Grief

Whenever I write one of these posts I sneak off to  review the existing the literature. Boy was I disappointed with the psychiatric literature on grief – there is zilch! Perhaps because psychiatry is pretty medication orientated these days .

The other thought I had is this. In the rural city I work in the most highly regarded therapist was a GP who did grief counselling (who unfortunately had to retire because of illness). So the public obviously values the grief work highly.

DSM V has a thing called “persistent complex bereavement disorder” (aka complicated bereavement)  which describes:

  1. grief lasting longer than 6 months
  2. grief impairing socio-occupational ability
  3. prominent an intense yearning for the lost person/pet/object
  4. guilt concerning the loss
  5. avoidance behaviour such as keeping rooms the same  , drinking to excess etc
  6. suicidal thinking

Its different from depression where intense yearning occurring in waves is not present. Depressed people describe more disturbance in sleep and appetite and energy levels typically.  ( In practice delineating the two is not easy)

PTSD can also be a differential diagnosis to consider in some circumstances.

Medical Illnesses such as hypothyroidism can look like grief.  Covert substance abuse and covert self-injury also need consideration.

What happens in the brain in grief ?  MRI studies show a diffuse network involvement –

  • posterior cingulate cortex   –   associated with autobiographical memory
  • precuneus  –  associated with memory related imagery
  • dorsal anterior cingulate – engages attentional resources -hence the preoccupation
  • insula –  visceral pain
  • left medial frontal gyrus – empathising
  • cerebellum- coordination of emotion and cognition

Management

The components of management are :

  1. Some form of  re exposure to the unresolved aspects of the grief either with hypnosis or EMDR.  This helps with self-regulation of the pain of grief
  2. Correction of irrational beliefs about grief – usually to do with guilt
  3. Asking the question “what would the deceased want for their loved one to be doing  and feeling now?”
  4. Building  social activities and connections
  5. Strategies for confronting or revisiting previously avoided situations
  6. Retelling of the story of the patient and the deceased the ups and downs of their life together.

Antidepressants or Sleeping Tablets can be useful .

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