STRESS IS LIKE SPICE.

IN THE RIGHT
PROPORTION , IT ENCHNCES THE FLAVOR
OF A DISH. TOO LITTLE PRODUCES A
BLEND, DULL MEAL; TOO MUCH MAY
CHOKE YOU.
(Donald Tubesing)
ACUTE STRESS REACTION
‘’It is a brief response to sudden intense stressors in
a person who previously had no psychiatric
disorder.’’
The response starts 1 hour after exposure and
begins to diminish after no more than 48 hours
CLINICAL PICTURE
ANXIETY
DEPRESSION
INSOMINA
RESTLESSNESS
POOR CONCENTRATION
FEELING OF NUMBNESS
DIFFICULTY IN REMEMBERING SEQUENCE
INSOMNIA
RESTLESSNESS
POOR CONCENTRATION
ANGER OR HISTRONIC BEHAVIOUR
PHYSICAL SYMPTOMS i.e. sweating, palpitations
AVOIDENCE
EXESSIVE USE OF ALCOHAL
DENIAL, REGRESSION, DISPLACEMENT
Etiology
MOTOR ACCIDENTS
FIRE
PHYSICAL ASSUALT
RAPE
SUDDEN DISCOVERY OF SERIOUS ILNESS
DIAGNOSTIC CRITERIA ACC. TO ICD-10
WITHDRAWAL FROM SOCIAL INTERACTION
NARROWING OF ATTENTION
APPARENT DISORENTATION
ANGER AND VERBAL AGGRESSION
DESPAIR AND HOPELESSNESS
EXCESSIVE GRIEF
PURPOSELESS ACTIVITY

* Four out of seven must be fulfilled to label it

WHO ARE MORE PRONE
DEPENDS UPON
• CONSTITUTION
• PREVIOUS EXPERIENCE
• COPING STYLE
TREATMENT
1- PSYCHOLOGICAL FIRST AID:

Following are the components:

Comfort and consolation
Protection from further threat and distress
Immediate physical care
Reunion with loved ones
Sharing experiences
Linking survivors with sources of support
Facilitating a sense of being in control
Identifying those who need further help
2- DEBRIEFING:

Explain the procedure to victim

Following stages:
• Facts.
• Thoughts.
• Feelings.
• Assessment.
• Education.
MANAGEMENT
• Watchful waiting(since in most cases stress reaction
will resolve with time)
• Follow-up after 1 month
• Formal psychotherapy:
Reassure patient’s condition is common and short lived
Give advice about ways dealing with such events.
• Anxiolytic drugs- if anxiety is sever
• Hypnotics- if sleep severely disturbed
• Brief trauma focused cognitive behavior therapy
 IT IS NOT THE STRESS THAT
KILLS US,
ITS OUR REACTION TO IT!
POST TRAUMATIC STRESS DISORDER
"An intense, prolonged and sometimes delayed
reaction to a stressful event."

The essential feature are:

Hyper arousal
Re experiencing aspects of event
Avoidance of reminders
STRESSORS

​NATURAL DISASTERS- Floods, famines, earthquake

​MAN-MADE CALAMITIES: Major fires, serious transport

Accident, rape, war , serious physical assaults
 CLINICAL PICTURE
1.Hyperarou​sal
• ​Persistent anxiety
• ​Irritability
• ​Insomnia
• Poor concentration

2.​Intrusions
• Intense intrusive imagery
• ​Flashbacks
• ​Recurrent distressing dreams

3.​Avoidance
• ​Detachment
• ​Difficulty in recalling events
• Avoidance of reminders of event
• Inability to feel emotions
• Diminished interest in activities
4.Other features
• Maladaptive coping responses
• Depressive symptoms
• Guilt
• Dissociative symptoms
DIAGNOSTIC CRITERIA

Symptoms begin within 6 months and present for at

least 1 month and must cause significant distress and
impaired functioning .
ETIOLOGY

1.Exeptionally Stressful Event

2.Genetic Factors
3.Predisposing Factors:
Past history of mood and anxiety disorders
Female gender
neuroticism
Lower intelligence
Lack of social support
Previous history of trauma
4.Neururo biological factors
Dysregulation of Hypothalamic Pituitary Adrenal Axis
Increased activity of noradrenaline
Brain imaging
5.Psychological factors
Fear conditioning
Cognitive theories
Psycho dynamic theories
Maintaining factors
• Negative appraisal of early symptoms
• Avoidance of reminders of trauma
• Suppression of intrusive memories
• rumination
ASSESSMENT

​Nature of symptoms

​Duration of symptoms
​Premorbid personality
​Past psychiatric symptoms
​Head injury
​Risk assessment
​Secondary complications i.e Substance abuse
DIFFERENTIAL DIAGNOSIS

​Acute stress disorder

​Adjustment disorder
​Enduring personality changes after catastrophic
experiences
​Stress-induced exacerbation of previous anxiety or
mood disorders
 TREATMENT
​COUNSELLING
​-Emotional support
​-Encourage recall of traumatic event to integrate them into the patient's
experience
​-Deal with persistent feeling of guilt
​COGNITIVE-BEHAVIORAL TREATMENT
​ Information about normal response
Self monitoring of symptoms
Exposure to situation that are being avoided
Recall of images of traumatic events
Cognitive restructuring
Anger management
EMDR( Eye movement desensitization reprocessing)
 medication
• No prolong use of benzodiazepines
• Mild Symptoms- duration less than 4 weeks – watchful
waiting
• Trauma-focused CBT
• Drugs should not be 1 st line treatment
• If pt having comorbid depressive illness , then antidepressants
as adjunctive to psychotherapy

•
• SSRI- PAROXITINE
• SNRI- VENLAFAXINE
• NASSA- MIRTAZAPINE
• TCA- AMITRIPTALINE
• MAOIs- PHENELZINE
 WHEN WE LONG FOR LIFE
WITHOUT DIFFICULTIES, REMIND
US THAT OAKS GROW STRONG IN
CONTARY WINDS AND DIAMONDS
ARE MADE UNDER PRESSURE.
(Peter Marshall)