Stress and Its Effects (Prehospital and Early Hospital Stages)
Problems of stress itself and the human response to an acute stress play an important role in the prehospital and early hospital stages of administering emergency medical care. This concerns both individual cases, and a large number of victims in emergency situations, various disasters, military actions, etc. Besides, this issue is of a current importance in administering the medical aid in emergencies in the structure of somatic pathology. An acute stress reaction and the reaction of the person to stress when exposed to isolated psychogenic factor and its combination with somatic one occupies a special place. Mentioned above implies a certain training of specialists of somatic profile or managing patients in conjunction with a psychiatrist, clinical psychologist or psychotherapist. The paper presents an analysis of the meanings used in the research and clinical practice terminology on stress problems. There was drawn a distinction between stress reaction itself to the impact of the stress factor in the structure of stress and psychosomatic reaction of the body to stress. It was shown that the response to stress takes a long period of time (in contrast to stress reaction) and has a significant influence on the course and treatment of somatic disorders after exposure of the stress factor. The paper presents the characteristics of the course of psychogenic and somatogenic stress. It is shown that an acute clinical course is peculiar only to somatogenic stress and it ends with recovery, adaptation of the organism to injury or with a death. Isolated psychogenic stress or such in the background of somatogenic one can acquire properties of chronic stress. The following factors can lead to the condition mentioned above: a) mental revival of experienced stress event; b) the features of the reaction of the person who has to endure stress. In the absence of adequate assistance and further treatment by appropriate specialists this can be accompanied by a further development of mental disorders (most often - posttraumatic stress disorder). A detailed analysis of the nosological types of the mental stress reactions has been carried out in terms of ICD-10. A clear distinction between the classes of the mental reaction was given. Particular attention is paid to the manifestations within the psychological reaction, which is often neglected in clinical practice. Neurotic level of violations has not specific signs, it differs little from generally accepted nosological forms, it is necessarily tied to the stress factor. As a rule, it has the nature of an asthenic, depressive, anxiety and depressive neuroses. Particular attention is paid to the acute stress response of psychotic rank, particularly the most common severe affective-shock response. This is important because of an inadequate perception of the reality by the victims; loss of ability to critical assessment of what is going on and, as a consequence, the lack of appropriate behavior; threats from victims to themselves and other people. Manifestations of the reactive psychosis are analyzed within the limits of psychotic rank. The paper presents an analysis of psychopharmacotherapy by the different classes of medications, indications for their use. There are given approximate treatment regimens for syndrome manifestations of acute stress reaction. There are shown tactical options for emergency medical and mental health care in disorders being analyzed, necessity of the further treatment. The necessity of careful attention to this disease is justifies, as in the absence of timely and adequate help it leads to the development of psychiatric disease and disability of victims. Data can be used in the training of paramedical personnel, doctors of emergency medical services, services involved in providing medical help to victims of emergencies, disasters, military operations, general practitioners in the treatment of emergency conditions.