Volume 7 Issue 2 February, 2017
Fatal (!?) Greif Reaction
A 54 year old man was brought to my outpatient clinic with the history of abnormal behavior characterized
by crying spells, blank staring, unusual laughing to self, reduced interaction and speech, withdrawn behavior and
poor self-care, lethargy, reduced sleep and food intake since he lost his son 2 days back in a road traffic accident.
Though expected in the context, family members found laughing to self as unusual as he had never behaved this
way when he lost his wife 2 years back and never had any hospitalizations or major illness. After a thorough
physical and mental status examination, patient had reduced blink rate with blank expression on face, psychomotor retardation and mutism. Patient would follow simple verbal commands though with a delayed reaction time and localized pain accurately. There were no focal neurological deficits and normal reflexes. Differentials of acute stress reaction, grief reaction & catatonic state were formed in my mind and did explain them with a caution that I wanted to evaluate for any possible underlying neurological adversities and hence needs to be subjected to investigations including brain imaging. But the family members somehow seemed pretty convinced about the first few differential diagnoses and did not agree for admission and wanted medicines plus counseling for stress! I had to end up prescribing a sedating antidepressant and SOS basis hypnotic and said let’s postpone counseling for next visit! It was only after 2 days they rushed to hospital with the patient in an unresponsive state. They said they did forget telling that patient had several vomiting episodes before as they thought it may had been due to acidity for having skipped meals. Emergency CT brain revealed a large right parital bleed in MCA territory. It’s only then they agreed to take him to a more specialized neuro-emergency setup and stopped asking for counseling to make him talk! Time and again, such experiences give us opportunities to take the role as a doctor first and then attempt psychological approach even when there are seemingly convincing clinical picture with something else perilous underlying.
Dr. T. R. Srinivas, Professor & HOD, Dept. of Psychiatry, Basaveshwara Medical College & Research Center, Chitradurga
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