decreased appetite, sadness, crying spells, guilt

[usmlestudy]

56 year-old female comes to see you 20 days after her husband died. Her complaints include: decreased appetite, sadness, crying spells, guilt. Sometime she sees her husband on a street and realizes that this is not him. She denies suicidal thoughts. Patient most likely has which of the following:



A Major depression
B Bipolar disorder
C Adjustment disorder
D Posttraumatic stress disosrder
E Normal grief
F Somatization disorder
G Panic disorder
H Pathologic grief

[usmlestudy]

Originally Posted by usmlestudy

56 year-old female comes to see you 20 days after her husband died. Her complaints include: decreased appetite, sadness, crying spells, guilt. Sometime she sees her husband on a street and realizes that this is not him. She denies suicidal thoughts. Patient most likely has which of the following:



A Major depression
B Bipolar disorder
C Adjustment disorder
D Posttraumatic stress disosrder
E Normal grief
F Somatization disorder
G Panic disorder
H Pathologic grief

E. This is normal grief.

[Asclepius1]

Originally Posted by usmlestudy

E. This is normal grief.

Why is this a normal grief versus major depression or adjustment disorder?

[usmlestudy]

Originally Posted by Anonymous

Why is this a normal grief versus major depression or adjustment disorder?

The timing of the symptoms will tell you if it is normal grief or adjustment disorder or major depression. Here is the DSM IV criteria to adjustment disorder


1. Behavioral or emotional symptoms must develop in response to an identifiable event(s) and occur within [highlight=red:21d52b98be]three months[/highlight:21d52b98be] of the onset of that event(s) / stressor(s).

2. These behaviors or symptoms must be clinically significant as evidenced by at least one of the following:
A. After exposure to the event(s) / stressor(s), the behavioral or emotional symptoms seem in excess of what would be normally expected.
B. Significant social, functioning, or occupational impairment..

3. The disturbance does not meet the criteria for another specific Axis I disorder or is not part of a preexisting Axis I or Axis II disorder.

4. The behavioral or emotional symptoms do not represent Bereavement.

5. Once the event(s) / stressor(s) has terminated, the [highlight=red:21d52b98be]symptoms do not last more than an additional six months.[/highlight:21d52b98be]
Acute: Last less than six months.

Chronic: Last for six months or longer. By definition the disturbance can not last longer then six months. Only use the chronic specifier if the disturbance is in response to a chronic event(s) / stressor(s).

[Asclepius1]

Human does not grief that long. She must have pathological grief.

[Asclepius1]

Originally Posted by Anonymous

Human does not grief that long. She must have pathological grief.

20 days is not that long. It is normal. I assured you.

[Asclepius1]

Adjustment disorder

[Asclepius1]

Originally Posted by Anonymous

Adjustment disorder

I don't think that is an adjustment disorder because she has the grief for such a short time. You grief when you lost a love one that is a normal human reaction.

Adjustment disorder is an exclusion Dx.
Is clearly a normal grief.

[chanderpaul]

Well I can understand all these factors can be attributed to normal grief but I have seen persons who never tend to overcome this problem. It is quite natural for these problems to be prevalent in a person owing to the loss of a dear person but then as we all know time is the best healer and with the passing time one should certainly overcome the said issues. So provided these issues stay longer then expected what can this situation be called?