Acute stress reaction Flashcards
Describe what is meant by acute stress reaction [1]
also known as psychological shock, is a psychological condition that manifests following exposure to severe stress or traumatic events
NB: If anxiety lasts >1 month=Post Traumatic Stress Disorder(PTSD)
Describe the cognitive symptoms of a that a patient with acute stress syndrome might present with
Intrusion symptoms:
- reexperiencing the traumatic event (memories, flashbacks, nightmares).
Confusion and disorientation:
- Patients may exhibit difficulty in understanding their surroundings or situation, often accompanied by an inability to concentrate or focus.
Negative mood:
- inability to experience positive emotions, such as happiness.
Dissociative symptoms:
- an altered sense of one’s surroundings or oneself, difficulty remembering the trauma
- The patient may feel detached from their body or experience distortions in time perception.
Arousal symptoms:
- these include an exaggerated startle response, insomnia, hypervigilance to threat, and angry outbursts.
NB: These features develop quickly but are not long-lasting; hence acute stress reaction.
Describe the behavioral symptoms of acute stress syndrome [2]
Avoidance symptoms:
- avoidance of thoughts and memories of the traumatic event or avoidance of activities, situations, or people that remind them of the traumatic event.
Hypervigilance:
- Patients may demonstrate heightened awareness and sensitivity to their surroundings, often leading to excessive startle responses.
Describe the physiological symptoms of acute stress syndrome [2]
Tachycardia and hypertension:
- An increased heart rate and blood pressure are commonly observed due to heightened arousal levels
Sweating and trembling:
- These symptoms result from activation of the sympathetic nervous system as part of a ‘fight-or-flight’ response.
Describe the DSM-V diagnostic criteria for acute stress disorder [+]
The diagnosis of an acute stress disorder is initially dependent on exposure to trauma.
The presence of nine or more of the following 14 symptoms from the below 5 categories is consistent with the diagnosis of acute stress disorder:
* Intrusion symptoms
* Negative mood
* Dissociative symptoms
* Avoidance symptoms
* Arousal symptoms
The clinical features of acute stress disorder and PTSD have significant overlap.
Describe how you differentiate between them
The key differentiator is the timeline of these disorders (i.e. when the symptoms occur in relation to the traumatic event and the symptom duration).
Acute stress disorder
* Symptom onset: Typically begins immediately or within a few days of the traumatic event.
* Minimum duration of symptoms: 3 days
* Maximum duration of symptoms: 1 month
- Post-traumatic stress disorder
- Symptom onset: May begin soon after the traumatic event and usually within 6 months of the trauma
- Minimum duration of symptoms: 1 month
- Maximum duration of symptoms: none
NB: PM - Differences: The timing distinguishes these two conditions. For a diagnosis of PTSD, symptoms must persist for more than one month following the trauma. In contrast, acute stress reaction manifests immediately after the traumatic event and resolves within four weeks.
Describe the management of ASR [+]
Immediate Management
* Ensure patient safety and stabilise any physical injuries.
* Provide psychological first aid: calm and supportive environment, basic needs met, active listening.
* If severe symptoms persist consider short-term use of benzodiazepines or antipsychotics. Monitor for side effects.
Ongoing Management
* Trauma-focused cognitive behavioural therapy (CBT) should be initiated as soon as possible.
* Mindfulness-based interventions may also be beneficial.
* If symptoms persist beyond four weeks, reassess for PTSD or other mental health conditions.
Follow-up Care
* Regular monitoring to assess symptom progression and response to treatment is recommended.
* Consider referral to a mental health specialist if symptoms do not improve with initial management strategies or if complex comorbidities are present.
What are the features of an acute stress reaction / disorder [5]
intrusive thoughts e.g. flashbacks, nightmares
dissociation e.g. ‘being in a daze’, time slowing
negative mood
avoidance
arousal e.g. hypervigilance, sleep disturbance
PM
What is the first and second line mx for acute stress disorder? [2]
trauma-focused cognitive-behavioural therapy (CBT) is usually used first-line
benzodiazepines
* sometimes used for acute symptoms e.g. agitation, sleep disturbance
* should only be used with caution due to addictive potential and concerns that they may be detrimental to adaptation
How do you differentiate between adjustment disorder and acute stress reaction? [1]
Adjustment disorder involves diverse maladaptive responses to stressors, leading to disproportionate mood disturbances, impaired functioning, and cognitive alterations persisting for up to six months.
The primary difference between acute stress reaction and adjustment disorder is the nature of the stressor
- In acute stress reaction, the stressor is typically severe or life-threatening (e.g., witnessing a fatal car accident), while in adjustment disorder, the stressor need not be severe or outside the “normal” human experience (e.g. being made redundant).
Describe what is meant by adjustment disorder [1]
Adjustment disorder is a mental health condition that is characterized by significant emotional distress and disturbance that interferes with normal social functioning
- It arises during the period of adaptation to a** major life change or a stressful life event**, such as bereavement or separation
How would adjustment disorder present with regards to:
- stressor response
- intensity
- duration
- onset
- distress
- impairment
ICD-11 Criteria:
* Stressor Response: Development of emotional or behavioral symptoms due to a stressor.
* Intensity: Symptoms are excessive, causing significant distress.
* Duration: Symptoms cease within six months after the termination of the stressor.
DSM-V Criteria:
* Onset: Within three months of stressor initiation.
* Distress: Out of proportion to the severity of the stressor.
* Impairment: Evident in social, occupational, or academic functioning.
Describe the clinical features of adjustment disorder [+]
Diverse clinical features reflecting maladaptive responses to stressors.
Mood disturbances: Symptoms of depression, anxiety, or a combination.
Behavioral manifestations: Impaired social or occupational functioning, marked irritability.
Interpersonal disruptions and avoidance behaviors.
Cognitive alterations: Preoccupations with the stressor, persistent negative outlook.
Intensity and persistence disproportionate to stressor severity.
How do you tx adjustment disorder? [2]
The mainstay of treatment for adjustment disorder is psychotherapy, which can include cognitive-behavioral therapy, group therapy, or family therapy.
In some cases, medications such as anti-anxiety drugs or antidepressants may be helpful.
