Acute stress disorder medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
Pharmacologic medical therapies for acute stress disorder include beta blockers, alpha adrenergic agents, benzodiazepines and/or SSRIs. | |||
==Medical Therapy== | ==Medical Therapy== | ||
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*Diphenhydramine may be helpful for improving sleep. Benzodiazepines, by decreasing hyperarousal and by fostering sleep, may be helpful in the initial stages; however, continuous administration may interfere with readaptation and grieving, because these agents can interfere with learning. Longer-acting agents are beneficial when medication is administered at the emergency site and follow-up treatment is feasible. | *Diphenhydramine may be helpful for improving sleep. Benzodiazepines, by decreasing hyperarousal and by fostering sleep, may be helpful in the initial stages; however, continuous administration may interfere with readaptation and grieving, because these agents can interfere with learning. Longer-acting agents are beneficial when medication is administered at the emergency site and follow-up treatment is feasible. | ||
*For core symptoms of anxiety, depression, withdrawal, and avoidance, SSRIs can be helpful and can play a central role in longer-term treatment. | *For core symptoms of anxiety, depression, withdrawal, and avoidance, SSRIs can be helpful and can play a central role in longer-term treatment. | ||
Comorbid conditions such as attention deficit hyperactivity disorder (ADHD) should be treated. Individual's ability to re-compensate is positively impacted by reduction in symptoms such as insomnia or hyperarousal. | *Comorbid conditions such as attention deficit hyperactivity disorder (ADHD) should be treated. Individual's ability to re-compensate is positively impacted by reduction in symptoms such as insomnia or hyperarousal. | ||
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Revision as of 03:34, 11 February 2016
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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]
Overview
Pharmacologic medical therapies for acute stress disorder include beta blockers, alpha adrenergic agents, benzodiazepines and/or SSRIs.
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 | |||||||||||||||||||
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. | |||||||||||||||||||
- The medications that decrease insomnia and arousal may have a long-term beneficial impact on acute stress disorder.
- Beta blockers and alpha-adrenergic agents decrease hyperarousal both initially and over the longer term. For symptoms of agitation, aggression, psychosis, or dissociation, an atypical neuroleptic or mood stabilizer may be needed.
- Diphenhydramine may be helpful for improving sleep. Benzodiazepines, by decreasing hyperarousal and by fostering sleep, may be helpful in the initial stages; however, continuous administration may interfere with readaptation and grieving, because these agents can interfere with learning. Longer-acting agents are beneficial when medication is administered at the emergency site and follow-up treatment is feasible.
- For core symptoms of anxiety, depression, withdrawal, and avoidance, SSRIs can be helpful and can play a central role in longer-term treatment.
- Comorbid conditions such as attention deficit hyperactivity disorder (ADHD) should be treated. Individual's ability to re-compensate is positively impacted by reduction in symptoms such as insomnia or hyperarousal.
Drug class | Drug Action | Examples | Features |
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Beta-Adrenergic Blocking agents | Beta blockers inhibit inotropic, chronotropic, and vasodilatory responses to beta adrenergic stimulation | Propranolol | Propranolol may be useful for the treatment of hyperarousal |
Selective Serotonin Reuptake Inhibtors |
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Escitalopram | Escitalopram i sthe S-enantiomer of citalopram
Escitalopram has a faster onset of depression relief, usually 1-2 weeks in comparison with other antidepressants |
Sertraline | Sertraline selectively inhibits presynaptic serotonin reuptake with minimal or no effect on the reuptake of norepinephrine or dopamine | ||
Citalopram | Citalopram enhances serotonin activity through selective reuptake inhibition at the neuronal membrane
Citalopram is the least activating of the SSRIs and is particularly useful in acute stress disorder The incidence of adverse effects especially sexual is less with citalopram than with other SSRIs | ||
Benzodiazepines |
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Clonazepam | Clonazepam is a long-acting benzodiazepine that increases presynaptic GABA inhibtion and reduces the monosynaptic and polysynaptic reflexes |
Diazepam | Diazepam depresses all levels of the CNS such as limbic and reticular formations, by increasing activity of GABA | ||
Lorazepam | Lorazepam is a sedative-hypnotic with short onset of effect and a relatively long half-life
By increasing the action of GABA, lorazepam may depress all levels of the CNS, including limbic and reticular formations It is important to monitor the patient's blood pressure after administering a dose and to adjust the dose as necessary | ||
Alpha-Adrenergic Receptors |
|
Clonidine | Clonidine affects alpha1, alpha2, and alpha3-adrenergic receptors
It is frequently given to children but is not approved by the US Food and Drug Administration (FDA0 for any psychiatric uses in children It is available in tablets and in transdermal skin patches |
Guanfacine | Guanfacine has an action similar to that of clonidine but has a longer half-life and is less sedating
It is more selective alpha-agonist, affecting only alpha2-adrenergic receptors Guanfacine is not recommended for children younger than 12 years | ||
Antihistamines | Older, sedating antihistamines such as diphenhydramine are often prescribed as sedatives because of their CNS- depressing properties | Diphenhydramine | Diphenhydramine is available as nonprescription preparations containing 25 mg of diphenhydramine in liquid, chewable, and capsule forms |