OSD is a severe 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 that threaten the life of an individual or those close to him (for example, a natural disaster, an accident, fighting, criminal behavior, rape) or an unusually abrupt and socially disruptive change in the patient's social status and/or environment, such as the loss of many loved ones or a house fire. 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 resilience 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 recovery and worsening 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).

Quite clear diagnostic criteria for OSD are formulated in the DSM-IV:

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

1) the traumatic event recorded was determined by an actual threat of death or serious injury (i.e., a threat to physical integrity) to the patient himself or to 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 time of or immediately after the completion of the traumatic event, the patient experienced three (or more) dissociative symptoms:

1) a subjective feeling of numbness, detachment (alienation) or lack of a live 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 a traumatic situation).

C. The traumatic event repeatedly appears forcefully in the mind with re-experiencing one of the following: images, thoughts, dreams, illusions, or subjective distress when reminded of the traumatic event.

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

E. There are symptoms of anxiety or increased tension (for example, problems with sleep, concentration, irritability, hypervigilance), excessive reactivity (increased fearfulness, flinching at unexpected sounds, motor restlessness, etc.).

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

G. The disorder lasts 1–3 days after the traumatic event.

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

Dissociative disorders

main feature dissociative disorders - disturbances in the integration of the functions of consciousness, memory, identity and perception. The following disorders are included in this section.

Dissociative amnesia (DA). Characterized by an inability to remember important personal information, usually of a traumatic or frustrating nature, that is too broad to be explained in terms of normal forgetting or deliberate malingering. The criteria for its diagnosis are:

A. Predominant Impairment - One or more episodes of inability to remember important personal information, usually of a traumatic or frustrating nature, that is too extensive to be explained by normal forgetting.

B. The impairments present occur independently and not solely within the context of other disorders, such as multiple personality disorder, dissociative fugue disorder, PTSD, OSD, or somatization disorder, and are not due to substance abuse or severe medical illness.

C. The symptoms cause clinically significant distress or impairment of functioning.

There are several types of dissociative amnesia. At limited form a person is unable to remember events that occurred within a specified short period of time, usually within the first few hours of a traumatic event (for example, a person who survived a car accident in which a family member died cannot remember anything that happened for 2 days since the accident). At selective amnesia a person can remember some, but not all, events within a limited period of time (for example, a combatant remembers only selected events during a period of intense hostilities). Three other types of amnesia - generalized, continuous And systematizing- less common. Generalized amnesia affects a person's entire life, including inability to remember given name. At continuous amnesia there is an inability to remember events that followed a certain point in time, up to the present. Systematized amnesia– loss of memory for events of a certain kind, for example all memories relating to a family or a specific person.

It is often combined with depressive disorders, anxiety, depersonalization, as well as other dissociative disorders (trances, psychogenic anesthesia, puerilism, conversion disorders).

Dissociative fugue (DF)– a sudden, unmotivated, causeless and unexpected trip or journey from home or not to the usual place of work, accompanied by amnesia of the personal past, a violation of ideas about one’s own personality, or imagining oneself as a different person. Such travel can range from short-term (i.e., hours or days) movements over short distances to complex involuntary wanderings over long periods of time (weeks, months) for some people, sometimes making transnational trips of thousands of kilometers. During the fugue, patients may appear completely normal, show no pathology, or attract attention at all. Outwardly, they habitually perform purposeful actions and logically explain their behavior. However, at some point they come to the attention of psychiatrists, usually due to amnesia for recent events, an inability to remember how they ended up in a given area, or due to a lack of information about their identity.

After returning to the pre-morbid state, there is often amnesia for traumatic events in the past (not counting the fugue period), as well as affective disorders - depression, dysphoria, anxiety, feelings of grief, shame, guilt. Suicidal and aggressive tendencies, manifestations of pseudodementia or Ganser syndrome may be present.

Diagnostic criteria for DF:

a) signs of dissociative amnesia;

b) purposeful travel that goes beyond normal daily activities;

c) maintaining personal care (eating, washing, etc.) and simple social interaction with strangers(for example, patients buy tickets or gasoline, ask for directions, order food).

The prevalence of DF in the population is about 0.2%, but can increase during natural disasters and wartime.

Dissociative stupor– a sharp decrease or absence of voluntary movements and speech, as well as normal reactions to light, noise and touch. At the same time, maintaining normal muscle tone, static posture and breathing (and often limited coordinated eye movements) is maintained.

Ganser syndrome- one of the variants of hysterical twilight stupefaction. Patients cannot answer basic questions, perform this or that simple action, solve a simple arithmetic problem, or explain the meaning of a picture. However, the patients’ answers, despite the obvious absurdity, are usually in line the question asked. At first glance, patients act at random, but nevertheless the general direction of the required action is preserved. Patients are disoriented in their surroundings, indifferent to what is happening around them, laugh senselessly and suddenly express fear, are fussy and restless. After exiting the described state, amnesia is noted.

Pseudo-dementia- a condition manifested by an imaginary loss of simple skills, basic knowledge, incorrect answers, close to Ganser syndrome, but characterized by a less deep twilight stupefaction. Patients are confused and complain about the inability to understand surrounding situation, look senselessly in front of them, answer inappropriately, are foolish, roll their eyes, sometimes laugh, sometimes become depressed. They cannot cope with the simplest task, answer a question of ordinary content, and at the same time unexpectedly correctly answer a complex question. There are depressive and agitated forms of pseudodementia: with the first, patients are lethargic, depressed, and lie around a lot, with the second, they are fussy, restless, and foolish. Pseudodementia states can last from several days to several months.

Puerilism- ridiculous, childish behavior inappropriate for an adult with childish manners, gestures, and pranks. Patients play with toys, are capricious, cry, form childish phrases, speak with childish intonations, and lisp. The “uncles” and “aunties” around them. Solving basic problems or performing the simplest actions is accompanied by gross miscalculations and mistakes. Along with childish traits, the behavior of patients retains individual habits and skills of an adult. The mood is usually depressed, despite playfulness and external mobility.

It should be borne in mind that dissociative symptoms are also included in the sets of criteria for other taxonomic units, for example PTSD, acute stress disorder according to DSM-IV, but there they are not decisive in the clinical picture.

Conversion disorders

Clinical manifestations of conversion disorders (CD) are observed mainly in the form of neurological and somatic symptoms. The term "conversion" (lat. conversio– transformation, replacement) is borrowed from psychoanalytic literature. In a clinical sense, it denotes a special pathological mechanism leading to the resolution of affect by sensorimotor acts or, in other words, causing the transformation of psychological conflicts into somatoneurological manifestations.

Among the characteristic properties of the manifestation of sensory-motor symptoms of hysteria are demonstrativeness, excessiveness, expressiveness, and intensity of manifestations; special dynamism - variability, mobility, suddenness of appearance and disappearance; enrichment and expansion of the range of symptoms under the influence of new information; the “instrumental” nature of painful disorders that act as a tool (tool) for manipulating others (weakening or even disappearance of symptoms due to the resolution of a difficult situation, exacerbation - when emotional needs are not met) (Yakubik A., 1982). The goal of manipulative behavior is to achieve participation and help, to draw attention to one’s problems, and to subordinate those close to one’s interests.

In the clinical picture of conversion disorders, two main categories of symptoms can be distinguished: motor and sensory disorders.

Movement disorders are represented by two types of disorders: hyperkinesis or other involuntary movements (trembling, shuddering, etc.) and manifestations of akinesia (paresis, paralysis). Hyperkinesis in hysteria can have various forms: tics, rough rhythmic tremor of the head and limbs, aggravated by fixation of attention, blepharospasm, glossolabial spasm, choreiform movements and twitching, but more organized and stereotypical than with neurological chorea. Unlike organic ones, hysterical hyperkinesis depends on the emotional state, is modified by the mechanism of imitation, is combined with unusual poses and other hysterical stigmas (lump in the throat, fainting), temporarily disappears or is weakened by switching attention or under the influence of psychotherapeutic influences.

Sometimes, in response to a psychogenic influence, often insignificant (a minor quarrel, unpleasant news, a sharp remark, etc.), generalized convulsive movements occur, accompanied by vegetative manifestations and impaired consciousness, which form the picture of a hysterical attack. The symptoms of a hysterical attack are varied; in severe cases, it is accompanied by loss of consciousness and a fall. Unlike epileptic paroxysms, during hysteria consciousness is not completely lost; the patient manages to fall in such a way as to avoid serious damage. A hysterical attack is often preceded by various stigmas, fainting and vegetative crises, and after convulsive paroxysms have passed, amaurosis, persistent hyperkinesis or pseudoparalysis can be detected.

Hysterical paresis and paralysis occur as mono-, hemi- and paraplegia; in some cases they resemble central spastic paralysis, in others - peripheral flaccid paralysis. Particularly common are gait disorders, best known as “astasia-abasia”, which consist in a psychogenically caused inability to stand and walk in the absence of muscle tone disorders and the preservation of passive and active movements in the supine position. Less common are aphonia, paralysis of the tongue, neck muscles and other muscle groups, hysterical contractures affecting the joints of the limbs and spine. The topography of hysterical paralysis usually does not correspond to the location of the nerve trunks or the localization of the focus in the central nervous system. They cover either the entire limb or part of it, strictly limited by the articular line (leg to knee, foot, etc.). Unlike organic ones, with hysterical paralysis there are no pathological reflexes or changes in tendon reflexes; muscle atrophy is extremely rare.

Sensory impairments most often manifested by sensitivity disorders (in the form of anesthesia, hypo- and hyperesthesia) and pain in various organs and parts of the body (hysterical pain). Skin sensitivity disorders can have the most bizarre location and configuration, but most often they are localized in the extremities. The topography of sensitivity disorders, as well as movement disorders, is most often arbitrary. Hence the amputation-type anesthesia characteristic of hysterics - in the form of stockings or gloves.

In the clinical picture of conversion hysteria, motor and sensory disorders rarely appear in isolation and are usually combined, characterized by great dynamism, variety of symptoms, complexity and variability of combinations. For example, hemiparesis usually occurs together with hemianesthesia, monoparesis - with amputation anesthesia.

More precise diagnostic criteria for conversion disorders are provided in the DSM-IV:

A. The presence of one or more symptoms affecting voluntary motor or sensory functions and resembling a neurological or physical disease.

B. The relationship of symptoms with psychological stressors ( conflict situations or other stressors precede the onset or worsening of symptoms).

C. No signs of feigning disorders.

D. Symptoms cannot be explained by a physical illness (after appropriate research).

E. Violation of social adaptation or severe distress due to the disease.

Depressive episode

An essential feature of a depressive episode is a long (at least 2 weeks) period during which the individual’s emotional background is characterized by either depressed mood or anhedonia (loss of interest or sense of satisfaction in almost all activities).

Mood during a depressive episode, patients are often described as depressed, sad, despondent, experiencing vague, painful anxiety, feelings of despair, hopelessness and desperation, which is reflected in their facial expressions with a characteristic expression of suffering, anguish, melancholy, and concern. Anhedonia, although not so noticeable in the picture of “reactive” depression, can be noted by the immediate environment of patients by the latter’s social detachment or neglect of previously enjoyable activities. These manifestations should occur almost daily for most of the duration of the episode. The severity of these impairments must be sufficient to result in noticeable impairment of social or occupational functioning.

In addition, there must be at least four additional symptoms from the following list: disturbances of appetite or weight, sleep, psychomotor activity (agitation or retardation); lethargy, fatigue, lack of strength, energy; feelings of inferiority or guilt; impaired concentration, thinking, and ability to make decisions; recurrent suicidal thoughts, plans, or attempts.

Appetite during a depressive episode, it usually decreases, in many cases to the level of physical aversion to food, so that patients feel that they have to force themselves to eat. Such appetite disturbances quickly lead to a pronounced loss of body weight.

The most common sleep disorder is insomnia, the nature of which is usually associated with the structure of affective disorders: in typical cases with the dominance of melancholy affect, shallow night sleep with frequent awakenings and early awakenings is noted; with severe anxiety, sleep disturbances also occur.

Movement disorders include agitation with the inability to sit still, constant unfocused walking, wringing of hands, fidgeting with folds of clothing, skin, etc. or lethargy with slowing of speech, thinking, up to mutism, motor skills, up to a stuporous state.

Typical are lethargy, tiredness, tiredness, lack of strength, energy even at rest. Any physical activity requires significant effort, which is reflected in a noticeable decrease in activity efficiency, even when performing ordinary, routine tasks that require much more time to complete.

A characteristic feature depressive episode in victims is guilt or less often, one’s own inferiority. This is manifested in a hypertrophied sense of responsibility for negative events that previously occurred, even through no fault of the patients, as well as in a distorted one-sided interpretation of neutral or ordinary everyday events as negative due to misbehavior patients. However, self-blame common in depression for the onset of illness or for the inability to fulfill professional or other social obligations due to illness is not yet sufficient to determine whether the symptoms meet this diagnostic criterion.

Many patients complain of impaired ability to think, concentrate or make decisions, which is often accompanied by complaints of absent-mindedness and memory loss. These symptoms are especially acute in people engaged in intellectual work, often leading to complete loss of ability to work.

A common symptom of a depressive episode is suicidal ideation. Moreover, the range of its manifestations can vary from thoughts that “it would be nice to fall asleep and not wake up” to distinct suicidal plans and preparations. In the least severe cases, such thoughts are rare (1-2 times a week), fleeting (lasting no more than 1-2 minutes) and easily suppressed by competitive ideas. On the contrary, in severe cases, patients are immersed in these experiences, purposefully and systematically, sometimes secretly, with a lot of tricks, they acquire the items necessary to commit suicide, planning well in advance when they can be left alone so that no one interferes with its implementation. The motivation for committing suicide can be very diverse - from recognition of a hopeless, seemingly insurmountable situation to the desire to end excruciatingly painful mental pain that is perceived as having no end.

As optional symptoms tearfulness, irritability, preoccupation with worries, rumination of anxious or depressive content, anxiety, phobias, hypochondriacal concern about one’s own physical health, various somatic complaints of pain (for example, headaches, back pain, etc.) are often present. Often, at the height of depressive experiences, the appearance of panic attacks can be observed.

A depressive episode should be differentiated from grief reactions that typically accompany catastrophic situations and are their integral companions. Typically the grief reaction lasts a few days or weeks and then turns to sadness. In uncomplicated cases, the reaction of loss goes through three stages: 1) emotional shock with numbness and “petrification”; 2) awareness of loss with melancholy, crying, sleep disturbance, appetite and narrowing of consciousness due to traumatic experiences; 3) humility - acceptance of what happened and the realization that life goes on.

J. Bowlby identified the following stages of grief and bereavement:

a) numbness or protest. Characterized by severe malaise, fear and anger. Psychological shock may last for moments, days or months;

b) longing and desire to return the object of loss. The world seems empty and meaningless, but self-esteem does not suffer. The patient is preoccupied with thoughts of what has been lost; physical restlessness, crying and anger occur periodically. The condition may last for several months or years;

c) disorganization and despair. Restlessness and performing aimless activities. Increased anxiety, withdrawal, introversion and frustration. Constant memories of the object of loss;

d) reorganization. The emergence of new impressions, objects and goals. Grief weakens and is replaced by highly valuable memories of the object of loss.

It is believed that a “normal” grief reaction should “conform to generally accepted norms in a given cultural environment and last, as a rule, no more than six months” (ICD-10). In longer-term cases, code F43.21, “prolonged depressive reaction,” is applied to this disorder. The phenomenology of the grief reaction may also be accompanied by the following manifestations:

– denial of loss;

– a feeling of powerlessness in the current situation;

– longing for the object of loss – obsessive thoughts, memories of it with the inability to switch;

– avoidance of everything connected with the object of loss: memories, things;

– self-identification with the object of loss (for example, adopting the character traits of a deceased person or even symptoms of an illness);

– idealization of the object of loss;

– nightmares combined with alienation, self-isolation from society.

The nature of feelings and affective experiences during the grief reaction is qualitatively different from the depressed mood characteristic of depression, especially in the case of the melancholic version of the depressive syndrome. Assessing the following symptoms may be helpful in differentiating between grief and loss reactions (Table 6).

The development of depressive symptoms during the grief reaction requires dynamic monitoring, reclassification of the condition and changes in the treatment strategy.

Table 6

Differentiating symptoms of grief and depression(based on: Kaplan G., Saddock B., 1996)

The most serious complication of a depressive episode is suicidal behavior, the risk of which is especially high in patients with psychotic forms of the disorder, with a history of previous suicide attempts, completed suicides in relatives, and concomitant substance abuse.

It should also be taken into account that the occurrence of a depressive episode is often the beginning of chronic or recurrent forms of depressive disorder, as a result of which the necessary phasing and duration of therapy should be strictly observed during the treatment and follow-up of such patients.

What is Acute Stress Reaction?

Acute reaction to stress A transient disorder of significant severity that develops in individuals without apparent mental disorder in response to exceptional physical and psychological stress and that usually resolves within hours or days. Stress may be a severe traumatic experience, including a threat to the safety or physical integrity of the individual or loved one (eg, natural disaster, accident, battle, criminal behavior, rape) or an unusually abrupt and threatening change in the social status and/or environment of the sufferer, e.g. 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).

What Causes Acute Stress Reaction?

SA;">Occurs during a strong traumatic experience (natural disaster, accident, rape, loss of loved ones). At the moment of stress, fixation on such defense mechanisms as extreme identification, repression occurs. As a result, changes in consciousness, disturbances in perception and behavior are possible.

Symptoms of 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 not all people exposed to severe stress develop this disorder. Symptoms show a typical mixed and fluctuating pattern and include an initial state of “dazedness” with some narrowing of the field of consciousness and decreased attention, inability to respond adequately 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). Partial or complete dissociative amnesia of the episode may be present. Autonomic signs of panic anxiety (tachycardia, sweating, flushing) are often present. Symptoms usually develop within minutes of exposure to a stressful stimulus or event and disappear within two to three days (often hours). The risk of developing the disease increases with physical exhaustion or in the elderly. After the loss of loved ones as a result of earthquakes, there is a conviction that the dead are actually alive, flight from the site of the tragedy, behavior with infantile traits (puerilism), freezing at the site of the tragedy and refusal to leave it. Similar reactions occur when sudden death close.

Diagnosis of Acute Stress Reaction

To make a diagnosis, there must be a clear and clear temporal relationship between exposure to the unusual stressor and the onset of symptoms; onset is usually immediate or within a few minutes. In addition, symptoms:

• have a mixed and usually changing picture; in addition to the initial state of stupor, depression, anxiety, anger, despair, hyperactivity and withdrawal may be observed, but none of the symptoms predominates for a long time;
• stop quickly (within a few hours at most) in cases where it is possible to eliminate the stressful situation. In cases where stress continues or by its nature cannot stop, symptoms usually begin to disappear after 24-48 hours and are minimized within 3 days.

If symptoms persist, then the question arises of changing the diagnosis (and management of the patient).

This diagnosis cannot be used to refer to sudden exacerbation of symptoms in individuals already presenting with symptoms that meet the criteria for any mental disorder other than specific personality disorders. However, a previous history of mental disorder does not make the use of this diagnosis inappropriate.

Treatment of Acute Stress Reaction

SA;">Tranquilizers, such as diazepam up to 20 mg, antidepressants, sleep therapy, gestalt therapy, group and family therapy.

Which doctors should you contact if you have an acute reaction to stress?

Psychiatrist

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A transient disorder of significant severity that develops in individuals without apparent mental disorder in response to exceptional physical and psychological stress and that usually resolves within hours or days. Stress may be a severe traumatic experience, including a threat to the safety or physical integrity of the individual or loved one (eg, natural disaster, accident, battle, criminal behavior, rape) or an unusually abrupt and threatening change in the social status and/or environment of the sufferer, e.g. 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).

Individual vulnerability and adaptive capacity play a role in the occurrence and severity of acute stress reactions; This is evidenced by the fact that not all people exposed to severe stress develop this disorder. Symptoms show a typical mixed and fluctuating pattern and include an initial state of “dazedness” with some narrowing of the field of consciousness and decreased attention, inability to respond adequately to external stimuli and disorientation. This state may be accompanied by either further withdrawal from the surrounding situation (up to dissociative stupor - F44.2), or agitation and hyperactivity (flight or fugue reaction). Autonomic signs of panic anxiety (tachycardia, sweating, flushing) are often present. Symptoms usually 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).

Diagnostic instructions:

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

a) have a mixed and usually changing picture; in addition to the initial state of stupor, depression, anxiety, anger, despair, hyperactivity and withdrawal may be observed, but none of the symptoms predominates for a long time;

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

This diagnosis cannot be used to refer to sudden exacerbations of symptoms in persons already having symptoms that meet the criteria for any mental disorder except those in F60.- (specific personality disorders). However, a previous history of mental disorder does not make the use of this diagnosis inappropriate.

Included:

Nervous demobilization;

Crisis state;

Acute crisis response;

Acute reaction to stress;

Combat fatigue;

Mental shock.

ACUTE REACTION TO STRESS (ICD 308)

very rapidly transient disorders of varying severity and nature, which are observed in persons without any obvious mental disorder in the past, in response to an exceptional physical or mental situation (for example, a natural disaster or combat) and which usually disappear after a few hours or days. An acute stress reaction may be a manifestation of a preexisting emotional disorder (eg, panic, agitation, fear, depression, or anxiety), a disorder of consciousness (eg, ambulatory automatism), or a psychomotor disorder (eg, agitation or stupor). Synonyms: catastrophic stress reaction; delirium in a state of exhaustion (not recommended); emotional reaction to the horrors suffered during combat operations; post-traumatic stress disorder.

The reaction to stress is acute

Thus, according to ICD-10 (F43.0.), clinical manifestations of a neurotic reaction are designated if its characteristic symptoms persist for a short period - from several hours to 3 days. In this case, stupor, some narrowing of the field of consciousness, decreased attention, inability to adequately respond to external stimuli, and disorientation are possible. Partial or complete amnesia of the stress factor is possible.

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 persons without a pre-existing mental disorder. Examples of such stress: a natural or man-made disaster, participation in a bloody military operation, a terrorist attack with many casualties, an accident with extremely tragic consequences, rape, especially group and infinitely cruel; loss of children; etc. Individual sensitivity to stress is very variable: what for one person is another serious test, for another can become a severe, unbearable mental trauma. The risk of developing this disorder increases significantly with physical exhaustion, in old age, in the presence of cerebral-organic factors, constitutional predisposition (reactive lability), the complete surprise of what happened, mass casualties, the absence of signs of adequate assistance to victims from outside, and a lack of positive experience of stress tests. The disorder develops acutely, within a few minutes, tens of minutes from the moment of realizing the fact that something indescribably terrible and unimaginable has happened. If the symptoms of an acute reactive psychotic state persist for more than 2-3 days, then its cause is not only or even not so much stress, but, most likely, something else.

The symptom complex of the disorder includes the following main features: 1. confusion with an incomplete, fragmented perception of the situation, often focusing attention on its random, side aspects 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 purposeful, adequate actions . Productive psychopathological symptoms (delusions, hallucinations, etc.) apparently do not exist or, if they occur, they are abortive, rudimentary in nature; 2. insufficient contact with patients, 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 is less common, motor and speech agitation with fussiness, confusion, confused, inconsistent verbosity, sometimes verbalizations of despair; in a relatively small proportion of patients, disordered and intense motor agitation occurs, usually in the form of panicked flight and impulsive actions that are carried out contrary to the demands of the situation and are fraught with serious consequences, including death; 4. severe autonomic disorders (mydriasis, pallor or hyperemia skin, vomiting, diarrhea, hyperhidrosis, symptoms of cerebral and cardiac circulatory failure, which causes some patients to die, etc.) and 5. subsequent complete or partial congrade amnesia. There may also be confusion, despair, a feeling of the unreality of what is happening, isolation, mutism, and unmotivated aggressiveness. The clinical picture of the disorder is polymorphic, changeable, and often mixed. In premorbid psychiatric patients, the acute reaction to stress may be somewhat different and not always typical, although information about the characteristics of the response of patients with various mental disorders to severe stress (depression, schizophrenia, etc.) seems insufficient. As a rule, the source of more or less reliable information about severe forms of the disorder is one of the strangers; they, in particular, can be rescuers.

At the end acute reaction In response to stress, in most patients, as Z.I. Kekelidze (2009) points out, symptoms of the transition period of the disorder (affective tension, sleep disturbances, psycho-vegetative 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 the confidence or hope that mobilizes him to overcome them. Treatment: placement in a safe environment, tranquilizers, antipsychotics, anti-shock measures, psychotherapy, psychological correction. Synonyms: Crisis state, Acute crisis reaction, Battle fatigue, Mental shock, Acute reactive psychosis.

Any strong traumatic event has an impact on a person. In a critical situation, the uncontrollable occurs; it begins with psychological stress and can last for a long time. If a person recovers within four weeks, then it is customary to talk about acute stress disorder. If symptoms persist longer, it is diagnosed. For this reason, a person who has experienced severe stress needs professional medical help.

Causes of acute disorder

1. Excitement or “motor storm”. Against the background of fear and shock, a person makes chaotic movements, rushes about aimlessly, and tries to escape.
2. Braking or “imaginary death”. The person cannot move, he is indifferent to what is happening, his gaze is lost, there is a state of stupor.

Let us consider the described reactions in more detail. How do they go, and what is the help?

Excitement or “motor storm”

In a situation of excitement, movements become fast and awkward. Gestures are animated and facial expressions are expressive. A person’s attention is impaired, he cannot concentrate and does not see interference around him. The pace of speech is fast, phrases are repeated, and the speech is confused. There is no semantic load in the statements. If the victim shows arousal reactions, then it is difficult for him to stay in one position.

When a person leaves the scene of an extreme event, the manifestation of acute reactions is a critical situation. For example, a pedestrian was injured in a traffic accident, but instead of calmly waiting for an ambulance, he may begin to move without feeling pain and want to leave.

What does the victim experience?

1. Fear. A panic state reduces behavioral control and the manifestation of logical actions. These factors can cause flight or an aggressive attack.
2. Nervous trembling. Such reactions are the most common after experiencing extreme events. Nervous tremors cannot stop of their own accord. This is how the tension is released. Doctors do not recommend removing it with medication - in the future this can cause psychosomatic diseases, for example, hypertension. The shaking may last for several hours, and then deep fatigue sets in.
3. Cry. Crying reactions are completely natural in an emergency situation, as internal stress is harmful to mental health. Emotional release is useful and alleviates the condition.
4. Aggressive behavior. Some people develop involuntary aggression in life-threatening situations. Anger can last for quite a long time, sometimes such a person interferes with rescue work, shouts at others, and can blame the people who suffered with him.
5. Hysterical reactions. Appears in a demonstrative manner, theatrical poses, speech is loud and with hysterical shades, there are loud sobs.

In rare cases, delusions and hallucinations occur. The person allegedly hears the voices of injured people, distorts reality, and talks to non-existent persons.

A person in a situation of excitement needs to be distracted from grief, not let out of sight, and attracted to work. Important ambulance a psychiatrist, especially if delusions or hallucinations are present.

Braking or “imaginary death”

When braking, motor and mental processes slow down, the victim alienates himself from real world. The surrounding reality is perceived as unnatural, objects seem unreal, for example, very large or of a different color.

A person sits motionless for a long time, does not perceive the people and objects around him, and does not respond to stimuli. There are no complaints, words or cries for help. If you look at the victim from the outside, it seems that he has been deprived of strength and is completely devastated. Basic reactions during braking:

1. Stupor. Characterized by a frozen posture, immobility, absence of facial expressions, gestures, speech and movements.
2. Apathy. The person has a sluggish, lethargic state, slow speech, in which there are many pauses. If help is not provided, then apathy develops into depression.

Such reactions can last for quite a long time, this leads to mental exhaustion. In addition, a person does not notice the danger; for example, during a fire, he does not see that a burning beam can fall on him.

Recovery or transition period

Acute stress disorder lasts about four weeks, during which time the person goes through several stages of experience. When the acute stress reaction has disappeared, then transition period. At this time, chest pain, abdominal pain, frequent crying, anxiety, sleep problems and other manifestations may occur.
Main stages of recovery:

1. Stressful event.
2. Severe emotional shock. Decreasing Critical Assessment situations, the body works to the limit. Psychological stress is high. Occurs after the stage of inhibition or excitation.
3. Awareness. Lasts up to 3-4 days. During this period, the scale of the tragedy is assessed, emotional deterioration begins, confusion and panic reactions predominate. All factors lead to the onset of depressive symptoms. In some cases, you feel the urge to “kill” the pain with alcohol, you want to find the culprits and punish them.
4. Gradual stabilization. It occurs in 3-12 days. Most victims experience decreased health, but the ability to act rationally returns. There is a need to remember what has been experienced. During this period, complaints of pain in the chest and stomach are recorded. This is the stage of emotional burnout.
5. Recovery. The recovery stage lasts about two weeks and begins 12-14 days after the traumatic event. Activity is restored and adaptation increases.

Video: documentary"Post-traumatic syndrome"

Conclusion

Experts say that after a strong shocking event, a person can remain in a serious condition without positive changes. In this case, the negative factors do not recede, but a syndrome of abandoned reactions occurs, which move into the post-traumatic stage, which affects the general state of the individual. Therefore, people who have experienced a traumatic event need the help of a psychiatrist or a doctor with psychotherapeutic practice. It is advisable that specialist help be provided immediately after the tragedy experienced.

Acute stress reaction is a mental disorder that develops due to significant stress. The peculiarity of this pathological condition is the fact that it develops in people who do not have mental illness.

An acute reaction to stress in the ICD-10 classifier is coded F43.0.

Reasons for appearance

This problem arises after a significant traumatic experience. Often an acute reaction to stress appears in those who have become a participant or witness to traumatic situations:

• rape;
• natural disasters;
• murders.

During times of severe stress, fixation occurs defense mechanisms: extreme identification and repression. As a result, a person falls into a new state of consciousness, which is accompanied by disturbances in behavior and perception of reality.

Predisposing factors

The appearance of an acute reaction to stress is facilitated by certain mental characteristics. Predisposing factors for such pathology include vulnerability and individual characteristics. As a result scientific research It was found that not all people who experience negative emotions and find themselves in unfavorable conditions develop mental pathology.

Factors that increase acute stress reactions during emergencies include: adolescence, physical exhaustion.

Video on the topic

Main symptoms

After an emergency, psychological disorders increase rapidly. An acute reaction to stress may persist for 2-3 days. Symptoms include a feeling of being “stunned” and disoriented in reality.

A person is unable to adequately respond to stimuli and does not perceive words addressed to him. People who have experienced severe stress try to “escape” the reality around them. Such behavior leads to increased activity and the desire to escape from the scene of a disaster (murder). An acute reaction to stress is accompanied by partial or complete amnesia of the episode that resulted in psychological trauma.

Consequences of stress reactions

In many cases, victims develop autonomic disorders:

• redness;
• tachycardia;
• fainting;
• fever or chills;
• redness;
• numbness of the limbs;
• rapid breathing.

Some people experience seizures and skin rashes on their face and body due to emergencies. The condition is characterized by decreased mental and physical performance, emotional instability, sleep disturbances, and rapid fatigue.

Diagnostic features

The doctor makes the diagnosis of “acute reaction to stress” only after completing a comprehensive examination of the patient. For many people, emergencies cause headaches that do not go away for several weeks. To clarify the diagnosis, you need to visit a psychiatrist. The doctor will not only select medications to normalize the condition, but will also choose medications that reduce the risk of complications.

Diagnostic criteria for acute stress reactions are determined through neurological testing and physical examination. Based on the results, the psychiatrist selects the optimal treatment methods for the patient.

Features of drug therapy

Stabilization of the condition of people who have an acute reaction to stress can be achieved by selecting medications that reduce the excitability of nerve fibers. Strong medications are used only if symptoms persist for a long time.

The treatment regimen, depending on the severity of the problem, involves the use of antidepressants, antipsychotics, and tranquilizers. If, against the backdrop of a reaction to stress, a person’s behavior becomes inappropriate and dangerous for other people, patients are prescribed Phenazepam. Accept this strong drug It is possible only with a doctor's prescription. The doctor selects the required dosage and duration of treatment.

Also, for acute reactions to stress, the psychiatrist prescribes Diazepam. This tranquilizer has a calming effect.

Treatment of acute reactions to stress in many cases involves long courses of antidepressants. Eat different types medicines, used in the case of such a pathological condition:

1. "Amitriptyline" is a drug with a sedative effect. If the body tolerates this drug without problems, its dose is gradually increased.

2. "Melipramine" is an antidepressant that reduces anxiety. The drug has many contraindications, so it should be taken strictly in dosages specified by the attending physician.

Traditional drug treatment complemented by psychotherapy. This recovery option is considered the most effective. It helps change the patient’s attitude towards the tragic event that happened in his life. Through psychotherapy, the patient's ability to control and regulate their negative thoughts increases. The algorithm for helping with acute reactions to stress is determined by the attending physician. Long-term work with a professional psychotherapist allows the patient to develop new behavioral tactics in the event of stressful situations.

Rehabilitation

To stabilize the mental state, it is desirable that the patient can change the environment. An excellent solution would be sanatorium treatment. Self-help for acute reactions to stress in the form of relaxation should be supported by physiotherapy. Only an integrated approach helps to stabilize the condition.

There are several operating in our country rehabilitation centers, in which people who have experienced extreme stress can restore their physical and mental health. With the coordinated work of a psychotherapist, psychologist and cardiologist, the patient receives optimal therapy and returns to normal life.

Folk remedies

In case of a short-term period of crisis or inability to contact a psychotherapist, you can use some medicinal herbs. Baths with herbal infusions help normalize sleep. Lavender gives excellent results. The procedure will require 50 g of plant flowers. They are poured with a liter of boiling water and left for 10 minutes. The finished product is filtered and poured into a hot bath. Thanks to the pleasant aroma of lavender, the body relaxes and sleep normalizes.

A bath with essential oils has a similar effect. It is better to carry out the procedures before bedtime, taking as a basis essential oils mint, chamomile, jasmine. Add 5-10 drops of the selected natural oil to the prepared warm bath.

You can also make a “sleeping pillow” with your own hands. A rag bag is filled with hop cones or a collection of herbs: St. John's wort, valerian, chamomile, mint, lavender, shamrock.

You can eliminate acute manifestations of the stress response with the help of special soothing tea. It is prepared from a collection of medicinal herbs: thyme, sweet clover, valerian, oregano, motherwort. Equal amounts of these natural components are mixed, poured with a glass of boiling water, and left to steep for 15-20 minutes. You need to take the prepared decoction 3 times a day, 1/3 cup.

Stabilization mental state An infusion of birch leaves also helps. You can prepare the product from 100 grams of young leaves by pouring 2 cups of boiling water over them. The pan with the broth is carefully wrapped in a blanket, and the mixture is infused for 5-6 hours. After straining, it is ready to eat. It is recommended to take a decoction of birch leaves 30 minutes before meals (½ cup) 3 times a day.

All folk remedies– additional methods of therapy for mental disorders. It is advisable to consult with your doctor before starting self-medication.

Important points

What are the characteristics of acute reactions to stress? The definition, symptoms, and types of this problem are well known in psychiatry. Patients who have experienced stress exhibit the following reactions:

• hallucinations;
• nervous trembling;
• aggression;
• fear;
• lethargy.

During an emergency, the balance in the body is disturbed, mental and physical condition worsens. Delusion manifests itself in false ideas or conclusions; it is impossible to convince a sick person of the erroneous conclusions.

Due to hallucinations, the patient perceives objects that actually do not affect him (hears voices, smells).

Without the slightest reason, a person begins to cry, his lips tremble, and depression occurs. Speech becomes unnatural, fast, rich. Nervous tremors when stressful situations can last up to several hours.

How to work with the victim

The implementation of psychotherapy is carried out in two ways:

• for a healthy population, acute panic reactions are prevented;
• For persons with obvious neuropsychic disorders, a course using medications is carried out.

PPP (first psychological help) is an element of medical care for people injured in road accidents who have witnessed brutal murders. A set of measures of psychological influence on the patient and the coordinated work of different specialists is a guarantee of reducing the victim’s feelings of anxiety, mental and physical suffering.

The PPP involves a set of specific actions:

1. Transportation or escort of injured persons to a specialized hospital.
2. Monitoring the patient during transportation.
3. The use of a standard set of psychopharmacological agents that will help calm the affected person.

Of the tranquilizers that are administered intramuscularly, the recommended bezodiazepine is “rRelanium” with a dosage of 2.0-4.0 ml.

Intravenous administration of the drug is undesirable, since anaphylactic shock is possible. It is not recommended to take the drug "Phenozepam" at the first stage, since its use is accompanied by a drop in blood pressure.