Situational reaction code according to ICD 10. Reaction to severe stress and adaptation disorders (F43). Prolonged grief reaction

In the third issue of the journal World Psychiatry for 2013 (currently available only in English, a Russian translation is in preparation), the working group for the preparation of ICD-11 diagnostic criteria for stress disorders presented its 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 remained the subject of serious controversy for a long time due to the nonspecificity of many clinical manifestations, difficulties in distinguishing painful conditions from normal reactions to stressful events, the presence of significant cultural characteristics in responding to stress, etc.

Much criticism has been leveled at the criteria for these disorders in the DSM-IV and DSM-5. For example, according to the working group members, adjustment disorder is one of the most poorly defined mental disorders, which is why it is often described as a “garbage bin” diagnosis in the psychiatric classification scheme. D The diagnosis of PTSD has been criticized for its wide combination of different symptom clusters, low diagnostic threshold, high level of comorbidity, and, in relation to DSM-IV criteria, for the fact that more than 10 thousand different combinations of 17 symptoms can lead to this diagnosis.

All this served as the reason for a fairly serious revision of the criteria for this group of disorders in the ICD-11 project.

The first innovation concerns a name for a group of stress-related disorders. In ICD-10 there is a heading F43 “Reaction to severe stress and adjustment disorders”, which belongs to the section F40 - F48 “Neurotic, stress-related and somatoform disorders”. The Working Group recommends avoiding the commonly 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 events. In this case, we are talking only about disorders for which stress is an obligatory and specific cause of their development. An attempt to emphasize this point in the ICD-11 draft was the introduction of the term “disorders specifically associated with stress,” which can probably most accurately be translated into Russian as “ disorders, directly stress related" This is the name planned to be given to the section where the disorders discussed below will be placed.

The working group's proposals for specific disorders include:

• more narrow concept of PTSD, which does not allow a diagnosis to be made based only on nonspecific symptoms;
• new category " complex PTSD"("complex PTSD"), which, in addition to the core symptoms of PTSD, additionally includes three groups of symptoms;
• new diagnosis prolonged grief reaction”, used to characterize patients who experience an intense, painful, disabling, and abnormally persistent reaction to bereavement;
• significant revision of diagnostics " adjustment disorders", including specification of symptoms;
• revision concepts« acute reaction to stress"in line with the idea of ​​this condition as a normal phenomenon, which, however, may require clinical intervention.

In general, the proposals of the working group can be presented as follows:

The next steps in the development of the ICD-11 project on disorders directly related to stress will be public discussion and field testing.

Acquaintance with the project and discussion of proposals will be carried out using the ICD-11 beta platform ( http://apps.who.int/classifications/icd11/browse/f/en). Field studies will evaluate the clinical acceptability, clinical utility (eg, ease of use), reliability, and, to the extent possible, validity of draft definitions and diagnostic guidelines, particularly in comparison with ICD-10.

WHO will use two main approaches to test draft ICD-11 sections: online studies and studies in clinical settings. Online research will be conducted primarily within , which currently includes more than 7,000 psychiatric and primary care physicians. Research into disorders directly related to stress is already planned. Research in clinical settings will be carried out through the international network of WHO Collaborating Clinical Research Centres.

The Working Group looks forward to collaborating with colleagues around the world to test and further refine proposals for diagnostic guidelines for disorders specifically related to stress in ICD-11.

Likes: 3

A - Interaction of 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; The response to acute stress is divided into:

* easy, criterion 1 is met.

* moderate, criterion 1 is met and any two symptoms from criterion 2 are present.

*severe, criterion 1 is met and any four symptoms from criterion 2 are present, or dissociative stupor is present.

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

2) sweating

3) tremor or shaking

4) dry mouth (but not from medications and dehydration)

Symptoms related to the chest and abdomen:

5) difficulty breathing

6) feeling of suffocation

7) chest pain or discomfort

8) nausea or abdominal distress (eg, burning stomach)

Symptoms related to mental state:

9) feeling dizzy, unsteady or faint.

10) feelings that objects are unreal (derealization) or that one’s own self has moved away and “is not really here”

11) fear of loss of control, madness or impending death

12) fear of dying

General symptoms:

13) hot flashes and chills

14) numbness or tingling sensation

Symptoms of tension:

15) muscle tension or pain

16) anxiety and inability to relax

17) feeling of nervousness, “on edge” or mental tension

18) feeling of a lump in the throat or difficulty swallowing

Other nonspecific symptoms:

19) increased reaction to small surprises or fear

20) difficulty concentrating or feeling “blank in the head” 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), anxiety-phobic disorders (F40.-), obsessive-compulsive disorder (F42-) or hypochondriacal disorder (F45.2).

* Most commonly used exclusion criteria. The anxiety disorder is not due to a physical illness, an organic mental disorder (F00-F09), or a disorder not associated with amphetamine-like substance use or benzodiazepine withdrawal.

Criterion 2.

a) avoidance of upcoming social interactions

b) narrowing of attention.

c) manifestation of disorientation

d) anger or verbal aggression.

e) despair or hopelessness.

f) inappropriate or aimless hyperactivity

g) uncontrollable or excessive grief (considered according to local cultural standards)

D – If the stressor is transient or can be alleviated, symptoms should begin to improve within 8 hours or less. If the stressor continues, symptoms should begin to subside within 48 hours or less.

D – Most commonly used exclusion criteria. The response must occur in the absence of other ICD-10 mental or behavioral disorders (except generalized anxiety disorder and personality disorder), and at least three months after the end of the episode of any other mental or behavioral disorder.

Criteria for post-traumatic stress disorder according to DSM-IV:

1. The individual has been exposed to a traumatic event and both of the following must be true:

1.1. The individual has participated in, witnessed, or been exposed to an event(s) that involves death or the threat of death, or the threat of serious injury, or a threat to the physical integrity of others (or one's own).

1.2. The individual's response includes intense fear, helplessness, or horror. Note: in children, the reaction may be replaced by agitating or disorganized behavior.

2. The traumatic event is persistently repeated in the experience in one (or more) of the following ways:

2.1. Repeated and obsessive replay of an event, corresponding images, thoughts and perceptions, causing severe emotional distress. Note: Young children may develop repetitive play that exhibits themes or aspects of trauma.

2.2. Recurring bad dreams about the event. Note: Children may experience nightmares, the content of which is not stored.

2.3. Acting or feeling as if the traumatic event were happening again (includes feelings of “reliving” the experience, illusions, hallucinations and dissociative episodes - “flashback” effects, including those that occur while intoxicated or while asleep). Note: Children may exhibit trauma-specific repetitive behaviors.

2.4. Intense, difficult experiences that were caused by an external or internal situation that is reminiscent of or symbolic of traumatic events.

2.5. Physiological reactivity to situations that externally or internally symbolize aspects of the traumatic event.

3. Persistent avoidance of trauma-related stimuli and numbing- blocking of emotional reactions, numbness (not observed before the injury). Identified 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 trigger memories of the trauma.

3.3. Inability to remember important aspects of the trauma (psychogenic amnesia).

3.4. Markedly decreased interest or participation in previously meaningful activities.

3.5. Feeling detached or separated from other people;

3.6. Reduced expression of affect (inability, for example, to feel love).

3.7. Feelings of lack of prospects for the future (for example, lack of expectations about a career, marriage, children, or desire for a long life).

4. Persistent symptoms of increasing agitation (not present before the injury). Identified 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 angry outbursts.

4.3. Difficulty concentrating.

4.4. An increased level of alertness, hypervigilance, a state of constant anticipation of a threat.

4.5. Exaggerated fear reaction.

5. The duration of the disorder (symptoms in criteria B, C and D) is more than 1 month.

6. The disorder causes clinically significant severe emotional distress or impairment in social, occupational, or other important areas of functioning.

7. As can be seen from the description of criterion A, the definition of a traumatic event is one of the primary criteria in diagnosing PTSD.

In the third issue of the journal World Psychiatry for 2013 (currently available only in English, a Russian translation is in preparation), the working group for the preparation of ICD-11 diagnostic criteria for stress disorders presented its 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 remained the subject of serious controversy for a long time due to the nonspecificity of many clinical manifestations, difficulties in distinguishing painful conditions from normal reactions to stressful events, the presence of significant cultural characteristics in responding to stress, etc.

Much criticism has been leveled at the criteria for these disorders in ICD-10, DSM-IV and DSM-5. For example, according to the working group members, adjustment disorder is one of the most poorly defined mental disorders, which is why it is often described as a “garbage bin” diagnosis in the psychiatric classification scheme. The diagnosis of PTSD has been criticized for its wide combination of different symptom clusters, low diagnostic threshold, high level of comorbidity, and, in relation to DSM-IV criteria, for the fact that more than 10 thousand different combinations of 17 symptoms can lead to this diagnosis.

All this served as the reason for a fairly serious revision of the criteria for this group of disorders in the ICD-11 project.

The first innovation concerns a name for a group of stress-related disorders. In ICD-10 there is a heading F43 “Reaction to severe stress and adjustment disorders”, related to sections F40 - F48 “Neurotic, stress-related and somatoform disorders”. The Working Group recommends avoiding the commonly 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 events. In this case, we are talking only about disorders for which stress is an obligatory and specific cause of their development. An attempt to emphasize this point in the ICD-11 draft was the introduction of the term “disorders specifically associated with stress,” which can probably most accurately be translated into Russian as “ disorders, directly stress related" This is the name planned to be given to the section where the disorders discussed below will be placed.

The working group's proposals for specific disorders include:

In general, the proposals of the working group can be presented as follows:

Previous ICD-10 codes

Acute reaction to stress

Definition and general information [edit]

Acute stress disorder

As a rule, to the occurrence of a particular situation, familiar or to one degree or another predictable, a person responds with an integral reaction - consistent 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 personal characteristics, the individual’s idea of ​​his own (desired and real) standard of behavior, ideas of the microsocial environment about the standards of an individual’s behavior in a given situation, and 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 this is acute psychomotor agitation, manifested by unnecessary, fast, sometimes unfocused movements. The victim's facial expressions and gestures become excessively lively. There is a narrowing of the volume 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 concentrating (selectivity) of attention is detected: patients are very easily distracted and cannot ignore various (especially sound) interference, and have difficulty perceiving explanations. In addition, there are difficulties in reproducing information received during 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, poorly modulated; it seems that the victims constantly speak in a raised voice. The same phrases are often repeated, and sometimes the speech begins to take on the character of a monologue. Judgments are superficial, sometimes lacking meaning.

For victims with acute psychomotor agitation, it is difficult to be in one position: they either lie down, then stand up, or move aimlessly. Tachycardia is noted, there is an increase in blood pressure, not accompanied by deterioration of the condition or headache, facial flushing, excessive sweating, and sometimes feelings of thirst and hunger appear. At the same time, polyuria and increased frequency of bowel movements may be detected.

The extreme expression of this option is when a person quickly leaves the scene of the incident, without taking into account the situation that has arisen. Cases are described when, during an earthquake, people jumped out of the windows of the upper floors of buildings and fell to their deaths, when parents first of all saved themselves and forgot about their children (fathers). All these actions were driven by the instinct of self-preservation.

With the second type of acute reaction to stress, a sharp slowdown in mental and motor activity occurs. At the same time, derealization disorders occur, manifested in a feeling of alienation from the real world. The surrounding objects begin to be perceived as altered, unnatural, and in some cases - as unreal, “lifeless”. There is also likely a change in the perception of sound signals: people’s voices and other sounds lose their characteristics (individuality, specificity, “richness”). There are also sensations of altered distance between various surrounding objects (objects located at a closer distance are perceived as larger than they actually are) - metamorphopsia.

Typically, victims with this variant of acute stress reaction 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. hyperprosexia occurs, which is outwardly manifested by absent-mindedness and seeming ignorance of important external stimuli. People do not seek help, do not actively express complaints during conversations, speak in a quiet, unmodulated voice and, in general, give the impression of being empty and emotionally emasculated. Blood pressure is rarely elevated, and feelings of thirst and hunger are dulled.

In severe cases, psychogenic stupor develops: the person lies with his eyes closed and 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 seems to be trying to protect itself as much as possible from reality.

Behavior during an acute reaction to stress is, first of all, determined by the instinct of self-preservation, and in women, in some cases, the instinct of procreation comes to the fore (i.e., the woman seeks to first save her helpless children).

It should be noted that immediately after a person has survived 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 an emergency (in the so-called isolation phase), the “right of the strong” begins to apply in the relationships between the victims, 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.

Reaction to severe stress and adaptation disorders according to ICD-10

This group of disorders differs from other groups in that it includes disorders identified not only on the basis of symptoms and course, but also on the basis of the 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 precipitate the onset or contribute to the manifestation of the wide range of disorders represented in this class of diseases, its etiological significance is not always clear, and in each case there will be a recognition of dependence on the individual, often on his/her hypersensitivity and vulnerability (i.e. i.e. life events are not necessary or sufficient to explain the occurrence and form of the disorder). In contrast, the disorders collected under this heading are always considered to be a 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 would not have occurred without their influence. Thus, the disorders classified under this heading may be viewed as perverse adaptive responses to severe or prolonged stress, interfering with successful stress management and consequently leading to problems in social functioning.

Acute reaction to stress

A transient disorder that develops in a person without any other mental health symptoms in response to unusual physical or mental stress and usually subsides after a few hours or days. Individual vulnerability and self-control play a role in the prevalence and severity of stress reactions. Symptoms show a typically mixed and variable pattern and include an initial state of “dazedness” with some narrowing of the range of consciousness and attention, inability to fully become aware of stimuli, and disorientation. This state may be accompanied by subsequent “withdrawal” from the surrounding situation (to a state of dissociative stupor - F44.2) or agitation and hyperactivity (flight or fugue reaction). Typically, some features of panic disorder are present (tachycardia, excessive sweating, flushing). Symptoms usually begin within minutes of exposure to a stressful stimulus or event and disappear within 2-3 days (often within a few hours). Partial or complete amnesia (F44.0) for the stressful event may be present. If the above symptoms are persistent, it is necessary to change the diagnosis. 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; The reaction to acute stress is divided into:
F43.00 light only the following criterion is met 1)
F43.01 moderate criterion 1) is met and any two 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) Avoidance of 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 experience (considered in accordance with
local cultural standards).
D. If the stressor is temporary or can be relieved, symptoms should begin
decrease after no more than eight hours. If the stressor persists,
Symptoms should begin to subside in no more than 48 hours.
D. Most commonly used exclusion criteria. The reaction must develop in
absence of any other mental or behavioral disorder in ICD-10 (except for F41.1 (generalized anxiety disorders) and F60- (personality disorders)) and at least three months after the end of an episode of any other mental or behavioral disorder.

Post-traumatic stress disorder

Occurs as a delayed or protracted response to a stressful event (brief or long-term) of an exceptionally threatening or catastrophic nature, which can cause profound stress in almost anyone. Predisposing factors, such as personality traits (compulsiveness, asthenia) or a history of nervous disease, may lower the threshold for the development of the syndrome or aggravate its course, but they are never necessary or sufficient to explain its occurrence. Typical signs include episodes of repeated reliving of the traumatic event in intrusive memories (“flashbacks”), thoughts, or nightmares that appear against a persistent background of feelings of numbness, emotional inhibition, detachment from other people, unresponsiveness to the environment, and avoidance of activities and situations that remind of the trauma. Overexcitement and severe hypervigilance, increased startle response and insomnia usually occur. Anxiety and depression are often associated with the above symptoms, and suicidal ideation is not uncommon. The onset of symptoms of the disorder is preceded by a latent period after the 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 become chronic over many years, with possible progression to permanent personality changes (F62.0). Traumatic neurosis

A. The patient must be exposed to a stressful event or situation (both short-term and long-lasting) of an extremely threatening or catastrophic nature, which can cause general distress in almost any individual.
B. Persistent memories or “reliving” of the stressor in intrusive flashbacks, vivid memories, or recurring dreams, or re-experiencing grief when exposed to circumstances reminiscent of or associated with the stressor.
B. The patient must exhibit actual avoidance or a desire to avoid circumstances that resemble or are associated with the stressor (which was not observed before exposure to the stressor).
D. Either of the two:
1. psychogenic amnesia (F44.0), either partial or complete regarding important aspects of the period of exposure to the stressor;
2. Persistent symptoms of increased psychological sensitivity or excitability (not observed before 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) increasing 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 a period of stress (for some purposes, the onset of the disorder delayed by more than six months may be included, but these cases must be clearly defined separately).

Adjustment disorder

A state of subjective distress and emotional disturbance that creates difficulties in social activities and behavior, occurring during the period of adaptation to a significant life change or stressful event. A stressful event may disrupt the integrity of an individual's social networks (bereavement, separation) or a broader system of social support and values ​​(migration, refugee status) or represent a wide range of changes and turning points in life (entry to school, becoming a parent, failure to achieve a cherished personal goals, retirement). Individual predisposition or vulnerability play an important role in the risk of occurrence and form of manifestation of disorders of adaptive reactions, but the possibility of such disorders occurring without a traumatic factor is not allowed. Manifestations are highly variable and include depressed mood, wariness or anxiety (or a combination of these), feelings of inability to cope, plan ahead, or decide to stay in the present situation, and also include some degree of decreased ability to function in daily life. At the same time, behavioral disorders may occur, especially in adolescence. A characteristic feature may be a short or long-term depressive reaction or disturbance of other emotions and behavior: Culture shock, Grief reaction, Hospitalization 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 of 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 conduct disorders (F91-) , but in the absence of criteria for these specific disorders. Symptoms can vary in form and severity. The predominant features of symptoms can be determined using the fifth character:
F43.20 Short depressive reaction.
Transient mild depressive state, lasting no more than one month
F43.21 Prolonged depressive reaction.
A mild depressive state resulting from prolonged exposure to a stressful situation, but lasting no more than two years.
F43.22 Mixed anxious and depressive reaction.
Symptoms of both anxiety and depression are prominent, but at levels no higher than those defined for mixed anxiety and depressive disorder (F41.2) or other mixed anxiety disorders (F41.3).
F43.23 With a predominance of disorders of other emotions
Symptoms are usually of several emotional types, such as anxiety, depression, restlessness, tension and anger. Symptoms of anxiety and depression may meet 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 would be diagnosed. This category should also be used for reactions in children who also have regressive behaviors such as bedwetting or thumb sucking.
F43.24 With a predominance of behavioral disorders. The main disorder involves behavior, for example, in adolescents, the grief reaction manifests itself as aggressive or antisocial behavior.
F43.25 With mixed disorders of emotions and behavior. Both emotional symptoms and behavioral disturbances are pronounced.
F43.28 With other specified predominant symptoms
B. Symptoms do not last more than six months after the stress or its consequences cease, with the exception of F43.21 (prolonged depressive reaction), but this criterion should not preclude a provisional diagnosis.

Other reactions to severe stress

Reaction to severe stress, unspecified

The selected group of neurotic disorders differs from the previous ones in that they have a clear temporal and causal connection with a psychotraumatic (usually objectively significant) event. A stressful life event is characterized by surprise, a significant disruption to life plans. Typical severe stressors are combat, natural and transport disasters, accident, witnessing the violent death of others, 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. The presence of “stupefaction” after exposure to psychological trauma, the inability to adequately respond to what is happening, disturbances in concentration and stability of attention, and disorientation are considered typical. Periods of agitation and hyperactivity, panic anxiety with vegetative manifestations are possible. Amnesia may be present. The duration of this disorder ranges from several hours to two to 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) development of symptoms immediately following this within an hour;

3) depending on the presence of the two groups of symptoms A and B below, the acute reaction to stress is divided into mild (F43.00, there are only symptoms of group A), moderate severity (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 criteria 2, 3 and 4 for generalized anxiety disorder (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 mitigated or eliminated, symptoms begin to reduce no earlier than after 8 hours, if stress persists - no earlier than after 48 hours;

5) absence of signs of any other mental disorder, with the exception of generalized anxiety (F41.1), an episode of any previous mental disorder was completed at least 3 months before the stress.

Post-traumatic stress disorder (F 43.0)

Post-traumatic stress disorder occurs as a delayed or prolonged reaction to a stressful event or situation of an exceptionally threatening or catastrophic nature, beyond the scope of ordinary everyday situations that can cause distress in almost any person. At first, only military actions (the war in Vietnam, Afghanistan) were classified as such events. However, the phenomenon was soon transferred to civilian life.

Post-traumatic stress disorder is usually caused by the following factors:

— natural and man-made disasters;

— terrorist acts (including hostage-taking);

- military service;

- serving a sentence in a prison;

- 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 that would cause almost everyone a feeling of deep despair;

2) persistent, involuntary and extremely vivid memories (flash-backs) of the experience, which are also reflected in dreams, intensifying when placed in situations reminiscent of or associated with stressful situations;

3) avoidance of situations resembling or associated with stressful situations, 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 stress experienced,

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) difficulty falling asleep, shallow sleep, b) irritability or outbursts of anger, c) decreased concentration, d) increased level of wakefulness, e) increased fearfulness ;

5) with rare exceptions, compliance with criteria 2-4 occurs within 6 months after exposure to stress or at the end of its effect.

It is believed that the most common 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 manifest primarily as emotional disturbances during the period of adaptation to a significant life change or stressful life event. A psychotraumatic factor can affect the integrity of a person’s social network (loss of loved ones, the experience of separation), a broad system of social support and social values, and also affect the microsocial environment. In the case of the depressive variant of adaptation disorder, such affective phenomena as grief, low mood, a tendency to solitude, as well as suicidal thoughts and tendencies appear in the clinical picture. With the anxious variant, symptoms of restlessness, restlessness, anxiety and fear, projected into the future and the expectation of misfortune, become dominant.

Adaptation disorders (F43.2) are diagnosed when the condition meets the following criteria:

1) identified psychosocial stress that does not reach an extreme or catastrophic scale, symptoms appear within a month;

2) individual symptoms (with the exception of delusional and hallucinatory symptoms) that meet the criteria for affective (F3), neurotic, stress and somatoform (F4) disorders and disorders of social behavior (F91), which do not fully correspond to any of them. Symptoms can vary in pattern and severity. Adaptation disorders are differentiated depending on the dominant manifestations in the clinical picture;

3) symptoms do not exceed 6 months in duration from the moment the stress or its consequences ceased, with the exception of prolonged depressive reactions (F43.21).

Reaction to acute stress - criteria in ICD-10

A - Interaction of 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; The response to acute stress is divided into:

* easy, criterion 1 is met.

* moderate, criterion 1 is met and any two symptoms from criterion 2 are present.

*severe, criterion 1 is met and any four symptoms from criterion 2 are present, or dissociative stupor is present.

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 shaking

4) dry mouth (but not from medications and dehydration)

Symptoms related to the chest and abdomen:

5) difficulty breathing

6) feeling of suffocation

7) chest pain or discomfort

8) nausea or abdominal distress (eg, burning stomach)

Symptoms related to mental state:

9) feeling dizzy, unsteady or faint.

10) feelings that objects are unreal (derealization) or that one’s own self has moved away and “is not really here”

11) fear of loss of control, madness or impending death

12) fear of dying

13) hot flashes and chills

14) numbness or tingling sensation

15) muscle tension or pain

16) anxiety and inability to relax

17) feeling of nervousness, “on edge” or mental tension

18) feeling of a lump in the throat or difficulty swallowing

Other nonspecific symptoms:

19) increased reaction to small surprises or fear

20) difficulty concentrating or feeling “blank in the head” 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), anxiety-phobic disorders (F40.-), obsessive-compulsive disorder (F42-) or hypochondriacal disorder (F45.2).

* Most commonly used exclusion criteria. The anxiety disorder is not due to a physical illness, an organic mental disorder (F00-F09), or a disorder not associated with amphetamine-like substance use or benzodiazepine withdrawal.

a) avoidance of upcoming social interactions

b) narrowing of attention.

c) manifestation of disorientation

d) anger or verbal aggression.

e) despair or hopelessness.

f) inappropriate or aimless hyperactivity

g) uncontrollable or excessive grief (considered according to local cultural standards)

D – If the stressor is transient or can be alleviated, symptoms should begin to improve within 8 hours or less. If the stressor continues, symptoms should begin to subside within 48 hours or less.

D – Most commonly used exclusion criteria. The response must occur in the absence of other ICD-10 mental or behavioral disorders (except generalized anxiety disorder and personality disorder), and at least three months after the end of the episode of any other mental or behavioral disorder.

Criteria for post-traumatic stress disorder according to DSM-IV:

1. The individual has been exposed to a traumatic event and both of the following must be true:

1.1. The individual has participated in, witnessed, or been exposed to an event(s) that involves death or the threat of death, or the threat of serious injury, or a threat to the physical integrity of others (or one's own).

1.2. The individual's response includes intense fear, helplessness, or horror. Note: in children, the reaction may be replaced by agitating or disorganized behavior.

2. The traumatic event is persistently repeated in the experience in one (or more) of the following ways:

2.1. Repeated and obsessive replay of an event, corresponding images, thoughts and perceptions, causing severe emotional distress. Note: Young children may develop repetitive play that exhibits themes or aspects of trauma.

2.2. Recurring bad dreams about the event. Note: Children may experience nightmares, the content of which is not stored.

2.3. Acting or feeling as if the traumatic event were happening again (includes feelings of “reliving” the experience, illusions, hallucinations, and dissociative episodes—“flashback” effects, including those that occur during a state of intoxication or while asleep). Note: Children may exhibit trauma-specific repetitive behaviors.

2.4. Intense, difficult experiences that were caused by an external or internal situation that is reminiscent of or symbolic of traumatic events.

2.5. Physiological reactivity to situations that externally or internally symbolize aspects of the traumatic event.

3. Persistent avoidance of trauma-related stimuli and numbing- blocking of emotional reactions, numbness (not observed before the injury). Identified 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 trigger memories of the trauma.

3.3. Inability to remember important aspects of the trauma (psychogenic amnesia).

3.4. Markedly decreased interest or participation in previously meaningful activities.

3.5. Feeling detached or separated from other people;

3.6. Reduced expression of affect (inability, for example, to feel love).

3.7. Feelings of lack of prospects for the future (for example, lack of expectations about a career, marriage, children, or desire for a long life).

4. Persistent symptoms of increasing agitation (not present before the injury). Identified 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 angry outbursts.

4.3. Difficulty concentrating.

4.4. An increased level of alertness, hypervigilance, a state of constant anticipation of a threat.

4.5. Exaggerated fear reaction.

5. The duration of the disorder (symptoms in criteria B, C and D) is more than 1 month.

6. The disorder causes clinically significant severe emotional distress or impairment in social, occupational, or other important areas of functioning.

7. As can be seen from the description of criterion A, the definition of a traumatic event is one of the primary criteria in diagnosing PTSD.

3.3.2. Acute stress reaction (acute stress reaction, ASR)

OSD is a severe 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 that threaten the life of the individual or those close to him (for example, a natural disaster, accident, combat, criminal behavior, rape) or an unusually abrupt and threatening change in social status 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 resilience 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 recovery and worsening 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).

Quite clear diagnostic criteria for OSD are formulated in the DSM-IV:

A. The person was exposed to a traumatic event and exhibited the following mandatory signs:

1) the traumatic event recorded was determined by an actual threat of death or serious injury (i.e., a threat to physical integrity) to the patient himself or to 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 time of or immediately after the completion of the traumatic event, the patient experienced three (or more) dissociative symptoms:

1) a subjective feeling of numbness, detachment (alienation) or lack of a live 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 a traumatic situation).

C. The traumatic event repeatedly appears forcefully in the mind with re-experiencing one of the following: images, thoughts, dreams, illusions, or subjective distress when reminded of the traumatic event.

D. Avoidance of stimuli that promote trauma memory (eg, thoughts, feelings, conversations, activities, places, people).

E. There are symptoms of anxiety or increased tension (for example, problems with sleep, concentration, irritability, hypervigilance), excessive reactivity (increased fearfulness, flinching at unexpected sounds, motor restlessness, etc.).

F. The symptoms cause clinically significant impairment in social, occupational (or other areas) functioning, or interfere with the person's ability to perform other necessary tasks.

G. The disorder lasts 1–3 days after the traumatic event.

ICD-10 has the following addition: there must be a mandatory and clear temporal relationship between exposure to an unusual stressor and the onset of symptoms; onset is usually immediate or within a few minutes. In this case, the symptoms: a) have a mixed and usually changing picture; in addition to the initial state of stupor, depression, anxiety, anger, despair, hyperactivity and withdrawal may be observed, but none of the symptoms predominates for a long time; b) stop quickly (within a few hours at most) in cases where it is possible to eliminate the stressful situation. If the stressful event continues or cannot by its nature stop, symptoms usually begin to subside within 24–48 hours and are minimal within 3 days.

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ACUTE REACTION TO STRESS

Found 5 definitions of the term ACUTE REACTION TO STRESS

F43.0 Acute reaction to stress

A transient disorder of significant severity that develops in individuals without apparent mental disorder in response to exceptional physical and psychological stress and that usually resolves within hours or days. Stress may be a severe traumatic experience, including a threat to the safety or physical integrity of the individual or loved one (eg, natural disaster, accident, battle, criminal behavior, rape) or an unusually abrupt and threatening change in the social status and/or environment of the sufferer, e.g. 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 not all people exposed to severe stress develop this disorder. Symptoms show a typical mixed and varying pattern and include an initial state of “dazedness” with some narrowing of the field of consciousness and decreased attention, inability to respond adequately to external stimuli and disorientation. This state may be accompanied by either further withdrawal from the surrounding situation (up to dissociative stupor - F44.2), or agitation and hyperactivity (flight or fugue reaction). Autonomic signs of panic anxiety (tachycardia, sweating, flushing) are often present. Symptoms usually 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 clear and clear temporal relationship between exposure to the unusual stressor and the onset of symptoms; It usually pumped immediately or within a few minutes. In addition, symptoms:

a) have a mixed and usually changing picture; in addition to the initial state of stupor, depression, anxiety, anger, despair, hyperactivity and withdrawal may be observed, but none of the symptoms predominates for a long time;

b) stop quickly (within a few hours at most) in cases where it is possible to eliminate the stressful situation. In cases where stress continues or by its nature cannot stop, symptoms usually begin to disappear after 24-48 hours and are minimized within 3 days.

This diagnosis cannot be used to refer to sudden exacerbations of symptoms in persons already having symptoms that meet the criteria for any mental disorder except those in F60.- (specific personality disorders). However, a previous history of mental disorder does not make the use of this diagnosis inappropriate.

Acute crisis response;

Acute reaction to stress;

ACUTE REACTION TO STRESS (ICD 308)

The reaction to stress is acute

Acute reaction to stress

The symptom complex of the disorder includes the following main features: 1. confusion with an incomplete, fragmented perception of the situation, often focusing attention on its random, side aspects 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 purposeful, adequate actions . Productive psychopathological symptoms (delusions, hallucinations, etc.) apparently do not exist or, if they occur, they are abortive, rudimentary in nature; 2. insufficient contact with patients, 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 is less common, motor and speech agitation with fussiness, confusion, confused, inconsistent verbosity, sometimes verbalizations of despair; in a relatively small proportion of patients, disordered and intense motor agitation occurs, usually in the form of panicked flight and impulsive actions that are carried out contrary to the demands of the situation and are fraught with serious consequences, including death; 4. severe autonomic disorders (mydriasis, pallor or hyperemia of the skin, vomiting, diarrhea, hyperhidrosis, symptoms of cerebral and cardiac circulatory failure, which causes some patients to die, etc.) and 5. subsequent complete or partial congrade amnesia. There may also be confusion, despair, a feeling of the unreality of what is happening, isolation, mutism, and unmotivated aggressiveness. The clinical picture of the disorder is polymorphic, changeable, and often mixed. In premorbid psychiatric patients, the acute reaction to stress may be somewhat different and not always typical, although information about the characteristics of the response of patients with various mental disorders to severe stress (depression, schizophrenia, etc.) seems insufficient. As a rule, the source of more or less reliable information about severe forms of the disorder is one of the strangers; they, in particular, can be rescuers.

After the end of the acute reaction to stress, most patients reveal, as Z.I. Kekelidze (2009) points out, symptoms of the transition period of the disorder (affective tension, sleep disturbances, psycho-vegetative 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 the confidence or hope that mobilizes him to overcome them. Treatment: placement in a safe environment, tranquilizers, antipsychotics, anti-shock measures, psychotherapy, psychological correction. Synonyms: Crisis state, Acute crisis reaction, Battle fatigue, Mental shock, Acute reactive psychosis.

Acute reaction to stress

QUESTION:“Good night, Andrey. This is my first time on the site and I'm desperately looking for help. Can I get a consultation from you? Unfortunately, I live abroad, and I cannot meet with you in person, even with a strong desire. Today I had an incident that I probably thought about earlier, but I hoped that it would still bypass me. I have long been in a depressed state, which is probably the majority of people in our country, due to lack of money, housing, and 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, I began to have straight out hysterics, as if from hopelessness, I began to shake, I cried and probably didn’t understand anything anymore. My husband and I divorced, but we still have a child. I got married again, but my psychological state did not change. Today what I feared most happened happened. I have a very strong-willed child, even at two years old. He doesn't 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 put himself in danger on the roadway; before that, he tested my nerves for a long time in the store. I don’t know if I can occupy your time with such detailed stories, the point 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, like him in the parking lot, when there was a lot of traffic, he pulled his hand out of my hand and began to run away from me with joy, 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 and asking if I was yelling at the child. Our laws are very strict, you can’t even shout at a child. I'm afraid it will be taken away from me. I know for sure that I definitely didn’t beat him, I couldn’t, I just couldn’t. I remember that I then went to my neighbor’s, and despite my character, I am afraid that if she had opened the door, our conversation would not have worked out. I'm scared. I’m afraid to contact a psychiatrist in our country, although I understand what is needed. I'm afraid that 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 accosted me on the street, yelled at me, and threw himself at me. I didn’t say anything special, but after talking with him I felt bad. There was a moral feeling that I was going to die. As if my soul was about to break out of me and I would lose consciousness. It has never been so scary. Then I vomited several times. I couldn’t sleep, as soon as I remembered it, I immediately felt like I couldn’t control myself, as if I wasn’t myself. The next day the condition recurred only in a mild form. A month passed from that moment and everything began to irritate me, for example, if a person she talks to me for more than a minute or the cat runs in front of me. What should I do about this? I have never had any mental health 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 10 code). This condition is classified as neurotic (F4 - code according to ICD 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, restlessness, horror, helplessness, insensibility, confusion, deterioration of perception, attention, mild stupor and some narrowing of consciousness. Possible derealization, depersonalization, dissociative amnesia. Motor disorders often manifest themselves either as retardation, numbness, even stupor, or agitation, agitation, unproductive, chaotic hyperactivity.

Often there are vegetative manifestations in the form of tachycardia, increased blood pressure, sweating, redness, feeling of lack of air, nausea, dizziness, increased body temperature, etc.

The basic symptoms for an acute reaction to stress are also: a) repeated obsessive anxiety experiences and “replaying” of traumatic events in the form of memories, fantasies, ideas, and nightmares; b) avoidance of situations, activities, thoughts, places, actions, feelings, conversations associated with traumatic events; c) emotional “dulling”, limitation, loss of interests, feeling of detachment from others; d) excessive excitement, irritability, short temper, 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, and sleep disturbances may appear for several days or weeks. In other cases, especially in the absence of adequate treatment, 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 (PSA), in particular alcohol, may develop.

All the best. Sincerely, Andrey Ivanovich Gerasimenko - psychiatrist, psychotherapist, narcologist (Kiev).

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acute reaction to stress

Acute reaction to stress

The disorder does not develop in all people exposed to 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. r. n. With. Individual vulnerability and adaptive capacity play a role.

From the moment rescue operations begin, part of the burden of providing psychological assistance falls on rescuers. The emergency psychological assistance team practically cannot begin to work during the acute (isolation) period of development of the situation in emergency situations, when signs of O. R. mainly appear. n. pp., due to the short duration of this period (lasts several minutes or hours).

Psychosocial support after a disaster occurs is usually provided by relatives, neighbors or other people who, due to circumstances, find themselves close to the victims. Those around you, as you know, quickly get involved in helping the victims. Help in such conditions is most often provided “in the manner of self- and mutual assistance.”

Since survivors of a disaster exhibit extremely pronounced emotional reactions that are quite natural in a given situation (anxiety, fear of death, despair, a feeling of helplessness or loss of life perspective), then when helping them, first of all you need to try to minimize these reactions by any available actions. The most effective will be expressions of compassion and care, as well as practical assistance to the victims.

Psychogenic states in victims

Mental disorders in the structure of reactive states in victims are represented mainly 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 the 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 adaptation disorders quite often develop. At the same time, some victims experience depressive, anxiety-depressive states, while others experience a sharpening of characterological characteristics or the formation of post-traumatic personality changes with persistent violations of social maladjustment.

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, a special place among psychogenic disorders in victims is occupied by an acute reaction to stress (F43.0). The ICD-10 description of this disorder states that it occurs in individuals without an apparent mental disorder in response to exceptional physical and psychological stress and resolves within hours or days. Psychological experiences associated with a threat to the life, health and physical integrity of the subject (disasters, accidents, criminal behavior, rape, etc.) are cited as stress.

Diagnosis requires a clear and clear temporal association with the unusual stressor and immediate or short-term development of the clinical picture of the disorder. The clinical picture is determined by the fact that when exposed to severe stress, nonspecific and specific effects can be distinguished.

The nonspecificity of the effects of stress is determined by the following parameters:

– it does not depend on age, it is determined by strength, speed, and the severity of the aggressive-violent component;

– little awareness, not accompanied by intrapersonal processing;

– the dynamics of acute affectogenic states are of leading importance – from short-term emotional stress and fear to affective-shock, sub-shock reactions with a narrowing of consciousness, fixation of attention on a narrow range of 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 what happened. As a result, the dynamics of emerging psychogenic disorders begin to be largely determined by the intrapsychic processing of new negative experiences associated with violence and their consequences for the individual. At the stage of emotional-cognitive processing, the following types of psychogenic disorders are most often formed.

In the clinical picture of these disorders, the leading place is occupied by the following symptoms:

– 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 are 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-depressed mood, the formation of intrapersonal complexes with vengeful fantasies, 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). Reported depressive conditions most often include the following clinical signs:

– adynamic or anxious depression with a feeling of despair, hopelessness, “a desire to quickly forget what happened” or an anxious expectation of negative consequences (illness, pregnancy, defects);

– somatovegetative disorders and sleep and appetite disorders.

Personal predisposition is of significant importance at the stage of emotional-cognitive processing. The following personality-characterological features determine a more protracted course of psychogenic states in victims:

– inhibited, hysterical, schizoid radicals with idealized ideas and moral principles;

– personal instability with the ease of inclusion of additional situational-reactive moments and deepening the severity of anxious or depressive personal reactions;

– asthenic radical (exhaustion, emotional lability, instability of self-esteem, self-pity and self-blame, tendency to introjection and isolation, refusal of personal support).

The next variant of psychogenic conditions, quite often found in victims, is post-traumatic stress disorder (F43.1).

Submitted by the State Scientific Center for Specialized SP. V.P. Serbsky, the incidence 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, repeated intrusive memories of the event, sleep disturbances with nightmares, associative inclusions with avoidance of stimuli that could evoke memories of the trauma, emotional detachment 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, the state of distress and emotional disorders with anxiety or depressive radicals, as well as behavioral deviations, occur as adaptation disorders.

In the formation of adaptation disorders (F43.2), individual predisposition and lesser severity of stress are of a certain importance. Along with a depressive or anxious mood, an individual’s reaction to a decrease in their level of functioning due to the effects of stress, productivity, and inability to cope with the current situation and control their condition is observed. This is often accompanied by sudden behavioral excesses, outbursts of aggressiveness or persistent demonstrative, deviant, dissocial behavior.

Forensic psychiatric qualification of psychogenic states in victims is significant for:

1) assessing the ability of victims to understand the nature and significance of the actions committed against them and to resist;

2) assessment of the criminal procedural capacity of victims - the ability to correctly perceive a legally significant situation of an offense, remember its circumstances, testify about them, understand and manage their actions during the investigation and trial;

3) assessment of harm to health from injuries resulting in mental disorders.

Practical commentary on the 5th chapter of the International Classification of Diseases, 10th revision (ICD -10)

Research Psychoneurological Institute named after. V.M. Bekhtereva, St. Petersburg

Typical severe stressors are combat, natural and transport disasters, accidents, witnessing the violent death of others, robbery, torture, rape, fire.

Premorbid burden of psychological trauma also increases vulnerability to the disorder. PTSD may have an organic cause. EEG abnormalities in these patients show similarities with those in endogenous depression. The alphanoradrenergic agonist clonidine, used to treat opiate withdrawal, appears to be successful in relieving some symptoms of PTSD. This allowed us to put forward the hypothesis that they are a consequence of endogenous opiate withdrawal syndrome, which occurs when memories of psychological trauma are revived.

Unlike PTSD, in adaptation disorders, the intensity of stress does not always determine the severity of the disorder. Stress can be single or overlapping, periodic (working stress) or constant (poverty). Different stages of life have their own specific stress situations (starting school, leaving the parental home, getting married, having children and leaving home, not achieving professional goals, retiring).

The experience of trauma becomes central to the patient's life, changing his lifestyle 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 fixated not on the injury itself, but on its consequences (disability, etc.). The onset of symptoms is sometimes delayed for varying periods of time, this also applies to adaptation disorders, where symptoms do not necessarily decrease when the stress stops. The intensity of symptoms may vary, 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.

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 to distinguish organic brain syndromes similar to PTSD. The diagnostic picture may be complicated by the abuse of alcohol, drugs, caffeine and tobacco, which is widely used in coping behavior of patients with PTSD.

Endogenous depression is a common 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 must be diagnosed. Patients with PTSD may develop symptoms of phobic avoidance; such cases from simple phobias help to distinguish the nature of the primary stimulus and the presence of other manifestations characteristic of PTSD. Motor tension, anxious expectations, and increased search settings can bring the picture of PTSD closer to that of generalized anxiety disorder. Here we need to pay attention to the acute onset and greater specificity of phobic symptoms for PTSD in contrast to generalized anxiety disorder.

Differences in the course stereotype make it possible to differentiate PTSD from panic disorder, which is sometimes very difficult and gives grounds for some authors to consider PTSD a variant of panic disorder. PTSD is distinguished from the development of physical symptoms due to mental causes (F68.0) by its acute onset after trauma and the absence of bizarre complaints before it. PTSD is distinguished from factitious disorder (F68.1) by the absence of inconsistent anamnestic data, an unexpected structure of the symptom complex, antisocial behavior and a chaotic lifestyle in premorbidity, which are more characteristic of factitious patients. PTSD differs from adaptation disorders in the greater 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 disorder must be differentiated from conditions not caused by mental disorders. Thus, the loss of loved ones without special aggravating circumstances may also be accompanied by a transient deterioration in social and professional functioning, which, however, remains within the expected framework of a reaction to the loss of a loved one and therefore is not considered a disorder of adaptation.

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A characteristic feature of this group of disorders is their clearly exogenous nature, a causal relationship with an external stressor, without the influence of which mental disorders would not have appeared. Reactions to stress

A characteristic feature of this group of disorders is their clearly exogenous nature, a causal relationship with an external stressor, without the influence of which mental disorders would not have appeared.

Typical severe stressors are combat, natural and transport disasters, accidents, witnessing the violent death of others, robbery, torture, rape, fire.

The prevalence of disorders naturally varies depending on the frequency of disasters and traumatic situations. The syndrome develops in 50–80% of those who have suffered severe stress. Morbidity is directly dependent on the intensity of stress. Cases of PTSD in peacetime in the population are 0.5% for men and 1.2% for women. 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, accounting for 1.1 – 2.6 cases per 1000 population, with a tendency towards greater representation in the low-income part of the population. They make up about 5% of those served by mental health institutions; occur at any age, but most often in children and adolescents.

Premorbid burden of psychological trauma also increases vulnerability to the disorder. PTSD may have an organic cause. EEG abnormalities in these patients show similarities to those seen in endogenous depression. The alphanoradrenergic agonist clonidine, used to treat opiate withdrawal, appears to be successful in relieving some symptoms of PTSD. This allowed us to put forward the hypothesis that they are a consequence of endogenous opiate withdrawal syndrome, which occurs when memories of psychological trauma are revived.

Unlike PTSD, in adaptation disorders, the intensity of stress does not always determine the severity of the disorder. Stress can be single or overlapping, periodic (working stress) or constant (poverty). Different stages of life have their own specific stress situations (starting school, leaving the parental home, getting married, having children and leaving home, not achieving professional goals, retiring).

The picture of the disease may include a general dulling of feelings (emotional anesthesia, a feeling of distance from other people, loss of interest in previous activities, the inability to experience joy, tenderness, orgasm) or feelings 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 impulse control are re-experienced. In an acute reaction, partial or complete dissociative amnesia of the episode is possible (F44.0). There may be consequences in the form of suicidal tendencies, as well as 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 to the patient's life, changing his lifestyle and social functioning. The response to a human stressor (rape) is more intense and lasting than to a natural disaster (flood). In protracted cases, the patient becomes fixated no longer on the injury itself, but on its consequences (disability, etc.). The onset of symptoms is sometimes delayed for varying periods of time, this also applies to adaptation disorders, where symptoms do not necessarily decrease when the stress stops. The intensity of symptoms may 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 disturbances in concentration. Inadequate nutrition during prolonged stress can also independently lead to organic brain syndromes, including memory and concentration problems, emotional lability, headaches and dizziness.

The presence of organic-type personality changes, changes in sensory or level of consciousness, focal neurological, delirious and amnestic symptoms, organic hallucinosis, states of intoxication and withdrawal can help distinguish organic brain syndromes similar to PTSD. The diagnostic picture can be complicated by abuse, which is widely used in coping behavior of patients with PTSD alcohol, drugs, caffeine and tobacco.

Endogenous depression is a common 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 must be diagnosed. Patients with PTSD may develop symptoms of phobic avoidance; such cases from simple phobias help to distinguish the nature of the primary stimulus and the presence of other manifestations characteristic of PTSD. Motor tension, anxious expectations, and increased search settings can bring the picture of PTSD closer to that of generalized anxiety disorder. Here we need to pay attention to the acute onset and greater specificity of phobic symptoms for PTSD, in contrast to generalized anxiety disorder.

Differences in the course stereotype make it possible to differentiate PTSD from panic disorder, which is sometimes very difficult and gives grounds for some authors to consider PTSD a variant of panic disorder. PTSD is distinguished from the development of physical symptoms for mental reasons (F68.0) by its acute onset after the injury and the absence of bizarre complaints before it. PTSD is distinguished from factitious disorder (F68.1) by the absence of inconsistent anamnestic data, unexpected structure of the symptom complex, antisocial behavior and a chaotic lifestyle in premorbidity, which are more characteristic of factitious patients. PTSD differs from adaptation disorders in the greater scope of the pathogenicity of the stressor and the presence of subsequent characteristic reproduction of 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 particularly aggravating circumstances may also be accompanied by a transient deterioration in social and professional functioning, which, however, remains within the expected framework of a reaction to the loss of a loved one and therefore is not considered a disorder of adaptation.

Based on the leading role of increased adrenergic activity in maintaining PTSD symptoms, adrenergic blockers such as propranolol and clonidine have been successfully used in the treatment of the disorder. The use of antidepressants is indicated when anxiety-depressive manifestations are severe in the clinical picture, prolongation and “endogenization” of depression; it also helps reduce repetitive trauma memories 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, pledging can be achieved with sedative neuroleptics.

The disorder does not develop in all people exposed to 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 states in victims

Mental disorders in the structure of reactive states in victims are represented mainly 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) Research Psychoneurological Institute named after. V.M. Bekhtereva, 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 disorder in response to exceptional physical and psychological stress and that usually resolves within hours or days. Stress may be a severe traumatic experience, including a threat to the safety or physical integrity of the individual or loved one (eg, natural disaster, accident, battle, criminal behavior, rape) or an unusually abrupt and threatening change in the social status and/or environment of the sufferer, e.g. the loss of many loved ones or a fire in the house.

1. ^ 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 persons who have not had 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 persons without a pre-existing mental disorder.... ... Encyclopedic Dictionary of Psychology and Pedagogy

F43.0 Acute reaction to stress- A transient disorder of significant severity that develops in individuals without apparent mental disorder in response to exceptional physical and psychological stress and that usually resolves within hours or days. Stress can be... Classification of mental disorders ICD-10. Clinical descriptions and diagnostic guidelines. Research diagnostic criteria

The reaction to stress is acute- a transient disorder of significant severity that develops in persons initially without visible mental impairment in response to exceptional physical and psychological stress and which usually resolves within hours or days.... ... Dictionary of emergency situations

The reaction to stress is acute- Thus, according to ICD 10 (F43.0.), clinical manifestations of a neurotic reaction are designated if the characteristic symptoms persist for a short period - from several hours to 3 days. In this case, stupefaction and some narrowing of the field are possible... ... Encyclopedic Dictionary of Psychology and Pedagogy

stress- A human condition characterized by nonspecific defensive reactions (at the physical, psychological and behavioral level) in response to extreme pathogenic stimuli (see Adaptation syndrome). Mental reaction to... ... Great psychological encyclopedia

STRESS- (English stress tension) a state of tension 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 general... ... Russian Encyclopedia of Occupational Safety and Health

“F43” Reaction to severe stress and adaptation 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 ... ... Classification of mental disorders ICD-10. Clinical descriptions and diagnostic guidelines. Research diagnostic criteria

Catastrophic stress reaction- See synonym: Acute reaction to stress. Brief explanatory psychological and psychiatric dictionary. Ed. igisheva. 2008 ... Great psychological encyclopedia

Affective shock reaction- acute reactive (i.e. psychogenic) psychosis, most often occurring with short-term stupefaction. Synonyms: Acute reaction to stress, Acute reactive psychosis ... Encyclopedic Dictionary of Psychology and Pedagogy

An acute reaction to stress is a mentally unhealthy state of a person. It lasts from several hours to 3 days. The patient is stunned, unable to fully comprehend the situation, the stressful event is partially recorded in memory, often in the form of fragments. This is due to caused by . Symptoms usually last no more than 3 days.

One of the reactions is. This syndrome develops solely due to situations that threaten a person’s life. Signs of such a state include lethargy, alienation, and recurring horrors that pop up in the mind. pictures of the incident.

Patients often have thoughts of suicide. If the disorder is not too severe, it gradually goes away. There is also a chronic form that lasts for years. PTSD is also called combat fatigue. This syndrome was observed among war participants. After the Afghan war, many soldiers suffered from this disorder.

Disorder of adaptive reactions occurs due to stressful events in a person’s life. This could 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. The person cannot continue to live a normal daily life. Insurmountable difficulties arise associated with social activities; there is no desire or motivation to make 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 or make any decisions.

Varieties of flow

Caused by sad, difficult experiences, tragedies or sudden changes in life situations, adaptation disorder can have a different course and character. Depending on the characteristics of the disease, adaptation disorders are distinguished with:

Typical clinical picture

Typically, the disorder and its symptoms disappear after 6 months of the stressful event. If the stressor is of a long-term nature, then the period is much longer than six months.

The syndrome interferes with normal, healthy life activities. Its symptoms not only depress a person mentally, but also affect the entire body and disrupt the functioning 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;
• impaired perception of events;
• abnormal, unusual behavior;
• chest pain;
• cardiopalmus;
• difficulty breathing;
• fear;
• dyspnea;
• suffocation;
• severe muscle tension;
• restlessness;
• increased consumption of tobacco and alcoholic beverages.

The presence of these symptoms indicates a disorder of adaptive reactions.

If symptoms persist for a long time, more than six months, steps should definitely be taken to eliminate the disorder.

Establishing diagnosis

Diagnosis of disorder of adaptive reactions is made only in a clinical setting; to determine the disease, the nature of the crisis conditions that led the patient to a dejected state is taken into account.

It is important to determine the strength of 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 and refer the patient to a specialist for treatment.

Concomitant, similar diseases

There are many diseases included in one large group. They are all characterized by the same characteristics. They can be distinguished by just one specific symptom or the strength of its manifestation. The following reactions are similar:

• short-term depression;
• prolonged depression;

Diseases vary in degree of complexity, nature of course and duration. Often one thing leads to another. If treatment measures are not taken in time, the disease can take a complex form and become chronic.

Treatment approach

Treatment of disorder of adaptive reactions is carried out in stages. An integrated approach prevails. Depending on the degree manifestations of one or another 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. The patient's ability to regulate negative thoughts increases. A strategy is created for the patient’s behavior in a stressful situation.

The prescription of drugs is determined by the duration of the disease and the degree of anxiety. Drug therapy lasts on average from two to four months.

Among the medications that must be prescribed:

The withdrawal of drugs occurs gradually, according to the behavior and well-being of the patient.

Sedative herbal infusions are used for treatment. They perform a sedative function.

Herbal collection number 2 helps well to get rid of the symptoms of the disease. It contains valerian, motherwort, mint, hops and licorice. Drink the infusion 2 times a day, 1/3 of a glass. Treatment lasts 4 weeks. Collection receptions number 2 and 3 are often prescribed at the same time.

Comprehensive treatment and frequent visits to a psychotherapist will ensure a return to a normal, familiar life.

What could be the consequences?

Most people suffering from adjustment disorder recover completely without any complications. This group is middle aged.

Children, adolescents and the elderly are susceptible to 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 character of the individual and his willpower.