prolonged grief -> artikel boelen: PGD

Question 1

introductie

Answer 1

Traditional models developed to understand grief therefore often unhelpfully suggest that all bereaved individual do, and even should, follow the same process towards recovery from loss. The newer grief task model offers a more neutral framework to describe normal
and disturbed grief. The model proposes that normal grief is the successful achievement of certain “grief tasks,” whereas complications in managing these tasks might indicate disturbed grief. There is no recommended or specific order in which to achieve these tasks. Grief tasks include: to accept the reality of the loss; to process the associated pain; to adjust to a world without the deceased; and to find an enduring connection with the deceased in the midst of embarking on a new life.

Question 2

Prolonged grief disorder (DSM)

Answer 2

Prolonged grief disorder (PGD) = diagnose in DSM-5 (persistent complex bereavement disorder -> PCBD in ICD). Termen zijn eigenlijk hetzelfde. PGD differs from normal and uncomplicated grief, not in terms of the nature of grief reactions, but rather the distress and
disability caused by these reactions and their persistence and pervasiveness.

• Langdurig en intense rouw die dagelijks functionering belemmert (6 maanden bij kinderen, 12 maanden bij volwassenen).
• Intense pijn, verlangen naar overledenen en gevoel van betekenisloosheid.
  o The distress in individuals with PGD might be maintained by negative cognitions and avoidance behaviours, and by sensitivity to loss-related stimuli. For example, following a loved one’s death in a road traffic incident, images of a particular car or media coverage of other accidents might trigger images of the accident and associated pain.
• Verhoogde PGD bij verlies kind of partner, onverwacht/gewelddadige sterfgevallen, personen met geschiedenis van psychische aandoeningen.

Question 3

prevalentie & risicofactoren

Answer 3

Prevalentie: 10% van de rouwenden ontwikkelt het.
Risicofactoren
- Mensen met onveilige hechtingsstijl
- Neuroticisme
- Vaker bij vrouwen, lager opgeleiden en na traumatische verliezen.
- De relatie met de overledene is belangrijk: dood van partner of kind of hechte en supportive relatie is gelinkt met PGD.

Question 4

Comorbide psysical and mental health conditions with PGD

Answer 4

Comorbide psysical and mental health conditions with PGD
- Elevated risk of poor physical health, suicidality, reduced quality of life and funcitonal impairment.
- MDD, PTSS, GAD and adult separation anxiety disorder.
- Na traumatische rouw, het samen voorkomen van PGD met posttraumatische stressstoornis en/of depressie bij personen die tekenen vertonen van ernstige emotionele distress komt vaak voor.

Question 5

PGD in children

Answer 5

• Criteria for persistent complex bereavement disorder in DSM-5 for children are similar to those for adults, except that the condition can already be classified at six months after loss (12 months in adults).
• The estimated prevalence of PGD in children is between 5% and 10%. PGD symptoms are associated with impairments in functioning and depression. The symptoms of longing and yearning for the deceased, inability to accept the death, shock, disbelief, loneliness, and a changed world view endorsed in the second half year of bereavement have been found to predict a disturbed course of grief. However, symptoms can manifest differently in children than in adults—for example, in an obsession with death during play.
• Meta-analyses show that interventions can reduce the severity of grief reactions in children without PGD symptoms with small to moderate effects, and with relatively greater effects in children with symptoms. Interventions that include confrontation with the most distressing aspects of the loss are particularly helpful (as opposed to interventions including no confrontation).
• Treatments found to be effective in single controlled studies are the group based Family Bereavement Program (found effective in reducing immediate and long term emotional problems in children confronted with parental loss) and trauma and grief component therapy developed for adolescents (effective in reducing grief, depression, and anxiety symptoms).
• Cognitive behavioural interventions show a reduction in PGD in uncontrolled studies

Question 6

Behoudende mechanismen

Answer 6

Behoudende mechanismen:
- Negatieve cognities/veranderingen -> over de zelf, leven, toekomst na verlies, neiging om catastrofale betekenis toe te kennen aan iemands rouwreacties. Dit kan ook voorspellend zijn voor aanhoudende symptomen
- Inactief/ terugtrekken uit sociale activiteiten
- Vermijdingsgedrag aan verliesherinneringen en piekeren over oorzaak en gevolg verlies
- Overgevoeligheid voor verliesgerelateerde triggers.
- Theorie: maladptieve cognities en vermijdende coping -> oorzaak PGD en in stand houden ervan.

Question 7

Effectieve behandelingen:

Answer 7

Effectieve behandelingen:
- Preventie behandelingen werken alleen op hoge risico patiënten/ families waarbij er een lang ziekte traject is.
- Online therapist assisted intervention – reductions in PGD, PTSS, depressive en anxiety. Encompassing exposure, cognitive interventions, and behavioural activation applied using writing assignments.
- CBT – combining exposure and cognitive interventions
- Complicated grief therapy – encompassing elements of exposure, cognitive restructuring and interpersonal therapy.
Behandelingen die belovend zijn:
- Behavioural activation
- Cognitive narrative therapy
- Integrated cognitive behavioural therapy

Medicatie:
- Antidepressiva kan helpen, maar niet aanbevolen als primaire behandeling.

Question 8

sociaal-maatschappelijke zorgen

Answer 8

Sociaal-maatschappelijke zorgen:
- Zorgen over het medicaliseren van normale rouw en mogelijke stigmatisering van mensen met PGD-diagnose.
- Terwijl mensen vaak gewoon zonder interventies kunnen herstellen (zonder PGD) -> en bang dat mensen te snel medicatie zullen gebruiken, ook al is het niet nodig. Daardoor minder aandacht naar ‘echte’ PGD-ers.