II. Definitions
- Preparatory Grief
- Grief experienced by a dying patient or loved one
III. Signs (as differentiated from Major Depression)
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Grief waxes and wanes over time
- Depression is constant dysphoria and flat affect
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Grief often diminishes over time
- Depression does not improve without treatment
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Grief maintains some self image, pleasure, and hope
- Depression loses these out of proportion to condition
- Depression associated symptoms
- Sense of worthlessness
- Anhedonia
- Hopelessness
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Grief allows for intermittent social withdrawal
- Depression associated with constant isolation
- Depressed patients do not enjoy social interaction
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Grief may cause Agitation early in the course
- Depression may cause persistent Agitation
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Grief may desire an early death (e.g. suffering, pain)
- Depression: Suicidal despite adequate symptom relief
IV. Differential Diagnosis: Major Depression
- See Depression in Cancer
- Focus questions to differentiate grief from depression
- Are you feeling depressed most of the time?
- Are you better off than others in similar situation?
- References
V. Management (Mnemonic: RELIEVER)
- Reflect (acknowledge feelings about condition, death)
- Empathize (identify with their condition)
- Lead (hone in on areas of concern, coping strategies)
- Improvise (adapt to individual patient's needs)
- Educate (discuss grief features - see signs above)
- Validate (grief is a normal reaction to dying)
- Recall (discuss accomplishments or special times)
- Reference
VI. Management: Additional Measures
- Addressing spiritual issues may be helpful
- Listening to patient talk about faith and end-of-life
- Be supportive, without offering spiritual advice
- Physician should avoid discussing own beliefs
- Avoid persuading patients and family against faith
- Example: Resuscitation in context of Religion
- Religious leaders best suited to put in perspective
- Reference