Complicated Grief and Manic Comorbidity in the Aftermath of the Loss of a Son

Abstract

Based on the recommendations of the sub-workgroup on trauma and dissociative disorders, the American Psychiatric Association (APA) removed the "bereavement exclusion" from the criteria for major depression in DSM-5. In addition, proposed DSM-5 research criteria for persistent complex bereavement disorder (PCBD) were included in the new manual in a section for conditions and criteria needing further research. We describe a case that warranted such a diagnosis. The patient was a 52- year-old woman who was admitted to the inpatient unit of our clinic on the birthday of her son who had died 18 months earlier. She was diagnosed with a manic episode with psychotic symptoms according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria and was treated accordingly. Three months after discharge, she made a suicide attempt and was admitted and re-assessed. During this admission, she completed the Inventory of Complicated Grief (ICG), the Mood-Spectrum Rating Scale (MOODS-SR), and the Trauma and Loss Spectrum questionnaire (TALS-SR). She endorsed symptoms of intense yearning for her son, feelings of shock and disbelief, anger and bitterness related to his death, estrangement from others, auditory, tactile and visual hallucinations of the deceased, and intense emotional reactivity to memories of her son. These symptoms were sufficiently prolonged and severe to meet criteria for complicated grief. While complicated grief appeared to be the primary diagnosis for this patient, when she was diagnosed using only DSMIV-TR criteria, her treatment failed to address herprimary problem. This case draws attention to the occurrence of manic-like symptoms as well as depression-like manifestations following bereavement and highlights the importance of including the syndrome of complicated grief in the diagnostic nomenclature.

Normal grief and its correlates in Lubumbashi, an urban city in the Democratic Republic of Congo

“…Our study found that 68% of the subjects saw their course of mourning disturbed by different problems, such as lack of family supports, rejection in the street immediately after the burial of the deceased, or being treated as a which craft and therefore the direct cause of death. Carnassir et al, in their clinical study have shown that bipolar disorder may have symptoms exacerbated by a commemoration of mourning, displaying therefore all the symptoms of bereavement [9]. In our study during the commemoration of mourning is more somatic symptoms that is followed anxiety and depressive disoders.…”

Mania Following Bereavement: State of the Art and Clinical Evidence

“…Authors describe changes in mood (euphoric), sometimes mixed with depressive feelings. Carmassi et al (19) reported how the patient alternated elevated mood to affective instability and dysphoria. Authors often describe sudden mood switches from euphoria to hostility and aggressiveness (18).…”

“…Several kinds of delusions were reported: persecutory (family conspiring against the patient) (18), of "grandeur" (being a millionaire) (16), having special powers to help people, thought broadcasting (18). These patients often developed delusions about the deceased: from asserting to be still in contact with him/her, to talking to him/her, to deny the reality of the death (19). Our case presented a patient with a previous history of depressive but not (hypo)maniac episodes, with a first manic episode in the aftermath of a loss event.…”

“…The second selection excluded two articles after being read and reviewed, as the information reported manic episode onset in the aftermath of bereavement in patients with an organic medical condition. Finally, seven papers were included in the present manuscript, reporting 15 case reports: three of these reports were excluded after being completely read and evaluated, as they describing manic relapse following bereavement in patients with a diagnosis of Bipolar Disorder (16)(17)(18)(19)(20)(21)(22). Key characteristics of included studies are summarized in Table 1.…”

“…Symptoms onset varied from a few hours/days to several years after the death. In one case, Rickarby (16) describes symptoms recurrence once every year, while someone of us published a case of a woman whose onset was on her son's birthday (19).…”