Stress-related Disorders/Clinical Stress

Stress as in Clinical Medicine

Acute stress disorder

• Occurs in individuals without any other apparent psychiatric disorder, in response to exceptional physical/or psychological stress.
• While severe, such reactions usually subside within hours or days.
• The stress may be an overwhelming traumatic experience (e.g accident, battle, physical assault, rape) or unusually sudden change in social circumstances of the individual, such as multiple bereavement.
• Individual vulnerability and coping capacity play a role in the occurrence and severity of acute stress reactions, as evidenced by the fact that not all people exposed to exceptional stress develop symptoms.

1. Symptoms show considerable variation but usually include:
   • an initial state of DAZE with some constriction of the field of consciousness and narrowing of attention
   • inability to comprehend stimuli
   • disorientation.
2. Followed either by further withdrawal from the surrounding situation to the extent of a dissociative stupor or by agitating and over activity.

Autonomic signs of "Panic Anxiety"

• Tachycardia
• Sweating
• Hyperventilation

The symptoms usually appear within minutes of the impact of the stressful stimulus and disappear within 2-3 days.

Post-traumatic disorders (PTSD)

This arises as a delayed and/or protracted response to a stressful event or situation of an exceptionally threatening nature and likely to cause pervasive distress in almost anyone.

Causes of PTSD

1. Natural or human disasters
2. war
3. serious accident
4. witness of violent death of others
5. being the victim of sexual abuse
6. rape
7. torture
8. terrorism or hostage taking

Predisposing factors

1. Personality traits
2. Previous history of Psychiatric illness

Typical symptoms

1. "Flashbacks" - the repeated reliving of the trauma in the form of intrusive memories or dreams.
2. intense distress at exposure to events that symbolize or resemble an aspect of the traumatic event, including anniversaries of the trauma
3. avoidance of activities and situations reminiscent of the trauma
4. emotional blunting or "numbness"
5. a sense of detachment from other people
6. autonomic hyper-arousal with hyper-vigilance, an enhanced startle reaction and insomnia
7. marked anxiety and depression and, occasionally, suicidal ideation

Treatment

• Psychiatric consultation
  • Exploration of memories of the traumatic event
  • relief of associated symptoms
  • counseling

Prognosis

• The course is fluctuating but recovery can be expected in the majority of cases.
• Few people may show chronic course over many years and a transition to an enduring personality change

Source

Kumar and Clark Clinical Medicine 4th Edition ISBN 0 7020 2458 9 page 1134