Grief and prolonged grief disorder — structured clinical viva

This is late-life bereavement with likely PGD: more than 12 months since death, yearning behaviours (setting place), avoidance, meaninglessness, social withdrawal, impairment, and passive reunion ideation. Tablets alone will not treat separation distress; engagement is the first clinical task.[1][4]

Diagnosis. Apply DSM-5-TR PGD criteria explicitly. ICD-11 would also be duration-eligible (≥6 months frame) with longing/preoccupation, emotional pain, cultural excess, impairment — state which system you are using.[4][5]

Differentials. Adaptive grief (severity/impairment/stalling argue against); MDD (screen fully — can co-occur; no bereavement exclusion); mild cognitive impairment/depression overlap in older adults; substances; PTSD only if trauma clusters about the dying process dominate.[4]

Risk. Expand passive wishes; means (medications); isolation; alcohol; protective factors (adult children, GP relationship). Safety plan and frequent review while engaging therapy.[4]

Therapy evidence. Cite CGT RCT superiority to IPT historically, elderly-specific CGT RCT, and optimising trial with citalopram questions. Name ingredients she can understand: learning how stuck grief works; goals for a life that still holds love; carefully revisiting the story of his death; gentle reconnection; rebuilding activities she values.[1][2][3]

Medication. Not first-line sole treatment for pure PGD. If comorbid MDD or severe depression blocking engagement, consider SSRI with geriatric caution (for example sertraline low and slow oral dosing with early review, fall risk, hyponatraemia vigilance, interaction check with her regimen) — still couple with grief-focused therapy.[3][4]

Engagement script. Validate love and yearning; reject false choice between loving him and accepting help; explain therapy aims to reduce suffering and avoidance, not erase him; offer a time-limited trial of sessions; involve family with consent.[1][4]