Tag: prolonged grief disorder

Reading of the Week: When Does Grief Become a Disorder? The Lancet Review; Also, Time to End Daylight Saving Time? And Dr. Hickey on Her Anxiety

May 8, 2025 /

From the Editor

After the unexpected loss of his spouse, my patient sank deeply into grief. He was tearful during our sessions, explaining that a part of him had died, too. Weeks turned to months. Was this a normal response to a profound loss? Or something more problematic? DSM-5 seeks to clarify the issue by recognizing prolonged grief disorder – though the disorder is controversial and has attracted much criticism. When The New York Times covered the topic in 2022, Joanne Cacciatore (of Arizona State University) commented: “I completely, utterly disagree that grief is a mental illness.”

Clare Killikelly (of the University of Zurich) and her co-authors shed light on prolonged grief disorder with a new review, just published in The Lancet. They write about the disorder, the differences from grief, its treatment, and more, drawing on 142 citations. “Grief is a universal experience. However, for a minority of individuals, grief becomes a debilitating, devastating mental health disorder with serious implications on a personal and societal level.” We examine the review, highlight four take-aways, and reflect on the broader debate.

Spring forward, fall back. Twice a year, we adjust our clocks (and our brains) to and from daylight saving time. In the second selection, Dr. David Dongkyung Kim (of the University of Toronto) and his co-authors argue that daylight saving time should be eliminated. In their JAMA Commentary, they draw on the literature. “Daylight saving time transitions cause acute disruptions in human circadian rhythm, and the medical literature shows detrimental effects for public health.”

Finally, in the third selection, Dr. Joanne Hickey (of Memorial University) discusses anxiety and her expectations. In a personal CMAJ paper, the hematologist reflects on her work – and on her own journey, including her anxiety, the decision to take medications, and her need to come to terms with her perfectionism. “Anxiety has been my life companion, though I often didn’t recognize it. It masqueraded as that internalized need to control.”

DG

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Reading of the Week: CBT vs Mindfulness for Prolonged Grief Disorder – the New JAMA Psych Study; Also, Wildman on Her Grief, and Clozapine & MedEd

July 11, 2024 /

From the Editor

She still wears black. She mourns her partner’s death every day. Despite the passing years, she can’t seem to move forward. DSM-5-TR includes prolonged grief disorder, which has sparked controversy, but it explains well my patient’s complicated bereavement.

What’s evidenced for treatment? Is CBT superior to mindfulness? Richard A. Bryant (of the University of New South Wales) and his co-authors try to address these questions in a new JAMA Psychiatry paper. They describe a randomized clinical trial involving 100 adults offered CBT or mindfulness-based cognitive therapy. “In this study, grief-focused cognitive behavior therapy conferred more benefit for core prolonged grief disorder symptoms and associated problems 6 months after treatment than mindfulness-based cognitive therapy.” We consider the paper and its implications.

In the second selection, Sarah Wildman, a writer and editor, discusses her daughter’s death in an essay for The New York Times. She is candid about her grief. She talks about the passage of time, small things like calendars, and, yes, signs – her daughter promised that if she sees a red fox, it will be her. “I wonder if I should keep every item of clothing I can picture Orli in, I wonder what she would say about each movie I see, each book I read.”

In the third selection, Dr. Theodore R. Zarzar (of the University of North Carolina) emphasizes the importance of clozapine in the treatment of patients with schizophrenia. In his JAMA Psychiatry Viewpoint, he argues for incorporating clozapine proficiency into medical education. “Clozapine initiation can be conceptualized as the community psychiatric equivalent of a procedural skill and deserves the mentorship, knowledge acquisition, and practice that learning a procedure entails.”

DG

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Reading of the Week: Way Up – Alcohol-Related Deaths During the Pandemic (JAMA); Also, Addressing the Opioid Crisis (CJP) and the NYT on Grief

March 31, 2022 /

From the Editor

Three patients have recently told their stories to me. With his business failing, he turned to alcohol. When she couldn’t get hours at the restaurant because of the lockdown, she started drinking in the mornings. After a decade of sobriety, he explained that he found comfort in alcohol after his job loss.

These stories aren’t, unfortunately, surprising. With the pandemic, substance use appears to be on the rise. But what about substance-related deaths? In the first selection, we look at a new research letter from JAMA. Aaron M. White (of the National Institute on Alcohol Abuse and Alcoholism) and his co-authors examine alcohol-related deaths in the United States and the impact of the pandemic. They conclude: “The number and rate of alcohol-related deaths increased approximately 25% between 2019 and 2020, the first year of the COVID-19 pandemic.” We consider the paper and its clinical implications.

In the second selection, Dr. Tony P. George (of the University of Toronto) and his co-authors focus on the opioid crisis. In this Canadian Journal of Psychiatry commentary, they argue for a stronger approach to help those with opioid use disorder (OUD), specifically by improving the psychosocial interventions available. “While psychosocial interventions are often expensive and time consuming, they do make a difference in the lives of patients with OUD and those at risk for fatal opioid overdoses, especially when combined with broad psychosocial supports that address social determinants of health.”

And in the third selection, continuing our consideration of the first update to the DSM series in nine years, we look at a New York Times article, just published. Reporter Ellen Barry writes about prolonged grief disorder: “The new diagnosis was designed to apply to a narrow slice of the population who are incapacitated, pining and ruminating a year after a loss, and unable to return to previous activities.”

DG

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Reading of the Week: Cannabis & Driving – a New RCT; Also, Prolonged Grief Disorder (JAMA Psych) and the Life and Legacy of Alan A. Stone (NYT)

February 10, 2022 /

From the Editor

It’s legal. It’s readily available. What are the implications for road safety?

Cannabis is the focus of more and more research. Little, though, has been studied for its effects on driving. In the first selection, Thomas D. Marcotte (of the University of California San Diego) and his co-authors consider cannabis and driving performance. In a new paper for JAMA Psychiatry, they report on an RCT: “In a placebo-controlled parallel study of regular cannabis users smoking cannabis with different THC content ad libitum, there was statistically significant worsening on driving simulator performance in the THC group compared with the placebo group.” We consider the paper and its clinical implications.

Next month, the American Psychiatric Association releases DSM-5-TR, the first major update to the DSM series in nine years. Though the diagnostic criteria of several disorders have been revised, there is only one new disorder: prolonged grief disorder. In the second selection, Holly G. Prigerson (of Cornell University) and her co-authors write about it for JAMA Psychiatry. “PGD is a serious mental disorder that puts the patient at risk for intense distress, poor physical health, shortened life expectancy, and suicide.”

Finally, in the third selection, we consider the life and legacy of Dr. Alan A. Stone, a psychiatrist who passed at the age of 92. In his obituary for The New York Times, reporter Clay Risen describes his incredible career – as a psychoanalyst, a Harvard professor (in both the faculties of law and medicine), and a former president of the American Psychiatric Association who championed dropping homosexuality as a psychiatric disorder.

DG

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