Acute stress and post-traumatic stress disorder arise in response to stressful events. The patient should have experienced the event as life threatening or as a physical threat to themselves or others, at which time they felt fear and helplessness.
Diagnostic Criteria
Symptoms associated with both of these conditions include:
- Re-experiencing of the event, e.g. flashbacks, dreams
- Avoidance of situations associated with the event
- Features of anxiety or increased arousal, e.g. hyper vigilance, heightened startle response and insomnia
The conditions are symptomatically similar but differ with regard to the duration and time of onset of symptoms. The symptoms of acute stress disorder arise within 4 weeks of the event and last up to 4 weeks, whereas the symptoms post-traumatic stress disorder last longer than 4 weeks, and may arise more than 4 weeks after the traumatic incident.
Non-Pharmacological Treatment
- Reassurance and support of patient and family
- Psychotherapy, supportive/cognitive-behavioural therapy
Pharmacological Treatment
Acute stress disorder:
For acute anxiety or agitation give:
D: Clonazepam 0.5–2 mg (PO) in divided doses
Note: Prolonged use of benzodiazepines > 1 week may be detrimental to adaptation, leading to higher rates of post-traumatic stress disorder
Post-traumatic stress-disorder:
A: Amitriptyline (PO) initially 50–75 mg daily at night, increase gradually to a maximum of 150 mg daily. Elderly: Initially 25- 50 mg. Max. 75mg.
OR
S: Fluoxetine, (PO), initial dose 20 mg in the morning (If there is no or partial response after 4–8 weeks, increase dose to 40 mg, if well tolerated)
OR
D: Citalopram, (PO), initial dose 20 mg daily. (If there is no or partial response after 4–8 weeks, increase dose to 40 mg, if well tolerated)
Note: An adequate antidepressant trial of treatment is 8–12 weeks, before an alternative treatment should be considered.
Referral
Refer to the next level in the following situations:
- Inadequate response to treatment
- Co-morbid conditions