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Acute Stress Disorder
Aka: Acute Stress Disorder, Acute Traumatic Stress Disorder
- See Also
- Posttraumatic Stress Disorder (PTSD)
- Psychological First Aid
- Anxiety Disorder
- Anxiety Secondary Cause
- Anxiety Symptoms
- Generalized Anxiety Disorder
- Obsessive Compulsive Disorder
- Body Dysmorphic Disorder
- Panic Disorder
- Social Anxiety Disorder (Social Phobia)
- Excessive Worry
- Anxiety Non-pharmacologic Management
- Anxiety Pharmacologic Management
- Pathophysiology
- See Spectrum of Trauma Response
- Causes: Trauma Triggers
- Acute Stress Disorder Triggers
- Diagnosis: DSM IV
- Exposure to Traumatic event
- Experienced or witnessed actual or threatened death, serious injury or threat to integrity AND
- Response involved intense fear, helplessness or horror
- Associated dissociative symptoms (at least 3 present)
- Numb, detached or emotionally unresponsive
- Dazed or reduced awareness of surroundings
- Derealization
- Depersonalization
- Dissociative amnesia with inability to recall important aspects of the Trauma
- Traumatic event is persistently reexperienced (at least 1 present)
- Images
- Thoughts
- Dreams
- Illusions
- Flashbacks
- Re-living experience
- Reminders of Trauma cause distress
- Marked avoidance of stimuli (e.g. places, people, conversations, activities) that recall the Trauma
- Marked anxiety or arousal
- Insomnia
- Irritability
- Poor concentration
- Hypervigilance
- Increased startle response
- Motor restlessness
- Clinically Significant distress or Impairment
- Onset within 4 weeks of the Trauma
- Duration of symptoms 2 days to 4 weeks
- Not due to other cause (e.g. CD, medication, medical condition, brief Psychotic Disorder)
- References
- (2000) DSM, 4th edition, APA, p. 471-2
- Management
- See Psychological First Aid
- Cognitive Behavioral Therapy (CBT) by Psychology
- See Relaxation Training
- Posttraumatic reaction education
- Progressive Muscle Relaxation
- Imagined Traumatic memory exposure
- Cognitive restructuring of distorted Trauma-related beliefs
- Graduated exposure to avoided situations
- Intervention strategies by physician (empiric methods in parallel to CBT)
- Promote sense of safety
- Avoid conversations, news reports about major Traumatic events
- Promote sense of calm
- Employ Relaxation Techniques
- Promote sense of self-efficacy
- Return to pre-Trauma ability to overcome adverse events
- Become involved in community activities
- Promote connectedness
- Re-connect with family and friends
- Instill hope
- Reassure that CBT will help the patient return to normal responses to triggers
- Hobfoll (2007) Psychiatry 70(4): 283-315 [PubMed]
- Medications
- No specific medications are recommended for treatment of Acute Stress Disorder
- Consider management of comorbid conditions and transient symptoms
- Insomnia management
- Major Depression Management
- Precautions
- Critical Incident Stress Debriefing
- Not recommended due to poor efficacy and risk of harm
- Complications
- Risk of progression to PTSD
- See Posttraumatic Stress Disorder Risk Factors
- References
- Bryant (2011) Depress Anxiety 28(9): 802-17 [PubMed]
- Forbes (2007) Aust N Z J Psychiatry 41(8): 637-48 [PubMed]
- Kavan (2012) Am Fam Physician 86(7): 643-9 [PubMed]