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Behavioral Health > Grief and Bereavement > Flashcards

Grief and Bereavement Flashcards

1
Q

What is grief?

What is bereavement?

A
  1. Grief is a natural response to loss of a loved one
    - Grief reactions are often painful and impairing with emotional and somatic distress
  2. Bereavement is a stressor that can precipitate or worsen mental disorders
    - This can lead into a condition called complicated grief
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2
Q

Define the following:
1. Bereavement?

  1. Grief?
  2. Complicated grief?
  3. Mourning?
A
  1. Situation in which someone who is close dies
  2. Natural response to bereavement
  3. Form of acute grief that is usually prolonged, intense, and disabling
  4. Process of adapting to a loss and integrating grief
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3
Q

Hallmark of Grief?

A

intense focus on thoughts and memories of the deceased person, accompanied by sadness and yearning

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4
Q

Grief can occur in response to other meaningful (non-bereavement) losses, including what?
2

A
  1. an interpersonal loss (eg, separation from a loved one through divorce) or
  2. loss of a pet, job, property, or community
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5
Q

Clinical Features

  1. Symptoms of separation distress? 3
  2. Symtpoms of trauma/stress reaction? 3
  3. Clinical Features: Other symtpoms? 3
A
  1. Symptoms of separation distress
    - Yearning for and seeking proximity to the deceased
    - Loneliness
    - Crying, sadness, and other painful emotions
  2. Symptoms of trauma/stress reaction
    - Disbelief and shock
    - Numbness
    - Impaired attention, concentration, or memory
  3. Other symtpoms
    - Difficult to feel connected and withdraw
    - Sometimes transiently wish they had died with their loved one or instead of the deceased
    - Thoughts and images of the deceased occur frequently and may become hallucinatory
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6
Q

Grief course

  1. Usually limited by what?
  2. Progress in adapting to loss occurs within __ months, with restoration of ongoing life within ____ months
  • Response to a loved one does not end
  • Certain kinds of thinking and behavior impede the process of adapting to loss
A
  1. Usually time-limited

2. 6, 6-12

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7
Q

Bereavement

  1. Requires what?
  2. Most adapt to loss with what?
  3. Differs from other what?
A
  1. Requires people to redefine goals and plans
  2. support from family and friends
  3. adverse life events
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8
Q

Bereavement: Types of losses? 4

A

Types of loss

  1. Type of lost relationship
  2. Sudden lost
  3. Chronic illness
  4. Terminal illness
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9
Q

Bereavement: Associated Psychopathology?

6

A
  1. Major depression
  2. Anxiety disorder
  3. Posttraumatic stress disorder
  4. Suicidality
  5. Other mental disorders
  6. Complicated grief
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10
Q
  1. Major depression does not preclude the diagnosis what is regarded as what?
  2. Posttraumatic stress disorder: WHat can this trigger?
A
  1. DSM V
    - regarded as a stressor that can trigger a depressive episode
  2. Can trigger onset and may occur more often in response to bereavement than other traumas or stressors
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11
Q

Grief and Bereavement
Management?
5

A
  1. General approach
  2. Grief typically does not require treatment
  3. Grief counseling can be helpful
  4. Support
  5. Encourage patients to maintain regular patterns of activity, sleep, exercise, and nutrition
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12
Q

Describe the general approach to Grief and Bereavement?

2

A
  1. Summon families prior to an expected death

2. Call immediate family members

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13
Q

Describe the support needed for Grief and Bereavement? 4

A
  1. Family,
  2. friends
  3. clergy
  4. Clinicians
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14
Q

COMPLICATED GRIEF
This disorder has been reviewed by the DSM-5 work groups, who have decided that it be called ________________________ disorder and placed it in the chapter on Conditions for Further Study in the new DSM-5

A

Persistent complex bereavement

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15
Q

COMPLICATED GRIEF
1. Clinical settings
Patients with ______________ the incidence is 20%

  1. Risk factors? 3
A
  1. mood disorders
    • Older age (>61 YO)
    • Female sex
    • Low socioeconomic status
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16
Q

COMPLCIATED GRIEF Pathogenesis

2 categories?

A
  1. Neurobiology

2. Loss of attachement relationship

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17
Q

Describe the components of each category of PP that contributes to COMPLICATED GRIEF:

  1. Neurobiology? 2
  2. Loss of attachement relationship? 2
A
  1. Neurobiology
    - Link to area of the brain associated with pain (anterior cingulate cortex)
    - Also a link to the reward center of the brain (nucleus accumbens)
  2. Loss of attachment relationship
    - Attachment system motivates people to form close relationships
    - Loss of this type of relationship entails intense activation of emotions
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18
Q
  1. Clinical Features of Acute grief lasting 6-12 months after the loss? 3
  2. Complicated grief clinical features? 4
A
  1. Acute grief lasting 6-12 months after the loss
    - Separation distress
    - Inhibition exploration of the world
    - Traumatic distress
  2. Complicated grief
    - Maladaptive rumination about the circumstances of the death
    - Intense emotional and/or physical reactions
    - Dysfunctional behaviors
    - Inadequate regulation of emotions
19
Q

Clinical Features: Grief? 2

Suicidality

  1. Ideation and behavior occurs in _____ of people?
  2. Risk? 2
A

Two most common symptoms

  1. Yearning
  2. Feeling upset by memories of the deceased
  3. 40-60%
  4. Risk
    - Greater number of years elapsed since death
    - Depression and anxiety
20
Q

Complicated Grief: Adverse consequences? 3

Course? 2

A
  1. Increase use of alcohol and tobacco
  2. Poor quality of life
  3. General medical illnesses and suicide
  4. Symptoms that last at least one month after 6 months of bereavement who are significantly and functionally impaired
  5. Patients seek treatment on average 2-4 years after the loss
21
Q

Assessment

for complicated grief?5

A
  1. H&P
  2. Mental status exam
  3. Labs
  4. Address suicide risk
  5. Brief Grief Questionnaire
22
Q

Labs: Complicated Grief?

4

A
  1. CBC
  2. CMP
  3. UA
  4. TSH
23
Q

Diagnostic Criteria for Complicated Grief?

5

A
  1. Patient has experienced the death of a loved one for at least 6 months
  2. At least one of the following symptoms has been present
    - Persistent, intense yearning or longing for the person who died
    - Frequent preoccupying thoughts about the deceased
    - Frequent intense feelings of loneliness or that life is empty or meaningless without the person who died
    - Recurrent thoughts that it is unfair or unbearable to live without the deceased, or a recurrent urge to find or join the deceased
24
Q

COMPLICATED GRIEF dx criteria continued: At least two of the following symptoms must be present:
6

A

At least 2 of the following have also been present

  1. Frequent troubling rumination about the circumstances or consequences of the death
  2. Recurrent disbelief or inability to accept the death
  3. Persistently feeling shocked, stunned, dazed, or numb since the death
  4. Anger or bitterness about the death
  5. Intense emotional or physiologic reactions (eg, insomnia) to reminders of the loss
  6. Marked change in behavior, characterized by either of the following or both:
    - Avoiding people, places, or situations that remind one of the loss
    - Wanting to see, touch, hear, or smell things to feel close to the persons who died
25
Q

Management goals of complicated grief?

6

A
  1. Relief of;
    - Ruminations
    - Excessive proximity seeking
    - Excessive avoidance behavior
  2. Improve emotion regulation
  3. Accepting finality
  4. A feeling of enduring connection to the deceased
  5. Ability to envision life with the possibility for happiness
  6. Engagement in satisfying activities and relationships
26
Q

Management

  1. Monitoring how?
  2. First line?
  3. Second line?
A
  1. Monitoring
    - Every 1-4 weeks in outpatient setting
  2. First-line
    - CBT
  3. Second-line
    - Those who do not respond to an entire course of CBT specific for complicated grief should be re-evaluated to determine the diagnosis
27
Q

Definition of death?

A

Absolute cessation of vital functions

28
Q

Absolute cessation of vital functions

3 specific descriptions that are included in this?

A
  1. Irretrievable cessation of circulatory and respiratory functions or…
  2. Irretrievable cessation of all functions of the entire brain, including the brainstem
  3. “pulseless and apneic”
29
Q

SIGNS OF DEATH

7

A
  1. Cessation of breathing
  2. Cardiac arrest
  3. Palor mortis
  4. Livor mortis
  5. Algo mortis
  6. Rigor mortis
  7. Decomposition
30
Q
  1. Terminal State is what?
  2. Life expectancy estimated to be what?
  3. Clinicians usually slightly ___________ survival
  4. May estimate __ weeks when ___weeks more likely
A
  1. Patient has a disease that is felt to be fatal
  2. less than 6 months
    (Inexact science and patients may live longer than 6 months)
  3. overestimate
  4. 6 weeks, 4 weeks
31
Q

Physiologic Changes While Dying

4

A
  1. INCREASING WEAKNESS, FATIGUE
  2. DECREASING APPETITE / FOOD INTAKE
  3. DECREASING BLOOD PERFUSION
  4. NEUROLOGIC DYSFUNCTION
32
Q

Describe what symptoms the following cause:
1. INCREASING WEAKNESS, FATIGUE? 2

  1. DECREASING APPETITE / FOOD INTAKE? 2
  2. DECREASING BLOOD PERFUSION? 3
  3. NEUROLOGIC DYSFUNCTION? 3
A
  1. INCREASING WEAKNESS, FATIGUE
    - Decreased ability to move – joint position fatigue
    - Increased risk of pressure ulcers and increased need for care
  2. DECREASING APPETITE / FOOD INTAKE
    - May have a fear of giving in and starving
    - Food may be nauseating and might be aspirated
  3. DECREASING BLOOD PERFUSION
    - Tachycardia, hypotension
    - Peripheral cooling, cyanosis, mottling of skin
    - Diminished urine output
  4. NEUROLOGIC DYSFUNCTION
    - Decreasing level of consciousness
    - Terminal delirium
    - Changes in respiration
33
Q

Signs That Suggest Active Dying

5

A
  1. No intake of water or food
  2. Sunken cheeks, relaxation of facial muscles
  3. Respiratory mandibular movement
  4. Dramatic skin color changes
  5. Rattles in chest
34
Q

In the Last 48 Hours, what happens? 5

A
  1. Orderly loss of the senses and desires
  2. Noisy, moist breathing
  3. Urinary incontinence/retention
  4. Pain and dyspnea
  5. Restlessness and agitation
35
Q

Advance Care Directives
1. Affords patients the opportunity to exercise their right to make determinations regarding their what?

  1. Provides patients opportunity to do what?
A
  1. medical care in the event they become incapable

2. determine goals

36
Q
  1. Hospice care focuses on what?
  2. Staff on call - ?
  3. What kind of approach?
A
  1. Focuses on caring, not curing
  2. Staff on-call 24/7
  3. Team approach
37
Q

Services provided by hospice?

3

A
  1. Manages patient’s pain and symptoms
  2. Assists the patient with the emotional and psychological and spiritual aspects of dying
  3. Provides needed drugs, medical supplies, and equipment
38
Q

Guidelines for the Family

4

A
  1. Be aware of the signs of increasing pain
    - -Notify staff if patient seems restless, grimacing, moaning, tense
  2. Patients close to death do not feel hungry or thirsty
    - Do not force food or fluids
    - Touch and massage them
  3. Breathing may become noisy and congested
    - Suctioning does not help
  4. Hearing is one of the last senses to go
    - Be sure to talk to the dying patient even if comatose
    - Tell them who is there
    - Assume they hear everything
    - Let them know it is okay to go
39
Q

Describe the attitudes towards death at the following ages:

  1. Under 5 years of age?
  2. 5 - 10 years of age?
  3. After 9 - 10 years of age?
  4. Adolescents?
A
  1. Awareness of death only in the sense of a separation similar to sleep
  2. Developing sense of inevitable human mortality and often fear that parents will die and that they will be abandoned
  3. Realize that death can happen to them and by puberty recognize death as universal, irreversible, and inevitable
    • Understand that death is inevitable and final
    • Broad range of emotions that mirror teenage angsts:
    • Loss of control, being imperfect, being different
40
Q

Attitudes Towards Death
Adults?
4

A
  1. Often readily accept that their time has come
  2. May talk or joke openly about dying and sometimes welcome it
  3. The older one gets… the more he/she no longer harbors illusions of indestructibility
  4. May either have a sense of integrity or despair (reflect on their time and how it was lived)
41
Q

Conveying Bad News

3 steps

A
  1. Prepare
  2. Be calm and clear
  3. Arrange follow-up – insure ongoing support
42
Q

Stages of Grief

5

A
  1. Denial
  2. Anger
  3. Bargaining
  4. Depression
  5. Acceptance
43
Q

Describe the following stages of grief:

  1. Denial? 2
  2. Anger? 3
  3. Bargaining? 2
  4. Depression? 4
  5. Acceptance? 3
A
    • Normal reaction to rationalize overwhelming emotions
    • It’s a defense mechanism that buffers the immediate shock
    • As denial fades, reality and its pain re-emerge
    • Intense emotion is deflected from our vulnerable core, redirected and expressed as anger
    • Rationally we know the person is not to blame, emotionally we resent the person causing pain or leaving
    • Normal reaction to feelings of helplessness and vulnerability to regain control
    • Secretly make a deal with God or higher power to postpone the inevitable
  4. Depression
    - 2 types
    - A reaction to practical implications relating to the loss
    - A quiet preparation to separate and to bid our loved one farewell
    - Feel like we don’t care about much of anything and wish life would just hurry up and pass on by
    • Not everyone reaches this stage
    • Marked by withdrawal and calm
    • Means we are ready to move on
44
Q

Traditionally, grief lasts about how long?, subsides over time, and resolves

A

6 months to 1 year

Behavioral Health (20 decks)

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