_______________________________________________________________________ Depression and Suicide
Criteria for Seasonal Pattern Specifier According to the DSM-5-TR, MDD with seasonal pattern specifier can be applied to the pattern of major depressive episodes in MDD, recurrent. The essential feature is the onset and remission of major depressive episodes at characteristic times of the year. Criteria include [10]: • A regular temporal relationship between the onset of MDD and a particular time of the year (e.g., fall, winter) • Full remissions (or a change from MDD to mania or hypomania) at a characteristic time of the year (e.g., depression disappears in the spring) • In the last two years, two MDD episodes have occurred that demonstrate the temporal seasonal relationships defined above and no nonseasonal major depressive episodes have occurred during that same period. • Seasonal MDD episodes substantially outnumber the nonseasonal MDD episodes that may have occurred over the individual’s lifetime. Bereavement and Prolonged Grief Disorder With bereavement, the loss of a loved one is a particularly severe stressor. Bereavement is commonly accompanied by the signs and symptoms of MDD, with roughly 25% of bereaved persons exhibiting a diagnosable major depression at two months and seven months following the loss [74]. The death of a loved one is followed by an intensely emotional and disruptive period that gradually attenuates as the death is comprehended and accepted and its consequences understood (integration). It is a highly stressful period accompanied by the need to attend to a range of things not usually on one’s agenda. Most people meet the coping demands and are able to find a pathway through the sorrow, numbness, and even guilt and anger that are part of the normal grieving process. A small minority, however, do not cope effectively. For them, the feelings of loss become debilitating. They do not improve with the passing of time and can become so long-lasting and severe that recovering from the loss and resuming a normal life is impossible without assistance [75]. These people are suffering from prolonged grief disorder, a syndrome in which healing is impeded and acute grief is intense and prolonged. Individuals with more severe and prolonged major depressive manifestations tend to be younger with a history of previous episodes of major depression, and antidepressant medications or psychotherapy should be used in cases with prolonged depressive reaction with significant functional impairment [10; 22]. Prolonged grief disorder is the newest disorder to be added to the DSM. The disorder was added to the DSM-5-TR in 2022 after several decades of studies that suggested many people were experiencing persistent difficulties associated with bereavement that exceeded expected social, cultural, or religious expectations [10]. Prolonged grief disorder often co-occurs with other mental disorders (e.g., PTSD, anxiety,
depression). Sleep problems, such as poor long-term sleep, occur in an estimated 80% of people with this disorder [501]. Prolonged grief disorder is defined as “intense yearning or longing for the deceased (often with intense sorrow and emo- tional pain) and preoccupation with thoughts or memories of the deceased. In children and adolescents, this preoccupation may focus on the circumstances of the death” [10]. In adults, this intense grief must still be present one year after a loss to be considered prolonged grief disorder; in children, the timeframe is six months. Additionally, the individual with prolonged grief disorder may experience significant distress or problems performing daily activities at home, work, or other important areas [10]. It is important for clinicians to differentiate prolonged grief disorder from usual acute grief, as well as depression and anxiety disorders [75]. Risk factors for prolonged grief disorder include past losses, separations that can impact current losses, and a history of depressive illness [115x]. Symptoms include [10]: • Identity disruption (e.g., feeling as though part of oneself has died) • A marked sense of disbelief about the death • Avoidance of reminders that the person is dead • Intense emotional pain (e.g., anger, bitterness, sorrow) • Difficulty reintegrating (e.g., unable to engage with friends, pursue interests, plan for the future) • Emotional numbness • Feeling that life is meaningless • Intense loneliness and feeling of being detached from others An estimated 7% to 10% of bereaved adults will experience the persistent symptoms of prolonged grief disorder, and 5% to 10% of bereaved children and adolescents will experience depression, PTSD, and/or prolonged grief disorder [501; 502]. Treatments using elements of CBT have been found to be effective in reducing symptoms [10]. Complicated grief treat- ment incorporates components of CBT and other approaches to help patients adapt to the loss. It focuses on accepting the reality of the loss and on working toward goals and a sense of satisfaction in a world without the loved one [501]. Research has shown that CBT is effective in addressing sleep problems associated with prolonged grief disorder. CBT also has been shown to be superior in long-term effects to supportive coun- seling in children and adolescents experiencing symptoms of prolonged grief disorder [502; 503]. Bereavement support groups can provide a useful source of social connection and support. They can help people feel less alone, thus helping to avoid the isolation that could increase the risk for prolonged grief disorder. Despite the existence of effective treatments, people experiencing prolonged grief dis- order may not seek help. One study of 86 bereaved caregivers with symptoms of prolonged grief disorder found that only 43% accessed mental health services [504].
177
EliteLearning.com/Psychology
Powered by FlippingBook