Cultural Manifestations of Bereavement in a Chinese American Patient

Complicated bereavement, or prolonged grief disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), is associated with an increase in medical and psychiatric comorbidities, which include somatic symptoms and even rare cases of psychosis.¹ Grief may present variably due to significant individual and cultural differences.²

Shenjing shuairuo, characterized by fatigue, concentration problems, dizziness, memory loss, and insomnia, is a Chinese cultural concept of distress described in the DSM-5.³ It is reminiscent of neurasthenia, present in earlier versions of the DSM. The etiology of shenjing shuairuo is still unclear; however, there does appear to be an association with acute psychosocial stressors.⁴ Although originating in China, shenjing shuairuo occurs in Asian Americans at a prevalence of 6.4%.⁵

Capgras syndrome is a delusional disorder that involves the belief that a familiar acquaintance, often a family member or close friend, has been replaced by an imposter.⁶

Case Report

A 54-year-old Chinese American woman with no previous psychiatric history experienced the unexpected death of her husband in July 2023. Weeks later, she began to have new-onset anxiety, nervous fatigue, concentration problems, insomnia, impaired short-term memory, and confusion. She received diagnoses such as major depressive disorder, generalized anxiety disorder, prolonged grief disorder, and cluster B traits and was subsequently prescribed medications such as mirtazapine, propranolol, quetiapine, sertraline, valproate, and clonazepam over the next 5 months with minimal efficacy.

Her confusion persisted, which led to medical hospitalization and psychiatric consultation. During the assessment, the patient’s family explained that she immigrated to the United States in her thirties and considered Mandarin Chinese her primary language, and thus, a Mandarin-speaking resident was introduced to her care. The patient exhibited significant confusion, restlessness, and anxiety but was ultimately cleared for discharge by the medical team after laboratory tests and imaging appeared unremarkable. These included a complete blood count, comprehensive metabolic panel, electrocardiogram, ethanol, urinary drug screen, urinalysis, thyroid-stimulating hormone, vitamin B₁₂, folate, infectious mononucleosis, and computed tomography of the head. A provisional diagnosis of prolonged grief disorder was given.

These symptoms continued to persist and worsen after discharge, and the patient alternated between periods of not recognizing her family and believing them to be imposters. Eventually, the patient became aggressive, the police were called. The patient spent 21 days in an inpatient psychiatric facility, requiring seclusion and restraints multiple times due to aggressive behavior and elopement attempts. A Montreal Cognitive Assessment⁷ administered early in admission resulted in a score of 21/30, indicating mild cognitive impairment. The laboratory tests previously performed were repeated, along with an N-methyl-D-aspartate receptor antibody test, but results continued to be unremarkable.

She received a diagnosis of brief psychotic disorder, and risperidone was initiated. She was transitioned to risperidone 25 mg intramuscularly every 2 weeks due to the severity of her psychosis and concerns for adherence. Venlafaxine extended release was started for anxiety and apathy, titrated to 150 mg daily. Her psychotic symptoms resolved, and discharge followed. Discussion of diagnosis with family at discharge included the Chinese cultural concept of distress shenjing shuairuo, and she was scheduled with the Mandarin-speaking resident for outpatient treatment.

Discussion

This case highlights the nosological difficulties of applying Western psychiatric concepts to cultural minorities. We see this case precipitated through complicated bereavement, leading to a neurasthenia prodrome and progressing to first-break psychosis with Capgras delusions.

In summary, this case highlights the importance of applying the biopsychosocial model, the cultural formulation interview, and cultural humility to provide patients with culturally informed care. Traditional biomedical models of illness may not be sufficient to capture the entire spectrum of mental illness, particularly in minority populations.⁸ Combining Eastern and Western perspectives may lead to better rapport and treatment outcomes.⁸

Article Information

Published Online: April 16, 2026. https://doi.org/10.4088/PCC.25cr04115
© 2026 Physicians Postgraduate Press, Inc.
Prim Care Companion CNS Disord 2026;28(2):25cr04115
Submitted: October 18, 2025; accepted January 9, 2026.
To Cite: Wang L, Kershaw K, Kim JH, et al. Cultural manifestations of bereavement in a Chinese American patient. Prim Care Companion CNS Disord. 2026;28(2):25cr04115.
Author Affiliations: Department of Psychiatry, Central Michigan University, Saginaw, Michigan (all authors).
Corresponding Author: Larry Wang, MD, 1000 Houghton Avenue, Saginaw, MI 48602 ([email protected]).
Relevant Financial Relationships: None.
Funding/Support: None.
Patient Consent: Consent was received from the patient to publish the case report, and information has been de-identified to protect patient anonymity.