Prolonged Grief Reaction

Question 1

Define

Answer 1

Prolonged Grief Reaction is a disturbance following the death of a partner, parent, child or other person close to the bereaved. There is persistent and pervasive grief response characterised by longing for the deceased, or persistent preoccupation with the deceased accompanied by intense emotional pain

The grief response has persistence for an atypically long period of time following the loss (> 6 months at a minimum) and clearly exceeds expected social, cultural, or religious norms for the individual’s culture and context.

Both cause significant impairment in personal, family, social, educational, occupational or other important areas of functioning

Brief depressive episode: transient mild depression <1 month

Prolonged depressive episode: 2 years

Mixed anxiety n depression

Question 2

Aetiology

Answer 2

Normal grief reaction: it is normal to feel sadness and grief following the death of a loved one. The most accepted model is the 5 stages of grief (can last up to 2 years):

Denial- feel numb, pseudohallucinations of the deceased (both auditory and visual), may focus on physical objects that remind them of their loved one or even prepare meals for them

Anger- commonly directed against other family members and medical professionals

Bargaining

Depression

Acceptance

Remember: pseudohallucinations may be normal and part of the grieving process

Abnormal or atypical grief reactions are more likely to occur if the death was unexpected or sudden

Delayed grief: sometimes said to occur when > 2 weeks have passed before grieving begins

NOTE: ICD-10 originally stated that symptoms need to occur WITHIN 1 month of original stressor to be diagnosed as Adjustment disorder but this is no longer stated in ICD-11

IMPORTANT: Grief reactions that have persisted for longer periods that are within a normative period of grieving given the person’s cultural and religious context are viewed as normal bereavement responses.

Question 3

Symptoms

Answer 3

Sadness

Guilt

Anger

Denial

Blame

Difficulty accepting death

Feeling one has lost a part of one’s self

Inability to experience positive mood

Emotional numbness

Difficulty in engaging with social or other activities

Distinguish from depression:

The sadness and symptoms are focussed around the person that was lost

In depression, the symptoms are more free-floating and not focussed on anything in particular

 

Question 4

Inv / Management

Answer 4

Support, reassurance and problem-solving are often all that is required

Psychological Therapy
- Supportive counselling - Can be individual, group or family
- Provide emotional support
- Understand why it affected the person so much
- Learn stress management and coping skills

Biological Treatment
- Often RESOLVE WITHOUT medication!
- Antidepressants (SSRIs) may help with symptoms of anxiety or depression

Social Interventions
- Eat well
- Reduce or avoid alcohol and coffee
- Increasing exercise (and breathing exercises)
- Offer support helplines (e.g. Samaritans, Campaign Against Living Miserably (CALM – only for men))

Referral to CAHMS for children if:
- Child is currently displaying signs of depression and has 2+ rf for developing depression
- Prolonged grief –> Interpersonal therapy can be useful +/- antidepressants