Acute Stress Reaction
Definition
- Acute Stress Reaction (ASR) is a transient psychological response to an extreme stressor or traumatic event (e.g., accident, assault, natural disaster).
- It occurs within minutes to hours of the event and typically resolves within days to a few weeks.
If symptoms persist >1 month, it may progress to Post-Traumatic Stress Disorder (PTSD).
Causes & Risk Factors
- Exposure to a traumatic stressor triggers an acute fight-or-flight response, mediated by the hypothalamic-pituitary-adrenal (HPA) axis.
- Dysregulation of stress hormones (cortisol, adrenaline) leads to emotional, cognitive, and physical symptoms.
Common Causes of Acute Stress Reaction
|
Cause |
Examples |
|
Physical Trauma |
Accidents, Assault, Physical Abuse, Natural Disasters. |
|
Psychological Trauma |
Sudden Bereavement, Witnessing Death or Injury. |
|
Combat or Emergency Situations |
Military Combat, First Responders, Hostage Situations. |
|
Serious Illness or Diagnosis |
New Terminal Illness, Severe Injury. |
Risk Factors for Acute Stress Reaction
|
Risk Factor |
Description |
|
Previous Trauma or PTSD |
Higher Risk of Severe Reaction. |
|
Personal or Family History of Anxiety or Depression |
Pre-existing Mental Health Disorders. |
|
Lack of Social Support |
Increases Vulnerability to Psychological Distress. |
|
Neurotic Personality Traits |
Greater Emotional Reactivity to Stressors. |
🔹 Severe trauma and pre-existing mental health conditions increase the risk of ASR.
Clinical Features
♠ Symptoms of Acute Stress Reaction
|
Category |
Common Symptoms |
|
Emotional Symptoms |
Anxiety, Fear, Helplessness, Guilt, Irritability. |
|
Cognitive Symptoms |
Difficulty Concentrating, Disorientation, Intrusive Thoughts. |
|
Dissociative Symptoms |
Detachment, Emotional Numbing, Amnesia. |
|
Physical Symptoms |
Palpitations, Sweating, Hyperventilation, Tremors. |
|
Behavioural Symptoms |
Avoidance of Reminders, Restlessness, Hypervigilance. |
♠ Signs on Examination
|
Feature |
Description |
|
Agitation & Restlessness |
Hyperalertness, Increased Startle Response. |
|
Emotional Distress |
Crying, Irritability, Fearfulness. |
|
Tachycardia & Hypertension |
Autonomic Activation. |
|
Hyperventilation & Sweating |
Physical Manifestation of Anxiety. |
🔹 Dissociation, intrusive thoughts, and autonomic symptoms are hallmarks of ASR.
Referral Criteria (NICE Guidelines)
Urgent Referral (If Severe Symptoms or Risk to Self/Others)
- Suicidal Ideation or Self-Harm Risk.
- Severe Functional Impairment (Unable to Perform Daily Activities).
- Violent or Aggressive Behaviour.
Routine Referral (If Symptoms Persist >4 Weeks or Affect Functioning)
- Ongoing Flashbacks, Hypervigilance, or Emotional Numbing.
- Avoidance Behaviour Leading to Social Isolation.
- Significant Sleep Disturbances.
🔹 Persistent symptoms (>4 weeks) suggest PTSD and warrant referral for psychological support.
♠ Diagnosis
Clinical Diagnosis (Based on ICD-10/DSM-5 Criteria)
|
Criterion |
Description |
|
Exposure to Severe Stressor |
Directly Experiencing or Witnessing Trauma. |
|
Immediate Emotional Reaction |
Fear, Helplessness, or Horror. |
|
Dissociative Symptoms |
Detachment, Depersonalisation, Derealisation. |
|
Re-Experiencing Symptoms |
Flashbacks, Intrusive Thoughts, Nightmares. |
|
Hyperarousal Symptoms |
Insomnia, Irritability, Exaggerated Startle Response. |
|
Duration <4 Weeks |
If >1 Month, Consider PTSD. |
♠ Differential Diagnosis
|
Condition |
Key Differences |
|
Panic Attack |
Sudden, Short-Lived (Minutes to Hours), No Trauma Preceding. |
|
Post-Traumatic Stress Disorder (PTSD) |
Symptoms Persist >1 Month, Flashbacks & Hyperarousal. |
|
Generalised Anxiety Disorder (GAD) |
Chronic Worry, No Specific Triggering Event. |
|
Depression |
Low Mood & Anhedonia Without Acute Hyperarousal. |
🔹 Diagnosis is clinical; PTSD should be considered if symptoms persist.
Management (NICE Guidelines)
Immediate Psychological First Aid (First-Line Management)
|
Intervention |
Details |
|
Calm & Supportive Environment |
Reduce Sensory Overload, Offer Reassurance. |
|
Encourage Social Support |
Friends, Family, Community Networks. |
|
Grounding Techniques |
Breathing Exercises, Reorienting to Present. |
|
Psychoeducation |
Explain Normal Stress Reactions & Coping Strategies. |
Short-Term Symptom Management (If Needed)
|
Symptom |
Management |
|
Insomnia |
Short-Term Zopiclone or Promethazine (Avoid Benzodiazepines). |
|
Anxiety & Hyperarousal |
Beta-Blockers (Propranolol) for Autonomic Symptoms. |
|
Emotional Distress |
Short-Term Psychological Support (CBT If Persistent). |
When to Consider Psychological Therapy
- If Symptoms Persist >4 Weeks (Risk of PTSD).
- If Symptoms Are Severe or Affecting Daily Life.
🔹 Most cases resolve with psychological support; medications should be avoided unless symptoms are severe.
Prognosis & Complications
Prognosis
|
Condition |
Outcome |
|
Mild ASR (Most Cases) |
Resolves Within Days to Weeks. |
|
Severe ASR |
Higher Risk of PTSD. |
Complications of Untreated Acute Stress Reaction
|
Complication |
Features |
|
Post-Traumatic Stress Disorder (PTSD) |
Persistent Flashbacks, Avoidance, Hyperarousal (>1 Month). |
|
Depression |
Chronic Low Mood, Social Withdrawal. |
|
Substance Abuse |
Self-Medication with Alcohol or Drugs. |
🔹 Early psychological intervention reduces the risk of PTSD.
∴ UKMLA Key Points
Best initial management:
Psychological First Aid (Supportive Environment, Reassurance).
Best long-term management for persistent symptoms:
Cognitive Behavioural Therapy (CBT).
When to suspect PTSD:
Symptoms >1 Month, Flashbacks, Avoidance, Hyperarousal.
When to refer urgently:
Suicidal Ideation, Violent Behaviour, Severe Functional Impairment.
Best pharmacological option (if needed):
Beta-Blockers for Autonomic Symptoms, Avoid Benzodiazepines.