Abnormal Stress Disorders

Important Clinical Evaluation

Diagnosis of ASD and PTSD is based on a history of exposure to severely frightening and horrifying trauma followed by reexperiencing, emotional numbing, and hyperarousal. These symptoms must be severe enough to cause social impairment or distress.
Symptoms lasting ≥ 3 days and < 1 month are considered ASD. Symptoms lasting > 1 month are considered PTSD, which can be a continuation of ASD or may manifest up to 6 months after the trauma.
Patients must have a number of manifestations in different symptom areas; specific criteria for ASD and PTSD in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) differ slightly.

A. Exposed to a traumatic
B. Dissociative symptoms:

Derealisation, Depersonalisation
Amnesia
C. The event is persistently reexperienced in the following ways:
Recurrent images, thoughts, dreams, illusions, flashback episodes
D. Marked avoidance of stimuli that arouse recollections of the trauma
E. Marked symptoms of anxiety of increased arousal
(e.g., difficulty sleeping, irritability, poor concentration, hypervigilance, exaggerated startle response, and motor restlessness)
F. Impairment in social, occupational, or other important areas of functioning.
G. The disturbance lasts for a minimum of 2 days and a maximum of 4 weeks and occurs within 4 weeks of the traumatic event. z H. Not due to the direct physiological effects of a substance.

A. Trauma event in which the following were present:

B. The traumatic event is reexperienced in one of the following ways:

Recurrent images, thoughts, or perceptions.
Recurrent distressing dreams of the event.
Acting or feeling as if the traumatic event were recurring flashback
Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event

C. Persistent avoidance of stimuli associated with the trauma.

D. Persistent symptoms of increased arousal (not present before).

E. Duration is more than 1 month. Z

F. Significant distress or impairment in social, or other important areas of functioning.

A. Emotional or behavioral symptoms in

B. These symptoms or behaviors are clinically significant as evidenced by:

C. The symptoms do not represent bereavement; grief.Z

D. Once the stressor has terminated

the symptoms do not persist for more than an additional 6 months.
Specify if:
- Acute: less than 6 months
- Chronic: for 6 months or longer
  - The specific stressor(s) can be specified on Axis IV
  - With depressed mood, anxiety, mixed or with disturbance of conduct

Cognitive Behavioral Therapy (CBT). Doctors usually recommend CBT as the first-line treatment for people with ASD. CBT involves working with a trained mental health professional to develop effective coping strategies.
Mindfulness-based interventions teach techniques for managing stress and anxiety. These can include meditation and breathing exercises.
Medications.
- Anti-depressants
  - SSRI e.g. Escitalopram 10 mg a day for 6 months
- Avoid benzodiazepines (given in alcohol withdrawl symptoms, convulsions,)
- Benzodiazepines for a very short period
- Anti-psychotics small dose as sedative
- Beta blockers e.g.: Propranolol (sideeffects; orthostatic hypotension)