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Adjustment disorders
Abstract
Adjustment disorder (AD) is a common condition, with a prevalence of between 12% and 23% in psychiatric outpatient and liaison psychiatry settings. It is usually characterized by mild depressive symptoms, anxiety symptoms, traumatic stress symptoms or a combination of these. AD is often self-limiting but between 20% and 50% of AD sufferers are diagnosed with a more serious psychiatric disorder within 5 years of their original diagnosis. There is limited evidence regarding how best to manage AD. Watchful waiting will often be appropriate. More active management should be informed by the evidence base for other conditions that present with similar symptoms.
... stress response. 13 In a longitudinal study conducted over 5 years, AD, particularly among children and adolescents, was identified as a strong predictor of future major disorders. 14 Furthermore, another follow-up study reported a 3.4-fold higher risk of developing a major disorder in individuals diagnosed with AD compared to the control group. ...
... 11,22 AD is a frequently used diagnosis in consultation-liaison psychiatry, 20 and it significantly diminishes the quality of life. 13 Moreover, it has been associated with elevated mortality and morbidity rates. 16 However, despite its impact, AD remains one of the least researched mental disorders in the literature. ...
Background
Adjustment disorder (AD) in individuals suffering from end‐stage organ failure can negatively impact treatment adherence and overall quality of life. Previous research focusing on adults has suggested that AD might serve as a precursor to major mental disorders. However, although it is frequently used as a diagnosis in consultation‐liaison psychiatry, our understanding of AD in pediatric transplant candidates remains limited. Therefore, the objective of this study is to assess AD and identify its associated risk factors among children who are candidates for heart, kidney, and liver transplantation.
Methods
Data were collected retrospectively from a cohort of 155 children, aged between 6 months and 18 years (mean age 9.4), who had undergone consultations for child and adolescent psychiatry at a hospital with a transplant center within the past 10 years.
Results
The predominant diagnosis among children assessed during the pre‐transplant period was AD (20%), with the subtype “with depressed mood” being the most commonly observed (35.5%). Organ type and length of hospital stay were identified as significant independent predictors of AD. Being a heart transplant candidate was determined as the strongest predictor of AD among children who underwent consultations with child and adolescent psychiatry within the population of transplant candidates.
Conclusions
The study found that AD was the most common diagnosis among transplant candidates who underwent psychiatric consultations. Additionally, the study identified the length of hospital stay and the type of organ needed as independent predictors of AD. Screening for AD by considering risk factors may provide an opportunity for early intervention before the occurrence of major mental disorders in transplant candidates.
... Stress has been persistently presented for more than 1 year among over one third of patients with AD [9]. Persistent stress might have an adverse effect on neuroendocrine function in patients with AD. ...
... Adjustment disorder is consistently associated with suicidal behavior [9]. In our study, a substantial proportion of suicidal ideation measured by a single item on the BDI-II, "thought about suicide," was observed in both the BMS and control groups at the baseline condition (47.1% for the BMS group; 64.9% for the control group). ...
... Identified risk factors for AjD include young age (15-25 years old), low levels of education, being single, and living in urban areas (Yaseen, 2017). In addition, between 20 and 50% of AjD sufferers are diagnosed with a more serious psychiatric disorder within the following 5 years after diagnosis (Bisson & Sakhuja, 2006), which justifies the need to delve into the characterization of the disorder and find effective interventions. ...
Objectives: Adjustment disorders (AjD) are common in clinical practice, but research on treatment alternatives is scarce, as it is on the impact of common comorbid symptoms such as pain. The present study explored the effect of mindfulness-based cognitive therapy (MBCT) on a sample of AjD outpatients and analyzed the role of pain in treatment response. Methods: Quantitative data were obtained from 278 individuals diagnosed with AjD who participated in an MBCT program. The sample was divided into two subgroups: “pain” vs. “no pain.” Depressive symptomatology was the main outcome. Paired t-tests were used to analyze the effect of the intervention. A repeated measures ANOVA was performed to compare the impact between the two subgroups. The predictive role of pain, among other variables, on treatment response was analyzed through linear regression.
Results: A significant decrease in depressive symptomatology was observed posttreatment (t = 9.27, p < .001; Cohen’s d = 0.44). Although both subgroups improved after MBCT, the “pain” subgroup presented a significantly smaller change (F = 5.85, p = .016). Pain was a significant predictor of treatment response (B = − 3.15, t = − 2.89, p = .004). Conclusions: Our results support the effectiveness of MBCT for treating adult outpatients with AjD. The presence of comorbid pain seems to minimize treatment response, which could in turn hinder recovery.
... 3 Adjustment disorder is usually triggered by other stressful life events (i.e., an identifiable and stressful life change, such as divorce and job loss), 1 demonstrating overlapping symptoms and physiological dysfunction with PTSD and acute stress reaction. 4,5 Growing evidence suggests that individuals with stress-related disorders have elevated risks of psychiatric comorbidities, 2 less healthy lifestyles (e.g., smoking, 6 poor diet, 7 and lack of physical activity), 6,8 and multiple somatic diseases (e.g., cardiovascular disease, 9 life-threatening infection, 10 autoimmune disease, 11 and neurodegenerative disease). 12 Although all these adverse health conditions have been shown to be associated with premature death, 13−15 whether there is excess mortality associated with stressrelated disorders remains less explored. ...
Background
Prior research provides suggestive evidence on an association between stress-related disorders and mortality. No previous study has however addressed the role of familial confounding on such association.
Methods
We conducted a nationwide cohort study of 189,757 individuals with a first-onset stress-related disorder between January 1, 1981 and December 31, 2016 in Sweden (i.e., exposed patients), 1,896,352 matched unexposed individuals, and 207,479 unaffected full siblings of the exposed patients. Cox proportional hazards models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) of all-cause and cause-specific mortality.
Findings
During a mean follow-up of 9.42 years, an elevated risk of all-cause mortality was observed during the entire follow-up among patients with stress-related disorders, compared with either unexposed individuals or their unaffected full siblings. Such excess risk was most pronounced within the first year after diagnosis of stress-related disorders (HR, 3.19 [95% CI, 2.87-3.54] in population-based comparison; HR, 3.21 [95% CI, 2.56-4.02] in sibling-based comparison). The excess risk decreased but remained statistically significant thereafter (HR, 1.64 [95% CI, 1.60-1.67] in population-based comparison; HR, 1.61 [95% CI, 1.54-1.68] in sibling-based comparison). An increased risk was observed for almost all cause-specific mortality, with greater risk increase for deaths from unnatural causes, especially suicide, and potentially avoidable causes.
Interpretation
Stress-related disorders were associated with an increased risk of all-cause mortality and multiple cause-specific mortality, and the risk elevation was independent of familial confounding. The excess mortality attributable to unnatural causes and potentially avoidable causes highlights the importance of clinical surveillance of major health hazards among patients with stress-related disorders.
Funding
EU Horizon 2020 Research and Innovation Action Grant, 1.3.5 Project for Disciplines of Excellence at West China Hospital of Sichuan University, National Natural Science Foundation of China, Icelandic Research Fund (Grant of Excellence), ERC Consolidator Grant, and Swedish Research Council.
... Depressive, anxiety and adjustment disorders are the most prevalent conditions among mental health outpatients, with prevalence rates in the general population ranging between 3.6% and 4.4% (Lefstad, 2017;Stevens et al., 2016). These mental health problems often have a negative impact on the individual's functionality and health-related quality of life (Bandelow & Michaelis, 2015;Richards, 2011), and in some cases can induce the development of severe psychiatric conditions, such as suicidality (Bisson & Sakhuja, 2006;Casey et al., 2015). It is, therefore, essential that effective interventions to treat these conditions should become widely available (Harris et al., 2015). ...
Objectives: To study the effectiveness of attachment-based compassion therapy (ABCT) for reducing affective distress in a sample of outpatients with depressive, anxiety or adjustment disorders, and to explore its mechanisms of action.
Methods: This randomised controlled trial involved the assessment time points of pre-treatment, post-treatment and 6-month follow-up. A total of 90 patients from three mental health units in Castellón, Spain, were recruited and randomly assigned to ‘ABCT + treatment as usual (TAU)’, ‘Mindfulness-based stress reduction (MBSR) + TAU’ or ‘TAU’ alone. Affective distress, as measured by the ‘Depression, Anxiety and Stress Scales’ (DASS-21) was the main outcome; self-compassion and mindfulness were also assessed. Multilevel mixed-effects models were used to estimate the effectiveness of the programme, and path analyses were conducted to study the potential mechanistic role of mindfulness and self-compassion.
Results: ABCT was not superior to MBSR in any outcome or at any assessment point. ABCT was superior to TAU alone both post-treatment (B=-13.20; 95% CI: -19.57, -6.84) and at 6-month follow-up (B=-7.20; 95% CI: -13.63, -0.76) for reducing DASS-21, and MBSR was superior to TAU alone both post-treatment (B=-11.51; 95% CI: -17.97, -5.05) and at 6-month follow-up (B=-8.59; 95% CI -15.09, -2.10), with large effects (d≥0.90). Changes produced by ABCT in DASS-21 were mediated by self-compassion, whereas changes produced by MBSR were mediated by both mindfulness and self-compassion.
Conclusion: ABCT is effective for reducing affective distress in patients with anxiety, depressive and adjustment disorders, although its effect is not superior to that offered by MBSR. Self-compassion seems to be a significant mediator of the effects of ABCT.
... 71 Göçmen bir kadın, uyum sürecinde intihar gibi yüksek riskli davranışları da içeren ruhsal bozukluğun hakim olduğu bir döneme girebilmektedir. 70 Yeni bir ortama girme zorlu bir uyum süreci gerektirdiğinden, göç sürecinin stres artırıcı olduğu varsayılmaktadır. ...
... Though the phenomenon of academic adaptation has recently become the subject of close attention of researchers, it is currently being studied quite intensively. Its various aspects are considered in a number of works [11][12][13][14][15][16][17]. ...
Adaptation of students with chronic diseases to the university educational environment is an important challenge in keeping with the equal opportunity strategy. This process is fraught not only with difficulties, but also with those opportunities that can be created within the framework of the versatile social activity of students. The aim of the research is to study the correlation between academic adaptation and adherence to various forms of social activities in students with chronic diseases and those without health limitations. The study involved 419 full-time students. We used an original questionnaire aimed at identifying socio-demographic characteristics, a methodology for assessing the components of academic adaptation and a scale of commitment to various forms of social activities. Our research revealed differences in adherence to the forms of social activities. We identified multiple linkages between academic adaptation and Internet cognitive, educational and socio-political forms of activities among students with chronic diseases, as well as linkages between leisure, civic, educational, protest, radical protest and subcultural forms of activities among students without chronic diseases. We found specificity in predicting academic adaptation in students' commitment to certain forms of social activities. We offer recommendations for psychological and pedagogical support of academic adaptation to students with chronic diseases.
... 8 When the adaptation resources of the organism are overwhelmed, a mental disorder can prevail, with specific symptoms and associated behaviors, potentially including severe high-risk behaviors such as suicide. 9 As it requires constant adaptation to a new environment, the migration process is generally assumed to be a major chronic environmental stressor. ...
Objective:
There is growing evidence supporting the association between migration and posttraumatic stress disorder (PTSD). Considering the growing population of migrants and the particularities of providing culturally sensitive mental health care for these persons, clinicians should be kept up to date with the latest information regarding this topic. The objective of this study was to critically review the literature regarding migration, trauma and PTSD, and mental health services.
Methods:
The PubMed, SciELO, LILACS, and ISI Web of Science databases were searched for articles published in Portuguese, English, Spanish, or French, and indexed from inception to 2017. The following keywords were used: migration, mental health, mental health services, stress, posttraumatic stress disorder, and trauma.
Results:
Migration is associated with specific stressors, mainly related to the migratory experience and to the necessary process of acculturation occurring in adaptation to the host country. These major stressors have potential consequences in many areas, including mental health. The prevalence of PTSD among migrants is very high (47%), especially among refugees, who experience it at nearly twice the rate of migrant workers.
Conclusions:
Mental health professionals must be trained to recognize and provide appropriate care for posttraumatic and/or stress-related disorders among migrants.
... Its weaknessesnebulous definition and boundaries, and lack of clear markers -are also its strengths, facilitating quick and handy usage of the diagnosis (the "trash can" approach) and is less stigmatizing than many other psychiatric diagnoses. Whereas it is difficult to find specific guidelines for treatment of adjustment disorder (Bisson and Sakhuja 2006), its diagnosis gives psychiatrists the freedom to use whatever treatment methods work. Researchers in the field of crisis, on the other hand, were busy with 'what to do', rather than systematically studying the field. ...
This review aimed to compare two concepts in the psychiatric literature: crisis and adjustment disorder. The two concepts stem from different theoretical perspectives, rely upon different (though relatively loose) bodies of data, and may serve different purposes. The concept of crisis originated from an approach that could be considered psychodynamic, humanistic, and community oriented. Treatment, according to this approach, is known as crisis intervention and is characterized as being principally psychological, social, humanistic, and systemic. The generic approach to crisis calls for immediate aid rather than for a diagnosis and regular appointments, as is customary in psychiatric practice. The concept of adjustment disorder, on the other hand, is a rather medical nosological approach, which strives to achieve a phenomenological and objective description of the patient, and which may lead to ordinary psychiatric treatment, such as pharmacotherapy. Herein we present a review of literature on both approaches, with an emphasis on theoretical and empirical data. The findings appear to provide rather weak empirical support for both concepts. Some theoretical resolutions are proposed in an attempt to link the two concepts, such as a continuum of severity. We conclude that practitioners should decide for themselves, according to one's own theoretical framework and purpose of usage. Nonetheless, as formal psychiatric diagnosis demands more extensive scientific support and bears further implications (such as stigma), the current use of the diagnosis of adjustment disorder may seems less justified.
The present study investigated the effect of family values, and adjustment abilities of the students belonging to JFs and NFs on their academic achievement. Considering the independent, dependent, and intervening variables the study tried to investigate the level of adjustment abilities, value patterns, and their effect on the academic accomplishment of secondary school students. The objectives of the study were to compare the academic achievement, family value traits, and adjustment ability scores of the students belonging to nuclear and joint families, concerning their demographic characteristics. To determine the impact of family value patterns and adjustment abilities on the academic achievement of secondary school students belonging to nuclear and joint families. To find out the relationship between Family Value Patterns, Adjustment abilities, and Academic Achievement of secondary school students of Joint families & Nuclear families. Accordingly, the null hypotheses were tested on the stated research questions. 300 students as a sample of the study were selected through the purposive sampling method. Standardized tools were used for collecting the data for this research and various statistical application were applied to find out the effect of dependent, and intervening variables on independent variables. The results of the study reveal that the Mean academic achievement of the students is above 80%. But the Mean family value trait score and the Mean adjustment abilities score of the students were close to 70% and 63% respectively. Again the research found that the students belonging to both JFs and NFs are quite equal in their adjustment abilities score, but, the students of NFs had better family value traits compared to the students of JFs. The study revealed that there was a significant effect of family value patterns and adjustment abilities on the academic achievement of the students for both JFs and NFs since the p-value <0.05. It was also found that a correlation existed between family value patterns, adjustment capacities, and the academic accomplishment of students belonging to JFs and NFs. There was a negative correlation between adjustment abilities and the family value patterns of secondary school students belonging to JFs and NFs. The study concluded with many valuable recommendations for future researchers.
The article provides a generalized overview of the directions and forms of adaptation disorders to schooling. This subject is currently highly relevant due to the modern integration of the interests of psychology, pedagogy, physiology and medicine, and has modern practical orientation of scientific psychology in this area. A significant problem is the unification of the methodological approach to the identification of types of school maladjustment. On the basis of the results of leading research presented in modern foreign literature, an attempt is made to classify areas and forms of school maladjustment. The types of violations by the leading maladaptive factor, by the forms and duration of their manifestation are identified. This typology may be useful to scholars and practitioners of various directions in the methodological plan for the analysis of school maladjustment.
Background
Adults in rural areas have a higher prevalence of obesity and some mental health conditions. The degree to which mental health influences weight loss among rural residents remains unclear. This study evaluated changes in body weight, physical activity, diet, and program engagement outcomes in a cohort of participants with vs. without an affective disorder in a behavioral weight loss trial.
Methods
A sample of 1407 adults with obesity were recruited from rural U.S. primary care practices to participate in a weight loss trial. In this secondary analysis, participants were stratified by those with vs. without an affective disorder at baseline. Mixed models were used to estimate changes in outcomes over 24 months.
Results
One-third of participants (n = 468) had an affective disorder. After covariate adjustment, both groups experienced significant weight loss over 24 months, but weight loss was significantly less among those with an affective disorder at all follow-up times (all p's < 0.001; 24-month weight loss −2.7 ± 0.4 vs. -4.8 ± 0.3 kg). Compared to those without an affective disorder, participants with an affective disorder also had significantly less improvement in physical activity and fruit/vegetable consumption, lower attendance at weight loss sessions, and less engagement in setting weight loss goals and strategies.
Conclusion
Participants with an affective disorder lost less body weight and less improvement in lifestyle measures over 24 months. These trends paralleled reduced engagement in critical intervention activities such as weight loss session attendance. Future interventions should consider additional methods to minimize disengagement in adults with underlying affective disorders.
L'être humain doit s'adapter quotidiennement aux changements de son environnement et aux situations qui lui sont inconnues. Pour cela, il va développer des stratégies d'adaptation lui permettant d'éviter le stress et ses conséquences néfastes pour sa santé physique et mentale. Mais dans la société actuelle, les causes de stress sont fréquentes. Si ses stratégies d'adaptation au stress sont insuffisantes ou inefficaces, l'homme va développer un Trouble de l'Adaptation. Cette pathologie peut donc être retrouvée à tous les âges de la vie. Nous réalisons dans ce travail une revue bibliographique accompagnée de la présentation de quelques observations cliniques. Les différents aspects cliniques, biologiques, cognitifs et sociaux de ce diagnostic ainsi que ses modalités thérapeutiques y sont développés. D'autres travaux de recherche sur ce sujet semblent souhaitables pour mieux en définir les particularités et permettre d'énoncer des recommandations concernant les modalités thérapeutiques les plus adaptées à cette pathologie.
Schwere Unfälle, Naturkatastrophen oder gewalttätige Angriffe, aber auch schwere lebensbedrohliche körperliche Erkrankungen können bei den Betroffenen zu einer Traumatisierung führen und psychische Folgeschäden hervorrufen. Als direkte psychische Traumafolge werden die akute Belastungsreaktion, die posttraumatische Belastungsstörung (PTBS) und die Anpassungsstörung mit charakteristischen Symptomen wie Wiedererleben (z. B Flashbacks oder Alpträume), Vermeidung und Übererregung diagnostiziert. Besonders hohe Raten psychischer Traumatisierungen finden sich bei Soldaten nach Auslandseinsätzen, Kriegs- und Katastrophenopfern, Verkehrsunfällen, Rückenmarksverletzungen und Schädel-Hirn-Traumata. Derartige psychische Traumafolgen können die Lebensqualität stark beeinträchtigen und gehen mit strukturellen und funktionellen Veränderungen des Gehirns sowie neurochemischen und endokrinologischen Veränderungen einher. Zur Behandlung der PTBS und der Anpassungsstörung ist zumeist eine traumaspezifische Psychotherapie indiziert.
Objective:
To the best of our knowledge, the mental health status of physically injured Syrian refugees has not yet been investigated. The aim of this study was to examine the prevalence of psychiatric morbidity among physically injured Syrian refugees in Turkey receiving treatment at the main rehabilitation centre near the Syrian border.
Method:
This is a cross sectional study. Information was collected from consenting injured Syrian refugees at Dar-el-Shefa'a Hospital in Reyhanlı (Turkey) during a one week period in December 2012 and another one week period in August 2013. A clinical psychiatric interview was conducted to determine a diagnosis according to the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM) IV-TR.
Results:
A total of 40 refugees consented and completed a clinical psychiatric interview. All refugees in this study did not have a significant past psychiatric history. The most prevalent current diagnosis was major depressive disorder (22.5%), adjustment disorder (20%), and post-traumatic stress disorder (15%). Five (12.5%) patients had no evidence of a psychiatric disorder.
Conclusion:
The prevalence of psychiatric morbidity among injured Syrian refugees in our study was extremely high. This may help guide the treatment and management of this select population.
Limitations:
This study had a low number of participants. The method of assessment was not standardized with a validated tool.
Clinical implications:
This study may help guide the treatment and management of this select population, both in neighbouring countries and as resettled refugees in Western host countries.
Background and objective
This study aims at assessing the prevalence and risk factors of Adjustment disorder (AD), the AD subtypes, and the common causing stressors.
Patients and methods
A cross sectional study was conducted at outpatient psychiatric clinic in Duhok City from July 2008 to July 2009. 637 patients equal and above 18 of both genders were selected randomly. SCID-I/P (Version 2.0) was adopted to diagnose patients with AD. SPSS (version 21), was used for data analysis.
Results
The study showed that the prevalence of AD was 11.5%. It was more common among youngest age group (15–25 years) with a rate 69.9% (p = 0.001) while lowest educational level (illiterate and primary) 53.5% (p = 0.040), single 54.8% (p < 0.001), students 39.7 (p < 0.001) and from urban areas 71.2% (p = 0.012) with statistically significant association. Although AD was more common among females (61.6%), no significant association was found between AD and gender (p = 0.380). The most common subtype of AD was AD with mixed anxiety and depressed mood (34.2%) and was the commonest among females (19.2%) followed by AD with Anxiety subtype 30.1% which was the commonest among males (13.7%). The commonest psychosocial stressor was the illnesses (28.8%) followed by love affairs (26%) and domestic problems (16.4%).
Conclusions
The prevalence of AD was found to be high. The risk factors included young, low educational level, single, students, and those from urban areas. The most common subtype was AD with mixed anxiety and depressed mood and the commonest psychosocial stressor was the illnesses followed by love affairs and domestic problems.
Mental Health Care: An Introduction for Health Professionals in Australia, 2nd edition is the ideal resource for students who will be future health professionals working in allied health and medical environments in Australia. Set firmly within a wellness framework the text is also useful for health professionals, already working in a health-related field, who need information to support them to effectively assist people who experience mental health problems.
Drawing on the multidisciplinary expertise of Australia's pre-eminent academics and clinicians, the text offers a user-friendly, jargon-free blend of theory and practice that will enable students to think carefully about the issues involved in mental health care and empower them to develop strategies for working effectively with people across the lifespan and from diverse cultures. Building on the success of the first edition, Mental Health Care: An Introduction for Health Professionals, 2nd edition has been bolstered with an increased focus on coverage of child and adolescent mental health issues.
To examine the individual contributions of insecure attachment styles and depression symptom severity to health-related quality of life (HRQoL) in patients diagnosed with adjustment disorder (AJD) with depressed mood.
Participants were 67 patients diagnosed with International Classification of Diseases, Tenth edition AJD with depressed mood, who completed standardised self-report questionnaires measuring study variables. Mean scores and SDs were computed for the outcome and predictor measures. Pearson correlations among the measures were computed. The study hypotheses were tested using analysis of variance (ANOVA) and multiple regression analyses. All analyses were performed using the SPSS-17 software package (SPSS Inc., Chicago, IL, United States).
ANOVA showed a significant main effect of the insecure attachment styles on depression symptom severity and life satisfaction scores. The results suggest that depressive symptoms were more severe (F = 4.13, df = 2.67, P < 0.05) and life satisfaction was poorer (F = 5.69, df = 2.67, P < 0.01) in both anxious-ambivalently and avoidantly attached patients compared with their securely attached counterparts, whereas the two insecure groups did not significantly differ by these variables. The anxious/ambivalent attachment style and depression symptom severity significantly contributed to HRQoL, accounting for 21.4% and 29.7% of the total variance, respectively [R(2) = 0.79; Adjusted R(2) = 0.77; F (5, 67) = 33.68, P < 0.0001], even after controlling for gender, marital and employment status confounders.
The results show that the anxious/ambivalent attachment style together with depression symptom severity substantially and independently predict the HRQoL outcome in AJD with depressed mood.
In ieders leven doen zich stressvolle gebeurtenissen voor, zoals gezondheidsproblemen, overlijden van dierbaren, scheiding
of betrokken raken bij conflicten. In een groep van 161 mensen bleken 96 personen over een tijdsduur van anderhalf jaar ernstige
levensgebeurtenissen te hebben meegemaakt (Sanderman, 1988). Door stressvolle gebeurtenissen kunnen mensen klachten ontwikkelen
van uiteenlopende aard. Of zich klachten voordoen na zo’n gebeurtenis is vooral afhankelijk van de wijze waarop mensen met
de stress omgaan en minder van de aard van de stressor. Wel is het zo dat de ernst van de gebeurtenis(sen) in het algemeen en een opeenstapeling van stressoren meestal tot meer klachten zullen leiden. Zo vond Sanderman (1988) in de genoemde groep van 161 personen, dat
onder de mensen die psychische klachten ontwikkelden, veel personen (76%) een ernstige levensgebeurtenis hadden meegemaakt.
Daarentegen maakten ook veel mensen een ernstige gebeurtenis mee zonder klachten te ontwikkelen (56%). Kortom, andere factoren
dragen bij tot het verklaren van psychisch disfunctioneren door stress. Bekende begrippen in dat verband zijn: coping (het
omgaan met stress), persoonlijke weerbaarheid en sociale ondersteuning. Veel stresssituaties kunnen leiden tot een kortdurende
verstoring van lichamelijk en/of psychisch functioneren. Indien deze verstoring uitstijgt boven wat verwacht kan worden in
intensiteit en duur van de klachten, spreken we van een aanpassingsstoornis.
Es existieren kaum evidenzbasierte und evaluierte Ansätze zur Psychotherapie der Anpassungsstörung. Allgemeine therapeutische
Hinweise auf Krisenintervention sind unzureichend und berücksichtigen nur ungenügend die ätiologischen Modelle der Anpassungsstörung.
Das Therapieprogramm für Anpassungsstörungen (TAPS) ist ein kognitiv-behavioraler Ansatz zur Einzel- und Gruppentherapie von
Patienten mit Anpassungsstörungen. Ziele, therapeutische Prinzipien und therapeutische Elemente des Ansatzes werden beschrieben.
Effekte einer evaluativen Studie werden vorgestellt und allgemeine Therapiehinweise formuliert.
There is a lack of evaluated and evidence-based approaches for the psychotherapy of adjustment disorder. General therapeutic
advice about crisis intervention are insufficient and take into consideration only insufficiently the etiologic models of
adjustment disorder. The therapy program for adjustment disorder (TAPS) is a cognitive-behavior therapy approach for individuals
and groups of patients with adjustment disorders. Goals, therapeutic principles and therapeutic elements of the approach are
described. The effects of an evaluative study are described and, in general terms, principles for psychotherapy are formulated.
One of the commonest psychological problems that a clinician would encounter in primary care is depression. Theprevalence of depression is high in women, the elderly and those with underlying physical problems or during the postpartumperiod. The spectrum of clinical presentations is wide and somatic complaints are more common in primary care clinics.Depression may present as a primary disorder and co-morbidity with other psychological problems or physical illnessesis high. A good clinical interview is an important form of assessment and a quick screening of depression can be donewith the administration of proper rating scales, such as the Patient Health Questionnaire, Hamilton Depression RatingScale or Geriatric Depression Scale. Repeated use of the same scale in a patient would help the clinician to monitor theprogress objectively.
Despite the relative frequency with which the diagnosis of adjustment disorder is made, there is a very limited research literature in regard to its cause, epidemiology and treatment. This review summarizes recent papers and findings in relation to this diagnostic category.
The conceptual underpinnings of the diagnosis adjustment disorder is the subject of ongoing debate as is its differentiation from other psychiatric disorders such as depressive disorders. One group has proposed and tested a diagnostic model of adjustment disorder as a stress-response syndrome, related to posttraumatic stress disorder, which is a distinct psychopathological entity rather than a diagnosis of exclusion. Initial neuroimaging work in adjustment disorder indicates that this may be a helpful approach for increasing understanding of the biology of the disorder. Recent studies support the use of brief psychotherapy in the treatment of adjustment disorder.
Although the studies and articles described in this review raise some interesting questions in relation to the diagnosis, cause, epidemiology and treatment of adjustment disorder, much more research is needed before we can draw some firm conclusions about the need for the redefinition and reclassification of this diagnostic category.
Although the psychiatric consultant in the general hospital setting is frequently called on to distinguish major depression from adjustment disorder, no studies to date have examined whether the two diagnoses are in fact distinguishable. Analysis of computerized data base records from 944 cases seen by psychiatric consultants from 1981-1987 revealed 59 cases of major depression and 130 cases of adjustment disorder with depressed mood. Patients with major depression were more likely to be older (p less than 0.001), widowed (p less than 0.001), and living alone (p less than 0.005). Patients with adjustment disorder with depressed mood received higher ratings on Axis IV (p less than 0.01), and lower severity of illness ratings (p less than 0.001) were seen later in the hospital stay (p less than 0.05), and they were more likely to be rated by the consultant as improved by the time the case was terminated (p less than 0.001). The results suggest that the two disorders may be distinguished in the consultation population and that adjustment disorder with depressed mood may have descriptive validity in the medical inpatient setting.
This brief overview of our study confirms the previous impression that depression is the most common formal psychiatric disorder in primary care. Much of this depression is, by psychiatric specialty standards, mild in degree. However, a quarter — almost 5% of consulting patients in Hoeper's similar study — are found to be suffering from major depressive disorder, which places it amongst the most common conditions encountered by GPs. The implications of this vis à vis the current and future management of such patients are considerable.
A previous investigation explored the diagnosis of adjustment disorder and found it to have descriptive and face validity. This study of the status at 5-year follow-up of 100 patients given this diagnosis strongly supports the validity of the category among adults but only partially among adolescents. Seventy-nine percent of the adults were well at follow-up, with 8% having had an intervening problem. Comparable figures for the adolescents were 57% and 13%. Most adults who were ill developed either major depression or alcoholism. The adolescents' illnesses included schizophrenia, schizoaffective disorder, major depression, bipolar disorder, antisocial personality, alcoholism, and drug use disorder. Chronicity and behavioral symptoms were the strongest predictors of poor outcome.
The face and descriptive validity of the diagnosis of adjustment disorders is examined in a sample of 402 adolescents and adults who received a DSM-II diagnosis of "transient situational disturbance" over a four-year period. The study suggests that the redefinition of the disorder in DSM-II should have substantially better face and descriptive validity. This redefinition recognizes that both the stressors that precipitate the disorder and the disorder itself may often by quite chronic, and that the stressor need not be overwhelming. Among adolescents in this study, 59% of the stressors had been present for a year of more, while among the adults, 36% of the stressors had been present for a year or more. A classification that subtypes adjustment disorders in terms of predominant symptomatology appears to have potential clinical utility. In this study, adolescents tended to have many behavioral symptoms and adults many depressive symptoms.
This study examines the diagnosis of adjustment disorder in DSM-III-R. In view of the methodological problems associated with this, we investigated clinical characteristics of patients to whom the diagnosis had been applied. The patients in question were treated at the University Psychiatric Outpatient Clinic in Lausanne, Switzerland (N = 1,308). Four groups of comparisons are made: between adjustment disorder, other diagnoses, and no diagnosis; between adjustment disorder with depressed mood and other mood disorders; between adjustment disorder with anxious mood and anxiety disorders; and between the clinical subdivisions of adjustment disorder. This diagnosis is characterized by a high number of marital stressors, low age, predominance of women, and short period of treatment. The clinical profile is marked by a predominance of depressive and mixed types, and the relationship between these is demonstrated. Finally, the course of a certain proportion of these disorders goes beyond the 6-month period stipulated by DSM-III-R. This result justifies the modifications introduced in DSM-IV.
The consultation-liaison (C-L) psychiatry services of seven university teaching hospitals in the United States, Canada, and Australia (the MICRO-CARES Consortium) used a common clinical database to examine 1039 consecutive referrals. A diagnosis of adjustment disorder (AD) was made in 125 patients (12.0%); as the sole diagnosis, in 81 (7.8%); and comorbidly with other Axis I and II diagnoses in 44 (4.2%). It had been considered as a rule-out diagnosis in a further 110 (10.6%). AD with depressed mood, anxious mood, or mixed emotions were the commonest subcategories used. AD was diagnosed comorbidly most frequently with personality disorder and organic mental disorder. Sixty-seven patients (6.4%) were assigned a V code diagnosis only. Patients with AD were referred significantly more often for problems of anxiety, coping, and depression; had less past psychiatric illness; and were rated as functioning better--all consistent with the construct of AD as a maladaptation to a psychosocial stressor. Interventions were similar to those for other Axis I and II diagnoses, in particular, the prescription of antidepressants. Patients with AD required a similar amount of clinical time and resident supervision. It is concluded that AD is an important and time-consuming diagnostic category in C-L psychiatry practice.
Adjustment disorder is a diagnosis that is commonly used, particularly in primary care and general medical settings. However, there has been relatively little research done on this disorder. In this article, the author reviews the information that is available on the epidemiology, clinical features, validity, measurement, and treatment of adjustment disorder. She first reviews the historical development of the diagnosis from transient situational personality disorder in DSM-I to its current definition in DSM-IV. The author also considers similarities and differences in how adjustment disorder is defined in the DSM and ICD systems. The clinical features of the disorder that distinguish it from disorders such as major depressive disorder, generalized anxiety disorder, posttraumatic stress disorder, and acute stress disorder are described. The author highlights a number of the common controversies concerning adjustment disorder, especially criticisms that the diagnostic criteria are often poorly applied and that the disorder itself involves the medicalizing of problems of living. Evidence in support of the validity of the adjustment disorder diagnosis is reviewed and the author concludes that the findings support the content and predictive validity of the diagnosis. The author then discusses the epidemiology of adjustment disorders, their comorbidity with other conditions, including personality disorders, substance abuse, and suicidal behavior, and their treatment and outcome. The article concludes with a discussion of the special problems involved in evaluating for and measuring adjustment disorder.
Antidepressants are widely used by primary care physicians. Very little comparative data exists regarding the newer antidepressants in regards to efficacy in naturalistic primary care outpatient settings where the treatment of adjustment disorder and major depressive disorder is concerned. Our objective was to determine if there is a difference in antidepressant effectiveness between disorders in the newer antidepressants (SSRIs) in a primary care setting when a formal systematic depression treatment protocol is used.
A retrospective review of 63 major depression patients and 33 adjustment disorder patients in a primary care setting was undertaken. Patients had been prescribed mostly SSRIs. DSM-IV symptoms, PHQ-9 depression rating scale scores, and functional disability reports were systematically used to evaluate partial and full remission from patients' depressive states.
Neither depressed patients, nor adjustment disordered patients demonstrated a difference in clinical response to any particular antidepressant. The main statistical difference was in response rates, where patients diagnosed with adjustment disorder were twice as likely to respond to standard antidepressant treatment as depressed patients. This retrospective database design with moderate sample size limits the statistical power of this study.
Antidepressants are very effective in treating depression in the primary care setting and may even be an effective and efficient treatment for adjustment disorder with depressed mood.