د . حسين هليل وداعة
- it is a term that can apply to any loss event ( from loss of relative by death
to ---------------- unemployment ( loss of job ) or divorce
the effect of bereavement may be modify by :
-
- suddenness
- degree of anticipation
- available support
- the appropriate mourning
- marital and social consequence
Grief
- it is psychological and emotional process express both internally and
externally , that accompany bereavement
complicated grief initially there is :
-
un
-
1- shock ----- disbelief , numbness followed by period of increasing
awareness of loss
2- sadness and anger
3- ambivalence concerning lost person
4- increase irritability and sleep disturbance and tear fullness
- culture bound social and cognitive process through which one that pass
on order to return to more normal functioning …. This is necessarily
lengthy period , with regression .
د . حسين هليل وداعة
- at time of anniversaries' and in response to other reminder of loss one
may be hear . such comment
- those who have experienced significant bereavement even after many
years . if poot asked ( the hole in my life still there ) l don’t come across it
Grief
:
normal grief
-
1
- is continuous process but can be described conventionally as having
3 stage :
A- stage one ( denial stage ) :
- last from few hours to several days . there is denial which is manifestation
as lack of emotional response ( numbness )
- feeling of unreality .
- incomplete acceptance that death has occur .
B- second stage ( anger stage )
- last from weeks ------- 6 months ) but may be much longer .
- extreme sadness and weeping
- lone- less
- overwhelming of yearning for dead person
- anxiety restless and sleep disturbance .
- panic experience
- loss of appetite
- guilt to word deceased that they
- belaming doctor or other .
د . حسين هليل وداعة
- vivid experience of absence dead person .
- brief hallucination .
- memory of dead person .
- mtrusive thoughts
- with-drawal from social relation
C- third stage (acceptance stage ) :
- symptoms subside .
- regain of daily activity .
- recall ……
Abnormal grief or pathological grief
* grief reaction cc by :
- inter symptoms than usual
- meet the criteria of depression
- prolong more than 6 months
* abnormal grief occur in up to 35% of bereavement people met the criteria
of depression such people have :
- poor social adjustment .
- excessive use of alcohol .
- practical value to add deferential of depression disorder when criteria
of them met .
- some loss of self-esteem .
د . حسين هليل وداعة
* social suicide thoughts :
- occur in interest grief .
- suicide more in first years and continuous next 5 years
- young widow and elderly widow are at high risk than other age group .
* prolong grief :
- grief persist more than 6 months .
- progressive and persistent symptoms associate with depression
symptoms .
* delay grief parkes :
- grief associate pathological guilt .
- when first stage doesn’t appear until more than two weeks often death .
- occur more in sudden , unexpected death .
* inhibited and distorted grief :
Dutsch ( 1937 ) suggest :
- absence of grief .
- feature of marked hostility , overactive .
- extreme social withdrawal .
- physical symptom that were part of deceased person .
* the mortality of bereavement :
- increase rate of mortality among bereavement spouse and other close
relative .
- great in increase first 6 month
- death from heart disease , cancer , liver cirrhosis ( alcohol ) and suicides.
د . حسين هليل وداعة
1- sudden and unexpected death .
2- when bereavement person had very close , ambivalent relanship ---
emphasized by freud ( 1917 ) in paper ( mourni and melanc 0
3- when the survivor is insecure , or has difficulty in expressing feeling .
4- previous psychiatric disorder .
5- lack of social support .
Management :
- young widow with small children has many difficulty that aren’t shared
by elderly widow whose adult children can support her .
Councelling :
* for bereaved follow general rules that applied to adjusement reaction :
1- bereaved need to talk about loss .
2- to understand of normal coursed .
3- awaring person of illusion and grief hallucination .
4- to accept that loss is real .
5- to work through of grief .
6- to work through of grief .
7- to adjust life without deceased .
8- help person to progress of first stage ( denial )
ترتيبات العزاء
9- funeral arrangement and mange difficulties .
د . حسين هليل وداعة
10- caring young children .
11- reassurance normal life .
Parent grief for still born children
- child need special
- encourage to name the dead baby .
- obtain photograph .
Drug treatment of grief :
* drug can help anxiety and depression in first stage hypnotic or anxiolytic
for many few days to restore sleep .
may benefit if criteria for depression
antidepressant
-------
stage
nd
* In 2
disorder .
Support grief person :
- organization in UK known as ( CRVSE ) by sharing their experience with
bereavement .
Psychotherapy
Management and hospitalization patient :
Indication for hospitalization
1- acute episode ( agitated ).
2- suicidal .
3- risk to other .
4- for physical restraint .
5- improve judgment and vault rest .
د . حسين هليل وداعة
Psychotherapy :
- supportive psychotherapy .
- unsight psychotherapy
1- patient doctor relanship .
2- it regain insight through psychotherapy .
3- exploration feeling of patient .
Group therapy
- family therapy .
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