Grief

In patients who have experienced a loss prepare them for the types of reactions (e.g., emotional, physical, varying length) they may have.
In all grieving patients, especially those with a prolonged or complex grief reaction:
1. Inquire about depression, suicidal ideation, self-medication, and alcohol and substance use
2. Consider the requirement for additional treatments or referral
Recognize that grief reactions may vary based on the individual’s context and experiences; life cycle and developmental stages; and cultural and family contexts.
In patients with presentations suggestive of grief reactions without obvious triggers look for triggers that may be unique to each patient (e.g., death of a pet, loss of a job, reactions to anniversary).
In patients with unexplained or unresponsive physical or mental health concerns; alcohol or substance use; or functional or behavioural change ask about loss and/or grief as possible contributing factors.

Adaptive response to loss (includes physical, emotional, cognitive, behavioral, and spiritual responses)
- Acute grief can be intense and disruptive, but usually is integrated over time (usually 6-12 months)
- Complicated grief is a form of acute grief that is abnormally prolonged, intense, and disabling
In grief, symptoms come in waves (mixed with positive memories) and decreases over time, daily function is difficult initially but manageable
- Denial, anger, disbelief, yearning, anxiety, sadness, helplessness, guilt, sleep and appetite changes, fatigue, and social withdrawal
Differentiate from depression
- Severe persistent symptoms, persistent decreased function, suicidal ideation
Management
- Acknowledge the loss and the associated grief
- Actively listen to and explore patients' concerns, reinforce patients' strengths in coping with their illness
- Encourage external sources of support including family, friends, and faith communities, or support groups
- Consider psychotherapy if requests or in complicated grief

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