Acute stress reaction Flashcards
Define an acute stress reaction.
Acute stress disorder is a psychiatric diagnosis that may occur in patients within four weeks of a traumatic event. Features include anxiety, intense fear or helplessness, dissociative symptoms, reexperiencing the event, and avoidance behaviors.
What is the aetiology of an acute stress reaction? What are risk factors for an acute stress reaction?
Being exposed to a traumatic event
Summarise the epidemiology of an acute stress reaction.
ASD affects 14 to 33 percent of persons exposed to severe trauma.
What are signs and symptoms of an acute stress reaction?
Symptoms are typically mixed and changing picture.
Initial state of ‘daze’ with some constriction of consciousness/attention, inability to comprehend stimuli and disorientation. This may be followed by further withdrawal from surrounding situation OR by agitation and over-activity (flight reaction or fugue)
Autonomic signs of panic (tachycardia, sweating, flushing) common. Symptoms start within minutes of event, and disappear within 2-3 days maximum (often hours). Partial/complete amnesia for episode may be present. Often disoriented and agitated but sometimes irritable, panicky or aggressive.
After event, may experience amnesia, depersonalisation and derealisation.
What investigations should be performed for an acute stress reaction?
ICD-10 acute stress reaction checklist
What is the management for an acute stress reaction?
Exclude injury
Often, support and reassurance is all that is required.
Benzodiazepines can alleviate extreme short-term distress but do not prevent later PTSD. More formal, immediate, psychological ‘debriefing’ (being required to describe trauma and emotional response to it) may increase likelihood of later PTSD
What are complications associated with acute stress reaction?
Later progression to PTSD
What are the risk factors for progression to PTSD?
Avoidance behavior
Below average IQ or cognitive ability
Excessive safety behavior (e.g., taking excessive precautions, excessively avoiding trauma reminders)
Family history of anxiety or mood disorders
Female sex
Greater distress at time of event
Greater perceived threat to life
Greater symptom severity at one to two weeks after trauma
High level of hostility
History of sexual or physical abuse in childhood
Less social support after trauma
Low level of self-efficacy
Mental defeat (i.e., processing the trauma as a complete loss of personal autonomy)
Negative self-appraisals
Nowness of trauma memories (i.e., when remembering the trauma, feeling as though it is happening now)
Peritraumatic dissociative symptoms during assault
Peritraumatic emotional responses
Prior psychological problems (e.g., anxiety or mood disorder)
Rumination about trauma
Severity of trauma
