Stress-Related Disorders

1. Stress-Related Disorders Rui Feng Sir Run Run Shao Hospital

2. The response to stressful events • An emotional response, with somatic accompaniments • A coping strategy • Problem-solving strategies • Maladaptive coping strategies • A defence mechanism

3. A defence mechanism • Repression • Denial • Displacement • Projection • Reaction formation • Rationalization • Sublimation • Identification

4. Modified factiors • Present circumstances • Previous experiences

5. Classification of reactions to stressful events • Normal? • e.g. grief • Abnormal? • Acute stress reaction/disorder • Post-traumatic stress disorder • Adjustment disorder

6. Acute Stress Disorder and PostTraumatic Stress Disorder • Similar symptoms, but “time-frame” of symptoms differ. • Both occur in reaction to traumatic events (e.g., natural disasters, rape, assault, war, etc). • Acute stress disorder, if it lasts past one month, will turn into a diagnosis of PTSD.

7. Acute stress disorder

8. Clinical picture • Core symptoms • Other symptoms

9. Diagnostic convention • experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others • the person's response involved intense fear, helplessness, or horror • three (or more) of the following dissociative symptoms: • (1) a subjective sense of numbing, detachment, or absence of emotional responsiveness • (2) a reduction in awareness of his or her surroundings (e.g., "being in a daze") • (3) derealization • (4) depersonalization • (5) dissociative amnesia (i.e., inability to recall an important aspect of the trauma)

10. DSM-IV TR Criteria • The traumatic event is persistently reexperienced in at least one of the following ways: recurrent images, thoughts, dreams, illusions, flash-back episodes, or a sense of reliving the experience; or distress on exposure to reminders of the traumatic event. • Marked avoidance of stimuli that arouse recollections of the trauma (e.g., thoughts, feelings, conversations, activities, places, people). • Marked symptoms of anxiety or increased arousal (e.g., difficulty sleeping, irritability, poor concentration, hypervigilance, exaggerated startle response, motor restlessness).

11. DSM-IV TR Criteria • The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or impairs the individual's ability to pursue some necessary task, such as obtaining necessary assistance or mobilizing personal resources by telling family members about the traumatic experience. • The disturbance lasts for a minimum of 2 days and a maximum of 4 weeks and occurs within 4 weeks of the traumatic event. • The disturbance is not due to the direct physiological effects of a substance(e.g., a drug of abuse, a medication) or a general medical condition, is not better accounted for by Brief Psychotic Disorder, and is not merely an exacerbation of a preexisting Axis I or Axis II disorder.

12. Epidemiology • Aetiology

13. Case study • A 23-year-old woman (gravida 1, para 0, aborta 1) who had a spontaneous abortion at 12 weeks' gestation reported a three-week history of feeling “numb and dazed” and emotionally unresponsive. She described frequently being in a dreamlike state in which things did not seem real. On careful questioning, she was unable to recall several aspects of her miscarriage. She was upset about reliving the experience over and over in her mind. She had difficulty falling asleep and was often troubled by nightmares about the miscarriage.

14. Being present in medical facilities caused intense distress. The patient noted that her job performance had diminished, and she had become irritable at home and at work. She had usually enjoyed reading but now found it hard to concentrate. She was hypersensitive to sounds while trying to concentrate. In fact, she was startled so violently by loud sounds that her husband and coworkers had asked her what was wrong, to which she replied, “I don't know.” • The patient had no other medical problems and took no medications. She denied drug, alcohol or tobacco use. Findings on physical examination were normal except for mild tachycardia and excessive perspiring, consistent with anxiety.

15. Post-traumatic stress disorder This term denotes an intense, prolonged, and sometimes delayed reactions to an intensely stressful event.

16. Traumatic events that can lead to PTSD include: • War • Natural disasters • Car or plane crashes • Terrorist attacks • Sudden death of a loved one • Rape • Kidnapping • Assault • Sexual or physical abuse • Childhood neglect

17. Case study • Josh is a 27 year-old male who recently moved back in with his parents after his wife was killed by a drunk driver 3 months ago. His wife, a beautiful young woman , was walking across a busy intersection to meet him for lunch one day. He still vividly remembers the horrific scene as the drunk driver ran the red light, plowing down his wife right before his eyes. He raced to her side, embracing her crumpled, bloody body as she died in his arms in the middle of the crosswalk. No matter how hard he tries to forget, he frequently finds himself reliving the entire incident as if it was happening all over.

18. Since the accident, Josh has been plagued with nightmares about the accident almost every night. He had to quit his job because his office was located in the building right next to the little café where he was meeting his wife for lunch the day she died. The few times he attempted to return to work were unbearable for him. He has since avoided that entire area of town. • Normally an outgoing, fun-loving guy, Josh has become increasingly withdrawn, “jumpy”, and irritable since his wife’s death. He’s stopped working out, playing his guitar, or playing basketball with his friends – all activities he once really enjoyed. His parents worry about how detached and emotionally flat he’s become.

19. PTSD:General Categories of Symptoms • Re-experiencing the traumatic event • Avoiding reminders of the trauma • Increased anxiety and emotional arousal

20. PTSD:General Categories of Symptoms Re-experiencing the traumatic event • Intrusive, upsetting memories of the event • Flashbacks • Nightmares • Feelings of intense distress when reminded of the trauma • Intense physical reactions to reminders of the event (e.g. pounding heart, rapid breathing, nausea, muscle tension, sweating)

21. PTSD:General Categories of Symptoms Avoiding reminders of the trauma • Avoiding activities, places, thoughts, or feelings that remind you of the trauma • Inability to remember important aspects of the trauma • Loss of interest in activities and life in general • Feeling detached from others and emotionally numb • Sense of a limited future (you don’t expect to live a normal life span, get married.

22. PTSD:General Categories of Symptoms Increased anxiety and emotional arousal • Difficulty falling or staying asleep • Irritability or outbursts of anger • Difficulty concentrating • Hypervigilance (on constant “red alert”) • Feeling jumpy and easily startled

23. Other common symptoms • Anger and irritability • Guilt, shame, or self-blame • Substance abuse • Feelings of mistrust and betrayal • Depression and hopelessness • Suicidal thoughts and feelings • Feeling alienated and alone • Physical aches and pains

24. causes and risk factors • around the nature of the traumatic event • Vulnerability：

25. Stress-Related Disorders:Adjustment Disorders

26. Adjustment Disorders • Mild • A maladaptive reaction to an identifiable psychosocial stressor • Typical sources of stress: • unemployment • relocation

27. Thank you for your attention!