Discuss the physical, emotional, cognitive and behavioral responses an individual is likely to experience in response to a newly diagnosed condition with a poor prognosis.

Definitions:
Physical: of body: relating to the body, rather than to the mind, the soul, or the feelings
Cognitive: 1.concerned with acquisition (gaining) of knowledge: relating to the process of acquiring knowledge by the use of reasoning, intuition, or perception. Relating to thought processes. The interpretation of stimuli and the organization of thoughts and ideas.
Emotional: a state of feeling. -a conscious mental reaction (as anger or fear) subjectively experienced as strong feeling usually directed toward a specific object and typically accompanied by physiological and behavioral changes in the body (merriam webster)
Behavioral: 1.way somebody behaves: the way in which somebody behaves

Research:

-Psychological responses of terminally ill patients who are experiencing suffering: A qualitative study
According to leading theories, suffering is dependent on the threats that the patient perceives and the resources the patient uses to respond to such threats.
Previously published reports have identified the occurrence of a terminal disease as a period of multiple threats that can generate intense suffering. Examples of such suffering include pain and other symptoms (Heath et al., 2010, Jurado-Martín et al., 2010, Abraham et al., 2006 and Lorenz et al., 2006), the progressive dependence associated with the evolution of the disease (Chio et al., 2008, Blinderman and Cherny, 2005 and Daneault et al., 2004), uncertainty regarding the future (The et al., 2001 and Clark, 2002), being a “burden” to others (Chochinov et al., 2007 and McPherson et al., 2007) and outstanding issues that the patient has left unfinished (Ando et al., 2008 and Williams, 2004).
Some authors have claimed that patients who suffer from a serious illness (or one with a poor prognosis) respond by experiencing a personal transformation regarding their way of viewing life and human relationships (Chio et al., 2008, Arman et al., 2002, Arman and Rehnsfeldt, 2003 and Nissim, 2008).
The meaning given to both the individual's own losses as well as the disease itself is also relevant, as is a consideration of the phase of the life cycle that the patient is passing through (Daneault et al., 2004 and Williams, 2004).
The analysis of the participants’ responses to the various questions of the semi-structured interview allowed the identification of the principle, “Realise that life is short.” When this discovery occurs, one observes in the participants’ answers various manners of responding to this threat: “revaluating life”, “opportunity for growth” and “resignation/acceptance”.
The emergence of disease causes a change in the mind-set of individuals regarding how they perceive their lives. This is the moment in which they realise that life, specifically their own life, is short. “Life is not the same anymore… I don’t know, you see it shorter” [4:24] [57].
The realisation that life is short causes patients to review their lives. Some participants feel reassured because they believe that they have accomplished the necessary life goals. These goals are usually associated with ensuring the futures of their children.
“I have already done, as they say, the thing in life. I got married, I raised a child, I planted many trees in the field and I have done harm to no one and I am thus waiting for whatever God wants” [18:8] [39].
“Because I see my children in their houses—those beautiful houses they have, and they have their jobs and their children, nothing worries me anymore. I am at ease” [6:31] [56].
In contrast, for other patients, the revaluation of their lives creates feelings of helplessness and frustration. They focus on what they are losing and the situations they have left unresolved rather than what they have accomplished or successfully resolved. In this sense, the commencement of the disease generates “pending tasks” that most often involve ensuring the future of their families but occasionally are related to certain personal endeavours that these patients have left unfinished or “This is one of the most saddening things, when you truly realise that life has an end, and you think, I did not do this or the other…” [2:13] [62].even desires to “settle scores”.
“You think about many things, of people that have done wrong to me…. I should have said some things, at the right time…and without revenge” [13:32] [117].
The onset of disease can be considered an opportunity for personal growth. The patients interpret their situation as a “signal” that incites them to change their attitudes towards life regardless of its duration.
One of the changes that concerns most patients is living in the present while trying not to think about the future. This concept is closely related to their uncertainty regarding the future.
“It is necessary to live in the moment, and because I don’t know what is going to happen tomorrow, I enjoy the moment, making a life within the possibilities available each moment” [10:19] [77].
However, although the patients describe their futures as negative, they maintain their uncertainty through verbal expressions of doubt or ignorance. Some patients choose to persevere in the hope of total healing despite their situation.
“Yes, I am confident I will get better” [19:17] [93].
“I have blind faith in him [the doctor]; he will solve my problem and give me back my health and quality of life” [22:30] [42].
Those patients who feel reassured that they have accomplished their necessary goals in life are ready to die in peace. The patients’ ability to re-evaluate their prior experiences in a positive light and to reintegrate and resolve conflicts enables them to assign new meanings to their current experiences of suffering and improves the communication between these patients and their family members.
Claiming a change in attitude has been a constant feature of end-of-life dialogues for many decades (Bingley et al., 2006).
Changes in relationships with others could be a response to the patients’ need to strengthen ties before their deaths, thus allowing them to be remembered positively by their loved ones (Ando et al., 2008 and Nissim, 2008).
The allusions to a higher power such as God or statements regarding “the Law of Life” also demonstrate the patients’ need to find a spiritual explanation for their suffering.

-The Behavioural Responses to Illness Questionnaire (BRIQ): a new predictive measure of medically unexplained symptoms following acute infection
The most well-known is the Illness Behaviour Questionnaire (IBQ), which despite its name, assesses largely cognitive variables ; hypochondriasis, disease conviction, psychological versus somatic focus, affective inhibition, affective disturbance, denial and irritability (Pilowsky,1993).
Rief and colleagues created the Scale for the Assessment of Illness Behaviour (SAIB; Rief et al. 2003). It includes items that measure the behavioural expression of verification of diagnosis, expression of symptoms, medication, consequences of illness, and scanning.
All-or-nothing behaviour describes a pattern of alternating extremes of behaviour, characterized by a cyclical response of pushing oneself to keep going until this feels no longer physically possible. The findings suggest that patients who engage in all-or-nothing behaviour attempt to be self-reliant when ill rather than impose on others. This is not a reflection of having a less severe illness, as all-or-nothing behavior showed a slight positive association to Campylobacter symptoms at the time of infection. All-ornothing behaviour also showed a small negative association with days off work suggesting that these patients’ attempts to keep going are reflected in their reluctance to take time off work.
-Effective Management of the Patient's Emotional Response to Acute and Chronic Illness
The brain contains a small almond-shaped gland that is called the amygdala and research has shown that this gland has a major impact on emotional regulation
(Porter & Kaplan, 2010)
Previous studies have shown that there can be changes in brain anatomy for patients with certain psychological illnesses. This has been shown through visualization of brain anatomy using CAT, MRI and PET scans. Many illnesses evolve into chronic states and can mirror the death and dying process, not only because of the morbidity of the illness but for some patients it is the loss of the familiar person they knew.
The recent advances in medications and health interventions allow patients to live with many diseases that might have killed them years ago. The nurse needs to recognize that a patient may experience depression or anxiety when diagnosed with a chronic illness.

-emotions and illness
Anxiety can be defined as a feeling of apprehension, uncertainty, and fear without apparent stimulus, and associated with physiological changes (Dorland's 1985). The ICD-10 [World Health Organization (WHO) 1992] classification of generalized anxiety disorder states in its diagnostic guidelines `The sufferer must have primary symptoms of anxiety most days for at least several weeks at a time, and usually for several months. These symptoms should usually involve elements of:
• apprehension (worries about future misfortunes, feeling `on edge', difficulty in concentrating, etc.)
• motor tension (restless fidgeting, tension headaches, trembling, inability to relax); and
• autonomic overactivity (light headedness, sweating, tachycardia or tachypnoea, epigastric discomfort, dizziness, dry mouth, etc.)'. (WHO 1992, p. 140).
Fear and sadness are discrete emotions associated with specific life events (Izard 1991, Lazarus 1991). Whereas, anxiety and depression are a complex combination of emotion and thought (Izard 1991, Lazarus 1991).
In patients suffering from multiple sclerosis, Rabins et al. (1986) state that depression is partly determined by the presence of brain involvement, but it is also an emotional reaction to the disorder
Perry and Cella (1987) believe much overdiagnosed depression as attributable to normal physical and adjustment events such as neurovegetative changes and grief.
Acute illness is an event from which individual psychological problems can develop. The emotional dissonance caused by acute illness combined with a vulnerable personality may be a trigger to mental health problems.
Illness cognition has been defined by Croyle & Ditto (1990) as `Any mental activity (e.g. appraisal, interpretation, recall) undertaken by an individual who believes himself or herself to be ill, regarding the state of his or her health and its possible remedies' (p. 32).

Commonpsychiatricproblemsneartheendoflifeincludedepression,anx- iety,delirium,andsuicidalideation,allofwhichcanemergeduringthecourseof aterminalillness.Anumberofmedicalandpsychosocialissuescanleadtothese various disorders, including medication side effects, physical impairments, dependency, bereavement, and family dysfunction, all of which frequently co- occur during a terminal illness and can increase the risk of psychological/psy- chiatric difficulties (Breitbart, Chochinov, & Passik, 1998

-assessing psychological distress near the end of life
Common psychiatric problems near the end of life include depression, anxiety, delirium, and suicidal ideation, all of which can emerge during the course of a terminal illness.
A number of medical and psychosocial issues can lead to these various disorders, including medication side effects, physical impairments, dependency, bereavement, and family dysfunction, all of which frequently cooccur during a terminal illness and can increase the risk of psychological/psychiatric difficulties (Breitbart, Chochinov, & Passik, 1998).
The presence of psychological distress, even at a mild to moderate level, can have a significant effect on the patient in the last weeks of life. Many patients describe a decrease in their capacity for pleasure, sense of meaning in their lives, and ability to make connections with others and cite these difficulties as having a negative effect on their overall quality of life (Breitbart, Bruera, Chochinov, & Lynch, 1995).
Psychiatric symptoms can also lead to heightened distress and worry among friends and family members, possibly leading to a downward spiral as family distress further fuels patient distress (Block, 2000
Depressed mood and sadness are common, even appropriate responses for patients who are facing a progressive illness that will ultimately lead to their death. Whether due to anticipatory grief over the impending loss of health, autonomy, loved ones, and life or a biochemical reaction related to one's illness or side effects, feelings of depression are so common as to be almost unnoticed in many terminally ill individuals.
Yet despite the common occurrence of feelings of sadness and depression among terminally ill individuals, the presence of a major depressive episode is much less common.
Many terminally ill patients suffer from more modest symptoms of depression that do not rise to the threshold of a major depression
Specifically, Endicott proposed substituting four cognitive/affective symptoms of depression (fearfulness or depressed appearance, social withdrawal or decreased talkativeness, brooding/self-pity, and lack of emotional reactivity)
However, other studies have suggested that the cognitive symptoms of depression (e.g., anhedonia and feelings of hopelessness, worthlessness, and guilt) are more accurate indicia of depression in medically ill individuals (Passik et al., 2000).
Anhedonia is defined as a loss of interest or pleasure in activities but is often confounded by the functional decline that accompanies advanced illness. As physical limitations restrict a patient's ability to participate in activities, some disengagement from activities or interests is common. Patients who are not depressed, however, will typically refocus their interests to those that are less physically or mentally demanding (e.g., social interactions and prayer/meditation) without losing interest in activities altogether (Wilson, Chochinov, de Faye, & Breitbart, 2000). When pervasive, anhedonia can manifest as a total loss of interest or pleasure in all activities, including interactions with loved ones. In these latter cases, severe anhedonia is virtually pathognomonic of a major depression.
Similar to depression, clinicians often assume that high levels of anxiety inevitably accompany the terminal phase of an illness,
Anxiety is quite common in patients receiving palliative care and can reduce a patient's tolerance for physical distress, especially pain, and substantially impede overall functioning (Noyes, Holt, & Massie, 1998).

-living with a terminal illness: patient priorities.

Personal/intrinsic factors: This theme encompassed issues related to the individual's bodily state and function, participation in daily activities, emotional well-being and involvement in work, leisure and social pursuits.

External/extrinsic factors: This theme addressed outside influences, including interpersonal responses (from other significant individuals), the system response (from health care and social services) and aspects of the physical environment (both natural and constructed) that either facilitated or impeded life involvement
Future issues: Participants’ prospects for the future, as well as strategies for moving forward, were addressed in this theme. Participants frequently reflected on their past activities and accomplishments and the feasibility of realising their life plans (made before the onset of illness).
Perceptions of normality: This theme incorporated issues related to the participant's life before the onset of illness. It provided a reference point for defining the current state of living with dying (i.e. life with, relative to life without, a terminal illness), as well as determining the consequences of this state of being.
Taking charge: Taking charge emerged as the central, overarching theme (Figure 2). It encompassed issues associated with participants’ experiences of living with dying, including (1) identifying and fulfilling their needs related to symptom management and life functioning and (2) determining and realising their philosophical positions about the meaning of life in the face of death. The concept of taking charge extended beyond the ‘locus of control’ notion that the individual's belief about the position of control (defined as either ‘internal’ or ‘external’) is critical in affecting outcome (Folkman 1984, Kraus & Stryker 1984). Rather, taking charge was concerned with people's ability to define and actualize their needs, with the position of control depending on their preferred means of achieving such outcomes. Despite acknowledging attempts to maintain normal activities in the early stages of illness, participants identified significant and persistent restrictions in relation to three themes: personal/intrinsic factors, external/extrinsic factors and future issues
Notable impacts with respect to personal/intrinsic factors were fatigue/lack of energy, loss of appetite, diminished ability to achieve activities of living, restricted involvement in relation to work and social and recreational pursuits, and the emotional impact of ongoing frustration.