User:Red027/Acute stress disorder

This is a sandbox page for edits to the article "Acute stress disorder".

Article Draft
Note: Bolded sections are my contributions. Other information is from the article and is there for context.

Signs and Symptoms
The DSM-IV specifies that acute stress disorder must be accompanied by the presence of dissociative symptoms, which largely differentiates it from posttraumatic stress disorder.

Dissociative symptoms include a sense of numbing or detachment from emotional reactions, a sense of physical detachment – such as seeing oneself from another perspective – decreased awareness of one's surroundings, the perception that one's environment is unreal or dreamlike, and the inability to recall critical aspects of the traumatic event (dissociative amnesia).

In addition to these characteristics, ASD can be present in the following four distinct symptom clusters;


 * Intrusion symptom cluster

Recurring and distressing dreams, flashbacks, and/or memories related to the traumatic event.

Intense/prolonged psychological distress or somatic reactions to internal or external traumatic cues.


 * Negative mood cluster

A persistent inability to experience positive emotions such as happiness, loving feelings, or satisfaction.


 * Avoidance symptom cluster

The avoidance of distressing memories, thoughts, feelings (or external reminders of them) that are closely associated with the traumatic event.


 * Arousal symptom cluster

Sleep disturbances, hyper-vigilance, difficulties with concentration, easily startled, and irritability/anger/aggression.

'''There are a number of issues that can arise from acute stress. Development of mood and substance issues can start with acute stress, as well as depression and anxiety. Untreated ASD can also lead to the development of Post-Traumatic Stress Disorder.  '''

Diagnosis
According to the DSM-V, symptom presentation must last for three consecutive days to be classified as acute stress disorder. If symptoms persist past one month, the diagnosis of PTSD is explored. There must be a clear temporal connection between the impact of an exceptional stressor and the onset of symptoms; onset is usually within a few minutes or days but may occur up to one month after the stressor. Also, the symptoms show a mixed and rapidly changing picture; although "daze" depression, anxiety, anger, despair, hyper-activity, and withdrawal may all be seen, no one symptom dominates for long. The symptoms usually resolve rapidly where removal from the stressful environment is possible. In cases where the stress continues, the symptoms usually begin to diminish after 24–48 hours and are usually minimal after about three days.

'''Evaluation of patients is done through close examination of emotional response. Using self-report from patients is a large part of diagnosing ASD, as acute stress is a result is the result of reactions to stressful situations. '''

The DSM-V specifies that there is a higher prevalence rate of ASD among females compared to males due to higher risk of experiencing traumatic events and neurobiological gender differences in stress response.

Treatment
This disorder may resolve itself with time or may develop into a more severe disorder, such as PTSD. However, results of Creamer, O'Donnell, and Pattison's (2004) study of 363 patients suggests that a diagnosis of acute stress disorder had only limited predictive validity for PTSD. Creamer et al. found that re-experiences of the traumatic event and arousal were better predictors of PTSD. Early pharmacotherapy may prevent the development of post-traumatic symptoms. Additionally, early trauma-focused cognitive behavioral therapy (TFCBT) for those with a diagnosis of ASD can protect an individual from developing chronic PTSD.

Studies have been conducted to assess the efficacy of counselling and psychotherapy for people with acute stress disorder. Cognitive behavioral therapy, which includes exposure and cognitive restructuring, was found to be effective in preventing PTSD in patients diagnosed with acute stress disorder with clinically significant results at six-month follow-up appointments. A combination of relaxation, cognitive restructuring, imaginal exposure, and in-vivo exposure was superior to supportive counselling. Mindfulness-based stress reduction programs also appear to be effective for stress management.

'''The pharmacological approach has made some progress in lessening the effects of ASD. To relax patients and allow for better sleep, Prazosin can be given to patients, which regulates their sympathetic response.'''

In a wilderness context where counselling, psychotherapy, and cognitive behavioral therapy is unlikely to be available, the treatment for acute stress reaction is very similar to the treatment of cardiogenic shock, vascular shock, and hypovolemic shock; that is, allowing the patient to lie down, providing reassurance, and removing the stimulus that prompted the reaction. In traditional shock cases, this generally means relieving injury pain or stopping blood loss. In an acute stress reaction, this may mean pulling a rescuer away from the emergency to calm down or blocking the sight of an injured friend from a patient.

History
The term "acute stress disorder" was first used to describe the symptoms of soldiers during World War I and II, and it was therefore also termed "combat stress reaction" (CSR). Approximately 20% of U.S. troops displayed symptoms of CSR during WWII. It was assumed to be a temporary response of healthy individuals to witnessing or experiencing traumatic events. Symptoms include depression, anxiety, withdrawal, confusion, paranoia, and sympathetic hyperactivity.

The APA officially included the term ASD in the DSM-IV in 1994. Before that, symptomatic individuals within the first month of trauma were diagnosed with adjustment disorder. According to the DSM-IV, acute stress reaction refers to the symptoms experienced immediately to 48-hours after exposure to a traumatic event. In contrast, acute stress disorder is defined by symptoms experienced 48-hours to one-month following the event. Symptoms experienced for longer than one month are consistent with a diagnosis of PTSD.

Initially, being able to describe different ASRs was one of the goals of introducing ASD. Some criticisms surrounding ASD's focal point include issues with ASD recognizing other distressing emotional reactions, like depression and shame. Emotional reactions similar to these may then be diagnosed as adjustment disorder under the current system of trying to diagnose ASD.

'''Since its addition to the DSM-IV, ASD has received criticism based on its purpose and criteria. The diagnosis of ASD was criticized as an unnecessary addition to the progress of diagnosing PTSD, as some considered it more akin to a sign of PTSD than an independent issue requiring diagnosis. The efficacy of the terms ASD and ASR has also been a concern, with the wide range of stress responses not fitting perfectly under these two labels.'''

'''This is a start, but I have no context for where you plan to include this contribution within your article - I would suggest bringing more of the article over to this sandbox so reviewers can see the edits you plan to make. With that, you will need to make your contributions distinct (e.g., italicize, bold, underline, etc...). What about COVID? Could individuals develop ASD as a result of stressors experienced with COVID? (LIZ)'''