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94 Cards in this Set
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What are the characteristics of Major depressive disorders? |
Mood disorder for more than 2 WEEKS!!!
at least 2 Weeks! Change in the level of functioning (not working, in bed..etc.) |
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What is anhedonia?
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don't enjoy what you use to
shopping, fishing, hunting absence of pleasure |
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Why do women have more depression?
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1) Hormonal Theory
2) Stress (Child Birth, Child Rearing) 3) Diagnosis Biased (Doctor's miss dianosing it) |
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What is the age of major depression?
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40 year old
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Who has higher depression?
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no close relatives
divorce separated |
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What neurotrasmitters are associated to depression?
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NE, Serotonin, Dopamine
low specially serotonin or NE |
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Tx for Depression?
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combination of Serotonin/NE
or pure Serotonin |
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What is the metabolite of serotonin?
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5-HIAA
5-hydroxy indolacetic acid |
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Why is 5-HIAA important?
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Found decreased levels of 5-HIAA in Suicide
Agression also has low levels of 5-HIAA |
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Alcohol is involved in what?
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Alcohol Disinhibits you
Kill someome or get killed |
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Why is alcohol like serotonin?
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low levels of serotonin tend to tender patients uninhibited
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Is family history involved in Major Depressive Disorder?
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Yes
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Behavioral Reasons?
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Learned helplessness
Give up and prone to depression Animal/Model Cat in cage/electrified So cat wont move |
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What is characteristic of Major Depression?
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Weight Loss
Insomnia Retardation |
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What is also associated with Major depression?
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Suicide
Diminsh ability to concentrate Stoop Posture Barely Audible |
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Cognitive Impairment?
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Serial 7
Serial 3 |
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What lab tests are given to Major Depresion?
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Usually for monitoring
1) Dexamethaosone Supression Test 2) Thyrotropin-Releasing Hormonte Test (TRH) |
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Dexamethasone test is what?
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Steroid suppress cortisol
administer dexamethasone measure cortisol next day increase in cortisol |
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TRH test?
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measure thyroid stimulation hormone...
normally increase TSH give TRH see blunted response low TSH |
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Major depression mimics what other condition?
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hypothyroidism
TSH low |
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Major Depressive Disorder with Psychotic features?
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Worst than Major Depression
meets criteria for Major Depression but also psychotic disorders hearing dead sister's voice |
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Major depression with atypical features?
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increase weight
increase appetite increase sleep gain 40 pounds sleepin 14 hours a day eats 10 times a day |
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Important to ask about suicide?
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yes
to make sure they are thinking about it or immediately admit or hospitalization |
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Tx to increase NE, Serotonin, DOPA?
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SSRI (Ser only)
TCA (Ser+NE) MAOI (all) |
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Which is best?
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SSRI
cleanest least S/E Compliace increases |
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Is ECT used?
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YES
Electro-Convulsive Therapy |
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Who is Tx w/ ECT?
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Patient w/ suicide tendencies
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Medication and Therapy is better than medication alone?
or only therapy? |
Both is better
Meds and Therapy |
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ECT S/E?
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Intracranial Pressure increases
safe for pregnancy safe for patient w/ MI |
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Differential Diagnosis for Major Depressive Dsor?
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hypothyroidism
parkinson dementia medication (like beta-blockers) Tumors (CT head not routine) CVA (right side causes apathy) Cocaine Withdrawal (suicidal) cocaine crash no energy, apetite disturbances Grief |
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Bipolar disorder is seen at what age?
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Usually peak at 30
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When are first episodes seen?
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College
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What is the race biased?
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African American Psychotic
White Mood Dz Mood gender (female) |
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Is there genetic linkage?
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The highest genetic component
Both parents (then really high 50-75% chance) |
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Manic have a coexisting drug dependence?
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They use alcohol (self-medicate) to calm down when they are manic
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What are the symtoms of mania?
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Euphoria
Smartest, grandiosity, distracted easily involved in many activities pressured speech less sleep (insomnia) libido goes up |
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What is pressured speech?
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fast speech
flight of ideas |
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Libido in patients w/ depression?
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decreased
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What do you find in signs and symptoms of bipolar dz?
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pressured speech
psychomotor agitation |
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Tx of bipolar?
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lithium
carbamazepine (Also benzodiazepines anti-psychotics) |
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What works faster mood stabilizers or anti-psychotics?
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Anti-psychotics in a few days... so in E.R. start the patient w/ anti-psychotics and then go into mood stabilizers in 14 days
Tx w/ individualized psychotherapy |
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Do Bipolar pat. has psychotic disorders?
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yes
schizophrenia could be perceived |
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What other disorders can mimmick bipolar dz?
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CNS infection
tumors hyperthyroidism Medications |
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What medications can mimmick bipolar dz?
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Amphetamines
Stimulants (Caffeine) |
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How much time do you look for in Dysthymnic Dz?
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2 years is key!!!!
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Dysthymia is called what?
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Mild form of Major Depression
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What sex if MC for dysthymia?
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Females
young (<64), low income anxiety substance abuse present |
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What personality is involved w/ dysthymia?
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borderline personality
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Do you usually hospitalize dysthymia pat?
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not usually
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What tx is given?
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Same as major depression
SSRI MAOI NE |
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What do you give if you can give only one drug for Dysthymia?
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SSRI is best
less S/E |
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What is cyclothymic Dsord? Key... is time?
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2 years
periods of hypomanic/depressed mood |
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Do you hospitalize cyclothymic disorder?
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not really
if you think of hospitalizing then it is Mania |
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Hypomania?
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You feel up
buying a lot of things but still basically functioning sex drive is up |
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What is bipolar I?
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Mania and Major Depression
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Bipolar II?
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Hypomania and Major Depression
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Key for Mania?
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tapping on strangers for sex
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Cyclothymia is?
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Minor Bipolar II Disorder
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Tx for cyclothemia?
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lithium
carbamazepine valproic acid |
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DOC for cyclothemia?
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Mood stabilizers
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Diff Diag for cyclothemia?
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seizures
drugs |
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What personality disorder is similar to cyclothemia?
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Borderline Personality
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Patient w/ every winter get depressed. Diagnostic?
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Cyclic pattern
Seasonal Affective Disorder |
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What is decreased in seasonal affective disorder?
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melatonin
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Tx for Seasonal Affective Disorder?
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Phototherapy
Sleep Deprivation |
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What do you treat first? Mood disorder or anti-psychotic symptoms?
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First treat the worst
Psychotic Symptoms |
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If you have mania and depression? What tx first?
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Tx give mania first
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Tx for Antipsychotic + Mood disorder?
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Risperidone
the best is both Risperidone and Fluoxetine |
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What's another name for Grief?
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Bereavement
so if you see two words in the same answer choices don't pick it |
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What is another name for depression?
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pathological grief
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Normal Grief is how long?
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< 1 year
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What if you have grief for more than a year?
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Depression
Need to tx it won't go away |
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What is characteritic of symptoms of Grief?
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waxing and waning
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Major depression involves what symptoms?
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Symptoms do not get better
affects level of fx don't get out of bed don't pay bill children taken care by Babysitter |
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Suicide in grief or depression?
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depression
thinking of doing it |
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How long does it takes for grief to go back to normal?
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Usually several months (2)
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How long does postpartum blues occur?
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lasts up to 2 weeks
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What is more stressfull? 1st 2nd or 3rd?
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1st baby
so the worst prognosis from 1st baby on Pospartum Psychosis occurs with 1st baby |
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When does baby blues start? Postpartum blues...
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at birth
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When does postpartum depression or psychosis begin?
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1 month after birth
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How long do pospartum depression last? Psychosis?
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they may continue
so Tx is needed |
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Does mother care for baby in postpartum blues?
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yes
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Which mother tend to kill their babies?
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Postpartum Psychosis
more than Postpartum Depression |
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Why do postpartum psychosis kill babies?
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because of their psychosis
they have an evil eye he is the anti-christ I see horns growing on them the baby is trying to control my mind |
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Why do Postpartum depression women kill their children?
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they feel pain suffering
I don't want my baby to suffer this is a bad world they kill their children because they want to limit their children's suffering |
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Tx of postpartum blues?
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no treatment
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What is the Tx for postpartum depression?
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SSRIs
Antidepressants |
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What are the Tx for Postpartum Psychosis?
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Antipsychotics
Mood stabilizers antidepressants |
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Stages of Death and Dying?
Stage I |
Shock and Denial
It's not possible |
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Stages of Death and Dying?
Stage II? |
Anger
Why me? |
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Stages of Death and Dying?
Stage III? |
Bargaining
Night before test going to pray |
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Stages of Death and Dying?
Stage IV? |
Depression
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Stages of Death and Dying?
Stage V? |
Acceptance
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Do the stages of death and dying are in what order?
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Not in order
It can be any stage, in any order |