A
acute stress disorder A dissociative state (men-
tal framework that creates emotional and psycho-
logic distance from the trauma) that occurs in
reaction to a traumatic event. Symptoms often
begin within hours of the event and may last for a
few hours to a few days. The person may speak
about the trauma in the third person as though it
happened to someone else, may act as though the
trauma did not occur, may be unable to remember
the event (dissociative amnesia), or may have an
apparent lack of emotional response regarding the
event. The person may appear dazed and “out of
it” or have acute and severe symptoms of DEPRES-
SIONor anxiety. Flashbacks and dreams in which
he or she relives the traumatic event are common.
Normal, everyday circumstances may also trigger
flashbacks.
Diagnosis is usually straightforward because the
connection between the traumatic event and the
symptoms is clear. Treatment may include sup-
portive therapy along with short-term ANTIANXIETY
MEDICATIONSor ANTIDEPRESSANT MEDICATIONS. Rarely,
the symptoms continue for as long as several
weeks, though psychiatrists are more likely to
diagnose continuing symptoms as POST-TRAUMATIC
STRESS DISORDER(PTSD).
See also BRIEF REACTIVE PSYCHOSIS; CHILD ABUSE;
DOMESTIC VIOLENCE; ELDER ABUSE; GENERAL ANXIETY
DISORDER(GAD); GRIEF; SEXUAL ASSAULT; STRESS AND
STRESS MANAGEMENT; VIOLENCE.
antianxiety medications Medications to relieve
symptoms of anxiety disorders. About 15 percent
of adults in the United States have anxiety disor-
ders for which they take antianxiety medications.
There are two types of antianxiety medications in
use today, the BENZODIAZEPINESand buspirone. As
well, many of the ANTIDEPRESSANT MEDICATIONS,
notably the selective serotonin reuptake inhibitors
(SSRIs), also successfully relieve the anxiety
symptoms.
The first medications to treat anxiety were bar-
biturates, which produce a fairly substantial level
of sedation, particularly at the onset of treatment.
Barbiturates, commonly called tranquilizers, are
also highly addictive and have significant risk for
death due to OVERDOSE. For these reasons doctors
no longer prescribe barbiturates to treat anxiety.
Meprobamate was the first medication developed
specifically to treat anxiety disorders. Though not
chemically a barbiturate, it has many of the same
actions and side effects. Doctors today occasionally
prescribe meprobamate to treat anxiety in people
who cannot take or do not respond to other
antianxiety medications or who have coexisting
psychotic disorders.
Doctors sometimes prescribe a beta blocker
medication, commonly propanolol, to relieve
episodic symptoms that arise specifically from per-
formance anxiety. Beta blockers inhibit the flow of
EPINEPHRINE, which prevents symptoms such as
rapid HEART RATE and increased sweating. Beta
blockers are not appropriate for other types of
anxiety, however, because they do not affect the
neurotransmitters primarily responsible for anxi-
ety symptoms.
BenzodiazepinesThe first generation of benzo-
diazepines, chlordiazepoxide (Librium) and
diazepam (Valium), came into use in the early
1960s and quickly replaced both barbiturates and
meprobamate in the treatment of anxiety disor-
ders. The benzodiazepines produce rapid relief
from symptoms, some of them within hours of the
first DOSE. This characteristic makes benzodi-
azepines useful for immediate or episodic relief of
anxiety symptoms. There are now nearly a dozen359