Mkb 10 stress. Acute reaction to stress

19.02.2022

Reactions to severe stress are currently (according to ICD-10) divided into the following:

Acute reactions to stress;

post-traumatic stress disorder;

Adjustment Disorders;

dissociative disorders.

Acute reaction to stress

A transient disorder of significant severity that develops in individuals without apparent mental impairment in response to exceptional physical and psychological stress, and which usually resolves within hours or days. Stress can be an intense traumatic experience, including a threat to the safety or physical integrity of an individual or loved one (eg, natural disaster, accident, battle, criminal behavior, rape) or an unusually abrupt and threatening change in the patient's social position and/or environment, such as the loss of many loved ones or a fire in the house. The risk of developing the disorder increases with physical exhaustion or the presence of organic factors (for example, in elderly patients).

Symptoms show a typical mixed and changing picture and include an initial state of "dazedness" with some narrowing of the field of consciousness and reduced attention, inability to adequately respond to external stimuli, and disorientation. This state may be accompanied by either further withdrawal from the surrounding situation up to dissociative stupor or agitation and hyperactivity (flight or fugue reaction).

Autonomic signs of panic anxiety (tachycardia, sweating, redness) are often present. Typically, symptoms develop within minutes of exposure to a stressful stimulus or event and disappear within two to three days (often hours). Partial or complete dissociative amnesia may be present.

Acute reactions to stress occur in patients immediately after traumatic exposure. They are short, from several hours to 2-3 days. Autonomic disorders are usually mixed: there is an increase in heart rate and blood pressure, along with this - pallor of the skin and profuse sweat. Motor disturbances are manifested either by a sharp excitation (throwing) or inhibition. Among them, there are affective-shock reactions described at the beginning of the 20th century: hyperkinetic and hypokinetic. In the hyperkinetic variant, patients rush about non-stop, make chaotic non-purposeful movements. They do not respond to questions, especially the persuasion of others, their orientation in the environment is clearly upset. In the hypokinetic variant, patients are sharply inhibited, they do not react to the environment, do not answer questions, and are stunned. It is believed that not only a powerful negative impact plays a role in the origin of acute reactions to stress, but also the personal characteristics of the victims - advanced age or adolescence, weakness due to some somatic disease, such character traits as hypersensitivity and vulnerability.

In ICD-10, the concept post-traumatic stress disorder combines disorders that do not develop immediately after exposure to a traumatic factor (delayed) and last for weeks, and in some cases for several months. These include: periodic occurrence of acute fear (panic attacks), severe sleep disturbances, obsessive memories of a traumatic event from which the victim cannot get rid of, persistent avoidance of places and people associated with a psychotraumatic factor. This also includes the long-term persistence of a gloomy, dreary mood (but not to the level of depression) or apathy and emotional insensitivity. Often people in this state avoid communication (run wild).

Post-traumatic stress disorder is a non-psychotic delayed reaction to traumatic stress that can cause mental impairment in almost anyone.

Historical research on post-traumatic stress has evolved independently of stress research. Despite some attempts to build theoretical bridges between "stress" and post-traumatic stress, the two areas still have little in common.

Some of the famous researchers of stress, such as Lazarus, who are followers of G. Selye, mostly ignore PTSD, like other disorders, as possible consequences of stress, limiting their field of attention to research on the characteristics of emotional stress.

Research in the field of stress is experimental in nature, using special experimental designs under controlled conditions. In contrast, PTSD research is naturalistic, retrospective, and largely observational.

Criteria for post-traumatic stress disorder (according to ICD-10):

1. The patient must have been exposed to a stressful event or situation (both brief and prolonged) of an exceptionally threatening or catastrophic nature that is capable of causing distress.

2. Persistent memories or "revival" of the stressor in intrusive reminiscences, vivid memories and recurring dreams, or re-experiencing grief when exposed to situations resembling or associated with the stressor.

3. The patient must exhibit actual avoidance or avoidance of circumstances resembling or associated with the stressor.

4. Any of the two:

4.1. Psychogenic amnesia, either partial or complete, for important periods of exposure to the stressor.

4.2. Persistent symptoms of increased psychological sensitivity or excitability (not present prior to exposure to the stressor) represented by any two of the following:

4.2.1. difficulty falling asleep or staying asleep;

4.2.2. irritability or outbursts of anger;

4.2.3. difficulty concentrating;

4.2.4. increased level of wakefulness;

4.2.5. enhanced quadrigeminal reflex.

Criteria 2,3,4 occur within 6 months after a stressful situation or at the end of a stressful period.

Clinical symptoms in PTSD (according to B. Kolodzin)

1. Unmotivated vigilance.

2. "Explosive" reaction.

3. Dullness of emotions.

4. Aggressiveness.

5. Violations of memory and concentration.

6. Depression.

7. General anxiety.

8. Fits of rage.

9. Abuse of narcotic and medicinal substances.

10. Unwanted memories.

11. Hallucinatory experiences.

12. Insomnia.

13. Thoughts of suicide.

14. Survivor's Guilt.

Speaking, in particular, about adjustment disorders, one cannot but dwell in more detail on such concepts as depression and anxiety. After all, they are always accompanied by stress.

Previously dissociative disorders described as hysterical psychoses. It is understood that in this case, the experience of a traumatic situation is forced out of consciousness, but is transformed into other symptoms. The appearance of very bright psychotic symptoms and the loss of sound in the experiences of the transferred psychological impact of the negative plan mark the dissociation. The same group of experiences includes conditions previously described as hysterical paralysis, hysterical blindness, and deafness.

The secondary benefit for patients of manifestations of dissociative disorders is emphasized, that is, they also arise according to the mechanism of flight into the disease, when psychotraumatic circumstances are unbearable, superstrong for the fragile nervous system. A common feature of dissociative disorders is their tendency to recur.

Distinguish the following forms of dissociative disorders:

1. Dissociative amnesia. The patient forgets about the traumatic situation, avoids places and people associated with it, a reminder of the trauma meets violent resistance.

2. Dissociative stupor, often accompanied by loss of pain sensitivity.

3. Puerilism. Patients in response to psychotrauma exhibit childish behavior.

4. Pseudo-dementia. This disorder occurs against a background of mild stunning. Patients are confused, look around in bewilderment and show the behavior of the weak-minded and incomprehensible.

5. Ganser's syndrome. This state is similar to the previous one, but includes passing, that is, patients do not answer the question ("What is your name?" - "Far from here"). Not to mention the neurotic disorders associated with stress. They are always acquired, and not constantly observed from childhood to old age. In the origin of neuroses, purely psychological causes (overwork, emotional stress) are important, and not organic influences on the brain. Consciousness and self-awareness in neurosis are not disturbed, the patient is aware that he is ill. Finally, with adequate treatment, neuroses are always reversible.

Adjustment disorder observed during the period of adaptation to a significant change in social status (loss of loved ones or prolonged separation from them, the position of a refugee) or to a stressful life event (including a serious physical illness). more than 3 months from the onset of the stressor.

At adjustment disorders in the clinical picture are observed:

depressed mood

anxiety
a feeling of inability to cope with the situation, to adapt to it
some decrease in productivity in daily activities
propensity for dramatic behavior
outbursts of aggression.

According to the predominant feature, the following are distinguished adjustment disorders:

short-term depressive reaction (no more than 1 month)

prolonged depressive reaction (no more than 2 years)

mixed anxiety and depressive reaction, with a predominance of disturbance of other emotions

reaction with a predominance of behavioral disorders.

Among other reactions to severe stress, nosogenic reactions are also noted (they develop in connection with a severe somatic disease). There are also acute reactions to stress, which develop as reactions to an exceptionally strong, but short-lived (within hours, days) traumatic event that threatens the mental or physical integrity of the individual.

By affect it is customary to understand a short-term strong emotional excitement, which is accompanied not only by an emotional reaction, but also by the excitation of all mental activity.

Allocate physiological affect, for example, anger or joy, not accompanied by clouding of consciousness, automatisms and amnesia. Asthenic affect- a rapidly depleting affect, accompanied by a depressed mood, a decrease in mental activity, well-being and vitality.

Sthenic affect characterized by increased well-being, mental activity, a sense of one's own strength.

Pathological affect- a short-term mental disorder that occurs in response to intense, sudden mental trauma and is expressed in the concentration of consciousness on traumatic experiences, followed by an affective discharge, followed by general relaxation, indifference and often deep sleep; characterized by partial or complete amnesia.

In some cases, the pathological affect is preceded by a long-term traumatic situation, and the pathological affect itself arises as a reaction to some kind of “last straw”.

An acute reaction to stress is a mentally unhealthy state of a person. It lasts from several hours to 3 days. The patient is overwhelmed, unable to fully understand the situation, the stressful event is partially recorded in the memory, often in the form of fragments. This is due to being called. Symptoms usually last no more than 3 days.

One of the reactions is This syndrome develops exclusively because of situations that threaten a person's life. Signs of this state are lethargy, aloofness, repetitive horrors that pop up in the mind. incident pictures.

Often patients are visited by ideas of suicide. If the disorder is not too severe, it gradually disappears. There is also a chronic form that lasts for years. PTSD is also called combat fatigue. This syndrome was observed in the participants of the war. After the Afghan war, a lot of soldiers suffered from this disorder.

Disorder of adaptive reactions occurs due to stressful events in a person's life. This can be the loss of a loved one, a sharp change in life situation or a turning point in fate, separation, resignation, failure.

As a result, the individual is unable to adapt to unexpected change. A person cannot continue to live a normal daily life. There are insurmountable difficulties associated with social activities, there is no desire, motivation for making simple everyday decisions. A person cannot continue to be in the situation in which he finds himself. However, he does not have the strength to change and any decisions.

Varieties of flow

Caused by sad, difficult experiences, tragedies or a sharp change in life situations, adjustment disorder can have a different course and character. Depending on the characteristics of the disease, adaptation disorders are distinguished with:

Characteristic clinical picture

Usually the disorder and its symptoms disappear after 6 months from the stressful event. If the stressor is long-term, then the time frame is much longer than six months.

The syndrome interferes with normal, healthy life. Its symptoms depress a person not only mentally, but affect the entire body, disrupt the performance of many organ systems. Main features:

sad, depressed mood;
inability to cope with daily or professional tasks;
inability and lack of desire to plan further steps and plans for life;
violation of the perception of events;
abnormal, unusual behavior;
chest pain;
cardiopalmus;
difficulty breathing;
fear;
dyspnea;
suffocation;
strong muscle tension;
restlessness;
increased use of tobacco and alcoholic beverages.

The presence of these symptoms indicates a disorder of adaptive reactions.

If the symptoms persist for a long time, more than six months, steps should definitely be taken to eliminate the violation.

Establishing diagnosis

Diagnosis of a disorder of adaptive reactions is carried out only in a clinical setting; to determine the disease, the nature of the crisis states that led the patient to a dejected state is taken into account.

It is important to determine the impact of an event on a person. The body is examined for the presence of somatic and mental diseases. An examination by a psychiatrist is carried out to exclude depression, post-traumatic syndrome. Only a full examination can help make a diagnosis, refer the patient to a specialist for treatment.

Concomitant, similar diseases

A lot of diseases are included in one large group. All of them are characterized by the same features. Only one specific symptom or the strength of its manifestation can distinguish them. The following reactions are similar:

short-term depressive;
prolonged depressive;

Diseases vary in degree of complexity, the nature of the course and duration. Often one leads to the other. If treatment measures are not taken in time, the disease can take a complex form and become chronic.

Treatment approach

Treatment of disorders of adaptive reactions is carried out in stages. An integrated approach prevails. Depending on the degree manifestations of a symptom, the approach to treatment is individual.

The main method is psychotherapy. It is this method that is most effective, since the psychogenic aspect of the disease is predominant. Therapy is aimed at changing the patient's attitude towards the traumatic event. Increases the patient's ability to regulate negative thoughts. A strategy is created for the patient's behavior in a stressful situation.

The purpose of drugs is due to the duration of the disease and the degree of anxiety. Drug therapy lasts an average of two to four months.

Among the medicines, it is mandatory to prescribe:

Cancellation of drugs occurs gradually, according to the behavior and well-being of the patient.

For treatment, sedative herbal preparations are used. They perform a sedative function.

Herbal collection number 2 helps to get rid of the symptoms of the disease. It contains valerian, motherwort, mint, hops and licorice. Infusion drink 2 times a day for 1/3 of a glass. Treatment continues for 4 weeks. Often appoint a collection reception number 2 and 3 at the same time.

Complete treatment, frequent visits to a psychotherapist will ensure a return to a normal, familiar life.

What could be the consequences?

Most people with adjustment disorder are completely cured without any complications. This group is middle age.

Children, adolescents and the elderly are at risk for complications. Individual characteristics of a person play an important role in the fight against stressful conditions.

It is often impossible to prevent the cause of stress and get rid of it. The effectiveness of treatment and the absence of complications depend on the nature of the individual and his willpower.

In the third issue of the journal World Psychiatry for 2013 (currently available only in English, translation into Russian is in preparation), the working group on the preparation of the ICD-11 diagnostic criteria for stress disorders presented their draft of a new section of the international classification.

PTSD and adjustment disorder are among the most widely used diagnoses in mental health care worldwide. However, approaches to diagnosing these conditions have long been the subject of serious controversy due to the non-specificity of many clinical manifestations, difficulties in distinguishing disease states with normal reactions to stressful events, the presence of significant cultural characteristics in response to stress, etc.

Many criticisms have been made of the criteria for these disorders in DSM-IV and DSM-5. Thus, for example, according to the members of the working group, adjustment disorder is one of the most poorly defined mental disorders, which is why this diagnosis is often described as a kind of "wastebasket" in the psychiatric classification scheme. D The diagnosis of PTSD is criticized for the wide combination of different clusters of symptoms, low diagnostic threshold, high level of comorbidity, and in relation to the DSM-IV criteria for the fact that more than 10,000 different combinations of 17 symptoms can lead to this diagnosis.

All this was the reason for a fairly serious revision of the criteria for this group of disorders in the draft ICD-11.

The first innovation concerns the name for a group of disorders caused by stress. In the ICD-10 there is a heading F43 "Reaction to severe stress and adjustment disorders", related to section F40 - F48 "Neurotic, stress-related and somatoform disorders". The Working Group recommends avoiding the widely used but confusing term " stress-related disorders”, due to the fact that numerous disorders can be associated with stress (for example, depression, disorders associated with the use of alcohol and other psychoactive substances, etc.), but most of them can also occur in the absence of stressful or traumatic life events. In this case, we are talking only about disorders, stress for which is an obligatory and specific cause of their development. An attempt to emphasize this point in the draft ICD-11 was the introduction of the term “disorders specifically associated with stress”, which, probably, can most accurately be translated into Russian as “ disorders, directly stress related". It is planned to give this title to the section where the disorders discussed below will be placed.

The working group's proposals for individual disorders include:

more narrow concept of PTSD, which does not allow a diagnosis to be made on the basis of only non-specific symptoms;
new category " complex PTSD” (“complex PTSD”), which, in addition to the core symptoms of PTSD, additionally includes three groups of symptoms;
new diagnosis prolonged grief reaction used to characterize patients who experience an intense, painful, disabling, and abnormally persistent bereavement reaction;
a significant revision of the diagnosis " adjustment disorders”, including specification of symptoms;
revision concepts« acute reaction to stress» in line with the concept of this condition as a normal phenomenon, which, however, may require clinical intervention.

In a generalized form, the proposals of the working group can be presented as follows:

	Previous ICD-10 codes	The main diagnostic signs in the new edition
Post Traumatic Stress Disorder (PTSD))		A disorder that develops following exposure to an extreme threatening or horrifying event or series of events and is characterized by three "core" manifestations: re-experiencing a traumatic event(s) in the present tense in the form of vivid intrusive memories accompanied by fear or horror, flashbacks or nightmares; avoidance of thoughts and memories about the event(s), or avoidance of activities or situations resembling the event(s); state of subjective sense of continued threat in the form of hyperalertness or increased fear reactions. Symptoms must last at least several weeks and cause significant deterioration in performance. The introduction of a criterion of dysfunction is necessary to increase the diagnostic threshold. In addition, the authors of the project are also trying to improve the ease of diagnosis and reduce comorbidity by identifying bar elements PTSD, and not lists of equivalent "typical signs" of the disorder, which, apparently, is a kind of deviation from the operational approach in diagnostics that is customary for the ICD to ideas that are closer to domestic psychiatry about the syndrome.
Complex post-traumatic stress disorder		A disorder that occurs after exposure to an extreme or long-term stressor that is difficult or impossible to recover from. The disorder is characterized main (core) symptoms of PTSD(see above), as well as (in addition to them) the development of persistent, pervasive impairments in the affective sphere, self-relationship and social functioning, including: difficulty regulating emotions feeling like a humiliated, defeated and worthless person, difficulties in maintaining relationships Complex PTSD is a new diagnostic category replaces the overlapping ICD-10 category F62.0 "Persistent personality change after a disaster experience" which failed to attract scientific interest and did not include disorders arising from long-term stress in early childhood. These symptoms may occur after exposure to a single traumatic stressor, but are more likely to occur following severe prolonged stress or multiple or recurring adverse events that cannot be avoided (eg, exposure to genocide, child sexual abuse, children in war, severe domestic violence). , torture or slavery).
Prolonged grief reaction		A disorder in which, after the death of a loved one, persistent and all-encompassing sadness and longing for the deceased or constant immersion in thoughts about the deceased persist. Experience data: continue for an abnormally long period compared to the expected social and cultural norm (for example, at least 6 months or more depending on cultural and contextual factors), they are severe enough to cause significant deterioration in human functioning. These experiences can also be characterized as difficulty accepting death, a sense of losing a part of oneself, anger at the loss, guilt, or difficulty engaging in social and other activities. Several sources of evidence at once point to the need for the introduction of prolonged grief reaction: The existence of this diagnostic unit has been confirmed in a wide range of cultures. Factor analysis has repeatedly demonstrated that the central component of prolonged grief reaction (longing for the deceased) is independent of nonspecific symptoms of anxiety and depression. However, these experiences do not respond to antidepressant treatment (whereas bereavement depressive syndromes do), and psychotherapy that strategically targets the symptoms of prolonged grief disorder appears to be more effective in alleviating its manifestations than treatment directed at depression. People with prolonged grief disorder have serious psychosocial and health problems, including other mental health problems such as suicidal behavior, substance abuse, self-destructive behavior, or physical disorders such as high blood pressure and an increased incidence of cardiovascular disease There are specific brain dysfunctions and cognitive patterns associated with prolonged grief disorder
Adjustment disorder		A maladjustment response to a stressful event, to ongoing psychosocial difficulties, or to a combination of stressful life events that typically occurs within a month of exposure to the stressor and tends to resolve within 6 months if the stressor is not sustained for longer. The response to the stressor is characterized by symptoms of preoccupation with the problem, such as excessive worry, recurrent and distressing thoughts about the stressor, or constant rumination about its consequences. There is an inability to adapt, ie. symptoms interfere with daily functioning, there are difficulties with concentration or sleep disturbances, leading to impaired performance. Symptoms may also be associated with a loss of interest in work, social life, caring for others, leisure activities, leading to disruption in social or professional functioning (limitation of social circle, conflicts in the family, absenteeism from work, etc.). If the diagnostic criteria are appropriate for another disorder, then that disorder should be diagnosed instead of adjustment disorder. According to the authors of the project, there is no evidence for the validity of the subtypes of adjustment disorder described in ICD-10, and therefore they will be removed from ICD-11. Such subtypes can be misleading by focusing on the dominant distress content, obscuring the underlying commonality of the disorders. Subtypes are not relevant to treatment choice and are not associated with a specific prognosis
reactive attachment disorder
Attachment disorder of the disinhibited type		See Rutter M, Uher R. Classification issues and challenges in childhood and adolescent psychopathology. Int Rev Psychiatry 2012; 24:514-29
Conditions that are not disorders and are included in the section “Factors influencing the health status of the population and visits to healthcare facilities” (chapter Z in ICD-10)
Acute reaction to stress		Refers to the development of transient emotional, cognitive, and behavioral symptoms in response to exceptional stress, such as an extreme traumatic experience, that causes serious harm or threat to the safety or physical integrity of the person or those close to them (e.g., natural disasters, accidents, military acts, assault, rape), or sudden and threatening changes in an individual's social position and/or environment, such as the loss of one's family in a natural disaster. Symptoms are treated like a normal reaction spectrum caused by the extreme severity of the stressor. Symptoms are usually found over a period of several hours to several days from exposure to stressful stimuli or events, and usually begin to subside within a week of the event or after the threatening situation has been removed. According to the authors of the project, the description of the acute reaction to stress proposed for the ICD-11 " does not meet the definition of mental disorder, and the duration of symptoms will help distinguish acute stress reactions from pathological reactions associated with more severe disorders. However, if we recall, for example, the classical descriptions of these states by E. Kretschmer (which the authors of the project, apparently, have not read and the latest edition of his "Hysteria" in English dates from 1926), then nevertheless, their removal from the boundaries of pathological states causes some doubt. Probably, following this analogy, hypertensive crisis or hypoglycemic states should be removed from the list of pathological conditions and headings of the ICD. They, too, are only transient states, not "disorders." In this case, the medically fuzzy term disorder (disorder) is interpreted by the authors closer to the concept of a disease than a syndrome, although according to the general (for all specialties) conceptual model used to prepare the ICD-11, the term "disorder" can include, as diseases and syndromes.

The next steps in the development of the ICD-11 project on disorders directly related to stress will be its public discussion and testing in the "field" conditions.

Acquaintance with the project and discussion of proposals will be carried out using the ICD-11 beta platform ( http://apps.who.int/classifications/icd11/browse/f/en). Field studies will assess clinical acceptability, clinical utility (eg ease of use), reliability and, to the extent possible, validity of draft definitions and diagnostic guidelines, in particular against ICD-10.

WHO will use two main approaches to pilot the draft sections of ICD-11: Internet research and clinical research. Internet research will be carried out primarily within the framework, which currently consists of more than 7,000 psychiatrists and primary care physicians. Research into disorders directly related to stress is already planned. Clinical research will be carried out through the international network of WHO Collaborating Clinical Research Centres.

The Working Group looks forward to working with colleagues around the world to test and further refine the proposals for diagnostic guidelines for disorders directly related to stress in ICD-11.

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3.3.2. Acute stress reaction (acute stress reaction, ASR)

ASD is a pronounced transient disorder that develops in mentally healthy individuals as a reaction to catastrophic (i.e., exceptional physical or psychological) stress and which, as a rule, is reduced within a few hours (maximum days). Such stressful events include situations of threat to the life of an individual or persons close to him (for example, a natural disaster, an accident, hostilities, criminal behavior, rape) or an unusually abrupt and threatening social status change in the social position and / or environment of the patient, for example the loss of many loved ones or a fire in the house. The risk of developing the disorder increases with physical exhaustion or the presence of organic factors (for example, in elderly patients). The nature of reactions to stress is largely determined by the degree of individual stability and adaptive abilities of the individual; Thus, with systematic preparation for a certain type of stressful events (in certain categories of military personnel, rescuers), the disorder develops extremely rarely.

The clinical picture of this disorder is characterized by rapid variability with possible outcomes - both in recovery and in the aggravation of disorders up to psychotic forms of disorders (dissociative stupor or fugue). Often, after convalescence, amnesia of individual episodes or the entire situation as a whole is noted (dissociative amnesia, F44.0).

Sufficiently clear diagnostic criteria for RSD are formulated in DSM-IV:

A. The person was exposed to a traumatic event, and the following mandatory signs were noted:

1) the recorded traumatic event was defined by an actual threat of death or serious injury (i.e., a threat to physical integrity) for the patient himself or for another person within his environment;

2) the person's reaction was accompanied by an extremely intense feeling of fear, helplessness or horror.

B. At the moment or immediately after the end of the traumatic event, the patient had three (or more) dissociative symptoms:

1) a subjective feeling of numbness, detachment (alienation) or lack of a lively emotional response;

2) underestimation of the environment or one's personality ("state of amazement");

3) symptoms of derealization;

4) symptoms of depersonalization;

5) dissociative amnesia (i.e. inability to remember important aspects of the traumatic situation).

C. The traumatic event constantly forcibly re-experiences consciousness in one of the following ways: images, thoughts, dreams, illusions, or subjective distress at the reminder of the traumatic event.

D. Avoidance of stimuli that promote trauma recall (eg, thoughts, feelings, conversations, actions, places, people).

E. Symptoms of anxiety or increased tension (for example, sleep disturbances, concentration of attention, irritability, hypervigilance), excessive reactivity (increased fearfulness, startling at unexpected sounds, motor restlessness, etc.) are noted.

F. Symptoms cause clinically significant impairment in social, occupational (or other) functioning, or interfere with the person's ability to perform other necessary tasks.

G. Disorder lasts 1–3 days after the traumatic event.

In ICD-10, there is the following addition: there must be a mandatory and clear temporal relationship between exposure to an unusual stressor and the onset of symptoms; the onset is usually immediate or after a few minutes. In this case, the symptoms: a) have a mixed and usually changing picture; depression, anxiety, anger, despair, hyperactivity, and withdrawal may be present in addition to the initial state of stupor, but none of the symptoms are long-term dominant; b) stop quickly (at most within a few hours) in cases where it is possible to eliminate the stressful situation. If the stressful event continues or cannot by its nature be stopped, symptoms usually begin to resolve after 24 to 48 hours and subside within 3 days.

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ACUTE STRESS REACTION

Found 5 definitions for the term ACUTE STRESS REACTION

F43.0 Acute stress reaction

Individual vulnerability and adaptive capacity play a role in the occurrence and severity of acute stress reactions; this is evidenced by the fact that this disorder does not develop in all people subjected to severe stress. Symptoms show a typical mixed and changing picture and include an initial state of "dazedness" with some narrowing of the field of consciousness and reduced attention, inability to adequately respond to external stimuli, and disorientation. This condition may be accompanied by either further withdrawal from the surrounding situation (up to dissociative stupor - F44.2), or agitation and hyperactivity (flight reaction or fugue). Autonomic signs of panic anxiety (tachycardia, sweating, redness) are often present. Typically, symptoms develop within minutes of exposure to a stressful stimulus or event and disappear within two to three days (often hours). Partial or complete dissociative amnesia (F44.0) of the episode may be present. If symptoms persist, then the question arises of changing the diagnosis (and management of the patient).

There must be a mandatory and clear temporal relationship between exposure to an unusual stressor and the onset of symptoms; pumped usually immediate or after a few minutes. In addition, symptoms:

a) have a mixed and usually changing picture; depression, anxiety, anger, despair, hyperactivity, and withdrawal may be present in addition to the initial state of stupor, but none of the symptoms are long-term dominant;

b) stop quickly (at most within a few hours) in cases where it is possible to eliminate the stressful situation. In cases where stress continues or cannot by its nature be relieved, symptoms usually begin to subside after 24-48 hours and subside within 3 days.

This diagnosis cannot be used to refer to sudden exacerbations of symptoms in persons who already have symptoms that meet the criteria for any psychiatric disorder excluding those in F60.- (specific personality disorders). However, a history of prior psychiatric disorder does not invalidate the use of this diagnosis.

Acute crisis reaction;

Acute reaction to stress;

ACUTE REACTION TO STRESS (ICD 308)

Acute stress response

Acute reaction to stress

The symptom complex of the disorder includes the following main features: 1. confusion with an incomplete, fragmentary perception of the situation, often focusing on random, side aspects of it and, in general, a lack of understanding of the essence of what is happening, which leads to a deficit in the perception of information, the inability to structure it for the organization of targeted, adequate actions . Productive psychopathological symptoms (delusions, hallucinations, etc.) apparently do not occur, or, if they occur, they are of an abortive, rudimentary nature; 2. insufficient contact with patients, their poor understanding of questions, requests, instructions; 3. psychomotor and speech retardation, reaching in some patients the degree of dissociative (psychogenic) stupor with freezing in one position or, on the contrary, which happens less often, motor and speech excitement with fussiness, stupidity, inconsistent, inconsistent verbosity, sometimes verbigerations of despair; in a relatively small part of patients, erratic and intense motor excitation occurs, usually in the form of a stampede and impulsive actions that are performed contrary to the requirements of the situation and are fraught with serious consequences, up to death; 4. pronounced vegetative disorders (mydriasis, pallor or hyperemia of the skin, vomiting, diarrhea, hyperhidrosis, symptoms of cerebral and cardiac circulatory failure, causing some patients to die, etc.) and 5. subsequent complete or partial congrade amnesia. There may also be confusion, despair, a sense of the unreality of what is happening, isolation, mutism, unmotivated aggressiveness. The clinical picture of the disorder is polymorphic, variable, often mixed. In premorbid psychiatric patients, the acute reaction to stress may be somewhat different, not always typical, although information about the characteristics of the response of patients with various mental disorders to severe stress (depression, schizophrenia, etc.) seems to be insufficient. As a rule, the source of more or less reliable information about severe forms of the disorder is someone from strangers, they, in particular, can be rescuers.

At the end of an acute reaction to stress, most patients, as Z.I. Kekelidze (2009) points out, show symptoms of a transitional period of the disorder (affective tension, sleep disturbances, psychovegetative disorders, behavioral disorders, etc.) or a period of post-traumatic stress disorder (PTSD) begins. ). An acute reaction to stress occurs in approximately 1-3% of disaster victims. The term is not entirely accurate - stress itself is considered to be psychotraumatic situations, in relation to which a person retains confidence or hope to overcome them that mobilizes him. Treatment: placement in a safe environment, tranquilizers, neuroleptics, anti-shock measures, psychotherapy, psychological correction. Synonyms: Crisis, Acute crisis reaction, Combat fatigue, Mental shock, Acute reactive psychosis.

Acute reaction to stress

QUESTION:“Good night, Andrey. This is my first time on the site, desperately looking for help. Can I get advice from you? Unfortunately, I live abroad, and in person, even with a strong desire, I cannot meet you. Today I had a case that I probably meant earlier, but hoped that it would bypass me all the same. I have long been in a depressed state, which is probably the majority of people in our country, from a lack of money, housing, conditions. It started with my previous husband, he liked to drink alcohol, I tried to fight, but to no avail. During our quarrels with him, tantrums began to happen directly, as if from hopelessness, I began to shake, I cried and probably didn’t understand anything. She divorced her husband, but left a child. I remarried, but my psychological state has not changed. Today happened what I was most afraid of. I have a very strong-willed child, even in his two years. He does not obey anyone. He believes that he is already an adult and can do everything himself. Everything would be fine, but it turned out that the child endangered himself on the roadway, before that he tested my nerves in the store for a long time. I don’t know if I can take your time with such detailed stories, the bottom line is that today I couldn’t stand it, and I’m afraid this won’t be the last time, I’m afraid that it will get worse. I don’t even remember what happened after he was in the parking lot, when there was a lot of traffic, he pulled his hand out of my hand and happily ran away from me, I don’t remember how I put him in the car, I don’t remember what happened near the entrance. I just remember a neighbor knocking on the door, asking if I was yelling at the child. Our laws are very harsh, you can’t even shout at a child. I'm afraid it will be taken away from me. I know for sure that I didn’t beat him for sure, I couldn’t, I just couldn’t. I remember that I later went to a neighbor, and despite my character, I'm afraid that if she opened the door, our conversation would not work out. I'm scared. I am afraid to go to a psychiatrist in our country, although I understand what is needed. I'm afraid the child will be taken away. But I'm also afraid that one day I won't be able to cope with myself. Help me please. What do i do? Please, help.

QUESTION:"Hello. I am very afraid of my condition. Recently, a criminal came up to me on the street, yelled at me, threw himself. I didn’t say anything special, but after talking with him I felt bad. There was a moral feeling that I would die. It was as if my soul would now break out of me and I would lose consciousness. It's never been that scary. Then I vomited several times. I couldn’t fall asleep, as soon as I remembered it, I immediately had a feeling that I didn’t control myself, as if out of my mind. The next day, the condition repeated only in a mild form. he talks to me for more than a minute or the cat will run in front of me. What to do with it? I didn’t have any psycho diagnoses and never had any problems.

ANSWER:"Hello Maria. The reaction to an event that happened to you about a month ago can be classified as an "acute reaction to stress" (F43.0 - ICD code 10). This condition refers to neurotic (F4 - ICD code 10) and is a temporary (hours, days) disorder of significant severity in response to an unusually strong physical or psychological stress factor (physical or psychological violence, security threat, fire, earthquake, accident , loss of loved ones, financial collapse, etc.).

The clinical picture, as a rule, is polymorphic, unstable, and is manifested by severe anxiety (sometimes reaching panic), fear, anxiety, horror, helplessness, insensitivity, confusion, deterioration in perception, attention, slight stupor and some narrowing of consciousness. Possible derealization, depersonalization, dissociative amnesia. Movement disorders are often manifested either by lethargy, stupor, up to stupor, or agitation, agitation, unproductive, chaotic hyperactivity.

Often there are vegetative manifestations in the form of tachycardia, increased blood pressure, sweating, redness, feelings of lack of air, nausea, dizziness, fever, etc.

The basic symptoms for an acute reaction to stress are also: a) repetitive obsessive anxious experiences and "scrolling" of traumatic events in the form of memories, fantasies, ideas, nightmares; b) avoidance of situations, activities, thoughts, places, actions, feelings, conversations associated with traumatic events; c) emotional "dulling", narrowness, loss of interests, feeling of detachment from others; d) excessive excitement, irritability, irascibility, insomnia, impaired concentration, alertness.

In some cases, the acute reaction to stress F43.0 is reduced on its own within a few hours (in the presence of a stress factor - within a few days), although residual asthenic, anxious, obsessive, depressive symptoms, agitation, sleep disturbances may appear for several days or weeks. In other cases, especially in the absence of adequate therapy, acute stress disorder may be a precursor to post-traumatic stress disorder (PTSD) F43.1, and if the disorder lasts more than 4 weeks, a diagnosis of post-traumatic stress disorder is made. In addition to PTSD, depressive disorder, obsessive-compulsive disorder (OCD), generalized anxiety disorder (GAD), and substance abuse (substance abuse), in particular alcohol, can develop.

All the best. Sincerely, Gerasimenko Andrey Ivanovich - psychiatrist, psychotherapist, narcologist (Kyiv).

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acute reaction to stress

Acute reaction to stress

The disorder does not develop in all people who have undergone severe stress (our data indicate the presence of O. r. N. S. in 38-53% of people who have experienced traumatic stress). The risk of developing the disorder increases with physical exhaustion or the presence of organic factors (for example, in elderly patients). In the occurrence and severity of O. p. n. from. individual vulnerability and adaptive capacity play a role.

From the moment the rescue work begins, part of the burden of providing psychological assistance is assigned to the rescuers. The brigade of the emergency psychological help practically cannot start work in the acute (isolation) period of development of a situation at emergencies when signs of O. r generally appear. n. s., due to the short duration of this period (lasts several minutes or hours).

Psychosocial support after a disaster is usually provided by relatives, neighbors or other people who, due to circumstances, are close to the victims. Surrounding people, as you know, are quickly included in the work to help the victims. Assistance in such conditions is most often carried out “in the order of self- and mutual assistance”.

Since survivors of a disaster show extremely pronounced emotional reactions that are quite natural in a given situation (anxiety, fear of death, despair, a sense of helplessness or loss of life prospects), when providing assistance to them, first of all, one should try to minimize these reactions by any available actions. The most effective will be the manifestations of sympathy and care, as well as practical assistance to the victims.

Psychogenic conditions in victims

Mental disorders in the structure of reactive states in victims are mainly represented by a reaction to severe stress, which occurs in the form of affective disorganization of mental activity with an affective narrowing of consciousness, a violation of voluntary regulation of behavior. Subsequently, in connection with the emotional and cognitive processing of a traumatic event, anxiety-phobic disorders, mixed anxiety and depressive disorders, as well as post-traumatic stress disorder, and adjustment disorders quite often develop. At the same time, some victims have depressive, anxiety-depressive states, while others experience sharpening of characterological features or the formation of post-traumatic personality changes with persistent violations of social maladaptation.

Mental disorders in the structure of psychogenic states in victims are characterized by specificity and differ from reactive states in the accused.

In connection with these features, an acute reaction to stress (F43.0) occupies a special place among psychogenic disorders in victims. The description of this disorder in ICD-10 states that it occurs in individuals without apparent mental disorder in response to exceptional physical and psychological stress and resolves within hours or days. As stresses, psychological experiences associated with a threat to the life, health and physical integrity of the subject (catastrophes, accidents, criminal behavior, rape, etc.) are given.

Diagnosis requires a mandatory and clear temporal relationship to the unusual stressful event and the development of a clinical picture of the disorder immediately or shortly after the event. The clinical picture is determined by the fact that under the action of severe stress, non-specific and specific effects can be distinguished.

The nonspecificity of the impact of stress is determined by the following parameters:

- it does not depend on age, it is determined by the strength, speed, severity of the aggressive-violent component;

- little realized, not accompanied by intrapersonal processing;

- the dynamics of acute affective states is of primary importance - from short-term emotional stress and fear to affective-shock, subshock reactions with a narrowing of consciousness, fixation of attention on a narrow circle of psycho-traumatic circumstances, psychomotor disorders and vasovegetative disorders.

The specific impact includes the processing of a traumatic event at the personal and social level with the significance of the personal meaning of the incident. As a result, the dynamics of emerging psychogenic disorders is largely determined by the intrapsychic processing of a new negative experience associated with violence and its consequences for the individual. At the stage of emotional-cognitive processing, the following variants of psychogenic disorders are most often formed.

The following symptoms dominate the clinical picture of these disorders:

- anxiety and fear dominate against the background of pronounced emotional stress;

- the plot of fear is associated with violence, threats, physical and mental trauma;

- the dynamics is determined by the risk of repeated excesses of violence and the situation of dependence, unresolved criminal situation, repeated threats;

- in situations of dependence, the risk of repeated excesses of violence - anxious and depressed mood, the formation of intrapersonal complexes with vengeful fantasizing, secondary personal-characterological reactions with radicals of anxiety, dependence, conformity.

Another type of common disorder: situational depressive reaction or prolonged depression of a neurotic level(F32.1) mixed anxiety and depressive disorders(F41.2). Marked depressive states most often include the following clinical signs:

- adynamic or anxious depression with a feeling of despair, hopelessness, "desire to forget what happened as soon as possible" or anxious expectation of negative consequences (illness, pregnancy, defects);

- somatovegetative disorders and disorders of sleep, appetite.

Personal predisposition is essential at the stage of emotional-cognitive processing. The following personality-characteristic features determine a more protracted course of psychogenic states in victims:

- inhibited, hysterical, schizoid radicals with idealized ideas and moral attitudes;

- personal instability with ease of inclusion of additional situational-reactive moments and a deepening of the severity of anxious or depressive personal reactions;

- asthenic radical (exhaustion, emotional lability, instability of self-esteem, self-pity and self-blame, a tendency to introjection and isolation, refusal of personal support).

The next variant of psychogenic states, which are quite common among victims, is post-traumatic stress disorder (F43.1).

Filed GNTSSS them. V. P. Serbsky, the frequency of occurrence of this disorder in victims is up to 14%. The clinical picture is determined by the following features:

– psychogenic factor: suddenness, brutality and force of impact, severe violence with physical suffering, threat to life, group nature of violence;

– Clinical signs: depressive mood, recurring obsessive memories of the event, sleep disturbances with nightmares, associative inclusions with avoidance of stimuli that could trigger memories of the trauma, emotional alienation combined with persistent psychophysical tension, hyperexcitability with easily occurring fear reactions, somatovegetative disorders, personality reactions with disorders of adaptation and social functioning, persistent behavioral disorders (irritability, aggressive conflict, demonstrative behavior with the role of "victim", auto-aggressive reactions, alcohol or drug use, deviant behavior).

Quite often, a state of distress and emotional disorders with anxiety or depressive radicals, as well as behavioral deviations, proceed according to the type of adaptation disorders.

In the formation of adjustment disorders (F43.2), individual predisposition and lesser severity of stressful effects are of certain importance. Along with a depressive or anxious mood, there is a reaction of the individual to a decrease in the level of his life activity due to the impact of stress, productivity, inability to cope with the current situation, to control his condition. This is often accompanied by sudden behavioral excesses, outbursts of aggressiveness, or persistent demonstrative, deviant, dissocial behavior.

Forensic psychiatric qualification of psychogenic conditions in victims is significant for:

1) assessing the ability of victims to understand the nature and significance of the actions committed with them and to resist;

2) assessing the criminal procedural capacity of victims - the ability to correctly perceive a legally significant situation of an offense, remember its circumstances, testify about them, realize and manage their actions during the investigation and trial;

3) assessment of harm to health from injuries that caused mental disorders.

Practical commentary on the 5th chapter of the International Classification of Diseases 10th revision (ICD-10)

Research Institute of Psychoneurology V.M. Bekhterev, St. Petersburg

Typical severe stressors are military operations, natural and transport disasters, an accident, the presence of others at a violent death, robbery, torture, rape, fire.

Vulnerability to the disorder also increases the premorbid burden of psychotrauma. PTSD may have an organic causation. EEG disturbances in these patients are similar to those in endogenous depression. The alpha-adrenergic agonist clonidine, used to treat opiate withdrawal, appears to be successful in relieving some of the symptoms of PTSD. This allowed us to put forward a hypothesis that they are a consequence of the endogenous opiate withdrawal syndrome that occurs during the revival of memories of psychotrauma.

In contrast to PTSD, in adaptation disorders, the intensity of stress does not always determine the severity of the disorder. Stresses can be solitary or overlapping, be periodic (hands-on at work) or permanent (poverty). Different stages of life are characterized by their own specifics of stressful situations (starting school, leaving the parental home, marriage, the appearance of children and their departure from home, failure to achieve professional goals, retirement).

The experience of trauma becomes central in the life of the patient, changing his style of life and social functioning. The reaction to a human stressor (rape) is more intense and prolonged than to a natural disaster (flood). In protracted cases, the patient no longer becomes fixated on the injury itself, but on its consequences (disability, etc.). The appearance of symptoms is sometimes delayed for a different period of time, this also applies to adjustment disorders, where the symptoms do not necessarily decrease when the stress stops. The intensity of symptoms may change, aggravated by additional stress. A good prognosis correlates with the rapid development of symptoms, good social adaptation in premorbidity, the presence of social support and the absence of concomitant mental and other diseases.

To distinguish organic brain syndromes similar to PTSD, the presence of organic personality changes, changes in sensory or level of consciousness, focal neurological, delirious and amnestic symptoms, organic hallucinosis, states of intoxication and withdrawal help. The diagnostic picture can be complicated by the abuse of alcohol, drugs, caffeine, and tobacco, which is widely used in coping of the behavior of PTSD patients.

Endogenous depression is a frequent complication of PTSD and should be intensively treated due to the fact that comorbidity significantly increases the risk of suicide. With such a complication, both disorders should be diagnosed. Patients with PTSD may develop symptoms of phobic avoidance, such cases from simple phobias helps to distinguish the nature of the primary stimulus and the presence of other manifestations characteristic of PTSD. Motor tension, anxious expectations, increased search settings can bring the picture of PTSD closer to that of generalized anxiety disorder. Here it is necessary to pay attention to the acute onset and the greater characteristic of phobic symptoms for PTSD, in contrast to generalized anxiety disorder.

Differences in the stereotype of the course make it possible to differentiate PTSD from panic disorder, which is sometimes very difficult and gives reason to some authors to consider PTSD a variant of panic disorder. From the development of physical symptoms due to mental causes (F68.0), PTSD is distinguished by an acute onset after trauma and the absence of bizarre complaints prior to it. From feigning disorder (F68.1) PTSD is distinguished by the absence of inconsistent anamnestic data, an unexpected structure of the symptom complex, antisocial behavior and a chaotic lifestyle in the premorbid period, which are more characteristic of feigned patients. PTSD differs from adaptation disorders in the large scope of the pathogenicity of the stressor and the presence of subsequent characteristic reproduction of the trauma.

In addition to the above nosological units, adaptation disorders have to be differentiated from conditions not caused by mental disorders. Thus, the loss of loved ones without special aggravating circumstances can also be accompanied by a transient deterioration in social and professional functioning, which, however, remains within the expected framework of the reaction to the loss of a loved one and therefore is not considered a violation of adaptation.

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A characteristic feature of this group of disorders is their distinctly exogenous nature, a causal relationship with an external stressor, without which mental disorders would not have appeared. Reactions to stress

A characteristic feature of this group of disorders is their distinctly exogenous nature, a causal relationship with an external stressor, without which mental disorders would not have appeared.

Typical severe stressors are military operations, natural and transport disasters, an accident, the presence of others at a violent death, robbery, torture, rape, fire.

The prevalence of disorders naturally varies depending on the frequency of catastrophes and traumatic situations. The syndrome develops in 50 - 80% of those who have experienced severe stress. Morbidity is directly related to the intensity of stress. The incidence of PTSD in peacetime is 0.5% for men and 1.2% for women in the population. Adult women describe similar traumatic situations as more painful than men, but among children, boys are more sensitive to similar stressors than girls. Adjustment disorders are quite common, they account for 1.1-2.6 cases per 1000 population with a tendency to be more represented in the low-income part of the population. They make up about 5% of those served by psychiatric institutions; occur at any age, but most often in children and adolescents.

Vulnerability to the disorder also increases the premorbid burden of psychotrauma. PTSD may have an organic causation. EEG disturbances in these patients are similar to those seen in endogenous depression. The alpha-adrenergic agonist clonidine, used to treat opiate withdrawal, appears to be successful in relieving some of the symptoms of PTSD. This allowed us to put forward a hypothesis that they are a consequence of the endogenous opiate withdrawal syndrome, which occurs when memories of psychotrauma are revived.

In contrast to PTSD, in adaptation disorders, the intensity of stress does not always determine the severity of the disorder. Stress can be single or superimposed on each other, be periodic (hands-on at work) or permanent (poverty). Different stages of life are characterized by their own specifics of stressful situations (starting school, leaving the parental home, marriage, the appearance of children and their departure from home, failure to achieve professional goals, retirement).

The picture of the disease may present a general dullness of feelings (emotional anesthesia, a feeling of remoteness from other people, loss of interest in previous activities, the inability to experience joy, tenderness, orgasm) or a feeling of humiliation, guilt, shame, anger. Dissociative states are possible (up to stupor), in which a traumatic situation, anxiety attacks, rudimentary illusions and hallucinations, transient decreases in memory, concentration and control of impulses are re-experienced. In an acute reaction, partial or complete dissociative amnesia of the episode (F44.0) is possible. There may be consequences in the form of suicidal tendencies, as well as the abuse of alcohol and other psychoactive substances. Victims of rape and robbery do not dare to go out unaccompanied for varying periods of time.

The experience of trauma becomes central in the life of the patient, changing his style of life and social functioning. The reaction to a human stressor (rape) is more intense and prolonged than to a natural disaster (flood). In protracted cases, the patient no longer becomes fixated on the injury itself, but on its consequences (disability, etc.). The appearance of symptoms is sometimes delayed for a different period of time, this also applies to adjustment disorders, where the symptoms do not necessarily decrease when the stress stops. The intensity of symptoms can change, intensifying with additional stress. A good prognosis correlates with the rapid development of symptoms, good social adaptation in premorbidity, the presence of social support, and the absence of concomitant mental and other diseases.

Mild concussions may not be directly accompanied by obvious neurological signs, but may lead to prolonged affective symptoms and impaired concentration. Malnutrition during prolonged stressful exposure can also independently lead to organic brain syndromes, including impaired memory and concentration, emotional lability, headaches and dizziness.

Organic brain syndromes similar to PTSD can be distinguished by the presence of organic personality changes, changes in sensory or level of consciousness, focal neurological, delirious and amnesic symptoms, organic hallucinosis, states of intoxication and withdrawal. alcohol, drugs, caffeine and tobacco.

Endogenous depression is a frequent complication of PTSD and should be intensively treated due to the fact that comorbidity significantly increases the risk of suicide. With such a complication, both disorders should be diagnosed. Patients with PTSD may develop symptoms of phobic avoidance, such cases from simple phobias helps to distinguish the nature of the primary stimulus and the presence of other manifestations characteristic of PTSD. Motor tension, anxious expectations, increased search settings can bring the picture of PTSD closer to that of generalized anxiety disorder. Here, attention should be paid to the acute onset and greater characteristic of phobic symptoms for PTSD, in contrast to generalized anxiety disorder.

Differences in the stereotype of the course make it possible to differentiate PTSD from panic disorder, which is sometimes very difficult and gives reason to some authors to consider PTSD a variant of panic disorder. From the development of physical symptoms due to mental causes (F68.0), PTSD is distinguished by an acute onset after trauma and the absence of bizarre complaints before it. From feigning disorder (F68.1) PTSD is distinguished by the absence of inconsistent anamnestic data, an unexpected structure of the symptom complex, antisocial behavior and a chaotic lifestyle in the premorbid period, which are more characteristic of feigned patients. PTSD differs from adaptation disorders in the large scope of the pathogenicity of the stressor and the presence of subsequent characteristic reproduction of the trauma.

In addition to the above nosological units, adaptation disorders must be differentiated from conditions not caused by mental disorders. Thus, the loss of loved ones without special aggravating circumstances can also be accompanied by a transient deterioration in social and professional functioning, which, however, remains within the expected framework of the reaction to the loss of a loved one and therefore is not considered a violation of adaptation.

Based on the leading role of increased adrenergic activity in maintaining the symptoms of PTSD, adrenergic blockers such as propranolol and clonidine are successfully used in the treatment of the disorder. The use of antidepressants is indicated for the severity of anxiety-depressive manifestations in the clinical picture, prolongation and "endogenization" of depression; it also helps to reduce repetitive memories of trauma and normalize sleep. There is an idea that MAO inhibitors may be effective for a limited group of patients. With significant disorganization of behavior for a short time, plegia can be achieved with sedative antipsychotics.

Psychogenic conditions in victims

Mental disorders in the structure of reactive states in victims are mainly represented by a reaction to severe stress, which occurs in the form of affective mental disorganization.

Practical commentary on the 5th chapter of the International Classification of Diseases, 10th revision (ICD-10) V.M. Bekhterev, St. Petersburg

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Acute reaction to stress

Acute reaction to stress- a transient disorder of significant severity that develops in individuals without apparent mental impairment in response to exceptional physical and psychological stress and which usually resolves within hours or days. Stress can be an intense traumatic experience, including a threat to the safety or physical integrity of an individual or loved one (eg, natural disaster, accident, battle, criminal behavior, rape) or an unusually abrupt and threatening change in the patient's social position and/or environment, such as the loss of many loved ones or a fire in the house.

^ World Health Organization. The ICD-10 classification of mental and behavioral disorders. Clinical description and diagnostic guideline. Geneva: World Health Organization, 1992

Wikimedia Foundation. 2010 .

See what "Acute Stress Reaction" is in other dictionaries:

Acute reaction to stress- Very quickly transient disorders of varying severity and nature, which are observed in individuals who did not have any obvious mental disorder in the past, in response to an exceptional somatic or mental situation (for example, ... ... Great psychological encyclopedia

Acute reaction to stress- - a transient and short-term (hours, days) psychotic disorder that occurs in response to exceptional physical and / or psychological stress with an obvious threat to life in people without a previous mental disorder. ... ... Encyclopedic Dictionary of Psychology and Pedagogy

F43.0 Acute stress reaction- A transient disorder of significant severity that develops in individuals without apparent mental impairment in response to exceptional physical and psychological stress, and which usually resolves within hours or days. Stress can be ... Classification of mental disorders ICD-10. Clinical descriptions and diagnostic instructions. Research Diagnostic Criteria

Acute stress response- a transient disorder of significant severity that develops in individuals who did not initially have visible mental disorders, in response to exceptional physical and psychological stress, and which usually resolves within hours or days. ... ... Dictionary of emergencies

Acute stress response- So, according to ICD 10 (F43.0.), Clinical manifestations of a neurotic reaction are indicated if the symptomatology characteristic of it persists for a short period - from several hours to 3 days. In this case, stunning, some narrowing of the field are possible ... ... Encyclopedic Dictionary of Psychology and Pedagogy

stress- A human condition characterized by non-specific defensive reactions (at the physical, psychological and behavioral level) in response to extreme pathogenic stimuli (see Adaptation Syndrome). The reaction of the psyche to ... ... Great psychological encyclopedia

STRESS- (eng. stress stress) a state of stress that occurs in humans (and animals) under the influence of strong influences. According to the Canadian pathologist Hans Selye (Selye; 1907 1982), the author of the concept and term stress, this is a common ... ... Russian encyclopedia of labor protection

"F43" Response to severe stress and adjustment disorders- This category differs from others in that it includes disorders that are defined not only on the basis of symptomatology and course, but also on the basis of the presence of one or the other of two causative factors: exceptionally severe stress ... ... ICD-10 classification of mental disorders. Clinical descriptions and diagnostic instructions. Research Diagnostic Criteria

catastrophic stress response- See synonym: Acute reaction to stress. Brief explanatory psychological and psychiatric dictionary. Ed. igisheva. 2008 ... Big Psychological Encyclopedia

Affective-shock reaction- acute reactive (that is, psychogenic) psychosis, most often occurring with a short-term clouding of consciousness. Synonyms: Acute reaction to stress, Acute reactive psychosis ... Encyclopedic Dictionary of Psychology and Pedagogy

Each of us dreams of living life calmly, happily, without excesses. But, unfortunately, almost everyone experiences dangerous moments, is exposed to powerful stresses, threats, up to attacks, violence. What should a person with post-traumatic stress disorder do? After all, the situation does not always go without consequences, many suffer from serious mental pathologies.

To make it clear to those who do not have medical knowledge, it is necessary to explain what PTSD means, what are its symptoms. First you need to imagine at least for a second the state of a person who has experienced a terrible incident: a car accident, beating, rape, robbery, death of a loved one, etc. Agree, this is difficult to imagine, and scary. At such moments, any reader will immediately turn with a plea for a petition - God forbid! And what to say about those who really turned out to be a victim of a terrible tragedy, how can he forget about everything. A person tries to switch to other activities, get carried away with a hobby, devote all his free time to communicating with relatives and friends, but all in vain. Severe, irreversible acute reaction to stress, terrible moments and causes stress disorder, post-traumatic. The reason for the development of pathology is the inability of the reserves of the human psyche to cope with the situation, it goes beyond the accumulated experience that a person can experience. The condition often occurs not immediately, but approximately 1.5-2 weeks after the event, for this reason it is called post-traumatic.

A person who has suffered severe trauma may be suffering from post-traumatic stress disorder.

Traumatic situations, single or repeated, can disrupt the normal functioning of the mental sphere. Provocative situations include violence, complex physiological trauma, being in the zone of a man-made or natural disaster, etc. Right at the moment of danger, a person tries to get together, save his own life, loved ones, tries not to panic or is in a state of stupor. After a short time, there are obsessive memories of what happened, from which the victim tries to get rid of. Post-traumatic stress disorder (PTSD) is a return to a difficult moment that “hurts” the psyche so much that there are serious consequences. According to the international classification, the syndrome belongs to the group of neurotic conditions caused by stress and somatoform disorders. A good example of PTSD is military personnel who served in "hot" spots, as well as civilians who ended up in such areas. According to statistics, after experiencing stress, PTSD occurs in approximately 50-70% of cases.

The most vulnerable categories are more susceptible to mental trauma: children and the elderly. In the former, the protective mechanisms of the organisms are not sufficiently formed, in the latter, due to the rigidity of the processes in the mental sphere, the loss of adaptive abilities.

Post Traumatic Stress Disorder - PTSD: Causes

As already mentioned, a factor in the development of PTSD are mass disasters, from which there is a real threat to life:

war;
natural and man-made disasters;
acts of terrorism: being in captivity as a prisoner, experienced torture;
serious illnesses of loved ones, own health problems that threaten life;
physical loss of loved ones;
experienced violence, rape, robbery.

In most cases, the intensity of anxiety, experiences directly depends on the characteristics of the individual, his degree of susceptibility, impressionability. Also important is the gender of the person, his age, physiological, mental state. If the traumatization of the psyche occurs regularly, then the depletion of mental reserves is formed. An acute reaction to stress, the symptoms of which are a frequent companion of children, women who have experienced domestic violence, prostitutes, may occur in police officers, firefighters, rescuers, etc.

Experts identify another factor contributing to the development of PTSD - this is neuroticism, in which there are obsessive thoughts about bad events, there is a tendency to neurotic perception of any information, a painful desire to constantly reproduce a terrible event. Such people always think about dangers, talk about serious consequences even in non-threatening situations, all thoughts are only about the negative.

Cases of post-traumatic disorder are often diagnosed in people who survived the war.

Important: those prone to PTSD also include individuals suffering from narcissism, any kind of addiction - drug addiction, alcoholism, prolonged depression, excessive addiction to psychotropic, neuroleptic, sedative drugs.

Post Traumatic Stress Disorder: Symptoms

The response of the psyche to severe, experienced stress is manifested by certain behavioral traits. The main ones are:

a state of emotional numbness;
constant reproduction in thoughts of an experienced event;
detachment, withdrawal from contacts;
the desire to avoid important events, noisy companies;
detachment from society, in which they again pronounce what happened;
excessive excitability;
anxiety;
panic attacks, anger;
feeling of physical discomfort.

The state of PTSD, as a rule, develops after a certain period of time: from 2 weeks to 6 months. Mental pathology can persist for months, years. Depending on the severity of the manifestations, experts distinguish three types of PTSD:

Acute.
Chronic.
Delayed.

The acute type lasts for 2-3 months, with chronic symptoms persist for a long period of time. With a delayed form, post-traumatic stress disorder can manifest itself after a long period of time after a dangerous event - 6 months, a year.

A characteristic symptom of PTSD is detachment, alienation, a desire to avoid others, that is, there is an acute reaction to stress and adaptation disorders. There are no elementary types of reactions to events that cause great interest in ordinary people. Regardless of the fact that the situation that traumatized the psyche is already far behind, patients with PTSD continue to worry and suffer, which causes the depletion of resources capable of receiving and processing fresh information flow. Patients lose interest in life, are not able to enjoy anything, refuse the joys of life, become uncommunicative, move away from former friends and relatives.

A characteristic symptom of PTSD is detachment, aloofness, and a desire to avoid others.

Acute reaction to stress (mcb 10): types

In the post-traumatic state, two types of pathologies are observed: obsessive thoughts about the past and obsessive thoughts about the future. At the first sight, a person constantly “scrolls” like a film an event that traumatized his psyche. Along with this, other shots from life that brought emotional, spiritual discomfort can be “connected” to the memories. It turns out a whole "compote" of disturbing memories that cause persistent depression and continue to injure a person. For this reason, patients suffer:

eating disorders: overeating or loss of appetite:
insomnia;
nightmares;
outbursts of anger;
somatic failures.

Obsessive thoughts about the future are manifested in fears, phobias, unfounded predictions of the repetition of dangerous situations. The condition is accompanied by symptoms such as:

anxiety;
aggression;
irritability;
isolation;
depression.

Often, affected persons try to disconnect from negative thoughts through the use of drugs, alcohol, psychotropic drugs, which significantly worsens the condition.

Burnout syndrome and post-traumatic stress disorder

Two types of disorders are often confused - EBS and PTSD, however, each pathology has its own roots and is treated differently, although there is a certain similarity in symptoms. Unlike stress disorder after a trauma caused by a dangerous situation, tragedy, etc., emotional burnout can occur with a completely cloudless, joyful life. The cause of SES can be:

monotony, repetitive, monotonous actions;
intense rhythm of life, work, study;
undeserved, regular criticism from outside;
uncertainty in the assigned tasks;
feeling of underestimation, uselessness;
lack of material, psychological encouragement of the work performed.

FEBS is often referred to as chronic fatigue, which can cause people to experience insomnia, irritability, apathy, loss of appetite, and mood swings. The syndrome is more often affected by persons with characteristic character traits:

maximalists;
perfectionists;
overly responsible;
inclined to give up their interests for the sake of business;
dreamy;
idealists.

Often housewives who daily engage in the same, routine, monotonous business come to specialists with CMEA. They are almost always alone, there is a lack of communication.

Burnout syndrome is almost the same as chronic fatigue.

The pathology risk group includes creative individuals who abuse alcohol, drugs, and psychotropic drugs.

Diagnosis and treatment of post-traumatic stress situations

The specialist diagnoses PTSD based on the patient's complaints and analysis of his behavior, collecting information about the psychological and physical traumas he has suffered. The criterion for establishing an accurate diagnosis is also a dangerous situation that can cause horror and numbness in almost all people:

flashbacks that occur both in the state of sleep and wakefulness;
the desire to avoid moments reminiscent of the stress experienced;
excessive excitement;
partial deletion from the memory of a dangerous moment.

Post-traumatic stress disorder, the treatment of which is prescribed by a specialized psychiatrist, requires an integrated approach. An individual approach to the patient is required, taking into account the characteristics of his personality, type of disorder, general health and additional types of dysfunctions.

Cognitive behavioral therapy: the doctor conducts sessions with the patient in which the patient fully talks about his fears. The doctor helps him to look at life differently, rethink his actions, directs negative, obsessive thoughts in a positive direction.

Hypnotherapy is indicated for the acute phases of PTSD. The specialist returns the patient to the moment of the situation and makes it clear how lucky the surviving person who survived the stress is. At the same time, thoughts switch to the positive aspects of life.

Drug therapy: taking antidepressants, tranquilizers, beta-blockers, antipsychotics is prescribed only when absolutely necessary.

Psychological assistance in post-traumatic situations may include group psychotherapy sessions with individuals who have also experienced an acute reaction at dangerous moments. In such cases, the patient does not feel “abnormal” and understands that a large number of people have difficulty coping with life-threatening tragic events and not everyone can cope with them.

Important: the main thing is to consult a doctor on time, with the manifestation of the first signs of a problem.

PTSD is treated by a qualified psychotherapist

Having eliminated the beginning problems with the psyche, the doctor will prevent the development of mental illness, make life easier and help you quickly and easily survive the negative. The behavior of loved ones of a suffering person is important. If he does not want to go to the clinic, visit the doctor yourself and consult with him, outlining the problem. You should not try to distract him from difficult thoughts on your own, talk in his presence about the event that caused the mental disorder. Warmth, care, common hobbies and support will be just right, by the way, and the black stripe will quickly change to light.