Features of Psychotherapy in Elderly Patients with Affective Disorders in the Outcome of a Pathological Reaction of Grief

The relevance of the work is due to the high prevalence and insufficient degree of study of the outcomes of the pathological reaction of grief (PRG) at a late age. Approaches to the treatment of these disorders, often carried out without taking into account the age factor, are not sufficiently developed. The various psychotherapeutic techniques used in PRG are contradictory and poorly structured. Solving these problems will not only achieve good quality remissions, but also prevent endogenization and chronification of mental disorders. The appearance of a new coronavirus infection, accompanied by high mortality, makes the problem of PRG therapy particularly relevant. Objective: to study the features of psychotherapy of depression in late-aged people with a history of PRG. Design: the work is a fragment of an open non-randomized study of patients with PRG, conducted in the Department of geriatric Psychiatry of the Federal State Budgetary Institution of the National Research Center. Inpatient patients over 60 years of age were studied. The clinical-psychopathological and catamnestic methods were used. Pharmaco-and psychotherapy was used. Results: 60 patients were examined, the majority were women, the average age was 66 years, patients with a first — time depressive episode prevailed-45% and recurrent depressive disorder — 28%. The majority (97.7%) of patients had delayed symptoms of PRG. The features of personality, age factors affecting the course of the disease and the peculiarities of psychotherapy are analyzed. Conclusions: the use of an integrated approach (a combination of psychopharmacotherapy and various types of psychotherapy) to the treatment of depressive disorders in the outcome of PRG is justified.

1. Bajbarina E.N., Makushkin E.V., Lysikov I.V., Chumakova O.V. Analiz jeffektivnosti sushhestvujushhih i napravlenija razrabotki dopolnitel'nyh mer po snizheniju smertnosti naselenija ot samoubijstv [Analysis of the effectiveness of existing and directions for the development of additional measures to reduce mortality from suicide].Rossijskij psihiatricheskij zhurnal [Russian Psychiatric Journal], 2017, № 1, pp. 75—76.
2. Bakanova A.A. Psihoterapija gorja: istorija stanovlenija i tekushhaja praktika v zarubezhnyh issledovanijah [Psychotherapy of grief: the history of formation and current practice in foreign studies].Konsul'tativnaja psihologija i psihoterapija. [Counseling psychology and psychotherapy], 2017, Vol. 25, no. 4, pp. 23—41. DOI: 10.17759/cpp.2017250403
3. Bek A., Frimen A. Kognitivnaja psihoterapija rasstrojstv lichnosti [Cognitive psychotherapy for personality disorders].Saint Petersburg: Piter, 2020, p. 448.
4. Vamik Volkan, Jelizabet Zintl. Zhizn' posle utraty: psihologija gorevanija [Life After Loss: Psychology of Mourning]. Moscow: Kogito-Centr, 2019,p. 160.
5. Vasiljuk F. Perezhit' gore [To survive grief].In Frolova I.T. (ed) O chelovecheskom v cheloveke [On the human in man]. Moscow: Politizdat, 1991, pp. 230—247.
6. Gnezdilov A.V. Psihologija i psihoterapija poter' [Psychology and psychotherapy of losses]. Saint Petersburg, 2002, p. 164.
7. Lindemann Je. Klinika ostrogo gorja [Clinic of acute grief]. In Viljunasa V.K., Gippenrejter J.B. [eds]. Psihologija jemocij [Psychology of emotions]. Moscow: Izd-vo Mosk. un-ta, 1984, pp. 78—86.
8. Lihi R. Svoboda ot trevogi. Spravit'sja s trevogoj, poka ona ne raspravilas' s toboj. [Freedom from anxiety. Deal with the anxiety before it deals with you]. Saint Petersburg: Piter, 2021, 368 p.
9. Malkina-Pyh I.G. Psihologija gorja i utraty. [The psychology of grief and loss]. Moscow: KnoRus, 2021, 282 p.
10. Moudi R., Arkjendzhel D. Zhizn' posle utraty. Kak spravit'sja s neschast'em i obresti nadezhdu [Life after loss. How to deal with adversity and find hope]. Moscow: Sofija, 2003, 288 p.
11. Savina M.A., Sheshenin V.S., Abdullina E.G. Diagnostika psihicheskih rasstrojstv u pozhilyh: sovremennye klassifikacii [Diagnosis of mental disorders in the elderly: modern classifications].Psihiatrija [Journal of Psychiatry], 2020, Vol. 18, no. 1, pp. 59—70. DOI: 10.30629/2618-6667-2020-18-1-59-70
12. Safarova T.P., Gavrilova S.I., Jakovleva O.B., Sheshenin V.S., Kornilov V.V., Shipilova E.S. Augmentacija karnicetinom terapii pozdnih depressij [Augmentation with carnicetin therapy of late depression]. Zhurnal nevrologii i psihiatrii im. C.C. Korsakova [Journal of Neurology and Psychiatry named after I. C.C. Korsakov], 2019, vol. 119, no. 5, p.65—75.
13. Starshenbaum G.V. Psihoterapija ostrogo gorja [Psychotherapy of acute grief]. Social'naja i klinicheskaja psihiatrija [Social and clinical psychiatry],1994, vol. 4, no. 3, pp. 73—77.
14. Tuhvatulina L.Sh. Posttravmaticheskoe stressovoe rasstrojstvo i jendogennye affektivnye zabolevanija (aspekty komorbidnosti) [Post-traumatic stress disorder and endogenous affective diseases (aspects of comorbidity)]. Psihiatrija [Psychiatry], 2004, no. 3, pp. 15—25.
15. Umanskij S.V. Tjazhelaja utrata i gore. Psihologicheskie i klinicheskie aspekty, [Bereavement and grief. Psychological and clinical aspects].URL: http://lifeyes. info/umanskij-tagelaja-utrata-i-gore/ (Accessed 15.01.2020)
16. Frejd Z. Pechal' i melanholija [Sadness and melancholy]. In Vilyunas V.C., Gippenreiter Yu.B. (eds.)Psihologija jemocij [Psychology of emotions].Moscow: Izd-vo Mosk. un-ta, 1984, pp. 174—186.
17. Holmogorova A.B., Garanjan N.G., Nikitina I.V., Pugovkina O.D. Nauchnye issledovanija processa psihoterapii i ee jeffektivnosti: sovremennoe sostojanie problemy. Chast' 1 [Scientific research of the process of psychotherapy and its effectiveness: the current state of the problem. Part 1]. Social'naja i klinicheskaja psihiatrija [Social and Clinical Psychiatry], 2009, vol. 19, no. 3,p.92—100.
18. Boelen P.A., Prigerson H.G. Commentary on the inclusion of persistent complex bereavement-related disorder in DSM-5. Death Studies, 2012, № 36 (9), pp. 771— 774. DOI: 10.1080/07481187.2012.706982
19. Clark A. Working with grieving adults. Advances in Psychiatric Treatment, 2004, vol. 10. DOI:10.1192/apt.10.3.164
20. Eisma M.C., Tamminga A., Smid G.E., Boelen P.A. Acute grief after deaths due to COVID-19, natural causes and unnatural causes: An empirical comparison. J. Affect Disord, 2021, № 278, рp. 54—56.DOI: 10.1016/j.jad.2020.09.049
21. Folstein M.F., Folstein S.E. , McHugh P.R. “Mini-mental state”.Journal of Psychiatric Research,1975, № 12(3), рp. 189—198. DOI: 10.1016/0022- 3956(75)90026-6
22. Hamilton M. A rating scale for depression. J. Neural.Neurosurg.Psychiatry, 1960, no. 23, рp. 56—62. DOI: 10.1007/springerreference_184614
23. Harris D. L., Winokuer H. R.When Grief Goes Awry: Identifying Complicated Grief and the Need for Professional Intervention Book Principles and Practice of Grief Counseling, 2019, pp. 165—166. DOI: 10.1891/9780826173331.0010
24. Iglewicz A., Shear M.K., Reynolds C.F., at all. Complicated grief therapy for clinicians: An evidence-based protocol for mental health practice. J. Depression and Anxiety, 2020, vol. 37, no. 1, pp. 90—98. DOI: 10.1002/da.22965
25. Iglewicz A., Zisook S. Grief, Complicated Grief and Bereavement-Related DepressionPsychiatric. Care of the Medical Patient, 2015, рp. 611—619. DOI: 10.1093/med/9780199731855.003.0029
26. Lund P.C. Deconstructing grief: a sociological analysis of Prolonged Grief Disorder. Soc Theory Health, 2021, рp. 186—200. DOI: 10.1057/s41285-020-00135-z
27. Maccallum F., Bryant R.A. Symptoms of prolonged grief and posttraumatic stress following loss: A latentclass analysis. Psychiatry, 2018. DOI: 10.1177/0004867418768429
28. Prigerson H.G., Maciejewski P.K. Rebuilding Consensus on Valid Criteria for Disordered Grief.JAMA Psychiatry, 2017, № 74 (5), р. 435. DOI:10.1001/ jamapsychiatry.2017.0293
29. Shear M.K., Simon N., Wall M., Zisook S. Complicated grief and related bereavement issues for DSM-5. Depression and anxiety, 2011, № 28 (2), рp. 103— 117. DOI: 10.1002/da.20780
30. Sheila A.M.,Rauch, Simon N. M, Rothbaum B. O. Rising Tide: Responding to the Mental Health Impact of the COVID-19. Pandemic, FOCUS, 2021, vol. 19, no. 2, pp. 243—246. DOI: 10.1176/appi.focus.19204