Acute stress reactions

Within the nervous system, ChEs were shown to be involved in membrane conductance and transmission of excitatory amino acids, learning and memory, neurite growth, neuritic translocation and acute stress reactions. Recent findings propose AChE s involvement in apoptosome formation [2]. 

Anticonvulsant As adjunctive therapy in the management of partial seizures (clorazepate) adjunctively in status epilepticus and severe recurrent convulsive seizures (diazepam IV) adjunctively in convulsive disorders (diazepam oral). Preoperative For preoperative apprehension and anxiety (chlordiazepoxide, diazepam IV) prior to cardioversion for the relief of anxiety and tension and to diminish patient s recall (diazepam IV) adjunctively prior to endoscopic procedures for apprehension, anxiety, or acute stress reactions and to diminish patient s recall (diazepam) ... 

Acute stress When symptoms are associated with acute stress reactions, treatment with methylphenidate usually is not indicated. 

BZDs such as chlordiazepoxide (Librium) or diazepam (Valium) may be prescribed to treat anxiety, seizures, acute stress reactions, and panic attacks, or to alleviate the side effects of drug or alcohol withdrawal. Those BZDs with a more sedating effect, such as estazo-lam (ProSom) or triazolam (Halcion), may be prescribed for short-term treatment of sleep disorders. However, the newer generation of non-BZD agents—zolpidem (Ambi-en) and (Sonata)—are less potentially addictive hypnotic drugs than the BZDs. 

The duration of treatment is often a controversial issue. Anxiety disorders (apart from the self-limiting acute stress reaction) are chronic conditions and may require treatment for as long as that used in depression. In a first episode, patients may need medication for at least 6 months, withdrawing over a further 4-8 weeks if they are well. Those with recurrent illness may need treatment for 1-2 years to enable them to learn and put into place psychological approaches to their problems. In many cases the illnesses are lifelong and chronic maintenance... 

Natural disasters, catastrophic illnesses, incest, rape, and assault are but a few common life experiences that can unleash a wave of intense emotional stress. Acute stress reactions or "traumatic neuroses" were first addressed in the clinical literature during World War I, as thousands of soldiers returned from the front suffering from severe anxiety, insomnia, and nightmares attributed to "shell shock." The understanding of acute stress reactions was furthered by the pioneering work of Eric Lindeman. 

Treatment of acute symptoms remains supportive, whereas longterm developments require more specific interventions. Psychiatric treatment of acute exposures requires initial management of acute stress reactions, often in a mass casualty environment, followed by individual treatment for posttraumatic stress disorder or other mood disorders in certain survivors. As seen in nuclear disasters, the lack... 

Acute stress reaction Exceptionally stressful trauma (see below) Immediately after trauma. Resolves within hours - days Dazed, disoriented, unable to take in information Tearful, angry, anxious, despairing Overactive/withdrawn Dissociated... 

Stress reactions Adjustment disorders Acute stress reaction Post-traumatic stress disorder (PTSD) Fugue/dissociative states Establish history of stressor(s) and timeline... 

The development of mild forms of anxiety and neuroveg-etative and/or cognitive responses to stress may represent an adaptive evolutionary step against environmentally (external) or self-triggered (internal) threats, but maladaptive reactions have also emerged in human evolution. Thus, anxiety disorders are maladaptive conditions in which disproportionate responses to stress, or even self-evoked responses, are displayed. Anxiety disorders are one of the most frequent psychiatric illnesses, and have a lifetime prevalence of 15- 20% [1, 89]. The most common presentations are generalized anxiety disorder, with a lifetime prevalence rate of close to 5% [1, 89] social anxiety disorder, with very variable lifetime prevalence rates ranging from 2 to 14% [90] panic disorder, with rates from 2 to 4% [1,89] and post-traumatic stress disorder (PTSD), with a prevalence rate close to 8%. Specific phobias, acute stress and obsessive-compulsive behavior are other clinical presentations of anxiety disorders. 

The NE system mediates various autonomic, neuroendocrine, emotional and cognitive functions. One of the central roles of NE is response to stress and aversion. This role can be summarized as an activation of response to the acute stress and aversion, followed by decreased reaction to repeated or chronic aversion. Since the response to stress and aversion is a basic part in pathology of mood disorder, NE should play an important role in anxiety, depression and mania. Indeed, this role has been demonstrated in numerous animal and human studies. Majority of antidepressant drugs and mood stabilizers affect NE system as their direct or indirect target. Various medications have different effects on NE neuronal activity. The majority of antidepressants, Li and benzodiazepines suppress NE transmission. Other medications, such as AADs, activate NE neuronal firing activity and NE release. Appropriate combination of different medications, based on the consideration of their effect on NE system, might be critical to obtain good treatment outcome. The combination of SSRIs... 

Acute stress disorder is anxiety in response to a recent extreme stress. Although in some respects it is a normal and understandable reaction to an event, the problems associated with it are not only the severe distress the anxiety causes but also the risk that it may evolve into a more persistent state. 

Ilechukwu ST. Acute psychotic reactions and stress response syndromes following intramuscular aqueous procaine penicillin. Br J Psychiatry 1990 156 554-9. 

Pregnancy triggers many physiological stress reactions and is associated with increased concentrations of acute-phase reactant proteins. The erythrocyte sedimentation rate increases fivefold during pregnancy. 

Vesicants share some common properties that are noteworthy in attempts to achieve a better understanding of their pathogenesis. One characteristic is that they all induce an acute inflammatory reaction (Sidell et al., 1997 Sciuto, 1998 Ricketts et al., 2000 Naghii, 2002 Segal and Lang, 2005), of which a subcomponent is oxidative stress (OS) (Bartsch and Nair, 2006). A consequence of OS is the oxidation of thiol groups, which is seen in all of the vesicant exposures (Vissers and Winterboum, 1995 Pant et al., 2000 Carr et al., 2001). 

As for the human experience, workers exposed to small amounts of nerve agents that produced mild, nonthreatening medical signs of exposure, reported CNS effects such as headache, insomnia, excessive dreaming, restlessness, drowsiness, and weakness. Clearly, exposure to nerve CWA may produce stress reactions, organic brain syndromes, or both, McDonough and Romano provide a deeper discussion of the effects of acute or chronic exposure to nerve agents in Chapter 4 of this book. 

Stress reactions to occupational and community chemical exposures occur in both acute and chronic forms. Much of the literature pertaining to community reactions to chronic chemical exposures involves hazardous waste sites. By 1988, the Environmental Protection Agency (EPA) identified 29,300 sites needing cleanup. The EPA listed 950 of them on the National Priorities List, also known as the Superfund sites [Health Aspects of the Disposal of Waste Chemicals 1986 Upton et al. 1989). Several sources review the medical and environmental aspects of hazardous waste sites (Andelman and Underhill 1987 Committee on Environmental Epidemiology 1991 Epstein et al. 1982 Health Aspects of the Disposal of Waste Chemicals 1986 Petts 1994 Weisaeth 1984). The most common chemicals in these sites include trichloroethylene, lead, toluene, benzene, chloroform, polychlorinated biphenyls, and miscellaneous solvents (Upton et al. 1989). 

Regardless of the chemical or radiation involved, acute and chronic stress reactions to perceived exposures have universal similarities (Table 2-2). The array of acute responses to such events was shown after a chemical disaster at Norway s largest paint factory in 1976 (Weisaeth 1989). Many victims completely lost the capacity to think and perceive. Some became stupified, torpid, and completely motionless. Others ran in uncontrolled flight or developed stereotyped actions. A few became leaders and led terrified victims to safety. 

TABLE 2-2. Acute and chronic stress reactions to chemical exposures... 

Acute stress disorder (a new category in DSM-IV to address acute reactions to extreme stress) Occurs within four weeks of the stressor and last from two days to four weeks may help predict the development of PTSD... 

In the DSM-IV, there is a new category similar to PTSD called acute stress disorder (ASD), which was added to address acute reactions to extreme stress. The onset of the stress reaction is expected to occur within four weeks of exposure to the stressor, and the experience will generally last from two days to four weeks. Many professionals believe that this condition may later lead to heightened symptoms present in the development of PTSD. 

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