Session 03 - Stress Reactions Flashcards
What is an acute stress reaction?
The acute reaction that occurs rapidly after a sudden and stressful event, leading to symptoms which usually arise very quickly and terminate within three days.
Symptoms of acute stress reaction.
- initial state of being dazed and confused
- purposeless overactivity and withdrawal
- intense brief anxiety
- autonomic arousal (sweating, dry mouth, vomiting).
Management of acute stress reaction.
Help patient to re-orientate with trauma focussed CBT.
Prognosis of acute stress reaction.
Most cases rapidly resolve within 3 days.
If symptoms persist >1 month, likely progression to PTSD.
What is PTSD?
A chronic condition that occurs following a traumatic event, where the event gets stored as emotionally charged memories which the patient re-experiences.
Symptoms of PTSD.
Present for >1 month:
- persistent instrusive thoughts and re-experiencing (flashbacks, nightmares, intrusive images).
- autonomic hyperarousal (startle, insomnia, hypervigilance).
- avoidance (patient avoids situations and stimuli associated with the event).
- emotional detachment (feeling detached from people and lack of ability to experience feelings).
Higher risk of depression, substance misuse, unexplained physical symptoms.
Management of PTSD.
First line is trauma-focused CBT or eye movement desensitisation and reprocessing (EMDR) therapy.
The aim is to recall these memories and emotionally resolve them.
What is an adjustment disorder?
A condition that encompasses the abnormal psychological symptoms which occur in response to life adversity (e.g. job loss, divorce).
The symptoms occur within weeks of a stressful life event and last <6 months.
Symptoms of adjustment disorder.
Symptoms <6 months, but can mimic those of anxiety and depression (lower severity).
Anxiety: autonomic arousal, insomnia, hypervigilance.
Depression: sadness, tearfulness, anhedonia, fatigue.
Diagnosis of adjustment disorder.
Only made when symptoms are not enough to justify diagnosis of anxiety or depression.
Management of adjustment disorder?
Encouraging ventilation of feelings and making problem-solving strategies.
Second line is CBT.
What is an abnormal grief reaction?
An adjustment disorder which specifically occurs after a bereavement.
Symptoms of abnormal grief reaction.
Characterised by a prolonged grief of greater intensity than would occur in other people.
Leaves people feeling numb, shocked and confused about their role in life.
What are the stages of a normal grief reaction?
1) shock
2) anger
3) guilt
4) sadness
5) acceptance
This lasts <2 years and does not require specific management other than support.
What factors may increase the risk of abnormal grief reaction?
- relationship with deceased was difficult
- sudden death
- normal grieving was constrained (e.g. putting on a brave face for the children)
