By HANI RAOUL KHOUZAM, MD, MPH
VA Central California Health Care Center, Fresno
University of California, San Francisco |
March 1, 2009
Dr Khouzam is medical director, chemical dependency treatment program, Veterans Affairs Central California Health Care System, Fresno. He is also clinical professor of psychiatry, University of California, San Francisco, Medical School Fresno Medical Education Program.
Acute stress disorder. Patients with acute stress disorder experienced a traumatic event in which they were threatened or seriously injured, or they witnessed a traumatic event in which other persons were seriously injured or died. During the traumatic event, they responded with intense fear and helplessness.1,11
The condition is usually associated with dissociative symptoms, such as numbing, detachment, a reduction in awareness of the surroundings, derealization, or depersonalization; re-experiencing of the trauma; avoidance of associated stimuli; and significant anxiety, including irritability, poor concentration, difficulty in sleeping, and restlessness.11 The diagnosis of acute stress disorder is made when the symptoms occur within 4 weeks of the traumatic event and are present for a minimum of 2 days and a maximum of 4 weeks.11 The disorder may resolve with prompt intervention or with the passage of time; however, in some patients, acute stress disorder may progress into a more severe psychiatric condition, such as posttraumatic stress disorder.1,11
Posttraumatic stress disorder. This disorder develops after a person experiences, witnesses, or confronts a physically and/or psychologically distressing event. The event may involve actual or threatened death or serious injury or a threat to the physical integrity of oneself or others.11 Symptoms of posttraumatic stress disorder include re-experiencing the traumatic event, a consistent pattern of avoidance of themes associated with the traumatic event, and hyperarousal and autonomic hyperactivities that may be manifested by difficulties with sleep or concentration, exaggerated startle reactions and, at times, anger outbursts.11,17 The diagnosis is made if the symptoms have been present for at least 1 month and cause clinically significant distress or impairment in functioning.11,17
Acknowledgments: The author thanks the VA Medical Center director, Mr Alan Perry, FACHE, for his administrative support; Drs Robert Hierholzer, Nestor Manzano, Scott Ahles, and Craig C. Campbell, for their clinical guidance; Dr Avak A. Howsepian for his constructive criticism; Matthew Battista, PhD, Thomas Williams, MSW, and Leonard Williams, PA, for their encouragement; and Ms Emma Nichols for her computer assistance.
Part 2 of this article:
Anxiety Disorders: Guidelines for Effective Primary Care, Part 2, Treatment
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