Background

• Acute Stress Disorder (ASD) is a psychological condition that can develop in response to a traumatic event. It is characterized by a set of symptoms that occur within a month of exposure to the traumatic event.  
• ASD is typically triggered by an event that involves actual or threatened death, serious injury, or sexual violation to oneself or others. This can include experiences like accidents, natural disasters, physical or sexual assault, military combat, or witnessing a traumatic event. 
• ASD is considered a short-term and often transient condition, but if the symptoms persist for more than a month and significantly impact daily functioning, it may evolve into post-traumatic stress disorder (PTSD). 

Epidemiology

• The incidence rates of ASD depend on the population studied and the types of traumatic events prevalent in that population. Certain populations may be more vulnerable to developing ASD.  
• This includes individuals with a history of trauma, those with pre-existing mental health conditions, individuals with limited social support, and those who have experienced particularly severe or life-threatening traumas. 

Anatomy

Pathophysiology

• Exposure to a traumatic event triggers the sympathetic nervous system, leading to the release of stress hormones such as adrenaline and noradrenaline. 
• Stress activates the hypothalamus-pituitary-adrenal (HPA) axis, leading to the release of cortisol. Elevated cortisol levels are associated with stress responses and their role in regulating various physiological functions. 
• Changes in neurotransmitter levels, including increased levels of norepinephrine and alterations in serotonin, may contribute to symptoms such as hyperarousal, intrusive thoughts, and mood disturbances. 
• Disruptions in the normal functioning of the hippocampus, it is a brain region involved in memory consolidation and contextual processing, may contribute to the fragmentation and reliving of traumatic memories in ASD. 

Etiology

• Individuals with a history of prior traumatic experiences may be more vulnerable to developing ASD. Past traumas can sensitize an individual’s stress response system. 
• Genetic and familial factors may contribute to an increased susceptibility to stress-related disorders, including ASD. 
• Individuals with pre-existing anxiety, depression, or other mental health disorders may be at a higher risk for developing ASD following a traumatic event. 
• The body’s stress response system, involving the release of hormones such as cortisol and adrenaline, contributes to the physiological aspects of ASD. Individual differences in the regulation of stress hormones may influence vulnerability. 

Genetics

Prognostic Factors

• The intensity and severity of ASD symptoms shortly after the traumatic event can be indicative of the potential for recovery.  
• Timely and appropriate interventions, especially trauma-focused cognitive-behavioral therapy (CBT), can positively impact the course of ASD. Early treatment has been associated with a reduced risk of symptoms persisting beyond the acute phase. 
• The level of social support an individual receives from family, friends, and the community can significantly influence prognosis. Persistent avoidance of reminders of the traumatic event is a core symptom of ASD.  
• The extent to which individuals engage in avoidance behaviors can influence prognosis, with higher levels of avoidance associated with a poorer outcome. 

Clinical History

Physical Examination

• General Examination: A routine physical examination may be conducted to assess overall health and identify any physical conditions that could be contributing to the symptoms or that may require medical attention. 
• Neurological Examination: A neurological examination may be performed to assess cognitive function, coordination, and sensory perception. This is done to rule out any neurological conditions that might be affecting mental well-being. 
• Laboratory Test: Blood tests may be ordered to rule out potential medical conditions that could be associated with symptoms, such as thyroid disorders or metabolic abnormalities. 

Age group

Associated comorbidity

• If ASD symptoms persist beyond one month, a diagnosis of PTSD may be considered. Both ASD and PTSD involve exposure to a traumatic event, intrusive thoughts, avoidance behaviours, negative mood alterations, and arousal symptoms. 
• Individuals with ASD may experience symptoms of depression, such as persistent sadness, feelings of hopelessness, and a loss of interest or pleasure in activities. The emotional toll of the traumatic event can contribute to the development of depressive symptoms. 
• ASD is characterized by heightened anxiety in response to a traumatic event.  

Associated activity

Acuity of presentation

• ASD symptoms typically begin to emerge shortly after exposure to a traumatic event, usually within three days to four weeks. The diagnostic criteria for ASD specify that the symptoms must persist for a minimum of three days and a maximum of four weeks to meet the criteria for diagnosis. 
• The timing of symptom onset can vary among individuals. Some people may experience immediate symptoms, while others may have a delayed onset. Factors influencing this variability include the nature and severity of the traumatic event, individual differences in coping mechanisms, and pre-existing vulnerabilities. 
• Symptoms of ASD often have a rapid onset, appearing soon after the traumatic experience. This quick onset distinguishes ASD from Post-Traumatic Stress Disorder (PTSD), where symptoms typically persist for more than a month. 

Differential Diagnoses

• Post-Traumatic Stress Disorder (PTSD): ASD and PTSD share many similar symptoms, but the key distinction lies in the duration of symptoms. If symptoms persist beyond four weeks, a diagnosis of PTSD may be more appropriate. 
• Adjustment Disorders: Adjustment disorders involve emotional and behavioral symptoms in response to a significant life stressor. The key difference is that the symptoms in adjustment disorders are not as severe, persistent, or characteristic as those seen in ASD. 
• Major Depressive Disorder (MDD): Depressive disorders, such as MDD, may share overlapping symptoms with ASD, particularly those related to mood alterations and disruptions in daily functioning.  
• Dissociative Disorders: Dissociative disorders involve disruptions in memory, identity, consciousness, or perception. ASD may involve dissociative symptoms, but a primary diagnosis of a dissociative disorder requires more pronounced and persistent dissociative experiences. 
• Bipolar Disorders: In bipolar disorders, individuals experience periods of depressive and manic episodes. While mood alterations are present, the trigger for symptoms may differ from the trauma-related triggers in ASD.

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

• Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT): TF-CBT involves cognitive restructuring, exposure techniques, and education about trauma reactions.  
• Prolonged Exposure Therapy (PE): PE involves systematic and gradual exposure to trauma-related memories, thoughts, and situations, helping individuals confront and process their traumatic experiences. It aims to reduce avoidance behaviors and decrease the emotional impact of memories. 
• Eye Movement Desensitization and Reprocessing (EMDR): EMDR is a therapeutic approach that involves bilateral stimulation (such as eye movements) while recalling traumatic memories. This process is used in individuals with traumatic memories and to reduce associated distress. 
• Relaxation Techniques: Teaching individuals relaxation techniques, such as deep breathing, progressive muscle relaxation, or mindfulness, can help manage anxiety and arousal symptoms. 

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

use-of-non-pharmacological-approach-for-acute-stress-disorder

• Safe Physical Space: Ensure that the individual feels physically safe in their environment. This may involve addressing any immediate safety concerns and providing a secure and comfortable place where they can relax. 
• Minimize Triggers: Identify and minimize exposure to reminders or triggers associated with the traumatic event. This may include avoiding specific places, people, or activities that evoke distressing memories. 
• Encourage Social Support: Foster a supportive social environment by encouraging the involvement of family, friends, or support groups. Positive social interactions can contribute to feelings of connection and understanding. 
• Limit Exposure to Media: Limit exposure to media coverage of traumatic events, as constant exposure can contribute to distress. Monitor and control access to news, social media, and other sources of information that may be triggering. 
• Encourage Relaxation Techniques: Introduce relaxation techniques, such as deep breathing, meditation, or guided imagery, that can be practiced in the environment. These techniques can help manage anxiety and promote a sense of calm. 

Role of selective serotonin reuptake inhibitors

• Citalopram: Citalopram is an SSRI that works by increasing the availability of serotonin in the brain. Serotonin is a neurotransmitter associated with mood regulation. 

It may help reduce symptoms of anxiety, intrusive thoughts, and depressed mood. 

• Sertraline: Sertraline, like citalopram, is an SSRI that increases serotonin levels in the brain. 

Use of Benzodiazepines

Benzodiazepines may be prescribed to provide short-term relief from symptoms of acute anxiety, hyperarousal, and insomnia associated with ASD. 

• Diazepam: Diazepam is a benzodiazepine that enhances the effects of the neurotransmitter gamma-aminobutyric acid (GABA) in the brain, leading to a calming effect. 

Role of Alpha-adrenergic agonists

Alpha-adrenergic agonists may be prescribed to reduce symptoms of hyperarousal, such as heightened startle response, irritability, and increased heart rate. 

• Prazosin: It an alpha-1 adrenergic antagonist, has been studied for its potential role in reducing nightmares and improving sleep quality in individuals with trauma-related disorders, including ASD. 

use-of-intervention-with-a-procedure-in-treating-acute-stress-disorder

Interventions for Acute Stress Disorder (ASD) typically involve evidence-based therapeutic approaches aimed at reducing symptoms, promoting coping strategies, and preventing the development of persistent stress-related disorders.  

• Ensuring Safety: The therapist addresses any safety concerns and collaborates with the individual to establish a sense of safety and stability. This may involve addressing current stressors and enhancing the support system. 
• Problem-Solving: The therapist and individual work together to identify and address current life challenges, providing practical strategies for problem-solving and stress management. 
• Developing Plans: The individual learns to anticipate and manage potential triggers and stressors. Relapse prevention strategies are developed to maintain progress and prevent a return of symptoms. 

use-of-phases-in-managing-acute-stress-disorder

• Assessment and Diagnosis: Identify the presence of ASD symptoms. Assess the impact of the traumatic event on daily functioning. Rule out other potential diagnoses and medical issues. 
• Psychoeducation: Provide information about ASD and normal stress reactions. Normalize the individual’s experiences. Set the stage for collaboration in treatment. 
• Social Support and Connection: Foster a supportive social environment. Enhance connections with family and friends. Reduce feelings of isolation. 
• Relapse Prevention and Follow-Up: Prevent the re-emergence of symptoms. Monitor progress and adjustment. Provide ongoing support as needed. 

Medication

Future Trends

Media Gallary

References

• Acute Stress Disorder – StatPearls – NCBI Bookshelf (nih.gov) 
• Acute Stress Disorder – PTSD: National Center for PTSD (va.gov)  
• Acute Stress Disorder – Mental Health Disorders – Merck Manuals Version