acute stress response
Introduction
Introduction to acute stress response Acute stress response, also known as acute psychogenic reaction, is a transient mental disorder caused by sudden and unusually intense mental stimulation, stressful life events or persistent distress. The onset time of most patients is related to mental stimulation, which occurs several minutes or hours after stimulation. The manifestations of the symptoms are clearly related to the content of mental stimulation. The course and prognosis are also related to the early elimination of mental factors. It lasts for a short time and can be recovered within hours, days or weeks, with complete remission and a good prognosis. basic knowledge The proportion of illness: 0.047% Susceptible people: no specific population Mode of infection: non-infectious Complications: affective disorder mental disorder
Cause
Acute stress response etiology
Serious life events (35%):
In the case of a serious traffic accident, the relatives suddenly die, especially the spouse or children, the marriage is broken, the unmarried is pregnant, abandoned, raped, suffering from cancer, suffering from blindness, disfigurement, long-term relationship between husband and wife or mother-in-law, and refugees living in exotic countries. In the case of a gangster attack, the family property was robbed and other traumatic experiences.
Major natural disasters (25%):
Such as catastrophic floods, flash floods, earthquakes, fires, storms, mudslides, etc., surviving relatives of disasters that seriously threaten life safety and huge property losses, and mental disorders after the disaster.
War (5%):
According to reports from the Second World War, when the warring parties engaged in a fierce battle between the two sides, due to the fear of shelling, bombing, and even the white-knife battle, some soldiers in the battle may have mental disorders, leading to disease.
Abuse (5%):
Being confined to concentration camps, being tortured, some may have mental disorders, and detained mental disorders are more common.
All of the above-mentioned stressors can undoubtedly contribute to the onset of the disease. In fact, not most people who suffer from abnormal stress will develop mental disorders, but only a few of them will develop symptoms, which indicates the individual's susceptibility and ability to cope with stress. There are certain differences. Therefore, in the analysis of specific cases, the nature, severity, current situation and personality characteristics of the stress source should be comprehensively analyzed and considered. In addition, the entire health status of the body is also related. In the case of a body weight disease or organic encephalopathy, the risk of an acute stress reaction may increase.
Pathogenesis
Kaplan classifies the consequences of stress into three phases: the first phase is the impact period. When the individual is under stress, he is in a state of stunned shock, which is characterized by a certain degree of disorientation and attentional dispersion. Minutes to hours, this is the main mechanism of clinical symptoms in the acute phase of the disease; the second phase is characterized by obvious confusion, ambiguity and uncertainty, accompanied by emotional disorders such as anxiety, depression, irritability; The third phase is long-term reconstruction and rebalance. The stress response can have two outcomes: one is the enhancement of function and the improvement of level; on the other hand, the obstacle between psychological, physical or interpersonal relationship, and May turn chronic.
According to the Pavlovian argument, sharp and super-strong stress acts on high-level neural activity processes, which can lead to excessive stress and conflict of excitement, inhibition and flexibility. The central nervous system avoids further damage or rupture. Excessive inhibition is often produced. This over-limit inhibition is a protective inhibition. In the diffusion of the inhibition process, the function of the lower part of the central nervous system, including some unconditioned reflexes, is released and released, which results in The abnormal form of interaction between cortex and subcortical activity can be clinically manifested as a certain degree of disturbance of consciousness, psychomotor excitement or psychomotor retardation, untargeted disordered movements and unconsciously controlled mood disorders.
Prevention
Acute stress response prevention
The prevention of acute psychogenic reactions is mainly to cultivate healthy psychology, self-protection awareness and improve coping ability in dealing with stress events. According to the specific conditions of patients, we can improve the environment in coordination with relevant parties, make reasonable arrangements, and get rid of the disease environment as soon as possible. Including the help, guidance and arrangement of patients' life and work after rehabilitation, re-adjust the life of patients, re-exchange jobs when necessary, improve interpersonal relationships, establish new life rules, cultivate the joy of life, and pay attention to society and family. Support system to facilitate the recovery of patients as soon as possible, which has a good effect on prevention.
1. Fully understand the enemy situation
The expected degree of stress caused by the expected event is significantly smaller than that of the unexpected event, because the predictable event enables the body to prepare for adaptation so as to withstand higher levels of stress stimulation. It is necessary to do a good pre-war analysis, understand the mastery of enemy equipment, operational intentions, and have a full and correct understanding of the nature of the war.
2. Enhance confidence
Even an event that may cause serious consequences, as long as the individual subjectively believes that it can be effectively controlled and handled, can greatly reduce the degree of stress. Therefore, it is necessary to have a full understanding of our military and individual's own combat capabilities. The determination and confidence to win.
3. Increase psychological support
Some people in danger are reaching out to rescue hands. Although sometimes this kind of rescue is only spiritual, it can also play a supporting and encouraging role. It is necessary to find more comrades before the war, lead the leaders, and get their support and trust. If necessary, you can also contact the psychological counseling agency of the system to obtain their psychological guidance.
4. Enhanced scenario simulation training
This is the main measure of wartime stress prevention. It is usually trained in the most realistic combat environment, experiencing panic symptoms under controlled conditions, and gradual stimulation of military psychology, making it repeatedly imagine the complexity of the battle situation and Hardship puts tremendous pressure on the mind, experiences tension, and controls tension in the best state of mental activity.
5. Strengthen physical exercise
A strong body is the physiological basis for combating stress. It is necessary to increase the amount of training for your physical and sports weaknesses, actively exercise, persevere, and maintain a strong physique to counter various stressors in the harsh environment of wartime.
6. Do a good job of relaxation training
Because emotional reactions under stress are accompanied by skeletal muscle tension, relaxing muscles can relieve emotional reactions. Therefore, self-relaxation therapy can relieve tension. Relaxation therapy is controlled by a variety of self-sense The method of muscle tension.
7. Improve the positional environment
Strengthening the logistical support environment can make the officers and men feel comfortable and help the prevention of wartime stress. Therefore, efforts should be made to improve the position of the position and eliminate the bodies and dirt on the battlefield in a timely manner. During the battle, conditions should be created to provide military personnel with A good diet, warmth and rest conditions ensure that the military sleeps for at least 4 hours a day.
Complication
Acute stress response complications Complications, affective disorder, mental disorder
Can be complicated by acute stress psychosis, is a subtype of acute stress disorder caused by a strong and sustained psychological traumatic event directly caused by a period of time, with delusions, severe affective disorders, symptom content and stress The source is closely related and is easier to be understood. Acute or subacute onset, with proper treatment, good prognosis, normal mental state after recovery, and generally no defects.
Symptom
Symptoms of acute stress response Common symptoms Awareness disorder Psychological disorder Orientation disorder Psychic trauma Psychiatric surgery Postoperative acute mental disorder
1. The most central symptoms - traumatic recurrence experience, avoidance and numbness, high alertness:
If the situation of a traumatic event or the psychological feelings at that time repeatedly appear in consciousness or in a dream, any situation related to the traumatic experience can be induced, and the patient can avoid all kinds of people or things related to trauma, and the emotion can be expressed as numbness. State, there are often autonomic symptoms such as tachycardia, sweating, and facial redness.
2. Separation symptoms:
Such as numbness, slow emotional response, decreased clarity of consciousness, unreality, separation and forgetting, disintegration of personality or disintegration of reality.
3. General performance:
After experiencing a traumatic event, there is sorrow, narrow attention, inability to understand external stimuli, misorientation, and even the degree of separation stiffness, or as escape, divine, emotional outburst, etc.
4. Psychiatric symptoms:
Some patients may have thought association relaxation, illusion of fragments, delusions, severe anxiety and depression, and the degree of mental illness in the severe stage of the disease.
Examine
Acute stress response check
In addition to the initial state of utter state, there may be depression, anxiety, anger, despair, hyperactivity, withdrawal, and no one type of symptoms continues to predominate.
There is no specific laboratory test for this disease. When other diseases such as infections occur, laboratory tests show positive results of other diseases, examination of the nervous system, and exclusion of organic lesions; ECG can be selected according to specific conditions. Gastroscopy, etc.
Diagnosis
Diagnosis and diagnosis of acute stress response
diagnosis
The diagnostic criteria can be found in the following items (CCMD-2-R):
1. Suddenly suffering from unusually intense stressful life events before the onset of stimulation or influence, without the influence of other mental disorders, that is, the use of unusual and serious mental assault as an inducement.
2. There is a close relationship between the appearance of mental symptoms and the stressors. Generally, they occur within a few minutes or a few hours after the mental attack. There must be a clear connection between the symptoms and the stressors.
3. Although the clinical manifestations have large variability, they can be summarized into two types of performance:
1 psychomotor inhibition, mainly manifested as a certain degree of disturbance of consciousness, and some are in a state of stupor;
2 psychomotor excitement, can be accompanied by strong emotional changes, such as fearful emotions, behavior has a certain degree of blindness, accompanied by autonomic nervous system symptoms, anxiety or depression is also more common in mood disorders.
4. The course of the disease is short, the symptoms usually last for a short time, a few hours or a few days, complete remission in about 1 week, rarely more than 1 week, the longest is no more than 4 weeks, the prognosis is good.
Differential diagnosis
1. snoring: often can occur after a stress event, if the acute attack should be differentiated from the stress response, generally speaking, snoring is mostly under the influence of psychological and social stress factors, and the symptoms are difficult to be associated with acute psychosis in the short term. The difference in sexual response, snoring performance is more diverse, with exaggerated or performance, giving people the feeling of pretentiousness, pre-existing personality is more self-centered, full of fantasy, like art and literature, etc., which is very important It has strong suggestiveness for the onset of snoring, and the condition is most likely to be repeated multiple times.
2. Affective disorders: It can also occur under the impact of a certain stress source, but its main symptoms are coordinated psychomotor excitability or inhibition, and affective disorders predominate, less conscious disturbances, longer duration, although the condition Have a good remission period, but often have a recurrent episode.
3. Acute brain organic dysfunction syndrome: acute brain organic dysfunction syndrome caused by infection, poisoning and other factors, such as toxic mental disorders, paralysis, emotional instability, excitement, etc., can express disturbance of consciousness, Symptoms such as disorientation, psychomotor excitement, etc., but such disorders are often seen as rich and vivid. The disturbance of consciousness is characterized by fluctuating fluctuations. The clinical symptoms are emphasized at night. In addition, a clear medical history corresponds. Positive signs, laboratory abnormalities, and clinical outcomes can be differentiated from acute stress disorder.
4. Post-traumatic stress disorder: The identification point is mainly in the course of the disease. If the mental symptoms persist after more than 4 weeks after trauma, it should be diagnosed as post-traumatic stress disorder.
