Acute
Stress Disorder In this disorder a traumatic event causes the patient
to experience various anxiety symptoms, which are similar to posttraumatic stress
disorder (PTSD). The symptoms, described in more detail below have to occur within
1 month of the traumatic event, have to last at least 2 days and have to be resolved
within 4 weeks at the latest. If symptoms persist beyond that the patient would
likely be considered to have PTSD. This would still have to be qualified by an
interview with a psychologist or psychiatrist. Symptoms of acute
stress disorder: In general the patient finds it difficult to
experience pleasure and feels guilty in carrying on with normal activities of
life. The patient may feel detached from the body and have difficulties remembering
important aspects of the traumatic event. Despite the memory loss regarding
one aspect of the traumatic event there is a constant re-experiencing of certain
other aspects. It is as if someone in the mind replays parts of a video over and
over again. This accompanies the patient even into the sleep with recurrent nightmares
about scenes regarding the traumatic event. On the other hand like in PTSD the
patient will avoid the places, events or people that remind the patient of the
traumatic event. The other symptoms that occur are an overreaction to stimuli
that are reminiscent of the original traumatic event. For instance, such stimuli
may cause irritability, pacing, exaggerated startling response and excessive watchfulness. Statistics
and course of acute stress disorder: There are no reliable statistics
as it varies with the type of exposure and the gravity of the traumatic event.
However, rates are likely higher than PTSD, but a higher percentage likely dissolves
on its own. The course of acute stress disorder is such that the symptoms
are experienced right after the traumatic event. The majority of patients are
already recovered from it within 2 weeks of onset of symptoms. If the traumatic
event was more severe, the exposure lasted longer and the patient was the immediate
target or was very close to the disaster, then the probability of developing an
acute stress disorder is very high and fewer of these cases will resolve in the
4 weeks that the DMS-IV has defined as the end point for this disorder (Ref. 2).
These cases would then go on to the post traumatic stress disorder(PTSD). The
literature has noted that good social support, family support and a supportive
partner can significantly improve the positive outcome of acute stress disorder.
On the negative side though it is a fact that the following factors can negatively
influence the outcome: a family history for this disorder, many traumatic childhood
experiences in the past and preexisting mental disorders.
Treatment
of acute stress disorder: Treatment consists of removing
the patient from the source of the acute stress disorder, if this has not already
taken place. The patient is then provided with an opportunity to vent feelings,
to retell the story of what happened, how it happened and what the patient experienced.
Many patients benefit from telling their story several times, finding it gradually
less and less stressful. The patient may need some medication to help with
falling asleep easier. Small doses of trazodone(brand name: Desyrel, Trazon, Trialodine)
are superior to hypnotics like zopiclone( brand names: Rhovane, Imovane). Many
people are O.K. with hypnotics for a short period of time, but some people, and
we do not know who will react this way, tend to get addicted to this medication.
Trazodone, one of the SSRI antidepressants, on the other hand has been shown in
sleep laboratories even in small doses to restore REM sleep and as it has a tiring
side effect for 1 or 2 hours 30 minutes after taking it, it can be conveniently
used as a sleeping pill (=hypnotic) replacement. If the above measures are not
enough, a psychologist or psychiatrist should be consulted. For more info
on acute stress disorder click on link. |
