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Flashcards in Grief and Bereavement Deck (44)
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1

What is grief?

What is bereavement?

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

2

Define the following:
1. Bereavement?

2. Grief?

3. Complicated grief?

4. Mourning?

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

3

Hallmark of Grief?

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

4

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

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

5

Clinical Features
1. Symptoms of separation distress? 3
2. Symtpoms of trauma/stress reaction? 3

3. Clinical Features: Other symtpoms? 3

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

6

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

1. Usually time-limited
2. 6, 6-12

7

Bereavement
1. Requires what?
2. Most adapt to loss with what?
3. Differs from other what?

1. Requires people to redefine goals and plans
2. support from family and friends
3. adverse life events

8

Bereavement: Types of losses? 4

Types of loss
1. Type of lost relationship
2. Sudden lost
3. Chronic illness
4. Terminal illness

9

Bereavement: Associated Psychopathology?
6

1. Major depression
2. Anxiety disorder
3. Posttraumatic stress disorder
4. Suicidality
5. Other mental disorders
6. Complicated grief

10

1. Major depression does not preclude the diagnosis what is regarded as what?

2. Posttraumatic stress disorder: WHat can this trigger?

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

11

Grief and Bereavement
Management?
5

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

12

Describe the general approach to Grief and Bereavement?
2

1. Summon families prior to an expected death
2. Call immediate family members

13

Describe the support needed for Grief and Bereavement? 4

1. Family,
2. friends
3. clergy
4. Clinicians

14

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

Persistent complex bereavement

15

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

2. Risk factors? 3

1. mood disorders

2.
-Older age (>61 YO)
-Female sex
-Low socioeconomic status

16

COMPLCIATED GRIEF Pathogenesis
2 categories?

1. Neurobiology
2. Loss of attachement relationship

17

Describe the components of each category of PP that contributes to COMPLICATED GRIEF:
1. Neurobiology? 2
2. Loss of attachement relationship? 2

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

18

1. Clinical Features of Acute grief lasting 6-12 months after the loss? 3

2. Complicated grief clinical features? 4

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

Clinical Features: Grief? 2


Suicidality
3. Ideation and behavior occurs in _____ of people?
4. Risk? 2

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

Complicated Grief: Adverse consequences? 3


Course? 2

1. Increase use of alcohol and tobacco
2. Poor quality of life
3. General medical illnesses and suicide

1. Symptoms that last at least one month after 6 months of bereavement who are significantly and functionally impaired
2. Patients seek treatment on average 2-4 years after the loss

21

Assessment
for complicated grief?5

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

22

Labs: Complicated Grief?
4

1. CBC
2. CMP
3. UA
4. TSH

23

Diagnostic Criteria for Complicated Grief?
5

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

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

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

Management goals of complicated grief?
6

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

Management
1. Monitoring how?
2. First line?
3. Second line?

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

Definition of death?

Absolute cessation of vital functions

28

Absolute cessation of vital functions
3 specific descriptions that are included in this?

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

SIGNS OF DEATH

7

1. Cessation of breathing
2. Cardiac arrest
3. Palor mortis
4. Livor mortis
5. Algo mortis
6. Rigor mortis
7. Decomposition

30

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

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