Which of the following is the main difference between PTSD and acute stress disorder Mcq?

Last updated: October 20, 2022

Summary

Overview

References:[1]

Acute stress disorder

Overview

Definition

• The development of a strong psychological reaction to a traumatic event characterized by acute symptom onset and the persistence of symptoms for at least 3 days and up to 1 month

Epidemiology [1]

Risk factors [1]

Diagnostic criteria (DSM-5) [1]

• Exposure to death (actual or threatened), serious injury, or sexual violence that occurs in ≥ 1 of the following ways:
• Presence of at least 9 of the following symptoms from any of the five categories below:
  • Intrusion
    • Recurrent distressing memories
    • Recurrent distressing dreams
    • Flashbacks
    • Severe psychological distress or physiological responses to internal or external cues related to the event
  • Negative mood: inability to feel positive emotions (e.g., happiness, satisfaction, or love)
  • Dissociation
    • Altered sense of reality
    • Loss of memory with regards to important details of the event
  • Avoidance
    • Avoidance of memories, thoughts, or feelings related to the event
    • Avoidance of external reminders (e.g., places, people, conversations, objects) related to the event
  • Arousal
    • Sleep disturbance
    • Irritable behavior
    • Hypervigilance
    • Poor concentration
    • Heightened startle reflex
• Duration: Symptoms last from 3 days to 1 month following the traumatic event.
• The affected individual has been experiencing significant distress or impaired social and/or occupational functioning since the traumatic event.
• Symptoms are not explained by substance use or another medical condition.

Treatment and prognosis [2]

• Assess all patients with acute first- and second-hand experiences of trauma for ASD and offer psychological care.
• Determine the setting of psychiatric treatment (inpatient or outpatient) based on the severity of symptoms, the risk of self-injurious behavior and suicide, and the severity of trauma experienced or exposed to.
• Provide education about the broad range of expected reactions to traumatic situations as well as about the natural course of the disorder and treatment options available
• First-line treatment: trauma-focused cognitive behavioral therapy [2]
• Pharmacotherapy: Benzodiazepines are not routinely recommended but may be useful in patients with severe anxiety, agitation, or sleep disturbances.
• Early intervention is important to avoid progression of ASD to PTSD. [3]

Posttraumatic stress disorder (PTSD)

Overview

Definition

• A psychiatric disorder triggered by a personally experienced or witnessed traumatic event that persists for more than 1 month

Epidemiology [4]

Etiology

• Triggers: exposure to traumatic events (either through direct experience or as a witness)
  • Sexual violence (most common) [5]
  • Physical violence
  • Accidents
  • Natural disasters
  • War: The duration of combat exposure, by either combatants or civilians, is directly proportional to the risk of developing PTSD. [6]
  • Diagnosis of a severe disease
  • Witnessing the death of another person
• Risk factors
  • Psychiatric comorbidities
  • Lower socioeconomic status
  • Younger age at the time of trauma
  • Lack of social support
  • Prior traumatic exposure and/or subsequent reminders, including childhood experiences
  • Initial severe reaction to the traumatic event
• Common comorbidities: depression, substance use disorders, somatic symptom disorder

Diagnostic criteria (DSM-5) [1]

• Experience of a traumatic event involving death (actual or threatened), serious injury, or sexual violence in one or more of the following ways:
  • Direct experience of the event(s)
  • Witnessing the event(s)
  • Learning about the event(s) happening to close friends or family
  • Repeated exposure to details of the traumatic event(s) occurring to others
• One or more the following intrusion symptoms that begin after the traumatic event(s):
  • Recurrent intrusive memories of the traumatic event(s)
  • Recurrent, distressing dreams related to the traumatic event(s)
  • Dissociative reactions (e.g., flashbacks): individuals act and/or feel as if they were reexperiencing the traumatic event(s)
  • Intense and persistent distress when exposed to internal or external cues related to the traumatic event(s)
  • Physiological reactions triggered by external or internal cues associated with the traumatic event(s)
• Avoidance of stimuli related to the traumatic event(s) as expressed in one or both of the following ways:
• Negatively affected mood and cognition associated with the traumatic event(s) that begins or worsens after the event(s) in at least two of the following ways:
  • Inability to remember important details of the event(s)
  • Exaggerated negative thoughts or expectations about oneself or the world
  • Distorted cognitions regarding the cause and/or consequences of the event(s)
  • Persistent negative emotions (e.g., fear, horror, distress, guilt)
  • Reduced or absent interest in important activities
  • Detachment from others
  • Inability to experience positive emotions (e.g., happiness, satisfaction, or love)
• Altered reactivity or arousal associated with the traumatic event(s) beginning or worsening after the event(s) in at least two of the following ways:
  • Irritability or angry outbursts
  • Hypervigilance
  • Excessive startle response
  • Sleep disturbance; (e.g., nightmares, difficulty initiating or maintaining sleep)
  • Poor concentration
  • Self-destructive behavior
• Duration: Symptoms last > 1 month following the traumatic event(s).
• The affected individual has been experiencing significant distress or impaired social and/or occupational functioning.
• Symptoms are not explained by substance use or another medical condition.
• Diagnostic criteria for children > 6 years of age are the same as for adults.

To remember the features of PTSD, think of “TRAUMMA”: Traumatic event, Reexpereince, Avoidance, Unable to function, More than a Month of duration, Arousal is increased

Treatment and prognosis [7]

• First-line: psychotherapy with or without adjunctive pharmacotherapy [7]
  • Trauma-focused cognitive-behavioral therapy
  • Eye movement desensitization and reprocessing: The patient recalls traumatic images while following the therapist's fingers with their eyes from left to right. [8]
• Pharmacotherapy
  • SSRIs, SNRIs (e.g., venlafaxine)
  • Prazosin: for nightmares
  • Benzodiazepines should generally be avoided due to the risk of misuse and lack of evidence supporting the benefits.
• Approx. 60% of patients receiving treatment achieve full recovery within an average timespan of 36 months. [9][10]

Pharmacotherapy alone is used in patients with PTSD who opt against or do not have access to psychotherapy.

Diagnostic criteria for PTSD in children < 6 years of age (DSM-5) [1]

Children with PTSD may experience developmental regression.

References:[11]

Adjustment disorder

Overview

Definition

• A maladaptive emotional (e.g., anxiety) or behavioral (e.g., outburst) response to a stressor, lasting ≤ 6 months following resolution of the stressor

Epidemiology

Etiology

• A combination of intrinsic and extrinsic stressors (e.g., divorce, losing a job, academic failure, difficulties with a peer group, illness)

Diagnostic criteria (DSM-5) [1]

• Emotions or behaviors in response to a stressor that occur within 3 months of onset
• Clinically significant responses that include ≥ 1 of the following:
  • A level of distress that is disproportionate to the expected response to the stressor
  • Impaired functioning in social, occupational, and/or other important areas
• Symptoms are not explained by another mental disorder.
• Symptoms are not explained by a normal response to grief.
• Symptoms last ≤ 6 months following resolution of the stressor.

Differential diagnosis

• Normal stress reaction
• Major depressive disorder: Although some symptoms can be shared between the two conditions, the criteria for MDD are not met. (See Diagnostic criteria for major depressive disorder.)
• Generalized anxiety disorder : If symptoms of adjustment disorder last > 6 months the diagnosis is changed to GAD.

Treatment and prognosis [12]

• Psychotherapy
  • First-line treatment: cognitive-behavioral therapy or psychodynamic psychotherapy
  • May be provided as individual, family, or group support therapy
  • Interpersonal psychotherapy
• Pharmacotherapy

Although psychotherapy alone is usually sufficient in patients with adjustment disorder who have no other disabling symptoms, pharmacotherapy may be used when psychotherapy has little or no effect.

References:[1][12][13]

References

Which of the following is the main difference between PTSD and acute stress disorder?

What is the difference between PTSD and trauma and stressor related disorder?

Which of the following is a symptom of acute stress disorder and posttraumatic stress disorder?