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Flashcards in Stress reactions Deck (19):
1

Types of stress reaction

Acute stress reaction

Adjustment disorder

PTSD

2

Timecourse of acute stress reaction

Immediate onset, 2-3d duration

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Time criteria for adjustment disorder

Onset within 1 month of stress (3mo for DSM), duration <6months

4

Clinical features of acute stress reaction

Emotion: 'Dazed'

Cognition: Amnesia, denial

Behaviour: Out of character, withdrawal or over-active

Somatic: High autonomic activity

Association: Acute stressor

5

Management of acute stress reaction

Reassurance (not debriefing)

Removal of stressor if possible

Possible short course of benzodiazepines

6

Features of adjustment disorder

Emotion: Depression, anxiety, irritability, poor concentration ( greater than expected)

Cognition: Preoccupation with event

Behaviour: Angry/sad outbursts, impairment of function

Somatic: Moderate autonomic symptoms

Association: Chronic stressor (e.g. grief, medical condition), occurs within a month of stressor

7

Management of adjustment disorder

Reassurance + practical support

Advice on stopping unhealthy coping behaviours e.g. substance misuse

Psych:

  • Self-help, incl. problem-solving therapy to avoid unhealthy thought patterns
  • Opportunity talk - friend/family or specific short-term counselling
  • Trearment for depressive/anxiety symptoms

8

Time criteria for PTSD

Symptoms for several weeks (>=4w after stressor)

9

Differntial for acute stress reaction

Initial neurosis

Acute psychosis

Delirium

10

PTSD features

Emotion: Numbness, irritability, anxiety and depression

Cognition: Repeated reliving of traumatic experience in memories/nightmares (as flashbacks)

Behaviour: Avoidance of reminders, social withdrawal

Somatic: Hypervigilance (startle response)

Associations: Substance misuse, depression, severe stressor

 

11

Time criterion for abnormal grief reaction

>=6 months

12

Features of complicated grief

ARTI grief....

Time: Persists >6 mo

Impairment: Intereferes with function

Rumination: Preoccupation with aspects of the death

Avoidance: Of reminders of the loss, excessive

13

Distinguishing grief from major depression

Pervasiveness: In grief may have periods of euthymia/positive emotions

Guilt: In grief focussed on the deceased, in depression is pervasive

Hope: Grief can imagine being happy if reunited with person, depression cannot imagine being happy

14

Prognosis of PTSD

30% chronic symptoms

Most recover within 1 year

15

Risk factors for PTSD

Bio: Female, FHx/PHx of psych disorder, children

Psycho: Hx of abuse, low self-esteem, low intelligence

Social: Ethnic minorities, occupation (e.g. military), lack of social support, socioeconomic adversity

16

Maintaining factors for PTSD

Classical conditioning: Stimuli/reminders --> fear response

Avoidance behaviour: of reminders

Reminders ofe vent

17

Management of PTSD

  1. Watchful waiting (see if symptoms persist for >=4w)
  2. CBT and/or EMDR
  3. Pharma: Paroxetine, venlafaxine, mirtazapine

18

Risk factors for prolonged grief reaction

Vulnerabilities

  • Past/family psych Hx
  • Dependence
  • Prior multiple losses
  • Socioeconomic adversity
  • Substance abuse

Nature of death

  • Child/partner
  • Stillirth/neonatal birth
  • Sudden, unexpected
  • Missing, believed dead

19

Management of grief reacction

  • Emotional support: Listening, guidance on normality of e.g. hallucinations
  • Practical support: Death certification, funeral proceedings, benefits
  • Psychological support: Self-help, CRUSE/other voluntary, short course of bereavement counselling, CBT