Diagnosis of prolonged grief disorder (PGD)

Author(s):  
Allison M. Marziliano ◽  
Wendy G. Lichtenthal ◽  
Holly G. Prigerson

This chapter provides a synthesis and up-to-date summary of studies on prolonged grief disorder (PGD)—an intense, persistent, and disabling response to loss experienced by a significant minority of bereaved individuals. Circumstances surrounding cause of death, relationship with the deceased, and predisposing characteristics of the bereaved individual increase the risk of PGD. PGD is associated with adverse health outcomes, and often is comorbid with major depressive disorder, generalized anxiety disorder, and posttraumatic stress disorder (PTSD). Cognitive-behavioural therapy (CBT) has proven effective in prevention and intervention efforts. Novel interventions have been adapted for subgroups of bereaved samples. New efforts to derive the clinical utility of PGD to create a common dialogue among professionals have been made. Although great strides have been made in developing clinically useful criteria for PGD, future research would benefit from extension to new cultural contexts, and further examination of the clinical utility of the PGD diagnosis.

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Paul A. Boelen ◽  
Jaap Lancee

There is preliminary evidence that poor sleep quality is associated with emotional problems following loss, including symptoms of prolonged grief disorder (PGD) and depression. We conducted two studies to improve existing knowledge about the role of sleep difficulties in recovery from loss. Study 1 that relied on self-reported data from a heterogeneous sample of 177 bereaved individuals replicated prior findings of a linkage between increased sleep difficulties and increased PGD severity. This study also suggested that sleep difficulties are more strongly associated with depression than with PGD. In Study 2, we examined whether prior evidence that sleep complaints are a residual symptom of PGD treatment could be replicated in a sample of 43 bereaved individuals who underwent cognitive behavioural therapy for PGD. Outcomes showed that, although sleep difficulties declined significantly during this cognitive behavioural therapy, after this therapy, over half of all patients still had sleep difficulties above the average sleep difficulties observed in the general Dutch population.


2017 ◽  
Vol 76 (4) ◽  
pp. 427-436 ◽  
Author(s):  
Wolfgang Marx ◽  
Genevieve Moseley ◽  
Michael Berk ◽  
Felice Jacka

Mental illness, including depression, anxiety and bipolar disorder, accounts for a significant proportion of global disability and poses a substantial social, economic and heath burden. Treatment is presently dominated by pharmacotherapy, such as antidepressants, and psychotherapy, such as cognitive behavioural therapy; however, such treatments avert less than half of the disease burden, suggesting that additional strategies are needed to prevent and treat mental disorders. There are now consistent mechanistic, observational and interventional data to suggest diet quality may be a modifiable risk factor for mental illness. This review provides an overview of the nutritional psychiatry field. It includes a discussion of the neurobiological mechanisms likely modulated by diet, the use of dietary and nutraceutical interventions in mental disorders, and recommendations for further research. Potential biological pathways related to mental disorders include inflammation, oxidative stress, the gut microbiome, epigenetic modifications and neuroplasticity. Consistent epidemiological evidence, particularly for depression, suggests an association between measures of diet quality and mental health, across multiple populations and age groups; these do not appear to be explained by other demographic, lifestyle factors or reverse causality. Our recently published intervention trial provides preliminary clinical evidence that dietary interventions in clinically diagnosed populations are feasible and can provide significant clinical benefit. Furthermore, nutraceuticals including n-3 fatty acids, folate, S-adenosylmethionine, N-acetyl cysteine and probiotics, among others, are promising avenues for future research. Continued research is now required to investigate the efficacy of intervention studies in large cohorts and within clinically relevant populations, particularly in patients with schizophrenia, bipolar and anxiety disorders.


2016 ◽  
Vol 208 (3) ◽  
pp. 252-259 ◽  
Author(s):  
Caecilie Böck Buhmann ◽  
Merete Nordentoft ◽  
Morten Ekstroem ◽  
Jessica Carlsson ◽  
Erik Lykke Mortensen

BackgroundLittle evidence exists on the treatment of traumatised refugees.AimsTo estimate treatment effects of flexible cognitive–behavioural therapy (CBT) and antidepressants (sertraline and mianserin) in traumatised refugees.MethodRandomised controlled clinical trial with 2×2 factorial design (registered with Clinicaltrials.gov, NCT00917397, EUDRACT no. 2008-006714-15). Participants were refugees with war-related traumatic experiences, post-traumatic stress disorder (PTSD) and without psychotic disorder. Treatment was weekly sessions with a physician and/or psychologist over 6 months.ResultsA total of 217 of 280 patients completed treatment (78%). There was no effect on PTSD symptoms, no effect of psychotherapy and no interaction between psychotherapy and medicine. A small but significant effect of treatment with antidepressants was found on depression.ConclusionsIn a pragmatic clinical setting, there was no effect of flexible CBT and antidepressants on PTSD, and there was a small-to-moderate effect of antidepressants and psychoeducation on depression in traumatised refugees.


2021 ◽  
Vol 7 (5) ◽  
pp. 520-544

To date, the impact of traditional cognitive behavioural therapy (CBT) on anhedonia in major depressive disorder (MDD) has yet been systematically evaluated. This systematic review aims to examine the efficacy of traditional CBT for depressed adults with anhedonia. A literature search for randomised controlled trials of traditional CBT in adults with MDD from inception to July 2020 was conducted in 8 databases. The primary outcome was the levels of anhedonia. Ten studies with adults with MDD met the eligibility criteria. Our results indicate that traditional CBT is as effective as euthymic therapy, positive psychology therapy, self-system therapy,and medications for anhedonia in depression. Besides, our data provide further support for the development of augmented CBT to optimise treatment outcome for depressed adults with anhedonia. Received 11th June 2021; Revised 2nd September 2021; Accepted 20th September 2021


2021 ◽  
Author(s):  
Stephanie McCrory ◽  
Astrid McLellan ◽  
Karolina Kiper ◽  
Clare Munro ◽  
Christopher-James Harvey ◽  
...  

Introduction: Adolescents are vulnerable to experiencing insufficient sleep which can increase the risk of developing insomnia, mental/physical health problems and mood regulation. School-based sleep improvement interventions (SBSII) have been developed utilising Cognitive Behavioural Therapy for Insomnia techniques and found improvements in sleep knowledge and behaviour. This study aimed to evaluate the effectiveness, feasibility and acceptability of a school-based sleep improvement intervention (iSLEEP) for improving sleep and psychological wellbeing in adolescents.Methods: A mixed-methods approach was adopted. The participants (115, aged 12-15) were recruited from secondary schools in Scotland. iSLEEP comprised of three lessons, combining formal sleep education and CBT-I, and were delivered over three consecutive weeks. Baseline (1 week before lesson 1) and follow-up (1 week following lesson 3) assessments comprised of self-report questionnaires to measure change in sleep, depression, anxiety and stress. Two weeks following the final lesson, a convenience sample of 19 pupils (14 females) were recruited to participate in focus groups.Results: There were significant improvements in overall sleep and marginal differences between those who were categorised with ‘probable insomnia’ at baseline and likewise for ‘good sleepers’. There were no significant improvements in symptoms of depression, anxiety or stress. Two themes and two sub-themes were generated. Participants reported that iSLEEP was acceptable and improved their sleep.Conclusions: These findings indicate that iSLEEP is an effective, feasible and acceptable SBSII. Future research should aim to utilise a controlled design to further investigate the efficacy of iSLEEP.


2019 ◽  
Vol 12 ◽  
Author(s):  
Farooq Naeem

AbstractCognitive behavioural therapy (CBT) in its current form might not be acceptable to service users from a variety of backgrounds. Therefore, it makes sense to adapt CBT when working with diverse populations. Contributors to this special issue of theCognitive Behaviour Therapisthave tackled the issues around the cultural adaptation of CBT from various perspectives, using a variety of methods, and have addressed topics ranging from cultural adaptation to improving access to CBT. Here, I briefly summarize and discuss the papers in this special issue. I start with a systematic review of CBT for social anxiety across cultures. Seven articles cover aspects of adaptation of therapies for people from different backgrounds. Three papers discuss the issues of gender and sexuality when using CBT, while another three papers focus on refugees, asylum seekers and the homeless, and two papers describe the application of CBT with religious populations. Finally, there are seven papers on issues related to service delivery, practice and training and supervision when working with a diverse population. Collectively, papers in this special issue provide us with sufficient evidence that cultural considerations play a vital role when using CBT, offer practical suggestions for improving cultural competence and most importantly, can catalyse future research. However, the full potential of culturally adapted interventions will not be realized until and unless access to CBT is improved. Therefore, there is a need to build robust evidence to convince funders, policy makers and service managers.


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