8) Dying, bereavement and sexual dysfunction Flashcards
Why are there less experiences of death in modern society?
- Fewer deaths at home
- Medicalisation of death
Why are death rates falling in England and Wales?
- Improvements in diet
- Medical advances
- Sanitation, housing etc
What is the current UK life expectancy at birth (2009-2011) for healthy men and women?
Men - 78.7 years
Women - 82.6 years
List the main three general factors that account for the largest diversity between groups, in death.
- Age
- Gender
- Socioecnomic status
What are the three main patterns of dying? (according to Clark and Seymour, 1999)
- Gradual death - slow decline in health/ability
- Catastrophic death - sudden/unexpected death
- Premature death - accident or illness in children
List the 5 stages of the Grief model suggested by Kübler-Ross in 1969.
- Denial
- Anger
- Bargaining
- Depression
- Acceptance
How can the first stage of the Grief model suggested by Kübler-Ross be dealt with clinically?
- Respect that it can be a coping mechanism and that they may desire “not to know”
- Offer written information for the patient to look at with the family
- Check and review so you can deal with it when they are ready.
What is grief?
A normal set of psychological and physical reactions to bereavement
What is mourning?
A process of adapting to the loss with an important focus often on the role of funeral rituals, going through their things and “saying goodbye”
What did Engel (1962) say about the grieving process?
- Disbelief and shock in early stages
- Developing awareness
- Resolution
What are some of the symptoms bereavement?
-Physical - shortness of breath, palpitations, fatigue, reduced immune function
-Behavioural - insomnia, irritability, crying, social withdrawal
-Emotional - depression, anxiety, anger, guilt, loneliness
–Cognitive - lack of concentration, memory loss, preoccupation, hopelessness, disturbance of identity, visual/auditory hallucinations
What are some of the risk factors for the development of chronic grief from poor bereavement? (Sheldon,1998)
-Prior bereavements
-Mental health
–Type of loss (young person, nature of death, caring status)
–Lack of social support
-Stress from other crises
Suggest two factors that can lead to complications in the grieving process.
-Expression of grief discouraged
–Ending of grief discouraged
Approximately what percentage of people adjust to bereavement within two years? (Parkes and Weiss 1983)
85%
N.B. 15% therefore experience chronic grief (PTSD, anxiety, depression)
How many people expressed a wish to die at home? How many actually did?
Between 56% and 74% people express a preference to die at home , but in 2006, only 35% of people died at home or in a care home
What is the Liverpool Care Pathway? What is its aim?
- The Liverpool Care Pathway for the Dying Patient (LCP) is a UK care pathway (excluding Wales) covering palliative care options for patients in the final days or hours of life.
- It has the aim to aid members of a multi-disciplinary team in matters relating to continuing medical treatment, discontinuation of treatment and comfort measures during the last days and hours of a patient’s life.
What are the main aims of palliative care?
- Improve quality of life
- Manage emotional and physical symptoms
- Support patients to live productively
- Give patients some control
How may a doctor feel when a patient they like dies?
- Failure
- Sadness
- Guilt/anger
- Reminder of mortality or own personal loss
Does the doctor have a right to express emotion after the death of the patient? What are the risks of showing emotion?
You can argue either way. If you agree you would say things like it’s a caring, holistic profession (empathy), acknowledging it with relatives, you are only human etc. If you don’t you say what the risks are:
- Burnout
- Different relationship with patient’s family - professionalism issues
- Affect clinical judgements
What are sexual dysfunctions?
A disturbance in sexual desire and in the psychophysiological changes that characterise the sexual response cycle and cause marked distress and interpersonal difficulty
What are the three components of the sexual response cycle? What has been suggested as the fourth one?
- Desire
- Arousal
- Orgasm
Resolution has been suggested as the fourth one
What are the three components required to diagnose a sexual dysfunction according to DSM IV?
1) Disruption in one of phases of the sexual response cycle
2) Marked distress
3) Interpersonal difficulties
What is the difference between primary and secondary vaginismus?
Primary vaginismus is here the muscles around the vagina suddenly and painfully contract (tighten) upon penetration. If it is primary this has happened since birth (tampon issues) and secondary (after a life event)
How might a sexual dysfunction occur?
- Problems may be lifelong
- Problems may be acquired
- Problems may be generalised or situational.
- Problems may be due to physical and/or psychological difficulties
What type of referral pathways are available to patients with sexual dysfunction?
- GUM
- Gynaecology units
- Ante or post natal services
- Family planning services
- Urology
- Psychiatry
- Pelvic pain clinic
- Voluntary sector
List the four main factors that can lead to sexual problems.
- Precipitating factors - history
- Predisposing factors - thoughts/past experience
- Perpetuating factors (self) - how you feel
- Perpetuating factors (partner) - how they feel
Describe what Masters and Johnson introduced in the 1970s. What was their basic assumption?
Introduced a behavioural approach, focusing on immediate causes in short-term, target directed therapy. With the assumption that attitudes, ignorance and anxiety are responsible for the majority of sexual dysfunctions.
What are the main components of psychosexual therapy?
- Educative counselling
- Modification of attitudes/beliefs
- Facilitation of communication/assertiveness
- Specific directions for sexual behaviour (sensate focus, dilator therapy, stop-start)
What physical treatments are available for sexual dysfunction in males?
- Oral therapy eg Viagra, Cialis, testosterone, SSRIs
- Local therapy eg EMLA cream
- Self injection therapy
- Mechanical therapy eg pumps, rings
- Surgery eg penile implant
What physical treatments are available for sexual dysfunction in females?
- Testosterone
- Lubricants
- Oestrogen
- Clitoral Therapy Device (EROS)
- Zestra gel
