Acute stress reaction: Difference between revisions
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{{SI}} | {{SI}} | ||
{{CMG}}; {{AE}} {{KS}} | {{CMG}}; {{AE}} {{KS}} | ||
{{SK}} Acute stress disorder; acute stress response | |||
==Overview== | ==Overview== | ||
Acute stress reaction is a [[psychology|psychological]] condition arising in response to a traumatic event in which the person experienced or witnessed an event that involved threatened or actual serious injury or death and responded with intense fear and helplessness. | |||
==Historical Perspective== | |||
"Acute Stress Response", was first described by [[Walter Cannon]] in the 1920s as a theory that animals react to threats with a general discharge of the [[sympathetic nervous system]]. The response was later recognized as the first stage of a general adaptation syndrome that regulates stress responses among vertebrates and other organisms. | "Acute Stress Response", was first described by [[Walter Cannon]] in the 1920s as a theory that animals react to threats with a general discharge of the [[sympathetic nervous system]]. The response was later recognized as the first stage of a general adaptation syndrome that regulates stress responses among vertebrates and other organisms. | ||
==Pathophysiology== | |||
The onset of a stress response is associated with specific physiological actions in the sympathetic nervous system, both directly and indirectly through the release of [[epinephrine]] and to a lesser extent [[norepinephrine]] from the [[medulla]] of the [[adrenal gland]]s. The release is triggered by [[acetylcholine]] released from pre-[[ganglion]]ic sympathetic nerves. These catecholamine [[hormone]]s facilitate immediate physical reactions by triggering increases in heart rate and breathing, constricting blood vessels in many parts of the body - but not in muscles (vasodilation), brain, lungs and heart - and tightening muscles. An abundance of catecholamines at neuroreceptor sites facilitates reliance on spontaneous or intuitive behaviors often related to combat or escape. | The onset of a stress response is associated with specific physiological actions in the sympathetic nervous system, both directly and indirectly through the release of [[epinephrine]] and to a lesser extent [[norepinephrine]] from the [[medulla]] of the [[adrenal gland]]s. The release is triggered by [[acetylcholine]] released from pre-[[ganglion]]ic sympathetic nerves. These catecholamine [[hormone]]s facilitate immediate physical reactions by triggering increases in heart rate and breathing, constricting blood vessels in many parts of the body - but not in muscles (vasodilation), brain, lungs and heart - and tightening muscles. An abundance of catecholamines at neuroreceptor sites facilitates reliance on spontaneous or intuitive behaviors often related to combat or escape. | ||
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If a stimulus is perceived as a threat, a more intense and prolonged discharge of the locus ceruleus activates the sympathetic division of the autonomic nervous system (Thase & Howland, 1995). The activation of the sympathetic nervous system leads to the release of norepinephrine from nerve endings acting on the heart, blood vessels, respiratory centers, and other sites. The ensuing physiological changes constitute a major part of the acute stress response. The other major player in the acute stress response is the hypothalamic-pituitary-adrenal axis. | If a stimulus is perceived as a threat, a more intense and prolonged discharge of the locus ceruleus activates the sympathetic division of the autonomic nervous system (Thase & Howland, 1995). The activation of the sympathetic nervous system leads to the release of norepinephrine from nerve endings acting on the heart, blood vessels, respiratory centers, and other sites. The ensuing physiological changes constitute a major part of the acute stress response. The other major player in the acute stress response is the hypothalamic-pituitary-adrenal axis. | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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*[[Panic disorder]] | *[[Panic disorder]] | ||
*[[Post traumatic stress disorder]] | *[[Post traumatic stress disorder]] | ||
*Psychotic | *[[Psychotic disorder]]s | ||
*Traumatic brain injury<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref> | *Traumatic brain injury<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref> | ||
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The prevalence of acute stress disorder in overall population is: | The prevalence of acute stress disorder in overall population is: | ||
*Less than 20,000 per 100,000 (<20%) | * Less than 20,000 per 100,000 (<20%) in case of non interpersonal traumatic events<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref> | ||
* | * 20,000-50,000 per 100,000 (20%-50%) in case of interpersonal traumatic events<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref> | ||
==Risk Factors== | ==Risk Factors== | ||
* | *Female gender | ||
*Negative affectivity(neuroticism) | *Negative affectivity ([[neuroticism]]) | ||
*Prior mental disorder | *Prior mental disorder | ||
*Prior trauma | *Prior [[trauma]] | ||
*Severity of the traumatic event<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref> | *Severity of the traumatic event<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref> | ||
==Natural History, Complications and Prognosis== | |||
=== Prognosis === | |||
Prognosis for this disorder is very good. If it should progress into another disorder, success rates can vary according to the specific of that disorder. | |||
==Diagnostic Criteria== | ==Diagnostic Criteria== | ||
===DSM-V Diagnostic Criteria for Acute<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref>=== | ===DSM-V Diagnostic Criteria for Acute Stress Disorder<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref>=== | ||
{{cquote| | {{cquote| | ||
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'''''AND''''' | '''''AND''''' | ||
*B. Presence of nine (or more) of the following symptoms from any of the five categories of intrusion, negative mood, dissociation, avoidance, and arousal, beginning or worsening | *B.Presence of nine (or more) of the following symptoms from any of the five categories of intrusion, negative mood, dissociation, avoidance, and arousal, beginning or worsening after the traumatic event(s) occurred: | ||
after the traumatic event(s) occurred: | |||
====Intrusion Symptoms==== | ====Intrusion Symptoms==== | ||
:*1. Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). | :*1. Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). | ||
<SMALL>''Note:In children, repetitive play may occur in which themes or aspects of the traumatic event(s) are expressed .''</SMALL> | <SMALL>''Note: In children, repetitive play may occur in which themes or aspects of the traumatic event(s) are expressed.''</SMALL> | ||
:*2. Recurrent distressing dreams in which the content and/or affect of the dream are related to the event(s). | :*2. Recurrent distressing dreams in which the content and/or affect of the dream are related to the event(s). | ||
<SMALL>''Note:In children, there may be frightening dreams without recognizable content .''</SMALL> | <SMALL>''Note: In children, there may be frightening dreams without recognizable content.''</SMALL> | ||
:*3. Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur on a | :*3. Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings.) | ||
with the most extreme expression being a complete loss of awareness of present surroundings.) | <SMALL>''Note: In children, trauma-specific reenactment may occur in play .''</SMALL> | ||
<SMALL>''Note:In children, trauma-specific reenactment may occur in play .''</SMALL> | :*4. Intense or prolonged psychological distress or marked physiological reactions in response to internal or external cues that symbolize or resemble an aspect of the traumatic event(s). | ||
:*4. Intense or prolonged psychological distress or marked physiological reactions in response to internal or external cues that symbolize or resemble an aspect of the | |||
traumatic event(s). | |||
====Negative Mood==== | ====Negative Mood==== | ||
:*5. Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings). | :*5. Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings). | ||
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====Avoidance Symptoms==== | ====Avoidance Symptoms==== | ||
:*8. Efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s). | :*8. Efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s). | ||
:*9. Efforts to avoid external reminders (people, places, conversations, activities, objects,situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s). | :*9. Efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s). | ||
====Arousal Symptoms==== | ====Arousal Symptoms==== | ||
:*10. Sleep disturbance (e.g., difficulty falling or staying asleep, restless sleep). | :*10. Sleep disturbance (e.g., difficulty falling or staying asleep, restless sleep). | ||
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<SMALL>''Note: Symptoms typically begin immediately after the trauma, but persistence for at least 3 days and up to a month is needed to meet disorder criteria .''</SMALL> | <SMALL>''Note: Symptoms typically begin immediately after the trauma, but persistence for at least 3 days and up to a month is needed to meet disorder criteria .''</SMALL> | ||
'''''AND''''' | |||
D. The disturbance causes clinically significant distress or impairment in social, occupational,or other important areas of functioning. | *D. The disturbance causes clinically significant distress or impairment in social, occupational,or other important areas of functioning. | ||
'''''AND''''' | '''''AND''''' | ||
E. The disturbance is not attributable to the physiological effects of a substance (e.g.,medication or alcohol) or another medical condition (e.g., mild traumatic brain injury) | *E. The disturbance is not attributable to the physiological effects of a substance (e.g., medication or alcohol) or another medical condition (e.g., mild traumatic brain injury) | ||
and is not better explained by brief psychotic disorder.This does not apply to exposure through electronic media, television, movies,or pictures, unless this exposure is work related. | and is not better explained by brief psychotic disorder.This does not apply to exposure through electronic media, television, movies,or pictures, unless this exposure is work related. | ||
}} | }} | ||
== Treatment == | |||
The disorder may resolve itself with time or may develop into a more severe disorder such as PTSD. Medication can be used for a very short duration (up to four weeks) or [[psychotherapy]] can be used to assist the victim in dealing with the fear and sense of helplessness. | The disorder may resolve itself with time or may develop into a more severe disorder such as PTSD. Medication can be used for a very short duration (up to four weeks) or [[psychotherapy]] can be used to assist the victim in dealing with the fear and sense of helplessness. | ||
=== | ==References== | ||
{{Reflist|2}} | |||
{{Mental and behavioural disorders}} | {{Mental and behavioural disorders}} | ||
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[[Category:Psychological stress]] | [[Category:Psychological stress]] | ||
[[Category:Psychiatry]] | [[Category:Psychiatry]] | ||
Latest revision as of 12:12, 24 October 2014
Template:DiseaseDisorder infobox
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kiran Singh, M.D. [2]
Synonyms and keywords: Acute stress disorder; acute stress response
Overview
Acute stress reaction is a psychological condition arising in response to a traumatic event in which the person experienced or witnessed an event that involved threatened or actual serious injury or death and responded with intense fear and helplessness.
Historical Perspective
"Acute Stress Response", was first described by Walter Cannon in the 1920s as a theory that animals react to threats with a general discharge of the sympathetic nervous system. The response was later recognized as the first stage of a general adaptation syndrome that regulates stress responses among vertebrates and other organisms.
Pathophysiology
The onset of a stress response is associated with specific physiological actions in the sympathetic nervous system, both directly and indirectly through the release of epinephrine and to a lesser extent norepinephrine from the medulla of the adrenal glands. The release is triggered by acetylcholine released from pre-ganglionic sympathetic nerves. These catecholamine hormones facilitate immediate physical reactions by triggering increases in heart rate and breathing, constricting blood vessels in many parts of the body - but not in muscles (vasodilation), brain, lungs and heart - and tightening muscles. An abundance of catecholamines at neuroreceptor sites facilitates reliance on spontaneous or intuitive behaviors often related to combat or escape.
Normally, when a person is in a serene, unstimulated state, the "firing" of neurons in the locus ceruleus is minimal. A novel stimulus, once perceived, is relayed from the sensory cortex of the brain through the thalamus to the brain stem. That route of signaling increases the rate of noradrenergic activity in the locus ceruleus, and the person becomes alert and attentive to the environment.
If a stimulus is perceived as a threat, a more intense and prolonged discharge of the locus ceruleus activates the sympathetic division of the autonomic nervous system (Thase & Howland, 1995). The activation of the sympathetic nervous system leads to the release of norepinephrine from nerve endings acting on the heart, blood vessels, respiratory centers, and other sites. The ensuing physiological changes constitute a major part of the acute stress response. The other major player in the acute stress response is the hypothalamic-pituitary-adrenal axis.
Differential Diagnosis
- Adjustment disorders
- Dissociative disorders
- Obsessive-compulsive disorder
- Panic disorder
- Post traumatic stress disorder
- Psychotic disorders
- Traumatic brain injury[1]
Epidemiology and Demographics
Prevalence
The prevalence of acute stress disorder in overall population is:
- Less than 20,000 per 100,000 (<20%) in case of non interpersonal traumatic events[1]
- 20,000-50,000 per 100,000 (20%-50%) in case of interpersonal traumatic events[1]
Risk Factors
- Female gender
- Negative affectivity (neuroticism)
- Prior mental disorder
- Prior trauma
- Severity of the traumatic event[1]
Natural History, Complications and Prognosis
Prognosis
Prognosis for this disorder is very good. If it should progress into another disorder, success rates can vary according to the specific of that disorder.
Diagnostic Criteria
DSM-V Diagnostic Criteria for Acute Stress Disorder[1]
| “ |
Note:In cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental .
exposed to details of child abuse). Note:This does not apply to exposure through electronic media, television, movies,or pictures, unless this exposure is work related . AND
Intrusion Symptoms
Note: In children, repetitive play may occur in which themes or aspects of the traumatic event(s) are expressed.
Note: In children, there may be frightening dreams without recognizable content.
Note: In children, trauma-specific reenactment may occur in play .
Negative Mood
Dissociative Symptoms
Avoidance Symptoms
Arousal Symptoms
AND
Note: Symptoms typically begin immediately after the trauma, but persistence for at least 3 days and up to a month is needed to meet disorder criteria . AND
AND
and is not better explained by brief psychotic disorder.This does not apply to exposure through electronic media, television, movies,or pictures, unless this exposure is work related. |
” |
Treatment
The disorder may resolve itself with time or may develop into a more severe disorder such as PTSD. Medication can be used for a very short duration (up to four weeks) or psychotherapy can be used to assist the victim in dealing with the fear and sense of helplessness.