*SCHOOL PAPER* Final: Acute Stress Disorder

 

Acute Stress Disorder (ASD)

We All Know Stress

Stress, by definition, is a chemical, emotional or physical influence that causes an individual mental, physical or emotional tension (Jones, T. L. 2001). Every person experiences their own stress: emotional, physical and mental. Hard day at work, arguing with a loved one, carrying a child, purse and the groceries... it is all stress. Every person experiences and acts out their stress differently, as well. A stressed infant may cry, a stressed teenager may slam doors and blast their music, and a stressed adult may pour a glass of wine or read a good book. These are normal every day stressors, but for some individuals, these normal stressors are much more intense as they live with a form of a stress disorder such as post traumatic stress disorder – often abbreviated as PTSD – or a lesser form known as Acute Stress Disorder.

What makes living with a stress disorder different than experiencing normal day to day stress? Simply put, many tress disorders are diagnosed in an individual after they experience a trauma, and therefore a lot of their stress becomes triggers for other things that may affect their lives and make different tasks nearly impossible to complete.

First Things First

When the individual begins to feel different, “off”, easily upset or if a loved one points out a change in the individual's emotions, behavior and demeanor after the traumatic event, these would be the first sign the the individual may want to make an appointment to speak with their doctor to get a diagnosis and develop a treatment plan. With Acute Stress Disorder, there are usually many options available as a treatment plan, but the main two are medications or cognitive behavioral therapy. At that time, it would the patient's choice of what route of treatment they would like to use. If the individual choose medications, then they have to have another discussion with their doctor to figure out what form and type of medication they would like to take based off of the doctors recommendation. The treatments can vary greatly as it would be dependent on the severity of the level of Acute Stress Disorder.

What Is Acute Stress Disorder?

Acute Stress Disorder – or abbreviated as ASD – is usually diagnosed after an individual has gone through or witnessed a traumatic or petrifying experience, such as a car accident, fire, shooting or assault. Acute Stress Disorder can even be diagnosed after an individual has been diagnosed with a life threatening disease, such as a terminal cancer that can not be treated. The individual has lived through the traumatic events or lived through receiving the terrifying news, of those individuals, an average of 5 to 20 percent (Acute Stress Disorder. 2019) of the individual's will end up diagnosed with Acute Stress Disorder due to the trauma.

The diagnosis of Acute Stress Disorder is often accompanied by the diagnosis of anxiety and depression – the three seem to dance hand in hand but with various factors and levels. An indiviaul is usually able to receive a diagnosis of Acute Stress Disorder as soon as three days after the individual began experiencing any of the symptoms that are caused by the body's natural stress hormones – such as epinephrine, adrenaline and cortisol. These hormones would have been triggered as the individual was experiencing the trauma.

The first symptoms that the individual may experience would include flashbacks to the trauma, nightmares, difficulty remembering the trauma, dissociation, difficulty concentrating, among many other possible symptoms. With these symptoms, also comes the symptomatic affects that come with depression and anxiety, such as restlessness, paranoia, heightened self awareness, a constant feeling of exhaustion and unable to find joy or energy in daily activities that used to be easy and enjoyable for the individual. The individual could also experience more physical symptoms such as chest pain, stomach pain, palpitations, difficulty breathing, headaches and nausea – though some individual's will experience different symptoms, it is not unusual for symptoms to start to affect the individual within minutes of the trauma that was experienced, but can also take days or weeks while the individual's adrenaline calms down allowing the body to feel other side effects.

What is PTSD?

Post Traumatic Stress Disorder is defined as a psychiatric disorder that is usually diagnosed in individuals who have witnessed or personally experienced a traumatic event, much like Acute Stress Disorder. Post Traumatic Stress Disorder often comes with the effects of having disturbing and realistic thoughts and feelings that the individual experienced during the initial traumatic event. The individuals who are diagnosed with Post Traumatic Stress Disorder may relive the trauma for the rest of their lives and possibly have more triggering events than someone who lives with Acute Stress Disorder, such as loud noises or someone bumping into them (Torres, F. 2020).

The main difference between Acute Stress Disorder and Post Traumatic Stress Disorder is within the symptoms. The symptoms of Post Traumatic Stress Disorder can usually be organized into four categories: avoidance, intrusion, change in cognition and mood and change in arousal. These symptoms will be experienced in various levels, but are often debilitating to the individual causing them to feel unable to perform daily activities or have a nervous response to the activities, such as if the individual has realistic flashback nightmares each night, the individual may become more nervous of sleeping in general. While society often ties the two together, Post Traumatic Stress Disorder is not just diagnosed in military personal, but in reality, an estimated 1 in 11 people will have a diagnosis of Post Traumatic Stress Disorder within their own lifetime, that is equivalent to around 3.5 percent of adults living in the United States will be diagnosed with Post Traumatic Stress Disorder every year (Torres, F. 2020).

Neurochemical Systems

It is theorized that if an individual is diagnosed with Acute Stress Disorder and chooses to not acknowledge the diagnosis or does not seek help through either a medication or counseling that the Acute Stress Disorder will progress into Post Traumatic Stress Disorder. The theory is based off of the fact that Acute Stress Disorder is a form of Post Traumatic Stress Disorder, which is also why there are many similarities to the two trauma stress disorders. The progression does not always happen, but it is possible for many individuals since they are both trauma based conditions which take a DSM 5 diagnostic (Lenferink, L. I., M. R., Kullberg, 2020).

Due to the similarities, it make it really important to pay attention to some of the differences in symptoms so the changes in the neurochemical system, along with the changes in the different regions of the individual's brain is detected and shows the progression of Acute Stress Disorder. These changes are pretty evident due to the effects will be seen when the individual is living with chronic stress, so it will be likely to see a trauma response in an individual who lives with a stress disorder compared to an individual who does not. The change in the individual's brain can become long term and affect how the individual's brain responds during times of high stress or future traumas. The regions of the brain that are effected the most are the amygdala, the hippocampus and the medial prefrontal cortex (Bremner J.D. 2006). In these changes, it is theorized that either an overabundance or an insufficiency of cortisol and norepinephrine are being transmitted through the brain and body of the individual. Cortisol and norepinephprine are the two neurochemical systems that play very important roles in an individual's stress and trauma response during heightened times.

Cortisol, which is created in the body's adrenal glands, is a steroid type hormone whose main job is regulating the majority of the processes that happen within the individual's body – such as the immune response and the body's metabolism. Cortisol also lends a huge helping hand to how the individual's body responds to stress and trauma, which is why it is important in diagnosis Acute Stress Disorder. Norepinephrine – which is the same as noradrenaline – is also created in the body's adrenal glands. Unlike cortisol, norepinephrine is a neurotransmitter that helps the individual's body send messages and important signals throughout the nerve endings within the body. Norepinephrine is responsible for the increase in an individual's heart rate and for the seemingly quickened speed of the blood that is pumping from the heart when the individual is experiencing stress or an increase in their adrenaline.

Is There Treatment?

To treat Acute Stress Disorder, or at least, put a stop in it from progressing into Post Traumatic Stress Disorder, the individual's primary care doctor will usually recommend one of three treatments: cognitive behavioral therapy, medications or mindfulness. Since the treatments do vary pending the severity of the level of the Acute Stress Disorder, the recommended treatment can also be based off of the goal that the individual has for themselves; whether they want help managing their Acute Stress Disorder during times where a triggering event is present or if the individual's main goal is to preent their Acute Stress Disorder from progressing into Post Traumatic Stress Disorder.

It is normal for the first recommendation from the doctor to be cognitive behavioral therapy – or CBT – which connect the individual with a mental health professional to work with. This is usually seen as the individual having sessions with a psychologist or counselor. Together the individual and professional will have a goal of creating and practicing coping mechanisms for the individual to use in times of heightened stress, experiencing flashbacks or is going through another traumatic event. This treatment is thought to give the individual tools to use so that their Acute Stress Disorder does not hold the reigns on the individual's life during heightened times by giving the individual tools to use to take back control and be able to work their own way through the stress and fear.

Mindfulness would likely be the second treatment to be suggested, especially if the individual already performs mindfulness techniques such as breathing techniques, yoga or other forms of meditation. Mindfulness is taking medication and breathing exercises and giving them a purpose of helping the individual feel better during heightened times. These would all be intervention based techniques formed around the goal of helping the individual manage their stress and anxiety on their own.

Medication would be the third recommendation, which would start by the individual consulting their primary care doctor about different antidepressants or anticonvulsants that their doctor would recommend and what the individual would feel comfortable taking after learning the side effects. The medication route could be more of a trial and error method as it is possible it may take some time to find the correct medication and dosage – if more than one dosage is offered, such as with Lexapro, and finding the correct combination for the individual and their case since each diagnosis of Acute Stress Disorder is different than the other.

The Medicated Side of ASD

If the individual decides that they want to go with a mediation based treatment plan, a discussion would happen between the individual and their doctor on what type of medication would be best for the individual's specific case: selective serotonin reuptake inhibitors – also known as SSRIs-, Benzodiazepines, Antidepressants, Propranolol, Morphine, Hydrocortisone or Docosahexaenoic Acid (Sauer, J., & Bhugra, D. 2001).

The individual choosing the pharmacotherapy route of treatment, the individual is looking into taking either a single medication or a mix of medications that have been previously tested and proved to either treat the symptoms of Acute Stress Disorder itself or, at minimum, put a stop to the escalation of the Acute Stress Disorder developing into Post Traumatic Stress Disorder. The trick would then be finding which pharmacotherapy that both the individual and the doctor feel would work in the individual's case (Friedman, M.J., & Sonis, J.H. 2020). This plan can be developed by some trial and error with the basis of what what seems to work best for the individual and what they feel most comfortable with – part of the treatment could also include the individual using a prescribed medication in hand with behavioral or psychological therapies.

So Many Medications, Who Has The Time

Selective serotonin reuptake inhibitors and other antidepressants, the most commonly prescribed example being medications such as Lexapro, are often the first form of pharmacotherapy that a doctor will recommend when reducing the chances of Acute Stress Disorder progressing into Post Traumatic Stress Disorder. Clinical trials have not proven any benefits in treating Acute Stress Disorder with SSRIs and have received mixed data and results with treatment using other forms of antidepressants. Even with the lack of proof in treatment, SSRIs are likely to be the first recommended medication due to the flexibility within the medications themselves due to being able to pair different medications with another and alter the dosage pending on the needs of the individual and what is most effective. This flexibility also leaves some room for adjustments in the treatments, such as starting at a lower dose of the medication and then increasing it as needed, and possibly vice versa as the individual learns other coping mechanisms that could cause them to not need the assist from medications. When an individual is taking antidepressants, the medication increases the reuptake of serotonin, while also assisting the individual's body in increasing how much serotonin and mirtazapine the body releases on its own (Day, L.T., & Jeanmonod, R.K. 2008).

Reuptake is the process that happens within the individual's brain that will affect how a neuron will retrieve a chemical that had not been retrieved by the previous neurons in the line, even though there is barely any space between neurons, things still get missed. After the chemical has been retrieved, the brain's neurons then send message like signals to each other by sending the retrieved chemical through one another, much like a message being sent through a telephone line from one home to another; the chemical going from one neuron to the next. Reuptake is a greatly important process since it allows the recycling and reuse of the brain's neurotransmitters while also working on balancing the population of the neurotransmitters and controls how long a signal and message is being passed through the brain and body's neurotransmitters.

Benzodiazepines- such as Valium – are usually prescribed if the anxiety that is holding hands with the Acute Stress Disorder, is the main stressor to the individual, instead of the depression or triggers. Benzodiazepines are prescribed to help with anxiety and sleeping problems, in most cases. Benzodiazepines are looked at medically as more of a sedative, sometimes the individual will even feel a hypnotic effect that will cause the individual to feel drowsy and unable to focus, when comared to other medications that doctors could prescribe. Benzodiazepines work to slow the individual's body's functions while also increasing the gamma amino butyric acid along with the effects that the GABA has on the individual's brain. As the benzodiazepines slow the body's functions, in turn, the central nervous system also slows down (Bryant, RA, Masterodomenico J, Felmingham KL. 2008).

Propranolol is a form of pharmacotherapy that has been shown to be more effective if used closer to the individual's exposure of their trauma. The theory behind using propranolol is to reduce any triggering and further trauma responses which would create the individual's brain to condition to the memories, causing the brain to be unable to create a condition response to any triggers that could potentially cause the Acute Stress Disorder to progress into Post Traumatic Stress Disorder. In short, the theory is that if the individual uses a propranolol, the chance of the escalation would be diminished (Sauer, J., & Bhugra, D. 2001). The path of using propanolol is more meant to be a short term relief since propranolol is a beta blocker which would change the reaction in the individual's body to nerve impulses. Propranolol is meant to slow the individual's heart rate, causing the heart to pump blood throughout the individual's body with each so that there is no “blood rushing” feeling that often is felt when an individual feels anxious during heightened times. This is an ideal form of treatment if the individual feels that they can manage their Acute Stress Disorder until faced with experiencing a trigger, such as long car rides or public speaking.

Morphine can also help an individual that has been through a traumatic experience due to morphine reducing the norepinephrine. Neroepinephrine increases the individual's heart rate and can cause the individual to feel a “blood rushing” feeling due to there being an increase in the blood that the individual's heart is trying to steadily pump throughout the body. Receiving a dose of morphine has been shown to reduce or at least slow down Post Traumatic Stress Disorder symptoms from being an initial concern right after the trauma, which gives the individual more time to receive help and develop a treatment plan to manage their Acute Stress Disorder before it progresses (Alder-nevo, G., & Manassis, K. 2005). The use of morphine has been seen to help ward off Post Traumatic Stress Disorder, randomized trials and testing has not been completed causing morphine to not be used as a treatment, but instead just as the first helping hand to help the individual's body reduce the pain that is being felt and helping give time before the brain conditions the pain to the traumatic event that was experienced.

Lithium, a mood stabilizer and commonly prescribed for individual's who live with manic depression, can be prescribed as a pairing with other medications to act as a booster, though can also be taken on its own. Lithium is not often prescribed for Acute Stress Disorder, but can be added to the medication cocktail if it is a severe case or the doctor and individual feel as if adding lithium is needed. When an individual takes lithium, their GABA neurotramission is boosted while the transmissions of other chemicals, such as dopamine, are slowed down and some even fully stopped. Lithium can also act as a dopamine receptor, increasing serotonin and decreasing the norepinphine. It is not uncommon for doctors to prescribe lithium as a last resort when working on a treatment plan for Acute Stress Disorder as lithium can cause a dependency along with lasting neurological effects on the individual who takes it.

What if Pharmacotherapy Does Not Feel Right

There seems to be an urgency for the individual to find a method that works for them to help manage, live with and cope with their Acute Stress Disorder before it progresses into Post Traumatic Stress Disorder, but in reality that is always time to change the form of treatment if the individual does not feel like medication, or any form of treatment they chose, is working for them. For some medications, different doses are available so if the individual likes the effects of the medications but feels like its too little or too much, the individual is able to speak with their doctor and adjust the dosage, or they can discuss changing the treatment plan all together (Pennington, J.G., & Guina, J. 2017).

The individual could possibly be advised to take a form of placebo or medication for the rest of their life in order to help them manage their Acute Stress Disorder, but just as with many diagnosis, there are always other options that can be looked into if the individual does not want to feel as if they are reliant on a medication for the rest of their days.Some natural remedies have been seen to help, such as Saint John's Wart when taken with Vitamin D. Medication and therapy are not the only options that an individual has as a treatment plan if that is not what they feel comfortable with, which is why it is important for the individual to speak openly about concerns, wants and what they do not want, with their doctors. Though developing a treatment plan seems as if it is time sensitive so that there is no progression or worsening of the Acute Stress Disorder diagnosis, it is important when an individual is dealing with a stress disorder, that the individual feel comfortable and confident in their treatment plans as it may be something that they use for the rest of their life.

Continue Living

Every person experiences stress, and those who live with a stress disorder possibly feel it more intensely, irrationally or more frequently but the good news is that in most cases its manageable and something that people can live with. The individual learns their new view on the world, possibly with assistance of medications or a mental health professional but the individual will learn to live with their Acute Stress Disorder along with the trauma that it came from, though it make take a lot of adjusting, time and patience from both the people in the individual's environment and, more importantly, the individual with themselves. This is a new world, things have changed without actually changing, and that is okay. Breathe, adjust and continue on.

Resources

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Bremner J. D. (2006). Traumatic stress: effects on the brain. Dialogues in clinical neuroscience, 8(4), 445–461.

Bryant, R. A. (2018). The Current Evidence for Acute Stress Disorder. Current Psychiatry Reports, 20(12), 111. https://doi-org.proxy-library.ashford.edu/10.1007/s11920-018-0976-x

Bryant RA, Mastrodomenico J, Felmingham KL, et al. Treatment of acute stress disorder: a randomized controlled trial. Arch Gen Psychiatry 2008; 65:659.

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Friedman, M. J., & Sonis, J. H. (2020). Pharmacotherapy for PTSD: What psychologists need to know. In L. F. Bufka, C. V. Wright, & R. W. Halfond (Eds.), Casebook to the APA Clinical Practice Guideline for the treatment of PTSD. (pp. 207–232). American Psychological Association. https://doi-org.proxy-library.ashford.edu/10.1037/0000196-010

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Torres, F. (2020). What is Posttraumatic Stress Disorder. American Psychiatric Association. Retrieved from: https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd