Acute Stress Disorder among 2022 Ukrainian war refugees: a cross-sectional study.

Introduction: Fleeing from war can be terrifying and result in Acute Stress Disorder (ASD), a mental health condition that can occur in the first month after a traumatic event. The study aimed to identify the prevalence of ASD among Ukrainian refugees and identify its risk factors to create a profile of the most vulnerable refugees. Methods: This cross-sectional study of 637 Ukrainian war-displaced persons and refugees in 2022 used the Acute Stress Disorder Scale. Results: The prevalence of ASD among participants was high (93.5%). Several factors increasing the risk of developing ASD in the sample were identified, e.g., witnessing Russian attacks (OR 2.92, 95% CI 1.26-6.78), insufficient financial resources (OR 3.56, 95% CI 1.61-7.91), and feeling of loneliness in the host country (OR 3.07, 95% CI 1.58-8.69). Pre-existing depression and the death of a close person, among others, were found to significantly (p < 0.05) exacerbate the ASD symptoms. At the same time, neither age, the distance traveled, time spent on fleeing the country, nor the type of companionship during refuge (escaping alone, with children, pets or the older adults) correlate with the severity of symptoms. Conclusion: The study shows extreme levels of trauma among Ukrainian war refugees and displaced persons. Knowledge regarding ASD vulnerabilities in the present conflict may facilitate prompt and adequate psychological help. Since ASD can be an antecedent of PTSD and several autoimmune disorders, these results may also serve as a predictor of future challenges for Ukrainian society.

A core role for cognitive processes in the acute onset and maintenance of post-traumatic stress in children and adolescents.

BACKGROUND: Post-traumatic stress disorder (PTSD) is a common reaction to trauma in children and adolescents. While a significant minority of trauma-exposed youth go on to have persistent PTSD, many youths who initially have a severe traumatic stress response undergo natural recovery. The present study investigated the role of cognitive processes in shaping the early reactions of child and adolescents to traumatic stressors, and the transition to persistent clinically significant post-traumatic stress symptoms (PTSS). METHODS: A prospective longitudinal study of youth aged 8-17 years who had attended a hospital emergency department following single trauma was undertaken, with assessments performed at 2-4 weeks (N = 226) and 2 months (N = 208) post-trauma. Acute stress disorder and PTSD were assessed using a structured interview, while PTSS, depression severity and peritraumatic and post-traumatic cognitive processes were assessed using self-report questionnaires. On the basis of their PTSS scores at each assessment, participants were categorised as being on a resilient, recovery or persistent trajectory. RESULTS: PTSS decreased between the two assessments. Cognitive processes at the 2- to 4-week assessment accounted for the most variance in PTSS at both the initial and follow-up assessment. The onset of post-traumatic stress was associated particularly with peritraumatic subjective threat, data-driven processing and pain. Its maintenance was associated with greater peritraumatic dissociation and panic, and post-traumatic persistent dissociation, trauma memory quality, rumination and negative appraisals. Efforts to deliberately process the trauma were more common in youth who experienced the onset of clinically significant PTSS. Regression modelling indicated that the predictive effect of baseline negative appraisals remained when also accounting for baseline PTSS and depression. CONCLUSIONS: Cognitive processes play an important role in the onset and maintenance of PTSS in children and adolescents exposed to trauma. Trauma-related appraisals play a particular role when considering whether youth make the transition from clinically significant acute PTSS to persistent PTSS.

The Current Evidence for Acute Stress Disorder.

PURPOSE OF REVIEW: 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). RECENT FINDINGS: 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.

Do screening and a randomized brief intervention at a Level 1 trauma center impact acute stress reactions to prevent later development of posttraumatic stress disorder?

BACKGROUND: Approximately 20% to 40% of trauma survivors experience posttraumatic stress disorder (PTSD). The American College of Surgeons Committee on Trauma reports that early screening and referral has the potential to improve outcomes and that further study of screening and intervention for PTSD would be beneficial. This prospective randomized study screened hospitalized patients for traumatic stress reactions and assessed the effect of a brief intervention in reducing later development of PTSD. METHODS: The Primary Care PTSD (PC-PTSD) screen was administered to admitted patients. Patients with symptoms were randomized to an intervention or control group. The brief intervention focused on symptom education and normalization, coping strategies, and utilizing supports. The control group received a 3-minute educational brochure review. Both groups completed in-hospital interviews, then 45- and 90-day telephone interviews. Follow-up collected the PTSD checklist-civilian (PCL-C) assessment and qualitative data on treatment-seeking barriers. RESULTS: The PC-PTSD screen was successful in predicting later PTSD symptoms at both 45 days (ß = 0.43, p < 0.001) and 90 days (ß = 0.37, p < 0.001) even after accounting for depression. Correlations of the intervention with the PCL-C scores and factor score estimates did not reach statistical significance at either time point (p = 0.827; p = 0.838), indicating that the brief intervention did not decrease PTSD symptoms over time. Of those at or above the PCL-C cutoff at follow-ups, a minority had sought treatment for their symptoms (43.2%). Primary barriers included focusing on their injury or ongoing rehabilitation, financial concerns, or location of residence. CONCLUSION: The PC-PTSD screen identified patients who later assess positive for PTSD using the PCL-C. The brief intervention did not reduce 45- and 90-day PTSD development. Follow-up interviews revealed lack of treatment infrastructure in the community. It will be important for trauma centers to align with community resources to address the treatment needs of at-risk patients. LEVEL OF EVIDENCE: Prospective randomized controlled trial, level II.

Posterior and prefrontal contributions to the development posttraumatic stress disorder symptom severity: an fMRI study of symptom provocation in acute stress disorder.

Acute stress disorder (ASD) is predictive of the development of posttraumatic stress disorder (PTSD). In response to symptom provocation, the exposure to trauma-related pictures, ASD patients showed increased activation of the medial posterior areas of precuneus and posterior cingulate cortex as well as of superior prefrontal cortex in a previous study. The current study aimed at investigating which activated areas are predictive of the development of PTSD. Nineteen ASD patients took part in an fMRI study in which they were shown personalized trauma-related and neutral pictures within 4 weeks of the traumatic event. They were assessed for severity of PTSD 4 weeks later. Activation contrasts between trauma-related and neutral pictures were correlated with subsequent PTSD symptom severity. Greater activation in, among others, right medial precuneus, left retrosplenial cortex, precentral and right superior temporal gyrus as well as less activation in lateral, superior prefrontal and left fusiform gyrus was related to subsequently increased PTSD severity. The results are broadly in line with neural areas related to etiological models of PTSD, namely multisensory associative learning recruiting posterior regions on the one hand and failure to reappraise maladaptive cognitions, thought to involve prefrontal areas, on the other.

Acute stress disorder as a predictor of posttraumatic stress: A longitudinal study of Chinese children exposed to the Lushan earthquake.

This study examined the prevalence of acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) in children who experienced the Lushan earthquake in Sichuan, China, and assessed the ability of ASD to predict PTSD. The Acute Stress Disorder Scale (ASDS) was used to assess acute stress reaction within weeks of the trauma. The University of California at Los Angeles Post-Traumatic Stress Disorder Reaction Index (UCLA-PTSD) for children was administered at intervals of 2, 6, and 12 months after the earthquake to 197 students who experienced the Lushan earthquake at the Longxing Middle School. The results demonstrated that 28.4% of the children suffered from ASD, but only a small percentage of the population went on to develop PTSD. Among all of the students, 35.0% of those who met the criteria for ASD were diagnosed with PTSD at the 12-month interval. The severity of ASD symptoms correlated with later PTSD symptoms.

Revolución tecnocientífica, sostenibilidad de los sistemas sanitarios y estrés / Techno-scientific revolution, sustainability of healthcare systems and stress

No disponible

Effects of acute stress on cardiac endocannabinoids, lipogenesis, and inflammation in rats.

OBJECTIVE: Trauma exposure can precipitate acute stress (AS) and cardiovascular disorders (CVD). Identifying AS-related physiologic changes that affect CVD risk could inform development of early CVD prevention strategies. The endocannabinoid system (ECS) regulates hypothalamic-pituitary-adrenal axis and stress-related cardiovascular function. We examine stress-related ECS activity and its association with cardiovascular biochemistry/function after AS. METHODS: Rodents (n = 8-16/group) were exposed to predator odor or saline; elevated plus maze, blood pressure, serum and cardiac ECS markers, and lipid metabolism were assessed 24 hours and 2 weeks postexposure. RESULTS: At 24 hours, the predator odor group demonstrated anxiety-like behavior and had a) elevated serum markers of cardiac failure/damage (brain natriuretic peptide: 275.1 versus 234.6, p = .007; troponin I: 1.50 versus 0.78, p = .076), lipogenesis (triacylglycerols: 123.5 versus 85.93, p = .018), and inflammation (stearoyl delta-9 desaturase activity: 0.21 versus 0.07, p < .001); b) decreased cardiac 2-arachidonoyl-sn-glycerol (29.90 versus 65.95, p < .001), oleoylethanolamide (114.3 versus 125.4, p = .047), and palmitoylethanolamide (72.96 versus 82.87, p = .008); and c) increased cardiac inflammation (interleukin [IL]-1ß/IL-6 ratio: 19.79 versus 13.57, p = .038; tumor necrosis factor α/IL-6 ratio: 1.73 versus 1.03, p = .019) and oxidative stress (thiobarbituric acid reactive substances: 7.81 versus 7.05, p = .022), which were associated with cardiac steatosis (higher triacylglycerol: 1.09 versus 0.72, p < .001). Cardiac lipogenesis persisted, and elevated blood pressure emerged 2 weeks postexposure. CONCLUSIONS: Acute psychological stress elicits ECS-related cardiac responses associated with persistent, potentially pathological changes in rat cardiovascular biochemistry/function.

Guidelines for the management of conditions specifically related to stress

These WHO mhGAP guidelines were developed to provide recommended management strategies for conditions specifically related to stress, including symptoms of acute stress, post-traumatic stress disorder and bereavement. The guidelines were developed by an independent Guidelines Development Group and inform a new mhGAP module on the Assessment and Management of Conditions Specifically Related to Stress.

Prediction of PTSD in police officers after six months--a prospective study.

The aim of this prospective study was to explore the predictors for the development of PTSD in police officers six months after encountering situations of a potentially traumatic nature. Fifty-nine police officers were studied immediately after the event (T1) and six months later (T2). At T2 PTSD was assessed using the Structured Clinical Interview for DSM-IV (SCID-I). PTSD was predicted by intrusions (Impact of Event Scale-Revised; IES-R), the impairment scale (is), global assessment of functioning scale (GAF), gender, age and sense of coherence scale (SOC). The diagnosis of an acute stress disorder (ASD) at T1 had a high specificity for identifying PTSD at T2. The strongest predictor for the development of PTSD was found to be the factor intrusions. Contrary to our expectations, age was not a significant predictive factor for PTSD. Thus, acute stress disorder (ASD) and a high degree of intrusions experienced immediately after a traumatic incident helped to identify early police officers at risk of developing chronic PTSD.

The structure of acute stress disorder among Chinese adults exposed to an earthquake: is dysphoric arousal a unique construct of acute posttraumatic responses?

As a diagnosis organized mainly on the basis of theoretical conceptualization, acute stress disorder (ASD) has been widely criticized for lack of empirical support since it was introduced into the DSM system. To address this issue, the present study investigated the latent structure of ASD symptoms measured by the Acute Stress Disorder Scale (ASDS). A total of 350 adults with a mean age of 32.9 years (SD = 14.0, range: 16-85) took part in this study 12 to 15 days after an earthquake. The results of confirmatory factor analyses showed that a five-factor intercorrelated model (dissociation, reexperiencing, avoidance, dysphoric arousal, and anxious arousal) demonstrated the best data fit. The findings provide preliminary empirical evidence in favor of a new reconceptualization of ASD symptoms, and are informative for the impending DSM-5.

Utilization of psychiatric services among low-income HIV-infected patients with psychiatric comorbidity.

INTRODUCTION: HIV-infected individuals face a tremendous burden of psychiatric comorbidity. This study evaluates a community health care system's effort to screen for psychiatric disorders among patients at an HIV clinic and evaluate adherence to psychiatric service utilization. METHODS: Standardized screening measures were used to identify participants who met diagnostic symptom criteria for post-traumatic stress disorder (PTSD), acute stress disorder (ASD) and depression. All participants who screened positive were referred for psychiatric follow-up. Rates of utilization were measured and barriers to adherence were investigated. RESULTS: Of the 210 participants, 118 patients met screening criteria for PTSD, ASD, and/or depression, and 116 of these had medical records available for review. Of the 116 patients with psychiatric comorbidity, 46.6% saw a psychiatrist and/or were prescribed a psychiatric medication. Thirty-two percent of Latinos, 40.5% of African Americans, and 38.5% of heterosexuals utilized referred psychiatric services, and these rates were significantly less than their counterparts. One hundred patients were seen by a social worker. DISCUSSION: While a large burden of psychiatric comorbidity exists among this population of HIV-positive patients, only half adhered to recommended psychiatric services referrals. Further research is warranted to examine cost-effective interventions to maximize psychiatric screening, referral, and follow-up with mental health services in this vulnerable population.

Acute stress reaction and completed suicide.

BACKGROUND: Acute stress reaction is a diagnosis given immediately following the experience of an exceptional mental or physical stressor. To the best of our knowledge, no study has examined the association between acute stress reaction diagnosis and suicide. The current study examined this association in a population-based sample. In addition, we examined comorbid psychiatric diagnoses as modifiers of this association. METHODS: Data for the current study were obtained from the nationwide Danish health and administrative registries, which include data for all 5.4 million residents of Denmark. All suicides between 1 January 1994 and 31 December 2006 were included and controls were selected from a sample of all Danish residents. Using this nested case-control design, we examined 9612 suicide cases and 199 306 controls matched to cases with respect to gender, date of birth and time. RESULTS: In total, 95 cases (0.99%) and 165 controls (0.08%) had a diagnosis of acute stress reaction. Those diagnosed with acute stress reaction had 10 times the rate of completed suicide compared with those without this diagnosis, adjusting for the control to case matching, depression and marital status (95% confidence interval 7.7-14). Additionally, persons with acute stress reaction and depression, or acute stress reaction and substance abuse, had a greater rate of suicide than expected based on their independent effects. CONCLUSIONS: Acute stress reaction is a risk factor for completed suicide.

[Stress gastrointestinal bleeding in critically ill patients and its effect on the prognosis].

OBJECTIVE: To investigate stress gastrointestinal bleeding in critically ill patients and its effect on the prognosis. METHODS: Clinical data of 1148 critically ill patients consecutively admitted to Intensive Care Unit of East Campuses of Peking Union Medical College Hospital during 2008 were analyzed retrospectively. The main contents of investigation included morbility and mortality of stress gastrointestinal bleeding in critically ill patients and its relationship with multiple organ dysfunction. RESULTS: Among the 1148 critically ill patients, organ dysfunction occurred in 254 cases, including 57 cases with shock, 124 with respiratory dysfunction, 46 with acute renal dysfunction, 192 with coagulation dysfunction and 40 with stress gastrointestinal bleeding. The patients with stress gastrointestinal bleeding took up 15.7% among organ dysfunction patients and 3.5% among critically ill patients. 97.5% stress gastrointestinal bleeding accompanied with other organ dysfunction. The mortality of stress gastrointestinal bleeding was 40.0%, which was higher than that of shock (28.1%), respiratory dysfunction (22.6%), renal dysfunction (30.4%) and coagulation dysfunction (13.5%) (all P<0.05). Binary Logistic regression analysis found that stress gastrointestinal bleeding was an independent risk factor associated with mortality (P<0.05). CONCLUSION: The patients with stress gastrointestinal bleeding usually have a poor prognosis.

Fase aguda de estrés postraumático en los accidentes de tránsito / Acute phase of post-traumatic stress disorders in traffic accidents

Uno de los aspectos importantes de los accidentes de tránsito son las posibles repercusiones derivadas del trauma psíquico. Toda persona que se expone a un hecho traumático puede reaccionar de diversas maneras, desde algunos síntomas aislados hasta un cuadro psicótico. El espectro de los trastornos por estrés postraumático abarca gran parte de estas reacciones. En este artículo se revisa el concepto de estrés postraumático, su clínica, su epidemiología, los aspectos neurobiológicos y las principales consideraciones para el tratamiento. Se pone especial atención a las variables psicológicas que intervienen en el escenario del accidente automovilístico y las medidas a adoptar por los distintos participantes. Además, se incluye información relacionada con la experiencia de un equipo de salud mental chileno en víctimas de accidentes de tránsito. Se establecen los criterios para la sospecha diagnóstica y el manejo inicial de los síntomas agudos postraumáticos.

Peritraumatic and persistent dissociation in the presumed etiology of PTSD.

OBJECTIVE: Dissociative responses that occur at the time of a trauma (peritraumatic dissociation) have been described as a major risk factor for subsequent posttraumatic stress disorder (PTSD). The current study evaluated peritraumatic dissociation and PTSD from a multivariate perspective, along with a less-investigated phenomenon: trauma-specific dissociation that begins during or after an event and continues until the time of assessment (persistent dissociation). METHOD: In two studies, 52 local community participants and 386 participants from the general population with histories of exposure to at least one traumatic event were assessed for the presence of PTSD and were administered measures of dissociation and peritraumatic distress. RESULTS: In both studies, peritraumatic dissociation, persistent dissociation, peritraumatic distress, and generalized dissociative symptoms were associated with PTSD by univariate analyses. However, multivariate analyses in both studies indicated that PTSD status was no longer related to peritraumatic dissociation once other variables (especially persistent and generalized dissociation) were taken into account. In contrast, persistent dissociation was a strong predictor at univariate and multivariate levels. CONCLUSIONS: Trauma-related persistent dissociation is a substantial predictor of PTSD, whereas peritraumatic dissociation ceases to predict PTSD at the multivariate level. These findings suggest that it is less what happens at the time of a trauma (e.g., disrupted encoding) that predicts PTSD than what occurs thereafter (i.e., persistent avoidance).

Acute stress disorder as a predictor of post-traumatic stress disorder in physical assault victims.

The authors' objective was to examine the ability of acute stress disorder (ASD) and other trauma-related factors in a group of physical assault victims in predicting post-traumatic stress disorder (PTSD) 6 months later. Subjects included 214 victims of violence who completed a questionnaire 1 to 2 weeks after the assault, with 128 participating in the follow-up. Measures included the Harvard Trauma Questionnaire, the Trauma Symptom Checklist, and the Crisis Support Scale. Twenty-two percent met the full PTSD diagnosis and 22% a subclinical PTSD diagnosis. Previous lifetime shock due to a traumatic event happening to someone close, threats during the assault, and dissociation explained 56% of PTSD variance. Inability to express feelings, hypervigilance, impairment, and hopelessness explained another 15% of PTSD variance. The dissociative, the reexperiencing, the avoidant, and the arousal criteria of the ASD diagnosis correctly classified 79% of the subsequent PTSD cases.