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Adjustment disorder

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Adjustment disorders are commonly seen in primary care settings in which the 1-year prevalence varies from 11% to 18% of those with any clinical psychiatric disorder. [Casey PR et al., 1984] 

A recent study [Maercker A et al., 2012] in the general population found the prevalence of adjustment disorder to be 0.9%,

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Adjustment disorder

  1. 1. Mrs. AMRITA ROY M.SC PSYCHIATRIC NURSING NIMHANS,BANGALORE
  2. 2. Adjustment disorders are commonly seen in primary care settings in which the 1-year prevalence varies from 11% to 18% of those with any clinical psychiatric disorder. [Casey PR et al., 1984] A recent study [Maercker A et al., 2012] in the general population found the prevalence of adjustment disorder to be 0.9%,
  3. 3. The cause is a life stressor. • child witnessing parents with chronic illnesses, chemotherapy, financial difficulties • In adolescents, common stressors include school problems, family or parents' marital problems, or traumatic event. • Adults frequently develop adjustment disorders to stressors related to marital discord, finances, work, or some sexuality issues.
  4. 4. depressed mood, anxiety, worry (or a mixture of these), a feeling of inability to cope, plan ahead, or continue in the present situation, and some degree of disability in the performance of daily routine. dramatic behaviour or outbursts of violence may be an associated feature, particularly in adolescents
  5. 5. Identification of specific stressors causing impairment Assessment of current symptoms- Risk factors such as suicidal or homicidal ideation Social support Mental status examination
  6. 6.  Psychosocial history, including premorbid functioning  Previous treatment history  Substance use - Use of a standardized assessment such as CAGE or AUDIT is recommended  Patient’s strengths and coping abilities
  7. 7. Diagnosis depends on a careful evaluation of the relationship between:  (a) form, content, and severity of symptoms;  (b) previous history and personality; and  (c) stressful event, situation, or life crisis. The onset is usually within 1 month of the occurrence of the stressful event or life change, and the duration of symptoms does not usually exceed 6 months, except in the case of prolonged depressive reaction (F43.21).
  8. 8.  F43.20 BRIEF DEPRESSIVE REACTION A transient, mild depressive state of duration not exceeding 1 month.  F43.21 PROLONGED DEPRESSIVE REACTION A mild depressive state occurring in response to a prolonged exposure to a stressful situation but of duration not exceeding 2 years.  F43.22 MIXED ANXIETY AND DEPRESSIVE REACTION Both anxiety and depressive symptoms are prominent, but at levels no greater than specified in mixed anxiety and depressive disorder (F41.2) or other mixed anxiety disorder (F41.3).
  9. 9.  F43.23 WITH PREDOMINANT DISTURBANCE OF OTHER EMOTIONS The symptoms are usually of several types of emotion, such as anxiety, depression, worry, tensions, and anger. Symptoms of anxiety and depression may fulfill the criteria for mixed anxiety and depressive disorder (F41.2) or other mixed anxiety disorder (F41.3), but they are not so predominant that other more specific depressive or anxiety disorders can be diagnosed. This category should also be used for reactions in children in which regressive behaviour such as bed- wetting or thumb-sucking are also present.
  10. 10.  F43.24 WITH PREDOMINANT DISTURBANCE OF CONDUCT The main disturbance is one involving conduct, e.g. an adolescent grief reaction resulting in aggressive or dissocial behaviour.  F43.25 WITH MIXED DISTURBANCE OF EMOTIONS AND CONDUCT Both emotional symptoms and disturbance of conduct are prominent features.
  11. 11. personality disorder substance use disorder
  12. 12. Major depressive disorder Personality disorder Mixed anxiety depression Acute stress reaction Post traumatic stress disorder Bereavement Normal non-pathological reaction to stress
  13. 13. Treatment should include: Improving the individual’s coping and problem‐solving skills Identifying and enacting social supports Teaching methods of stress reduction
  14. 14. Psychotherapy • within a supportive, non-judgmental environment • Solution focused • Coping mechanisms • Relaxation techniques Group therapy Family therapy Medications – comorbid psychiatric conditions
  15. 15. o Patient’s subjective experience of the treatment sessions o Possibility of an underlying Axis II condition or other Axis I conditions o Need for psychosocial interventions (e.g.., support groups) o Reassessment of possible co‐occurring conditions (e.g., medical conditions, substance abuse) o Possible need for medication evaluation o “Goodness of fit” between the therapist’s style and interventions with the patient’s expectations, and consideration of a change in approach or referral to different provider when appropriate.
  16. 16.  After 5-year follow-up of 100 patients, 71% adults and 44% adolescents with adjustment disorder were well.  The adult group developed major depressive disorder and alcohol abuse while adolescents developed a wider range psychiatric disorder like schizophrenia, bipolar disorder, antisocial personality disorder, drug abuse, and major depressive disorder.  The predictors of poor outcome were chronicity and behavioral disturbances.  The risk of suicide in adjustment disorder was found to be 4%, mostly along with presence of alcohol abuse. (Andreasen NC, Hoenk PR, 1982).
  17. 17. S. D. Manoranjitham, A. P. Rajkumar, P. Thangadurai, J. Prasad, R. Jayakaran, K. S. Jacob The British Journal of Psychiatry Dec 2009, 196 (1) 26-30; DOI: 10.1192/bjp.bp.108.063347
  18. 18.  Results Thirty-seven (37%) of those who died by suicide had a DSM–III–R psychiatric diagnosis. Alcohol dependence (16%) and adjustment disorders (15%) were the most common categories. The prevalence rates for schizophrenia, major depressive episode and dysthymia were 2% each. Ongoing stress and chronic pain heightened the risk of suicide. Living alone and a break in a steady relationship within the past year were also significantly associated with suicide.
  19. 19. THANK YOU

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