Treating complicated grief.
Treating complicated grief.
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DOI：
10.1001/jama.2013.8614
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发表时间：
2013-07-24
期刊：
影响因子：
--
通讯作者：
Simon NM
中科院分区：
文献类型：
--
作者：
Simon NM
亲人的去世是生命中最大的普遍压力之一，大多数失去亲人的人无需临床干预即可成功适应。对于少数失去亲人的人来说，悲伤因叠加的问题而变得复杂，并且无法治愈。由此产生的复杂悲伤综合症即使在失去亲人多年后也会造成严重的痛苦和功能障碍，但知道何时以及如何进行干预可能是一个挑战。根据现有证据和临床观察，讨论复杂性悲伤的鉴别诊断、危险因素和治疗。 MEDLINE 的检索时间为 1990 年 1 月至 2012 年 10 月。其他引文来自选定的研究和评论文章的参考文献。包括针对复杂悲伤的现有治疗研究。大量的研究文献导致将复杂性悲伤纳入《精神疾病诊断和统计手册》（第五版）（称为持续性复杂性丧亲障碍，作为其他特定创伤和压力源相关障碍的亚型），尽管正式建议对此进行更多研究，并且关于该障碍的最佳名称和诊断标准的讨论仍在进行中。有可靠的筛查仪器，估计丧亲者的患病率为 7%。随机对照数据支持有针对性的心理治疗的功效，包括促进解决复杂问题和促进自然愈合过程的要素。初步研究表明抗抑郁药物可能有帮助。患有复杂悲伤的人出现不良健康结果的风险更大，应诊断和评估自杀风险以及抑郁症和创伤后应激障碍等共病，并应考虑治疗。
The death of a loved one is one of life’s greatest, universal stressors to which most bereaved individuals successfully adapt without clinical intervention. For a minority of bereaved individuals, grief is complicated by superimposed problems and healing does not occur. The resulting syndrome of complicated grief causes substantial distress and functional impairment even years after a loss, yet knowing when and how to intervene can be a challenge. To discuss the differential diagnosis, risk factors for and management of complicated grief based on available evidence and clinical observations. MEDLINE was searched from January 1990 to October 2012. Additional citations were procured from references of select research and review articles. Available treatment studies targeting complicated grief were included. A strong research literature led to inclusion of complicated grief in the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (termed persistent complex bereavement disorder as a subtype of other specified trauma and stressor-related disorders), although it is a condition for which more research is formally recommended, and there is still ongoing discussion about the optimal name and diagnostic criteria for the disorder. Reliable screening instruments are available, and the estimated prevalence rate is 7% of bereaved people. Randomized controlled data support the efficacy of a targeted psychotherapy including elements that foster resolution of complicating problems and facilitate the natural healing process. Preliminary studies suggest antidepressant medications may be helpful. Individuals with complicated grief have greater risk of adverse health outcomes, should be diagnosed and assessed for suicide risk and comorbid conditions such as depression and posttraumatic stress disorder, and should be considered for treatment.