Acute Stress Reaction

Question 1

Define Acute Stress Reaction

Answer 1

A reaction that occurs in the first 4 weeks after a person has been exposed to a traumatic event

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

Question 2

How may someone be exposed to an event leading to acute stress reaction

Answer 2

Directly experiencing it
Witnessing, in person, events as it occurs to others
Learning that the traumatic events(s) occurred to a close family member or close friend (must be violent or accidental)
Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse).

Question 3

What are the risk factors for acute stress reaction

Answer 3

Pre-trauma:
Female
Intellectual disability
Lack of education
Hx traumatic events
Hx psychiatric or personality disorder

Peri-trauma:
Severe trauma
Assault, rape, physical injuries

Post-
ICU stay, brain injury, disability

Question 4

What are the symptoms of acute stress reaction

Answer 4

Intrusive thoughts e.g. flashbacks, nightmares
Dissociation e.g. “being in a daze”, time slowing, narrowing of attention, inability to comprehend stimuli
Negative mood
Avoidance
Arousal e.g. hypervigilance, sleep disturbance

Physical: sweating, tachycardia, flushing
± depression, anxiety, anger, substance misuse

Question 5

What are the differentials for acute stress reaction

Answer 5

PTSD (>4 weeks)
Adjustment disorder
Brief psychotic disorder
Mild traumatic brain injury
Major depressive disorder

Question 6

What are the investigations for acute stress reaction

Answer 6

Child Stress Reaction Checklist (CSDC): measures symptoms of ASD and PTSD (10 mins)
Acute stress disorder scale

Question 7

What is the management for acute stress reaction

Answer 7

1. Ensure patient safety
2. Debriefing
3. Assess emotional support sources (friends, family)
4. Practical support
   a. Police reporting
   b. Sick note/absence letter
   c. Health insurance
5. Follow ups: regular visits for 6 months
6. Risk assess

First line: Trauma-focused cognitive behavioural therapy (CBT)
Second line: SSRI or SNRI

Alternatives: Cognitive procession therapy, cognitive therapy, prolonged exposure therapy

Question 8

Describe trauma-focused CBT

Answer 8

Increases knowledge on:
- Trauma psychology
- Symptom management skills
- Identifying and disputing cognitive distortions
- Exposure therapy (controlled patient exposure to the traumatic source to relieve the trauma memory mimicking fear extension - may cause a transient worsening of symptoms)

Question 9

What is the prognosis for acute stress reaction

Answer 9

May progress to PTSD
Suicide and self harm more likely
Higher risk of substance misuse
Majority will recover within the next few years