Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Module 6 > UNIT 2- DEPRESSION > Flashcards

UNIT 2- DEPRESSION Flashcards

1
Q

What is depression?

A

Depression is a syndrome rather than one specific disease. Depression disorders represent a group of syndromes that share some common symptoms but with different etiologies, courses and treatments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is major depressive disorder (MDD)

A

Affects how you feel, think and behave causing persistent feelings of sadness and loss of interest in previously enjoyed activites
Most common expression of depressive symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is Peristent Depressive Disorder (dysthmyia) PDD

A

Also known and unipolor depression. A person experiences depression without every experiencing an excessive elevated mood or mania

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

True or false: Confusion or attention problems in older adults may often be misdiagnosed for things like dementia?

A

True- depression can cause confusion and attention problems in older adults

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What should we keep in mind with older adults and depression?

A
  1. Complaints of sadness are less prominent
  2. excessive concern with physical health compared
  3. Complain of feeling tired and have trouble sleeping
  4. Seem grumpy or irritable
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What should we keep in mind with children & adolescents and depression?

A
  1. Children presents as irritability, phsyical complaints, decline in school performance, or social withdraw and may start to use drugs and alcohol at a younger age
  2. After puberty, girls are twice as likely to develope depression
  3. Adolescents may present with sulkking, being negative grouchy, getting introuble, feeling misunderstood, withdrawing from others, or running away from home
  4. Major depression in adolescents is associated with substance use disorders, behavior problems and other mental illnessess
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are risk factors for depression?

A
  1. Histor of prior episodes od depression
  2. Family hx of depressive disorder esp. in first degree realitives
  3. History of suicide attempts, or family hx of suicide attempts
  4. Memebers of the LGBTQ community
  5. Female gender
  6. postpartum period
  7. age 40 or younger
  8. Chonic medical illness
  9. absence of social support
  10. negative, stressful life evens, particulary early trauma
  11. Active alcohol or substance use disorder
  12. hx of sexual abuse
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are biochemical factors that affect depression?

A

Changes in receptor-neurotransmitter relationship in the following areas
1. limbic system
2. hypothalmus
3. prefrontal cortex
4. hippocampus
5. amygdala

Neutrotransmitters
1. decreased levels of serotonin
2. decreased levels of norepinephrine
3. decreased levels of dopamine
4. decreased levels of glutamate
5. decreased gaba
6. decreased acetylcholine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What should we know about the stress-diathesis model of depression?

A
  1. Environmental,interpersonal and life evens
  2. biological vulnerability and predisposition
  3. stress can cause neurphysiological and neurochemical changes in the brain
    4. Early life trauma can result in long-term hyperactivty of the corticotropin-releasing factor (CRF) and norepinephrine systme of the central nervious system leading to neuronal loss and damage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what should we know about the cognitive theory? (depression)

A

Aaron T. Beck
1. people acquire a psycholgical predisoostion to depression through early life expereinces
2. Contributing to negative, illogical and irrational thought processes which are activated when stressed
3. what you think = what you feel (and do)
4. Triad- automatic negative thought
- A negative, self depreciating view of self
- A pessimistic view of the world
- The belief that negative reinforcement will continue
5. **GOal of cognitive behavior theory (CBT) is to change the way a patient thinks reducing negative thoughts. **

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is filtering?

A

Taking negative details and magnifying them while giltering out all the postive aspects of a situation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is polorized thinking for “black and white” thinking

A

Things are either “black or white”. We have to be perfect or we are a failure there is no middle ground

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is personalization?

A

A distorted belief that everything others do or say is somehow about us

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is control fallacies?

A
  1. we see ourselves as helpless a victim of fate, having no control or we assume total responsibility for the pain and happiness of everyone around us (overcontrol)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is fallacy of fairness

A
  1. we feel resentful because we think we know what is fair but other people wont agree with us
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is shoulds

A

we have a list of ironclad rules about how we and others should and must behave

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Using SIGECAPS what is the clinical picture of MDD?

A

S- sleep distrubances
I-interest diminshed in pleasurable activites
G- guilt feeling; feeling of worthlessness
E- energy decreased or fatiuge and esteem loss
C- concentration diminished and indecisiveness
A- appetite changes
P- Psychomotor retardation or agitation
S- Suicidal thought and behaviors and thoughts of death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the clincial picture for PDD?

A
  1. Less severe symptoms than MDD
  2. Depressive symptoms that have been present for atleast 2 years
  3. Somtimes taken as the persons normal behavior
  4. Usually dosent require hosptialization
  5. Age of onset is usually adolescene or with severe stress can manifest in adulthood
  6. daytime fatigue
  7. Functions at work and insocial settings but not optimally
  8. chronic low-level depressed/irritable mood
  9. Eating too much or too little
  10. usually has trouble falling asleep and once asleep, hypersomnia
  11. loss of energy, chornic tiredness
  12. Decreased ability to experience pleasure, enthusiasm or motivation
  13. Irritablity
  14. Neagtive, pestimistic thnking
  15. low self esteem
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are some pychotic features that you might have with MDD?

A

Hallucinations and delsuions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What should we know about MDD and peripartum onset?

A

During pregnancy and following delievery. May include psychotic features and risk to infant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is seasonal affective disorder?

A

SAD, most commonly occurs in fall or winter. Remits in spring includes overeating, angeria, hypersomnia – linked to the absence of sunlight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are catatonic features that we might see in MDD?

A
  1. nonresponsive, psychomotor retardation and withdrawl or aggitated or physically active.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is disruptive mood dysregualtion disorder?

A

seen in children, chronic severe persistent irritability with outbursts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is premenstrual dysphoric disorder?

A
  1. Depressive symptoms are present in the week before the onset of menses and gradually improve afte the onset of menses
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What should we know about premenstrual dysphoric disorder?

A
  1. Occurs in luteal phase of cycles
  2. emotionally liable
  3. anger or irritable
  4. depressed mood
  5. may also include lack of energy, overeating, sleep distrubances, physical symptoms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is PPD?

A

Postpartum depression
includes
1. Baby blues- feels depressed anxious. cries for no reason, sleep problems. occurs in 70-80 % of new moms, improvement within 1-2 weeks without treatment
2. PPD- strong feelings of sadness anxiety, despair, guilt, difficult coping. Symptoms DO NOT subside. May have thoughts of self harm, or harm to the baby.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is Postpartum psychosis?

A
  1. Rare
  2. Recurrance is extremely high with each pregnancy with more severe episodes
  3. Onset is fairly rapid within 3 days to 1 week after delivery
  4. agitated, anxious, disorganized behavior
  5. delusions are baby foucsed

think of the story where the mom killed her 4 children because she thought they were not pure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are some examples of stadardized screening tools for depression?

A
  1. Beck depression inventory
  2. Hamilton depression scale
  3. Geriatric depression scale
  4. Zung’s self-rating depression scale
  5. The patient health questionare
  6. the Edinburgh post natal depression scale
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Our detailed mood and affect assessment for depression disorders should look for?

A
  1. feeling of worthelessness
  2. guilt
  3. helplessness
  4. hopelessness-negative expectations for the future
  5. anger and irritablity
  6. anxiety-60-90% of depressed patients experience anxiety as well
  7. affect
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are some phsycial changes-clinical symptoms we should assess for when assessing for depression?

A
  1. Poor posture
  2. Appears older than they are
  3. sees world through gray colored glassess
  4. facial expression conveys sadness and dejection
  5. Frequent bouts of weeping
  6. Anergia 97%
  7. psychomotor agitation
  8. grooming and hygeine neglected
  9. vegitative signs of depression
  10. pain 50-75%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is a depressed patients cognition and thought content going to look like?

A
  1. Thnking is slow
  2. memory and ability to concentrate may be affected
  3. ruminate
  4. decrease in problem solving
  5. poor judgment
  6. indecisivess
  7. delusional thinking with psychotic features
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What might our nursing process/diagnosis be for a patient with depression disorder

A
  1. Risk of harm
  2. mood regulation/stability
  3. withdrawn behavior leading to social isolation
  4. lack of motivation leading to self care deficits
  5. loss of appetite can lead to impaired nutrition
  6. Distrubance of sleep
  7. impairment of self esteem reduing quality of life
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What do we want our nursing outcomes to be for a pt with depression

A
  1. Evidence of weight gain
  2. sleep 6-8 hours per night
  3. identify symptoms related to relapse
  4. return to normal bowel activity
  5. showers daily
34
Q

What are some interventions we can do for a patient with depression

A
  1. Offering self- aka presence
  2. use simple concrete words
  3. allow time for response
  4. Listen for covert messages
  5. avid false reassurance or minimizing feelings
  6. Health promotion and health taching to pt and family
    • explain biological, psychoscoial and cognitive changes associated with depression
  7. teach covert and overt signs of SI and precautionary measures
  8. Medication teaching
  9. relapse prevention plan
  10. nutrition
  11. sleep hygiene
  12. exercise
  13. informatics with self help
  14. elimination
35
Q

What should we know about depression intervention psychotherapy?

A
  1. CBT- psychotherpay, talk therpay, grou therapy and group support
  2. interpersonal psychotherapy (IPT) structred addressing socal issues
  3. Problem solving therapy (PST)
    • define problem
    • develope multiple solutions
    • identify best one and implement
    • Assess effectiveness
  4. CBT-1 addresses insomnia
  5. Social skills training
  6. Behavior activation
  7. Psychodynamic therapy
36
Q

Midfulness based cognitive therapy (MBCT) used for…

A

reocurrence of MDD– it is a combination of CBT and mindfulness based stressed reduction

37
Q

What are some pharmacological therapies that may be used to treat Depression and what will it target

A
  1. Antidepressant medicaton
  2. sleep distrubances
  3. appetite distrubance
  4. fatigue
  5. decreased sex drive
  6. psychomotor retardation or agitation
  7. Impaired concentration/forgetfulness
  8. Anhedonia
  9. May take 1-3 weeks
38
Q

What are safety consideration with pharmacological therapy to tx depression

A
  1. Black box warning- children, adolescents and young adults may experience suicidal ideation with SSRIs
  2. Elderly-start low and go slow
  3. Bith defects in pregnancy during fetal development
  4. Increased cerebral microbleeds in those 45 and older
39
Q

What considerations should be looked at when using pharmacolgical tx to tx depression

A
  1. Previous respose to antidepressants
  2. ease of adminsitration
  3. safety and medical comorbities
  4. neurotransmitter specificity
  5. family hx of response
  6. cosedt
40
Q

What are 4 types of antidepressants used to treat depression?

A

MAOI
TCA
SSRI
Atypical antidepressants

41
Q

What is the MOA of MAOIs

A

Monoamine oxidase breaks down norepinephrine, serotonin, dopamine and tyramine. MAOI inhibits this breakdown increase these nuerotransmitters

NOT 1st- line treatment due to food interaction and drug interactions from elevated tyramine may lead to HBP, Hypertensive cirsis, CVA and death

42
Q

What are side effects of MAOIs

A
  1. muscle cramps
  2. weight gain
  3. sexual dysfunction
  4. anticholinergic effect
  5. serious food/drug interactions (tyramine)
    • aged cheese/meats
    • goods with yeast
    • soy
    • beer/wine
    • avacados and bananas
43
Q

What are some examples of MAOIs

A
  1. Phenelzine (nardil)
  2. Tranylcypromine (PARNATE)
  3. Isocarboxazid (Marplan)
  4. Selegiline (EnSAM) patch
44
Q

What should we know about TCA’s

A
  1. Effective but frequent noncompliance due to anti-cholinergic side effect
  2. Mood elevation may take up to 4-8 weeks for full effect
  3. Potential for lethal overdose
45
Q

What are some examples of tricyclic antidepressants (TCAs)

A
  1. amitriptyline (elavil)
  2. Amoxipine (asendin)
  3. Doxepin (sinequan)
  4. Imipramine (Tofranil)
  5. Desipramine (norpramine)
  6. Nortripytyline (pamelor)
46
Q

What are side effects of TCAs?

A
  1. Sedation
  2. Mydriasis (dilated pupils in responce to trauma illness and drugs)
  3. Weight gain
  4. sweating
  5. toxicity
  6. sexual dysfunction
  7. Decreased seizure threshold
  8. Orthostatic hypotension
  9. Anticholinergic effect
47
Q

What should we know about SSRIs?

A
  1. Effective with fewer adverse effects & lower lethality if overdose occurs, more costly
  2. Potential for serotonin syndrome
48
Q

What are examples of SSRIs

A
  1. fluoxetine (prozac)
  2. Sertraline (zoloft)
  3. Paroxetine (paxil)
  4. Citalopram (celexia)
  5. Escitalopram (lexapro)
  6. Fluvoxamine (luvox)
  7. Vilazodone (viibyrd)
49
Q

What are s/s of serotonin syndrome? Use SHIVERS

A

S-sheivering
H-Hyperreflexia
I- Increased temp
V- VItal sign changes
E- Encephalopathy
R- Restlessness
S-Sweating

50
Q

What should we know about serotonin syndrome?

A
  1. Discontinue offending agent; call health care provider immediately
  2. Initiate symptomatic tx per orders
  3. Muscle relaxants. Benzos can help control agitation, seizures, and muscle stiffness; and/or dantrolene for muscle relaxation
  4. Serotonin- production blocking agents, such as cyproheptadine, can help by blocking serotin production
  5. oxygen and intravenous (IV) fluids. O2 helps maintain normal oxygen blood levels, and IV fluids treat dehydration and fever
  6. Drugs that control heart rate and blood pressure
  7. Phenylephrine (neo-synephrine) or epinephrine (adrenalin, EpiPen) for hypotension
  8. Cooling blankets for high fever
  9. Use of a breathing turbe and machine and medication to paralyze muscles
51
Q

What are side effects of SSRIs?

A
  1. tremors
  2. nausea
  3. headache
  4. insomnia/drowsiness
  5. sexual dysfunction
  6. bruxism (teeth griding)
  7. Anxiety/agitation
  8. Dry mouth
  9. Diarrhea
  10. hyponatremia
52
Q

What are examples of atypical antidepressants?

A
  1. Venafaxine (effexor)SNRI
  2. Duloxetine (cymbalta) SNRI
  3. Desvenlafaxine (Pristiq) SNRI
  4. Bupropion (Wellbutrin) NDRI
  5. Trazadone(desyrel) TSA related
  6. Mirtazapine (rameron) NASSA
53
Q

What should we know about electroconvulsive Therapy ECT

A
  1. Used when previous medication trails failed
  2. 70-90% remission rate for depression
  3. Used for tx of psychosis and schizophrenia
  4. Safe during pregnancy
  5. Marked agitation, begetative symptoms, catatonia not effective in the tx of personality, substancce use, or situational depression
  6. Informed consent obtained
  7. Course: 6-12 treatments, 2-3 times/week
54
Q

What is ECT?

A
  1. Electric current passed through the brain by unilateral or bilateral electrodes placed temples producing a generalized (tonic-clonic) seizure masked by muscle relaxant. Seizure lasts 30-60 seconds
  2. ECT enhances effects of neurotransmitters & increases hippocampal & amygdala volume in the brain
55
Q

What instructions should be given prior to ECT?

A
  1. NPOx6hours
  2. Informed consent signed
  3. REmove jewlry, hearing aids, eyeglassess, contacts, dentures
  4. Assess vital signs & mental status
  5. Atropine administed 30 mins before procedure
  6. IV in place
  7. EEG electrodes placed
56
Q

During an ECT what should we know?

A
  1. Short acting anesthetic agent: methohexital or propofol IV bolus
  2. Muscle relaxant: Succinylcholine
  3. Monitor vital signs, EKG, o2 sats
  4. Administer 100% o2 throughout the procedure
  5. IV in place
  6. EEG moinitoring
57
Q

What should we know post ECT?

A
  1. Observe for everal of anesthetic agent
  2. support physiologic stability
  3. Place in lateral, recumbant position
  4. Continue to monitor thorughout recovery should be alert in 15 mins
  5. IV in place until full recovery
58
Q
A
59
Q

What should we know about VNS?

A

Vagus ervious stimulation?
1. Surgical implant of device in left chest wall with wire threated around vagus nerve in neck that delivers electrical impulses. Requires informed consent
2. Increased levels of neurtransmitters
3. S/E include voice changes, neck pain, cough, dysphagia, dyspnea

60
Q

What is rapid transcranial magnetic stimulation r(TMS)

A
  1. FDA approved for treatment of resistant depression
  2. Noninvasive
  3. Use magnetic impulses to stimulate focal areas of cerebral cortex may fell tapping or knocking
  4. Prescribed daily, 4-6 weeks
  5. S/E include HA, light-headdness, sclap tingling
61
Q

What is DBS?

A

Deep brain stimulation
1. Experimental therapy for treatment resistant depression
2. Surgical implant of pacemaker-like device implanted in sub-clavicle region, sending electric currents through a wire to electrodes implanted in the brain.

It either works or makes things worse

62
Q

What is light therapy?

A

Influences melatonin, exposed to light sourced 30-60 mins/day

63
Q

What should we know about st. Johns wort and depression?

A
  1. Improves mild depression, not regulated by FDA, not approved for those who have MDD, who are pregnant or children
64
Q

What are risk factors of suicide?

A
  1. PRevious attempt
  2. financial problems
  3. End of relationship
  4. new diagnois or worsening health conditon
  5. refugees
  6. indigenous people
  7. LBGQT community
  8. Someone who knew someone who comitted suicide
  9. childhood trauma
  10. access to means
65
Q

Suicide is linked to

A

Lowe levels of serotonin
Chronically overactive noradrenergic system (stress response- fight or flight response)
Hypothalamic-pituaiatry-adrenal (HPA axis (another stress response system)

66
Q

What puts youth at an increased risk of suicide?

A
  1. Agression
  2. disruptive behavior
  3. depression
  4. social isolation
  5. episdoes of running away
  6. expressions of rage
  7. family loss or instability
  8. Frequent problems with parents
  9. Withdraw from family and friends
  10. Talk of death or after life when sad or bored
  11. dealing with sexual orientation
  12. unplanned pregnancy
  13. perception of school, work, social culture
67
Q

What are older adutls risk factors?

A
  1. social isolation
  2. SOlitary living
  3. Widowhood
  4. Lack of financial resources
  5. Poor health
  6. Feelings of hoplessness
68
Q

QPR…. means

A

question, persuade, refer
1. if a friend or loved one is threatenting, talking about or making plans for suicide, these are signs of an acute crisis
2. do not leave the person aone
3. remove from the vicinity of any firearms , drugs or sharp objecs that could be used for suicide
4. take the person to the hospital room, walk in clinic or call 911 or crisis line

69
Q

Our assessement of depression/suicide should include

A
  1. suicide assessment five step evalution and triage
  2. modified sad persons scale
  3. identify risk factors
  4. identify progective factors
  5. conduct suicide inquiry
  6. determine risk level intervention
70
Q

What are examples of overt verbal cues?

A
  1. I cant take it anymore
  2. life istn worth living anymore
  3. I wish I were dead
  4. Everyone would be better of I were dead
71
Q

What are examples of covert verbal cues

A
  1. Its ok now everything will be okay
  2. things will never work out
  3. I won’t be a problem much longer
  4. NOthing feels good to me anymore and probably never will
  5. How can I give my body to medical science
72
Q

Using the assessment SAD PERSON scale what are we looking at

A

S- male sex–>1
A: Age if <19 or >45 years–>1
D: Depression or hopelessness –>2
P: Previous suicidal attempts of psychiatric care–>1
E: Excessive ethonol or drug use–> 1
R: Rational thinking loss (psychotic or organic illness)–>2
S: Separated, widowed, or divorced–>1
O: Organized plan or serious attempt–> 2
N: No social support–>1
S: Stated future intent (determined to repeat or ambivalent)–>

0-5: may be safe to discharge depending on circumstances
6-8: Probably requires psychiatric consultation
>8 Probably requires hospital admission (voluntary or involuntary)

73
Q

What are some behavior clues that could tell us that our patient is at risk for suicide?

A
  1. Giving away prized possessions
  2. Writing farewell noes
  3. Making out a will
  4. Putting personal affairs in order
  5. Having gloval insomnia
  6. Exhibiting a sudden improvement in mood after being depressed or withdrawn
  7. neglecting peronsal hygine
74
Q

What would our nursing diagnosis or problem for a suicidal patient

A
  1. Risk for suicide
  2. impaired family process
  3. lack of family support
  4. negative self image
  5. risk for self-destrucive behavior
75
Q

What would our outcomes for a suicide patients be

A
  1. Patient will reamin safe
  2. Family will stay overnight with patient
  3. Follow up appointment with counselor or therapist
  4. phone numbers of hotlines, self-help groups
  5. Is enegaged in treatment
  6. States feelings of isolation and loneliness are fewwer and less severe
  7. Increase problem solving skill
76
Q

What are our suicide precautions/observations?

A
  1. 1:1 percautions: continual observation at arms length for actively suicidal
  2. Oberservation: 15mins, percautions observe every 15 min and document affect/behavior/location
  3. nurse can implement then obtain orders
77
Q

What are some environmental guidlines for suicidal patients?

A
  1. Besides continual observation
  2. plastic eating utensils
  3. do not place in private room, keep door open
  4. Place close to nurse’s station
  5. Ensure patient swallows all oral medication
  6. Minimize self harm objects on unit: electrical cords, housekeeping carts, glass unlocked windows, keep other doors on unit locked
  7. Safety search: remove medications, sharps, belts, shoestring razors, matches, glassess, shampoo,
  8. check visitors/gifts
  9. review hopital P&P
78
Q

What is our interventions for managment of poisioning

A
  1. medically stabilize; identify toxin if possible
  2. prevent further absorption; give activated charcol po or ng (inital adult dose 50gm/240ml)
79
Q

What is the antidote for acetaminophen?

A

Acetylcysteine: PO,NG, or IV
inital adult dose 150m/kg IVPB

80
Q

What is the antidote for benzos

A

flumazenil (romazicom) IV (inital adult dose 0.2mg IVP)

81
Q

What is the antidote for opiods?

A

Narcan IV, IM, SQ (inital adult dose 0.4mg IVP)

82
Q

What should we know about postvention?

A
  1. survivors are stigmatized and isolated
  2. Complicated and painful
  3. mourning without normal social supports
  4. Five stages of grief
    • denial
    • anger
    • bargaining
    • depression
    • acceptance
  5. Post traumatic stress reactions
    • Irritability
    • sleep distrubances
    • anxiety
    • exaggerated startle reacion
    • nausea and headache
    • difficulty concentrating
    • guilt
    • withdrawl
    • reactive depressive

Module 6 (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions