Stress reactions Flashcards
Types of stress reaction
Acute stress reaction
Adjustment disorder
PTSD
Timecourse of acute stress reaction
Immediate onset, 2-3d duration
Time criteria for adjustment disorder
Onset within 1 month of stress (3mo for DSM), duration <6months
Clinical features of acute stress reaction
Emotion:‘Dazed’
Cognition: Amnesia, denial
Behaviour: Out of character, withdrawal or over-active
Somatic: High autonomic activity
Association: Acute stressor
Management of acute stress reaction
Reassurance (not debriefing)
Removal of stressor if possible
Possible short course of benzodiazepines
Features of adjustment disorder
Emotion: Depression, anxiety, irritability, poor concentration ( greater than expected)
Cognition: Preoccupation with event
Behaviour: Angry/sad outbursts, impairment of function
Somatic: Moderate autonomic symptoms
Association: Chronic stressor (e.g. grief, medical condition), occurs within a month of stressor
Management of adjustment disorder
Reassurance + practical support
Advice on stopping unhealthy coping behaviours e.g. substance misuse
Psych:
- Self-help, incl. problem-solving therapy to avoid unhealthy thought patterns
- Opportunity talk - friend/family or specific short-term counselling
- Trearment for depressive/anxiety symptoms
Time criteria for PTSD
Symptoms for several weeks (>=4w after stressor)
Differntial for acute stress reaction
Initial neurosis
Acute psychosis
Delirium
PTSD features
Emotion: Numbness, irritability, anxiety and depression
Cognition: Repeated reliving of traumatic experience in memories/nightmares (as flashbacks)
Behaviour: Avoidance of reminders, social withdrawal
Somatic: Hypervigilance (startle response)
Associations: Substance misuse, depression, severe stressor
Time criterion for abnormal grief reaction
>=6 months
Features of complicated grief
ARTI grief….
Time: Persists >6 mo
Impairment: Intereferes with function
Rumination: Preoccupation with aspects of the death
Avoidance: Of reminders of the loss, excessive
Distinguishing grief from major depression
Pervasiveness: In grief may have periods of euthymia/positive emotions
Guilt: In grief focussed on the deceased, in depression is pervasive
Hope: Grief can imagine being happy if reunited with person, depression cannot imagine being happy
Prognosis of PTSD
30% chronic symptoms
Most recover within 1 year
Risk factors for PTSD
Bio: Female, FHx/PHx of psych disorder, children
Psycho: Hx of abuse, low self-esteem, low intelligence
Social: Ethnic minorities, occupation (e.g. military), lack of social support, socioeconomic adversity