Adjustment disorders

Other

Clinicals - History

Fact Explanation
The onset of symptoms is within 3 months (DSM-IV) or 1 month (ICD-10) of exposure to the stressor Symptoms of low mood, sadness, worry, anxiety, insomnia, poor concentration, having their onset following a recent stressful. Above mentioned symptoms occurs following a event happened 1-3 months back. The event must be external and occur in close time proximity to the onset of symptoms. The longer the time period between the triggering event and the onset of symptoms, the less likely is the diagnosis to be adjustment disorder.,, The onset of symptoms is within 3 months (DSM-IV) or 1 month (ICD-10) of exposure to the stressor
Symptoms of low mood, sadness, worry, anxiety, insomnia, poor concentration, having their onset following a recent stressful. Above mentioned symptoms occurs following a event happened 1-3 months back. The event must be external and occur in close time proximity to the onset of symptoms. The longer the time period between the triggering event and the onset of symptoms, the less likely is the diagnosis to be adjustment disorder.,,
Symptoms must be clinically significant Above mentioned symptoms are distressing and in excess of what would be expected by exposure to the stressor and/or there is significant impairment in social or occupational functioning. ,, Symptoms must be clinically significant
Above mentioned symptoms are distressing and in excess of what would be expected by exposure to the stressor and/or there is significant impairment in social or occupational functioning. ,,
The symptoms are not due to another disorder such as depression, anxiety disorders, bipolar disorder, ADHD, autism spectrum disorders, anorexia nervosa, bulimia nervosa or schizophrenia. Symptoms must not meet the criteria for another disorder as depression, anxiety disorders, bipolar disorder, ADHD, autism spectrum disorders, anorexia nervosa, bulimia nervosa, and schizophrenia and must not be merely an exacerbation of a pre-existing depression, anxiety disorders, bipolar disorder, ADHD, autism spectrum disorders, anorexia nervosa, bulimia nervosa, and schizophrenia or personality disorders. ,, The symptoms are not due to another disorder such as depression, anxiety disorders, bipolar disorder, ADHD, autism spectrum disorders, anorexia nervosa, bulimia nervosa or schizophrenia.
Symptoms must not meet the criteria for another disorder as depression, anxiety disorders, bipolar disorder, ADHD, autism spectrum disorders, anorexia nervosa, bulimia nervosa, and schizophrenia and must not be merely an exacerbation of a pre-existing depression, anxiety disorders, bipolar disorder, ADHD, autism spectrum disorders, anorexia nervosa, bulimia nervosa, and schizophrenia or personality disorders. ,,
Symptoms resolve within 6 months once the stressor or its consequences are removed. The symptoms must resolve within 6 months of the termination of the stressor but may persist for a prolonged period (longer than 6 months) if they occur in response to a chronic stressor or to a stressor that has enduring consequences. ,, Symptoms resolve within 6 months once the stressor or its consequences are removed.
The symptoms must resolve within 6 months of the termination of the stressor but may persist for a prolonged period (longer than 6 months) if they occur in response to a chronic stressor or to a stressor that has enduring consequences. ,,

Clinicals - Examination

Fact Explanation
Mental state examination: Appearance and behaviour Patient may neglect self care and may appear unshaved, with out dressing properly. ,, Mental state examination: Appearance and behaviour
Patient may neglect self care and may appear unshaved, with out dressing properly. ,,
Mental state examination: Speech Most of time speech is normal. But some patients may have soft volume of speech and decrease rate of speech. ,, Mental state examination: Speech
Most of time speech is normal. But some patients may have soft volume of speech and decrease rate of speech. ,,
Mental state examination: Mood Patient is usually in low mood. ,, Mental state examination: Mood
Patient is usually in low mood. ,,
Mental state examination: Thoughts Normal ,, Mental state examination: Thoughts
Normal ,,
Mental state examination: Perception Normal ,, Mental state examination: Perception
Normal ,,
Mental state examination: Cognitive function Attention span may reduced. ,, Mental state examination: Cognitive function
Attention span may reduced. ,,
Mental state examination: Insight Normal ,, Mental state examination: Insight
Normal ,,

Management - Supportive

Fact Explanation
Ventilating emotions This can be achieved by talking to a relative, friend or to the doctor/ psychologist. This will help to identify the causative stressor and develop a coping mechanism., Ventilating emotions
This can be achieved by talking to a relative, friend or to the doctor/ psychologist. This will help to identify the causative stressor and develop a coping mechanism.,
Prevent retraumatisation Some patients do not like to talk about the experience, they should not be pressurized to talk about it as it can cause much distress to the patient. , Prevent retraumatisation
Some patients do not like to talk about the experience, they should not be pressurized to talk about it as it can cause much distress to the patient. ,
Enhancing coping stratergies This will encourage the patient to take care of themselves and take part in daily activity. Patients are encouraged to develop coping strategies as: seeking support - Asking for help, or finding emotional support from family members or friends, can be an effective way of maintaining emotional health during a stressful period.

Problem-solving counselling is an instrumental coping mechanism that aims to locate the source of the problem and determine solutions. This coping mechanism is often helpful in work situations.

Relaxation techniques such as engaging in relaxing activities, or practicing calming techniques, can help to manage stress and improve overall coping.

Physical recreation activities such as regular exercise, such as running, or team sports, is a good way to handle the stress of given situation. This may involve yoga, meditation, progressive muscle relaxation, among other techniques of relaxation.

Adjusting expectations and anticipating various outcomes to scenarios in life may assist in preparing for the stress associated with any given change or event.,
Enhancing coping stratergies
This will encourage the patient to take care of themselves and take part in daily activity. Patients are encouraged to develop coping strategies as: seeking support - Asking for help, or finding emotional support from family members or friends, can be an effective way of maintaining emotional health during a stressful period.

Problem-solving counselling is an instrumental coping mechanism that aims to locate the source of the problem and determine solutions. This coping mechanism is often helpful in work situations.

Relaxation techniques such as engaging in relaxing activities, or practicing calming techniques, can help to manage stress and improve overall coping.

Physical recreation activities such as regular exercise, such as running, or team sports, is a good way to handle the stress of given situation. This may involve yoga, meditation, progressive muscle relaxation, among other techniques of relaxation.

Adjusting expectations and anticipating various outcomes to scenarios in life may assist in preparing for the stress associated with any given change or event.,

Management - Specific

Fact Explanation
Cognitive Behavioral Therapy (CBT) Psychotherapy remains the treatment of choice for adjustment disorders. Goals of psychotherapy are: analysis of the stressors affecting and determine whether they can be eliminated or minimized. Clarification and interpretation of the meaning of the stressor for the patient,identification a means of reducing the stressor, and improvement of the patient’s coping skills. ,, Cognitive Behavioral Therapy (CBT)
Psychotherapy remains the treatment of choice for adjustment disorders. Goals of psychotherapy are: analysis of the stressors affecting and determine whether they can be eliminated or minimized. Clarification and interpretation of the meaning of the stressor for the patient,identification a means of reducing the stressor, and improvement of the patient’s coping skills. ,,
Pharmacological management: Antidepressants - Selective Serotonin Reuptake Inhibitors (SSRIs), Serotonin–Norepinephrine Reuptake Inhibitors (SNRIs), Tricyclic Antidepressants (TCAs) and Monoamine Oxidase Inhibitors (MAOIs) Used when depression is prolonged or psychotherapy is unsuccessful. They medications were effective because they enhanced serotonergic or noradrenergic mechanisms or both. Neither single antidepressant was found to be more effective than another agent in treating adjustment disorder, nor combining antidepressants improved symptom relief over monotherapy.,,, Pharmacological management: Antidepressants - Selective Serotonin Reuptake Inhibitors (SSRIs), Serotonin–Norepinephrine Reuptake Inhibitors (SNRIs), Tricyclic Antidepressants (TCAs) and Monoamine Oxidase Inhibitors (MAOIs)
Used when depression is prolonged or psychotherapy is unsuccessful. They medications were effective because they enhanced serotonergic or noradrenergic mechanisms or both. Neither single antidepressant was found to be more effective than another agent in treating adjustment disorder, nor combining antidepressants improved symptom relief over monotherapy.,,,
Pharmacological management: Anxiolytics (Benzodiazepines - Alprazolam, Lorazepam) Used when symptoms as anxiety or sleeping disturbances are prolonged or psychotherapy is unsuccessful. Action mechanisms include complex interaction with GABA-receptor.The binding sites are unevenly distributed in various brain areas and are associated with a GABA receptor and a chloride channel. Drug potentiate the increase in chloride ion conduction produced by GABA, thus enhancing this amino acid’s inhibitory effect. ,, Pharmacological management: Anxiolytics (Benzodiazepines - Alprazolam, Lorazepam)
Used when symptoms as anxiety or sleeping disturbances are prolonged or psychotherapy is unsuccessful. Action mechanisms include complex interaction with GABA-receptor.The binding sites are unevenly distributed in various brain areas and are associated with a GABA receptor and a chloride channel. Drug potentiate the increase in chloride ion conduction produced by GABA, thus enhancing this amino acid’s inhibitory effect. ,,

Concise, fact-based medical articles to refresh your knowledge

Access a wealth of content and skim through a smartly presented catalog of diseases and conditions.

  1. CARTA MG, BALESTRIERI M, MURRU A, HARDOY MC. Adjustment Disorder: epidemiology, diagnosis and treatment Clin Pract Epidemiol Ment Health [online] :15 [viewed 17 July 2014] Available from: doi:10.1186/1745-0179-5-15
  2. CASEY P, BAILEY S. Adjustment disorders: the state of the art World Psychiatry [online] 2011 Feb, 10(1):11-18 [viewed 16 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3048515
  3. CASEY P.. Adjustment disorders: Fault line in the psychiatric glossary. [online] 2001 December, 179(6):479-481 [viewed 16 July 2014] Available from: doi:10.1192/bjp.179.6.479
  4. CRESTANI FLORENCE, MARTIN JAMES R, MöHLER HANNS, RUDOLPH UWE. Mechanism of action of the hypnotic zolpidem . [online] 2000 December, 131(7):1251-1254 [viewed 16 July 2014] Available from: doi:10.1038/sj.bjp.0703717
  5. GRADUS JL, QIN P, LINCOLN AK, MILLER M, LAWLER E, LASH TL. The association between adjustment disorder diagnosed at psychiatric treatment facilities and completed suicide Clin Epidemiol [online] :23-28 [viewed 16 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2943177
  6. GRAY A M, SPENCER P S J, SEWELL R D E. The involvement of the opioidergic system in the antinociceptive mechanism of action of antidepressant compounds. [online] 1998 June, 124(4):669-674 [viewed 16 July 2014] Available from: doi:10.1038/sj.bjp.0701882
  7. SANSONE RA, SANSONE LA. Demoralization in Patients with Medical Illness Psychiatry (Edgmont) [online] , 7(8):42-45 [viewed 16 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2945856
  8. Semprini, F., Fava, G. A., & Sonino, N. (2010). The spectrum of adjustment disorders: too broad to be clinically helpful. CNS Spectr, 15(6), 382-388. [viewed 16 July 2014] Available from: http://www.cnsspectrums.com/aspx/articledetail.aspx?articleid=2661