Psych Vivas · Old age psychiatry — grief and loss
Bereavement in later life — structured clinical viva
Fellowship viva covering late-life PGD criteria, widowhood risk, dual process, Shear 2014 CGT, selective medication, and practical care.
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Study tools
Target exams
FRANZCPMRCPsychABPNMD-DNB
Prompt
You are the old-age psychiatry registrar. A GP refers an 82-year-old woman 13 months after her husband's death. She still talks to his empty chair, cannot re-engage with bowls club, and says life has no meaning. Family want 'something to settle her nerves' and ask for diazepam. Discuss normal grief versus PGD (DSM and ICD clocks), differential from MDD and psychosis, dual-process model, suicide/self-neglect risk, CGT evidence including the elderly RCT, role of antidepressants, and why long-term benzodiazepines are a poor plan.
Interpretation
Reveal interpretationShowHide
Working formulation: likely prolonged grief disorder 13 months after spousal death with stalled restoration and meaning collapse. Confirm DSM-5-TR criteria (adult ≥12 months, yearning/preoccupation, additional symptoms, impairment, cultural-norm judgement). Screen carefully for comorbid MDD and for culturally congruent continuing bonds versus psychosis. Family request for diazepam is the wrong default — prioritise safety, practical supports, and grief-focused psychotherapy.[1][2][6]
References8ShowHide
- [1]Shear MK, Wang Y, Skritskaya N, et al. Treatment of complicated grief in elderly persons: a randomized clinical trial JAMA Psychiatry, 2014.PMID 25250737
- [2]Prigerson HG, Horowitz MJ, Jacobs SC, et al. Prolonged grief disorder: Psychometric validation of criteria proposed for DSM-V and ICD-11 PLoS Med, 2009.PMID 19652695
- [3]Stroebe M, Schut H The dual process model of coping with bereavement: a decade on Omega (Westport), 2010.PMID 21058610
- [4]Kendler KS, Myers J, Zisook S Does bereavement-related major depression differ from major depression associated with other stressful life events? Am J Psychiatry, 2008.PMID 18708488
- [5]Stroebe M, Schut H, Stroebe W Health outcomes of bereavement Lancet, 2007.PMID 18068517
- [6]Simon NM, Shear MK, Reynolds CF, et al. Commentary on evidence in support of a grief-related condition as a DSM diagnosis Depress Anxiety, 2020.PMID 31916663
- [7]Shear MK, Reynolds CF 3rd, Simon NM, et al. Optimizing Treatment of Complicated Grief: A Randomized Clinical Trial JAMA Psychiatry, 2016.PMID 27276373
- [8]Onrust SA, Cuijpers P Mood and anxiety disorders in widowhood: a systematic review Aging Ment Health, 2006.PMID 16798624