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

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

Medications to decrease arousal and insomnia have a long-term impact on acute stress disorder == Headline text ==

Alpha-adrenergic agents and beta blockers limit hyperarousal. An atypical neuroleptic or mood stabilizer may be needed for an extreme aggression, agitation, dissociation, or psychosis

SSRIs may be helpful in dealing with the symptoms such as depression, anxiety, withdrawal, and avoidance and can be effective in longer-term treatment

Benzodiazepines, can be helpful in the initial stages, by there ability to limit hyperarousal and ability to foster sleep; however, continuous administration of benzodiazepines may interfere with readaptation and grieving. Longer-acting agents are beneficial when follow-up treatment is in short supply and medication is administered at the emergency site

Comorbid conditions such as attention deficit hyperactivity disorder (ADHD) should be treated. Reduction in atleast one disabling symptom such as insomnia or hyperarousal may have a powerful positive impact on the individual’s ability to re-compensate.