1. Death and Dying Max Angelo G. Terrenal Post Graduate Medical Intern 2013-2014 Veterans Memorial Medical Center

2. DeathAbsolute cessation of vital function 3. Free from avoidable distress and suffering for patients, families, and caregiversGood Death 4. Needless suffering Dishonoring of patient or family wishes or values Offending norms of decencyBad Death 5. Losing these functions Developmental concomitant of living Part of birth-to-death continuumDying 6. Clinical Criteria for Brain Death in Adults and Children Coma Absence of motor responses corneal reflexes caloric responses gag reflexcoughing in response to tracheal suctioning sucking and rooting reflexes pupillary responses to light and at midposition with respect to dilatation (4-6 mm) 7. Clinical Criteria for Brain Death in Adults and Children Interval between two evaluations, according to patient's age Term to 2 mos old, 48 hr >2 mos to 1 yr old, 24 hr >1 yr to 18 yr old, interval optional 8. Stages of Death and Dying 9. Stage 1Shock and Denial 10. Stage 2Anger 11. Bargaining Stage 3 12. Stage 4Depression 13. Stage 5Acceptance 14. Grief subjective feeling precipitated by the death of a loved one 15. process by which grief is resolvedMourning 16. Bereavement deprived of someone by death 17. Duration of Grief the bereaved is expected to return to work or school in a few weeks to establish equilibrium within a few months to be capable of pursuing new relationships within 6 months to 1 year 18. Phenomenology of Grief 19. initial shock , disbelief, and denial 20. social withdrawal 21. restitution 22. Phases of Uncomplicated Grief 23. Complicated Bereavement Chronic Hypertrophic Delayed 24. Chronic Grief Close relationship Lack of social support 25. Hypertrophic Grief Unexpected death Intense bereavement Long-term course 26. Delayed Grief Absent or inhibited grief Prolonged denial 27. Biological Perspectives immune functioning decreased lymphocyte proliferation impaired functioning of natural killer cells 28. Bereavement vs MDD 29. Bereavement Symptoms may meet syndromal criteria for major depressive episode, but survivor rarely has morbid feelings of guilt and worthlessness, suicidal ideation, or psychomotor retardationMDD Any symptoms as defined by DSMIV-TR 30. Bereavement Considers self bereavedMDD May consider self weak, defective, bad 31. Bereavement Dysphoria often triggered by thoughts or reminders of the deceased.MDD Dysphoria often autonomous and independent of thoughts or reminders of the deceased 32. Bereavement Onset is within the first 2 mos of bereavement.MDD Onset at any time 33. Bereavement MDD Functional Clinically significant impairment is distress or transient and mild impairment 34. Bereavement No family or personal history of major depression.MDD Family and/or personal history of major depression. 35. Grief Therapy 36. should not routinely see a psychiatrist mild sedative antidepressant medication or antianxiety agents are rarely indicated group counselling 37. Dying, and the individual's awareness of it, imbues humans with values, passions, wishes, and the impetus to make the most of time 38. Thank you