Acute Stress Disorder

Question 1

Extreme stress reaction disorders

Answer 1

Following extremely stressful events, three different conditions can affect someone:

1. Acute Stress Reaction
   - Disorder hours -> days
   - do not tend to persist >1m

2.Adjustment Disorder / Prolonged Grief Reaction
- <1 month
- do not tend to persist >6m

3.Post-Traumatic Stress Disorder (PTSD) -
- symptoms for >1m
- within 6m of incident

Question 2

Define

Answer 2

ICD-10: a transient disorder that develops in an individual without any other apparent mental disorder in response to exceptional physical and mental stress and that usually subsides within hours or days

• DSM-V says symptoms must last for ≥3 days; if they last >1 month, consider diagnosis of PTSD
• Onset of symptoms is within minutes

lthough ASD and PTSD both begin with an acute stressor, ASD differs from PTSD in…

• PTSD is diagnosed based on symptoms in clusters, not in totality
• PTSD has a dissociative sub-type however, in ASD, depersonalisation and derealisation are symptoms
• PTSD includes non-fear-based symptoms (i.e. risky behaviour) whereas ASD does not

Question 3

Epidemiology

Answer 3

Epidemiology

Anxiety disorders are very common

affect women more than men

Question 4

Aetiology

Answer 4

The state starts within minutes of the trauma and resolves spontaneously within hours

It can last for up to 1 month

ICD-11: The response to the stressor is considered to be normal given the severity of the stressor, and usually begins to subside within a few days (1-3dys) after the event or following removal from the threatening situation

Traumatic events: serious/ life-threatening accident, physical or sexual assault, abuse (including childhood, domestic), work-related exposure to trauma, trauma related to serious health problems or childbirth experiences, war and conflict, torture, etc.

 

Question 5

Symptoms

Answer 5

Symptoms may show mixed and changing picture- including an initial state of:

• Being in a daze- ‘dream world’ with some constriction of the field of consciousness and narrowing of attention
• Inability to comprehend stimuli
• Disorientation

This may be followed by:

• Further withdrawal from surrounding situation (to the extent of dissociative stupor)
• Agitation and over-activity (flight reaction or fugue)
• Autonomic signs of panic anxiety- tachycardia, sweating ,flushing
• Sadness, despair
• Anger
• Depersonalisation
• Derealisation

Question 6

Investigations

Answer 6

Full history (and MSE if indicated) and collateral history

Must be a clear history between stressor and reaction

 

Question 7

Management

Answer 7

Self-limiting and supportive only

Biological Treatment
- Exclude any injury
- Benzodiazepines
- Can alleviate extreme short-term distress but does NOT prevent later PTSD

Psychological Therapy
- trauma-focused cognitive-behavioural therapy (CBT) is usually used first-line
- NOTE: Psychological ‘debriefing’ (by describing the trauma and the emotional response to it) may increase the likelihood of PTSD later

Social Interventions
- Support
- Reassurance

Question 8

Prognosis

Answer 8

 

Complications

Anxiety disorders: PTSD

 

Prognosis

In most people, these symptoms disappear as they come to terms with the events