Peritraumatic and persistent panic attacks in acute stress disorder

IntroductionUp to 30% of women view their childbirth as traumatic. This experience can lead to acute stress disorder or post-traumatic stress disorder. The negative impact of maternal post-traumatic stress disorder following childbirth reaches beyond the mother, potentially affecting her child's development and the couple's relationship. Research on paternal post-traumatic stress disorder following childbirth is scarce. Acute stress disorder is suggested to be an important predictor of post-traumatic stress disorder in mothers, but little is known about paternal acute stress disorder following childbirth. Furthermore, there is limited information about the comparison or relation of acute stress disorder and post-traumatic stress disorder following childbirth between parents.Aim[1] To compare the prevalence rates and severity of acute stress disorder and post-traumatic stress disorder symptoms between parents following childbirth by taking anxiety and depression symptoms, as well as obstetric variables and previous traumatic events into account and [2] To determine if acute stress disorder is a predictor of post-traumatic stress disorder.MethodA prospective population-based design was used. N = 647 participants were recruited from future parents who attended appointments at the Obstetrics and Gynecology unit at a Swiss university hospital. Self-report questionnaires were used: Post-traumatic Diagnostic Scale in the third trimester of pregnancy (T1) and 1 month post-partum (T3), Acute Stress Disorder Scale at 1 week post-partum (T2), and Hospital Anxiety and Depression Scale at all time points. Obstetric and neonatal variables were retrieved from hospital records.ResultsAt T2, 8.9% of mothers and 4.4% of fathers presented symptoms of acute stress disorder. At T3, 20.7% of mothers and 7.2% of fathers had symptoms of post-traumatic stress disorder. Acute stress disorder was a predictor of post-partum post-traumatic stress disorder (Odds ratio: 8.6, IC 95% [1.85; 40.42]). Depression symptoms was a significant confounder in the prediction of post-traumatic stress disorder following childbirth, but not anxiety or previous perinatal loss.ConclusionLittle is known about parental differences in acute stress disorder and post-traumatic stress disorder symptoms following childbirth. Results indicate that both parents may suffer from acute stress disorder and post-traumatic stress disorder symptoms after childbirth and that acute stress disorder is a predictor of post-traumatic stress disorder after childbirth for both parents. Sensitization of maternity staff to these results may assist in earlier identification of and appropriate treatment for at-risk parents.

Background: The anxiety disorders specified in the fourth edition, text revision, of The Diagnostic and Statistical Manual (DSM-IV-TR) are identified universally in human societies, and also show substantial cultural particularities in prevalence and symptomatology. Possible explanations for the observed epidemiological variability include lack of measurement equivalence, true differences in prevalence, and limited validity or precision of diagnostic criteria. One central question is whether, through inadvertent “over-specification” of disorders, the post-DSM-III nosology has missed related but somewhat different presentations of the same disorder because they do not exactly fit specified criteria sets. This review canvases the mental health literature for evidence of cross-cultural limitations in DSM-IV-TR anxiety disorder criteria. Methods: Searches were conducted of the mental health literature, particularly since 1994, regarding cultural or race/ethnicity-related factors that might limit the universal...

Acute stress disorder permits early identification of trauma survivors who are at risk of developing chronic posttraumatic stress disorder (PTSD). This study aimed to prevent PTSD in people who developed acute stress disorder after a mild brain injury by early provision of cognitive behavior therapy. Twenty-four civilian trauma survivors with acute stress disorder were given five individually administered sessions of either cognitive behavior therapy or supportive counseling within 2 weeks of their trauma. Fewer patients receiving cognitive behavior therapy than supportive counseling met criteria for PTSD at a posttreatment evaluation (8% versus 58%, respectively). There were also fewer cases of PTSD at a 6-month follow-up evaluation among those receiving cognitive behavior therapy (17%) than among those receiving supportive counseling (58%). Patients in the cognitive behavior therapy condition displayed less reexperiencing and avoidance symptoms at the follow-up evaluation than patients receiving supportive counseling. These findings suggest that PTSD following mild brain injury can be effectively prevented with early provision of cognitive behavior therapy.

In attempting to explain the familial predisposition to panic disorder, most studies have focused on the heritability of physiologic characteristics (e.g., CO2 sensitivity). A heretofore unexplored possibility is that a psychological characteristic that predisposes to panic-anxiety sensitivity-might be inherited. In this study, the authors examined the heritability of anxiety sensitivity through use of a twin group. Scores on the Anxiety Sensitivity Index were examined in a group of 179 monozygotic and 158 dizygotic twin pairs. Biometrical model fitting was conducted through use of standard statistical methods. Broad heritability estimate of the Anxiety Sensitivity Index as a unifactorial construct was 45%. Additive genetic effects and unique environmental effects emerged as the primary influences on anxiety sensitivity. There was no evidence of genetic discontinuity between normal and extreme scores on the Anxiety Sensitivity Index. This study suggests that one psychological risk factor for the development of panic disorder-anxiety sensitivity-may have a heritable component. As such, anxiety sensitivity should be considered in future research on the heritability of panic disorder.

Background: The presence of mild traumatic brain injury (mTBI) increases post-traumatic stress disorder (PTSD) symptoms in the months following injury. However, factors that link mTBI and PTSD development are still unclear. Acute stress responses after trauma have been associated with PTSD development. mTBI may impair cognitive functions and increase anxiety immediately after trauma. Objective: This research aimed to test the possibility that mTBI increases acute stress symptoms rapidly, which in turn results in PTSD development in the subsequent months. Method: Fifty-nine patients were recruited from the emergency rooms of local hospitals. Post-mTBI, acute stress, and PTSD symptom severity were measured using the Rivermead Post-Concussion Symptoms Questionnaire (RPQ), Acute Stress Disorder Scale (ASDS), and PTSD Checklist for DSM-5 (PCL-5), respectively. Results: Moderated mediation analysis indicated that ASDS, at 2 weeks post-trauma, mediated the relationship between RPQ scores at 2 weeks and PCL-5 scores at 3 months post-trauma, only for patients who met mTBI diagnostic criteria. Conclusions: These findings present preliminary evidence suggesting that acute stress disorder symptoms may be one of the mechanisms involved in the development of PTSD among trauma survivors who have experienced mTBI, which provides a theoretical basis for early intervention of PTSD prevention after mTBI.

P01-292 - Impact of surgery on mental health of children and adolescents

The aim of the present study was to investigate the prevalence and symptoms of acute stress disorder (ASD) in the paediatric surgical children and adolescents injured during the Wenchuan earthquake in China. One hundred eighteen children and adolescent inpatients were surveyed by the ASD scale (ASDS) within 1 month of the earthquake. Using the validated ASDS score above cut‐off threshold levels, the incidence of ASD in this sample was 54.3 per cent. The morbidity of ASD were 56.1, 24.6 and 19.3 per cent in the child, in the early adolescent and in the middle adolescent, respectively. There was no significant difference among the three age groups about the severity of ASD symptom. The proportions of ASD positive were 44.0 per cent in boys and 63.6 per cent in girls that showed significant difference. The exposure risk factors were being buried in the earthquake, injury of parent, injury of relatives, amputation and operation. These results indicated that ASD was widely prevalent among the children and adolescents wounded in the earthquake, which needed an effective psychosocial intervention. Copyright © 2009 John Wiley & Sons, Ltd.

Anxiety sensitivity predicts depression severity in individuals with dissociative identity disorder

This article examines the ability of the panic attack–posttraumatic stress disorder (PTSD) model to predict how panic attacks are generated and how panic attacks worsen PTSD. The article does so by determining the validity of the panic attack–PTSD model in respect to one type of panic attack among traumatized Cambodian refugees: orthostatic panic (OP) attacks (i.e. panic attacks generated by moving from lying or sitting to standing). Among Cambodian refugees attending a psychiatric clinic, the authors conducted two studies to explore the validity of the panic attack–PTSD model as applied to OP patients (i.e. patients with at least one episode of OP in the previous month). In Study 1, the panic attack–PTSD model accurately indicated how OP is seemingly generated: among OP patients (N = 58), orthostasis‐associated flashbacks and catastrophic cognitions predicted OP severity beyond a measure of anxious–depressive distress (Symptom Checklist‐90‐R subscales), and OP severity significantly mediated the effect of anxious–depressive distress on Clinician‐Administered PTSD Scale severity. In Study 2, as predicted by the panic attack–PTSD model, OP had a mediational role in respect to the effect of treatment on PTSD severity: among Cambodian refugees with PTSD and comorbid OP who participated in a cognitive behavioural therapy study (N = 56), improvement in PTSD severity was partially mediated by improvement in OP severity.

This recent study assesses the correlation of incidence- and reaction-related variables to predict acute and posttraumatic stress disorder in rescue workers after the catastrophe of Kaprun (2000) in Austria, Europe. In a prospective longitudinal study, 250 emergency medical personnel, crisis intervention teams and police officers were assessed using the Acute Stress Disorder Scale (ASD), the Posttraumatic Stress Diagnostic Scale (PDS) and an incidence- and reaction-related questionnaire 6 weeks and 6 months after their mission. After 6 weeks, 7.3 % of the emergency medical personnel, 22.2 % of the crisis intervention team workers and 25.7 of police officers suffered from ADS. At 6 months after the disaster, 6.3 % of all rescue workers showed PTSD. The incidence-related predictors of PTSD assessed in the study were duration of the mission and early arrival at the site. Uncertainty about the help given was found to be a reaction-related predictor. This study provides further support for the usefulness of incidence- and reaction-related factors to predict acute and posttraumatic stress disorder in rescue workers. These results will aid in the development of special prevention strategies for rescue workers.

Anxiety sensitivity and panic attacks in a nonclinical population

The Acute Stress Disorder Scale (ASDS) is crucial for assessing acute stress disorder (ASD), especially in high-stress environments like Intensive Care Units (ICUs). Traditional methods struggle to interpret all 19 ASDS variables simultaneously. This study introduces a novel polar histogram visualization approach to enhance ASDS score analysis, focusing on elderly ICU caregivers. A polar histogram visualization for ASDS scores was developed using MATLAB. Data from healthy elderly controls (n=106) and elderly ICU caregivers (EC-ICU; n=309) were used to compare ASDS profiles. A subgroup of EC-ICU participants (n=109) received interventions on social support and positive coping strategies. Intervention effectiveness and stress dysregulation patterns were analyzed using this new technique and traditional statistical methods. The polar histogram effectively displayed all 19 ASDS variables simultaneously, revealing distinct patterns between healthy controls (mean ASDS score: 29.36) and EC-ICU participants (mean ASDS score: 62.61). This technique highlighted significant differences in stress profiles not apparent in conventional bar charts. Post-intervention, the EC-ICU subgroup showed a 5%-8% reduction across ten ASDS indicators related to avoidance, hyperarousal, and emotional distress. The most significant improvements were physical reactions to trauma reminders, hypervigilance, and sleep disturbances. This polar histogram approach offers comprehensive, intuitive visualization of ASDS scores, enhancing clinical interpretation and ASD assessment. Integrating multi-dimensional psychological indicators into a single visual framework enables a more precise analysis of stress states and intervention efficacy. The technique shows particular utility in identifying stress patterns in elderly ICU caregivers and evaluating targeted interventions. This innovative method has significant implications for developing personalized support strategies, improving ASD assessment, and advancing stress disorder research across clinical settings.

The Impact of Anxiety and Anxiety Sensitivity On Visual Perception; Differences Between Two Genders

The authors investigated acute stress disorder and later posttraumatic stress disorder (PTSD) in children and adolescents who had been involved in assaults or motor vehicle accidents. They interviewed 93 patients 10-16 years old who were seen in an emergency department for having been assaulted or involved in a motor vehicle accident within 4 weeks after the assault or accident to assess acute stress disorder. At 6 months, they reinterviewed 64 (68.8%) of the patients to assess PTSD. At initial interview, 18 (19.4%) of the 93 patients had acute stress disorder and 23 (24.7%) met all acute stress disorder criteria except dissociation. At 6 months, eight of the 64 patients (12.5%) had PTSD. Acute stress disorder and PTSD did not differ in prevalence between patients who had been assaulted and those who had been in accidents. Sensitivity and specificity statistics and regression modeling revealed that the diagnosis of acute stress disorder was a good predictor of later PTSD but that dissociation did not play a significant role. Acute stress disorder has merit as a predictor of later PTSD in children and adolescents, but dissociation has questionable utility.

Parental problem drinking and anxiety disorder symptoms in adult offspring: examining the mediating role of anxiety sensitivity components.