Contents

Search

abnormal grief; depressive grief; complicated grief; prolonged grief disorder

Classification: 2 patterns: 1) depressive pattern a) excessive rumination about acts of commission b) extreme vegetative symptoms c) profoundly & persistently depressed mood d) complete anhedonia e) major sleep disturbance f) feelings of worthless or hopelessness g) active thought of suicide h) depressed symptoms extending more than 2 months from loss 2) complicated grief a) abnormal functioning b) persistent & prolonged yearning for the deceased c) crying, searching, disbelieving in the loss d) established 6 months after loss [1] Etiology: 1) excessive dependence on the deceased 2) latent psychosis 3) traumatic loss a) unexpected loss b) multiple losses c) homicide d) suicide e) loss of a child Management: 1) treatment of depression 2) psychotherapy - complicated grief therapy emphasizing exposure to painful grief memories better than interpersonal therapy [3] - psychotherapy dimimishes all symptoms of complicated grief (NNT=3.6); citalopram treats only depression [5] 3) support groups for traumatic losses 4) AVOID confronting denial; it may serve as a defense against a psychosis

Related

bereavement

General

grief

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 11, 16, 18 American College of Physicians, Philadelphia 1998, 2012, 2018.
  2. Wittouck C, Van Autreve S, De Jaegere E et al The prevention and treatment of complicated grief: a meta-analysis. Clin Psychol Rev. 2011 Feb;31(1):69-78. PMID: 21130937
  3. Shear MK et al. Treatment of complicated grief in elderly persons: A randomized clinical trial. JAMA Psychiatry 2014 Sep 24 PMID: 25250737
  4. Shear MK Complicated Grief N Engl J Med 2015; 372:153-160. January 8, 2015 PMID: 25564898 http://www.nejm.org/doi/full/10.1056/NEJMcp1315618
  5. Shear MK et al. Optimizing treatment of complicated grief: A randomized clinical trial. JAMA Psychiatry. 2016 Jul 1;73(7):685-94 PMID: 27276373