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Updated: Nov 30 2019


  • 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)
  •  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
  •  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
  •  Psychiatric evaluation
    • assess suicidality
  •  Psychotherapy
    • cognitive, supportive (reassurance)
  • Pharmacologic
    • SSRIs
      • only indicated in abnormal grief 
Symptoms Tearfulness

Frequency of symptoms < 1 year
Tend to persist
Duration of symptoms Wax and Wane
Suicidal ideation Less common
More common
Treatment Supportive therapy
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