Acute Stress Reaction

An Acute Stress Reaction (ASR) is the experience of symptoms after a particularly stressful event. These symptoms are usually very severe and occur after an unexpected life crisis (last 2-3 days). Examples of these crises include a serious accident, sudden bereavement, sexual assault, terrorist incidents, major disasters, and war.

It presents with:

• Psychological – Anxiety, Low mood, Irritability, Mood swings, Poor sleep, Poor concentration, Desire to be alone

• Recurrent dreams or flashbacks

• Avoidance of anything that triggers memories e.g. people, conversations

• Reckless/aggressive behaviours

• Emotional numbness and Detachment

• Physical – Palpitations, Chest pain, Headache, Nausea, Abdominal pain, Dyspnoea

It's managed without any active treatment as symptoms usually resolve once the stressful event is over.

It becomes an Acute Stress Disorder if the symptoms last between 3 days to 1 month. It's managed with:

• CBT (often the treatment of choice)

• Counselling – Processing of trauma - Not often done soon after incident as it can make things worse

• Medication – B-blockers PRN for symptomatic relief

If the patient is refractory to all management options, they should be assessed for PTSD.

Adjustment Disorder

This is a prolonged severe abnormal response to stress within 1 month of a stressful life event, and it can last up to 6 months. The key difference between it and an ASR is that an ASR follows an extremely stressful event, whereas adjustment disorder follows a less stressful event.

It presents with:

• Anxiety – Irritability, Increased arousal, Insomnia

• Depression – Tearfulness, Low mood, but usually w/o any biological features, such as decreased sleep or appetite