Acute stress reaction

Question 1

Define acute stress reaction.

Answer 1

Acute stress disorder is defined as an acute stress reaction that occurs in the first 4 weeks after a person has been exposed to a traumatic event (threatened death, serious injury e.g. road traffic accident, sexual assault etc).

Question 2

How common is ASR?

Answer 2

• F>M
• 5-20% affected

Question 3

How soon after the stressor does acute stress reaction appear?

Answer 3

Symptoms appear immediately / within minutes of stressor.

Question 4

What are some risk factors for ASR?

Answer 4

Biological:

• Female gender

Psychological:

• Neuroticism
• Avoidant coping

Social:

• Hx of a pretrauma psychiatric disorder,
• Hx of traumatic exposures prior to recent exposure,
• High severity trauma

Question 5

What is the difference between ASR and PTSD?

Answer 5

ASR occurs within <4 weeks of the traumatic event occurring

PTSD is diagnosed >4 weeks.

Question 6

What are the symptoms of ASD?

Answer 6

• intrusive thoughts e.g. flashbacks, nightmares
• arousal e.g. hypervigilance, sleep disturbance
• avoidance
• dissociation e.g. ‘being in a daze’, time slowing
• negative mood

Question 7

What is the management of ASR?

Answer 7

• Exclude injury
• Support and reassure - usually self limiting
• Benzodiazepines* - sometimes used for acute symptoms e.g. agitation, sleep disturbance
• +/- Trauma-focused CBT

*should only be used with caution due to addictive potential and concerns that they may be detrimental to adaptation

Question 8

Does benozdiazepine use in ASR prevent progression to PTSD?

Answer 8

No - does not prevent later PTSD

Question 9

What are some triggers of ASR?

Answer 9

• Natural disaster
• Motor vehicle accident
• Mild traumatic brain injury
• Burn
• Industrial accident
• Witnessing a mass shooting