scholarly journals Complicated grief: recent developments in diagnostic criteria and treatment

2018 ◽  
Vol 373 (1754) ◽  
pp. 20170273 ◽  
Author(s):  
Satomi Nakajima
Keyword(s):  
Diagnostic Criteria ◽  
Complicated Grief ◽  
Behavioural Therapy ◽  
Pathological State ◽  
Human Beings ◽  
Duration Of Symptoms ◽  
Related Disorder ◽  
Biological Studies ◽  
Persistent Complex Bereavement ◽  
Persistent Complex Bereavement Disorder

Although grief is a natural response to loss among human beings, some people have a severe and prolonged course of grief. In the 1990s, unusual grief persisting with a high level of acute symptoms became known as ‘complicated grief (CG)’. Many studies have shown that people who suffer from CG are at risk of long-term mental and physical health impairments and suicidal behaviours; it is considered a pathological state, which requires clinical intervention and treatment. DSM-5 (2013 Diagnostic and statistical manual of mental disorders , 5th edn) proposed ‘persistent complex bereavement disorder’ as a psychiatric disorder; it is similar to CG in that it is a trauma- and stress-related disorder. In recent years, there has been considerable research on the treatment of CG. Randomized controlled trials have suggested the efficacy of cognitive behavioural therapy including an exposure component that is targeted for CG. However, experts disagree about the terminology and diagnostic criteria for CG. The ICD-11 ( International classification of diseases , 11th revision) beta draft proposed prolonged grief disorder as a condition that differs from persistent complex bereavement disorder with respect to terminology and the duration of symptoms. This divergence has arisen from insufficient evidence for a set of core symptoms and the biological basis of CG. Future studies including biological studies are needed to reach consensus about the diagnostic criteria for CG. This article is part of the theme issue ‘Evolutionary thanatology: impacts of the dead on the living in humans and other animals’.

Complicated grief: Is there a place in psychiatry?

2017 ◽  
Vol 41 (S1) ◽  
pp. S458-S458
Author(s):  
S.L. Azevedo Pinto ◽  
J. Soares ◽  
A. Silva ◽  
R. Curral
Keyword(s):  
Depressive Disorders ◽  
Complicated Grief ◽  
Adjustment Disorder ◽  
Classification Systems ◽  
Post Traumatic Stress ◽  
Adequate Treatment ◽  
Psychiatric Syndrome ◽  
Persistent Complex Bereavement ◽  
Competing Interest ◽  
Persistent Complex Bereavement Disorder

IntroductionGrief is as normal reactive to a significant personal loss. It is characterized by affective, cognitive, behavioural and physiological symptoms. The grieving process is usually divided in five different stages, but in most cases presents a benign course, with decreased suffering and better adaptation to the new context. However, when high levels of emotional suffering or disability persist over a long time period, it becomes a case of complicated grief (CG), which should be adequately addressed.ObjectivesTo review the characteristics of CG, the evidence that supports it as an individual pathological entity, and its place in current classification systems.MethodsWe performed a bibliographic search in Pubmed and PsychInfo, of articles written in English, Portuguese and Spanish, containing the key words: grief, bereavement, psychiatry, classification.ResultsThe main issue regarding grief is the degree to which it is reasonable to interfere with a usually benign process. Since DSM-III bereavement has been referred to as an adaptive reaction to an important loss, which should not be diagnosed as major depressive disorder or adjustment disorder. However, DSM-5 has stated persistent complex bereavement disorder as an independent entity. In fact, CG fulfils the general criteria of every psychiatric syndrome, namely regarding specific diagnosis criteria, differential diagnosis from depressive disorders and post-traumatic stress disorder, and improvement with adequate treatment.ConclusionIt is important to correctly approach CG, since it presents with characteristic diagnosis features and much improvement may be achieved once adequate treatment is provided.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Impact and consequences of COVID-19 pandemic on complicated grief and persistent complex bereavement disorder

2021 ◽  
pp. 113916
Author(s):  
Francesca Diolaiuti ◽  
Donatella Marazziti ◽  
Maria Francesca Beatino ◽  
Federico Mucci ◽  
Andrea Pozza
Keyword(s):  
Complicated Grief ◽  
Persistent Complex Bereavement ◽  
Persistent Complex Bereavement Disorder

Complicated grief: A systematic review of the last 20 years

2020 ◽  
pp. 002076402096020
Author(s):  
Rosa De Stefano ◽  
Maria Rosaria Anna Muscatello ◽  
Antonio Bruno ◽  
Clemente Cedro ◽  
Carmela Mento ◽  
...  
Keyword(s):  
Diagnostic Criteria ◽  
Pathological Condition ◽  
Diagnostic Category ◽  
Complicated Grief ◽  
Therapeutic Interventions ◽  
Correct Treatment ◽  
Cultural Aspects ◽  
Traumatic Distress ◽  
Persistent Complex Bereavement Disorder ◽  
Clinical Category

Background: Grief is a common reaction to the feeling of loss and it is considered a physiological and instinctive response. The ‘normal’ grief evolves into an ‘integrated’ phase within 1 year from death, and it is a non-pathological condition, that do not require specific therapeutic interventions. When this ‘integrated phase’ does not occur, the subject could reach pathological manifestations related to the grief. The Persistent Complex Bereavement Disorder (PCBD) is a new DSM5 clinical category characterized by symptoms related to the detachment and to the post-traumatic distress and it differs from normal and uncomplicated grief, for the disability caused by these reactions and their persistence and pervasiveness. Aim: The purpose of this work is the analysis of the pathways that led to this new definition, through a review of the main studies published in the last 20 years, with the aim to clarify the clinical utility of this new diagnostic category. Method: Relevant publications done in the last 20 years were identified via electronic searches of Pubmed, Embase, and Elsevier databases using the terms ‘complicated grief’ AND ‘persistent’, according to PRISMA guideline and PICO study design. Results: PCBD results a new important clinical category showing specific symptoms, diagnostic criteria, and treatment. It presents many differences with other pathologies, that goes into differential diagnosis with PCBD, and it and can be treated with targeted therapeutic approaches. Diagnostic criteria for PCBD could allow an early diagnosis and a correct treatment avoiding underdiagnosis and misdiagnosis. Conclusion: Further researches could focus on the evaluation of more neurobiological aspects, new psychometric tools, for assessing susceptibility to this pathology, and on the cultural aspects that may influence mourning reactions, in an ethno-psychiatric perspective.

Performance characteristics and clinical utility of diagnostic criteria proposals in bereaved treatment-seeking patients

2016 ◽  
Vol 47 (4) ◽  
pp. 608-615 ◽  
Author(s):  
C. Mauro ◽  
M. K. Shear ◽  
C. F. Reynolds ◽  
N. M. Simon ◽  
S. Zisook ◽  
...  
Keyword(s):  
Clinical Research ◽  
Comparison Group ◽  
Clinical Sample ◽  
Complicated Grief ◽  
Assessment Instrument ◽  
Treatment Seeking ◽  
Prolonged Grief ◽  
Persistent Complex Bereavement ◽  
Clinically Significant ◽  
Persistent Complex Bereavement Disorder

BackgroundPersistent complex bereavement disorder (PCBD) is a protracted form of grief included in DSM Section 3 indicating a need for more research. Two other criteria sets [prolonged grief disorder (PGD) and complicated grief (CG) disorder] are also currently in use by researchers. This study evaluates rates of diagnosis of each proposed criteria set in a clinical sample of bereaved individuals participating in clinical research.MethodTwo groups in which persistent grief was judged to be present or absent completed an assessment instrument that included items needed to diagnose PCBD as well as PGD and CG. One group included grief treatment-seeking participants in our multicenter National Institute of Mental Health (NIMH)-sponsored study who scored ⩾30 on the Inventory of Complicated Grief (ICG) and the other comprised bereaved adults enrolled in clinical research studies who scored <20 on the ICG. Rates of diagnosis were determined for proposed PCBD, PGD and CG criteria.ResultsPCBD criteria diagnosed 70 [95% confidence interval (CI) 64.2–75.8] % of the grief treatment-seeking group, PGD criteria identified 59.6 (95% CI 53.4–65.8) % of these individuals and CG criteria identified 99.6 (95% CI 98.8–100.0) %. None of the three proposed criteria identified any cases in the bereaved comparison group.ConclusionsBoth proposed DSM-5 criteria for PCBD and criteria for PGD appear to be too restrictive as they failed to identify substantial numbers of treatment-seeking individuals with clinically significant levels of grief-related distress and impairment. Use of CG criteria or a similar algorithm appears to be warranted.

Prospective evaluation of the DSM-5 persistent complex bereavement disorder criteria in adults: dimensional and diagnostic approaches

2020 ◽  
pp. 1-10 ◽  
Author(s):  
Elie G. Aoun ◽  
Giovanna Porta ◽  
Nadine M. Melhem ◽  
David A. Brent
Keyword(s):  
Functional Impairment ◽  
High Sensitivity ◽  
Close Relative ◽  
Related Disorder ◽  
Prolonged Grief ◽  
Dsm 5 ◽  
Persistent Complex Bereavement ◽  
Persistent Complex Bereavement Disorder ◽  
Grief Reactions ◽  
Over Time

Abstract Background We examine the performance of the Diagnostic and Statistical Manual of Mental Disorders-fifth edition (DSM-5) persistent complex bereavement-related disorder (PCBD) criteria in bereaved adults to identify prolonged grief cases determined prospectively. Methods Bereaved adults (n = 138) were assessed at 8, 21, 32, 67, and 90 months after the sudden death of a spouse or close relative. We used latent class growth analysis to identify the longitudinal trajectories of grief assessed using the Inventory for Complicated Grief. To validate the trajectory that corresponded to prolonged grief, we examined the baseline predictors of these trajectories and their relationship with functional impairment. Results We found three distinct trajectories of grief reactions. One of these trajectories (13.8%) showed high and sustained grief reactions that persisted for almost 7.5 years after the death. Participants with prolonged grief showed greater functional impairment [relative risk ratio (RRR) = 0.82, 95% confidence interval (CI): 0.70 to −0.97; p = 0.02] and higher self-reported depression (RRR = 1.21, 95% CI 1.09 to 1.96; p = 0.001) than participants whose grief reactions subsided over time. The original PCBD (requiring 6 criterion C symptoms) criteria correctly identified cases (57.9–94.7%) with perfect specificity (100%) but low to high sensitivity (5.6–81.3%); however, its sensitivity increased when revising criterion C to require ⩾3 (45.5–94.1%). The dimensional approach showed high sensitivity (0.50–1) and specificity (0.787–0.97). Conclusions We recommend revisions to the PCBD criteria, which are overly restrictive and may exclude cases with clinically significant grief-related distress and impairment. In the meantime, clinicians need to monitor grief symptoms over time using available dimensional approaches to reduce the burden of grief.

Diagnosis of Menière’s disease according to the criteria of 2015: Characteristics and challenges in 96 patients

2021 ◽  
pp. 1-13
Author(s):  
Friedrich Ihler ◽  
Ivelina Stoycheva ◽  
Jennifer L. Spiegel ◽  
Daniel Polterauer ◽  
Joachim Müller ◽  
...  
Keyword(s):  
Diagnostic Criteria ◽  
Clinical Signs ◽  
Real Life ◽  
Meniere’S Disease ◽  
Menière’S Disease ◽  
Meniere's Disease ◽  
Ménière’S Disease ◽  
Menière's Disease ◽  
Duration Of Symptoms ◽  
Ménière's Disease

BACKGROUND: The diagnosis of Menière’s disease (MD) is made according to diagnostic criteria, the last revision of which was in 2015. For diagnosis, symptoms are weighted with audiometric findings and this can be challenging in individual patients. OBJECTIVE: To analyze patient’s characteristics and symptoms in a real-life cohort of 96 patients with diagnosed MD regarding sociodemographic parameters, clinical specifics, and audiometry. METHODS: Prospective clinical patient registry containing demographic and socioeconomic parameters, symptoms, as well as pure-tone audiometry data. RESULTS: 31 patients with definite MD, and 36 with probable MD were identified. 29 patients showed typical clinical signs of MD, but did not meet the full diagnostic criteria, and were considered separately. Mean duration of symptoms prior to presentation was 3.9±4.6 years. Significant differences between categories were found regarding aural fullness, tinnitus, and fluctuating hearing. If multiple audiograms were available, 28.6 %(6/21) documented fluctuating hearing. CONCLUSIONS: Current diagnostic criteria probably do not represent patients with monosymptomatic presentation or an early stage very well. Long-term follow-up with repeated audiometry is advisable.

Behavioral Activation and Therapeutic Exposure vs. Cognitive Therapy for Grief Among Combat Veterans: A Randomized Clinical Trial of Bereavement Interventions

2021 ◽  
pp. 104990912198902
Author(s):  
Ron Acierno ◽  
Brooke Kauffman ◽  
Wendy Muzzy ◽  
Melba Hernandez Tejada ◽  
Carl Lejuez
Keyword(s):  
Cognitive Therapy ◽  
Behavioral Activation ◽  
Controlled Trial ◽  
Patient Characteristics ◽  
Department Of Veterans Affairs ◽  
Post Traumatic Stress ◽  
Significant Treatment ◽  
Persistent Complex Bereavement ◽  
Treatment Gains ◽  
Persistent Complex Bereavement Disorder

Approximately two-thirds of Operations Enduring Freedom, Iraqi Freedom, and New Veterans reported knowing someone who was killed or seriously injured, lost someone in their immediate unit, or personally saw dead or seriously injured Americans (Hoge et al., 2004; Thomas et al., 2010; Toblin et al., 2012). Thus, it is not surprising that prevalence of Persistent Complex Bereavement Disorder (PCBD) is high in these groups. Importantly, PCBD impact appears to be independent of both Post-Traumatic Stress Disorder (PTSD) and Major Depressive Disorder (Bonnano, 2007), 2 disorders that are also highly prevalent in these groups, thus tailored treatments for grief are indicated. The Department of Veterans Affairs suggests Cognitive Therapy for Grief as a first line psychotherapy, however treatments relatively more focused on behavior change and exposure to grief cues also may be useful for this population. To address this question, the present study used a randomized controlled trial to compare a 7-session program of Behavioral Activation and Therapeutic Exposure for Grief vs. Cognitive Therapy for Grief among 155 OIF/OEF/OND veterans. Both treatments produced significant treatment gains over baseline, and these improvements were maintained over 6-month followup; however no differences were observed between groups. Given equal efficacy, implications for matching treatment to patient characteristics are discussed.

scholarly journals Collective intentionality and autism: Against the exclusion of the “social misfits”

2019 ◽  
Vol 30 (1) ◽  
pp. 135-148
Author(s):  
Kristina Lekic
Keyword(s):  
Diagnostic Criteria ◽  
Autistic Spectrum Disorders ◽  
Collective Intentionality ◽  
Human Beings ◽  
Autistic Spectrum ◽  
Psychological States ◽  
The Social ◽  
Spectrum Disorders ◽  
Shed Light

The paper aims to shed light on Searle?s notion of collective intentionality (CI) as a primitive phenomenon shared by all humans. The latter could be problematic given that there are individuals who are unable to grasp collective intentionality and fully collaborate within the framework of ?we-intentionality?. Such is the case of individuals with autism, given that the lack of motivation and skills for sharing psychological states with others is one of the diagnostic criteria for Autistic Spectrum Disorders (ASD). The paper will argue that exclusion of individuals with autism is not a threat for Searle?s notion of collective intentionality, as the notion can be read as merely a biological disposition that all human beings share. Furthermore, the paper proposes the extension of Searle?s concept of CI so it can include behaviors of individuals who have the disposition towards CI, but which was not evolved through ontogenesis; namely, for individuals with autism.

scholarly journals Impact of Mobile Endoscopy Unit for Rendering Gastrointestinal Endoscopy Services at Two Community Health Centers in Western India

2021 ◽  
Vol 12 (04) ◽  
pp. 190-195
Author(s):  
Amit Maydeo ◽  
Shivaji Thakare ◽  
Amol Vadgaonkar ◽  
Gaurav Patil ◽  
Ankit Dalal ◽  
...  
Keyword(s):  
Medical Care ◽  
Community Health ◽  
Community Health Centers ◽  
Health Centers ◽  
Rapid Urease Test ◽  
Pathological State ◽  
Duration Of Symptoms ◽  
Endoscopy Unit ◽  
Gi Symptoms ◽  
Urease Test

Abstract Background Patients with gastrointestinal (GI) symptoms in remote areas do not have access to standard medical care with the issues related to cost of medical care, transportation, health literacy, lack of healthcare insurance—all preventing healthcare access in a timely manner. To overcome this, we designed a mobile endoscopy van with the intent to provide free essential medical services to the rural population. Methods This is a retrospective study of patients with predominantly upper GI symptoms at two community health centers (each 2 days camp). This is an audit of endoscopy findings in a community set up using a Mobile Endoscopy Unit (MEU). Patients' details were collected in a pre-designed questionnaire. Only those patients with alarm symptoms and suspicion of any pathological state underwent esophagogastroduodenoscopy (EGD) in MEU. Data analysis was done using descriptive statistics. Results A total of 724 patients (424 [58.5%] males; mean [SD] age 48.5 [5.2] years) were included. The commonest presenting symptom was heartburn in 377 (52.1%) patients. The median duration of symptoms was 6.5 (range: 2–36) months. Gastroesophageal reflux disease was seen in 16 (6.8%) patients, ulceroproliferative growth was noted in the stomach in 3 (1.3%) patients. Eighteen (7.6%) patients had a positive rapid urease test and received Helicobacter pylori eradication therapy. The most commonly prescribed drugs were proton-pump inhibitors in 692 (95.6%) patients. Nine (1.2%) patients had chronic liver disease secondary to alcoholism and were counseled for abstinence. All procedures were safely performed without any immediate adverse events. Conclusions Community outreach strategies such as the use of mobile endoscopy unit were found to be very useful in the diagnosis of GI symptoms. More research is needed in low-income countries to treat complex pathological states in rural patients.

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