Physiological responses

Question 1

What are the symptoms and typical duration of the disruption phase?

Answer 1

Symptoms:

• Disbelief
• Denial
• Shock/numbness
• Despair

Days → weeks

Question 2

What are the symptoms and typical duration of the dysphoric phase?

Answer 2

Symptoms:

• Anxiety
• Insomnia
• Poor concentration
• Anger
• Guilt
• Activities disrupted
• Sadness
• Depression

‘What has your mood been like lately?’

Weeks → months

Question 3

What are the symptoms and typical duration of the adaptation phase?

Answer 3

(as dysphoria diminishes)
Implications confronted
New goals established
Hope refocused and restored
Activities resumed

Months

Question 4

Differential diagnoses of the withdrawn patient

Answer 4

• personality
• pathological: brain tumour, CVA, concurrent illness (eg: hypoT)
• Pharmacological: oversedation, tardive dyskinesia
• psychological: anger, distrust, fear, guilt, shame (‘no point talking about feelings’, too painful/ embarassing)
• psychiatric: depression, paranoia (too dangerous)

Question 5

Psychological approach

Answer 5

acknowledge: ‘We seem to be finding it difficult to get into a deeper convo’
Invite to accept/reject: Are you able to tell me why you find it difficult to talk to me about things?’
‘Can you tell me exactly what’s troubling you?’

Question 6

What are the emotional manifestations of bereavement (relatives/ friends)?

Answer 6

Depression
Anxiety - fear of breaking down, going crazy
Guilt - events surrounding loss or past behaviour
Anger - with people, God
Loneliness
Loss of enjoyment - nothing pleasurable w/o deceased
Relief that suffering has ended

Question 7

What are the behavioural manifestations of bereavement (relatives/ friends)?

Answer 7

Agitation
Fatigue & poor concentration
Crying

Question 8

What are the attitudes associated with bereavement (relatives/ friends)?

Answer 8

Self-reproach
Low self-esteem
Hopelessness
Sense of unreality (disconnected)
Suspicion
Social withdrawal
Toward deceased - yearning, hallucinations, idealisation

Question 9

What are the physiological manifestations of bereavement (relatives/ friends)?

Answer 9

Loss of appetite, weight change
Insomnia
Physical complaints - headache, mm pains etc
Substance use 
Stress-related illness

Question 10

Traditional model of grief

Answer 10

Numbness
Separation and pain
Despair 
Acceptance
Adapting to live without them

Question 11

What are the sources of help available for grieving relatives/ friends?

Answer 11

GP
Voluntary organisations - Cruse, Bereavement Care, Compassionate Friends
Church groups
Childrens bereavement services - SeeSaw, Winston’s Wish

Question 12

What are the steps of a risk assessment in bereavement?

Answer 12

• Mode of death: untimely, unexpected or disturbing deaths are likely to cause more severe and prolonged grief
• nature of relationship
• perceived support: are they able to share feelings with others? are they feeling supported or isolated?
• anticipatory grieving: were the family and patient able to talk about the illness, share feelings, and make plans for the future before the patient died
• concurrent life events: how much stress are they facing, are others dependent on them, do they have space to grieve?
• previous losses, how have they grieved in the past? new loss remind of old loss?
• medical hx: illness that is likely to me exacerbated? hx of alcoholism, drug use, suicidal behaviour?

Question 13

What is the effect of bereavement on children?

Answer 13

• changes in their social and financial situation
• significance of their relationship with the remaining parent
• emotional climate

Question 14

What are the important points for enabling children to grieve and adapt? (Charter)

Answer 14

B - bereavement support
E - Express feelings and thoughts
R - Remember the person who has died
E - Education and information
A - Appropriate and positive response from schools or colleges
V - Voice in important decisions
E - Enjoyment
M - Meeting others
E - Established routines
N - Not to blame
T - Tell their story