Death & Bereavement

Question 1

Grief

Answer 1

Intense focus on thoughts/memories of deceased person + sadness and yearning

Sx: Separation distress, hallucinations of loved one, trauma/stress reaction, with to reunite w/ loved one

-Have to screen for suicide

Most adapt to loss w/in 6 months, restore ongoing life in 6-12 months

Question 2

Bereavement

Answer 2

Require people to redefine goals and plans

-most adapt to loss w/ social support

Type of loss (sudden, terminal illness) affects sx experienced

Associated w/ MDE, anxiety, PTSD, suicidality, complicated grief

Psychotherapy can be harmful - inhibit grieving process

Monitor pts, healthy lifestyle and social support

Question 3

Mourning

Answer 3

Process of adapting to a loss and integrating grief

Question 4

Complicated grief

Answer 4

Grief > 6 months - maladaptive rumination

-physical & emotional rxn, dysfunctional behavior, inadequate emotional regulating

Usually seek treatment after 2-4 years

Tx: Monitor outpatient, CBT 1st line

Re-evaluate Dx if no response to therapy

Question 5

Pallor mortis

Livor mortis

Algo mortis

Rigor mortis

Answer 5

Pallor mortis = pale skin after death

Livor mortis = settling of blood in lower portion of body

Algo mortis = steady decline of body temp after death

Rigor mortis = stiffness after death

Question 6

Terminal State

Answer 6

Patient has fatal disease

Life expectancy < 6 months

• usually overestimated

Question 7

Physiological changes with dying

Answer 7

Increased weakness and fatigue

Decreased appetite/food intake

Decreased blood perfusion

Neurologic dysfunction

Question 8

Physiological changes in last 48 hours of dying

Answer 8

Orderly loss of senses and desires

Noisy, moist breathing not relieved by suction

Pain and dyspnea

Urinary incontinence or retention

Restlessness and agitation

Question 9

Stages of death

Answer 9

Denial

Anger

Bargaining

Depression

Acceptance - not everyone gets to here