Death & Dying

DEATH & DYING

Q. 1

An 82 year old woman, whose husband passed away 6 weeks ago after a long illness, is admitted to the hospital for worsening of her cardiac problems. During the hospital stay, a psychiatrist is invited to consult at the request of her daughters. The daughters think their mother is depressed, because she is tearful, often talks about her dead husband, and states that she had heard his voice several times. She blames herself for not having gone with him on his last visit to his sister, and she starts crying. She has never seen a psychiatrist before and has been “strong” all her life. Which of the following is the most likely diagnosis?

 A

Depression secondary to general medical condition

 B

Dysthymia

 C

Grief reaction

 D

Major depressive disorder

Q. 1

An 82 year old woman, whose husband passed away 6 weeks ago after a long illness, is admitted to the hospital for worsening of her cardiac problems. During the hospital stay, a psychiatrist is invited to consult at the request of her daughters. The daughters think their mother is depressed, because she is tearful, often talks about her dead husband, and states that she had heard his voice several times. She blames herself for not having gone with him on his last visit to his sister, and she starts crying. She has never seen a psychiatrist before and has been “strong” all her life. Which of the following is the most likely diagnosis?

 A

Depression secondary to general medical condition

 B

Dysthymia

 C

Grief reaction

 D

Major depressive disorder

Ans. C

Explanation:

A normal or uncomplicated grief reaction after the loss of a beloved person may resemble depression in some ways (e.g., changes in sleep or appetite, sadness, withdrawal).
However, as the loss becomes remote, the grief-stricken person is able to re- experience joy.
Self-blame is focused on what was not done in relation to the deceased person.
Illusions or hallucinations of the deceased person are common. The uncomplicated grief reaction can last several months, or longer, depending on the relationship to the deceased.
 
Depression secondary to a general medical condition  can be seen in association with cardiopulmonary disease, among other disorders; however, since the symptoms are related to the precipitating event, one would have to wait till the normal grief is resolved and then reassess the presence of symptoms of depression.
 
The main diagnostic criterion of dysthymia involves milder symptoms of depression occurring every day for at least 2 years.
 
Major depressive disorder can be precipitated by the loss of a beloved person, but it has a distinct quality even though some symptoms are the same. Suicidal ideation, guilt related to the person alone and not to the deceased person, and feelings of worthlessness are common. Significant functional impairment is typical.
 
Ref: Ropper A.H., Samuels M.A. (2009). Chapter 24. Fatigue, Asthenia, Anxiety, and Depressive Reactions. In A.H. Ropper, M.A. Samuels (Eds), Adams and Victor’s Principles of Neurology, 9e.

Q. 2

A man coming from mountain whose wife died 6 months prior says that his wife appeared to him and asked him to join her. The diagnosis is

 A

Normal grief

 B

Grief psychosis

 C

Berevement reaction

 D

Supernatural phenomenon

Q. 2

A man coming from mountain whose wife died 6 months prior says that his wife appeared to him and asked him to join her. The diagnosis is

 A

Normal grief

 B

Grief psychosis

 C

Berevement reaction

 D

Supernatural phenomenon

Ans. B

Explanation:

B i.e. Grief psychosis 

  • Bereavement, Grief or Mourning is a psychological reaction of those who survive a significant loss. Differences between normal & abnormal grief:

Identifying with deceased person such as taking on certain admired traits or treasuring certain possessions is normal; believing that one is the deceased person or is dying of exactly what the deceased person died of (if infact this is untrue) is not normal.

Hearing the fleeting, transient voice of a deceased person may be normal; persistent, intrusive, complex auditory hallucinations are not normalQ.

Denial of certain aspects of the death is normal; denial that includes the belief that the dead person is still alive is not normal.

Grief

  • Is a normal response of an individual to the loss of a loved object which presents with:

– Various physical & mental symptoms like sighing, crying, chocking, breathing difficulty, weakness etc. – Preoccupation with memory of deceased

– Sense of presence of deceased & misinterpretation of voices & faces of others as that of lost. – Seeing person in dreams & fleeting hallucinations.

Abnormal Grief Exaggeration of one or more normal symptoms of griefQ

– Duration > 6 months.Q 

 

Pathological/Morbid Grief

Complicated Grief

1

Associated with psychotic or

neurotic illness

•     Chronic Grief

•     Delayed Grief

•     Inhibited Grief =

•     Anniversary Reaction

=

Duration > 6 monthsQ

Onset after 2 weeks of lost (death)

Denial of loss

Grief reaction on death anniversary

       
  • Over idealization of deceased.

Quiz In Between



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