9. Bereavement

Question 1

Define: Bereavement (3)

Answer 1

• bereavement is a normal psychological and emotional reaction to a significant loss, also called grief or mourning
• length and characteristics of “normal” bereavement vary between individual cultures
• normal response: protest -> searching and acute anguish -> despair and detachment -> reorganization

Question 2

In bereavement, presence of the following symptoms may indicate abnormal grief/presence of major depressive disorder (5)

Answer 2

• guilt about things other than actions taken or not taken by the survivor at the time of death
• thoughts of death other than the survivor feeling that they would be better off dead or should have died with the deceased person; morbid preoccupation with worthlessness
• marked psychomotor retardation; prolonged and marked functional impairment
• hallucinatory experiences other than hearing the voice or transiently seeing the image of the deceased person
• dysphoria that is pervasive and independent of thoughts or triggers of the deceased, absence of mood reactivity

Question 3

When to consider diagnosis of “persistent complex bereavement disorder”? (3)

Answer 3

after 12 mo, if patient continues

• to yearn/long for the deceased
• experience intense sorrow/emotional pain in response to the death
• remain preoccupied with the deceased or with their circumstance of death

then may start to consider a diagnosis

Question 5

In the case of bereavement, if a patient meets criteria for major depressive disorder (MDD), are they diagnosed with MDD?

Answer 5

even in the context of a loss or bereavement scenario, they are still diagnosed with MDD

Question 6

Name: Risk Factors for Poor Bereavement Outcome (7)

Answer 6

• Poor social supports
• Unanticipated death or lack of preparation for death
• Highly dependent relationship with deceased
• High initial distress
• Other concurrent stresses and losses
• Death of a child
• Pre-existing psychiatric disorders, especially depression and separation anxiety

Question 7

Bereavement is associated with a significant increase in what? (1)

Answer 7

morbidity and mortality acutely following the loss, with effects seen up to 1 yr after

Question 8

Name the most common symptom that continues to persist in normal bereavement (1)

Answer 8

Loneliness is the most common symptom that continues to persist in normal bereavement and may last several years

Question 9

Describe tx: Bereavement (5)

Answer 9

• support and watchful waiting should be first line, as well as education and normalization of the grief process
• screen for increased alcohol, cigarette and drug use
• normal grief should not be treated with antidepressant or antianxiety medications, as it is important to allow the person to experience the whole mourning process to achieve resolution
• psychosocial: grief therapy (individual or group) is indicated for those needing additional support, or experiencing complex grief/bereavement, or significant MDD
• pharmacotherapy: if MDD present, past history of mood disorders, severe symptoms