Abstract
Bereavement is the state of loss, determined in most of the cases by the death of a close person. It is probably the greatest sorrow that can occur in an individual life. Grief is a normal, healthy response to loss, evolving through stages in the process of mourning. In some cases, bereavement may lead to the outburst of manic episode: despite literature data being scarce, reports have explored this important clinical entity, variously called as “funeral mania” or “bereavement mania”. We systematically reviewed the literature exploring the possible relationships between bereavement and the onset of a manic episode, both first or recurrent pre-existing episode, besides describing a case report on a manic episode in the aftermath of a loss event, with an accurate evaluation of prior mild mood spectrum instability, supporting the role of loss-events as potential risk factor for bipolar illness progression. This article tries summarizing existing evidence on the debate whether clinicians should consider mania as a possible bereavement reaction.
Highlights
Increasing interest has been recently devoted to psychopathological reactions to loss and evidences have supported the existence of a specific clinical diagnosis addressing about 7–20% of subjects who develop long-lasting symptoms of intense grief, that interfere with adaptation and re-engagement in life, differently named as Complicated Grief (CG), Traumatic Grief or Prolonged Grief Disorder [1, 2], characterized by persistent desire and pervasive yearning of the deceased person, deep pain and frequent crying or worrying [3,4,5,6,7,8]
Seven papers were included in the present manuscript, reporting 15 case reports: three of these reports were excluded after being completely read and evaluated, as they describing manic relapse following bereavement in patients with a diagnosis of Bipolar Disorder [16,17,18,19,20,21,22]
Bereavement could lead to several pathological reactions, whose most common, experienced by up to 7% of bereaved people, is CG [53, 54]
Summary
Increasing interest has been recently devoted to psychopathological reactions to loss and evidences have supported the existence of a specific clinical diagnosis addressing about 7–20% of subjects who develop long-lasting symptoms of intense grief, that interfere with adaptation and re-engagement in life, differently named as Complicated Grief (CG), Traumatic Grief or Prolonged Grief Disorder [1, 2], characterized by persistent desire and pervasive yearning of the deceased person, deep pain and frequent crying or worrying [3,4,5,6,7,8]. The death of a loved one may trigger the onset or the worsening of mental disorders, Major Depression Disorder (MDD) and Post-Traumatic Stress Disorder (PTSD), different reactions have been described in the literature in the framework of a loss event, such as mania [10, 11]. This is interesting, considering the possible partial clinical and neurobiological overlap between grief reaction, mood disorder and PTSD [12,13,14]. “Funeral mania” refers to a typical manic episode occurring within one week from the death of a close relative or friend, while “bereavement mania” is considered to be a kind of
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