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.
- 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
- 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.
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
- Natural or human disasters
- serious accident
- witness of violent death of others
- being the victim of sexual abuse
- terrorism or hostage taking
- Personality traits
- Previous history of Psychiatric illness
- "Flashbacks" - the repeated reliving of the trauma in the form of intrusive memories or dreams.
- intense distress at exposure to events that symbolize or resemble an aspect of the traumatic event, including anniversaries of the trauma
- avoidance of activities and situations reminiscent of the trauma
- emotional blunting or "numbness"
- a sense of detachment from other people
- autonomic hyper-arousal with hyper-vigilance, an enhanced startle reaction and insomnia
- marked anxiety and depression and, occasionally, suicidal ideation
- Psychiatric consultation
- Exploration of memories of the traumatic event
- relief of associated symptoms
- 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
Kumar and Clark Clinical Medicine 4th Edition ISBN 0 7020 2458 9 page 1134