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Acute stress reaction

Specialties > General practice

Background knowledge 🧠

Definition

  • Acute stress reaction (ASR) is a psychological response to a traumatic event, occurring immediately or within hours after exposure.
  • Characterized by an intense emotional and physical response.
  • Also known as acute stress disorder or psychological shock.
  • Short-lived, typically resolves within days to weeks.

Epidemiology

  • Affects individuals of all ages and backgrounds.
  • More common in people with a history of mental health disorders.
  • Higher incidence in those exposed to severe trauma, such as natural disasters, accidents, or violence.
  • Estimated prevalence of 20-30% following a traumatic event.
  • Slightly more common in females.

Aetiology and Pathophysiology

  • Triggered by exposure to an extreme stressor or traumatic event.
  • Activation of the hypothalamic-pituitary-adrenal (HPA) axis leading to a stress response.
  • Increased levels of cortisol and adrenaline.
  • Disruption of normal psychological functioning, leading to dissociation, anxiety, and hyperarousal.
  • Genetic, psychological, and social factors contribute to individual susceptibility.

Types

  • Simple ASR: Brief, transient response with rapid recovery.
  • Complicated ASR: Prolonged or severe symptoms, may lead to post-traumatic stress disorder (PTSD).
  • Delayed ASR: Symptoms develop hours or days after the event.
  • Dissociative ASR: Prominent dissociative symptoms such as detachment or derealization.

Clinical Features 🌡️

Symptoms

  • Intense fear, anxiety, or panic.
  • Intrusive thoughts or flashbacks related to the traumatic event.
  • Numbness or detachment from reality.
  • Hypervigilance and exaggerated startle response.
  • Sleep disturbances, including nightmares.
  • Difficulty concentrating.

Signs

  • Tachycardia and hypertension.
  • Sweating and tremors.
  • Pale or flushed skin.
  • Agitation or restlessness.
  • Distress or emotional outbursts.
  • Avoidance of reminders of the trauma.

Investigations 🧪

Tests

  • Clinical diagnosis based on history and presentation.
  • Psychological assessment for severity and impact on daily functioning.
  • Screening for risk factors for PTSD.
  • Consider differential diagnoses (e.g., panic disorder, substance use).
  • No specific laboratory tests required.

Management 🥼

Management

  • Immediate psychological support, including reassurance and a safe environment.
  • Brief cognitive-behavioural therapy (CBT) for symptom relief.
  • Medication (e.g., short-term benzodiazepines) may be considered for severe anxiety or insomnia.
  • Monitor for development of PTSD and refer to mental health services if needed.
  • Encourage healthy coping strategies and social support.

Complications

  • Development of PTSD in a subset of individuals.
  • Chronic anxiety or depression.
  • Substance misuse as a coping mechanism.
  • Impaired social and occupational functioning.
  • Risk of suicide in severe cases.

Prognosis

  • Generally good with appropriate support and management.
  • Most cases resolve within days to weeks.
  • A small percentage may develop chronic conditions, such as PTSD.
  • Prognosis is worse in individuals with poor social support or pre-existing mental health conditions.
  • Early intervention is key to preventing long-term complications.

Key Points

  • Acute stress reaction is a transient psychological response to trauma.
  • Diagnosis is clinical, based on history and symptoms.
  • Management involves psychological support and monitoring for complications.
  • Prognosis is generally good, but early intervention is crucial.
  • Awareness of risk factors for PTSD is important for follow-up care.

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General practice