Postpartum Psychosis in Bipolar Disorder: No Association with Personality, Cognitive Style and Temperament

Background and Aims: Bipolar disorder has been associated with a number of personality traits, cognitive styles and affective temperaments. Women who have bipolar disorder are at increased risk of experiencing postpartum psychosis, however no previous research has investigated these traits in relationship to postpartum episodes. Our aim was to establish whether aspects of personality, cognitive style and affective temperament, that have been associated with bipolar disorder, confer vulnerability to postpartum psychosis over and above their known association with bipolar disorder. Methods: Participants were 552 parous women with DSM-IV bipolar I disorder recruited into the Bipolar Disorder Research Network (www.bdrn.org). Postpartum psychosis group: lifetime episode of postpartum psychosis within 6 weeks of delivery (N = 284). Non-postpartum psychosis group: no history of any perinatal mood episodes (N = 268). Bipolar disorder-associated personality traits (neuroticism, extraversion, schizotypy and impulsivity), cognitive styles (low self-esteem and dysfunctional attitudes) and affective temperaments were measured using well validated self-report questionnaire measures. Results: After controlling for key demographic, clinical and pregnancy-related variables, and measures of current mood state, there were no statistically significant differences between the postpartum psychosis group and non-postpartum psychosis group on any of the personality, cognitive style or affective temperament measures. Conclusions: Personality traits, cognitive styles and affective temperaments associated with the bipolar disorder diathesis in general were not associated with the onset of postpartum psychosis specifically. We have found no evidence that these traits should play a key role when evaluating risk of postpartum psychosis in women with bipolar I disorder considering pregnancy.

Interpersonal Relationships in the Primary Classroom: an Analysis of Social and Affective Outcomes

Recent research regarding the quality of relationships in primary classrooms has focused largely on the enhancement and development of cognitive skills. The study reported here focused on a range of social and affective outcomes with the intention of broadening our understanding of the classroom as an interactive system, from the child's perspective. This paper provides empirical evidence on children's perceptions at Key Stage 2 (pupil age 7-11 years) of their relationships with teachers, other adults and children. Data were collected via an attitudinal questionnaire survey in nine primary schools in England. Results indicate that, in addition to the development of social skills, children also valued academic confidence, learning and the involvement of their parents in homework, and that these were associated with the interactions and routines established within the primary classroom settings. Some variations in terms of pupil age, teacher career phase, and the socio-economic context of the school were identified; however, the importance of the relationship between pupil and teacher remained consistent across schools.

Affective Instability, Childhood Trauma and Major Affective Disorders

BACKGROUND: Affective instability (AI), childhood trauma, and mental illness are linked, but evidence in affective disorders is limited, despite both AI and childhood trauma being associated with poorer outcomes. Aims were to compare AI levels in bipolar disorder I (BPI) and II (BPII), and major depressive disorder recurrent (MDDR), and to examine the association of AI and childhood trauma within each diagnostic group. METHODS: AI, measured using the Affective Lability Scale (ALS), was compared between people with DSM-IV BPI (n=923), BPII (n=363) and MDDR (n=207) accounting for confounders and current mood. Regression modelling was used to examine the association between AI and childhood traumas in each diagnostic group. RESULTS: ALS scores in descending order were BPII, BPI, MDDR, and differences between groups were significant (p<0.05). Within the BPI group any childhood abuse (p=0.021), childhood physical abuse (p=0.003) and the death of a close friend in childhood (p=0.002) were significantly associated with higher ALS score but no association was found between childhood trauma and AI in BPII and MDDR. LIMITATIONS: The ALS is a self-report scale and is subject to retrospective recall bias. CONCLUSIONS: AI is an important dimension in bipolar disorder independent of current mood state. There is a strong link between childhood traumatic events and AI levels in BPI and this may be one way in which exposure and disorder are linked. Clinical interventions targeting AI in people who have suffered significant childhood trauma could potentially change the clinical course of bipolar disorder.

Combinative Aspects of Leadership Style and Emotional Intelligence

Purpose – The purpose of this paper is to examine whether the leader’s emotional intelligence influences the leader’s preferences for different ways of combining leadership behaviors (i.e. combinative aspects of leadership style). Design/methodology/approach – The authors used a hybrid design to collect the data to avoid common-method biases. The authors described a high-stress workplace in a vignette and asked participants to rank four styles of combining a task-oriented leadership (i.e. Pressure) statement and a socio-emotional leadership (i.e. Support) statement. The authors then asked participants to complete a Likert-scale based questionnaire on emotional intelligence. Findings – The authors found that leaders who prefer to provide Support immediately before Pressure have higher levels of emotional intelligence than do leaders who prefer the three other combinative styles. Leaders who prefer to provide Pressure and Support separately (i.e. provide Pressure 30 minutes after Support) have the lowest levels of emotional intelligence. Research limitations/implications – A key implicit assumption in the work is that leaders do not want to evoke negative emotions in followers. The authors did not take into account factors that influence leadership style which participating managers would be likely to encounter on a daily basis such as the relationship with the follower, the follower’s level of performance and work experience, the gender of the leader and the gender of the follower, the hierarchical levels of the leader and follower, and the followers’ preferred combinative style. The nature of the sample and the use of a hypothetical scenario are other limitations of the study. Practical implications – Providing leadership behaviors that are regarded as effective is necessary but not enough because the emotional impact of leadership behaviors appears to also depend on how the behaviors are configured. Originality/value – This is the first study to show that the emotional intelligence of leaders is related to their preferences for the manner in which they combine task and social leadership statements. Furthermore, two-factor theories of leadership propose that the effects of task and social leadership are additive. However, the findings show that the effects are interactive.

Confluent Learning: Using a Design Approach to Develop Cognitive Abilities and Enhance Affective Capacities Through Change Management Curriculum

Purpose The aim of the study is to explore the role of confluent learning in supporting the development of change management knowledge, skills and attitudes and to inform the creation of a conceptual model based upon a priori and a posteriori knowledge gained from literature and the research. Design/methodology/approach The research adopts qualitative approach based on reflective inquiry methodology. There are two primary data sources, interviews with learners and the researchers’ reflective journals on learners’ opinions. Findings The confluent learning approach helped to stimulate affective states (e.g. interest and appreciation) to further reinforce cognitive gains (e.g. retention of knowledge) as a number of higher order thinking skills were further developed. The instructional design premised upon confluent learning enabled learners to further appreciate the complexities of change management. Research implications/ limitations The confluent learning approach offers another explanation to how learning takes place, contingent upon the use of a problem solving framework, instructional design and active learning in developing inter- and trans-disciplinary competencies. Practical implications This study not only explains how effective learning takes place but is also instructive to learning and teaching, and human resource development (HRD) professionals in curriculum design and the potential benefits of confluent learning. Social implications The adoption of a confluent learning approach helps to re-naturalise learning that appeals to learners affect. Originality/value This research is one of the few studies that provide an in-depth exploration of the use of confluent learning and how this approach co-develops cognitive abilities and affective capacity in the creation of a conceptual model.

Large-scale Roll Out of Online Prospective Measurement of Mood Symptoms in Affective Disorders

Background and Aims: True Colours is an online prospective mood-monitoring system developed at the University of Oxford to assist local patients and clinicians with monitoring course of illness in bipolar disorder. We report our initial experiences of using True Colours for research purposes in the Bipolar Disorder Research Network (BDRN; www.bdrn.org), a large research network of individuals with mood disorders spread throughout the UK. Methods: After initial piloting to ensure the practicality/acceptability of using True Colours within BDRN, we invited all BDRN participants (n = 7000) to participate in weekly True Colours ratings via three postal invitations sent over an 8-month period. Results: Following the three postal invitations, 915 individuals have so far expressed an interest in joining True Colours, and, of these, 662 (72.3%) have registered. 32 of those who registered for True Colours (5%) have so far asked to leave the system. Positive feedback from participants has focused around the ease of use and convenience of True Colours and potential clinical utility of the graphical representation of weekly mood scores. Conclusions: We have demonstrated that large-scale prospective mood monitoring for research purposes using a contemporary online approach is feasible. Challenges have included: (i) variation in participants’ technological ability; (ii) management of requests for clinical advice based on mood scores within a research setting; and, (iii) resources required to provide access and on-going support for participants using True Colours. We continue to expand recruitment to True Colours within BDRN, and plan to trial email invitations in the next phase of recruitment.

Affective Instability, Childhood Trauma and Major Affective Disorders

Background and Aims Affective instability (AI), childhood trauma, and mental illness are linked, but evidence in affective disorders is limited, despite both AI and childhood trauma being associated with poorer outcomes. Aims were to compare AI levels in bipolar disorder I (BPI) and II (BPII), and major depressive disorder recurrent (MDDR), and to examine the association of AI and childhood trauma within each diagnostic group. Methods AI, measured using the Affective Lability Scale (ALS), was compared between people with DSM-IV BPI (n = 923), BPII (n = 363) and MDDR (n = 207) accounting for confounders and current mood. Regression modelling was used to examine the association between AI and childhood traumas in each diagnostic group. Results ALS scores in descending order were BPII, BPI, MDDR, and differences between groups were significant (p < 0.05). Within the BPI group any childhood abuse (p = 0.021), childhood physical abuse (p = 0.003) and the death of a close friend in childhood (p = 0.002) were significantly associated with higher ALS score but no association was found between childhood trauma and AI in BPII and MDDR. Conclusions AI is an important dimension in bipolar disorder independent of current mood state. There is a strong link between childhood traumatic events and AI levels in BPI and this may be one way in which exposure and disorder are linked. Clinical interventions targeting AI in people who have suffered significant childhood trauma could potentially change the clinical course of bipolar disorder.