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PubMedDate not supplied

Clinical relevance of adjustment disorder in DSM-III-4 and DSM-IV.

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.

Adjustment Disorders↗
PubMed1999

Outcome for adjustment disorder with depressed mood: comparison with other mood disorders.

BACKGROUND: A review of the research literature on the diagnostic category of adjustment disorder indicates that its construct validity has not been established. Nevertheless, the diagnosis is made frequently, with an estimated incidence of 5-21% in psychiatric consultation services for adults. METHODS: Retrospective data was used to evaluate the construct validity of the adjustment disorder diagnostic category. The data primarily consisted of SF-36 Health Status Survey responses by a large group of adult psychiatric outpatients before treatment and again six months after beginning treatment. Subjects were divided into five diagnostic groups, and MANOVA, MANCOVA and chi square were used to clarify relationships among diagnoses, sociodemographic data and SF-36 scores. RESULTS: Diagnostic categories were significantly different at baseline, but did not differ in terms of outcome at six-months follow-up. There was a significant gender difference at baseline and a significant difference in gender distribution across diagnostic categories. LIMITATIONS: Structured interviews were not used for initial diagnoses, nor is there an estimate of the reliability of diagnoses among the clinicians. The patient attrition rate for six-months follow-up data was about 50%. Finally, patients received individualized treatment, with some patients receiving both medication and psychotherapy. CONCLUSIONS: Female patients were significantly more likely to be diagnosed with major depression or dysthymia than with an adjustment disorder. Females were also more likely than males to score lower on the mental health related scales of the SF-36 at admission. Patients diagnosed with an adjustment disorder scored higher on all SF-36 scales than did the other diagnostic groups at baseline and again at follow-up. There was no significant difference among diagnostic groups with regard to treatment outcome, suggesting that the adjustment disorder group can benefit as much as the other groups from treatment.

Adjustment Disorders↗
PubMed1995

Adjustment disorder as an admission diagnosis.

OBJECTIVE: The authors' goal was to study subtyping, demographic variables, suicidality, diagnostic stability, and 2-year rehospitalization outcome for inpatients given the admission diagnosis of adjustment disorder at their institution. METHOD: They reviewed the charts of 54 adolescent and 102 adult inpatients given the diagnosis of adjustment disorder at admission and compared them with the charts of 156 matched comparison subjects given other admission diagnoses. RESULTS: Adolescents and adults with adjustment disorder had significantly shorter index hospitalizations and more presenting suicidality than the comparison subjects. Adults but not adolescents with adjustment disorder had significantly fewer psychiatric readmissions and fewer rehospitalization days 2 years after discharge than comparison subjects, and more adults with adjustment disorder had diagnoses of comorbid substance use disorder. Forty percent of the patients admitted with the diagnosis of adjustment disorder were discharged with different diagnoses. Only 18% of the inpatients with adjustment disorder who were rehospitalized were given that diagnosis at readmission. CONCLUSIONS: Adjustment disorder diagnoses were associated with suicidality, shorter lengths of stay, and, in adults, more substance use disorders and fewer rehospitalizations.

Adjustment Disorders↗
PubMed2004

Difficulties in screening for adjustment disorder, Part I: Use of existing screening instruments in cancer patients undergoing bone marrow transplantation.

OBJECTIVE: Although success rates for bone marrow transplantation (BMT) continue to improve, there is still a high level of morbidity and physical and emotional distress associated with BMT. To date, limited research has focused on the assessment of and screening for specific psychiatric disorders of patients facing BMT. This is especially true with regard to identifying adjustment disorder (AD), despite the fact that AD is the most prevalent psychiatric diagnosis in cancer patients. METHODS: A sample of 95 BMT patients were interviewed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th edition (SCID) and completed several commonly used self-report instruments to determine if these tools could be used to identify patients with adjustment disorder in need of further assessment and intervention. RESULTS: Of these patients, 34.7% were diagnosed with adjustment disorder, 11.6% with major depression, and 5.3% with generalized anxiety disorder. The instruments were not found to be predictive of AD. However, the results of a regression analysis showed that the Social Subscale of the Functional Assessment of Cancer Therapy-General (R2 delta = 0.04, F = 4.30, p < 0.05) was a significant predictor of adjustment disorder. SIGNIFICANCE OF RESULTS: We conclude that there is little efficacy in using existing scales for detecting adjustment disorders in cancer patients undergoing bone marrow transplantation, and that other tools for identifying patients with adjustment disorder who might benefit from counseling are needed.

Adjustment Disorders↗
PubMedDate not supplied

[Cross-sectional study of the prevalence of adjustment disorder with anxiety in general practice].

Although Adjustment Disorder (AD) is considered a marginal diagnostic category by many clinicians and researchers, all the rare studies undertaken in the last decades indicate that the prevalence of this disorder is high in psychiatric settings, but has never been investigated in general practice. The purpose of this study was to evaluate the current prevalence of Adjustment Disorders With Anxiety (ADWA) in primary care settings and to describe the characteristics of the population, nature of the stressors and management of the disorder by General Practitioners (GPs). This French study involved 78 random liberal GPs, in 7 distinct regions (Paris, Lille, Bordeaux, Rouen, Dijon, Castres and Compiègne). GPs had to register all the consecutive attenders over 18 years old. For each physician, the registration period was over when 200 patients were registered, or 10 days of consultation were completed, or when 5 MINI had been performed. The average study period was 10 days per physician. At the first stage, they selected all the patients with psychological complaints, which were eventually associated to physical complaints. At the second stage, only the patients whose complaints were linked to a psychosocial stressor and without A1 and/or A2 DSM IV criteria for a Major Depressive Episode (MDE) were proposed the Mini International Neuropsychiatric Interview (MINI). The MINI is a brief structured clinical diagnostic interview that identifies the main axis-I DSM IV diagnoses in about 15 minutes. Before starting the study, all of the GPs participated in an intensive course on AD criteria recognition and were trained to use the MINI. The GPs registered a total of 7,759 consecutive patients. Twenty-two per cent (n = 1,719) of the patients reported psychological complaints, associated or not to physical complaints. Among them, 49% (n = 844) linked their complaints to identifiable psychosocial stressors. About half of the latter (n = 450) coded positive to A1 and/or A2 criteria for MDE. At the end, a total of 314 patients agreed to complete the MINI. Among the 1,719 patients with psychological complaints, the prevalence of ADWA eventually associated to other psychiatric disorders was 9.2%. The prevalence of "pure" ADWA was 4.5%. When considering the whole population of consecutive patients in primary care settings, the prevalence of pure ADWA was 1.0%. Patients suffering from pure ADWA were mostly women (66.7%), young patients (mean age: 42 years), with a professional activity. Patients had a psychiatric disorder history in 53.8% of the cases (mostly anxiety disorder). The main life events cited as being responsible for the disorder were work-associated problems (23.1%), followed by family illness (9.0%) and serious personal illness or accident (7.7%). The average duration of the disorder was 2.32 months. In 91% of the cases, GPs estimated that the patient required a pharmacological or psychological treatment. In most cases, they treated the patients with drug therapy (74.0%) associated with psychological support (counselling or psychotherapy, 76%). Anxiolytic agents were usually prescribed (64.9%), followed by antidepressants (10.8%) and hypnotics (8.1%). In conclusion, this first prevalence study of ADWA in general practice demonstrates that this disorder is frequent in primary care. It seems to be more present in patients who are of working age, especially women. ADWA would thus seem to preferentially affect active subjects. In most cases, GPs treat their patients with both psychological support and drug therapy. Anxiolytic is the elicited treatment of this disorder.

Adjustment Disorders↗
PubMedDate not supplied

[Autogenic training as a therapy for adjustment disorder in adults].

INTRODUCTION: Autogenic training is a widely recognised psychotherapy technique. The British School of Autogenic Training cites a large list of disorders, states, and changes, where autogenic training may prove to be of help. We wanted to explore the application of autogenic training as a therapy for adjustment disorder in adults. Our sample consisted of a homogeneous group of 35 individuals, with an average age of 39.3 +/- 1.6 years, who were diagnosed with adjustment disorder, F 43.2, in accordance with ICD 10 search criteria. AIM: The aim of our study was to research the effectiveness of autogenic training as a therapy for adjustment disorder in adults, by checking the influence of autogenic training on the biophysical and biochemical indicators of adjustment disorder. METHOD: We measured the indicators of adjustment disorder and their changes in three phases: before the beginning, immediately after the beginning, and six months after the completion, of a practical course in autogenic training. We measured systolic and diastolic arterial blood pressure, brachial pulse rate as well as the levels of cortisol in plasma, of cholesterol in blood, and of glucose. During that period, autogenic training functioned as the sole therapy. RESULTS: The study confirmed our preliminary assumptions. The measurements we performed demonstrated that arterial blood pressure, pulse rate, concentration of cholesterol and cortisol, after the application of autogenic training among the subjects suffering from adjustment disorder, were lower in comparison to the initial values. These values remained lower even six months after the completion of the practical course in autogenic training. CONCLUSION: Autogenic training significantly decreases the values of physiological indicators of adjustment disorder, diminishes the effects of stress in an individual, and helps adults to cope with stress, facilitating their recuperation.

Adjustment Disorders↗
PubMedDate not supplied

Frequency and correlates of adjustment disorder related to cardiac surgery in older patients.

The diagnosis of adjustment disorder is a dilemma in older medically ill patients. The authors conducted a prospective study of older cardiac surgery patients. Semistructured interview techniques were used to distinguish emotional impairment from physical impairment to diagnose an adjustment disorder. Among 71 patients interviewed at three points in time, 50.7% had an adjustment disorder. At 6 months after surgery, 30.6% were still showing evidence of emotional functional impairment. Continued impairment was related to initial severity of depressive and anxiety symptoms. Implications and suggestions for future research are discussed.

Activities of Daily Living↗
PubMedDate not supplied

[Autogenic training as a therapy for adjustment disorder in adolescents].

INTRODUCTION: Autogenic training is a widespread technique used in psychotherapy. The British school of autogenic training cites a large list of diseases, health states, and life changes, in which autogenic training can be of help. We wanted to explore the application of autogenic training as a therapy for adjustment disorder in adolescents. The sample consisted of a homogeneous group of 31 individuals, with an average age of 17.3 +/- 0.2 years, who were diagnosed with adjustment disorder, F 43.2, in accordance with ICD 10 search criteria. OBJECTIVE: The aim of our work was to figure out the influence of autogenic training on adjustment disorder, through biophysical and biochemical indicators, and to research the efficiacy of autogenic training as a therapy for adjustment disorder in adolescents. METHOD: We observed adjustment disorder indicators and their changes in three phases, using initial, final, and control values, which we measured immediately before the beginning, immediately after the completion, and six months after the completion, of the practical course in autogenic training. We measured systolic and diastolic arterial blood pressure, brachial pulse rates, cortisol levels in plasma, cholesterol levels in blood, as well as glucose concentrations. During that period, autogenic training was employed as the sole therapy. RESULTS: The study confirmed our preliminary assumptions. The measurements we performed showed that arterial blood pressure, pulse rates, cholesterol and cortisol concentrations, after the application of autogenic training among adolescents suffering from adjustment disorder, were lower than the initial values. They remained lower even six months after the completion of the practical course in autogenic training. CONCLUSION: We concluded that autogenic training significantly decreases the values of physiological indicators of adjustment disorder, diminishes the effects of stress in an individual, and eases the adaptation of adolescents to stress, helping with recovery.

Adjustment Disorders↗
PubMed1992

Adjustment disorder in children and adolescents.

The literature on adjustment disorder in children and adolescents is reviewed to evaluate the empirical and conceptual basis of this disorder as defined in DSM-III-R, and to determine whether revisions, are indicated in DSM-IV. Existing studies suggest that adjustment disorder is a disorder of high prevalence in all settings, which carries significant morbidity and poor outcome in children and adolescents. Problems identified with the DSM-III-R definition include low reliability, the predominance of mixed rather than discrete symptom presentations in children and adolescents, and the persistence of symptoms in excess of 6 months in a significant number of cases.

Adjustment Disorders↗
PubMed2002

The relationship between life adjustment and parental bonding in military personnel with adjustment disorder in Taiwan.

The aim of the present study was to examine the characteristics of military personnel with adjustment disorder to give them more appropriate treatment. The participants were 36 military personnel who met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria of adjustment disorder as diagnosed by a psychiatrist at a teaching hospital in southern Taiwan. Another 24 persons were recruited as an age-matched control group. Each individual completed the clinical interview and the Wechsler Adult Intelligence Scale-Revised and then completed the questionnaires which included demographic information, the Parental Bonding Instrument, the Eysenck Personality Questionnaire, and the Chinese Health Questionnaire. We found statistically significant differences between the case and control groups in personality and parental bonding attitudes. Soldiers with higher neuroticism, lower extraversion, and maternal overprotection had an increased risk of suffering from adjustment disorder. The inclusion of family function and the military environment and such other factors as cultural variables is recommended for future study. The statistical approach of structural equation modeling also should be considered in future studies to determine competing risk factors and mediating effects.

Adjustment Disorders↗
PubMed1986

Prevalence of DSM-III conduct and adjustment disorders for adolescent psychiatric inpatients.

The prevalence of DSM-III conduct and adjustment disorders in two adolescent psychiatric facilities, both located near large U.S. cities, was investigated. Overall, 31.6% of the adolescent inpatients were conduct disordered while 12.5% were adjustment disordered. The conduct disorders were primarily "aggressive" subtypes suggesting that this characteristic may influence hospitalization and diagnostic decisions. Such data on prevalence assists future treatment planning, allowing anticipation of case loads.

Adjustment Disorders↗
PubMed2005

Development of an Impact Thermometer for use in combination with the Distress Thermometer as a brief screening tool for adjustment disorders and/or major depression in cancer patients.

Screening cancer patients for adjustment disorders and major depression is important, because both are prevalent and often underrecognized. The purpose of this study was to validate the Distress and Impact Thermometer, a 2-item questionnaire, which we newly developed as a brief screening tool for detection of adjustment disorders and/or major depression. Two hundred ninety-five cancer patients completed the Distress and Impact Thermometer and the Hospital Anxiety and Depression Scale (HADS), and were examined by psychiatrists based on DSM-IV criteria. Using cutoff points for detection of adjustment disorders and major depression of "3/4" on "distress" score and "2/3" on "impact," the sensitivity and specificity were 0.82 and 0.82, respectively. Screening performance of the Distress and Impact Thermometer was comparable to that of the Hospital Anxiety and Depression Scale. Its brevity and good performance suggest that the Distress and Impact Thermometer is an effective tool for routine screening in clinical oncology settings.

Adaptation, Psychological↗
PubMedDate not supplied

[Treatment of adjustment disorder with anxiety: efficacy and tolerance of etifoxine in a double-blind controlled study].

Adjustment disorder with anxiety is defined as a clinically significant anxiety that occurs within 3 months after the onset of an identifiable psychological stressor. Recent studies indicate that this disorder is not uncommon and must be quickly identified and treated. However, few therapeutic trials have been done in relation with this disorder. According to the criteria set by DSM IV, 170 patients with a primary diagnosis of adjustment disorder with anxiety have been enrolled in a double blind multicenter controlled trial. Patients were treated for 4 weeks with etifoxine (150-200 mg/d), or buspirone (15-20 mg/d). Also both etifoxine and buspirone show clinical efficacy and safety, the two treatments are not equivalent. The global improvement score and the efficacy index are significantly improved in the etifoxine group. These results show the interest of using etifoxine in the treatment of adjustment disorder with anxiety and should be confirmed by further studies.

Adaptation, Psychological↗
PubMed2005

Adjustment disorder: a review of diagnostic pitfalls.

Adjustment disorder is a common diagnosis in psychiatric settings and carries a significant rate of morbidity and mortality. However, both current and previous diagnostic criteria are vague and lead to many difficulties in terms of validity and reliability. This review is based on a thorough literature search and a systematic evaluation of the empiric and theoretic data. The various pitfalls inherent in the process of diagnosing this disorder are discussed in light of the diagnostic criteria for the disorder.

Adjustment Disorders↗
PubMedDate not supplied

Antidepressant treatment in the primary care office: outcomes for adjustment disorder versus major depression.

BACKGROUND: 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. METHOD: 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. RESULTS: 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. CONCLUSION: 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.

Adjustment Disorders↗
PubMed2003

[Adjustment disorders: a clinical study of a psychiatric hospital population in Tunisia].

The objectives of this study were to determine the frequency of adjustment disorders in psychiatric hospital and to establish the clinical and evolutional profiles of these disorders. A descriptive and retrospective study with approximately 115 patients hospitalized a first time in a psychiatric setting of the university hospital of Monastir in Tunisia for adjustment disorders according to the DSM-IV. The frequency of adjustment disorders in a psychiatric hospital was estimated at 11,8 %. The majority of patients were young (65,3 % between 16 and 20), female (60,9 %), of low professional and socio-economical status, and without any psychiatric history (59,1 %). The acute appearance of adjustment disorders caused by psychosocial stress factors which were usually various (60 %), recent (61,7 %) and with a high severity (69,6 %). The suicide attempts were frequent (53 %) representing the first reason for hospitalization. An evolution was favourable in 75,7 % of cases after a short hospitalization (about 8,2 days). Finally, the authors insist on the short hospitalization in order to provide evaluation, observation and treatment setting for these disorders.

English Abstract↗
PubMed1990

Differentiating major depression from adjustment disorder with depressed mood in the medical setting.

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.

Adaptation, Psychological↗
PubMedDate not supplied

Validity of adjustment disorder, comparison with major depression.

Twenty inpatients suffering from an adjustment disorder with depressed mood according to the DSM-III criteria were compared with 22 inpatients with a (situationally provoked) major depression without an additional DSM-III/axis I diagnosis, with regard to expert- and self-rated symptomatology, social dysfunction and personality features. Furthermore, social support prior to admission was described. Subjects who had developed an adjustment disorder had less severe depressive symptomatology, associated social dysfunction and premorbid rigidity, and they remitted faster. Social support for both groups was similar to that of healthy controls.

Adjustment Disorders↗