Acute Stress Disorder

The basic response of the body is the same as in the normal stress reaction, but the symptoms are more severe and last for a longer period.

Acute stress disorder lasts no more than 4 weeks.

It is generally accept that having symptoms after a stressful event is normal for up to about 48 hours, but after this point the majority of people will have recovered. [1]

Indian epidemiology then other

Many kinds of highly stressful event can provoke an acute stress disorder, for example involvement in an either accident or fire, physical assault, or rape.

Since the stress response does not become abnormal in everyone exposed to the same events, there must be some kind of personal predisposition, but it is not known what this is.

Acute stress disorder can occur among bystanders as well as those directly involved, and among those involved in rescuing or caring for others.

Psychological theories:

• A variety of psychological mechanisms are probably at work in acute stress disorder, but dissociation is the most studied.
• It is thought that dissociation reduces the negative consequences of trauma by restricting awareness of the event and thereby preventing the person from being overwhelmed by the traumatic experience.
• Unfortunately, this prevents recovery as it does not allow the experience to be processed also integrated into existing coping mechanisms.
• A similar problem occurs when a person uses avoidance strategies excessively.

Biological theories:

• The main theory is based upon classical conditioning.
• When a traumatic event occurs (an unconditioned stimulus), people respond with fear (unconditioned response).
• As reminders of the trauma occur (conditioned stimulus), people then respond with fear reactions (conditioned response).
• It is thought that in some people, the stress response becomes sensitized to repeated stimuli, and a larger response is produced to each stimulus.
• Those people who suffer a panic attack during a traumatic event are very likely to experience increasing panic attacks in the few weeks afterwards. [1]

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Pathophysiology of Acute stress disorder

The exact reason why most people recover after a traumatic event but few develop acute stress disorder (ASD) remains unknown. Various models were developed to explain the response to traumatic events. The majority of them are related to "fear conditioning." It is a form of Pavlovian learning that when a traumatic stimulus (e.g., explosion) occurs together with a neutral stimulus (e.g., smell) or context (e.g., night time), in the future encounters of the neutral stimulus or context, the brain, and the body exhibits the same fear responses (even in the absence of the traumatic stimulus)

Most healthy people adapt to fear conditioning by extinction learning – a gradual reduction in response to the traumatic stimulus. If this mechanism fails, the patient continues to re-experience fearful symptoms of the initial traumatic event.

Functional magnetic resonance imaging (fMRI) scans of PTSD patients have shown hypoactivity of the frontal cortex and hyperactivity of the temporal cortex, demonstrating the possibility of a correlation between PTSD and neural functioning. A more recent study showed hyperactivation of the superior prefrontal and cingulate cortex and medial posterior precuneus.

[3]

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Symptoms of acute stress disorder are:

Increased arousal:

• Anxiety and panic attacks
• Restlessness, impaired concentration, and purposeless activity
• Irritability, depression, anger, or despair
• Insomnia

‘Dissociative’ symptoms:

• Emotional numbness and ‘being in a daze’
• Reduced awareness of surroundings
• Difficulty in recall of the stressful events
• Depersonalization and derealization

‘Re-experiencing’ symptoms":

• Flashbacks
• Recurrent images or thoughts
• Disturbing dreams

Avoidance of reminders of the stressful events

Maladaptive coping strategies

Acute stress disorder is diagnos when symptoms last from 2 days up to 4 weeks. [1]

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DSM-IV diagnostic criteria for acute stress disorder:

1. Exposure to a traumatic event in which the following were present:

• Either Actual or threatened death or serious injury, or a threat to the physical integrity of self or others;
• The person’s response involved intense fear, helplessness, or horror.

2. Due to the distressing event, the individual has at least three of the following dissociative symptoms:

• A subjective sense of numbing, detachment, or absence of emotional responsiveness;
• A reduction in awareness of his or her surroundings;
• Derealization;
• Depersonalization;
• Dissociative amnesia.

3. The traumatic event is persistently re-experienced through recurrent images, thoughts, dreams, illusions, flashback episodes, or a sense of reliving the experience.

4. Marked avoidance of stimuli that arouse recollections of the trauma.

5. After that, Marked symptoms of anxiety or increased arousal.

6. The disturbance leads to, clinically significant distress.

7. The disturbance lasts for a minimum of 2 days and a maximum of 4 weeks and occurs within 4 weeks of the traumatic event.

8. The disturbance is not due to the direct physiological effects of a substance or a general medical condition, is not better accounted for by Brief Psychotic Disorder, and is not merely an exacerbation of a pre-existing Axis I or Axis II disorder. [1]

Differential Diagnoses

• Adjustment Disorders

• Brief Psychotic Disorder

• Depression

• Dissociative Disorders

• Postconcussion Syndrome

• Posttraumatic Stress Disorder

• Substance abuse[4]

Complications are what happen after you have a disease. They are the negative consequences of the disease process.

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General measures:

Provide emotional support:

• Usually the person can be comforted effectively by relatives or friends, and can talk to them about the stressful experience.
• Meanwhile, If no close friend or relative is available, or if the response is severe, comfort may be offered by a healthcare professional.
• At last, It is important to explain the course and prognosis of an acute stress disorder.

Provide practical support:

• The period after a traumatic event is usually very busy and confusing.
• The person involved will need advice regarding police procedures, support in obtaining medical care, help with insurance claims, assistance with dealing with the media, additionally, help with domestic tasks.

Help with residual problems:

• Sometimes an acutely stressful situation results in lasting adversity to which the person has to adjust; for example, a serious car accident may lead to permanent disability.
• When this happens the treatment of an acute reaction should be followed by help in readjustment.

Psychological treatments:

Encourage recall i.e.:

• As anxiety is reduced, the person is usually able to recall and come to terms with the experience.
• When memories of the events remain fragmented, help may be needed to remember the events and integrate them into memory.

Develop more effective coping strategies i.e.:

• As explained above, in a time of crisis some people will use maladaptive coping strategies such as using substances.
• It is important to try and help them develop more productive strategies for example, provide a supportive atmosphere for working through problems, and encourage recall of events.
• Specific counselling is available in these situations and is called crisis intervention.

Debriefing i.e.:

• Until recently, a type of counselling know as debriefing was often make widely available after stressful events.
• The aim was to promote adaptation to the traumatic event, and it was usually gave within 24 to 72 hours of the trauma.
• Subjects talked about the stressful events and were encourage to express their thoughts and feelings at the time and since.
• A Cochrane review of randomized controlled trials found that whilst the majority of people said they found the counselling useful, additionally, it did not reduce the proportion of patients developing PTSD.
• UK guidance is now that debriefing should not routinely offered to patients.

Cognitive behavioural therapy i.e.:

• CBT differs from debriefing crucially in its emphasis on integrating recovered memories with existing ones, also on self-help.
• Evidence suggests the most effective strategy is a brief intervention, typically five sessions of individual therapy.
• Studies vary in their results but on average CBT reduces the proportion of people developing PTSD by 20 – 50 % .

Pharmacological treatments:

There has been very little research done on to which pharmacological interventions are effective in acute stress disorder.

Anxiolytics i.e.:

• A short course (3–5 days) of a benzodiazepine may be indicated in patients with a high level of anxiety immediately after the event.
• Occasionally, insomnia is severe, and a hypnotic drug (e.g. temazepam) should be given, but again only for a short period to avoid the development of tolerance and dependence.

Antidepressants i.e.:

• SSRIs are the most effective drug treatment for PTSD.
• Consider prescribing an SSRI if the symptoms continue to be severe, there is evidence of either depression, or the patient is too unwell to engage in psychological therapy.
• It is also an option for those patients who fail to improve after CBT. [1]

Research on prevention strategies for stress-related disorders has taken a number of avenues, including intervention before and after trauma and the use of both psychosocial and somatic approaches.

Despite advances in neurobiological understanding of response to trauma, clinical evidence for preventive interventions remains sparse. This review provides an overview of prevention approaches also summarizes the existing literature on prevention of ASD and PTSD, including clinical and preclinical studies.

Given the potential benefits to trauma survivors and society, the development of effective preventive interventions should be given greater priority.[5]

Homeopathic Treatment of Acute Stress Disorder

Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines selected after a full individualizing examination and case-analysis.

Which includes

• The medical history of the patient,
• Physical and mental constitution,
• Family history,
• Presenting symptoms,
• Underlying pathology,
• Possible causative factors etc.

A miasmatic tendency (predisposition/susceptibility) also often taken into account for the treatment of chronic conditions.

What Homoeopathic doctors do?

A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’?

The disease diagnosis is important but in homeopathy, the cause of disease not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness also looked for. Now a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition.

The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can greatly improve with homeopathic medicines.

Homeopathic Medicines for Acute Stress Disorder:

The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications also taken into account for selecting a remedy, potency and repetition of dose by Homeopathic doctor.

So, here we describe homeopathic medicine only for reference and education purpose. Do not take medicines without consulting registered homeopathic doctor (BHMS or M.D. Homeopath).

1. Arsenicum album:

• This remedy covers a lot of fears and anxieties that lead to obsessive-compulsive behaviors. Your mind can’t stop playing the same trauma over and over again.
• You can only focus on the negative-worrying, perhaps, that something bad will happen either to you or a loved one. In addition, you may overly concerned about germs or your health, to the point of hypochondria.

2. Aconitum napellus:

• Often follows a sudden, unexpected trauma, such as an earthquake or car accident.
• A deep fear of death sends you into a panic state.
• You can feel your heart beating at a rapid pace that comes on all of a sudden.
• You may feel faint, along with perspiration and trembling.
• Things that would not have bothered you before can trigger panic attacks, such as driving on a freeway, getting into an elevator, or flying in an airplane.
• "I went to the supermarket and on the way in the car, I thought I would die," is the type of statement you might make.

3. Argentum nitricum:

• Very anxious, especially about health.
• I call it "Monkey Brain," when patients can only focus on their health or lack of it, convinced that every minor ache or ailment is the symptom of a fatal disease, and tend to go from doctor to doctor to get diagnoses.
• Lots of fear- for example heights, crowds, small spaces, etc.
• They have a need to express their feelings in an impulsive way with anyone who will listen.
• They have a feeling of impending doom, such as some evil force is coming for them.

4. Stramonium:

• Night fears and nightmares.
• Fear of the dark, animals, violence, especially when being alone.
• Terrifying nightmares, waking up panic-stricken and full of anxiety. Similarly, anxiety turns into destructive and malicious behavior, an out-of-control feeling, and anger.
• The fears are so deep that they bring on panic.
• Patients can’t stand to be alone. Their reaction to fear is violence.
• They feel they need to protect themselves, so are always on the attack.

5. Lyssinum:

• Hypersensitive to sound, light, smell, also even others’ emotions. Furthermore, their emotions are raw, like exposed nerves.
• They feel they are being torment or ridiculed, also have a dread that something bad will happen to them.
• May have many phobias, such as fear of driving, flying, injury, suffocation.
• May also fear being alone, even though they tend to do better by themselves in a quiet room without much light.
• They have an irrational fear of water, either seeing it or just thinking of it.
• They have bitten by an animal and had fears since then.

Foods that are promoted on the Mediterranean diet are the same foods that are good to eat when you’re stressed: fish, poultry, fruits, vegetables, fruits, whole grains, and healthy fats.

In fact, patients to adopt a Mediterranean diet for overall health and wellness, including stress relief.

The goal is to eat foods that reduce inflammation in your body, thus reducing cortisol levels.

In contrast, some foods raise cortisol levels. Foods that cause stress on your body include:

• Alcohol.
• Caffeine.
• High-sugar foods.
• Simple carbs, such as cakes and pastries.
• Soda.

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1. Psychiatry, Fourth Edition- Oxford Medical Publications – SRG- by Geddes, Jonathan Price, Rebecca McKnight / Ch 23.
2. https://www.betternutrition.com/natural-rx/homeopathic-remedies-stress-anxiety-ptsd
3. https://www.ncbi.nlm.nih.gov/books/NBK560815/
4. https://emedicine.medscape.com/article/2192581-differential
5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4677144/

What is Acute Stress Disorder?

Acute stress disorder is an abnormal reaction to sudden stressful events.

Homeopathic Medicines use by Homeopathic Doctors in treatment of Acute Stress Disorder?

• Arsenicum album
• Aconitum napellus
• Argentum nitricum
• Stramonium
• Lyssinum

What are the symptoms of Acute Stress Disorder?

• Anxiety and panic attacks
• Restlessness, impaired concentration
• Purposeless activity
• Irritability, depression, anger, despair
• Insomnia
• Reduced awareness of surroundings
• Difficulty in recall of the stressful events
• Disturbing dreams