Stress disorders

Acute stress disorder (ASD) and post-traumatic stress disorder (PTSD): They follow a highly stressful or traumatic event like war, serious car accident, armed robbery, natural catastrophe etc. experienced either by oneself or close friend/family member, which is followed by symptoms as follows:

i) Intrusion symptoms where the patient re-experiences the traumatic event like recurring dreams, flashbacks, intense or prolonged distress or marked physiological reactions in response to events that remind the patient of their past experience

ii) Negative mood as in the inability to experience happiness, satisfaction, or loving feelings

iii) Actively tries to avoid situations, thoughts or places etc. that remind them of the past experience

iv) Arousal symptoms like disturbed sleep, hypervigilance, exaggerated startle response and problems with concentration.

iv) Results in clinically significant distress, 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: It 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, interferes with social and/or occupational functioning, symptoms do not persist > 6 months after the stressor has ended, may manifest as anxiety, mood changes like 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 the risk of dependence/addiction potential.