Acute Stress Disorder

Question 1

Derealization

Answer 1

Perception that the environment is somehow different or strange, although the individual cannot account for the changes

Question 2

Dissociative amnesia

Answer 2

Memory loss of some component of an event, which in the case of ASD is usually traumatic

Question 3

Time window of acute stress disorder vs PTSD

Answer 3

Acute stress: 3 days to 4 weeks

PTSD: Longer than 4 weeks

Question 4

Head injury in the history of a patient with acute stress disorder

Answer 4

Head injury should raise concern for post-concussive syndrome in the ddx

This may result in mood and arousal symptoms similar to ASD, however intrusive symptoms and avoidance symptoms will not be present.

Question 5

Diagnostic criteria for Acute Stress Disorder

Answer 5

• At least 9 of 14 symptoms in the following categories in a time window of 3 days to 4 weeks following the event:
  
  • Intrusion
    
    1. Intrusive memories
    2. Recurrent dreams of the event
    3. Sense that the event is reoccurring
    4. Distress due to reminders of the event
  • Negative mood
    
    1. Inability to experience positive emotions
  • Dissociative symptoms
    
    1. Altered sense of reality
    2. Dissociative amnesia
  • Avoidance symptoms
    
    1. Efforts to avoid memories/thoughts/feelings of the event
    2. Efforts to avoid reminders of the event
  • Arousal symptoms
    
    1. Sleep disturbance
    2. Irritability or angry outburst
    3. Hypervigilance
    4. Problems with concentration
    5. Exaggerated startle response

Question 6

Treatment of acute stress disorder

Answer 6

• The first intervention should always be supportive (mobilize social supports to assist the individual, meet with social worker, education about symptoms and coping skills, supportive psychotherapy)
• Pharmacologic methods can be used to address symptoms, but ASD will typically resolve without pharmacologic treatment:
  
  • Insomnia or hypervigilance: hypnotics and anxiolytics may be used in the short-term
• Preventing PTSD:
  
  • Early CBT is helpful to reduce progression
  • Beta blockers with central activity (propranolol) have demonstrated some efficacy

Question 7

Individuals with ASD feel. . .

Answer 7

. . . detached, “unreal”, and can have dissociative amnesia in addition to intrusive symptoms