ICD 10 situational response. Response to severe stress and adaptation disorders (F43)
In the third issue of the journal World Psychiatry for 2013 (currently available only in English, translation into Russian is in preparation), the working group on the preparation of the ICD-11 diagnostic criteria for stress disorders presented their draft of a new section of the international classification.
PTSD and adjustment disorder are among the most widely used diagnoses in mental health care worldwide. However, approaches to diagnosing these conditions have long been the subject of serious controversy due to the non-specificity of many clinical manifestations, difficulties in distinguishing disease states with normal reactions to stressful events, the presence of significant cultural characteristics in response to stress, etc.
Many criticisms have been made of the criteria for these disorders in ICD-10, DSM-IV and DSM-5. Thus, for example, according to the members of the working group, adjustment disorder is one of the most poorly defined mental disorders, which is why this diagnosis is often described as a kind of "wastebasket" in the psychiatric classification scheme. The diagnosis of PTSD has been criticized for the wide combination of different clusters of symptoms, low diagnostic threshold, high comorbidity, and in relation to the DSM-IV criteria for the fact that more than 10,000 different combinations of 17 symptoms can lead to this diagnosis.
All this was the reason for a fairly serious revision of the criteria for this group of disorders in the draft ICD-11.
The first innovation concerns the name for a group of disorders caused by stress. In the ICD-10 there is a heading F43 "Reaction to severe stress and adjustment disorders", related to section F40 - F48 "Neurotic, stress-related and somatoform disorders". The Working Group recommends avoiding the widely used but confusing term " stress-related disorders”, due to the fact that numerous disorders can be associated with stress (for example, depression, disorders associated with the use of alcohol and other psychoactive substances, etc.), but most of them can also occur in the absence of stressful or traumatic life events. In this case, we are talking only about disorders, stress for which is an obligatory and specific cause of their development. An attempt to emphasize this point in the draft ICD-11 was the introduction of the term "disorders specifically associated with stress", which, probably, can most accurately be translated into Russian as " disorders, directly stress related". It is planned to give this title to the section where the disorders discussed below will be placed.
The working group's proposals for individual disorders include:
In a generalized form, the proposals of the working group can be presented as follows:
Previous ICD-10 codes
Acute reaction to stress
Definition and background[edit]
Acute stress disorder
As a rule, to the occurrence of a particular situation, familiar or to some extent predictable, a person responds with a whole reaction - sequential actions that ultimately form behavior. This reaction is a complex combination of phylogenetic and ontogenetic patterns that are based on the instincts of self-preservation, reproduction, mental and physical personality traits, the individual's idea of his own (desired and real) standard of behavior, the microsocial environment's ideas about the standards of individual behavior in a given situation, and the foundations of society.
Mental disorders, which most often occur immediately after an emergency, form an acute reaction to stress. In this case, two variants of such a reaction are possible.
Etiology and pathogenesis[edit]
Clinical manifestations[edit]
More often it is an acute psychomotor agitation, manifested by unnecessary, fast, sometimes non-purposeful movements. The facial expressions and gestures of the victim become excessively alive. There is a narrowing of the scope of attention, which is manifested by the difficulty of retaining a large number of ideas in the circle of arbitrary purposeful activity and the ability to operate with them. Difficulty in concentration (selectivity) of attention is found: patients are very easily distracted and cannot ignore various (especially sound) interference, they hardly perceive explanations. In addition, there are difficulties in reproducing information received in the post-stress period, which is most likely due to a violation of short-term (intermediate, buffer) memory. The pace of speech accelerates, the voice becomes loud, low-modulated; it seems that the victims constantly speak in raised tones. The same phrases are often repeated, sometimes the speech begins to take on the character of a monologue. Judgments are superficial, sometimes devoid of semantic load.
For victims with acute psychomotor agitation, it is difficult to be in one position: they either lie, then stand up, or move aimlessly. Tachycardia is noted, there is an increase in blood pressure, not accompanied by deterioration or headache, flushing of the face, excessive sweating, sometimes there are feelings of thirst and hunger. At the same time, polyuria and increased defecation may be detected.
The extreme expression of this option is when a person quickly leaves the scene, without taking into account the situation. Cases are described when, during an earthquake, people jumped out of the windows of the upper floors of buildings and crashed to death, when parents first of all saved themselves and forgot about their children (fathers). All these actions were due to the instinct of self-preservation.
In the second type of acute reaction to stress, there is a sharp slowdown in mental and motor activity. At the same time, there are derealization disorders, manifested in a feeling of alienation from the real world. Surrounding objects begin to be perceived as changed, unnatural, and in some cases - as unreal, "inanimate". A change in the perception of sound signals is also likely: people's voices and other sounds lose their characteristics (individuality, specificity, "juiciness"). There are also sensations of a changed distance between various surrounding objects (objects that are at a closer distance are perceived more than they really are) - metamorphopsia.
Usually, victims with the considered variant of an acute reaction to stress sit for a long time in the same position (after an earthquake near their destroyed home) and do not react to anything. Sometimes their attention is completely absorbed by unnecessary or completely unusable things, i.e. there is hyperprosexia, which is outwardly manifested by absent-mindedness and seeming ignorance of important external stimuli. People do not seek help, they do not actively express complaints during a conversation, they speak in a low, low-modulated voice and, in general, give the impression of devastated, emotionally emasculated. Blood pressure is rarely elevated, feelings of thirst and hunger are dulled.
In severe cases, a psychogenic stupor develops: a person lies with his eyes closed, does not react to his surroundings. All body reactions are slowed down, the pupil reacts sluggishly to light. Breathing slows down, becomes silent, shallow. The body, as it were, tries to protect itself from reality as much as possible.
Behavior during an acute reaction to stress, first of all, determines the instinct of self-preservation, and in women, in some cases, the instinct of procreation comes to the fore (i.e., a woman seeks first to save her helpless children).
It should be noted that immediately after a person has experienced a threat to his own safety or the safety of his loved ones, in some cases he begins to absorb large amounts of food and water. An increase in physiological needs (urination, defecation) is noted. The need for intimacy (solitude) when performing physiological acts disappears. In addition, immediately after the emergency (in the so-called phase of isolation) in the relationship between the victims, the "right of the strong" begins to operate, i.e. a change in the morality of the microsocial environment begins (deprivation of morality).
Acute stress reaction: Diagnosis[edit]
An acute stress reaction is diagnosed if the condition meets the following criteria:
- Experiencing severe mental or physical stress.
- Development of symptoms immediately following this within 1 hour.
Response to severe stress and adaptation disorders according to ICD-10
This group of disorders differs from other groups in that it includes disorders that are identifiable not only on the basis of symptoms and course, but also on the basis of evidence of the influence of one or even both causes: an exceptionally adverse life event that caused an acute stress reaction, or a significant changes in life leading to prolonged unpleasant circumstances and causing adaptation disorders. Although less severe psychosocial stress (life circumstances) may hasten the onset or contribute to the manifestation of a wide range of disorders present in this class of diseases, its etiological significance is not always clear, and dependence on the individual, often on his hypersensitivity and vulnerability (t i.e. life events are not necessary or sufficient to explain the occurrence and form of the disorder). The disorders collected under this rubric, on the other hand, are always considered as the direct consequence of acute severe stress or prolonged trauma. Stressful events or prolonged unpleasant circumstances are the primary or predominant causative factor and the disorder could not have arisen without their influence. Thus, the disorders classified under this rubric can be seen as perverted adaptive responses to severe or prolonged stress that interfere with successful coping and therefore lead to social functioning problems.
Acute reaction to stress
A transient disorder that develops in a person without any other psychiatric manifestations in response to unusual physical or mental stress and usually subsides after a few hours or days. In the prevalence and severity of stress reactions, individual vulnerability and the ability to control oneself matter. Symptoms show a typical mixed and variable picture and include an initial state of "dazedness" with some narrowing of the field of consciousness and attention, inability to fully recognize stimuli, and disorientation. This state may be accompanied by a subsequent "withdrawal" from the surrounding situation (to the state of dissociative stupor - F44.2) or agitation and hyperactivity (flight reaction or fugue). Some features of panic disorder (tachycardia, excessive sweating, flushing) are usually present. Symptoms usually appear a few minutes after exposure to a stressful stimulus or event and disappear after 2-3 days (often after several hours). There may be partial or complete amnesia (F44.0) for the stressful event. If the above symptoms persist, the diagnosis should be changed. Acute: crisis reaction reaction to stress, Nervous demobilization, Crisis state, Mental shock.
A. Exposure to a purely medical or physical stressor.
B. Symptoms occur immediately following exposure to the stressor (within 1 hour).
B. There are two groups of symptoms; response to acute stress is subdivided into:
F43.00 light only the following criterion is met 1)
F43.01 moderate, criterion 1) is met and any two of the symptoms from criterion 2) are present
F43.02 severe, criterion 1) is met and any 4 symptoms from criterion 2 are present); or there is dissociative stupor (see F44.2).
1. Criteria B, C, and D for generalized anxiety disorder (F41.1) are met.
2. a) Avoiding upcoming social interactions.
b) Narrowing of attention.
c) Manifestations of disorientation.
d) Anger or verbal aggression.
e) Despair or hopelessness.
f) Inappropriate or aimless hyperactivity.
g) Uncontrollable and excessive grief (considered in accordance with
local cultural standards).
D. If the stressor is transient or can be relieved, symptoms should begin
decrease after no more than eight hours. If the stressor continues to act,
symptoms should begin to decrease in no more than 48 hours.
E. Most commonly used exclusion criteria. The reaction must develop
the absence of any other mental or behavioral disorders in the ICD-10 (with the exception of P41.1 (generalized anxiety disorders) and F60- (personality disorders)) and at least three months after the completion of an episode of any other mental or behavioral disorder.
Post Traumatic Stress Disorder
Occurs as a delayed or prolonged response to a stressful event (brief or prolonged) of an exceptionally threatening or catastrophic nature that can cause profound distress to almost anyone. Predisposing factors, such as personality traits (compulsivity, asthenicity) or a history of neurological disease, may lower the threshold for the development of the syndrome or exacerbate its course, but they are never necessary or sufficient to explain its occurrence. Typical signs include episodes of repetitive experiences of the traumatic event in intrusive flashbacks, thoughts, or nightmares that appear against a persistent background of feelings of numbness, emotional retardation, alienation from other people, unresponsiveness to the environment, and avoidance of actions and situations reminiscent of the trauma. Hyperarousal and marked hypervigilance, increased startle response, and insomnia are common. Anxiety and depression are often associated with the above symptoms, and suicidal ideation is not uncommon. The appearance of symptoms of the disorder is preceded by a latent period after injury, ranging from several weeks to several months. The course of the disorder varies, but in most cases recovery can be expected. In some cases, the condition may take a chronic course for many years with a possible transition to a permanent change in personality (F62.0). Traumatic neurosis
A. The patient must have been exposed to a stressful event or situation (whether of short or long duration) of an exceptionally threatening or catastrophic nature that is capable of causing general distress in almost any individual.
B. Persistent memories or "revival" of the stressor in intrusive reminiscences, vivid flashbacks, or recurring dreams, or re-experiencing grief when exposed to circumstances resembling or associated with the stressor.
C. The patient must exhibit actual avoidance or avoidance of circumstances resembling or associated with the stressor (which was not observed prior to exposure to the stressor).
D. Any of the two:
1. psychogenic amnesia (F44.0), either partial or complete, in relation to important aspects of the period of exposure to the stressor;
2. Persistent symptoms of increased psychological sensitivity or excitability (not observed prior to the stressor), represented by any two of the following:
a) difficulty falling asleep or staying asleep;
b) irritability or outbursts of anger;
c) difficulty concentrating;
d) increase in the level of wakefulness;
e) enhanced quadrigeminal reflex.
Criteria B, C, and D occur within six months of the stressful situation or at the end of the stressful period (for some purposes, the onset of the disorder more than six months late may be included, but these cases must be specifically identified separately).
Disorder of adaptive reactions
A state of subjective distress and emotional distress that creates difficulties for social activities and actions that occurs during the period of adaptation to a significant change in life or a stressful event. A stressful event may disrupt the integrity of an individual's social relationships (bereavement, separation) or broad social support and value systems (migration, refugee status) or represent a wide range of life changes and upheavals (going to school, becoming parents, failure to achieve a cherished personal goals, retirement). Individual predisposition or vulnerability play an important role in the risk of occurrence and the form of manifestation of disorders of adaptive reactions, however, the possibility of such disorders without a traumatic factor is not allowed. Manifestations are highly variable and include depressed mood, alertness or anxiety (or a combination of these conditions), a feeling of inability to cope with the situation, plan ahead or decide to stay in the present situation, and also include some degree of decrease in the ability to function in daily life. At the same time, behavioral disorders can join, especially in adolescence. A characteristic feature may be a brief or prolonged depressive reaction or disturbance of other emotions and behaviors: Culture shock, Grief reaction, Hospitalism in children. Excludes: separation anxiety disorder in children (F93.0)
A. The development of symptoms must occur within one month of exposure to an identifiable psychosocial stressor that is not an unusual or catastrophic type.
B. Symptoms or behavioral disturbance of the type found in other affective disorders (F30-F39) (excluding delusions and hallucinations), any of the disorders in F40-F48 (neurotic, stress-related and somatoform disorders) and behavioral disorders (F91-) , but in the absence of criteria for these specific disorders. Symptoms can be variable in form and severity. The predominant features of the symptoms can be identified using the fifth digit:
F43.20 Brief depressive reaction.
Transient mild depression, lasting less than one month
F43.21 Prolonged depressive reaction.
A mild depressive state that arose as a result of a prolonged action of a stressful situation, but lasting no more than two years.
F43.22 Mixed anxiety and depressive reaction.
Symptoms of both anxiety and depression are prominent, but not higher in level than that defined for mixed anxiety and depressive disorder (F41.2) or other mixed anxiety disorders (F41.3).
F43.23 Other emotion disorders predominate
The symptoms are usually of several emotional types, such as anxiety, depression, restlessness, tension, and anger. Symptoms of anxiety and depression may meet the criteria for mixed anxiety-depressive disorder (F41.2) or other mixed anxiety disorders (F41.3), but they are not so dominant that other more specific depressive or anxiety disorders might be diagnosed. This category should also be used for responses in children who also have regressive behaviors such as enuresis or thumb sucking.
F43.24 With a predominance of behavioral disorders. The main disorder affects behavior, for example, in adolescents, the grief reaction is manifested by aggressive or antisocial behavior.
F43.25 With mixed disorders of emotions and behaviour. Both emotional symptoms and behavioral disturbances are prominent.
F43.28 With other specified predominant symptoms
B. Symptoms do not continue for more than six months after cessation of stress or its effects, except for F43.21 (prolonged depressive reaction), but this criterion should not preclude a provisional diagnosis.
Other reactions to severe stress
Response to severe stress, unspecified
The selected group of neurotic disorders differs from the previous ones in that it has a clear temporal and causal relationship with a traumatic (usually objectively significant) event. A stressful life event is characterized by unexpectedness, a significant violation of life plans. Typical severe stressors are military operations, natural and transport disasters, an accident, the presence of others at a violent death, robbery, torture, rape, natural disaster, fire.
Acute stress reaction (F 43.0)
An acute reaction to stress is characterized by a variety of psychopathological symptoms that tend to change rapidly. Typical is the presence of "stupefaction" after the impact of psychotrauma, the inability to adequately respond to what is happening, impaired concentration and stability of attention, impaired orientation. There may be periods of agitation and hyperactivity, panic anxiety with vegetative manifestations. Amnesia may be present. The duration of this disorder ranges from several hours to two or three days. The main thing is the experience of psychotrauma.
An acute stress reaction is diagnosed when the condition meets the following criteria:
1) experiencing severe mental or physical stress;
2) the development of symptoms immediately following this within an hour;
3) depending on the presence of the following two groups of symptoms A and B, an acute reaction to stress is divided into mild (F43.00, there are only symptoms of group A), moderate (F43.01, there are symptoms of group A and at least 2 symptoms from group B) and severe (symptoms of group A and at least 4 symptoms of group B or dissociative stupor F44.2). Group A includes generalized anxiety disorder criteria 2, 3 and 4 (F41.1). Group B includes the following symptoms: a) withdrawal from expected social interaction, b) narrowing of attention, c) obvious disorientation, d) anger or verbal aggression, e) despair or hopelessness, f) inappropriate or senseless hyperactivity, g) uncontrollable, extremely severe (by the standards of relevant cultural norms) sadness;
4) when stress is reduced or eliminated, symptoms begin to decrease no earlier than after 8 hours, while maintaining stress - no earlier than after 48 hours;
5) the absence of signs of any other mental disorder, with the exception of generalized anxiety (F41.1), the episode of any previous mental disorder ended at least 3 months before the stress.
Post-traumatic stress disorder (F 43.0)
Post-traumatic stress disorder (PTSD) occurs as a delayed or prolonged reaction to a stressful event or situation of an exceptionally threatening or catastrophic nature, beyond the scope of everyday life situations that can cause distress to almost anyone. Initially, only military actions (the war in Vietnam, Afghanistan) were classified as such events. However, soon the phenomenon was transferred to civilian life.
Post-traumatic stress disorder is usually caused by the following factors:
- natural and man-made disasters;
— acts of terrorism (including taking hostages);
- service in the army;
- serving a sentence in places of deprivation of liberty;
- Violence and torture.
Post-traumatic stress disorder (F43.1) is diagnosed when the condition meets the following criteria:
1) a short or long stay in an extremely threatening or catastrophic situation, which would cause in almost everyone a feeling of deep despair;
2) persistent, involuntary and extremely vivid memories (flash-backs) of what has been transferred, which are also reflected in dreams, intensifying when they get into situations that resemble or are associated with stress;
3) avoidance of situations resembling stressful or related to it, in the absence of such behavior before stress;
4) one of the following two signs - A) partial or complete amnesia of important aspects of the transferred stress,
B) the presence of at least two of the following signs of increased mental sensitivity and excitability that were absent before exposure to stress - a) sleep disturbances, superficial sleep, b) irritability or outbursts of anger, c) decreased concentration, d) increased level of wakefulness, e) increased fearfulness ;
5) with rare exceptions, fulfillment of criteria 2-4 occurs within 6 months after exposure to stress or after its end.
It is believed that the most common among social stress disorders are: neurotic and psychosomatic disorders, delinquent and addictive forms of abnormal behavior, prenosological mental disorders of mental adaptation.
Adjustment disorder (F 43.2)
Adjustment disorders are considered states of subjective distress and are manifested primarily by emotional disturbances during the period of adaptation to a significant change in life or a stressful life event. A traumatic factor can affect the integrity of a person's social network (loss of loved ones, experiencing separation), a broad system of social support and social values, and also affect the microsocial environment. In the case of a depressive variant of an adaptation disorder, such affective phenomena as grief, lowering of mood, a tendency to solitude, as well as suicidal thoughts and tendencies appear in the clinical picture. With an anxious variant, the symptoms of anxiety, restlessness, anxiety and fear, projected into the future, the expectation of misfortune, become dominant.
Adjustment disorders (F43.2) are diagnosed when the condition meets the following criteria:
1) identified psychosocial stress that does not reach extreme or catastrophic proportions, symptoms appear within a month;
2) individual symptoms (with the exception of delusional and hallucinatory ones) that meet the criteria for affective (F3), neurotic, stressful and somatoform (F4) disorders and social behavior disorders (F91) that do not fully correspond to any of them. Symptoms may vary in structure and severity. Adaptation disorders are differentiated depending on the manifestations dominant in the clinical picture;
3) the symptoms do not last more than 6 months from the moment of cessation of the stress or its consequences, with the exception of protracted depressive reactions (F43.21).
Acute stress response - criteria in ICD-10
A - The interaction of an exclusively medical or physical stressor.
B - Symptoms occur immediately following exposure to the stressor (within 1 hour).
B - There are two groups of symptoms; response to acute stress is divided into:
* easy, criterion 1 is met.
* moderate, criterion 1 is met and any two of the symptoms from criterion 2 are present.
*severe, criterion 1 is met and any four of the symptoms from criterion 2 are present, or there is dissociative stupor.
Criterion 1 (Criteria B, C, D for generalized anxiety disorder).
* At least four symptoms from the following list must be present, with one of them from list 1-4:
1) increased or rapid heartbeat
3) tremor or shivering
4) dry mouth (but not from drugs and dehydration)
Symptoms relating to the chest and abdomen:
5) difficulty in breathing
6) feeling of suffocation
7) chest pain or discomfort
8) nausea or abdominal distress (such as burning in the stomach)
Mental symptoms:
9) Feeling dizzy, unsteady or faint.
10) feelings that objects are not real (derealization) or that one's self has moved away and "is not really here"
11) fear of loss of control, insanity or impending death
12) fear of dying
13) hot flashes and chills
14) numbness or tingling sensation
15) muscle tension or pain
16) restlessness and inability to relax
17) feeling nervous, "on edge" or mental stress
18) sensation of a lump in the throat or difficulty in swallowing
Other non-specific symptoms:
19) heightened response to small surprises or fear
20) Difficulty concentrating or "head blankness" due to anxiety or restlessness
21) constant irritability
22) difficulty falling asleep due to anxiety.
* The disorder does not meet the criteria for panic disorder (F41.0), phobic anxiety disorder (F40.-), obsessive-compulsive disorder (F42-) or hypochondriacal disorder (F45.2).
* Most commonly used exclusion criteria. Anxiety disorder is not due to a physical illness, an organic psychiatric disorder (F00-F09), or a non-amphetamine substance use disorder or benzodiazepine withdrawal disorder.
a) withdrawal from upcoming social interactions
b) narrowing of attention.
c) manifestation of disorientation
d) anger or verbal aggression.
e) despair or hopelessness.
e) inappropriate or aimless hyperactivity
g) uncontrollable or excessive grief (treated according to local cultural standards)
D - If the stressor is transient or can be relieved, symptoms should begin to decrease in no more than 8 hours. If the stressor continues, symptoms should begin to decrease in no more than 48 hours.
D - The most commonly used exclusion criteria. The reaction must occur in the absence of other ICD-10 psychiatric or behavioral disorders (with the exception of generalized anxiety disorder and personality disorder), and at least three months after the completion of an episode of any other psychiatric or behavioral disorder.
criteria for post-traumatic stress disorder DSM IV:
1. The individual was under the influence of a traumatic event, both of the following must be true:
1.1. The individual was a participant, witness, or experienced an event(s) that involves death or a threat of death, or a threat of serious injury, or a threat to the physical integrity of others (or one's own).
1.2. The response of the individual includes intense fear, helplessness, or horror. Note: In children, the reaction may be replaced by agitated or disorganized behavior.
2. The traumatic event is persistently experienced in one (or more) of the following ways:
2.1. Repetitive and obsessive reproduction of an event, corresponding images, thoughts and perceptions, causing severe emotional experiences. Note: Young children may develop repetitive play that brings out themes or aspects of the trauma.
2.2. Recurring heavy dreams about the event. Note: Children may have nightmares that are not stored.
2.3. Actions or sensations as if the traumatic event were happening again (includes reliving experiences, illusions, hallucinations, and dissociative flashback episodes, including those that occur in a state of intoxication or a sleepy state). Note: Trauma-specific repetitive behaviors may appear in children.
2.4. Intense difficult experiences that were caused by an external or internal situation that is reminiscent of traumatic events or symbolizes them.
2.5. Physiological reactivity in situations that externally or internally symbolize aspects of the traumatic event.
3. Constant avoidance of trauma-related stimuli, and numbing- blocking of emotional reactions, numbness (not observed before the injury). Defined by the presence of three (or more) of the following features.
3.1. Efforts to avoid thoughts, feelings, or conversations related to the trauma.
3.2. Efforts to avoid activities, places, or people that evoke memories of the trauma.
3.3. Inability to remember important aspects of the trauma (psychogenic amnesia).
3.4. Markedly reduced interest in or participation in previously significant activities.
3.5. Feeling detached or separated from other people;
3.6. Reduced severity of affect (inability, for example, to feel love).
3.7. Feelings of a lack of future prospects (for example, lack of expectations about a career, marriage, children, or wishes for a long life).
4. Persistent symptoms of increasing arousal (which were not observed before the injury). Defined by the presence of at least two of the following symptoms.
4.1. Difficulty falling asleep or poor sleep (early awakenings).
4.2. Irritability or outbursts of anger.
4.3. Difficulty concentrating.
4.4. An increased level of alertness, hypervigilance, a state of constant expectation of a threat.
4.5. Hypertrophied fear reaction.
5. Duration of the disorder (symptoms in criteria B, C and D) for more than 1 month.
6. The disorder causes clinically significant severe emotional distress or impairment in social, occupational, or other important areas of life.
7. As can be seen from the description of Criterion A, the identification of a traumatic event is one of the primary criteria for diagnosing PTSD.
/F40 - F48/ Neurotic related with stress, and somatoform disorders Introduction Neurotic stress-related and somatoform disorders are combined into one large group due to their historical connection with the concept of neurosis and the connection of the main (although not clearly established) part of these disorders with psychological causes. As already noted in the general introduction to ICD-10, the concept of neurosis was retained not as a fundamental principle, but in order to facilitate the identification of those disorders that some professionals may still consider neurotic in their own understanding of this term (see note on neuroses in general introduction). Combinations of symptoms are often observed (the most common being the coexistence of depression and anxiety), especially in cases of less severe disorders commonly found in primary care. Despite the fact that one should strive to isolate the leading syndrome, for those cases of a combination of depression and anxiety in which it would be artificial to insist on such a decision, a mixed rubric of depression and anxiety (F41.2) is provided.
/F40/ Phobic anxiety disorders
A group of disorders in which anxiety is triggered exclusively or predominantly by certain situations or objects (external to the subject) that are not currently dangerous. As a result, these situations are usually characteristically avoided or endured with a sense of fear. Phobic anxiety is subjectively, physiologically, and behaviorally no different from other types of anxiety and can vary in intensity from mild discomfort to terror. The patient's anxiety may focus on individual symptoms, such as palpitations or feeling faint, and is often associated with secondary fears of death, loss of self-control, or insanity. Anxiety is not relieved by the knowledge that other people do not consider the situation as dangerous or threatening. The mere idea of entering a phobic situation usually triggers anticipatory anxiety in advance. Accepting the criterion that the phobic object or situation is external to the subject implies that many fears of having some disease (nosophobia) or deformity (dysmorphophobia) are now classified under F45.2 (hypochondriac disorder). However, if the fear of disease arises and recurs mainly through possible contact with infection or contamination, or is simply a fear of medical procedures (injections, operations, etc.) or medical institutions (dental offices, hospitals, etc.), in in this case the appropriate rubric is F40.- (usually F40.2, specific (isolated) phobias). Phobic anxiety often coexists with depression. Prior phobic anxiety almost invariably increases during a transient depressive episode. Some depressive episodes are accompanied by temporary phobic anxiety, and low mood often accompanies certain phobias, especially agoraphobia. Whether two diagnoses (phobic anxiety and a depressive episode) or only one should be made depends on whether one disorder clearly preceded the other, and whether one disorder is clearly predominant at the time of diagnosis. If the criteria for a depressive disorder were met before the first onset of the phobic symptoms, then the first disorder should be diagnosed as a major disorder (see note in the general introduction). Most phobic disorders other than social phobias are more common in women. In this classification, panic attack (F41. 0) occurring in an established phobic situation is considered to reflect the severity of the phobia, which should be coded as the primary disorder in the first place. Panic disorder as such should only be diagnosed in the absence of any of the phobias listed under F40.-.
/F40.0/ Agoraphobia
The term "agoraphobia" is used here in a broader sense than when it was originally introduced, or than it is still used in some countries. Now it includes fears not only of open spaces, but also situations close to them, such as the presence of a crowd and the inability to immediately return to a safe place (usually home). Thus, the term includes a whole set of interrelated and usually overlapping phobias, covering fears of leaving the house: entering shops, crowds or public places, or traveling alone in trains, buses or planes. Although the intensity of anxiety and avoidance behavior can vary, this is the most maladaptive of the phobic disorders, and some patients become completely housebound. Many patients are horrified at the thought of falling and being left helpless in public. Lack of immediate access and exit is one of the key features of many agoraphobic situations. Most patients are women, and the onset of the disorder usually occurs in early adulthood. Depressive and obsessional symptoms and social phobias may also be present, but they do not dominate the clinical picture. In the absence of effective treatment, agoraphobia often becomes chronic, although it usually flows in waves. Diagnostic guidelines All of the following criteria must be met for a definite diagnosis: a) psychological or autonomic symptoms must be the primary expression of anxiety and not secondary to other symptoms such as delusions or obsessive thoughts; b) anxiety should be limited to only (or predominantly) at least two of the following situations: crowds, public places, movement outside the home and traveling alone; c) avoidance of phobic situations is or was a prominent feature. It should be noted: The diagnosis of agoraphobia provides for behavior associated with the listed phobias in certain situations, aimed at overcoming fear and / or avoiding phobic situations, leading to a violation of the usual life stereotype and varying degrees of social maladaptation (up to a complete rejection of any activity outside the home). Differential Diagnosis: It must be remembered that some patients with agoraphobia experience only mild anxiety, as they always manage to avoid phobic situations. The presence of other symptoms, such as depression, depersonalization, obsessional symptoms, and social phobias, does not conflict with the diagnosis, provided they do not dominate the clinical picture. However, if the patient was already overtly depressed by the time the phobic symptoms first appeared, a depressive episode may be a more appropriate primary diagnosis; this is more often observed in cases with a late onset of the disorder. The presence or absence of panic disorder (F41.0) in most cases of exposure to agoraphobic situations should be indicated by the fifth character: F40.00 without panic disorder; F40.01 with panic disorder. Included: - agoraphobia without a history of panic disorder; - panic disorder with agoraphobia.
F40.00 Agoraphobia without panic disorder
Includes: - agoraphobia without a history of panic disorder.
F40.01 Agoraphobia with panic disorder
Includes: - panic disorder with agoraphobia F40.1 Social phobias Social phobias often begin in adolescence and are centered around the fear of being noticed by others in relatively small groups of people (as opposed to crowds), leading to avoidance of social situations. Unlike most other phobias, social phobias are equally common in men and women. They can be isolated (for example, limited only to fear of eating in public, speaking in public, or meeting the opposite sex) or diffuse, including almost all social situations outside the family circle. The fear of vomiting in society may be important. In some cultures, face-to-face confrontation can be particularly frightening. Social phobias are usually combined with low self-esteem and fear of criticism. They may present with complaints of facial flushing, hand tremors, nausea, or an urge to urinate, with the patient sometimes convinced that one of these secondary expressions of his anxiety is the underlying problem; symptoms can progress to panic attacks. Avoidance of these situations is often significant, which in extreme cases can lead to almost complete social isolation. Diagnostic guidelines For a definite diagnosis, all of the following criteria must be met: a) the psychological, behavioral, or autonomic symptoms must be primarily a manifestation of anxiety and not be secondary to other symptoms such as delusions or obsessive thoughts; b) anxiety should be limited only or predominantly to certain social situations; c) avoidance of phobic situations should be a prominent feature. Differential Diagnosis: Both agoraphobia and depressive disorders are common and may contribute to the patient becoming housebound. If it is difficult to differentiate between social phobia and agoraphobia, agoraphobia should be coded as the underlying disorder in the first place; depression should not be diagnosed unless a complete depressive syndrome is detected. Included: - anthropophobia; - social neurosis.
F40.2 Specific (isolated) phobias
These are phobias limited to strictly defined situations, such as being near certain animals, heights, thunderstorms, darkness, flying in airplanes, closed spaces, urinating or defecation in public toilets, eating certain foods, being treated by a dentist, seeing blood or injuries and fear of being exposed to certain diseases. Even though the trigger situation is isolated, being caught in it can cause panic like agoraphobia or social phobia. Specific phobias usually appear in childhood or adolescence and, if left untreated, can persist for decades. The severity of the disorder resulting from reduced productivity depends on how easily the subject can avoid the phobic situation. Fear of phobic objects shows no tendency to fluctuate in intensity, in contrast to agoraphobia. Radiation sickness, venereal infections and, more recently, AIDS are common targets for disease phobias. Diagnostic guidelines All of the following criteria must be met for a definite diagnosis: a) the psychological or autonomic symptoms must be primary manifestations of anxiety and not secondary to other symptoms such as delusions or obsessive thoughts; b) the anxiety must be limited to a specific phobic object or situation; c) the phobic situation is avoided whenever possible. Differential diagnosis: Usually found that other psychopathological symptoms are absent, in contrast to agoraphobia and social phobias. Blood and injury phobias differ from others in that they lead to bradycardia and sometimes syncope rather than tachycardia. Fears of certain diseases, such as cancer, heart disease or sexually transmitted diseases, should be classified under hypochondriacal disorder (F45.2) unless they are associated with specific situations in which the disease may be acquired. If the belief in the presence of the disease reaches the intensity of delusion, the rubric "delusional disorder" (F22.0x) is used. Patients who are convinced that they have a disorder or malformation of a particular part of the body (often the facial) that is not objectively noticed by others (sometimes referred to as body dysmorphic disorder) should be classified under Hypochondriacal Disorder (F45.2) or Delusional Disorder (F22.0x), depending on the strength and firmness of their conviction. Included: - fear of animals; - claustrophobia; - acrophobia; - phobia of exams; - a simple phobia. Excludes: - body dysmorphic disorder (non-delusional) (F45.2); - fear of getting sick (nosophobia) (F45.2).
F40.8 Other phobic anxiety disorders
F40.9 Phobic anxiety disorder, unspecified Included: - phobia NOS; - phobic states NOS. /F41/ Other anxiety disorders Disorders in which manifestations of anxiety are the main symptoms are not limited to a particular situation. Depressive and obsessional symptoms and even some elements of phobic anxiety may also be present, but these are distinctly secondary and less severe.F41.0 Panic disorder
(episodic paroxysmal anxiety)
The main symptom is repeated attacks of severe anxiety (panic) that are not limited to a specific situation or circumstance and are therefore unpredictable. As with other anxiety disorders, the dominant symptoms vary from patient to patient, but the common ones are sudden onset of palpitations, chest pain, and a feeling of suffocation. dizziness and a feeling of unreality (depersonalization or derealization). Almost inevitable is also a secondary fear of death, loss of self-control or insanity. Attacks usually last only minutes, although sometimes longer; their frequency and course of the disorder are quite variable. In a panic attack, patients often experience sharply increasing fear and autonomic symptoms, which lead to the fact that patients hastily leave the place where they are. If this occurs in a specific situation, such as on a bus or in a crowd, the patient may subsequently avoid the situation. Likewise, frequent and unpredictable panic attacks cause a fear of being alone or going out in crowded places. A panic attack often leads to a constant fear of another attack occurring. Diagnostic guidelines: In this classification, a panic attack that occurs in an established phobic situation is considered to be an expression of the severity of the phobia, which should be taken into account in the diagnosis in the first place. Panic disorder should only be diagnosed as a primary diagnosis in the absence of any of the phobias in F40.-. For a reliable diagnosis, it is necessary that several severe attacks of autonomic anxiety occur over a period of about 1 month: a) under circumstances not associated with an objective threat; b) attacks should not be limited to known or predictable situations; c) between attacks, the state should be relatively free of anxiety symptoms (although anticipatory anxiety is common). Differential Diagnosis: Panic disorder must be distinguished from panic attacks occurring as part of established phobic disorders, as already noted. Panic attacks may be secondary to depressive disorders, especially in men, and if criteria for depressive disorder are also met, panic disorder should not be established as the primary diagnosis. Included: - panic attack; - panic attack; - panic state. Excludes: panic disorder with agoraphobia (F40.01)
F41.1 Generalized anxiety disorder
The main feature is anxiety, which is generalized and persistent, but not limited to any specific environmental circumstances, and does not even occur with a clear preference in these circumstances (that is, it is "non-fixed"). As with other anxiety disorders, the dominant symptoms are highly variable, but complaints of constant nervousness, trembling, muscle tension, sweating, palpitations, dizziness, and epigastric discomfort are common. Fears are often expressed that the patient or his relative will soon fall ill or have an accident, as well as various other worries and forebodings. This disorder is more common in women and is often associated with chronic environmental stress. The course is different, but there are tendencies to undulation and chronification. Diagnostic guidelines: The patient must have primary symptoms of anxiety on most days for a period of at least several consecutive weeks, and usually several months. These symptoms usually include: a) apprehension (worry about future failures, feelings of anxiety, difficulty concentrating, etc.); b) motor tension (fussiness, tension headaches, trembling, inability to relax); c) autonomic hyperactivity (sweating, tachycardia or tachypnea, epigastric discomfort, dizziness, dry mouth, etc.). Children may have a pronounced need to be reassured and recurrent somatic complaints. Transient occurrence (for several days) of other symptoms, especially depression, does not rule out generalized anxiety disorder as the main diagnosis, but the patient must not meet the full criteria for a depressive episode (F32.-), phobic anxiety disorder (F40.-), panic disorder (F41 .0), obsessive-compulsive disorder (F42.x). Included: - alarm condition; - anxiety neurosis; - anxiety neurosis; - anxiety reaction. Excludes: - neurasthenia (F48.0).
F41.2 Mixed anxiety and depressive disorder
This mixed category should be used when symptoms of both anxiety and depression are present, but neither are distinctly dominant or prominent enough to warrant a diagnosis on their own. If there is severe anxiety with less depression, one of the other categories for anxiety or phobic disorders is used. When both depressive and anxiety symptoms are present and sufficiently severe to warrant a separate diagnosis, then both diagnoses should be coded and this category should not be used; if, for practical reasons, only one diagnosis can be established, depression should be preferred. There must be some autonomic symptoms (such as tremors, palpitations, dry mouth, abdominal gurgling, etc.), even if they are intermittent; this category is not used if only anxiety or excessive anxiety is present without autonomic symptoms. If symptoms meeting the criteria for this disorder occur in close association with significant life changes or stressful life events, then category F43.2x, adjustment disorder is used. Patients with this mixture of relatively mild symptoms are often seen at first presentation, but there are many more of them in a population that goes unnoticed by the medical profession. Included: - anxious depression (mild or unstable). Excludes: - chronic anxious depression (dysthymia) (F34.1).
F41.3 Other mixed anxiety disorders
This category should be used for disorders that meet the criteria for F41.1 for generalized anxiety disorder and also have overt (though often transient) features of other disorders in F40 to F49, but do not fully meet the criteria for those other disorders. Common examples are obsessive-compulsive disorder (F42.x), dissociative (conversion) disorders (F44.-), somatization disorder (F45.0), undifferentiated somatoform disorder (F45.1) and hypochondriacal disorder (F45.2). If symptoms meeting the criteria for this disorder occur in close association with significant life changes or stressful events, category F43.2x, adjustment disorder is used. F41.8 Other specified anxiety disorders It should be noted: This category includes phobic states in which the symptoms of the phobia are complemented by massive conversion symptoms. Included: - disturbing hysteria. Excludes: - dissociative (conversion) disorder (F44.-).
F41.9 Anxiety disorder, unspecified
Included: - anxiety NOS.
/F42/ Obsessive-compulsive disorder
The main feature is repetitive obsessive thoughts or compulsive actions. (For brevity, the term "obsessive" will be used later instead of "obsessive-compulsive" in relation to the symptoms). Obsessional thoughts are ideas, images, or drives that come to the patient's mind over and over again in a stereotyped form. They are almost always painful (because they have an aggressive or obscene content, or simply because they are perceived as meaningless), and the patient often tries unsuccessfully to resist them. Nevertheless, they are perceived as one's own thoughts, even if they arise involuntarily and are unbearable. Compulsive actions or rituals are stereotyped actions repeated over and over again. They do not deliver intrinsic pleasure and do not lead to the performance of intrinsically useful tasks. Their meaning is to prevent any objectively unlikely events that cause harm to the patient or on the part of the patient. Usually, although not necessarily, such behavior is perceived by the patient as meaningless or fruitless, and he repeats attempts to resist it; under very long conditions, the resistance may be minimal. Often there are autonomic symptoms of anxiety, but painful sensations of internal or mental tension without obvious autonomic arousal are also characteristic. There is a strong relationship between obsessive symptoms, especially obsessive thoughts, and depression. Patients with obsessive-compulsive disorder often have depressive symptoms, and patients with recurrent depressive disorder (F33.-) may develop obsessive thoughts during depressive episodes. In both situations, an increase or decrease in the severity of depressive symptoms is usually accompanied by parallel changes in the severity of obsessional symptoms. Obsessive-compulsive disorder can equally affect men and women, and anancaste traits are often the basis of personality. The onset is usually in childhood or adolescence. The course is variable and in the absence of severe depressive symptoms, its chronic type is more likely. Diagnostic guidelines: For a definitive diagnosis, obsessional symptoms or compulsive acts, or both, must occur on the greatest number of days in a period of at least 2 consecutive weeks and be a source of distress and impaired activity. Obsessional symptoms must have the following characteristics: a) they must be regarded as the patient's own thoughts or impulses; b) there must be at least one thought or action that the patient unsuccessfully resists, even if there are others that the patient no longer resists; c) the thought of performing an action should not in itself be pleasant (a simple decrease in tension or anxiety is not considered pleasant in this sense); d) thoughts, images or impulses must be unpleasantly repetitive. It should be noted: The performance of compulsive actions is not in all cases necessarily correlated with specific obsessive fears or thoughts, but may be aimed at getting rid of a spontaneously arising feeling of internal discomfort and / or anxiety. Differential Diagnosis: Differential diagnosis between obsessive-compulsive disorder and depressive disorder can be difficult because the 2 types of symptoms often occur together. In an acute episode, preference should be given to the disorder whose symptoms first appeared; when both are present but neither dominates, it is usually better to consider the depression to be primary. In chronic disorders, preference should be given to the one whose symptoms persist most often in the absence of symptoms of the other. Occasional panic attacks or mild phobic symptoms are not a barrier to diagnosis. However, obsessive symptoms that develop in the presence of schizophrenia, Gilles de la Tourette syndrome, or an organic mental disorder should be regarded as part of these conditions. Although obsessive thoughts and compulsive actions usually coexist, it is advisable to establish one of these types of symptoms as dominant in some patients, since they may respond to different types of therapy. Included: - obsessive-compulsive neurosis; - obsessional neurosis; - Anancastic neurosis. Excludes: - obsessive-compulsive personality (disorder) (F60.5x). F42.0 Predominantly obsessive thoughts or ruminations (mental cud) They may take the form of ideas, mental images, or impulses to action. They are very different in content, but almost always unpleasant for the subject. For example, a woman is tormented by the fear that she might accidentally be overcome by the impulse to kill her beloved child, or by recurring obscene or blasphemous and alien images. Sometimes the ideas are simply useless, including endless quasi-philosophical speculations on unimportant alternatives. This non-decisional reasoning about alternatives is an important part of many other obsessive thoughts and is often combined with the inability to make trivial but necessary decisions in everyday life. The relationship between obsessive rumination and depression is particularly strong: a diagnosis of obsessive-compulsive disorder should be given preference only if rumination occurs or persists in the absence of a depressive disorder.
F42.1 Predominantly compulsive action
(compulsive rituals)
Most obsessions (compulsions) involve cleanliness (particularly handwashing), constant monitoring to prevent a potentially dangerous situation, or to be orderly and tidy. Outward behavior is based on fear, usually danger to the sick person or danger caused by the sick person, and the ritual action is a fruitless or symbolic attempt to avert the danger. Compulsive ritual actions can take many hours daily and are sometimes combined with hesitation and slowness. They occur equally in both sexes, but handwashing rituals are more common in women, and procrastination without repetition is more common in men. Compulsive ritual activities are less strongly associated with depression than obsessive thoughts and are more easily amenable to behavioral therapy. It should be noted: In addition to compulsive actions (obsessive rituals) - actions directly related to obsessive thoughts and / or anxious fears and aimed at preventing them, this category should also include compulsive actions performed by the patient in order to get rid of spontaneously arising internal discomfort and / or anxiety.
F42.2 Mixed obsessive thoughts and actions
Most obsessive-compulsive patients have elements of both obsessive thinking and compulsive behavior. This subcategory should apply if both disorders are equally severe, as is often the case, but it is reasonable to assign only one if it is clearly dominant, as thoughts and actions may respond to different therapies.
F42.8 Other obsessive-compulsive disorders
F42.9 Obsessive-compulsive disorder, unspecified
/F43/ Response to severe stress and adjustment disorders
This category differs from others in that it includes disorders that are defined not only on the basis of symptomatology and course, but also on the basis of the presence of one or the other of two causative factors: an exceptionally severe stressful life event that causes an acute stress reaction, or a significant change in life leading to long-lasting unpleasant circumstances, resulting in the development of an adjustment disorder. Although less severe psychosocial stress ("life event") may precipitate or contribute to a very wide range of disorders classified elsewhere in this class, its etiological significance is not always clear and depends in each case on individual, often particular, vulnerabilities. In other words, the presence of psychosocial stress is neither necessary nor sufficient to explain the occurrence and form of the disorder. In contrast, the disorders considered in this rubric always seem to arise as a direct consequence of acute severe stress or prolonged trauma. A stressful event or prolonged unpleasant circumstance is the primary and main causal factor, and the disorder would not have arisen without their influence. This category includes reactions to severe stress and adjustment disorders in all age groups, including children and adolescents. Each of the individual symptoms that make up acute stress reaction and adjustment disorder can occur in other disorders, but there are some special features in the way these symptoms manifest that justify grouping these conditions into a clinical unit. The third condition in this subsection, PTSD, has relatively specific and characteristic clinical features. The disorders in this section can thus be seen as impaired adaptive responses to severe prolonged stress, in the sense that they interfere with the successful adaptation mechanism and therefore lead to impaired social functioning. Acts of self-harm, most commonly self-poisoning with prescribed drugs, coinciding in time with the onset of a stress response or adjustment disorder, should be marked using the additional code X from Class XX of ICD-10. These codes do not allow differentiation between suicide attempt and "parasuicide", as both concepts are included in the general category of self-harm.
F43.0 Acute stress reaction
A transient disorder of significant severity that develops in individuals without apparent mental impairment in response to exceptional physical and psychological stress, and which usually resolves within hours or days. Stress can be a severe traumatic experience, including a threat to the safety or physical integrity of an individual or loved one (eg, natural disaster, accident, battle, criminal behavior, rape) or an unusually abrupt and threatening change in the patient's social position and/or environment, for example, the loss of many loved ones or a house fire. The risk of developing the disorder increases with physical exhaustion or the presence of organic factors (for example, in elderly patients). Individual vulnerability and adaptive capacity play a role in the occurrence and severity of acute stress reactions; this is evidenced by the fact that this disorder does not develop in all people subjected to severe stress. Symptoms show a typical mixed and changing picture and include an initial state of "dazedness" with some narrowing of the field of consciousness and reduced attention, inability to adequately respond to external stimuli, and disorientation. This condition may be accompanied by either further withdrawal from the surrounding situation (up to dissociative stupor - F44.2), or agitation and hyperactivity (flight reaction or fugue). Autonomic signs of panic anxiety (tachycardia, sweating, redness) are often present. Typically, symptoms develop within minutes of exposure to a stressful stimulus or event and disappear within two to three days (often hours). Partial or complete dissociative amnesia (F44.0) of the episode may be present. If symptoms persist, then the question arises of changing the diagnosis (and management of the patient). Diagnostic guidelines: There must be a consistent and clear temporal relationship between exposure to the unusual stressor and the onset of symptoms; pumped usually immediate or after a few minutes. In addition, the symptoms: a) have a mixed and usually changing picture; depression, anxiety, anger, despair, hyperactivity, and withdrawal may be present in addition to the initial state of stupor, but none of the symptoms are long-term dominant; b) stop quickly (at most within a few hours) in those cases where it is possible to eliminate the stressful situation. In cases where stress continues or cannot by its nature be relieved, symptoms usually begin to subside after 24-48 hours and subside within 3 days. This diagnosis cannot be used to refer to sudden exacerbations of symptoms in persons who already have symptoms that meet the criteria for any psychiatric disorder excluding those in F60.- (specific personality disorders). However, a history of prior psychiatric disorder does not invalidate the use of this diagnosis. Included: - nervous demobilization; - crisis state; - acute crisis reaction; - acute reaction to stress; - combat fatigue; - mental shock. F43.1 Post-traumatic stress disorder Occurs as a delayed and/or prolonged reaction to a stressful event or situation (short or long) of an exceptionally threatening or catastrophic nature, which in principle can cause general distress to almost anyone (for example, natural or man-made disasters, battles, serious accidents, surveillance behind the violent death of others, the role of a victim of torture, terrorism, rape or other crime). Predisposing factors such as personality traits (eg, compulsive, asthenic) or prior neurotic illness may lower the threshold for the development of this syndrome or worsen its course, but they are neither necessary nor sufficient to explain its onset. Typical signs include episodes of re-experiencing trauma in the form of intrusive memories (reminiscences), dreams or nightmares that occur against a background of chronic feelings of "numbness" and emotional dullness, alienation from other people, lack of reaction to the environment, anhedonia and avoidance of activities and situations. reminiscent of trauma. Usually the individual fears and avoids what reminds him of the original trauma. Rarely, there are dramatic, acute outbursts of fear, panic, or aggression provoked by stimuli that evoke an unexpected memory of the trauma or of the initial reaction to it. Usually there is a state of increased autonomic excitability with an increase in the level of wakefulness, an increase in the startle reaction and insomnia. Anxiety and depression are usually combined with the above symptoms and signs, suicidal ideation is not uncommon, and excessive alcohol or drug use may be a complicating factor. The onset of this disorder follows trauma after a latency period that can vary from weeks to months (but rarely more than 6 months). The course is undulating, but in most cases recovery can be expected. In a small proportion of cases, the condition may show a chronic course over many years and transition to a permanent change in personality after experiencing a catastrophe (F62.0). Diagnostic guidelines: This disorder should not be diagnosed unless there is evidence that it occurred within 6 months of a severe traumatic event. A "presumptive" diagnosis is possible if the interval between the event and onset is more than 6 months, but the clinical manifestations are typical and there is no possibility of an alternative classification of disorders (eg, anxiety or obsessive-compulsive disorder or depressive episode). Evidence of trauma must be supplemented by recurring intrusive memories of the event, fantasies, and daytime imaginings. Marked emotional withdrawal, sensory numbness, and avoidance of stimuli that would trigger memories of the trauma are common but not necessary for diagnosis. Autonomic disorders, mood disorder, and behavioral disturbances may be included in the diagnosis, but are not of paramount importance. Long-term chronic effects of devastating stress, i.e. those that manifest decades after exposure to stress, should be classified in F62.0. Includes: - traumatic neurosis.
/F43.2/ Disorder of adaptive reactions
Conditions of subjective distress and emotional distress, usually interfering with social functioning and productivity, and occurring while adjusting to a significant life change or stressful life event (including the presence or possibility of a serious physical illness). The stress factor can affect the integrity of the patient's social network (loss of loved ones, experiencing separation), a wider system of social support and social values (migration, refugee status). The stressor (stress factor) may affect the individual or also his microsocial environment. More important than in other disorders in F43.-, individual predisposition or vulnerability plays a role in the risk of occurrence and formation of manifestations of adjustment disorders, but nevertheless it is believed that the condition would not have arisen without a stressor. Manifestations vary and include depressed mood, anxiety, restlessness (or a mixture of the two); feeling unable to cope, plan, or continue in the present situation; as well as some degree of decreased productivity in daily activities. The individual may be prone to dramatic behavior and aggressive outbursts, but these are rare. However, in addition, especially in adolescents, conduct disorders (eg, aggressive or antisocial behavior) may be noted. None of the symptoms are so significant or predominant as to be indicative of a more specific diagnosis. Regressive phenomena in children, such as enuresis or childish speech or thumb sucking, are often part of the symptomatology. If these traits predominate, F43.23 should be used. The onset is usually within a month after a stressful event or life change, and the duration of symptoms usually does not exceed 6 months (except for F43.21 - prolonged depressive reaction due to adjustment disorder). If symptoms persist, the diagnosis should be changed according to the present clinical picture, and any ongoing stress may be coded using one of the ICD-10 Class XX "Z" codes. Contacts with medical and mental health services due to normal grief reactions that are culturally appropriate for the individual and typically do not exceed 6 months should not be coded in this Class (F) but should be qualified using ICD-10 Class XXI codes such as , Z-71.- (consultation) or Z73. 3 (stress condition, not classified elsewhere). Grief reactions of any duration judged to be abnormal due to their form or content should be coded F43.22, F43.23, F43.24, or F43.25, and those that remain intense and last more than 6 months F43.21 (prolonged depressive reaction due to adjustment disorder). Diagnostic guidelines Diagnosis depends on a careful assessment of the relationship between: a) the form, content and severity of symptoms; b) anamnestic data and personality; c) stressful event, situation and life crisis. The presence of the third factor must be clearly established and there must be strong, although perhaps speculative, evidence that the disorder would not have occurred without it. If the stressor is relatively small and if a temporal relationship (less than 3 months) cannot be established, the disorder should be classified elsewhere according to the features present. Included: - culture shock; - grief reaction; - hospitalism in children. Excluded:
Separation anxiety disorder in children (F93.0).
Under the criteria for adjustment disorders, the clinical form or predominant features should be specified by the fifth character. F43.20 Short-term depressive reaction due to adjustment disorder Transient mild depressive state, not exceeding 1 month in duration. F43.21 Prolonged depressive reaction due to adjustment disorder Mild depressive state in response to prolonged exposure to a stressful situation, but lasting no more than 2 years. F43.22 Adjustment disorder mixed anxiety and depressive reaction Distinctly marked anxiety and depressive symptoms, but no greater than in mixed anxiety and depressive disorder (F41.2) or other mixed anxiety disorder (F41.3).
F43.23 Adjustment disorder
with a predominance of violations of other emotions
Usually the symptoms are several types of emotions such as anxiety, depression, restlessness, tension and anger. Symptoms of anxiety and depression may meet the criteria for mixed anxiety and depressive disorder (F41.2) or other mixed anxiety disorder (F41.3), but they are not so prevalent that other more specific depressive or anxiety disorders can be diagnosed. This category should also be used in children when there is regressive behavior such as enuresis or thumb sucking.
F43.24 Adjustment disorder
with a predominance of behavioral disorders
The underlying disorder is behavioral disorder, i.e. adolescent grief reaction leading to aggressive or antisocial behaviour. F43.25 Adjustment disorder mixed emotion and behavior disorder Clear characteristics are both emotional symptoms and behavioral disorders. F43.28 Other specific predominant symptoms due to adjustment disorder F43.8 Other reactions to severe stress It should be noted: This category includes nosogenic reactions that occur in connection with with a severe somatic disease (the latter acts as traumatic event). Fears and anxious fears about one's ill health and the impossibility of complete social rehabilitation, combined with heightened self-observation, hypertrophied assessment of the health-threatening consequences of the disease (neurotic reactions). With prolonged reactions, the phenomena of rigid hypochondria come to the fore with careful registration of the slightest signs of bodily distress, the establishment of a sparing regimen that “protects” from possible complications or exacerbations of a somatic disease (diet, the primacy of rest over work, the exclusion of any information perceived as “stressful”, tough regulation of physical activity, medication, etc. In a number of cases, consciousness of the pathological changes that have taken place in the activity of the body is accompanied not by anxiety and fear, but by the desire to overcome the disease with a feeling of bewilderment and resentment (“health hypochondria”). It becomes common to ask how a catastrophe could have occurred that hit the body. Dominated by the idea of a complete restoration "at any cost" of physical and social status, the elimination of the causes of the disease and its consequences. Patients feel in themselves the potential to "reverse" the course of events, to positively influence the course and outcome of somatic suffering, to "modernize" the treatment process with increasing loads or physical exercises performed contrary to medical recommendations. The syndrome of pathological denial of the disease is common mainly in patients with life-threatening pathology (malignant neoplasms, acute myocardial infarction, tuberculosis with severe intoxication, etc.). Complete denial of the disease, coupled with the belief in the absolute safety of body functions, is relatively rare. More often there is a tendency to minimize the severity of manifestations of somatic pathology. In this case, patients do not deny the disease as such, but only those aspects of it that have a threatening meaning. Thus, the possibility of death, disability, irreversible changes in the body is excluded. Includes: - "health hypochondria". Excludes: - hypochondriacal disorder (F45.2).
F43.9 Severe stress response, unspecified
/F44/ Dissociative (conversion) disorders
The common features that characterize dissociative and conversion disorders are partial or complete loss of normal integration between past memory, awareness of identity and direct sensations on the one hand, and control of body movements on the other. There is usually a considerable degree of conscious control over the memory and sensations that can be selected for immediate attention, and over the movements that must be performed. It is assumed that in dissociative disorders this conscious and elective control is impaired to such an extent that it can change from day to day and even from hour to hour. The degree of loss of function under conscious control is usually difficult to assess. These disorders have generally been classified as various forms of "conversion hysteria". This term is undesirable due to its ambiguity. It is assumed that the dissociative disorders described here are "psychogenic" in origin, being closely associated in time with traumatic events, intractable and intolerable problems, or disturbed relationships. Therefore, it is often possible to make assumptions and interpretations about individual ways of coping with intolerable stress, but concepts derived from particular theories such as "unconscious motivation" and "secondary gain" are not included among the diagnostic guidelines or criteria. The term "conversion" is widely used for some of these disorders and refers to an unpleasant affect generated by problems and conflicts that the individual cannot resolve and translated into symptoms. The onset and end of dissociative states are often sudden, but they are rarely observed except in specially designed modes of interaction or procedures, such as hypnosis. The change or disappearance of the dissociative state may be limited by the duration of these procedures. All types of dissociative disorders tend to relapse after weeks or months, especially if their onset was associated with a traumatic life event. Sometimes more gradual and more chronic disorders may develop, especially paralysis and anesthesia, if the onset is associated with insoluble problems or disturbed interpersonal relationships. Dissociative states that persisted for 1-2 years before contacting a psychiatrist are often resistant to therapy. Patients with dissociative disorders usually deny problems and difficulties that are obvious to others. Any problems that they recognize are attributed by patients to dissociative symptoms. Depersonalization and derealization are not included here because they usually only affect limited aspects of personal identity and there is no loss of productivity in sensation, memory, or movement. Diagnostic guidelines For a definite diagnosis there must be: a) the presence of the clinical features set out for the individual disorders in F44.-; b) the absence of any physical or neurological disorder with which the identified symptoms could be associated; c) the presence of psychogenic conditioning in the form of a clear connection in time with stressful events or problems or disturbed relationships (even if it is denied by the patient). Convincing evidence for psychological conditioning can be difficult to find, even if it is reasonably suspected. In the presence of known disorders of the central or peripheral nervous system, the diagnosis of a dissociative disorder should be made with great caution. In the absence of evidence of a psychological causation, the diagnosis should be provisional, and physical and psychological aspects should continue to be investigated. It should be noted: All disorders of this rubric, in case of their persistence, insufficient connection with psychogenic influences, compliance with the characteristics of "catatonia under the guise of hysteria" (persistent mutism, stupor), signs of increasing asthenia and / or personality changes in the schizoid type, should be classified within pseudopsychopathic (psychopathic-like) schizophrenia (F21.4). Included: - conversion hysteria; - conversion reaction; - hysteria; - hysterical psychosis. Excludes: - "catatonia disguised as hysteria" (F21.4); - simulation of illness (conscious simulation) (Z76.5). F44.0 Dissociative amnesia The main symptom is memory loss, usually for recent important events. It is not due to organic mental illness and is too pronounced to be explained by ordinary forgetfulness or fatigue. Amnesia usually focuses on traumatic events such as accidents or unexpected loss of loved ones, and is usually partial and selective. The generalization and completeness of the amnesia often varies from day to day and as assessed by different investigators, but the inability to recall while awake is a consistent common feature. Complete and generalized amnesia is rare and usually presents as a manifestation of a fugue state (F44.1). In this case, it should be classified as such. The affective states that accompany amnesia are very varied, but severe depression is rare. Confusion, distress, and varying degrees of attention-seeking behavior may be evident, but an attitude of calm reconciliation is sometimes conspicuous. It most often occurs at a young age, with the most extreme manifestations usually occurring in men exposed to the stress of battle. In the elderly, non-organic dissociative states are rare. There may be aimless vagrancy, usually accompanied by hygienic neglect and rarely lasting more than one or two days. Diagnostic guidelines: A definite diagnosis requires: a) amnesia, partial or complete, for recent events of a traumatic or stressful nature (these aspects may be clarified in the presence of other informants); b) the absence of organic disorders of the brain, intoxication or excessive fatigue. Differential Diagnosis: In organic mental disorders, there are usually other signs of nervous system disturbance, which are combined with clear and consistent signs of clouding of consciousness, disorientation and fluctuating awareness. Loss of memory for very recent events is more characteristic of organic conditions, regardless of any traumatic events or problems. Alcohol or drug addiction palimpsests are closely related to substance abuse over time, and lost memory cannot be recovered. Loss of short-term memory in an amnestic state (Korsakov's syndrome), when direct reproduction remains normal but is lost after 2–3 minutes, is not detected in dissociative amnesia. Amnesia following a concussion or major brain injury is usually retrograde, although it may be anterograde in severe cases; dissociative amnesia is usually predominantly retrograde. Only dissociative amnesia can be modified by hypnosis. Amnesia after seizures in patients with epilepsy and in other states of stupor or mutism, which is sometimes found in patients with schizophrenia or depression, can usually be differentiated by other characteristics of the underlying disease. It is most difficult to differentiate from conscious simulation and may require repeated and careful evaluation of the premorbid personality. The conscious feigning of amnesia is usually associated with obvious money problems, danger of death in wartime, or possible imprisonment or a death sentence. Excludes: - amnestic disorder due to the use of alcohol or other psychoactive substances (F10-F19 with a common fourth character.6); - amnesia NOS (R41.3) - anterograde amnesia (R41.1); - non-alcoholic organic amnestic syndrome (F04.-); - postictal amnesia in epilepsy (G40.-); - retrograde amnesia (R41.2).
F44.1 Dissociative fugue
Dissociative fugue has all the hallmarks of dissociative amnesia, combined with outwardly purposeful travel during which the patient maintains self-care. In some cases, a new personality identity is adopted, usually for a few days, but sometimes for extended periods and with surprising degrees of completeness. Organized travel can be to places previously known and emotionally significant. Although the fugue period is amnestic, the patient's behavior during this time may appear completely normal to independent observers. Diagnostic guidelines For a definite diagnosis there must be: a) signs of dissociative amnesia (F44.0); b) purposeful travel outside of normal everyday life (differentiation between travel and wandering should be carried out taking into account local specifics); c) maintenance of personal care (eating, washing, etc.) and simple social interaction with strangers (for example, patients buying tickets or gasoline, asking for directions, ordering food). Differential Diagnosis: Differentiation from postictal fugue occurring predominantly after temporal lobe epilepsy usually presents no difficulty in accounting for history of epilepsy, absence of stressful events or problems, and less goal-directed and more fragmented activity and travel in patients with epilepsy. As with dissociative amnesia, it can be very difficult to differentiate from the conscious feigning of a fugue. Excludes: - fugue after epileptic seizure (G40.-).
F44.2 Dissociative stupor
The patient's behavior meets the criteria for stupor, but examination and examination do not reveal its physical condition. As with other dissociative disorders, psychogenic conditioning is additionally found in the form of recent stressful events or pronounced interpersonal or social problems. Stupor is diagnosed on the basis of a sharp decrease or absence of voluntary movements and normal responses to external stimuli such as light, noise, and touch. For a long time the patient lies or sits essentially motionless. Speech and spontaneous and purposeful movements are completely or almost completely absent. Although some degree of impaired consciousness may be present, muscle tone, body position, breathing, and sometimes eye opening and coordinated eye movements are such that it is clear that the patient is neither asleep nor unconscious. Diagnostic guidelines For a definite diagnosis there must be: a) the above-described stupor; b) the absence of a physical or mental disorder that could explain the stupor; c) information about recent stressful events or current problems. Differential Diagnosis: Dissociative stupor must be differentiated from catatonic, depressive, or manic stupor. Stupor in catatonic schizophrenia is often preceded by symptoms and behavioral signs suggestive of schizophrenia. Depressive and manic stupor develop relatively slowly, so information received from other informants may be decisive. Due to the widespread use of therapy for an affective illness in the early stages, depressive and manic stupor are becoming less common in many countries. Excludes: - catatonic stupor (F20.2-); - depressive stupor (F31 - F33); - manic stupor (F30.28).
F44.3 Trance and possession
Disorders in which there is a temporary loss of both a sense of personal identity and full awareness of the environment. In some cases, individual actions are controlled by another person, spirit, deity, or "power." Attention and awareness may be limited or focused on one or two aspects of the immediate environment, and there is often a limited but repetitive set of movements, vines and sayings. This should include only those trances that are involuntary or unwanted and interfere with daily activities by arising or persisting outside of religious or other culturally acceptable situations. This should not include trances developing during schizophrenia or acute psychoses with delusions and hallucinations, or multiple personality disorders. Nor should this category be used when the trance state is thought to be closely related to any physical disorder (such as temporal lobe epilepsy or head injury) or substance intoxication. Excludes: - conditions associated with acute or transient psychotic disorders (F23.-); - conditions associated with organic personality disorder (F07.0x); - conditions associated with post-concussion syndrome (F07.2); - conditions associated with intoxication caused by the use of psychoactive substances (F10 - F19) with a common fourth character.0; - conditions associated with schizophrenia (F20.-). F44.4-F44.7 Dissociative disorders of movement and sensation In these disorders, there is loss or difficulty in movement or loss of sensation (usually skin sensation). Therefore, the patient appears to be suffering from a physical illness, although one that explains the occurrence of symptoms cannot be found. Symptoms often reflect the patient's concept of physical illness, which may be in conflict with physiological or anatomical principles. In addition, an assessment of the patient's mental state and social situation often suggests that the decline in productivity resulting from the loss of function helps him avoid unpleasant conflict or indirectly express dependence or resentment. Although problems or conflicts may be obvious to others, the patient himself often denies their existence and attributes his troubles to symptoms or impaired productivity. In different cases, the degree of productivity impairment resulting from all these types of disorders may vary depending on the number and composition of the people present and the emotional state of the patient. In other words, in addition to the basic and permanent loss of sensation and movement, which is not under voluntary control, behavior aimed at attracting attention can be noted to some extent. In some patients, symptoms develop in close connection with psychological stress, in others this relationship is not found. Calm acceptance of severe disruption of productivity ("beautiful indifference") may be conspicuous, but is not required; it is also found in well-adapted persons who face the problem of an obvious and severe physical illness. Premorbid anomalies of personality relationships and personality are usually found; moreover, physical illness, with symptoms resembling that of the patient, may occur in close relatives and friends. Mild and transient variants of these disorders are often seen during adolescence, especially in girls, but chronic variants usually occur at a young age. In some cases, a recurrent type of reaction to stress in the form of these disorders is established, which can manifest itself in middle and old age. Disorders with only loss of sensation are included here, while disorders with additional sensations such as pain or other complex sensations in which the autonomic nervous system is involved are placed under the rubric
An acute reaction to stress is a mentally unhealthy state of a person. It lasts from several hours to 3 days. The patient is overwhelmed, unable to fully understand the situation, the stressful event is partially recorded in the memory, often in the form of fragments. This is due to being called. Symptoms usually last no more than 3 days.
One of the reactions is This syndrome develops exclusively because of situations that threaten a person's life. Signs of this state are lethargy, aloofness, repetitive horrors that pop up in the mind. 
incident pictures.
Often patients are visited by ideas of suicide. If the disorder is not too severe, it gradually disappears. There is also a chronic form that lasts for years. PTSD is also called combat fatigue. This syndrome was observed in the participants of the war. After the Afghan war, a lot of soldiers suffered from this disorder.
Disorder of adaptive reactions occurs due to stressful events in a person's life. This can be the loss of a loved one, a sharp change in life situation or a turning point in fate, separation, resignation, failure.
As a result, the individual is unable to adapt to unexpected change. A person cannot continue to live a normal daily life. There are insurmountable difficulties associated with social activities, there is no desire, motivation for making simple everyday decisions. A person cannot continue to be in the situation in which he finds himself. However, he does not have the strength to change and any decisions.
Varieties of flow
Caused by sad, difficult experiences, tragedies or a sharp change in life situations, adjustment disorder can have a different course and character. Depending on the characteristics of the disease, adaptation disorders are distinguished with:
Characteristic clinical picture
Usually the disorder and its symptoms disappear after 6 months from the stressful event. If the stressor is long-term, then the time frame is much longer than six months.
The syndrome interferes with normal, healthy life. Its symptoms depress a person not only mentally, but affect the entire body, disrupt the performance of many organ systems. Main features:
- sad, depressed mood;
- inability to cope with daily or professional tasks;
- inability and lack of desire to plan further steps and plans for life;
- violation of the perception of events;
- abnormal, unusual behavior;
- chest pain;
- heart palpitations;
- difficulty breathing;
- fear;
- dyspnea;
- suffocation;
- strong muscle tension;
- restlessness;
- increased use of tobacco and alcoholic beverages.
The presence of these symptoms indicates a disorder of adaptive reactions.
If the symptoms persist for a long time, more than six months, steps should definitely be taken to eliminate the violation.
Establishing diagnosis
Diagnosis of a disorder of adaptive reactions is carried out only in a clinical setting; to determine the disease, the nature of the crisis states that led the patient to a dejected state is taken into account.
It is important to determine the impact of an event on a person. The body is examined for the presence of somatic and mental diseases. An examination by a psychiatrist is carried out to exclude depression, post-traumatic syndrome. Only a full examination can help make a diagnosis, refer the patient to a specialist for treatment.
Concomitant, similar diseases
A lot of diseases are included in one large group. All of them are characterized by the same features. Only one specific symptom or the strength of its manifestation can distinguish them. The following reactions are similar:
- short-term depressive;
- prolonged depressive;
Diseases vary in degree of complexity, the nature of the course and duration. Often one leads to the other. If treatment measures are not taken in time, the disease can take a complex form and become chronic.
Treatment approach
Treatment of disorders of adaptive reactions is carried out in stages. An integrated approach prevails. Depending on the degree 
manifestations of a symptom, the approach to treatment is individual.
The main method is psychotherapy. It is this method that is most effective, since the psychogenic aspect of the disease is predominant. Therapy is aimed at changing the patient's attitude towards the traumatic event. Increases the patient's ability to regulate negative thoughts. A strategy is created for the patient's behavior in a stressful situation.
The purpose of drugs is due to the duration of the disease and the degree of anxiety. Drug therapy lasts an average of two to four months.
Among the medicines, it is mandatory to prescribe:
Cancellation of drugs occurs gradually, according to the behavior and well-being of the patient.
For treatment, sedative herbal preparations are used. They perform a sedative function.
Herbal collection number 2 helps to get rid of the symptoms of the disease. It contains valerian, motherwort, mint, hops and licorice. Infusion drink 2 times a day for 1/3 of a glass. Treatment continues for 4 weeks. Often appoint a collection reception number 2 and 3 at the same time.
Complete treatment, frequent visits to a psychotherapist will ensure a return to a normal, familiar life.
What could be the consequences?
Most people with adjustment disorder are completely cured without any complications. This group is middle age.
Children, adolescents and the elderly are at risk for complications. Individual characteristics of a person play an important role in the fight against stressful conditions.
It is often impossible to prevent the cause of stress and get rid of it. The effectiveness of treatment and the absence of complications depend on the nature of the individual and his willpower.
3.3.2. Acute stress reaction (acute stress reaction, ASR)
ASD is a pronounced transient disorder that develops in mentally healthy individuals as a reaction to catastrophic (i.e., exceptional physical or psychological) stress and which, as a rule, is reduced within a few hours (maximum days). Such stressful events include situations of threat to the life of an individual or persons close to him (for example, a natural disaster, an accident, hostilities, criminal behavior, rape) or an unusually abrupt and threatening social status change in the social position and / or environment of the patient, for example the loss of many loved ones or a fire in the house. The risk of developing the disorder increases with physical exhaustion or the presence of organic factors (for example, in elderly patients). The nature of reactions to stress is largely determined by the degree of individual stability and adaptive abilities of the individual; Thus, with systematic preparation for a certain type of stressful events (in certain categories of military personnel, rescuers), the disorder develops extremely rarely.
The clinical picture of this disorder is characterized by rapid variability with possible outcomes - both in recovery and in the aggravation of disorders up to psychotic forms of disorders (dissociative stupor or fugue). Often, after convalescence, amnesia of individual episodes or the entire situation as a whole is noted (dissociative amnesia, F44.0).
Sufficiently clear diagnostic criteria for RSD are formulated in DSM-IV:
A. The person was exposed to a traumatic event, and the following mandatory signs were noted:
1) the recorded traumatic event was defined by an actual threat of death or serious injury (i.e., a threat to physical integrity) for the patient himself or for another person within his environment;
2) the person's reaction was accompanied by an extremely intense feeling of fear, helplessness or horror.
B. At the moment or immediately after the end of the traumatic event, the patient had three (or more) dissociative symptoms:
1) a subjective feeling of numbness, detachment (alienation) or lack of a lively emotional response;
2) underestimation of the environment or one's personality ("state of amazement");
3) symptoms of derealization;
4) symptoms of depersonalization;
5) dissociative amnesia (i.e. inability to remember important aspects of the traumatic situation).
C. The traumatic event constantly forcibly re-experiences consciousness in one of the following ways: images, thoughts, dreams, illusions, or subjective distress at the reminder of the traumatic event.
D. Avoidance of stimuli that promote trauma recall (eg, thoughts, feelings, conversations, actions, places, people).
E. Symptoms of anxiety or increased tension (for example, sleep disturbances, concentration of attention, irritability, hypervigilance), excessive reactivity (increased fearfulness, startling at unexpected sounds, motor restlessness, etc.) are noted.
F. Symptoms cause clinically significant impairment in social, occupational (or other) functioning, or interfere with the person's ability to perform other necessary tasks.
G. Disorder lasts 1–3 days after the traumatic event.
In ICD-10, there is the following addition: there must be a mandatory and clear temporal relationship between exposure to an unusual stressor and the onset of symptoms; the onset is usually immediate or after a few minutes. In this case, the symptoms: a) have a mixed and usually changing picture; depression, anxiety, anger, despair, hyperactivity, and withdrawal may be present in addition to the initial state of stupor, but none of the symptoms are long-term dominant; b) stop quickly (at most within a few hours) in cases where it is possible to eliminate the stressful situation. If the stressful event continues or cannot by its nature be stopped, symptoms usually begin to resolve after 24 to 48 hours and subside within 3 days.
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ACUTE STRESS REACTION
Found 5 definitions for the term ACUTE STRESS REACTION
F43.0 Acute stress reaction
A transient disorder of significant severity that develops in individuals without apparent mental impairment in response to exceptional physical and psychological stress, and which usually resolves within hours or days. Stress can be an intense traumatic experience, including a threat to the safety or physical integrity of an individual or loved one (eg, natural disaster, accident, battle, criminal behavior, rape) or an unusually abrupt and threatening change in the patient's social position and/or environment, such as the loss of many loved ones or a fire in the house. The risk of developing the disorder increases with physical exhaustion or the presence of organic factors (for example, in elderly patients).
Individual vulnerability and adaptive capacity play a role in the occurrence and severity of acute stress reactions; this is evidenced by the fact that this disorder does not develop in all people subjected to severe stress. Symptoms show a typical mixed and changing picture and include an initial state of "dazedness" with some narrowing of the field of consciousness and reduced attention, inability to adequately respond to external stimuli, and disorientation. This condition may be accompanied by either further withdrawal from the surrounding situation (up to dissociative stupor - F44.2), or agitation and hyperactivity (flight reaction or fugue). Autonomic signs of panic anxiety (tachycardia, sweating, redness) are often present. Typically, symptoms develop within minutes of exposure to a stressful stimulus or event and disappear within two to three days (often hours). Partial or complete dissociative amnesia (F44.0) of the episode may be present. If symptoms persist, then the question arises of changing the diagnosis (and management of the patient).
There must be a mandatory and clear temporal relationship between exposure to an unusual stressor and the onset of symptoms; pumped usually immediate or after a few minutes. In addition, symptoms:
a) have a mixed and usually changing picture; depression, anxiety, anger, despair, hyperactivity, and withdrawal may be present in addition to the initial state of stupor, but none of the symptoms are long-term dominant;
b) stop quickly (at most within a few hours) in cases where it is possible to eliminate the stressful situation. In cases where stress continues or cannot by its nature be relieved, symptoms usually begin to subside after 24-48 hours and subside within 3 days.
This diagnosis cannot be used to refer to sudden exacerbations of symptoms in persons who already have symptoms that meet the criteria for any psychiatric disorder excluding those in F60.- (specific personality disorders). However, a history of prior psychiatric disorder does not invalidate the use of this diagnosis.
Acute crisis reaction;
Acute reaction to stress;
ACUTE REACTION TO STRESS (ICD 308)
Acute stress response
Acute reaction to stress
The symptom complex of the disorder includes the following main features: 1. confusion with an incomplete, fragmentary perception of the situation, often focusing on random, side aspects of it and, in general, a lack of understanding of the essence of what is happening, which leads to a deficit in the perception of information, the inability to structure it for the organization of targeted, adequate actions . Productive psychopathological symptoms (delusions, hallucinations, etc.) apparently do not occur, or, if they occur, they are of an abortive, rudimentary nature; 2. insufficient contact with patients, their poor understanding of questions, requests, instructions; 3. psychomotor and speech retardation, reaching in some patients the degree of dissociative (psychogenic) stupor with freezing in one position or, on the contrary, which happens less often, motor and speech excitement with fussiness, stupidity, inconsistent, inconsistent verbosity, sometimes verbigerations of despair; in a relatively small part of patients, erratic and intense motor excitation occurs, usually in the form of a stampede and impulsive actions that are performed contrary to the requirements of the situation and are fraught with serious consequences, up to death; 4. pronounced vegetative disorders (mydriasis, pallor or hyperemia of the skin, vomiting, diarrhea, hyperhidrosis, symptoms of cerebral and cardiac circulatory failure, causing some patients to die, etc.) and 5. subsequent complete or partial congrade amnesia. There may also be confusion, despair, a sense of the unreality of what is happening, isolation, mutism, unmotivated aggressiveness. The clinical picture of the disorder is polymorphic, variable, often mixed. In premorbid psychiatric patients, the acute reaction to stress may be somewhat different, not always typical, although information about the characteristics of the response of patients with various mental disorders to severe stress (depression, schizophrenia, etc.) seems to be insufficient. As a rule, the source of more or less reliable information about severe forms of the disorder is someone from strangers, they, in particular, can be rescuers.
At the end of an acute reaction to stress, most patients, as Z.I. Kekelidze (2009) points out, show symptoms of a transitional period of the disorder (affective tension, sleep disturbances, psychovegetative disorders, behavioral disorders, etc.) or a period of post-traumatic stress disorder (PTSD) begins. ). An acute reaction to stress occurs in approximately 1-3% of disaster victims. The term is not entirely accurate - stress itself is considered to be psychotraumatic situations, in relation to which a person retains confidence or hope to overcome them that mobilizes him. Treatment: placement in a safe environment, tranquilizers, neuroleptics, anti-shock measures, psychotherapy, psychological correction. Synonyms: Crisis, Acute crisis reaction, Combat fatigue, Mental shock, Acute reactive psychosis.
Acute reaction to stress
QUESTION:“Good night, Andrey. This is my first time on the site, desperately looking for help. Can I get advice from you? Unfortunately, I live abroad, and in person, even with a strong desire, I cannot meet you. Today I had a case that I probably meant earlier, but hoped that it would bypass me all the same. I have long been in a depressed state, which is probably the majority of people in our country, from a lack of money, housing, conditions. It started with my previous husband, he liked to drink alcohol, I tried to fight, but to no avail. During our quarrels with him, tantrums began to happen directly, as if from hopelessness, I began to shake, I cried and probably didn’t understand anything. She divorced her husband, but left a child. I remarried, but my psychological state has not changed. Today happened what I was most afraid of. I have a very strong-willed child, even in his two years. He does not obey anyone. He believes that he is already an adult and can do everything himself. Everything would be fine, but it turned out that the child endangered himself on the roadway, before that he tested my nerves in the store for a long time. I don’t know if I can take your time with such detailed stories, the bottom line is that today I couldn’t stand it, and I’m afraid this won’t be the last time, I’m afraid that it will get worse. I don’t even remember what happened after he was in the parking lot, when there was a lot of traffic, he pulled his hand out of my hand and happily ran away from me, I don’t remember how I put him in the car, I don’t remember what happened near the entrance. I just remember a neighbor knocking on the door, asking if I was yelling at the child. Our laws are very harsh, you can’t even shout at a child. I'm afraid it will be taken away from me. I know for sure that I didn’t beat him for sure, I couldn’t, I just couldn’t. I remember that I later went to a neighbor, and despite my character, I'm afraid that if she opened the door, our conversation would not work out. I'm scared. I am afraid to go to a psychiatrist in our country, although I understand what is needed. I'm afraid the child will be taken away. But I'm also afraid that one day I won't be able to cope with myself. Help me please. What do i do? Please, help.
QUESTION:"Hello. I am very afraid of my condition. Recently, a criminal came up to me on the street, yelled at me, threw himself. I didn’t say anything special, but after talking with him I felt bad. There was a moral feeling that I would die. It was as if my soul would now break out of me and I would lose consciousness. It's never been that scary. Then I vomited several times. I couldn’t fall asleep, as soon as I remembered it, I immediately had a feeling that I didn’t control myself, as if out of my mind. The next day, the condition repeated only in a mild form. he talks to me for more than a minute or the cat will run in front of me. What to do with it? I didn’t have any psycho diagnoses and never had any problems.
ANSWER:"Hello Maria. The reaction to an event that happened to you about a month ago can be classified as an "acute reaction to stress" (F43.0 - ICD code 10). This condition refers to neurotic (F4 - ICD code 10) and is a temporary (hours, days) disorder of significant severity in response to an unusually strong physical or psychological stress factor (physical or psychological violence, security threat, fire, earthquake, accident , loss of loved ones, financial collapse, etc.).
The clinical picture, as a rule, is polymorphic, unstable, and is manifested by severe anxiety (sometimes reaching panic), fear, anxiety, horror, helplessness, insensitivity, confusion, deterioration in perception, attention, slight stupor and some narrowing of consciousness. Possible derealization, depersonalization, dissociative amnesia. Movement disorders are often manifested either by lethargy, stupor, up to stupor, or agitation, agitation, unproductive, chaotic hyperactivity.
Often there are vegetative manifestations in the form of tachycardia, increased blood pressure, sweating, redness, feelings of lack of air, nausea, dizziness, fever, etc.
The basic symptoms for an acute reaction to stress are also: a) recurring obsessive anxious experiences and "scrolling" of traumatic events in the form of memories, fantasies, ideas, nightmares; b) avoidance of situations, activities, thoughts, places, actions, feelings, conversations associated with traumatic events; c) emotional "dulling", narrowness, loss of interests, feeling of detachment from others; d) excessive excitement, irritability, irascibility, insomnia, impaired concentration, alertness.
In some cases, the acute reaction to stress F43.0 is reduced on its own within a few hours (in the presence of a stress factor - within a few days), although residual asthenic, anxious, obsessive, depressive symptoms, agitation, sleep disturbances may appear for several days or weeks. In other cases, especially in the absence of adequate therapy, acute stress disorder may be a precursor to post-traumatic stress disorder (PTSD) F43.1, and if the disorder lasts more than 4 weeks, a diagnosis of post-traumatic stress disorder is made. In addition to PTSD, depressive disorder, obsessive-compulsive disorder (OCD), generalized anxiety disorder (GAD), and substance abuse (substance abuse), in particular alcohol, can develop.
All the best. Sincerely, Gerasimenko Andrey Ivanovich - psychiatrist, psychotherapist, narcologist (Kyiv).
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acute reaction to stress
Acute reaction to stress
The disorder does not develop in all people who have undergone severe stress (our data indicate the presence of O. r. N. S. in 38-53% of people who have experienced traumatic stress). The risk of developing the disorder increases with physical exhaustion or the presence of organic factors (for example, in elderly patients). In the occurrence and severity of O. p. n. with. individual vulnerability and adaptive capacity play a role.
From the moment the rescue work begins, part of the burden of providing psychological assistance is assigned to the rescuers. The brigade of the emergency psychological help practically cannot start work in the acute (isolation) period of development of a situation at emergencies when signs of O. r generally appear. n. s., due to the short duration of this period (lasts several minutes or hours).
Psychosocial support after a disaster is usually provided by relatives, neighbors or other people who, due to circumstances, are close to the victims. Surrounding people, as you know, are quickly included in the work to help the victims. Assistance in such conditions is most often carried out “in the order of self- and mutual assistance”.
Since survivors of a disaster show extremely pronounced emotional reactions that are quite natural in a given situation (anxiety, fear of death, despair, a sense of helplessness or loss of life prospects), when providing assistance to them, first of all, one should try to minimize these reactions by any available actions. The most effective will be the manifestations of sympathy and care, as well as practical assistance to the victims.
Psychogenic conditions in victims
Mental disorders in the structure of reactive states in victims are mainly represented by a reaction to severe stress, which occurs in the form of affective disorganization of mental activity with an affective narrowing of consciousness, a violation of voluntary regulation of behavior. Subsequently, in connection with the emotional and cognitive processing of a traumatic event, anxiety-phobic disorders, mixed anxiety and depressive disorders, as well as post-traumatic stress disorder, and adjustment disorders quite often develop. At the same time, some victims have depressive, anxiety-depressive states, while others experience sharpening of characterological features or the formation of post-traumatic personality changes with persistent violations of social maladaptation.
Mental disorders in the structure of psychogenic states in victims are characterized by specificity and differ from reactive states in the accused.
In connection with these features, an acute reaction to stress (F43.0) occupies a special place among psychogenic disorders in victims. The description of this disorder in ICD-10 states that it occurs in individuals without apparent mental disorder in response to exceptional physical and psychological stress and resolves within hours or days. As stresses, psychological experiences associated with a threat to the life, health and physical integrity of the subject (catastrophes, accidents, criminal behavior, rape, etc.) are given.
Diagnosis requires a mandatory and clear temporal relationship to the unusual stressful event and the development of a clinical picture of the disorder immediately or shortly after the event. The clinical picture is determined by the fact that under the action of severe stress, non-specific and specific effects can be distinguished.
The nonspecificity of the impact of stress is determined by the following parameters:
- it does not depend on age, it is determined by the strength, speed, severity of the aggressive-violent component;
- little realized, not accompanied by intrapersonal processing;
- the dynamics of acute affective states is of primary importance - from short-term emotional stress and fear to affective-shock, subshock reactions with a narrowing of consciousness, fixation of attention on a narrow circle of psycho-traumatic circumstances, psychomotor disorders and vasovegetative disorders.
The specific impact includes the processing of a traumatic event at the personal and social level with the significance of the personal meaning of the incident. As a result, the dynamics of emerging psychogenic disorders is largely determined by the intrapsychic processing of a new negative experience associated with violence and its consequences for the individual. At the stage of emotional-cognitive processing, the following variants of psychogenic disorders are most often formed.
The following symptoms dominate the clinical picture of these disorders:
- anxiety and fear dominate against the background of pronounced emotional stress;
- the plot of fear is associated with violence, threats, physical and mental trauma;
- the dynamics is determined by the risk of repeated excesses of violence and the situation of dependence, unresolved criminal situation, repeated threats;
- in situations of dependence, the risk of repeated excesses of violence - anxious and depressed mood, the formation of intrapersonal complexes with vengeful fantasizing, secondary personal-characterological reactions with radicals of anxiety, dependence, conformity.
Another type of common disorder: situational depressive reaction or prolonged depression of a neurotic level(F32.1) mixed anxiety and depressive disorders(F41.2). Marked depressive states most often include the following clinical signs:
- adynamic or anxious depression with a feeling of despair, hopelessness, "desire to forget what happened as soon as possible" or anxious expectation of negative consequences (illness, pregnancy, defects);
- somatovegetative disorders and disorders of sleep, appetite.
Personal predisposition is essential at the stage of emotional-cognitive processing. The following personality-characteristic features determine a more protracted course of psychogenic states in victims:
- inhibited, hysterical, schizoid radicals with idealized ideas and moral attitudes;
- personal instability with ease of inclusion of additional situational-reactive moments and a deepening of the severity of anxious or depressive personal reactions;
- asthenic radical (exhaustion, emotional lability, instability of self-esteem, self-pity and self-accusation, a tendency to introjection and isolation, refusal of personal support).
The next variant of psychogenic states, which are quite common among victims, is post-traumatic stress disorder (F43.1).
Filed GNTSSS them. V. P. Serbsky, the frequency of occurrence of this disorder in victims is up to 14%. The clinical picture is determined by the following features:
– psychogenic factor: suddenness, brutality and force of impact, severe violence with physical suffering, threat to life, group nature of violence;
– Clinical signs: depressive mood, recurring obsessive memories of the event, sleep disturbances with nightmares, associative inclusions with avoidance of stimuli that could trigger memories of the trauma, emotional alienation combined with persistent psychophysical tension, hyperexcitability with easily occurring fear reactions, somatovegetative disorders, personality reactions with disorders of adaptation and social functioning, persistent behavioral disorders (irritability, aggressive conflict, demonstrative behavior with the role of "victim", auto-aggressive reactions, alcohol or drug use, deviant behavior).
Quite often, a state of distress and emotional disorders with anxiety or depressive radicals, as well as behavioral deviations, proceed according to the type of adaptation disorders.
In the formation of adjustment disorders (F43.2), individual predisposition and lesser severity of stressful effects are of certain importance. Along with a depressive or anxious mood, there is a reaction of the individual to a decrease in the level of his life activity due to the impact of stress, productivity, inability to cope with the current situation, to control his condition. This is often accompanied by sudden behavioral excesses, outbursts of aggressiveness, or persistent demonstrative, deviant, dissocial behavior.
Forensic psychiatric qualification of psychogenic conditions in victims is significant for:
1) assessing the ability of victims to understand the nature and significance of the actions committed with them and to resist;
2) assessing the criminal procedural capacity of victims - the ability to correctly perceive a legally significant situation of an offense, remember its circumstances, testify about them, realize and manage their actions during the investigation and trial;
3) assessment of harm to health from injuries that caused mental disorders.
Practical commentary on the 5th chapter of the International Classification of Diseases 10th revision (ICD-10)
Research Institute of Psychoneurology V.M. Bekhterev, St. Petersburg
Typical severe stressors are military operations, natural and transport disasters, an accident, the presence of others at a violent death, robbery, torture, rape, fire.
Vulnerability to the disorder also increases the premorbid burden of psychotrauma. PTSD may have an organic causation. EEG disturbances in these patients are similar to those in endogenous depression. The alpha-adrenergic agonist clonidine, used to treat opiate withdrawal, has been shown to be successful in relieving some of the symptoms of PTSD. This allowed us to put forward a hypothesis that they are a consequence of the endogenous opiate withdrawal syndrome that occurs during the revival of memories of psychotrauma.
In contrast to PTSD, in adaptation disorders, the intensity of stress does not always determine the severity of the disorder. Stress can be single or superimposed on each other, be periodic (hands-on at work) or permanent (poverty). Different stages of life are characterized by their own specifics of stressful situations (starting school, leaving the parental home, marriage, the appearance of children and their departure from home, failure to achieve professional goals, retirement).
The experience of trauma becomes central in the life of the patient, changing his style of life and social functioning. The reaction to a human stressor (rape) is more intense and prolonged than to a natural disaster (flood). In protracted cases, the patient no longer becomes fixated on the injury itself, but on its consequences (disability, etc.). The appearance of symptoms is sometimes delayed for a different period of time, this also applies to adjustment disorders, where the symptoms do not necessarily decrease when the stress stops. The intensity of symptoms may change, aggravated by additional stress. A good prognosis correlates with the rapid development of symptoms, good social adaptation in premorbidity, the presence of social support and the absence of concomitant mental and other diseases.
To distinguish organic brain syndromes similar to PTSD, the presence of organic personality changes, changes in sensory or level of consciousness, focal neurological, delirious and amnestic symptoms, organic hallucinosis, states of intoxication and withdrawal help. The diagnostic picture can be complicated by the abuse of alcohol, drugs, caffeine, and tobacco, which is widely used in coping of the behavior of PTSD patients.
Endogenous depression is a frequent complication of PTSD and should be intensively treated due to the fact that comorbidity significantly increases the risk of suicide. With such a complication, both disorders should be diagnosed. Patients with PTSD may develop symptoms of phobic avoidance, such cases from simple phobias helps to distinguish the nature of the primary stimulus and the presence of other manifestations characteristic of PTSD. Motor tension, anxious expectations, increased search settings can bring the picture of PTSD closer to that of generalized anxiety disorder. Here it is necessary to pay attention to the acute onset and the greater characteristic of phobic symptoms for PTSD, in contrast to generalized anxiety disorder.
Differences in the stereotype of the course make it possible to differentiate PTSD from panic disorder, which is sometimes very difficult and gives reason to some authors to consider PTSD a variant of panic disorder. From the development of physical symptoms due to mental causes (F68.0), PTSD is distinguished by an acute onset after trauma and the absence of bizarre complaints prior to it. From feigning disorder (F68.1) PTSD is distinguished by the absence of inconsistent anamnestic data, an unexpected structure of the symptom complex, antisocial behavior and a chaotic lifestyle in the premorbid period, which are more characteristic of feigned patients. PTSD differs from adaptation disorders in the large scope of the pathogenicity of the stressor and the presence of subsequent characteristic reproduction of the trauma.
In addition to the above nosological units, adaptation disorders have to be differentiated from conditions not caused by mental disorders. Thus, the loss of loved ones without special aggravating circumstances can also be accompanied by a transient deterioration in social and professional functioning, which, however, remains within the expected framework of the reaction to the loss of a loved one and therefore is not considered a violation of adaptation.
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A characteristic feature of this group of disorders is their distinctly exogenous nature, a causal relationship with an external stressor, without which mental disorders would not have appeared. Reactions to stress
A characteristic feature of this group of disorders is their distinctly exogenous nature, a causal relationship with an external stressor, without which mental disorders would not have appeared.
Typical severe stressors are military operations, natural and transport disasters, an accident, the presence of others at a violent death, robbery, torture, rape, fire.
The prevalence of disorders naturally varies depending on the frequency of catastrophes and traumatic situations. The syndrome develops in 50 - 80% of those who have experienced severe stress. Morbidity is directly related to the intensity of stress. The incidence of PTSD in peacetime is 0.5% for men and 1.2% for women in the population. Adult women describe similar traumatic situations as more painful than men, but among children, boys are more sensitive to similar stressors than girls. Adjustment disorders are quite common, they account for 1.1-2.6 cases per 1000 population with a tendency to be more represented in the low-income part of the population. They make up about 5% of those served by psychiatric institutions; occur at any age, but most often in children and adolescents.
Vulnerability to the disorder also increases the premorbid burden of psychotrauma. PTSD may have an organic causation. EEG disturbances in these patients are similar to those seen in endogenous depression. The alpha-adrenergic agonist clonidine, used to treat opiate withdrawal, appears to be successful in relieving some of the symptoms of PTSD. This allowed us to put forward a hypothesis that they are a consequence of the endogenous opiate withdrawal syndrome, which occurs when memories of psychotrauma are revived.
In contrast to PTSD, in adaptation disorders, the intensity of stress does not always determine the severity of the disorder. Stress can be single or superimposed on each other, be periodic (hands-on at work) or permanent (poverty). Different stages of life are characterized by their own specifics of stressful situations (starting school, leaving the parental home, marriage, the appearance of children and their departure from home, failure to achieve professional goals, retirement).
The picture of the disease may present a general dullness of feelings (emotional anesthesia, a feeling of remoteness from other people, loss of interest in previous activities, the inability to experience joy, tenderness, orgasm) or a feeling of humiliation, guilt, shame, anger. Dissociative states are possible (up to stupor), in which a traumatic situation, anxiety attacks, rudimentary illusions and hallucinations, transient decreases in memory, concentration and control of impulses are re-experienced. In an acute reaction, partial or complete dissociative amnesia of the episode (F44.0) is possible. There may be consequences in the form of suicidal tendencies, as well as the abuse of alcohol and other psychoactive substances. Victims of rape and robbery do not dare to go out unaccompanied for varying periods of time.
The experience of trauma becomes central in the life of the patient, changing his style of life and social functioning. The reaction to a human stressor (rape) is more intense and prolonged than to a natural disaster (flood). In protracted cases, the patient becomes fixed no longer on the injury itself, but on its consequences (disability, etc.). The appearance of symptoms is sometimes delayed for a different period of time, this also applies to adjustment disorders, where the symptoms do not necessarily decrease when the stress stops. The intensity of symptoms can change, intensifying with additional stress. A good prognosis correlates with the rapid development of symptoms, good social adaptation in premorbidity, the presence of social support and the absence of concomitant mental and other diseases.
Mild concussions may not be directly accompanied by obvious neurological signs, but may lead to prolonged affective symptoms and impaired concentration. Malnutrition during prolonged stressful exposure can also independently lead to organic brain syndromes, including impaired memory and concentration, emotional lability, headaches and dizziness.
Organic brain syndromes similar to PTSD can be distinguished by the presence of organic personality changes, changes in sensory or level of consciousness, focal neurological, delirious and amnesic symptoms, organic hallucinosis, states of intoxication and withdrawal. alcohol, drugs, caffeine and tobacco.
Endogenous depression is a frequent complication of PTSD and should be intensively treated due to the fact that comorbidity significantly increases the risk of suicide. With such a complication, both disorders should be diagnosed. Patients with PTSD may develop symptoms of phobic avoidance, such cases from simple phobias helps to distinguish the nature of the primary stimulus and the presence of other manifestations characteristic of PTSD. Motor tension, anxious expectations, increased search settings can bring the picture of PTSD closer to that of generalized anxiety disorder. Here, attention should be paid to the acute onset and greater specificity of phobic symptoms for PTSD, in contrast to generalized anxiety disorder.
Differences in the stereotype of the course make it possible to differentiate PTSD from panic disorder, which is sometimes very difficult and gives reason to some authors to consider PTSD a variant of panic disorder. From the development of physical symptoms due to mental causes (F68.0), PTSD is distinguished by an acute onset after trauma and the absence of bizarre complaints before it. From feigning disorder (F68.1) PTSD is distinguished by the absence of inconsistent anamnestic data, an unexpected structure of the symptom complex, antisocial behavior and a chaotic lifestyle in the premorbid period, which are more characteristic of feigned patients. PTSD differs from adaptation disorders in the large scope of the pathogenicity of the stressor and the presence of subsequent characteristic reproduction of the trauma.
In addition to the above nosological units, adaptation disorders must be differentiated from conditions not caused by mental disorders. Thus, the loss of loved ones without special aggravating circumstances can also be accompanied by a transient deterioration in social and professional functioning, which, however, remains within the expected framework of the reaction to the loss of a loved one and therefore is not considered a violation of adaptation.
Based on the leading role of increased adrenergic activity in maintaining the symptoms of PTSD, adrenergic blockers such as propranolol and clonidine are successfully used in the treatment of the disorder. The use of antidepressants is indicated for the severity of anxiety-depressive manifestations in the clinical picture, prolongation and "endogenization" of depression; it also helps to reduce repetitive memories of trauma and normalize sleep. There is an idea that MAO inhibitors may be effective for a limited group of patients. With significant disorganization of behavior for a short time, plegia can be achieved with sedative antipsychotics.
The disorder does not develop in all people who have undergone severe stress (our data indicate the presence of O. r. N. S. in 38-53% of people who have experienced traumatic stress). Development risk
Psychogenic conditions in victims
Mental disorders in the structure of reactive states in victims are mainly represented by a reaction to severe stress, which occurs in the form of affective mental disorganization.
Practical commentary on the 5th chapter of the International Classification of Diseases, 10th revision (ICD-10) V.M. Bekhterev, St. Petersburg
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Acute reaction to stress
Acute reaction to stress- a transient disorder of significant severity that develops in individuals without apparent mental impairment in response to exceptional physical and psychological stress and which usually resolves within hours or days. Stress can be an intense traumatic experience, including a threat to the safety or physical integrity of an individual or loved one (eg, natural disaster, accident, battle, criminal behavior, rape) or an unusually abrupt and threatening change in the patient's social position and/or environment, such as the loss of many loved ones or a fire in the house.
- ^ World Health Organization. The ICD-10 classification of mental and behavioral disorders. Clinical description and diagnostic guideline. Geneva: World Health Organization, 1992
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See what "Acute reaction to stress" is in other dictionaries:
Acute reaction to stress- Very quickly transient disorders of varying severity and nature, which are observed in people who did not have any obvious mental disorder in the past, in response to an exceptional somatic or mental situation (for example, ... ... Great psychological encyclopedia
Acute reaction to stress- - a transient and short-term (hours, days) psychotic disorder that occurs in response to exceptional physical and / or psychological stress with an obvious threat to life in people without a previous mental disorder. ... ... Encyclopedic Dictionary of Psychology and Pedagogy
F43.0 Acute stress reaction- A transient disorder of significant severity that develops in individuals without apparent mental impairment in response to exceptional physical and psychological stress, and which usually resolves within hours or days. Stress can be ... Classification of mental disorders ICD-10. Clinical descriptions and diagnostic instructions. Research Diagnostic Criteria
Acute stress response- a transient disorder of significant severity that develops in individuals who did not initially have visible mental disorders, in response to exceptional physical and psychological stress, and which usually resolves within hours or days. ... ... Dictionary of emergencies
Acute stress response- So, according to ICD 10 (F43.0.), Clinical manifestations of a neurotic reaction are indicated if the symptomatology characteristic of it persists for a short period - from several hours to 3 days. In this case, stunning, some narrowing of the field are possible ... ... Encyclopedic Dictionary of Psychology and Pedagogy
stress- A human condition characterized by non-specific defensive reactions (at the physical, psychological and behavioral level) in response to extreme pathogenic stimuli (see Adaptation Syndrome). The reaction of the psyche to ... ... Great psychological encyclopedia
STRESS- (eng. stress stress) a state of stress that occurs in humans (and animals) under the influence of strong influences. According to the Canadian pathologist Hans Selye (Selye; 1907 1982), the author of the concept and term stress, this is a common ... ... Russian encyclopedia of labor protection
"F43" Response to severe stress and adjustment disorders- This category differs from others in that it includes disorders that are defined not only on the basis of symptomatology and course, but also on the basis of the presence of one or the other of two causative factors: exceptionally severe stress ... ... ICD-10 classification of mental disorders. Clinical descriptions and diagnostic instructions. Research Diagnostic Criteria
catastrophic stress response- See synonym: Acute reaction to stress. Brief explanatory psychological and psychiatric dictionary. Ed. igisheva. 2008 ... Big Psychological Encyclopedia
Affective-shock reaction- acute reactive (that is, psychogenic) psychosis, most often occurring with a short-term clouding of consciousness. Synonyms: Acute reaction to stress, Acute reactive psychosis ... Encyclopedic Dictionary of Psychology and Pedagogy
Each of us dreams of living life calmly, happily, without excesses. But, unfortunately, almost everyone experiences dangerous moments, is exposed to powerful stresses, threats, up to attacks, violence. What should a person with post-traumatic stress disorder do? After all, the situation does not always go without consequences, many suffer from serious mental pathologies.
To make it clear to those who do not have medical knowledge, it is necessary to explain what PTSD means, what are its symptoms. First you need to imagine at least for a second the state of a person who has experienced a terrible incident: a car accident, beating, rape, robbery, death of a loved one, etc. Agree, this is difficult to imagine, and scary. At such moments, any reader will immediately turn with a plea for a petition - God forbid! And what to say about those who really turned out to be a victim of a terrible tragedy, how can he forget about everything. A person tries to switch to other activities, get carried away with a hobby, devote all his free time to communicating with relatives and friends, but all in vain. Severe, irreversible acute reaction to stress, terrible moments and causes stress disorder, post-traumatic. The reason for the development of pathology is the inability of the reserves of the human psyche to cope with the situation, it goes beyond the accumulated experience that a person can experience. The condition often occurs not immediately, but approximately 1.5-2 weeks after the event, for this reason it is called post-traumatic.
A person who has suffered severe trauma may be suffering from post-traumatic stress disorder.
Situations traumatic to the psyche, single or repeated, can disrupt the normal functioning of the mental sphere. Provoking situations include violence, complex physiological trauma, being in the zone of a man-made or natural disaster, etc. Right at the moment of danger, a person tries to get together, save his own life, loved ones, tries not to panic or is in a state of stupor. After a short time, there are obsessive memories of what happened, from which the victim tries to get rid of. Post-traumatic stress disorder (PTSD) is a return to a difficult moment that “hurts” the psyche so much that there are serious consequences. According to the international classification, the syndrome belongs to the group of neurotic conditions caused by stress and somatoform disorders. A good example of PTSD is military personnel who served in "hot" spots, as well as civilians who ended up in such areas. According to statistics, after experiencing stress, PTSD occurs in approximately 50-70% of cases.
The most vulnerable categories are more susceptible to mental trauma: children and the elderly. In the former, the protective mechanisms of the organisms are not sufficiently formed, in the latter, due to the rigidity of the processes in the mental sphere, the loss of adaptive abilities.
Post Traumatic Stress Disorder - PTSD: Causes
As already mentioned, a factor in the development of PTSD are mass disasters, from which there is a real threat to life:
- war;
- natural and man-made disasters;
- acts of terrorism: being in captivity as a prisoner, experienced torture;
- serious illnesses of loved ones, own health problems that threaten life;
- physical loss of loved ones;
- experienced violence, rape, robbery.
In most cases, the intensity of anxiety, experiences directly depends on the characteristics of the individual, his degree of susceptibility, impressionability. Also important is the gender of the person, his age, physiological, mental state. If the traumatization of the psyche occurs regularly, then the depletion of mental reserves is formed. An acute reaction to stress, the symptoms of which are a frequent companion of children, women who have experienced domestic violence, prostitutes, may occur in police officers, firefighters, rescuers, etc.
Experts identify another factor contributing to the development of PTSD - this is neuroticism, in which there are obsessive thoughts about bad events, there is a tendency to neurotic perception of any information, a painful desire to constantly reproduce a terrible event. Such people always think about dangers, talk about serious consequences even in non-threatening situations, all thoughts are only about the negative.
Cases of post-traumatic disorder are often diagnosed in people who survived the war.
Important: those prone to PTSD also include individuals suffering from narcissism, any kind of addiction - drug addiction, alcoholism, prolonged depression, excessive addiction to psychotropic, neuroleptic, sedative drugs.
Post Traumatic Stress Disorder: Symptoms
The response of the psyche to severe, experienced stress is manifested by certain behavioral traits. The main ones are:
- a state of emotional numbness;
- constant reproduction in thoughts of an experienced event;
- detachment, withdrawal from contacts;
- the desire to avoid important events, noisy companies;
- detachment from society, in which they again pronounce what happened;
- excessive excitability;
- anxiety;
- panic attacks, anger;
- feeling of physical discomfort.
The state of PTSD, as a rule, develops after a certain period of time: from 2 weeks to 6 months. Mental pathology can persist for months, years. Depending on the severity of the manifestations, experts distinguish three types of PTSD:
- Acute.
- Chronic.
- Delayed.
The acute type lasts for 2-3 months, with chronic symptoms persist for a long period of time. With a delayed form, post-traumatic stress disorder can manifest itself after a long period of time after a dangerous event - 6 months, a year.
A characteristic symptom of PTSD is detachment, alienation, a desire to avoid others, that is, there is an acute reaction to stress and adaptation disorders. There are no elementary types of reactions to events that cause great interest in ordinary people. Regardless of the fact that the situation that traumatized the psyche is already far behind, patients with PTSD continue to worry and suffer, which causes the depletion of resources capable of receiving and processing fresh information flow. Patients lose interest in life, are not able to enjoy anything, refuse the joys of life, become uncommunicative, move away from former friends and relatives.
A characteristic symptom of PTSD is detachment, aloofness, and a desire to avoid others.
Acute reaction to stress (mcb 10): types
In the post-traumatic state, two types of pathologies are observed: obsessive thoughts about the past and obsessive thoughts about the future. At the first sight, a person constantly “scrolls” like a film an event that traumatized his psyche. Along with this, other shots from life that brought emotional, spiritual discomfort can be “connected” to the memories. It turns out a whole "compote" of disturbing memories that cause persistent depression and continue to injure a person. For this reason, patients suffer:
- eating disorders: overeating or loss of appetite:
- insomnia;
- nightmares;
- outbursts of anger;
- somatic failures.
Obsessive thoughts about the future are manifested in fears, phobias, unfounded predictions of the repetition of dangerous situations. The condition is accompanied by symptoms such as:
- anxiety;
- aggression;
- irritability;
- isolation;
- depression.
Often, affected persons try to disconnect from negative thoughts through the use of drugs, alcohol, psychotropic drugs, which significantly worsens the condition.
Burnout syndrome and post-traumatic stress disorder
Two types of disorders are often confused - EBS and PTSD, however, each pathology has its own roots and is treated differently, although there is a certain similarity in symptoms. Unlike stress disorder after a trauma caused by a dangerous situation, tragedy, etc., emotional burnout can occur with a completely cloudless, joyful life. The cause of SES can be:
- monotony, repetitive, monotonous actions;
- intense rhythm of life, work, study;
- undeserved, regular criticism from outside;
- uncertainty in the assigned tasks;
- feeling of underestimation, uselessness;
- lack of material, psychological encouragement of the work performed.
FEBS is often referred to as chronic fatigue, which can cause people to experience insomnia, irritability, apathy, loss of appetite, and mood swings. The syndrome is more often affected by persons with characteristic character traits:
- maximalists;
- perfectionists;
- overly responsible;
- inclined to give up their interests for the sake of business;
- dreamy;
- idealists.
Often housewives who daily engage in the same, routine, monotonous business end up in specialists with CMEA. They are almost always alone, there is a lack of communication.
Burnout syndrome is almost the same as chronic fatigue.
The pathology risk group includes creative individuals who abuse alcohol, drugs, and psychotropic drugs.
Diagnosis and treatment of post-traumatic stress situations
The specialist diagnoses PTSD based on the patient's complaints and analysis of his behavior, collecting information about the psychological and physical traumas he has suffered. The criterion for establishing an accurate diagnosis is also a dangerous situation that can cause horror and numbness in almost all people:
- flashbacks that occur both in the state of sleep and wakefulness;
- the desire to avoid moments reminiscent of the stress experienced;
- excessive excitement;
- partial deletion from the memory of a dangerous moment.
Post-traumatic stress disorder, the treatment of which is prescribed by a specialized psychiatrist, requires an integrated approach. An individual approach to the patient is required, taking into account the characteristics of his personality, type of disorder, general health and additional types of dysfunctions.
Cognitive behavioral therapy: the doctor conducts sessions with the patient in which the patient fully talks about his fears. The doctor helps him to look at life differently, rethink his actions, directs negative, obsessive thoughts in a positive direction.
Hypnotherapy is indicated for the acute phases of PTSD. The specialist returns the patient to the moment of the situation and makes it clear how lucky the surviving person who survived the stress is. At the same time, thoughts switch to the positive aspects of life.
Drug therapy: taking antidepressants, tranquilizers, beta-blockers, antipsychotics is prescribed only when absolutely necessary.
Psychological assistance in post-traumatic situations may include group psychotherapy sessions with individuals who have also experienced an acute reaction at dangerous moments. In such cases, the patient does not feel “abnormal” and understands that a large number of people have difficulty coping with life-threatening tragic events and not everyone can cope with them.
Important: the main thing is to consult a doctor on time, with the manifestation of the first signs of a problem.
Treatment for PTSD is carried out by a qualified psychotherapist
Having eliminated the beginning problems with the psyche, the doctor will prevent the development of mental illness, make life easier and help you quickly and easily survive the negative. The behavior of loved ones of a suffering person is important. If he does not want to go to the clinic, visit the doctor yourself and consult with him, outlining the problem. You should not try to distract him from difficult thoughts on your own, talk in his presence about the event that caused the mental disorder. Warmth, care, common hobbies and support will be just right, by the way, and the black stripe will quickly change to light.
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