Stress-related disorders

Stress-related disorders can present in the form of acute stress reaction and post-traumatic stress disorder.

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Acute stress reaction

Acute stress reaction is a condition involving short-term intrusive memories that occur shortly after a person witnesses or participates in an extremely stressful situation.

In acute stress reaction, a person who has experienced a traumatic event periodically experiences influxes of memories of the trauma, avoids factors that remind him of it, and experiences increased anxiety. Symptoms develop within 4 weeks of the traumatic event and last at least 2 days, but, unlike post-traumatic stress disorder, no more than 4 weeks. A patient with this disorder has 3 or more dissociative symptoms: a feeling of numbness, detachment, and lack of emotional reactions; decreased ability to evaluate the environment (confusion); a feeling that things around are unreal; a feeling that the person himself is unreal; amnesia for important details of the traumatic situation.

Many patients recover when removed from the traumatic situation if they feel understood, empathized with, and given the opportunity to describe what happened and their reactions to it. Some experts recommend systematic debriefing to help those who were involved in or witnessed the traumatic event talk about what happened and express their views on the impact of the event. One approach views the event as a critical event and the debriefing as critical event stress debriefing (CISD). Others believe that this method is not as helpful as supportive conversation and may be quite distressing for some patients.

Drug therapy may include medications to normalize sleep; other medications are not indicated.

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Post-traumatic stress disorder

Posttraumatic stress disorder is a condition characterized by recurrent intrusive memories of a traumatic event. The pathophysiology of this disorder is not fully understood. Symptoms also include avoidance of situations associated with the traumatic event, nightmares, and flashback phenomena. Diagnosis is based on anamnestic information. Treatment consists of exposure therapy and medication.

In disaster situations, many patients have long-term effects, but for some, the effects are so long-lasting and severe that they affect health and constitute a medical condition. Typically, events that trigger the development of post-traumatic stress disorder (PTSD) cause fear, helplessness, and horror. These events include situations in which a person suffers serious physical injuries or is in danger of death, or when a person witnesses serious injuries, the risk of death, or the death of others.

Lifetime prevalence is 8%, 12-month incidence is about 5%.

Symptoms of stress-related disorders

Typically, patients experience frequent involuntary flashbacks and repeated replays of the traumatic situation. Nightmares with the content of the traumatic event are common. Much less common are short-term dissociative disorders in the waking state, when events of a previously experienced trauma are perceived as occurring in the present (flashback), sometimes the patient reacts as if he were in a real situation of a traumatic event (for example, the wail of a fire siren can cause the perception that the patient is in a combat zone and force him to seek shelter or lie down on the ground for protection).

Such a patient avoids stimuli associated with the trauma and often feels emotionally numb and indifferent to everyday activities. Sometimes the onset of the disease is delayed, with symptoms appearing only months or even years after the traumatic event. If the duration is more than 3 months, PTSD is considered chronic. Patients with chronic PTSD often have depression, other anxiety disorders, and substance abuse.

In addition to trauma-specific anxiety, patients may express feelings of guilt for their actions during the incident or survivor's guilt when others were not saved.

Clinical diagnosis is based on the criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), 4th edition.

Treatment of stress-related disorders

Without treatment, the symptoms of chronic PTSD often lessen in severity but are not completely eliminated. Some patients experience symptoms that are so severe that they are virtually incapacitated. The main form of psychotherapy used is exposure therapy, which involves exposure to situations that the patient avoids because they fear they may trigger memories of the trauma. Repeated mental exposure to the traumatic experience itself usually reduces distress after some initial increase in discomfort. Stopping certain ritualistic behaviors, such as excessive washing to achieve a feeling of cleanliness after sexual abuse, also helps.

Drug therapy is also effective, especially with SSRIs. Mood stabilizing drugs such as valproate, carbamazepine, topiramate help relieve irritability, nightmares, and flashbacks.

Often anxiety is severe, so supportive psychotherapy is important. Doctors should be empathetic and sympathetic, recognizing and acknowledging the patient's pain and the reality of the traumatic events. Doctors also need to support patients in the face of memories through behavioral desensitization and training in anxiety management techniques. If the patient has "survivor guilt," psychotherapy aimed at helping the patient understand and change his or her overly self-critical attitudes toward himself or herself and eliminating self-blame is helpful.