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%,

1. Mrs. AMRITA ROY
M.SC PSYCHIATRIC NURSING
NIMHANS,BANGALORE

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. 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. 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. Identification of specific stressors causing
impairment
Assessment of current symptoms- Risk
factors such as suicidal or homicidal
ideation
Social support
Mental status examination

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. 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.  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.  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.  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. personality disorder
substance use disorder

12. Major depressive disorder
Personality disorder
Mixed anxiety depression
Acute stress reaction
Post traumatic stress disorder
Bereavement
Normal non-pathological reaction to stress

13. Treatment should include:
Improving the individual’s coping and
problem‐solving skills
Identifying and enacting social supports
Teaching methods of stress reduction

14. Psychotherapy
• within a supportive, non-judgmental environment
• Solution focused
• Coping mechanisms
• Relaxation techniques
Group therapy
Family therapy
Medications – comorbid psychiatric
conditions

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.  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. 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.  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. THANK YOU