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Reaction to Severe, Stress, and Adjustment Disorders

  1. Acute stress disorder and PTSD
    Severe anxiety symptoms following a life-threatening event that caused feelings of fear , helplessness and horror
    If > 2 days but < 1 month— acute stress disorder
    If >1 month——PTSD
  2. Key symptoms-
    1. Re-experiencing the traumatic event: nightmares, flashbacks or intrusive recollections.
    2. Avoidance of stimuli associated with the trauma.
    3. Autonomic arousal, anxiety, sleep disturbance.
This category differs from others in that it includes disorders identifiable not only on grounds of symptomatology and course but also on the basis of one or other of two causative influences

Acute Stress Reaction.
  1. A transient disorder of significant severity which develops in an individual without any other apparent mental disorder in response to exceptional physical and/or mental stress and which usually subsides within hours or days.
  2. The stressor may be an overwhelming traumatic experiences involving serious threat to the security or physical integrity of the individual or of a loved person(s) (e.g. natural catastrophe, accident, battle, criminal assault rape), of an unusually sudden and threatening change in the social position and/ or network of the individual, such as multiple bereavement or domestic fire.
  3. The risk of this disorder developing is increased if physical exhaustion or organic factors (e.g. in the elderly) are also present.
Diagnostic guidelines.
There must be an immediate and clear temporal connection between the impact of an exceptional stressor and the onset of symptoms; onset is usually within a few minutes if not immediate. In addition, the symptoms:
  1. Show a mixed and usually changing picture; in addition to the initial state of “daze” depression, anxiety, anger, despair, overactivity, and withdrawal may all be seen, but no one types of symptom predominates for long:
  2. Resolve rapidly (within a few hours at the most) in those cases where removal from the stressful environment is possible; in cases where the stress continues or cannot by its nature be reversed, the symptoms usually begin to diminish after 24-48 hours and are usually minimal after about 3 days.- usually last < 1 month
Post-traumatic stress disorder
  1. This arises as a delayed and/or protracted response to a stressful event or situation (either short or long lasting) of an exceptionally threatening or catastrophic nature, which is likely to cause pervasive distress in almost anyone (e.g. natural or man-made disaster, combat, serious accident, witnessing the violent death of other, of being the victim of torture, terrorism rape or other crime).
  2. Typical symptoms include episodes of repeated reliving of the trauma in intrusive memories (“flashbacks”) or dreams.
  3. The persisting background of a sense of numbness and emotional blunting detachment from other people unresponsiveness to surroundings anhedonia and avoidance of activeness and situations reminiscent of the trauma. Commonly there is fear and avoidance of cues that remind the sufferer of the original trauma.
  4. There is usually state of autonomic hyperarousal with hypervigilance an enhanced startle reaction and insomnia.
  5. Anxiety and depression are commonly associated with the above symptoms and signs, and suicidal ideation is not infrequent. Excessive use of alcohol or drugs may be a complicating factors.
  6. There onset follows te trauma with a latency period which may range from a few weeks to months (but rarely exceeds 6 months).
  7. The course is fluctuating but recovery can be expected in the majority of cases. In a small proportion of patients the condition may show a chronic course over many years and a, transition to an enduring personality change.
  8. Treatment of Choice is Behaviour therapy.(Eye Movement Desensitization and Reprocessing) Drug of choice is SSRI. r-tms is also now approved by FDA for treatment of PTSD (EMDR)

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