Bereavement and grief Flashcards
What is grief?
Grief refers to the psychological components of bereavement, the feelings evoked by a significant loss, especially the suffering entailed when a loved one dies.
What is bereavement?
Refers to the death of a significant person.
What does mourning mean?
The actions and manner of expressing grief.
What can cause grief?
Death
Miscarriage
Friendship
Relationship break-up
Health
Job
Finance
Safety
Home
Pet
Personal dreams
Types of grief?
Integrated grief (pt is able to move forward with life)
Complicated grief
What factors affect the intensity and length of grief?
Personality
Attachment style
Genetics
Age
Health
Spiritual and cultural identity
Support
Other losses
Nature of relationship (ambivalent, loving)
Type of loss (sudden or gradual, natural or traumatic)
What are the stages of grief?
Kubler-Ross:
Denial
Anger
Bargaining
Depression
Acceptance
Not everyone will experiences all of the stages and they may repeat, overlap or happen in a different order.
Colin Murray Parkes:
Numbness (shock, disbelief)
Pining (anger, guilt, physical restlessness)
Disorganisation and despair (depression, loneliness, anxiety)
Re-organisation (recover and acceptance)
Presentation of a pt suffering from grief reaction?
Crying
Headaches
Difficulty sleeping
Questioning the purpose of life
Questioning your spiritual beliefs
Feelings of detachment
Isolation from friends and family
Abnormal behaviour
Worry
Anxiety
Frustration
Guilt
Fatigue
Anger
Loss of appetite
Aches and pains
Stress
Inability to attend work or school.
No desire to attend social gatherings.
What is complicated grief?
Abnormal
Prolonged:
- denial may last >2 weeks
- total grief reaction can last >1 year
Symptoms:
- social withdrawal, inability to work
- severe guilt, bitterness, feelings of hostility to others
- suicidal thoughts and acts
- extreme somatisation and hypochondrial symptoms
- psychotic symptoms
- insomnia
Other comorbidities -depression, adjustment disorder, psychosis, substance use
What makes a person more likely to have an atypical reaction?
Unexpected
Felt to be too early -child
Mother of small children
Normal grieving process not possible:
- when a death cannot be openly mourned, acknowledged or socially supported.
- circumstances have prevented normal grief at an early stage (e.g. unable to see the body)
- the relationship before the deceased died was hostile/unresolved problems
- pt has a small social circle and/or few relatives
How do you differentiate grief from depression?
Depression
- person enjoys nothings
- may express suicidal thoughts
- no sense of a positive future
- biological and psychological symptoms of hopelessness, worthlessness, guilt
Grief
- able to look forward to the future
- most people cope without medical intervention
- grief comes in waves
- distress relates to a particular loss
- can have pleasure
- biological symptoms of loss of sleep, appetite, concentration.
How might someone with grief present?
GP:
- sick note
- unable to sleep
- physical health problem
ED:
- self-harm or suicide attempt
- physical health
Occupational health
- return to work
Family and friend
- speaking to them
How to assess a pt suffering from grief?
Hx:
- is the pt suffering from grief?
- type of grief (normal or complicated)
- symptoms present and severity
- length of time
- stages of grief gone through
- support
MSE:
- symptoms consistent with grief or another comorbidity
Risk:
- safe to go home?
- what risks are of concern?
How to manage a pt suffering from grief?
Biological:
- exclude underlying physical cause
- symptoms medication
Psychological:
- Bereavement counselling
- Support groups
- CBT
- educate about normal grief process
Social:
- Friends and family
- Faith
- Hobbies
- Healthy lifestyle (diet, sleep)
- Daily schedules
