Bereavement is the period of grief after the death of someone close, and it brings waves of sadness, longing and disrupted sleep that usually ease over months. Most people need only support, but some develop prolonged grief disorder or major depression and need treatment.
Key symptoms
- Waves of sadness and yearning, often triggered by reminders
- Crying, trouble sleeping, poor appetite
- Feeling the presence of or briefly hearing the person who died
- Guilt about things done or not done
- Self-esteem usually stays intact, unlike in depression
What you find on exam
- Mental status exam: mood, affect, thought content
- Ask directly about suicidal thoughts
- Ask about alcohol and drug use
- Check sleep, eating and daily function
Tests
- Diagnosis is clinical
- PHQ-9 to screen for major depression
- Prolonged grief disorder if intense grief lasts at least 12 months and impairs life
- Suicide risk screening
Treatment basics
- Express sympathy, listen and normalize grief
- Encourage social support, routines, sleep and exercise
- Grief counseling or support groups
- Grief-focused therapy for prolonged grief disorder
- Treat major depression with therapy and an antidepressant if present
Red flags
- Suicidal thoughts or wish to join the person who died
- Hallucinations beyond brief sensing of the person, or psychosis
- Heavy alcohol or drug use, or inability to function for months
Practice it in Making Synapses
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Related guides
Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.