Stress disorders

Acute stress disorder (ASD) and post-traumatic stress disorder (PTSD): These disorders can occur after a highly stressful or traumatic event (e.g., war, a serious car accident, armed robbery, natural catastrophe) experienced either by the person themself or by a close friend/family member. The event is followed by symptoms such as:

i) Intrusion symptoms, where the patient re-experiences the traumatic event (e.g., recurring dreams, flashbacks, intense or prolonged distress, or marked physiological reactions) in response to reminders of the trauma

ii) Negative mood, such as an inability to experience happiness, satisfaction, or loving feelings

iii) Active avoidance of situations, thoughts, places, etc. that remind them of the traumatic experience

iv) Arousal symptoms, such as disturbed sleep, hypervigilance, exaggerated startle response, and problems with concentration

iv) Clinically significant distress and impairment in social or occupational functioning

v) Depersonalization or derealization may be seen

In ASD, symptoms typically start immediately after the trauma and persist for up to 3 days to 1 month. In PTSD, symptoms may start immediately but persist for > 6 months.

Adjustment disorder: This is the development of emotional or behavioral symptoms in response to an identifiable stressor(s), occurring within 3 months of the onset of the stressor(s). It causes marked distress that is out of proportion to the severity or intensity of the stressor and interferes with social and/or occupational functioning. Symptoms do not persist > 6 months after the stressor has ended. It may manifest as anxiety, mood changes (e.g., depressed mood), or with conduct disorders.

SSRIs and SNRIs are first line drugs in the treatment of anxiety disorders. Benzodiazepines and propranolol can be used as second line agents. Benzodiazepines carry a risk of dependence/addiction potential.