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Flashcards in Death & Grief Deck (49)
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1

Define Bereavement

Situation in which someone who is close dies

2

Define Grief

natural response to bereavement

3

Define Complicated Grief

Form of acute grief that is usually prolonged, intense, and disabling

4

Define Mourning

Process of adapting to a loss & integrating grief

5

Hallmark of Grief

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

6

Non-bereavement Losses

Separation through divorce
Pet
Job
Property
Community

7

Symptoms of Grief due to Separation Distress

Yearning for & seeking proximity to the deceased
Loneliness
Crying, sadness, and other painful emotion
Somatic symptoms
Hallucinations of deceased person

8

Symptoms of Grief due to a Trauma/Stress Reaction

Disbelief & shock
Numbness
Impaired attention, concentration, or memory

9

Other Symptoms of Grief

Difficult to feel connected & withdraw
Transiently wish they had died with their loved one or instead of deceased
Thoughts & images of the deceased occur frequently

10

Grief Course

Time-limited
Adapting occurs within 6 months
Restoration of ongoing life within 6-12 months
Can return for "big" events

11

Types of Bereavement Loss

Type of relationship lost (survival guilt)
Sudden lost (homicide/suicide)
Chronic illness
Terminal illness

12

Associated Psychotherapy to Bereavement

Major depression
Anxiety disorder
PTSD
Suicidality
Other mental disorders (sleep, somatoform, substance, eating)
Complicated grief

13

Management of Grief & Bereavement

Summon families prior to expected death
Grief counseling
Support from family, friends, & clergy
Remind family to maintain regular patterns of activity, sleep, exercise, & nutrition
Send condolence letter

14

Risk Factors for Complicated Grief

Older age (>61)
Female
Low SES
Non-Caucasion
Prior psych history
Death of spouse, child, young person
Sudden death

15

Acute Grief Clinical Features

Separation distress
Inhibition exploration of the world
Traumatic distress

16

Complicated Grief Clinical Features

Maladaptive rumination about circumstances of the death
Intense emotional and/or physical reactions
Dysfunctional behaviors
Inadequate regulation of emotions

17

Most Common Symptoms of Complicated Grief

Yearning
Feeling upset by memories of deceased

18

Risk of Suicidality in Complicated Grief

Greater number of years elapsed since death
Depression & anxiety

19

Adverse Consequences of Complicated Grief

Increase use of ETOH & tobacco
Poor QOL
General medical illness & suicide

20

Course of Complicated Grief

Symptoms last at least 1 month after 6 months of bereavement who are significantly & functionally impaired
Seek treatment on average 2-4 years after loss

21

Assessment of Complicated Grief

H&P
Mental status exam
Labs: CBC, CMP, UA, TSH
Address suicide risk
Brief Grief Questionnaire

22

Diagnostic Criteria for Complicated Grief

Experience death of loved on for >6 months
Persistent, intense yearning for deceased
Frequent preoccupying thoughts about deceased
Frequent intense feelings of loneliness or that life is meaningless without deceased
Recurrent thought that it is unfair to live without deceased; urge to join deceased
Frequent troubling rumination about circumstances of death
Recurrent disbelief or inability to accept death
Persistently feeling shocked, stunned, dazed, or numb since death
Anger or bitterness about death
Intense emotional or physiologic reactions to reminders of loss
Marked change in behavior

23

Goals of Management of Complicated Grief

Relief of rumination, excessive proximity seeking & avoidance behavior
Improve emotion regulation
Accepting finality
Feeling of enduring connection to deceased
Ability to envision life with the possibility of happiness
Engagement satisfying activities & relationships

24

Treatment for Complicated Grief

CBT

25

Define Death

Absolute cessation of vital functions

26

Signs of Death

Cessation of breathing
Cardiac arrest
Palor mortis: paleness
Livor mortis: blood settles to dependent parts
Algo mortis: decrease in body temp
Rigor mortis: limbs become stiff
Decomposition

27

Define Terminal State

Disease felt to be fatal
Life expectancy

28

Physiologic Changes While Dying

Increasing weakness, fatigue
Decreasing appetite/food intake
Decreasing blood perfusion
Neurologic dysfunction

29

Signs of Increasing Weakness & Fatigue

Decreased ability to move
Increased risk of pressure ulcers & need for care

30

Signs of Decreasing Appetite & Food Intake

Fear of giving in & starving
Food nauseating
Aspiration