II. Pathophysiology

III. Causes: Trauma Triggers

IV. Diagnosis: DSM IV

  1. Exposure to Traumatic event
    1. Experienced or witnessed actual or threatened death, serious injury or threat to integrity AND
    2. Response involved intense fear, helplessness or horror
  2. Associated dissociative symptoms (at least 3 present)
    1. Numb, detached or emotionally unresponsive
    2. Dazed or reduced awareness of surroundings
    3. Derealization
    4. Depersonalization
    5. Dissociative amnesia with inability to recall important aspects of the Trauma
  3. Traumatic event is persistently reexperienced (at least 1 present)
    1. Images
    2. Thoughts
    3. Dreams
    4. Illusions
    5. Flashbacks
    6. Re-living experience
    7. Reminders of Trauma cause distress
  4. Marked avoidance of stimuli (e.g. places, people, conversations, activities) that recall the Trauma
  5. Marked anxiety or arousal
    1. Insomnia
    2. Irritability
    3. Poor concentration
    4. Hypervigilance
    5. Increased startle response
    6. Motor restlessness
  6. Clinically Significant distress or Impairment
  7. Onset within 4 weeks of the Trauma
  8. Duration of symptoms 2 days to 4 weeks
  9. Not due to other cause (e.g. CD, medication, medical condition, brief Psychotic Disorder)
  10. References
    1. (2000) DSM, 4th edition, APA, p. 471-2

V. Management

  1. See Psychological First Aid
  2. Cognitive Behavioral Therapy (CBT) by Psychology
    1. See Relaxation Training
    2. Posttraumatic reaction education
    3. Progressive Muscle Relaxation
    4. Imagined Traumatic memory exposure
    5. Cognitive restructuring of distorted Trauma-related beliefs
    6. Graduated exposure to avoided situations
  3. Intervention strategies by physician (empiric methods in parallel to CBT)
    1. Promote sense of safety
      1. Avoid conversations, news reports about major Traumatic events
    2. Promote sense of calm
      1. Employ Relaxation Techniques
    3. Promote sense of self-efficacy
      1. Return to pre-Trauma ability to overcome adverse events
      2. Become involved in community activities
    4. Promote connectedness
      1. Re-connect with family and friends
    5. Instill hope
      1. Reassure that CBT will help the patient return to normal responses to triggers
    6. Hobfoll (2007) Psychiatry 70(4): 283-315 [PubMed]
  4. Medications
    1. No specific medications are recommended for treatment of Acute Stress Disorder
    2. Consider management of comorbid conditions and transient symptoms
      1. Insomnia management
      2. Major Depression Management

VI. Precautions

  1. Critical Incident Stress Debriefing
    1. Not recommended due to poor efficacy and risk of harm

VII. Complications

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Ontology: Stress Disorders, Traumatic, Acute (C0236816)

Definition (NCI) An anxiety disorder precipitated by an experience of intense fear or horror while exposed to a traumatic (especially life-threatening) event. The disorder is characterized by dissociative symptoms; vivid recollections of the traumatic event; avoidance of stimuli associated with the traumatic event; and a constant state of hyperarousal for no more than one month.
Definition (MSH) A class of traumatic stress disorders that is characterized by the significant dissociative states seen immediately after overwhelming trauma. By definition it cannot last longer than 1 month, if it persists, a diagnosis of post-traumatic stress disorder (STRESS DISORDERS, POST-TRAUMATIC) is more appropriate.
Definition (PSY) Disorder characterized by the development of anxiety and dissociative symptoms as a result of exposure to a traumatic event. Symptoms last at least two days and no longer than four weeks.
Concepts Mental or Behavioral Dysfunction (T048)
MSH D040701
ICD9 308.9, 308
ICD10 F43.0
SnomedCT 67195008, 268791005, 268657003, 41897001, 192036009, 192414001, 192045005, 30319004, 154959008
DSM4 308.3
English Unspecified acute reaction to stress, Acute stress reaction NOS, STRESS DIS ACUTE, STRESS DIS TRAUMATIC ACUTE, ACUTE STRESS DIS, acute stress disorder (diagnosis), acute reaction to stress, gross stress reaction (acute), acute stress disorder, acute reaction to stress (diagnosis), Acute reaction to stress, unspecified, Acute stress react NOS, Stress Disorders, Traumatic, Acute [Disease/Finding], Reaction after;acute stress, acute disorders stress, acute traumatic stress disorder, Acute Stress Disorder, Acute stress reaction NOS (disorder), Post-traumatic stress - acute, [X]Acute reaction to stress, Gross stress reaction (disorder), [X]Psychic shock, Psychic shock (disorder), [X]Acute crisis reaction, (Examination fear) or (flying phobia) or (stage fright) or (acute stress reaction NOS) (disorder), (Examination fear) or (flying phobia) or (stage fright) or (acute stress reaction NOS), [X]Acute stress reaction, Acute Stress Disorders, Stress Disorder, Acute, Stress Disorders, Acute, Stress Disorders, Traumatic, Acute, Acute reaction to stress, Gross stress reaction, Psychic shock, Acute crisis reaction, Acute stress reaction, Acute stress disorder, Acute stress disorder (disorder), crisis; acute reaction, disorder; acute stress, acute reaction; crisis, acute; stress disorder, acute; stress reaction, psychic; shock, shock; psychic, stress reaction; acute, Gross stress reaction, NOS, acute stress reaction
Italian Disturbo acuto da stress, Reazioni acute allo stress non specificate, Reazione acuta allo stress, Disturbi acuti da stress di origine traumatica
Dutch niet-gespecificeerde acute stressreactie, acute stressreactie, acute reactie door stress, Acute stressreactie, acute reactie; crisis, acuut; stressreactie, acuut; stressstoornis, crisis; acute reactie, psychisch; shock, shock; psychisch, stoornis; acute stress, stressreactie; acuut, acute stressstoornis, Stressstoornissen, acute, Stressstoornissen, traumatische, acute
French Autre réaction aiguë non précisée au stress, Réaction aiguë au stress, Réaction de stress aigu, Réaction aiguë au stress, non précisée, Trouble aigu lié au stress, État de stress traumatique aigu, Syndromes de stress traumatique aigus, Troubles aigus dus au stress, Troubles de stress traumatique aigus, États de stress aigu
German unspezifische akute Reaktion auf Stress, akute Reaktion auf Stress, akute Reaktion auf Stress, unspezifisch, akute Stressreaktion, Akute Belastungsstörungen, Akute traumatische Belastungsstörungen, Akute Belastungsreaktion, akute Belastungsreaktion, Belastungsreaktion, akute, Belastungsstörungen, akute, Belastungsstörungen, traumatische, akute
Portuguese Reacção aguda a stress, Reacção aguda NE a stress, Reacção aguda de stress, Perturbação aguda de stress, Transtornos de Estresse Traumático Agudo, Transtornos por Estresse Agudo
Spanish Reacción aguda al estrés, Reacción aguda al estrés, no especificada, Reacción de estrés aguda, Reacción aguda no especificada al estrés, shock psíquico, reacción de estrés general, reacción situacional aguda general, reacción a estrés agudo, SAI (trastorno), reacción de stress general, shock psíquico (concepto no activo), reacción aguda al estrés, reacción aguda al stress, reacción de estrés general (concepto no activo), reacción a estrés agudo, SAI, trastorno por estrés agudo (trastorno), trastorno por estrés agudo, trastorno por stress agudo, trastorno por tensión aguda, Trastorno agudo por estrés, Trastornos de Estrés Traumático Agudo, Trastornos por Estrés Agudo
Japanese 急性ストレス反応、詳細不明, 急性ストレス反応, キュウセイストレスハンノウショウサイフメイ, キュウセイストレスハンノウ, ストレス性障害-急性, 急性ストレス障害, ストレス障害-急性
Swedish Stressyndrom, traumatiskt, akut
Czech stresové poruchy traumatické akutní, stresové poruchy akutní, Akutní reakce na stres, blíže neurčená, Akutní stresová porucha, Akutní reakce na stres, Akutní stresová reakce, Blíže neurčená akutní reakce na stres
Finnish Äkilliset traumaperäiset stressireaktiot
Russian STRESS TRAVMATICHESKII OSTRYI, СТРЕСС ТРАВМАТИЧЕСКИЙ ОСТРЫЙ
Korean 급성 스트레스 반응
Polish Ostra reakcja na stres urazowy, Zespół stresu urazowego ostry
Hungarian Acut stressreakció, nem meghatározott, Nem meghatározott acut stressreakció, Acut stresszreakció, Acut stressreakció, Acut stress betegség
Norwegian Stressyndrom, akutt traumatisk, Akutt traumatisk stressforstyrrelse, Stressforstyrrelse, akutt traumatisk, Akutt traumatisk stressyndrom