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Query: UMLS:C0848237 (acute stress)
 4,619 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The diagnosis of acute stress disorder (ASD) was introduced to describe initial trauma reactions that predict chronic posttraumatic stress disorder (PTSD). This review outlines and critiques the rationales underpinning the ASD diagnosis and highlights conceptual and empirical problems inherent in this diagnosis. The authors conclude that there is little justification for the ASD diagnosis in its present form. The evidence for and against the current emphasis on peritraumatic dissociation is discussed, and the range of biological and cognitive mechanisms that potentially mediate acute trauma response are reviewed. The available evidence indicates that alternative means of conceptualizing acute trauma reactions and identifying acutely traumatized people who are at risk of developing PTSD need to be considered.
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PMID:Acute stress disorder: a synthesis and critique. 1240 36

Increasing scientific evidence point to a non-pharmacological complementary treatment for insomnia: white noise. Its presentation has been shown to induce sleep in human neonates and adults, probably by reducing the signal-to-noise ratio of ambient sound. White noise may be a simple, safe, cost-effective alternative to hypnotic medication in many psychiatric disorders, especially acute stress disorder and PTSD.
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PMID:Evidence based complementary intervention for insomnia. 1242 83

An understanding of PTSD and stress-related conditions is in its infancy. This is not surprising given the fact PTSD was not recognized as a distinct diagnostic entity until 1980. Since that time, the diagnostic classification has undergone continuous change as our understanding of PTSD is refined. The authors believe that PTSD can be best understood through a dimensional conceptualization viewed along at least three spectra: (1) symptom severity, (2) the nature of the stressor, and (3) responses to trauma. Along the severity spectrum, studies that review diagnostic thresholds reveal significant prevalence of PTSD symptoms and impairment that results from subthreshold conditions. Comorbidity patterns suggest that when PTSD is associated with other psychiatric illness, diagnosis is more difficult and the overall severity of PTSD is considerably greater. With regard to a stressor criteria spectrum, the diagnostic nomenclature initially only recognized severe forms of trauma personally experienced. More recently, however, the person's subjective response and events occurring to loved ones were included. This has greatly broadened the stressor criteria by leading to an appreciation of the range of precipitating stressors and the potential impact of "low-magnitude" events. Given that responses to trauma vary considerably, another possible spectrum includes trauma-related conditions. Traumatic grief, somatization, acute stress disorder and dissociation, personality disorders, depressive disorders, and other anxiety disorders all have significant associations with PTSD. Further research is needed to clarify and expand the current understanding of PTSD and other trauma-related conditions. Consideration of the severity of symptoms and the range of stressors coupled with the various disorders precipitated by trauma should greatly influence scientific research. The future undoubtedly will bring a refinement of the current understanding of PTSD and improved treatments.
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PMID:Rationale for a posttraumatic stress spectrum disorder. 1246 60

The clinician manages trauma patients in the emergency room, operation theatre, intensive care unit and trauma ward with an endeavour to provide best possible treatment for physical injuries. At the same time, it is equally important to give adequate attention to behavioural and psychological aspects associated with the event. Knowledge of the predisposing factors and their management helps the clinician to prevent or manage these psychological problems. Various causes of psychological disturbances in trauma patients have been highlighted. These include pain, the sudden and unexpected nature of events and the procedures and interventions necessary to resuscitate and stabilise the patient. The ICU and trauma ward environment, sleep and sensory deprivation, impact of injury on CNS, medications and associated pre-morbid conditions are also significant factors. Specific problems that concern the traumatised patients are helplessness, humiliation, threat to body image and mental symptoms. The patients react to these stressors by various defence mechanisms like conservation withdrawal, denial, regression, anger, anxiety and depression. Some of them develop delirium or even more severe problems like acute stress disorder or post-traumatic stress disorder. Physical, pharmacological or psychological interventions can be performed to prevent or minimise these problems in trauma patients. These include adequate pain relief, prevention of sensory and sleep deprivation, providing familiar surroundings, careful explanations and reassurance to the patient, psychotherapy and pharmacological treatment whenever required.
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PMID:Psychological care in trauma patients. 1253 72

The pharmacotherapy of burn care has evolved from the first topical antibiotics instituted > 30 years ago. These have helped greatly to reduce the incidence of burn wound sepsis, but a better understanding of the principles of burn care has resulted in earlier burn wound excision and complete coverage with autograft, cadaver skin, synthetic dressings, and amnion. This has markedly reduced septic complications and ameliorated the hypermetabolic response to burn injury. The hypermetabolic response, which is mediated by hugely increased levels of circulating catecholamines, prostaglandins, glucagon and cortisol, causes profound skeletal muscle catabolism, immune deficiency, peripheral lipolysis, reduced bone mineralisation, reduced linear growth, and increased energy expenditure. Supportive therapy and pharmacological manipulation, acutely and during rehabilitation, with growth hormone, insulin and related proteins, oxandrolone and propranolol can ameliorate the hypermetabolic response, improving survival and long-term outcome. Despite judicious use of topical and systemic antibiotics, opportunistic nosocomial bacterial resistance threatens to annul the improved survival of patients with severe burns. Patterns of emerging resistance encountered in burn units need to be considered, in light of a decreasing antibiotic armamentarium. A holistic approach to pharmacotherapy of severely burned patients including current practice in antimicrobial control, analgesia, sedation, and anxiety management is required. Current therapy of frequently encountered problems, such as post-burn pruritus, prophylaxis of deep venous thrombosis and peptic ulceration, and pharmacological manipulation of inhalation injury in the burned patient is described. Current pharmacotherapy to ameliorate psychosocial problems associated with burns such as acute stress disorder, depression and post traumatic stress disorder are discussed. Better analgesics, newer antibiotics and immune stimulating drugs are required to reduce mortality and morbidity in large burns.
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PMID:Current pharmacotherapy for the treatment of severe burns. 1261 89

The aim of this study was to index the long-term benefits of early provision of cognitive behavior therapy to trauma survivors with acute stress disorder. Civilian trauma survivors (n = 80) with acute stress disorder were randomly allocated to either cognitive behavior therapy (CBT) or supportive counseling (SC) - 69 completed treatment, and 41 were assessed four years post-treatment for post-traumatic stress disorder (PTSD) with the Clinician Administered PTSD Scale. Two CBT patients (8%) and four SC patients (25%) met PTSD criteria at four-year follow-up. Patients who received CBT reported less intense PTSD symptoms, and particularly less frequent and less avoidance symptoms, than patients who received SC. These findings suggest that early provision of CBT in the initial month after trauma has long-term benefits for people who are at risk of developing PTSD.
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PMID:Cognitive behaviour therapy of acute stress disorder: a four-year follow-up. 1264 70

The purpose of this article is to provide an overview of the acute stress response with additional information on post-traumatic stress. There is an emphasis on the theoretical foundations and post-traumatic stress disorder symptoms. Risk factors, symptom clusters, and the diagnostic criteria for post-traumatic stress disorder are described as a foundation for clinical implications and a focused nursing assessment.
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PMID:Overview of post-traumatic stress. 1268 60

Many psychiatric disorders, including depression, post-traumatic stress disorder and other anxiety disorders, result from an interaction between genetic factors and exposure to a sufficiently sensitizing environmental stressor. The inbred Wistar Kyoto (WKY) rat strain has been proposed as a model of stress vulnerability, exhibiting an exaggerated hypothalamic-pituitary-adrenal (HPA) response to stress and susceptibility to gastric ulceration. Previously, we showed that stress-activation of the brain noradrenergic system was deficient in WKY rats, and they lacked noradrenergic facilitation of the HPA response in the lateral bed nucleus of the stria terminalis (BSTL), compared to outbred Sprague-Dawley (SD) controls. Deficient modulatory function of the noradrenergic system may contribute to the stress susceptibility of WKY rats. Thus, we investigated the influence of a sensitizing stimulus, chronic intermittent cold exposure, on neuroendocrine and noradrenergic stress reactivity, and on noradrenergic facilitation of the HPA response in these two strains. Chronic cold exposure (7 days, 4 h/day, 4 degrees C) potentiated activation of the HPA axis by acute immobilization stress, assessed by measuring plasma adrenocorticotropic hormone (ACTH), in both strains, although to a greater extent in WKY rats, and enhanced stress-induced norepinephrine (NE) release in BSTL of WKY but not SD rats. We then compared the influence of chronic cold exposure on noradrenergic modulation of the HPA stress response in BSTL, by measuring changes in acute stress-induced elevation of plasma ACTH after microinjecting the alpha(1)-adrenoreceptor antagonist benoxathian into the BSTL. As shown previously, benoxathian attenuated stress-induced ACTH secretion in control SD but not control WKY rats. After chronic cold, the ACTH response to acute stress was attenuated by benoxathian administration into BSTL of both strains, such that the WKY response was not different from that of SD rats. Thus, chronic cold not only sensitized the release of NE in BSTL of WKY rats, but also restored noradrenergic facilitation of their already-elevated HPA response. Such functional sensitization of a previously-deficient facilitatory system may be one mechanism whereby exposure to repeated or severe stress may induce pathologic dysregulation of the stress response in susceptible individuals, resulting in psychiatric illness.
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PMID:Chronic cold stress sensitizes brain noradrenergic reactivity and noradrenergic facilitation of the HPA stress response in Wistar Kyoto rats. 1269 37

The benefits of providing early intervention for people recently exposed to trauma have highlighted the need to develop means to identify people who will develop chronic posttraumatic stress disorder (PTSD). This review provides an overview of prospective studies that have indexed the acute reactions to trauma that are predictive of chronic posttraumatic stress disorder. Ten studies of the predictive power of the acute stress disorder diagnosis indicate that this diagnosis does not have adequate predictive power. There is no convergence across studies on any constellation of acute symptoms that predict posttraumatic stress disorder. A review of biological and cognitive mechanisms occurring in the acute posttraumatic phase suggests that these factors may provide more accurate means of predicting chronic posttraumatic stress disorder. Recommendations for future research to facilitate identification of key markers of acutely traumatized people who will develop posttraumatic stress disorder are discussed.
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PMID:Early predictors of posttraumatic stress disorder. 1272 71

There is little empirical support for the diagnosis of acute stress disorder (ASD) in children and adolescents. Most reports treat ASD as "provisional posttraumatic stress disorder (PTSD)" (meaning that children evidence ASD on the way to a formal diagnosis of PTSD), while speculating on factors that might moderate or mediate the transformation of ASD into PTSD. This report briefly reviews the literature on ASD in the context of presenting a testable, multivariate model for understanding acute stress responses in youth.
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PMID:Acute stress disorder in youth: a multivariate prediction model. 1272 73


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