Stress related disorders

Stress related disorders can be presented in the form of an acute reaction to stress and post-traumatic stress disorder.

[1], [2], [3], [4], [5], [6], [7]

Acute stress reaction

An acute reaction to stress is a state with short-term obsessive memories that arise shortly after a person has witnessed or participated in an extremely stressful situation.

In acute reaction to stress in a person who has been through a traumatic event, there are periodic influxes of memories of trauma, he avoids factors that remind him of her, his anxiety level increases. Symptoms develop within 4 weeks after a traumatic event and last at least 2 days, but, unlike post-traumatic stress disorder, no more than 4 weeks. The patient with this disorder has 3 or more dissociative symptoms: sensation of numbness, detachment and lack of emotional reactions; decreased ability to evaluate the surrounding (confusion); feeling that things around are unreal; the feeling that the person himself is unreal; amnesia on important details of a traumatic situation.

Many patients recover after removing them from the traumatic situation, if they feel understanding, empathy, it is possible to describe what happened and their reaction to it. Some experts recommend systematic debriefing to help those who have been a participant or witness of a traumatic event, to tell what happened, to express their opinions about the impact of this event. According to one approach, the incident is seen as a critical event, and debriefing is the debriefing of the stress of the critical event (DSCS). Other experts believe that this method is not as useful as a supportive conversation, and for some patients it can be quite painful.

Drug therapy may be prescribed to normalize sleep, the appointment of other drugs is not indicated.

[8], [9], [10], [11], [12]

Post-Traumatic Stress Disorder

Post-traumatic stress disorder is a condition with recurrent obsessive memories of an extreme traumatic event. The pathophysiology of this disorder is not fully understood. Symptoms also include avoiding situations associated with a traumatic event, nightmarish dreams and "flashback" -phenomenons. Diagnosis is based on anamnestic information. Treatment consists in exposure and drug therapy.

In catastrophe situations, many patients have long-term effects, but in some they are so long and serious that they affect health and are a painful condition. As a rule, events that provoke the development of post-traumatic stress disorder (PTSD) cause fear, helplessness, horror. These incidents include situations where the person himself has serious bodily injuries or there is a threat to his life or when a person witnesses serious injuries, death or death of others.

Prevalence during life is 8%, incidence in the 12-month period is about 5%.

Symptoms of disorders associated with Stress

As a rule, patients often experience involuntary bursts of memories, repeated plays of a traumatic situation. Frequent nightmares with the contents of a traumatic event are frequent. Significantly less frequent short-term dissociative disorders in the state of wakefulness, when the events of the previously suffered trauma are perceived as occurring at the present time (flashback), sometimes the patient reacts as if he is in a real situation of a traumatic event (for example, the fire siren's howl can cause perception the fact that the patient is in the combat area, and force him to seek shelter or lie down on the ground for protection).

Such a patient avoids the incentives associated with trauma, and often feels emotional stupor and indifference in daily activities. Sometimes the onset of the disease is delayed, the symptoms appear only months and even years after the traumatic event. With a duration of more than 3 months, PTSD is considered chronic. Patients with chronic PTSD often experience depression, other anxiety disorders, and dependence on psychoactive substances.

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

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

Treatment of disorders associated with Stress

In the absence of treatment, the severity of symptoms of chronic PTSD is often reduced, but the symptomatology is not completely reduced. In some patients, the severity of the symptoms is so pronounced that they are practically invalid. The main form of psychotherapy used is exposure, which includes exposing situations that the patient avoids because of fear that they can trigger memories of trauma. Repeated mental exposure of the actual traumatic experience usually reduces distress after some initial increase in discomfort. Also, cessation of certain ritual behavior, such as excessive washing with the goal of achieving a sense of purity after sexual violence, helps.

Medication therapy is also effective, especially with the use of SSRIs. Stabilizing drugs, such as valproate, carbamazepine, topiramate, help to remove irritability, nightmarish dreams and flashbacks.

Often anxiety is strongly pronounced, so supportive psychotherapy is important. Doctors should show empathy and sympathy, recognizing and recognizing the patient's mental pain and the reality of traumatic events. Physicians also need to support patients in the face of memories through behavioral desensitization and training in anxiety control techniques. If the patient has a "guilt feeling of the survivor", psychotherapy is useful, helping to understand and change the self-critical attitude of the patient to himself and to eliminate self-flagellation.