Acute Stress Disorder Diagnosis Research Articles

Acute Stress among Nurses in Sweden during the COVID-19 Pandemic

Sweden was hit hard in the beginning of the COVID-19 pandemic with deaths per capita among the highest in Europe. The pandemic was a stressful time especially for healthcare workers caring for COVID-19 patients. Various studies have evaluated whether nurses caring for these patients had higher levels of acute stress, but typically with measures that either used older DSM-IV criteria for Acute Stress Disorder (ASD) or general measures of acute stress. We recruited an online sample (N = 101) of nurses in Sweden from COVID-19 specialized units (ICU), Emergency (ER), and other units (Other), and asked them to answer questionnaires retrospectively to the peak of infections in Sweden. We aimed to evaluate: 1) the psychometric properties of the translation of the Stanford Acute Stress Reaction Questionnaire-II (SASRQ-II, which follows DSM-5 criteria for ASD) into Swedish, 2) whether nurses in COVID-19 units had experienced more acute stress than nurses in other units, and 3) the extent of potential acute stress disorder. The SASRQ-II evidenced good construct, convergent and divergent validity, and good reliability. It showed that ICU nurses reported significantly more acute stress than the other two groups, a difference that could not be accounted for by demographic or other variables. A retrospective diagnosis of ASD using the SASRQ-II suggested that 60% of nurses might have fulfilled ASD criteria, but no differences across groups were found.

Predictors and severity of probable acute stress disorder following the Beirut Port Blast

ABSTRACT Background The Beirut Port Blast on August 4, 2020 is the largest (non-nuclear) explosion on record. St George Hospital University Medical Center (SGHUMC), a leading academic medical centre in Lebanon, adjacent to the Port, sustained a massive loss in lives and infrastructure. Objective The current study uses the baseline data of an ongoing longitudinal study to explore the prevalence, severity, and predictors of probable Acute Stress Disorder (ASD) among health workers at SGHUMC following the blast. Methods In the context of COVID-19 tests administered 9–15 days after the blast, SGHUMC staff were asked to complete a questionnaire that included socio-demographic details, the Beirut Port Exposure Inventory, and the Acute Stress Disorder Scale (ASDS). Results A total of 570 health workers participated in the study. The prevalence of probable DSM-5 ASD [95%CI] was 38.34% [31.41; 45.32]. Many specific exposures were related, on a bivariate level, to ASD be it as a probable DSM-5 diagnosis or its severity as measured by the ASDS. A classification and regression tree (CART) analysis identified the highest risk predictors of probable DSM-5 ASD diagnosis to be: being a female, seeing dead or mutilated bodies, death of a close one, and being scared at the time of the explosion. Nurses carried the highest risks of all health workers with a probable DSM-5 ASD prevalence of 51.28%, (OR = 3.72 [95% CI: 2.22; 6.25]). Being scared at the time of the blast was the most single predictor of probable ASD. Conclusion Both the prevalence and severity of probable DSM-5 ASD in this sample are higher than most reported in the literature, which may be explained by the severity of the trauma and the ongoing stress in the context of the pandemic. Fear at the time of the explosion was independently the most predictive parameter of probable ASD. HIGHLIGHTS On 4 August 2020, 2700 tons of ammonium nitrate exploded in the port of Beirut 38.34% of all health workers and 51.2% of nurses at St Georges Hospital University Medical Center, which faces the port, had probable DSM-5 ASD in this ongoing longitudinal study

Prevalence and risk factors for acute stress disorder in female victims of sexual assault

Sexual assault is one of the most traumatic events a person can experience. Despite this, information regarding the risk factors associated with the development of Acute Stress Disorder (ASD) in sexual assault victims is scarce. A follow-up prospective cohort study was designed to examine the prevalence and risk factors of ASD in women exposed to a recent sexual assault. A total of 156 women were treated at the Emergency Department of a university general hospital shortly after sexual assault. Sociodemographic, clinical and sexual assault-related variables were collected. The Acute Stress Disorder Interview was used to estimate the prevalence of ASD at three weeks post-SA. From the 156 victims, 66.6% (N = 104) met ASD diagnosis using DSM-5 criteria, whereas 59.6% (N = 93) met ASD diagnosis using DSM-IV criteria. The risk factors associated with the development of ASD were nationality, psychiatric history, peritraumatic dissociation and type of assault. In conclusion, the prevalence of ASD in female victims of recent sexual assault was high, affecting approximately two thirds of them. The recognition of the risk factors associated with ASD development, like peritraumatic dissociation or type of assault, may aid in the prompt detection of vulnerable women that require early and specific interventions shortly after trauma.

Screening of Acute Traumatic Stress Disorder and Posttraumatic Stress Disorder in Pediatric Trauma Patients: A Pilot Study.

Children who experience traumatic physical injuries are at risk of developing acute stress disorder and posttraumatic stress disorder (PTSD). Early identification and treatment of these high-risk children can lead to improved mental health outcomes in this population. This study assesses the feasibility of a study protocol that compares 3 screening tools for identifying patients at a high risk of later development of acute stress disorder or PTSD among pediatric trauma patients. This pilot study compared 3 questionnaires used as screening tools for predictors of later development of PTSD in a convenience sample of pediatric trauma patients aged 7-17 years. Patients were randomized to one of 3 screening tools. Families were contacted at 30, 60, and 90-120 days postinjury to complete the Child Report of Post-Traumatic Symptoms questionnaire. The sensitivity and negative predictive value of the screening tools were compared for the diagnosis of PTSD defined using the Child Report of Post-Traumatic Symptoms questionnaire. Of the 263 patients identified for possible enrollment, 52 patients met full inclusion criteria and agreed to participate. Only 29 (55.7%) patients completed at least one follow-up questionnaire. The prevalence of acute stress disorder and PTSD in our population was 41% (95% CI [24, 61]) and 31% (95% CI [15, 51]), respectively. In this pilot study, we sought to determine the utility of the 3 commonly used screening instruments for measuring traumatic stress symptoms in pediatric trauma patients to predict the diagnosis of acute stress disorder or PTSD. Limitations include the use of the Child Report of Post-Traumatic Symptoms screening tool as the gold standard for calculating test characteristics and lack of 24/7 enrollment capabilities. As such, a significant portion of patients were discharged prior to our teams' engagement for enrollment.

98 The Epidemiology of Acute Stress Disorder Among Inpatient Adult Patients with Burn Injury

Abstract Introduction Burn injured patients are at high risk for developing Acute Stress Disorder (ASD) and Posttraumatic Stress Disorder (PTSD) following injury. ASD itself is a reliable predictor for the development of PTSD, which usually persists once established. Injury-related characteristics in burn patients (TBSA and anatomic location of burn) do not predict the development of psychological trauma. There is a paucity of literature examining acute psychosocial evaluations of patients with burn injury to address the need for early interventions. Behavioral health assessment and treatment in burn centers may foster improved detection and management of ASD among a variety of other mental health conditions. The goal of this study is to investigate the demographic and injury characteristics associated with new ASD diagnoses in a cohort of inpatient burn survivors. Methods Burn injured patients who were admitted to a regional burn center between June 2019 and June 2020 and referred for burn psychology evaluation were retrospectively reviewed. Minors, non-burn injured patients, and those with incomplete evaluations were excluded. Demographic, injury characteristic, health history, and psychologic evaluation results were collected from the medical record. ASD diagnosis was defined by criteria outlined in the PTSD Checklist for DSM-5 (PCL-5). Demographic and injury characteristic were compared between patients with and without ASD diagnoses. Statistical analysis was performed with Mann-Whitney, Chi-square, and Fisher’s Exact test as appropriate. Significance was set at a p=0.05. Results Fifty-two patients with median age of 49.5 (IQR, 29–62) years and median TBSA of 6 (2.8–14.4) % met inclusion criteria. Of these, 11 (21%) patients were diagnosed with ASD. Patients with ASD were more often female, (73% vs. 29%, p=0.01), younger (38.5 years vs. 46 years, p=0.05), involved in a structural fire (45.5% vs. 10%, p=0.01), and employed at the time of injury (63% vs. 14.6%, p=0.002). There were no significant differences between groups in TBSA, hospital length of stay, ICU admission, or proportion of patients requiring operative intervention. Among patients who required operative intervention, those in the ASD group underwent fewer total procedures (1 vs. 4, p=0.05). Conclusions Patients who developed ASD were younger, more likely female, more often involved in structural fires, and employed. Markers of injury severity such as TBSA, need for operative intervention, ICU admission and hospital length of stay were not associated with the development of ASD.

A Dissociation Between Two Cognitive Biases in Acute Stress Disorder: Preliminary Evidence for the Reverse Gambling Fallacy

Rationality biases, such as the gambling fallacy (e.g., predicting future coin-tosses based on previous tosses) and the famous “Linda” conjunction fallacy (estimating the conjunction that “Linda” is both teller and feminist based on her description) have not been examined in people suffering from acute stress disorder (ASD). We analyze potential outcomes and align them with different theories. To discern the precise pattern of rationality biases in persons with ASD, we examined performance on these 2 tasks within a month of the Hayian Super-Typhoon (August 27th, 2013). Out of a sample of 1001 persons, 82 had clinical ASD and their performance was compared to the remaining 919 participants. A specific link between ASD and rationality biases revealed that although conjunction task performance was not associated with ASD diagnosis, coin-task performance was. Namely, responding “Heads” to a 6th coin-toss after 5 successive “Heads” (reverse gambling fallacy) was robustly linked with ASD diagnosis. The results align with the bridging of trauma theories claiming that trauma symptoms are generated by disequilibrium following trauma exposure, with prospect theory’s notion of chance, which is conceived as belief in equilibrium restoration. Such disequilibrium following trauma exposure is thus linked with the belief underlying reverse gambling fallacy biases, namely “what-was-will-be”. Implications regarding themes important to address in therapy are mentioned.

Analysis of the Point Prevalence and Influencing Factors of Acute Stress Disorder in Elderly Patients with Osteoporotic Fractures.

BackgroundIncreasing attention has been paid to posttraumatic affective disorders. However, orthopedic surgeons dealing with trauma often ignore the harm of such diseases.ObjectiveTo investigate the point prevalence and influencing factors of acute stress disorder (ASD) in elderly patients with osteoporotic fractures (EPOFs) from the perspective of orthopedic surgeons.Patients and MethodsA total of 595 cases of EPOFs were treated at our hospital from January 1, 2018, to June 30, 2019. The patients meeting our inclusion criteria were assessed using a structured interview based on the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) criteria to verify the presence of ASD. After diagnosis, the participants were divided into two groups (those with and without ASD). The sociodemographic characteristics, disease characteristics, and Social Support Rating Scale (SSRS) scores were assessed. The chi-square test was used for univariate analysis, and multivariate analysis was performed using binary logistic regression.ResultsOf the 524 participants, 32 (6.1%) met the criteria for the diagnosis of ASD. The results of the univariate analysis showed that gender, personality, living alone, monthly family income, initial fear, poor prognosis expectation, anxiety/depression, pain, and social support were associated with ASD in EPOFs (P<0.05). The multivariate regression analysis showed that isolation, low monthly family income, introversion, poor prognosis expectation, previous traumatic history, and intense pain were the main influencing factors and risk factors (OR>1) for ASD in EPOFs.ConclusionBeing female, living alone, introversion, poor family income, intense initial fear, poor prognosis expectation, anxiety/depression, intense pain perception and low social support were significantly related to the occurrence of ASD in EPOFs. To achieve optimal recovery in EPOFs, orthopedic surgeons should meet both the physiological and psychological needs of the patients.

Parental Mental Health Care After Their Child’s Pediatric Intensive Care Hospitalization*

Post-traumatic stress disorder, depression, and anxiety have all been found in parents of PICU survivors. How these research findings translate to actual use of mental health services by parents remains unknown. Retrospective observational cohort study. Insurance claims data from 2006 to 2013 obtained from the IBM MarketScan Commercial Database. Parents of PICU survivors. We examined rates of: 1) mental health diagnoses, 2) outpatient mental health visits, and 3) prescriptions for antidepressants and anxiolytics among parents, 6 months before and 6 months after their child's PICU admission, using each parent as their own control. Of the 95,070 parents identified, 9.5% received a new mental health diagnosis in the 6 months after their child's PICU hospitalization, which represented a 110% increase from pre-PICU rates. A smaller proportion of parents were given new prescriptions for antidepressants (3.4%) and anxiolytics (3.9%) in the 6 months after their child's PICU hospitalization. Mothers were twice as likely to receive a new mental health diagnosis and be taking a new medication than fathers in the post-PICU period. The parental diagnosis of acute stress disorder or post-traumatic stress disorder increased by 87% from the pre-PICU to the post-PICU period. After their child's PICU hospitalization, the proportion of parents with a new mental health diagnosis nearly doubled. Mothers were at nearly twice the risk of receiving a new mental health diagnosis and receiving a new mental health medication compared with fathers. The proportion of parents receiving mental healthcare is much lower than the proportion reporting mental health symptoms in long-term outcomes studies. Whether this indicates a gap in healthcare delivery for parents with mental health symptoms remains unknown.

The Current Evidence for Acute Stress Disorder.

The aim of this review is to provide a summary of the current evidence pertaining to the course of acute and chronic posttraumatic stress, the diagnosis of acute stress disorder (ASD), and treatment of acute stress disorder and prevention of posttraumatic stress disorder (PTSD). Although acute stress disorder was introduced partly to predict subsequent PTSD, longitudinal studies indicate that ASD is not an accurate predictor of PTSD. Recent analytic approaches adopting latent growth mixture modeling have shown that trauma-exposed people tend to follow one of four trajectories: (a) resilient, (b) worsening, (c) recovery, and (d) chronically distressed. The complexity of the course of posttraumatic stress limits the capacity of the ASD diagnosis to predict subsequent PTSD. Current evidence indicates that the treatment of choice for ASD is trauma-focused cognitive behavior therapy, and this intervention results in reduced chronic PTSD severity. Recent attempts to limit subsequent PTSD by early provision of pharmacological interventions have been promising, especially administration of corticosterone to modulate glucocorticoid levels. Although the ASD diagnosis does not accurately predict chronic PTSD, it describes recently trauma-exposed people with severe distress. Provision of CBT in the acute phase is the best available strategy to limit subsequent PTSD.

Acute stress disorder and defense mechanisms: a study of physical trauma patients admitted to an emergency hospital.

Acute stress disorder (ASD) encompasses a set of symptoms that can arise in individuals after exposure to a traumatic event. This study assessed the defense mechanisms used by victims of physical trauma who developed ASD. This was a controlled cross-sectional study of 146 patients who suffered physical trauma and required hospitalization. A structured questionnaire was used to evaluate ASD symptoms based on DSM-5 diagnostic criteria, in addition to the Defense Style Questionnaire (DSQ). Ten participants (6.85%) received a positive diagnosis of ASD, and 136, (93.15%) a negative diagnosis. The majority of the sample consisted of men with median age ranging from 33.50 to 35.50. The most prevalent defense mechanisms among the 10 patients with ASD were cancellation and devaluation, which belong to the neurotic and immature factors, respectively. Positive associations between the presence of symptoms from criterion B of the DSM-5 and defense mechanisms from the DSQ were found. These included the mechanisms of undoing, projection, passive aggression, acting out, autistic fantasy, displacement, and somatization. Patients with ASD employed different defense mechanisms such as undoing and devaluation when compared to patients not diagnosed with ASD. These results mark the importance of early detection of ASD symptoms at a preventative level, thereby creating new possibilities for avoiding exacerbations related to the trauma, which represents an important advance in terms of public health.

Does Acute Stress Disorder Predict Subsequent Posttraumatic Stress Disorder in Pediatric Burn Survivors?

This study examined the prevalence of posttraumatic stress disorder (PTSD) in pediatric burn survivors who had been treated for acute stress disorder (ASD) symptoms during their initial hospitalization and compared them to patients who had been asymptomatic for ASD symptoms. Participants were identified from electronic medical records from 1995 to 2008 and data were collected from 2006 to 2008. Participants were primarily matched on total body surface area burned and gender, and as close as possible on age at time of burn and number of years postburn. Pediatric burn survivors completed a semistructured clinical interview, the Missouri Assessment of Genetics Interview for Children-PTSD section, which is based on criteria from the DSM-IV for evaluating lifetime PTSD. There were 183 participants in the study, and from this sample 85 matched pairs were identified. Most were 5 years postburn. The prevalence of PTSD at the time of follow-up was 8.24% (7 of 85) for the ASD group and 4.71% (4 of 85) for the non-ASD comparison group. No significant differences were found between these groups at P value ≥ .05. A logistic regression analysis was conducted to determine if prior ASD diagnosis, burn size, gender, ethnicity, age at time of study participation, and number of years postburn predicted subsequent PTSD. None of the variables were significant predictors. The prevalence of PTSD was similar in children who had ASD symptoms and those without ASD symptoms. The lifetime prevalence of PTSD was lower than reported in other studies. A possible explanation for this finding is that children received timely pharmacotherapy and psychotherapy during their acute hospitalization.

Stress disorders following prolonged critical illness in survivors of severe sepsis.

To examine the frequency of acute stress disorder and posttraumatic stress disorder in chronically critically ill patients with a specific focus on severe sepsis, to classify different courses of stress disorders from 4 weeks to 6 months after transfer from acute care hospital to postacute rehabilitation, and to identify patients at risk by examining the relationship between clinical, demographic, and psychological variables and stress disorder symptoms. Prospective longitudinal cohort study, three assessment times within 4 weeks, 3 months, and 6 months after transfer to postacute rehabilitation. Patients were consecutively enrolled in a large rehabilitation hospital (Clinic Bavaria, Kreischa, Germany) admitted for ventilator weaning from acute care hospitals. We included 90 patients with admission diagnosis critical illness polyneuropathy or critical illness myopathy with or without severe sepsis, age between 18 and 70 years with a length of ICU stay greater than 5 days. None. Acute stress disorder and posttraumatic stress disorder were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, criteria by a trained and experienced clinical psychologist using a semistructured clinical interview for Diagnostic and Statistical Manual of Mental Disorders. We further administered the Acute Stress Disorder Scale and the Posttraumatic Symptom Scale-10 to assess symptoms of acute stress disorder and posttraumatic stress disorder. Three percent of the patients had an acute stress disorder diagnosis 4 weeks after transfer to postacute rehabilitation. Posttraumatic stress disorder was found in 7% of the patients at 3-month follow-up and in 12% after 6 months, respectively. Eighteen percent of the patients showed a delayed onset of posttraumatic stress disorder. Sepsis turned out to be a significant predictor of posttraumatic stress disorder symptoms at 3-month follow-up. A regular screening of post-ICU patients after discharge from hospital should be an integral part of aftercare management. The underlying mechanisms of severe sepsis in the development of posttraumatic stress disorder need further examination.

Trauma Reactions in Mothers and Fathers After Their Infant's Cardiac Surgery

To investigate the prevalence and nature of trauma symptoms in mothers and fathers of infants who had cardiac surgery. Parents of infants who underwent cardiac surgery before 3 months of age were recruited at the time of surgery. 77 mothers and 55 fathers completed the Acute Stress Disorder Scale 1 month after their infant was discharged from hospital. 26 of 77 (33.8%) mothers and 10 of 55 (18.2%) fathers satisfied criteria for acute stress disorder. For all symptom clusters, except dissociation, mothers had significantly higher mean scores (and therefore higher levels of symptoms) than did fathers, ps = .01, -.02. 83 percent of parents endorsed at least 1 trauma symptom and 11.4% endorsed only 1 symptom at a clinical level. Symptoms of dissociation were the most commonly endorsed by both parents, with each symptom in that cluster being endorsed at a clinical level by at least 26% of parents. Consistent with our hypotheses, approximately one-third of parents overall, as well as one-third of mothers and close to one-fifth of fathers, experienced trauma symptoms consistent with a diagnosis of acute stress disorder. Most parents experienced at least one symptom at a clinical level, with symptoms of dissociation being the most commonly endorsed symptom cluster. These findings highlight the need for clinical supports for parents.

Predictors of acute stress disorder severity

BackgroundThe DSM-IV diagnosis of acute stress disorder (ASD) describes a posttraumatic reaction that occurs two to twenty-eight days following a trauma and involves symptoms of intrusion, avoidance, hyper-arousal and dissociation. A better understanding of ASD and its pathogenesis could lead to improved post-trauma health care interventions. The aim of this study was to determine prospectively whether a combination of clinical, cognitive and demographic variables were predictive of ASD severity in an acutely traumatized sample. MethodsWe assessed demographic (e.g. age, gender, education), clinical (e.g. sleep quality, trait anxiety, previous psychiatric diagnoses), and cognitive (e.g. negative cognitions following trauma) variables in a sample of 125 adult motor vehicle accident survivors (age: 32.26±9.99; gender: 56.6% male) approximately 10 days after the accident. Univariate analyes and stepwise linear regression were performed to identify variables predictive of ASD severity. ResultsAlthough a number of factors were individually associated with ASD severity, in a regression model only 3 factors, trait anxiety, suicide risk and post-traumatic cognitions, emerged as predictive of the severity of the disorder. LimitationsThe cross-sectional nature of the study and use of self-report measures are important to bear in mind. ConclusionsHigher levels of trait anxiety, risk for suicide and negative appraisals of the traumatic event were predictive of ASD severity. As these factors may help to identify those who may be at risk of more severe responses after a traumatic event, and who may benefit from secondary prevention strategies, they should be assessed for in acute trauma survivors.

The latent factor structure of acute stress disorder following bank robbery: Testing alternative models in light of the pending DSM‐5

Acute stress disorder (ASD) was introduced into the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994) to identify posttraumatic stress reactions occurring within the first month after a trauma and thus help to identify victims at risk of developing posttraumatic stress disorder (PTSD). Since its introduction, research into ASD has focused on the prediction of PTSD, whereas only a few studies have investigated the latent structure of ASD. Results of the latter have been mixed. In light of the current proposal for the ASD diagnosis in the pending DSM-5, there is a profound need for empirical studies that investigate the latent structure of ASD prior to the DSM-5 being finalized. Based on previous factor analytic research, the DSM-IV, and the proposed DSM-5 formulation of ASD, four different models of the latent structure of ASD were specified and estimated. The analyses were based on a national study of bank robbery victims (N = 450) using the acute stress disorder scale. The results of the confirmatory factor analyses showed that the DSM-IV model provided the best fit to the data. Thus, the present study suggests that the latent structure of ASD may best be characterized according to the four-factor DSM-IV model of ASD (i.e., dissociation, re-experiencing, avoidance, and arousal) following exposure to bank robbery. The results are pertinent in light of the pending DSM-5 and add to the debate about the conceptualization of ASD. .

Does Acute Stress Disorder Predict Posttraumatic Stress Disorder Following Bank Robbery?

Unfortunately, the number of bank robberies is increasing and little is known about the subsequent risk of posttraumatic stress disorder (PTSD). Several studies have investigated the prediction of PTSD through the presence of acute stress disorder (ASD). However, there have only been a few studies following nonsexual assault. The present study investigated the predictive power of different aspects of the ASD diagnosis and symptom severity on PTSD prevalence and symptom severity in 132 bank employees. The PTSD diagnosis, based on the three core symptom clusters, was best identified using cutoff scores on the Acute Stress Disorder scale. ASD severity accounted for 40% and the inclusion of other risk factors accounted for 50% of the PTSD severity variance. In conclusion, results indicated that ASD appears to predict PTSD differently following nonsexual assault than other trauma types. ASD severity was a stronger predictor of PTSD than ASD diagnosis.

Acute Stress Symptoms in Children: Results From an International Data Archive

To describe the prevalence of acute stress disorder (ASD) symptoms and to examine proposed DSM-5 symptom criteria in relation to concurrent functional impairment in children and adolescents. From an international archive, datasets were identified that included assessment of acute traumatic stress reactions and concurrent impairment in children and adolescents 5 to 17 years of age. Data came from 15 studies conducted in the United States, United Kingdom, Australia, and Switzerland and included 1,645 children and adolescents. Dichotomized items were created to indicate the presence or absence of each of the 14 proposed ASD symptoms and functional impairment. The performance of a proposed diagnostic criterion (number of ASD symptoms required) was examined as a predictor of concurrent impairment. Each ASD symptom was endorsed by 14% to 51% of children and adolescents; 41% reported clinically relevant impairment. Children and adolescents reported from 0 to 13 symptoms (mean = 3.6). Individual ASD symptoms were associated with greater likelihood of functional impairment. The DSM-5 proposed eight-symptom requirement was met by 202 individuals (12.3%) and had low sensitivity (0.25) in predicting concurrent clinically relevant impairment. Requiring fewer symptoms (three to four) greatly improved sensitivity while maintaining moderate specificity. This group of symptoms appears to capture aspects of traumatic stress reactions that can create distress and interfere with children's and adolescents' ability to function in the acute post-trauma phase. Results provide a benchmark for comparison with adult samples; a smaller proportion of children and adolescents met the eight-symptom criterion than reported for adults. Symptom requirements for the ASD diagnosis may need to be lowered to optimally identify children and adolescents whose acute distress warrants clinical attention.

Review of VA/DOD Clinical Practice Guideline on management of acute stress and interventions to prevent posttraumatic stress disorder

This article summarizes the recommendations of the Department of Veterans Affairs (VA)/Department of Defense (DOD) VA/DOD Clinical Practice Guideline for Management of Post-Traumatic Stress that pertain to acute stress and the prevention of posttraumatic stress disorder, including screening and early interventions for acute stress states in various settings. Recommended interventions during the first 4 days after a potentially traumatic event include attending to safety and basic needs and providing access to physical, emotional, and social resources. Psychological first aid is recommended for management of acute stress, while psychological debriefing is discouraged. Further medical and psychiatric assessment and provision of brief, trauma-focused cognitive-behavioral therapy are warranted if clinically significant distress or functional impairment persists or worsens after 2 days or if the criteria for a diagnosis of acute stress disorder are met. Follow-up monitoring and rescreening are endorsed for at least 6 months for everyone who experiences significant acute posttraumatic stress. Four interventions that illustrate early intervention principles contained in the VA/DOD Clinical Practice Guideline are described.

The capacity of acute stress disorder to predict posttraumatic psychiatric disorders

Background One rationale for establishing the acute stress disorder diagnosis was to identify recently trauma-exposed people who may develop later posttraumatic stress disorder (PTSD). This study conducted a multi-site assessment of the extent to which ASD predicts subsequent PTSD, and also major depressive disorder, panic disorder, agoraphobia, social phobia, specific phobia, generalized anxiety disorder, and substance use disorder, 12 months after trauma. Method Consecutive admissions to 5 major trauma hospitals across Australia ( N = 1084) were assessed during hospital admission and within one month of trauma exposure and subsequently re-assessed for psychiatric disorder 12 months after the initial assessment ( N = 859). Results Whereas 120 (10%) patients met criteria for ASD in the initial month after trauma, 83 (10%) met criteria for PTSD, and 268 (31%) had any psychiatric disorder at 12 months. In terms of those diagnosed with ASD, 28 (36%) subsequently met criteria for PTSD and 50 (65%) subsequently developed any psychiatric disorder. Conclusions Whereas the majority of people with ASD subsequently develop a psychiatric disorder, most people with a disorder at 12 months do not initially display ASD.

Acute stress in patients with brain cancer during primary care

This study investigated whether diagnosis and neurosurgical removal of a brain tumour induced Acute Stress Disorder (ASD) in adults. We also aimed to identify factors associated with the development of ASD in this specific patient group and setting. Forty-seven consecutive patients with intracranial neoplasms completed a variety of self-report questionnaires and underwent a structured clinical interview (SCID) within the first 4 weeks after tumour detection on average 1 week after neurosurgical treatment. Moreover, the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), A1 and A2 criterion and thus the characteristics of the traumatic event were explored in detail. ASD symptoms were common. Twenty-three percent of the patients met stringent criteria of ASD and another 4% suffered from subsyndromal ASD. Predisposing factors previously reported in literature with the exception of previous trauma could not be identified in this study (e.g., sex, age, intelligence). It has been critically discussed whether the diagnosis of ASD is appropriate in cancer patients due to the often future-related nature of cancer-related traumatic events. The diagnosis of ASD was justified in the vast majority of affected patients due to the specific, acute and past traumatic experiences in concordance with the DSM and International Statistical Classification of Diseases and Related Health Problems (ICD) trauma definitions. Thus, ASD is a common and relevant psychiatric comorbidity in patients with brain tumours. Our data highlight both the need for the routine psychological assessment as well as of psychosocial support in this early treatment phase.