Acute and Posttraumatic Stress Disorders (ASD and PTSD) in ...

Acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) are reactions to traumatic events. The reactions involve intrusive thoughts or dreams, ... MSDManual Pleaseconfirmthatyouareahealthcareprofessional Yes No LeavethisSite? Thelinkyouhaveselectedwilltakeyoutoathird-partywebsite.Wedonotcontrolorhaveresponsibilityforthecontentofanythird-partysite. 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MedicalTopics&Chapters A B C D E F G H I J K L M N O P Q R S T U V W X Y Z Professional / Pediatrics / MentalDisordersinChildrenandAdolescents / ... / AcuteandPosttraumaticStressDisorders(ASDandPTSD)inChildrenandAdolescents / OTHERTOPICSINTHISCHAPTER OverviewofMentalDisordersinChildrenandAdolescents OverviewofAnxietyDisordersinChildrenandAdolescents AcuteandPosttraumaticStressDisorders(ASDandPTSD)inChildrenandAdolescents AgoraphobiainChildrenandAdolescents BipolarDisorderinChildrenandAdolescents ConductDisorder DepressiveDisordersinChildrenandAdolescents GeneralizedAnxietyDisorderinChildrenandAdolescents NonsuicidalSelf-Injury(NSSI)inChildrenandAdolescents Obsessive-CompulsiveDisorder(OCD)andRelatedDisordersinChildrenandAdolescents OppositionalDefiantDisorder(ODD) PanicDisorderinChildrenandAdolescents SchizophreniainChildrenandAdolescents SeparationAnxietyDisorder SocialAnxietyDisorderinChildrenandAdolescents SomaticSymptomandRelatedDisordersinChildren SuicidalBehaviorinChildrenandAdolescents AcuteandPosttraumaticStressDisorders(ASDandPTSD)inChildrenandAdolescents By JosephineElia ,MD,Nemours/A.I.duPontHospitalforChildren Lastfullreview/revisionApr2021 ClickhereforPatientEducation Generalreference SymptomsandSigns Diagnosis Prognosis Treatment KeyPoints Acutestressdisorder(ASD)andposttraumaticstressdisorder(PTSD)arereactionstotraumaticevents.Thereactionsinvolveintrusivethoughtsordreams,avoidanceofremindersoftheevent,andnegativeeffectsonmood,cognition,arousal,andreactivity.ASDtypicallybeginsimmediatelyafterthetraumaandlastsfrom3daysto1month.PTSDcanbeacontinuationofASDormaymanifestupto6monthsafterthetraumaandlastsfor>1month.Diagnosisisbyclinicalcriteria.Treatmentiswithbehavioraltherapyandsometimeswithselectiveserotoninreuptakeinhibitorsorantiadrenergicdrugs.(SeealsoAcuteStressDisorderAcuteStressDisorderAcutestressdisorderisabriefperiodofintrusiverecollectionsoccurringwithin4weeksofwitnessingorexperiencinganoverwhelmingtraumaticevent.(SeealsoOverviewofTrauma-andStressor-Related...readmoreandPosttraumaticStressDisorderPosttraumaticStressDisorder(PTSD)Posttraumaticstressdisorder(PTSD)isrecurring,intrusiverecollectionsofanoverwhelmingtraumaticevent;recollectionslast>1monthandbeginwithin6monthsoftheevent.Thepathophysiology...readmoreinadults.)ASDandPTSDaretrauma-andstressor-relateddisorders.Theyusedtobeconsideredanxietydisordersbutarenowconsidereddistinctbecausemanypatientsdonothaveanxietybuthaveothersymptomsinstead.Becausevulnerabilityandtemperamentaredifferent,notallchildrenwhoareexposedtoaseveretraumaticeventdevelopastressdisorder.Traumaticeventscommonlyassociatedwiththesedisordersincludeassaults,sexualassaults,caraccidents,dogattacks,andinjuries(especiallyburns).Inyoungchildren,domesticviolenceisthemostcommoncauseofPTSD.Childrendonothavetodirectlyexperiencethetraumaticevent;theymaydevelopastressdisorderiftheywitnessatraumaticeventhappeningtoothers(eventhroughmediaexposure;1GeneralreferenceAcutestressdisorder(ASD)andposttraumaticstressdisorder(PTSD)arereactionstotraumaticevents.Thereactionsinvolveintrusivethoughtsordreams,avoidanceofremindersoftheevent...readmore)orlearnthatoneoccurredtoaclosefamilymember.Generalreference1.ComerJS,KendallPC:Terrorism:Thepsychologicalimpactonyouth.ClinPsychol14:179-212,2007.SymptomsandSignsofASDandPTSDSymptomsofASDandPTSDaresimilarandgenerallyinvolveacombinationofthefollowing:Intrusionsymptoms:Recurrent,involuntary,anddistressingmemoriesordreamsofthetraumaticevent(inchildren<6years,itmaynotbeclearwhethertheirdistressingdreamsarerelatedtotheevent);dissociativereactions(typicallyflashbacksinwhichpatientsreexperiencethetrauma,althoughyoungchildrenmayfrequentlyreenacttheeventinplay);anddistressatinternalorexternalcuesthatresemblesomeaspectofthetrauma(eg,seeingadogorsomeonewhoresemblesaperpetrator)Avoidancesymptoms:Persistentavoidanceofmemories,feelings,orexternalremindersofthetraumaNegativeeffectsoncognitionand/ormood:Inabilitytorememberimportantaspectsofthetraumaticevent,distortedthinkingaboutthecausesand/orconsequencesofthetrauma(eg,thattheyaretoblameorcouldhaveavoidedtheeventbycertainactions),adecreaseinpositiveemotionsandanincreaseinnegativeemotions(fear,guilt,sadness,shame,confusion),generallackofinterest,socialwithdrawal,asubjectivesenseoffeelingnumb,andaforeshortenedexpectationofthefuture(eg,thinking“Iwillnotlivetosee20”)Alteredarousaland/orreactivity(eg,hyperarousal):Jitteriness,exaggeratedstartleresponse,difficultyrelaxing,difficultyconcentrating,disruptedsleep(sometimeswithfrequentnightmares),andaggressiveorrecklessbehaviorDissociativesymptoms:Feelingdetachedfromone'sbodyasifinadreamandfeelingthattheworldisunrealTypically,childrenwithASDareinadazeandmayseemdissociatedfromeverydaysurroundings.ChildrenwithPTSDhaveintrusiverecollectionsthatcausethemtoreexperiencethetraumaticevent.Themostdramatickindofrecollectionisaflashback.Flashbacksmaybespontaneousbutaremostcommonlytriggeredbysomethingassociatedwiththeoriginaltrauma.Forexample,thesightofadogmaytriggeraflashbackinchildrenwhoexperiencedadogattack.Duringaflashback,childrenmaybeinaterrifiedstateandunawareoftheircurrentsurroundingswhiledesperatelysearchingforawaytohideorescape;theymaytemporarilylosetouchwithrealityandbelievetheyareingravedanger.Somechildrenhavenightmares.Whenchildrenreexperiencetheeventinotherways(eg,inthoughts,mentalimages,orrecollections),theyremainawareofcurrentsurroundings,althoughtheymaystillbegreatlydistressed.DiagnosisofASDandPTSDClinicalevaluationDiagnosisofASDandPTSDisbasedonahistoryofexposuretoseverelyfrighteningandhorrifyingtraumafollowedbyreexperiencing,emotionalnumbing,andhyperarousal.Thesesymptomsmustbesevereenoughtocauseimpairmentordistress.Symptomslasting≥3daysand<1monthareconsideredASD.Symptomslasting>1monthareconsideredPTSD,whichcanbeacontinuationofASDormaymanifestupto6monthsafterthetrauma.Patientsmusthaveanumberofmanifestationsindifferentsymptomareas;specificcriteriaforASDDiagnosisAcutestressdisorderisabriefperiodofintrusiverecollectionsoccurringwithin4weeksofwitnessingorexperiencinganoverwhelmingtraumaticevent.(SeealsoOverviewofTrauma-andStressor-Related...readmoreandPTSDDiagnosisPosttraumaticstressdisorder(PTSD)isrecurring,intrusiverecollectionsofanoverwhelmingtraumaticevent;recollectionslast>1monthandbeginwithin6monthsoftheevent.Thepathophysiology...readmoreintheDiagnosticandStatisticalManualofMentalDisorders,FifthEdition(DSM-5)differslightly.PrognosisforASDandPTSDPrognosisismuchbetterforchildrenwithASDthanforthosewithPTSD,butbothbenefitfromearlytreatment.Riskfactorsinclude(1PrognosisreferenceAcutestressdisorder(ASD)andposttraumaticstressdisorder(PTSD)arereactionstotraumaticevents.Thereactionsinvolveintrusivethoughtsordreams,avoidanceofremindersoftheevent...readmore)SeverityofthetraumaAssociatedphysicalinjuriesTheunderlyingresiliencyandtemperamentofchildrenandfamilymembersSocioeconomicstatusAdversityduringchildhoodFamilydysfunctionMinoritystatusFamilypsychiatrichistoryFamilyandsocialsupportbeforeandafterthetraumamoderatesthefinaloutcome.Prognosisreference1.TrickeyD,SiddawayAP,Meiser-StedmanR,etal:Ameta-analysisofriskfactorsforpost-traumaticstressdisorderinchildrenandadolescents.ClinPsycholRev32(2):122-138,2012.doi:10.1016/j.cpr.2011.12.001TreatmentofASDandPTSDTrauma-basedpsychotherapiesSupportivepsychotherapySelectiveserotoninreuptakeinhibitors(SSRIs)andsometimesantiadrenergicdrugsTrauma-basedpsychotherapieshavebeenreportedtobeefficaciousinchildrenwithPTSD(1–4)TreatmentreferencesAcutestressdisorder(ASD)andposttraumaticstressdisorder(PTSD)arereactionstotraumaticevents.Thereactionsinvolveintrusivethoughtsordreams,avoidanceofremindersoftheevent...readmore.Trauma-basedpsychotherapyinvolvesshort-terminterventionsthatusecognitive-behavioraltechniquestomodifydistortedthinking,negativereactions,andbehavior.Itcanalsoincludeteachingparentsstressreductionandcommunicationskills.Supportivepsychotherapymayhelpchildrenwhohaveadjustmentissuesassociatedwithtrauma,asmayresultfromdisfigurementduetoburns.Behavioraltherapycanbeusedtosystematicallydesensitizechildrentosituationsthatcausethemtoreexperiencetheevent(exposuretherapyExposuretherapySpecificphobicdisordersconsistofpersistent,unreasonable,intensefears(phobias)ofspecificsituations,circumstances,orobjects.Thefearsprovokeanxietyandavoidance.Thecauses...readmore).BehavioraltherapyisclearlyeffectiveinreducingdistressandimpairmentinchildrenandadolescentswithPTSD.TherearenodrugsapprovedforPTSDinchildrenbecauseadequateclinicaltrialsremaintobeconducted.However,inyouthswithcomorbidanxiety,depression,sleepdifficulties,selectiveserotoninreuptakeinhibitors(SSRIs)canbehelpful(5TreatmentreferencesAcutestressdisorder(ASD)andposttraumaticstressdisorder(PTSD)arereactionstotraumaticevents.Thereactionsinvolveintrusivethoughtsordreams,avoidanceofremindersoftheevent...readmore).Antiadrenergicdrugs(eg,clonidine,guanfacine[6TreatmentreferencesAcutestressdisorder(ASD)andposttraumaticstressdisorder(PTSD)arereactionstotraumaticevents.Thereactionsinvolveintrusivethoughtsordreams,avoidanceofremindersoftheevent...readmore],prazosin[7TreatmentreferencesAcutestressdisorder(ASD)andposttraumaticstressdisorder(PTSD)arereactionstotraumaticevents.Thereactionsinvolveintrusivethoughtsordreams,avoidanceofremindersoftheevent...readmore])mayhelprelievehyperarousalsymptoms,butsupportivedataarepreliminary.Treatmentreferences1.KowalikJ,WellerJ,VenterJ,etal:Cognitivebehavioraltherapyforthetreatmentofpediatricposttraumaticstressdisorder:Areviewandmeta-analysis.JBehavTherExpPsychiatry42(3):405-413,2011.doi:10.1016/j.jbtep.2011.02.0022.KataokaSH,SteinBD,JaycoxLH,etal:Aschool-basedmentalhealthprogramfortraumatizedLatinoimmigrantchildren.JAmAcadChildAdolescPsychiatry42(3):311-318,2003.doi:10.1097/00004583-200303000-000113.McMullenJ,O'CallaghanP,ShannonC,etal:Grouptrauma-focusedcognitive-behaviouraltherapywithformerchildsoldiersandotherwar-affectedboysintheDRCongo:Arandomisedcontrolledtrial.JChildPsycholPsychiatry54(11):1231-1241,2013.doi:10.1111/jcpp.120944.DeblingerE,SteerRA,LippmannJ:Two-yearfollow-upstudyofcognitivebehavioraltherapyforsexuallyabusedchildrensufferingpost-traumaticstresssymptoms.ChildAbuseNegl23(12):1371-1378,1999.doi:10.1016/s0145-2134(99)00091-55.StrawnJR,KeeshinBR,DelBelloMP,etal:Psychopharmacologictreatmentofposttraumaticstressdisorderinchildrenandadolescents:Areview.JClinPsychiatry71(7):932-941.doi:10.4088/JCP.09r05446blu6.ConnorDF,GrassoDJ,SlivinskyMD,etal:Anopen-labelstudyofguanfacineextendedreleasefortraumaticstressrelatedsymptomsinchildrenandadolescents.JChildAdolescPsychopharmacol23(4):244-251,2013.7.KeeshinBR,DingQ,PressonAP,etal:UseofprazosinforpediatricPTSD-associatednightmaresandsleepdisturbances:Aretrospectivechartreview.NeurolTher6(2):247-257,2017.doi:10.1007/s40120-017-0078-4KeyPointsASDtypicallybeginsimmediatelyafterthetraumaandlastsfrom3daysto1month;PTSDlastsfor>1monthandcanbeacontinuationofASDormaymanifestupto6monthsafterthetrauma.Stressdisordersmaystartafterchildrendirectlyexperienceatraumaticevent,iftheywitnessone,orlearnthatonehappenedtoaclosefamilymember.SymptomsofASDandPTSDaresimilarandusuallyinvolveacombinationofintrusionsymptoms(eg,reexperiencingtheevent),avoidancesymptoms,negativeeffectsoncognitionand/ormood(eg,emotionalnumbing),alteredarousaland/orreactivity,anddissociativesymptoms.Treatwithtrauma-basedpsychotherapyand,inchildrenwithcomorbidanxiety,depressionand/orsleepdifficulties,SSRIs;sometimesantiadrenergicdrugsmaybehelpful. 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