-being and to understand the interplay of work and life on health and well-being. Design/methodology/approach Data were collected via semi-structured individual or group interviews with 31 professional caregivers from in-home or residential care situations in three geographic locations across NZ and analysed for themes. The general inductive approach was used for data analysis. Findings The authors present two themes: “A holistic interpretation of health” discusses caregivers’ perceptions of the meaning of health and well-being. Three interrelated sub-themes (“Fulfilment of an inherent nature”, “Obligation to look after oneself”, and “Risk management”) reflect the interplay of factors which influence health and well-being as a caregiver and make up the second theme of “Being in tune”. If balance was not achieved, caregivers recognised this as a risk to their health and well-being, especially to their psychological health, and considered leaving the profession. Originality/value The authors identified that caregivers considered health and well-being from a holistic perspective. They had insight into factors influencing their health. Despite high levels of stress, there was an overall positive perception of health and well-being that appears due in part to participating in a profession that fulfils an inherent nature. Collaborative problem solving between management and workforce, alongside recognising and affirming the unique skills of this workforce may help to empower caregiver resilience.

BackgroundNorth American studies show bipolar disorder is associated with elevatedrates of problem gambling; however, little is known about rates in thedifferent presentations of bipolar illness.AimsTo determine the prevalence and distribution of problem gambling inpeople with bipolar disorder in the UK.MethodThe Problem Gambling Severity Index was used to measure gambling problemsin 635 participants with bipolar disorder.ResultsModerate to severe gambling problems were four times higher in peoplewith bipolar disorder than in the general population, and were associatedwith type 2 disorder (OR = 1.74, P = 0.036), history ofsuicidal ideation or attempt (OR = 3.44, P = 0.02) andrapid cycling (OR = 2.63, P = 0.008).ConclusionsApproximately 1 in 10 patients with bipolar disorder may be at moderateto severe risk of problem gambling, possibly associated with suicidalbehaviour and a rapid cycling course. Elevated rates of gambling problemsin type 2 disorder highlight the probable significance of modest butunstable mood disturbance in the development and maintenance of suchproblems.

Pregnancy and childbirth are a period of high risk for women with bipolar disorder and involve difficult decisions particularly about continuing or stopping medications.AimsTo explore what clinical predictors may help to individualise the risk of perinatal recurrence in women with bipolar disorder. Information was gathered retrospectively by semi-structured interview, questionnaires and case-note review from 887 women with bipolar disorder who have had children. Clinical predictors were selected using backwards stepwise logistic regression, conditional permutation random forests and reinforcement learning trees. Previous perinatal history of affective psychosis or depression was the most significant predictor of a perinatal recurrence (odds ratio (OR) = 8.5, 95% CI 5.04-14.82 and OR = 3.6, 95% CI 2.55-5.07 respectively) but even parous women with bipolar disorder without a previous perinatal mood episode were at risk following a subsequent pregnancy, with 7% developing postpartum psychosis. Previous perinatal history of affective psychosis or depression is the most important predictor of perinatal recurrence in women with bipolar disorder and can be used to individualise risk assessments.Declaration of interestNone.

Childhood abuse is a risk factor for poorer illness course in bipolar disorder, but the reasons why are unclear. Trait-like features such as affective instability and impulsivity could be part of the explanation. We aimed to examine whether childhood abuse was associated with clinical features of bipolar disorder, and whether associations were mediated by affective instability or impulsivity. We analysed data from 923 people with bipolar I disorder recruited by the Bipolar Disorder Research Network. Adjusted associations between childhood abuse, affective instability and impulsivity and eight clinical variables were analysed. A path analysis examined the direct and indirect links between childhood abuse and clinical features with affective instability and impulsivity as mediators. Affective instability significantly mediated the association between childhood abuse and earlier age of onset [effect estimate (θ)/standard error (SE): 2.49], number of depressive (θ/SE: 2.08) and manic episodes/illness year (θ/SE: 1.32), anxiety disorders (θ/SE: 1.98) and rapid cycling (θ/SE: 2.25). Impulsivity significantly mediated the association between childhood abuse and manic episodes/illness year (θ/SE: 1.79), anxiety disorders (θ/SE: 1.59), rapid cycling (θ/SE: 1.809), suicidal behaviour (θ/SE: 2.12) and substance misuse (θ/SE: 3.09). Measures of path analysis fit indicated an excellent fit to the data. Affective instability and impulsivity are likely part of the mechanism of why childhood abuse increases risk of poorer clinical course in bipolar disorder, with each showing some selectivity in pathways. They are potential novel targets for intervention to improve outcome in bipolar disorder.

Major depressive disorder (MDD) and migraine are both more common among women than men. Women’s reproductive years are associated with increased susceptibility to recurrence of both conditions, suggesting a potential role of sex hormones in aetiology. We examined associations between comorbid migraine and clinical features of MDD in women, including relationships with lifetime reproductive events such as childbirth. Lifetime clinical characteristics and reproductive events in a well-characterised sample of 222 UK women with recurrent MDD, with (n = 98) and without (n = 124) migraine were compared. Women had all been recruited as part of a UK-based ongoing programme of research into the genetic and non-genetic determinants of mood disorders. Multivariate analysis showed a specific association between the lifetime presence of migraine and postpartum depression (PPD) within 6 weeks of delivery (OR = 2.555; 95% CI: 1.037–6.295, p = 0.041). This association did not extend to a broader definition of PPD with onset up to 6 months postpartum. All other factors included in the analysis were not significantly associated with the presence of migraine: family history of depression, younger age at depression onset, history of suicide attempt and severe premenstrual syndrome symptoms. The finding that women with MDD and comorbid migraine may be particularly sensitive to hormonal changes early in the postpartum period leads to aetiological hypotheses and suggests this group may be useful for future studies attempting to characterise PPD and MDD phenotypes. The refinement of such phenotypes has implications for individualising risk and treatment and for future biological and genetic studies.