DEALING WITH DEATH AND BEREAVEMENT DR NEVIN ZAKI Assistant professor of Psychiatry تحت اشراف أد/هاله البرعي

Reaction to death varies Sudden death Accidents Peaceful death in elderly Cause :natural or environmental Extreme physical illness due to death Process of death is frightening

Factors influencing reaction to death Religious and spiritual beliefs Sudden or due t chronic illness Age (young will be more anxious Older will worry about their dependents Feeling of disengagement and depression Anticipatory grief about losses Dying person is withdrawing

We should encourage to support patient’s attempts to remain as independent as possible. He can be involved in making decisions concerned with the family

In our culture there is a tendency to hide facts from the patient In our culture there is a tendency to hide facts from the patient. When we do not talk about death with the patient, it does not mean that the patient is not aware of it.

Bereavement The effect of death on those who are still alive Typical or uncomplicated grief is usually seen following the death of a parent, child, sibling or first-degree relative

stages Shock and denial Despair and distress Searching for the dead Irritability and anger Blame the doctor or oneself Behaving as if he is still alve Appearance of traits similar to the deceased Acceptance stages

Children develop the concept of death around seven years of age. young children often cannot accept the absence of the person due to death. As children do not openly express their fears regarding death, They often develop emotional problems, which are manifested in a sudden drop in their academic performance, sleep disturbances, development of fears, depression and insecurity.

Provide some information Attitudes of doctors Its not right to tell Provide some information Mum effect Have to tell the truth

The bereaved person needs empathetic understanding but not pity, and at this time, social support system provided by relatives and friends in our culture is very helpful in coping with the loss

There is evidence for an increased incidence of both morbidity and mortality from organic disease, following bereavement. Bereavement may also result in a psychiatric illness such a neurotic illness, depression, schizophrenia, or mania

There are three types of abnormal grief. Chronic grief represents an intensification and prolongation of the typical form, and is frequently associated with recurrent ideas of guilt and self-blame, Inhibited grief tends to occur in the very young or the very old, and is characterised by the prolonged inhibition of a large part of the total picture of typical grief Delayed grief is typical or chronic grief occurring after a delay of months or years.

Breaking bad news The first position is that patients should always be given full information regardless of their individual perceptions or needs. Second view states exactly the opposite; that under no circumstances should patients be informed that they have acquired a fatal disease, and that falsehood and deception should be used if necessary, on the basis that the patient needs protection from the terrible reality of terminal illness. A third view suggests a more flexible approach, with a variety of psychological and sociological factors to be taken into consideration, but without guidelines as to how this might be done