Acute stress disorder medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]

Medical Therapy

Ensure that survivors have a safe environment Promote contact with loved ones and other sources of support (eg, religious organizations) Support self-esteem; help patients understand that their reaction to the trauma is a normal reaction to an abnormal situation, not a sign of weakness or psychopathology Help survivors focus on immediate needs, such as rest, food, shelter, social supports, or a sense of belonging to a community (some feel cut off and detached) Promote coping mechanisms Help patients reframe any destructive cognitions (eg, beliefs that they acted terribly and are terrible people or are weak for being so distraught, that life is hopeless or worthless, or that the world is totally unsafe) Administer medication (eg, beta-blockers, alpha-agonists, benzodiazepines, or nonactivating selective serotonin reuptake inhibitors [SSRIs]), if needed, to decrease arousal Avoid increasing stress - Avoid prompting discussion of issues that cannot be resolved; avoid abreaction in groups and the resulting contagion effect; respect defenses, and do not force reality on people who cannot handle it yet; keep in mind that debriefing may be harmful Discuss the experience with patients who want to talk about it, and avoid pressuring those who do not wish to discuss it Identify persons at high risk - Screen for physical causes of psychiatric problems (eg, dehydration, head trauma, infection, metabolic abnormality, or toxins) Have faith in the normal healing processes

Basic principles of intervention after emotional trauma include the following:

Reduce stress by all possible means

Ensure that survivors have a safe environment

Promote contact with loved ones and other sources of support

Support self-esteem; help patients understand that their reaction to the trauma is a normal reaction to an abnormal situation, not a sign of weakness or psychopathology

Help survivors focus on immediate needs, such as rest, food, shelter, social supports, or a sense of belonging to a community

Promote coping mechanisms

Help patients reframe any destructive cognitions

Administer medication (eg, beta-blockers, alpha-agonists, benzodiazepines, or nonactivating selective serotonin reuptake inhibitors [SSRIs]), if needed, to decrease arousal

Avoid increasing stress - Avoid prompting discussion of issues that cannot be resolved; avoid abreaction in groups and the resulting contagion effect; respect defenses, and do not force reality on people who cannot handle it yet; keep in mind that debriefing may be harmful

Discuss the experience with patients who want to talk about it, and avoid pressuring those who do not wish to discuss it

Identify persons at high risk - Screen for physical causes of psychiatric problems (eg, dehydration, head trauma, infection, metabolic abnormality, or toxins)

Have faith in the normal healing processes'