Acute Stress Disorder/Grief and bereavement - MH Flashcards
1
Q
Acute Stress Disorder-Basics
A
- acute stress reaction
- occurs during initial month after traumatic event after a month would be PTSD
- may progress to Posttraumatic Stress Disorder (PTSD)
2
Q
Acute Stress Reaction-Epidemiology
A
- Prevalence b/w 5-20% following trauma
- Prevalence depends on severity/nature of event
Specific types of trauma:
- Witnessing a mass shooting - Assault - MVA - Mild traumatic brain injury - Burn - Industrial accident
3
Q
Acute Stress Reaction-Risk Factors
A
- Hx of pre-trauma psychiatric disorder
- Hx of traumatic events prior to recent exposure
- Female gender
- Severity of trauma
- Neuroticism
- Avoidant coping skills
4
Q
Acute Stress Reaction-Sxs
A
Clinical Presentation:
- Severe anxiety in response to reminders of traumatic event
- Reactions tend to be activated in multiple situations – lots of triggers
- May develop amnesia to some aspects of the event – everything up to a certain point
- Generalized fears of subsequent threats – worry that it will happen again
- Engagement in avoidance strategies
5
Q
Acute Stress Reaction
A
- Sxs typically severe in initial days/wks after trauma
- Majority of people adapt and sxs resolve
- Some individuals go on to develop PTSD
6
Q
Acute Stress Reaction-Diagnosis
A
- Disturbance lasts minimum of 2 days, maximum of 4 wks
- Actual or threatened death/injury causing intensely fearful response
- Dissociative sxs (at least 3) during or after event (numbing/detachment, depersonalization, amnesia, reduced awareness of surroundings)
- Event is re-experienced (nightmares, flashbacks etc.)
- Avoidance of conversations, situations etc. that provoke memories of the event
- Anxiety or increased arousal (hypervigilance, insomnia, poor concentration, startle response etc.)
- Sxs cause significant impairment in social, occupational, or other areas of functioning
- Disturbance is NOT due to effects of a substance or other underlying condition
7
Q
Acute Stress Reaction-Tx
A
- Trauma-focused cognitive behavioral therapy (first-line*)
- Reduces sxs and progression to PTSD
- Short-term use of Benzodiazepines
- Reduces anxiety, agitation, insomnia
-Some individuals will adapt w/o formal interventions (25-50%)
8
Q
Grief and Bereavement-Basic Terms
A
- Death is the most powerful stressor in everyday life
- Effects on others may be intense and long-lasting
- Bereavement: reaction to the loss of a close relationship
- Grief: response caused by a loss including pain, distress, physical suffering, and emotional suffering
- Mourning: psychological process a bereaved person uses to untie bonds w/the deceased
- Anticipatory grief: when an individual is aware of an impending death -may take on many forms (sadness, anxiety, attempts to reconcile relationships etc.)
9
Q
Types of Grief-Normal grief
A
- Normal grief reaction: immediately following death (anticipated or not)
- Often includes feelings of numbness, shock, intense sadness, emptiness, yearning for deceased, anxiety about the future
- “Going through the motions” (financial matters, funeral arrangements)
- Anger may occur, survivor often replays events and ruminates over missed opportunities
- Grief often comes in waves precipitated by reminders/memories
10
Q
Normal Grief Resolution
A
- Typically sadness/distress will gradually diminish in intensity/resolve over a 6 month time frame
- Acceptance slowly sets in
- Survivors begin to reorganize/reinvest
- Enjoyment and pleasure begin to return
- Anniversaries of death continue to be difficult and may never improve
- Certain variables may cause a longer and more intense grief reaction (i.e.-death of a child)
11
Q
5 Stages of Grief
A
Dr. Elisabeth Kubler Ross
- Denial: shock, disbelief before reality sets in
- Anger: at self and others
- Bargaining: most commonly in someone who knows they are dying
- Depression: loneliness and hopelessness
- Acceptance: adjusting to the finality
12
Q
Abnormal grief outcomes
A
-Must be watchful for this as a Primary Care Provider*
RF’s for poor outcomes:
- Lack of support
- Hx of psychiatric problems-esp. depression
- Hx of childhood separation anxiety
- Hx of abuse or neglect as a child
- Extreme initial distress
- Unanticipated death
- Highly dependent relationship w/the deceased
- Death of a child
13
Q
Sequelae of grief/loss
A
- Depression
- Anxiety
- Suicide
- Complicated/Prolonged grief
- Substance abuse
- Hospitalization
- Disability
- Decreased quality of life
14
Q
Complicated/prolonged grief
A
-Persistence of several emotional reactions for at least 6 months
Must include yearning for the deceased + 4 of the following sxs:
- Difficulty moving on
- Numbness/detachment
- Bitterness
- Emptiness
- Difficulty accepting the death
- Lack of meaning in life w/o deceased
- Agitation
- Loss of trust after loss
15
Q
Clinician’s role in caring for the bereaved
A
- When possible should begin before the death takes place
- Pay close attention to patients and their family members
- Consider referring for psychological support
- Listen to the patient’s requests (may vary greatly)
- Provide clear recommendations and resources to guide decision making
- Use palliative care clinicians and hospice resources
- A letter of condolence to the family or attending a funeral/memorial is often greatly appreciated
- Be on lookout for suicidal ideations in patients who have suffered a recent loss
- “Check in” regularly and initiate follow up
- Encourage patients to maintain healthy lifestyle habits (sleep, exercise, nutrition etc.)
- Encourage open environment for crying during visits
- Short-term prescriptions to help with sleep and anxiety can be helpful (short-term)
- Recommend support groups
