stress disorders

Question 1

what is acute stress disorder?

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

features of acute stress disorder?

Answer 2

intrusive thoughts e.g. flashbacks, nightmares

dissociation e.g. ‘being in a daze’, time slowing

negative mood

avoidance

arousal e.g. hypervigilance, sleep disturbance

Question 3

management of acute stress disorder?

Answer 3

trauma-focused cognitive-behavioural therapy (CBT) is usually used first-line
benzodiazepines

Question 4

what are benzes used for in acute stress disorder?

Answer 4

sometimes used for acute symptoms e.g. agitation, sleep disturbance

Question 5

what is adjustment disorder?

Answer 5

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

Question 6

difference between acute stress and adjustment disorder?

Answer 6

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).

Question 7

features of adjustment disorder?

Answer 7

maladaptive responses to stressors

Mood disturbances

Impaired social or occupational functioning, marked irritability.

Interpersonal disruptions and avoidance behaviors

Preoccupations with the stressor, persistent negative outlook.

Question 8

management of adjustment disorder?

Answer 8

psychotherapy, which can include cognitive-behavioral therapy, group therapy, or family therapy.

antidepressants

stress management, regular physical activity, and maintaining strong social support networks, are also beneficial.

Question 9

what is PTSD?

Answer 9

a complex psychiatric condition arising from exposure to traumatic events. Its hallmark features include persistent intrusion symptoms such as distressing memories and nightmares, coupled with deliberate avoidance of trauma-related reminders.

Question 10

how long do symptoms have to be present to diagnose PTSD?

Answer 10

> 1 month

Question 11

features of PTSD?

Answer 11

re-experiencing: flashbacks, nightmares, repetitive and distressing intrusive images

avoidance: avoiding people, situations or circumstances resembling or associated with the event

hyperarousal: hypervigilance for threat, exaggerated startle response, sleep problems, irritability and difficulty concentrating

emotional numbing - lack of ability to experience feelings, feeling detached

Question 12

what is mild PTSD?

Answer 12

distress caused by the symptoms is manageable, and the person’s social and occupational functioning are not significantly impaired.

Question 13

what is moderate PTSD?

Answer 13

distress and impact on functioning lie somewhere between mild and severe and there is not considered to be a significant risk of suicide, harm to self, or harm to others.

Question 14

what is severe PTSD?

Answer 14

distress caused by the symptoms is felt to be unmanageable, and/or there is significant impairment in social and/or occupational functioning, and/or there is considered to be significant risk of suicide, harm to self, or harm to others.

Question 15

management of PTSD?

Answer 15

watchful waiting may be used for mild symptoms lasting less than 4 weeks

trauma-focused cognitive behavioural therapy (CBT) or eye movement desensitisation and reprocessing (EMDR)

Question 16

what is important to remember about drug treatment in PTSD?

Answer 16

drug treatments for PTSD should not be used as a routine first-line treatment for adults.

If drug treatment is used then venlafaxine or sertraline should be tried.

In severe cases, NICE recommends that risperidone may be used