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

In the acute aftermath of exposure to extreme stress, nearly all trauma survivors experience one or more transient symptoms of stress. In the short run, these symptoms may serve an adaptive role and generally remit; in some cases, however, acute stress-related symptoms do not diminish and instead evolve into posttraumatic stress disorder (PTSD). At present it is not clear when and with whom to intervene. On one hand, it is possible that some responses, such as early intrusive memories, effectively recruit support from others and facilitate the psychological processing of trauma; on the other hand, failing to intervene clinically with a recently traumatized individual may permit the subsequent development of PTSD. In this review, we focus on potential pharmacologic interventions aimed at treating early symptoms of extreme arousal or dissociation with the hope of possibly preventing PTSD. To date there is almost no empirical data on effective pharmacologic interventions in the immediate aftermath of extreme psychological trauma. As a result, much of what is discussed in this review is speculative in nature
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PMID:Toward early pharmacological posttraumatic stress intervention. 1272 76

Research seeking to establish the relationship between sleep and posttraumatic stress disorder (PTSD) is in its infancy. An empirically supported theory of the relationship is yet to emerge. The aims of the present paper are threefold: to summarise the literature on the prevalence and treatment of sleep disturbance characteristic of acute stress disorder (ASD) and PTSD, to critically review this literature, and to draw together the disparate theoretical perspectives that have been proposed to account for the empirical findings. After a brief overview of normal human sleep, the literature specifying the relation between sleep disturbance and PTSD is summarized. This includes studies of the prevalence of sleep disturbance and nightmares, content of nightmares, abnormalities in rapid eye movement (REM) sleep, arousal threshold during sleep, body movement during sleep, and breathing-related sleep disorders. In addition, studies of the treatment of sleep disturbance in individuals with PTSD are reviewed. We conclude that the role of sleep in PTSD is complex, but that it is an important area for further elucidating the nature and treatment of PTSD. Areas for future research are specified. In particular, a priority is to improve the methodology of the research conducted.
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PMID:Sleep and posttraumatic stress disorder: a review. 1272 78

Although there has been a marked increase in research on psychological disorders following physical injury in recent years, there are many discrepancies between the reported findings. This paper reviews the prevalence outcomes of recent studies of the mental health sequelae of physical injury with a focus on posttraumatic stress disorder (PTSD), acute stress disorder (ASD), and depression. The review critically outlines some of the methodological factors that may have contributed to these discrepancies. The phenomenological overlap between organic and psychogenic symptoms, the use of narcotic analgesia, the role of brain injury, the timing and content of assessments, and litigation are discussed in terms of their potential to confound findings with this population. Recommendations are proposed to clarify methodological approaches in this area. It is suggested that a clearer understanding of the psychological effects of physical injury will require the widespread adoption of more rigorous, standardized and transparent methodological procedures.
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PMID:Posttraumatic disorders following injury: an empirical and methodological review. 1278 11

This report presents 2 patients who were diagnosed to have acute stress disorder (ASD), received early psychiatric intervention (crisis intervention as a short-term psychotherapy), and subsequently had good outcome. Encounter with an event that causes psychological trauma may induce post-traumatic stress disorder (PTSD). However, the 2 patients described here have shown no particular mental symptoms for more than 2 years after the event and are leading normal lives. Psychological debriefing as a group used to be regarded as effective for the prevention of PTSD, but early identification of the stress-related disorder and intensive treatment of individual patients is recently considered to be more necessary. Both of the 2 patients presented here showed good outcome, and early crisis intervention in individual patients is suggested to be effective for the treatment of stress-related disorders and prevention of PTSD.
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PMID:Early crisis intervention to patients with acute stress disorder in general hospital. 1288 Mar 1

Numerous epidemiological studies report increased prevalence rates for women as compared to men for stress-related disorders such as acute stress disorder, post-traumatic stress disorder, and major depressive disorder. Stress disorders disrupt work and home life and pose a high risk for suicide. Multiple factors contribute to the increased vulnerability in women. Physiological differences account for some of the differential. Other factors that make a significant contribution to the overall risk for health problems in response to stressors or trauma include the nature and meaning of the trauma, accessibility of resources, and restrictive diagnostic categories. Increasing our knowledge of the individual impact of each factor as well as the interactions among the factors is central to understanding the development of stress disorders. Comprehensive sex- and gender-sensitive middle-range theory, which explores the role of key factors identified in qualitative and quantitative research, is required. The authors discuss structural equation modelling as one method of theory testing.
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PMID:Stress disorders and gender: implications for theory and research. 1290 96

Trauma is prevalent in the lives of children. It derives from many sources, and, depending on its characteristics, can produce transient or enduring and devastating consequences. Early trauma, if left untreated, can set the stage for chronic deficits in the behavioral repertoires of affected children, and thus shape personality development. Additionally, when trauma is repetitive and chronic, the developing brain may be affected in ways that impede otherwise effective intervention. Yet diagnosing traumatic stress in children requires a departure from exclusively adult-like considerations and attention must be devoted to the ongoing developmental processes. Trauma-associated clinical features in children are sharply distinct from those that are associated with adult traumatization and must be taken into account from screening and diagnosis through treatment and outcome evaluation. We suggest that a learning foundation for symptom development will best assist the identification and selection of efficacious treatments. Pediatricians should make use of validated screening procedures that effectively identify affected children to facilitate timely referral and ongoing monitoring of treatment outcomes for their patients. A representative list of such instruments can be found in Table 1. With respect to hospital-based trauma work, we suggest the following recommendations: Professionals must be alert to the presence of acute stress symptoms in any child or parent after all injury incidents. These symptoms may occur in any injured child regardless of age, gender, injury severity, mechanism of injury, or length of time since injury. Certain mechanisms of injury, (ie, pedestrian versus motor vehicle collision), place the parent at higher risk for symptomatology. All family members, including parents and siblings, must be considered at risk for acute and long-term functional abnormalities. It is important to educate patients and family members that acute stress symptoms are common after an injury incident and are likely to resolve as the patient's injuries heal. Yet despite this, before discharge from the hospital, parents must be taught to evaluate their traumatized child's behavior, as well as their own, for any evidence of posttraumatic stress disorder. Health care providers must anticipate potential strain upon family relationships and financial resources. Parent's posttraumatic stress symptoms may result in deterioration of their own ability to support their injured child. And finally, reassessment of patient and family members should occur within the first days, at 1 to 2 weeks, 6 months, and 1 year following injury to ensure proper recovery and optimization of psychosocial function.
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PMID:Behavioral aspects of trauma in children and youth. 1296

This study examined the prevalence of peritraumatic and persistent panic symptoms following trauma. Survivors of civilian trauma (n=30) with either acute stress disorder (ASD) or no acute stress disorder (non-ASD) were administered the Panic Module of the Structured Clinical Interview for DSM-IV (SCID). Participants also completed the Impact of Event Scale, Acute Stress Disorder Scale, Beck Depression Inventory, Beck Anxiety Inventory, and the Anxiety Sensitivity Index. Panic attacks were experienced by 77% of participants during their trauma, and 47% reported recurrent panic attacks post-trauma. ASD participants demonstrated more panic symptoms during and after their trauma than non-ASD participants. Posttraumatic panic was most strongly associated with anxiety sensitivity. These findings are discussed in terms of cognitive factors that may mediate posttrauma panic and treatment implications for managing posttraumatic anxiety. There is increasing evidence that panic attacks play a role in psychopathological response to trauma. A significant proportion of people with panic disorder report a history of trauma (). Moreover, two-thirds of trauma survivors report panic attacks within the previous 2 weeks (). There is also evidence that people with posttraumatic stress disorder (PTSD) display elevated levels of anxiety sensitivity (). Recent attention has focused on acute panic reactions because of proposals that panic during trauma may condition trauma-related cues to subsequent panic (). There is evidence that panic attacks occur in 53-90% of trauma survivors during the traumatic experience (). Further, people with acute stress disorder (ASD) are more likely to report peritraumatic panic attacks than non-ASD individuals. ASD is a useful framework in which to investigate the role of panic in posttraumatic stress because ASD describes acute responses to trauma that are strongly predictive of chronic PTSD (). This study investigated the relationship between peritraumatic panic and ongoing panic attacks following trauma. Specifically, we indexed panic attacks during trauma and subsequent to trauma in trauma survivors with and without ASD. We also indexed the extent to which distorted interpretations about somatic sensations may be associated with panic attacks following trauma. We considered that the strong evidence that maladaptive appraisals of somatic sensations mediate panic () is directly relevant to posttraumatic panic. We hypothesized that ASD participants would report more peritraumatic and persistent panic than non-ASD participants, and that this panic would be associated with dysfunctional interpretations about somatic stimuli.
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PMID:Peritraumatic and persistent panic attacks in acute stress disorder. 1297 43

This study investigated the role of acute arousal in the development of posttraumatic stress disorder (PTSD). Hospitalized motor vehicle accident survivors (n = 146) were assessed for acute stress disorder (ASD) within 1 month of the trauma, 6 months later, and reassessed for PTSD 2 years posttrauma (n = 87). Heart rates (HR) were assessed on the day of hospital discharge. Participants who had PTSD 2 years posttrauma had higher HR at hospital discharge than those without PTSD. A diagnosis of ASD or a resting HR of 95 beats per minute had moderate sensitivity (74%) and specificity (91%) in predicting PTSD. These findings suggest that caution is required in using acute HR as a predictor of longer-term PTSD following trauma.
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PMID:Acute psychophysiological arousal and posttraumatic stress disorder: a two-year prospective study. 1458 27

Although there is converging evidence that posttraumatic stress disorder (PTSD) is associated with higher levels of hypnotizability, there are no studies concerning the stability of hypnotizability levels following trauma. Acutely traumatized participants with acute stress disorder (N = 45) were administered the Stanford Hypnotic Clinical Scale (SHCS) within 4 weeks of their trauma. Participants were subsequently administered a brief cognitive-behavior therapy program. Six months after treatment, participants were re-assessed with the SHCS. Although SHCS scores were generally stable (r = .47), two thirds of participants responded differently across the 2 assessments. Increased SHCS scores at the second assessment were correlated with elevated PTSD avoidance scores. This finding suggests that elevated hypnotizability in PTSD populations may not be entirely stable and may be associated with specific PTSD responses.
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PMID:Hypnotizability and posttraumatic stress disorder: a prospective study. 1459 86

Anxiety is a heterogeneous term encompassing not only state or trait characteristics but also a wide range of pathologies such as generalized anxiety disorders, phobias, panic and obsessive-compulsive disorders, acute stress disorder, and posttraumatic stress disorder. Given that diverse forms of anxiety exist, numerous animal models have been developed, which are considered to be useful in identifying mechanisms underlying anxiety states. Examples of such animal models include paradigms that assess the behavioral response to neurogenic (or painful stimuli) or psychogenic stressors or to cues that had previously been associated with painful stimuli. The present report presents data regarding the impact of stressors on corticotropin-releasing hormone (CRH), and relates these to changes in anxiety-like states. Specifically, we demonstrate that (1) psychogenic stressors influence the in vivo release of CRH at the central nucleus of the amygdala (CeA); (2) although CRH changes within the CeA are exquisitely sensitive to stressors, they are also elicited by positive stimuli; and (3) while treatment with diazepam attenuates behavioral signs of anxiety, the CRH release associated with a stressor is unaffected by the treatment. The position is offered that although release of CRH within the CeA is increased under stressful conditions, it is not a necessary condition for the consequent behavioral expression of anxiety-like reactions, at least not in minimally threatening situations. We suggest that the CRH responses at the CeA may be involved in a preparatory capacity and, as such, may accompany a range of emotionally significant stimuli, be they appetitive or aversive.
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PMID:Differential involvement of amygdaloid CRH system(s) in the salience and valence of the stimuli. 1465 75


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