Grief in chronic illness: assessment and management

Grief is a normal reaction to the loss of physical function. Its symptoms, however, are often mistaken for major depressive episode and treatment may be inappropriate. Symptoms of grief include a preoccupation with the lost object (a limb, a function, a loved one), somatic distress, inappropriate behavior, hostility, and denial. Depression may be a manifestation of illness or drug therapy. Grief should be treated like a major depressive episode but without antidepressive medications. The first step in management of grief is the development of a proper therapeutic milieu which will encourage the reappearance of self worth. Once the milieu is established, specific rehabilitation problems can be addressed. In formulating a prognosis, it is important to consider the severity of the patient's disability, the premorbid psychologic make-up, and the type of family and community support available to the patient.