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      Mania Following Bereavement: State of the Art and Clinical Evidence

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          Abstract

          Bereavement is the state of loss, determined in most of the cases by the death of a close person. It is probably the greatest sorrow that can occur in an individual life. Grief is a normal, healthy response to loss, evolving through stages in the process of mourning. In some cases, bereavement may lead to the outburst of manic episode: despite literature data being scarce, reports have explored this important clinical entity, variously called as “funeral mania” or “bereavement mania”. We systematically reviewed the literature exploring the possible relationships between bereavement and the onset of a manic episode, both first or recurrent pre-existing episode, besides describing a case report on a manic episode in the aftermath of a loss event, with an accurate evaluation of prior mild mood spectrum instability, supporting the role of loss-events as potential risk factor for bipolar illness progression. This article tries summarizing existing evidence on the debate whether clinicians should consider mania as a possible bereavement reaction.

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          Most cited references50

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          The burden of loss: unexpected death of a loved one and psychiatric disorders across the life course in a national study.

          Unexpected death of a loved one is common and associated with subsequent elevations in symptoms of multiple forms of psychopathology. Determining whether this experience predicts novel onset of psychiatric disorders and whether these associations vary across the life course has important clinical implications. The authors examined associations of a loved one's unexpected death with first onset of common anxiety, mood, and substance use disorders in a population-based sample.
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            Attachment, loss, and complicated grief.

            Bereavement is a highly disruptive experience that is usually followed by a painful but time-limited period of acute grief. An unfortunate minority of individuals experience prolonged and impairing complicated grief, an identifiable syndrome that differs from usual grief, major depression, and other DSM IV diagnostic entities. Underlying processes guiding symptoms are not well understood for either usual or complicated grief. We propose a provisional model of bereavement, guided by Myron Hofer's question "What exactly is lost when a loved one dies?" We integrate insights about biobehavioral regulation from Hofer's animal studies of infant separation, research on adult human attachment, and new ideas from bereavement research. In this model, death of an attachment figure produces a state of traumatic loss and symptoms of acute grief. These symptoms usually resolve following revision of the internalized representation of the deceased to incorporate the reality of the death. Failure to accomplish this integration results in the syndrome of complicated grief. Copyright 2005 Wiley Periodicals, Inc.
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              Depression, Serotonin and Tryptophan.

              Depression is a major cause of worldwide disability. Although its etiology is unclear, for over sixty years the study of its pathophysiology has focused mainly on serotonin (5-HT) and serotonergic neurotransmission. Generally, the study of the pathophysiological processes underpinning depression have led to the appreciation of its complexity, although such study continues to support the role of 5-HT in this disorder. The aim of this review is to briefly summarize the available findings on 5-HT and depression, with a special focus on alterations in tryptophan (TRP) metabolism that can shift from 5-HT synthesis towards other, potentially neurotoxic, compounds, such as the tryptophan catabolite, quinolinic acid. The evidence that the TRP shunt may be promoted by stress hormones and proinflammatory cytokines strongly supports the notion that depression should now be considered a systemic disorder that can be triggered by different factors that ultimately target the 5-HT system in vulnerable individuals. In addition, such intriguing findings suggest biochemical targets for novel treatment options in depression.
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                Author and article information

                Contributors
                Journal
                Front Psychiatry
                Front Psychiatry
                Front. Psychiatry
                Frontiers in Psychiatry
                Frontiers Media S.A.
                1664-0640
                06 May 2020
                2020
                : 11
                : 366
                Affiliations
                [1] 1Department of Clinical and Experimental Medicine, University of Pisa , Pisa, Italy
                [2] 2Columbia University School of Social Work , New York, NY, United States
                Author notes

                Edited by: Geert E. Smid, Stichting Centrum ‘45, Arq Psychotrauma Expert Group, Netherlands

                Reviewed by: Aislinn Joanmarie Williams, University of Iowa, United States; Paul Boelen, Utrecht University, Netherlands

                *Correspondence: Martina Corsi, dott.martinacorsi@ 123456gmail.com

                This article was submitted to Mood and Anxiety Disorders, a section of the journal Frontiers in Psychiatry

                Article
                10.3389/fpsyt.2020.00366
                7218050
                3e4c109a-e9a2-45c7-be16-727ebd0583ad
                Copyright © 2020 Carmassi, Shear, Corsi, Bertelloni, Dell’Oste and Dell’Osso

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 28 November 2019
                : 14 April 2020
                Page count
                Figures: 1, Tables: 1, Equations: 0, References: 56, Pages: 7, Words: 3283
                Funding
                Funded by: Università di Pisa 10.13039/501100007514
                Categories
                Psychiatry
                Perspective

                Clinical Psychology & Psychiatry
                funeral mania,bereavement,complicated grief,bipolar disorder,manic episode,manic onset

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