Grief and Bereavement

Question 1

Normal vs abnormal

Answer 1

Normal Anticipatory Grief -> reaction -> resolution ABNORMAL Depression, suicide, anxiety, and complicated grief

Question 2

Grief vs Bereavement vs Mourning

Answer 2

• Bereavement: the REACTION to the loss.
• Grief: the EMOTIONAL RESPONSE caused by a loss including pain, distress, and physical and emotional suffering.
• Mourning: the psychological PROCESS through which the bereaved person undoes his or her bonds to the deceased.

Question 3

Normal grief reactions

Answer 3

processes and tasks at emotional, cognitive and behavioral levels. The initial shock of learning of impending or actual loss evolves into a process of creating a new relationship between the grieving person and the person (or object) of loss.

Question 4

Anticipatory/ Preparatory grief

Answer 4

• Patient: features include rumination about the past, withdrawal from family/friends, and periods of sadness, crying or anxiety
• Families/friends: looking to a future without the dying person

Question 5

Distinguishing preparatory grief from depression

Answer 5

• It has “Good days and Bad days”
• Hope SHIFT not hopeless: a hope for cure to hope for life prolongation, or dying well.
• Grieving patients NEEDS socail interactions and RESPONSE well to supoort.
• A persistent, active desire for an early death in WELL-symptom-controlled pt is DEPRESSION until prove otherwise.

Question 6

Complicated grief

Answer 6

Persistence, for at least six months, of a constellation of disruptive emotional reactions Plus 4/8

• Difficulty moving on
• Persistent feeling shocked, numbness/detachment
• Intense loneliness feeling, Bitterness Feelings that life is empty without the deceased
• Trouble accepting the death: yearning, pining, or longing for the deceased
• A sense that the future holds no meaning without the deceased
• Being on edge or agitated
• Difficulty trusting others since the loss -social withdrawal and difficulty reengaging with life

TREAT

• cognitive-behavioral and group therapy
• NO randomized controlled trials evaluating the pharmacologic treatment.

Question 7

Bereavement related depression

Answer 7

clues to the diagnosis of major depression in this context include generalized feelings of hopelessness, helplessness, worthlessness, and guilt, as well as persistence of the initial and severe symptoms of early grief; for at least two weeks, six to eight weeks after a major loss

Question 8

Common presentation of anticipatory grief

Answer 8

• emotional symptoms: Anger, withdrawal, sadness, denial, numbness, helplessness, yearning, and guilt.
• physical symptoms: Insomnia, loss of appetite, fatigue, headaches, dizziness, muscle aches, and breathlessness.
• cognitive symptoms: Difficulty with concentration, a sense of confusion, and disbelief..