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持续性复杂丧亲之痛障碍:《精神疾病诊断与统计手册》第5版所提议类别的临床实用性与分类

Persistent complex bereavement disorder: clinical utility and classification of the category proposed for Diagnostic and Statistical Manual of Mental Disorders, 5th edition.

作者信息

Shimizu Kanako, Kikuchi Senichiro, Kobayashi Toshiyuki, Kato Satoshi

机构信息

Department of Psychiatry, Jichi Medical University, Tochigi, Japan.

Oyamafujimidai Hospital, Tochigi, Japan.

出版信息

Psychogeriatrics. 2017 Jan;17(1):17-24. doi: 10.1111/psyg.12183. Epub 2016 Jan 18.

Abstract

AIM

Persistent complex bereavement disorder (PCBD) was proposed as a bereavement-related clinical category in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, which included the disorder among conditions for further study. This is an independent clinical category in which intense yearning for the deceased continues for at least 12 months. However, the diagnostic features are still inconclusive. We suggest a variation of PCBD for making category from our clinical experiences.

METHOD

We presented two representative case studies in which grief caused by bereavement was observed as the root of the pathological condition. We examined the disorder's pathological conditions, diagnoses, and appropriate treatments based on the cases we experienced.

RESULTS

Both cases involved elderly women who lost their spouse through illness and experienced prolonged grief for an extended period, resulting in hospital admission. Based on the two cases, we believe that PCBD can also include a psychotic type with hallucinations as a major symptom. While studying PCBD, we took into account specific cultural characteristics of Japanese people and their present day social environment.

CONCLUSIONS

Such cases would be suggestive when determining the PCBD clinical category in the future. PCBD is considered to be clinically very useful, especially in an extremely aged society as seen in developed countries, including Japan.

摘要

目的

持续性复杂丧亲障碍(PCBD)在《精神疾病诊断与统计手册》第5版中被提议作为一种与丧亲相关的临床类别,该手册将其纳入需进一步研究的病症之中。这是一个独立的临床类别,其中对逝者的强烈思念会持续至少12个月。然而,其诊断特征仍不明确。我们根据临床经验提出一种PCBD的变体分类。

方法

我们展示了两个具有代表性的案例研究,其中观察到丧亲所致的悲痛是病理状况的根源。我们根据所经历的案例研究了该病症的病理状况、诊断及适当治疗方法。

结果

两例均为老年女性,她们因病失去配偶,并经历了长时间的悲痛,最终入院治疗。基于这两个案例,我们认为PCBD还可包括以幻觉为主要症状的精神病类型。在研究PCBD时,我们考虑了日本人的特定文化特征及其当今的社会环境。

结论

此类案例对未来确定PCBD临床类别具有提示作用。PCBD在临床上被认为非常有用,尤其是在包括日本在内的发达国家所呈现的极度老龄化社会中。

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