Acute Stress Response Patterns

The search for effective treatment measures in acute trauma patients may be due to the lack of knowledge of psychological responses a trauma patient could have during and following an accident. A current study seeks to shed light on this subject.

Of 110 subjects studied, 77% were males and 50% were under the age of 30. The author's methods of assessment included a General Health Questionnaire, Injury Severity Score, and the Comprehensive Psychopathological Rating Scale. The CPRS included inquiries about bad thoughts, survivor guilt, vigilance, pessimistic thought, and disturbing dreams. During the interview with the trauma patients the researchers assessed the patients' reactions at five different time-points:

Period when the patient became aware of threat until the moment of injury.
The immediate response to injury.
Period between immediate reaction and admission to the hospital.
Period when patient was admitted to the surgical ward.
At the time of the current interview.

The authors looked for the focus of cognitive activities, their prominent emotions and behaviors, and personal appraisals at the 5 different time-points. The authors could identify an unique pattern of responses for each patient; they later concluded that due to these individual factors, intervention must be custom-tailored to the patient, and that, "one type of therapy to all victims would most likely fail".

After cross-examining all the patterns in 110 patients, the researchers established five major psychological response patterns prevalent in their sample:

The ordinary response pattern: the patient has no specific emotions, or moderate degree of worry and anxiousness.
The emotional response pattern: the patient has strong anxiety, or deeply depressed emotions.
The controlled fear response: the patient has appraised the accident as deadly or disabling, but possesses no strong emotions.
Derealization response pattern: the patient has experienced depersonalization at least once during the major time-points.
Denial-Elation response pattern: the patient does not appraise the accident as harmful (although it was serious) and did not report any specific emotions.

The authors then suggest methods of treatment for each type severe response pattern:

Type of Response Pattern	General Indicators	Suggested Clinical Care
Emotional	Patients are usually female	Psychological support, incorporating considerations of life factors before the accident/trauma
Controlled Fear	Patients are usually males, and tend to somatize the distress	Early intervention, which investigates the personal meaning of the trauma to assess the psychological impact.
Derealization	Patients are usually young individuals involved in frightening accidents; they have the highest percentage of psychopathy and bad childhood environments	Psychosocial interventions
Denial-Elation	Patients are generally not manic	Consider a diagnosis of severe head injury

Schnyder U, Malt UF. Acute stress response patterns to accidental injuries. Journal of Psychosomatic Research 1998;45(5):419-24.

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