Acute Stress Disorder

Acute stress disorder is distress with at least 9 intrusion, dissociative, avoidance or arousal symptoms lasting 3 days to 1 month after trauma exposure.

• Occurs in 6 to 33% of trauma survivors depending on type.
• About 50% progress to PTSD, though many with PTSD never meet the acute criteria.
• Risk factors: previous trauma, psychiatric history, peritraumatic dissociation, injury severity.

• Intrusive memories, nightmares, flashbacks, numbness, derealisation, amnesia for events, avoidance, irritability, hypervigilance, insomnia.
• Functional impairment; anxiety, guilt.
• Associated injuries and ongoing threats.

• Clinical assessment 3 days to 1 month post trauma; Acute Stress Disorder Scale.
• Exclude concussion, delirium, substance intoxication, brief psychotic disorder, medical conditions (thyroid disease, head injury), adjustment disorder.
• Evaluate safety and suicide risk.

• Practical support, safety, sleep, social contact, psychoeducation, and monitoring ("watchful waiting") for mild cases.
• Trauma focused CBT (4 to 6 sessions starting 2 to 4 weeks after trauma) for persistent symptoms reduces progression to PTSD.
• Avoid single session debriefing and routine benzodiazepines.
• Short term hypnotic (zopiclone 3.75 to 7.5 mg for up to 1 to 2 weeks) for severe insomnia; propranolol and hydrocortisone for prevention lack consistent evidence.
• Treat injuries and pain; follow up at 1 and 3 months for PTSD.