Snapshot A 67-year-old female lost her husband of 41 years to a massive MI 7 months ago. She occasionally "sees" her husband but she does not believe him to be real. She also reports crying several times per week when she thinks of him. (normal grieving) Introduction Clinical definition altered emotional state following the death of a loved one can be normal or pathological normal symptoms for up to a year abnormal suicidal ideation characterized by more severe symptoms or continued symptoms much longer than normal when symptoms persist beyond a year and are very severe, the patient may meet criteria for persistent complex bereavement disorder Presentation Symptoms normal grief intense yearning for loved one sadness irritability sleep difficulties poor concentration illusions/hallucinations patient realizes that the experience is not real abnormal grief feelings of worthlessness thoughts of death or suicidal ideation psychosis psychomotor retardation illusions/hallucinations patient believes that the experience is real Evaluation Psychiatric evaluation assess suicidality Treatment Psychotherapy cognitive, supportive (reassurance) Pharmacologic SSRIs only indicated in abnormal grief Grief Depression Symptoms TearfulnessSadnessInsomniaAnorexiaAnhedonia Frequency of symptoms < 1 year Tend to persist Duration of symptoms Wax and Wane Constant Suicidal ideation Less common More common Treatment Supportive therapy Antidepressants