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:
 * 2) *an initial state of DAZE with some constriction of the field of consciousness and narrowing of attention
 * 3) *inability to comprehend stimuli
 * 4) *disorientation.
 * 5) 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"
The symptoms usually appear within minutes of the impact of the stressful stimulus and disappear within 2-3 days.
 * Tachycardia
 * Sweating
 * Hyperventilation

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
 * war
 * 1) serious accident
 * 2) witness of violent death of others
 * 3) being the victim of sexual abuse
 * 4) rape
 * 5) torture
 * 6) 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