Acute stress disorder physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]

Overview

Patients with acute stress disorder usually appear disheveled and unclean and may show the effects of dehydration and failure to care for themselves. Mental status examination of patients with acute stress disorder is usually remarkable for anxious, sad, irritable, apathetic, emotionally labile, angry, or calm, individuals may feel helpless, be confused, be in a state of disbelief, have markedly impaired concentration, have lowered self-esteem, or be driven to search for the deceased, patients may have visual or auditory hallucinations that the deceased person is present; feelings of unreality, flashbacks, numbness, and denial may occur, confusion in combination with preoccupation with those they have lost may be present that impair an individuals’ judgment and insight, and suicidal thoughts occur in as many as approximately 54% of survivors and may continue up to 6 months after the death; thoughts or plans of homicide may be present.

Physical Examination

If serious signs appear and last more than a couple of weeks, help should be sought. Signs that need help include the following:

Signs	Signs for which help is needed include the following
Sign 1	Extended depression and loss of interest in activities and events
Sign 2	Inability to sleep, loss of appetite, or prolonged fear of being alone
Sign 3	Extended period of marked regression
Sign 4	Excessive imitation of the deceased or repeated statements about wanting to join the deceased
Sign 5	Withdrawal from friends
Sign 6	Encourage bereaved individuals to care for themselves
Sign 7	Serious drop in school performance or refusal to go to school
Sign 8	Persistent fears
Sign 9	Persistent irritability and being easily startled
Sign 10	Behavior problems
Sign 11	physical complaints

Appearance of the patient

• Patients may be disheveled and unclean and may show the effects of dehydration and failure to care for themselves

Mental status examination

• The mental status examination is used to assess the patient's current mental condition
• Affect and mood
  • Patients may appear anxious, sad, irritable, apathetic, emotionally labile, angry, or calm
• Thought content
  • Individuals may feel helpless, be confused, be in a state of disbelief, have markedly impaired concentration, have lowered self-esteem, or be driven to search for the deceased
• Perceptions
  • Patients may have visual or auditory hallucinations that the deceased person is present; feelings of unreality, flashbacks, numbness, and denial may occur
• Judgment and insight
  • Confusion in combination with preoccupation with those they have lost may be present that impair an individuals’ judgment and insight
• Suicidal or homicidal ideation
  • Suicidal thoughts occur in as many as approximately 54% of survivors and may continue up to 6 months after the death; thoughts or plans of homicide may be present

Heart

• Palpitations
• Chest pain

Abdomen

• Gastrointestinal distress

Neuromuscular

• Headache

Acute Stress Disorder Assessment Instruments

In addition to using diagnostic criteria to assess for ASD, physicians may use self-report instruments, which are structured measures specifically designed to assess for acute stress disorder based on DSM-IV criteria. Assessment tools for DSM-V are not yet available.

• The Stanford Acute Stress Reaction Questionnaire, a 30-item self-report inventory, encompasses each of the ASD symptoms that has been validated against a DSM-IV-TR diagnosis.
• The Acute Stress Disorder Interview (ASDI), a 19-item structured clinical interview that is based on DSM-IV-TR criteria, possesses.
• The Acute Stress Disorder Scale is a self-report inventory that is based on the same items described in the ASDI. The scale is widely used as a clinical screen for people who may have ASD; however, it is optimally used as a tool to measure severity of acute stress symptoms rather than to diagnose acute stress disorder. Some studies have employed an overall cutoff score on the ASDS to identify people who are high risk for PTSD; a score of 50 or more may identify severe acute stress reactions.

This is a 19-item inventory based on the Acute Stress Disorder Interview 21 and designed to assist physicians in the diagnosis of ASD.