Psykiatriske patienter med patologiske sorgreaktioner

Abstract

The article describes the diagnostical and therapeutic problems, psychiatric patients with pathological grief exhibit. The grief reactions can be divided into stress-specific reactions (typical, chronic, inhibited, and delayed grief) and non-specific and mixed reactions (distorted grief). It is especially in the latter group the diagnostical difficulties show up. The reason is, that the symptomatology in these cases is very diffuse and the clinical picture may look like many other psychiatric diseases. A case with the clinical picture of depression caused by pathological grief is discussed in relationship to other kinds of depression. Regarding psychiatric patients it is often difficult to unveil the trauma/loss. In some patients there will be more than one loss, and the problem is to find out which one has caused the symptoms. Besides, sometimes the traumatic loss is unconscious. In order to unveil the trauma we have used a combined physio-psychotherapy, which in the uncovering phase is characterized by a therapeutic non-directive attitude, where the patient is grounded, relaxed, concentrated, and as close to himself as possible in order to facilitate thoughts, emotions, body sensations etc. to emerge. When you have identified the type of loss, the therapy follows the basic principles: The inhibited emotions must be expressed and painful situations must be repeated until the emotions are extinguished. During the therapy the psychiatric patient will be in danger of becoming psychotic or committing suicide, and often it has been necessary to apply psychopharmaca to accomplish the therapy, even if many authors warn against it. The difficulties of treating hospitalized patients with pathological grief are to my opinion counterbalanced by the advantages of the in-patient psychiatric department, where you have the possibility of using various kinds of professionals, whose combined methods of treatment may ensure a successful therapy.