Prolonged grief reaction

Question 1

Define adjustment disorder and prolonged grief reaction?

Answer 1

AD: Prolonged severe abnormal repsonse to stress beginning within 1m of stressful episode and lasting no longer than 6months

PGR: Abnormal prolonged repsonse to grief. Normal grief onset within a few days and lasts over 2 years, with initial response of anger, guilt, self blame, and later pining, despair and sadness. Abnormal responses include delayed or prolonged response.

Question 2

What are risk factors for prolonged grief reaction?

Answer 2

Maladaptive psychological processing.

Question 3

Summarise the epidemiology of adjustment disorder and prolonged grief reaction.

Answer 3

PGR: Usually occurs with sudden and unexpected deaths. May have problems in relationships leading to processing difficulties, or being unable to grieve due to putting on brave face.

Question 4

What are the signs and symptoms of adjustment disorder and prolonged grief reaction?

Answer 4

AD: Precipitated by stressor. Patient has symptoms of anxiety, depression, irritability, insomnia, low mood. No biological features of depression (i.e. apetite changes). Adjustment to terminal illness may follow a similar course. May have high autonomic arousal.

PGR: Hx of difficult relationship, symptoms such as shock, disbelief, anger, sadness and despair may be severe, May feel depressed or have suicidal thoughts.

Question 5

What is the management for a prolonged grief reaction?

Answer 5

AD: Remove stressor. Supportive psychotherapy, coping mechanisms.

PGR: Bereavement counselling, CBT, suicide risk assess.

Question 6

What are complications for adjustment disorder and prolonged grief reaction?

Answer 6

AD: Disrupt work and social life, symptoms usually improve rapidly.

PGR: Depresison, substance abuse, suicide. Most improve with treatment.