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PubMed2003

Quality of rehabilitation among workers with adjustment disorders according to practice guidelines; a retrospective cohort study.

AIMS: To assess the quality of occupational rehabilitation for patients with adjustment disorders and to determine whether high quality of care is related to a shorter period of sickness absence. METHODS: A retrospective cohort study was conducted by means of an audit of 100 files of patients with adjustment disorders who visited their occupational physicians. Quality of rehabilitation was assessed by means of 10 performance indicators, derived from the guidelines for the treatment of employees with mental health disorders. Performance was dichotomised into optimal and deviant care according to explicit criteria. The performance rates were related to time until work resumption during a one year follow up period. Kaplan-Meier survival analyses and Cox proportional hazards analysis were used to study this relation. RESULTS: Four of 10 performance rates were below 50%: continuity of care (34%), interventions aimed at providers of care in the curative sector (39%), assessment of impediments in the return to work process (41%), and assessment of symptoms (45%). The highest performance rate concerned assessment of work related causes (94%). Overall optimal care was found in 10% of the cases. Median time to complete recovery was 195 days (IQR 97 to 365), and 73% of all patients recovered completely after one year. Optimal continuity of care was significantly related to a shorter time to both partial and complete work resumption (hazard ratio (HR) 0.3; CI 0.2 to 0.6) independently of other performance indicators. Performance regarding interventions aimed at the organisation was also related to a shorter time until first return to work (HR 0.5; CI 0.3 to 0.9). CONCLUSIONS: This study shows that the rehabilitation process of employees with adjustment disorders leaves significant room for improvement, especially with regard to continuity of care. Quality of care was partly related to a better outcome. More rigorous study designs are needed to corroborate these findings.

Adjustment Disorders↗
PubMed2005

[The efficacy and safety of trazodone in the treatment of adjustment disorders--naturalistic research].

UNLABELLED: There are a great number of traumatic and stressful events that people are exposed to in the contemporary world. The response to them is the subjectively felt stress and numerous emotional reactions with anxiety and lowering of the mood. These symptoms substantially limit the ability of social and vocational performance. Their appearance allow to diagnose adjustment disorders. AIM OF THE STUDY: The evaluation of therapeutic efficiency and safety of using trazodone in treatment of adjustment disorders with the particular focus on dominant symptoms in this illness that is anxiety, lowering of the mood, low self-esteem, sleep disorders and also aggression level. MATERIAL AND METHODS: 52 people of both sexes participated in this study. They were diagnosed with adjustment disorders and underwent some treatment in psychiatric surgery. The completed Hamilton's Depressive Scale and Anxiety Symptoms Scale COVI. Clinical condition of the patients was examined with Clinical General Impression Scale. The level of self-Acceptance was measured with ACL test. The examination lasted 56 days. RESULTS: Post hoc statistical tests allowed to form the idea that in the case of depression the intensity of the symptoms decreased significantly on the 14th day of the therapy. However, the anxiety symptoms decreased dramatically on the 7th day. CONCLUSION: (1). Trazodone turned out to be an efficacious medicine in the therapy of adjustment disorders. On the 56th day of the study the illness of 65.4% of patients was in remission, 26.9% of them responded to treatment, and 7.7% of them didn't. (2). Trazodone on the 7th day of therapy diminishes considerably the anxiety intensity and sleep disorder, and on the 14th day of the therapy it has an antidepressive effect. (3). As result of treating patients with trazodone the level of self-acceptance measured by ACL test has increased.

Adjustment Disorders↗
PubMed1990

Adjustment disorders in medically ill inpatients referred for consultation in a university hospital.

The study examined medical records of 121 medical-surgical inpatients diagnosed with adjustment disorder by psychiatric consultants in a university hospital. Medical illness was the primary stressor, evoking the maladaptive reaction in 83 (68.6%) cases. These patients were largely free of preceding psychiatric problems, suffering protracted hospitalizations for advanced illnesses, particularly malignancy and diabetes; in contrast, the 38 (31.4%) patients whose adjustment disorder was precipitated by a stressor other than medical illness had established psychiatric histories and recurrent problems with relationships or finances. The data suggest that in the medically ill, identifying the primary stressor producing an adjustment disorder is more instructive than focusing upon "predominant" symptomatology and "subtypes."

Adaptation, Psychological↗
PubMed2006

Adolescent adjustment disorder: precipitant stressors and distress symptoms of 89 outpatients.

OBJECTIVE: Research on adolescent adjustment disorder (AD) is scarce. We characterized adolescent outpatients with AD in psychosocial background and treatment received compared with patients with other non-psychotic disorders (OND). Furthermore, we explored precipitant stressors, distress symptoms and behavioral problems among males and females with AD. METHOD: Data were collected prospectively on 290 consecutive psychiatric outpatients, aged 12-22 yrs, at a secondary care clinic in Finland. DSM-III-R diagnoses were assigned, based on all available information, at the end of treatment. RESULTS: AD was the second most common diagnosis among non-psychotic patients (31% of 290). Compared to OND-patients, those with AD were predominantly female and had less severe psychosocial impairment. In multivariate comparisons school-related stressors, problems with law and restlessness characterized males, and parental illness and internalizing symptoms females with AD. Intensity and duration of treatment of AD-patients varied widely. CONCLUSIONS: Adjustment disorder comprised a common clinical entity among adolescent outpatients. Psychiatric assessment and treatment should be individually targeted by taking into account gender-specific stressors and distress symptoms among young people with AD.

Adjustment Disorders↗
PubMed2002

Parenting received in childhood and early separation anxiety in male conscripts with adjustment disorder.

The purpose of this study was to investigate parenting received in childhood and early separation anxiety experiences in young male soldiers with adjustment disorder. Fifty-four conscripts suffering from adjustment disorder completed the following questionnaires: the Symptom Checklist-90-Revised (SCL-90-R), the Measurement of Parental Style (MOPS), and the Separation Anxiety Symptom Inventory (SASI). Seventy-eight conscripts, matched for age and education, were used as a control sample. The research showed that compared with the controls, patients had significantly increased scores on the SCL-90-R (p < 0.001), the SASI (p < 0.03), and the father's and mother's MOPS Abuse subscale (p < 0.001). The father's MOPS Abuse score, the mother's MOPS Overcontrol score, and the SASI score were also significantly correlated with the SCL-90-R score (p < 0.01). Finally, a patient's separation anxiety can be predicted from the mother's overcontrol behavior, and the severity of the disorder can be predicted from the father's abuse behavior. These findings are in agreement with previous findings in patients with depression and anxiety disorders.

Adjustment Disorders↗
PubMed1980

Adjustment disorders in adolescents and adults.

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.

Adjustment Disorders↗
PubMed1996

Recognition of adjustment disorder in college athletes: a case study.

The occurrence of a sports-related adjustment disorder can inhibit optimum athletic performance and scholastic achievement and impair the overall functioning of athletes. Physicians and trainers caring for athletic teams must maintain an acute awareness of the athlete's mental and physical well-being to detect subtle signs of a mood or psychological disturbance. The case of the collegiate basketball player discussed here exemplifies the subtle presentation and stages of an adjustment disorder with the predominant manifestation of depression mixed with anxiety and disordered conduct. This player's lack of participation in practice and game play led to a distorted view of his self-worth, which slowly eroded his ability to play basketball, attend classes, and enjoy previously pleasurable activities.

Adjustment Disorders↗
PubMed2003

Reducing long term sickness absence by an activating intervention in adjustment disorders: a cluster randomised controlled design.

AIMS: To compare an innovative activating intervention with "care as usual" (control group) for the guidance of employees on sickness leave because of an adjustment disorder. It was hypothesised that the intervention would be more effective than care as usual in lowering the intensity of symptoms, increasing psychological resources, and decreasing sickness leave duration. METHODS: A prospective, cluster randomised controlled trial was carried out with 192 patients on first sickness leave for an adjustment disorder. Symptom intensity, sickness duration, and return to work rates were measured at 3 months and 12 months. Analyses were performed on an intention to treat basis. RESULTS: At 3 months, significantly more patients in the intervention group had returned to work compared with the control group. At 12 months all patients had returned to work, but sickness leave was shorter in the intervention group than in the control group. The recurrence rate was lower in the intervention group. There were no differences between the two study groups with regard to the decrease of symptoms. At baseline, symptom intensity was higher in the patients than in a normal reference population, but decreased over time in a similar manner in both groups to approximately normal levels. CONCLUSION: The experimental intervention for adjustment disorders was successful in shortening sick leave duration, mainly by decreasing long term absenteeism.

Absenteeism↗
PubMed1996

A study of deliberate self-poisoning in patients with adjustment disorders.

A sample of 140 patients (34 men and 106 women), hospitalized for deliberate self-poisoning in a toxicological clinic, was evaluated clinically and by Pöldinger's risk list for assessment of suicidality. All subjects met the criteria of DSM-IV adjustment disorder with no additional Axis I and Axis II comorbidity. 18% of the patients had a chronic adjustment disorder. The most common problems on Axis IV were those with the primary support group (especially in women). Occupational and economic problems were more frequent in men than in women. Most of the studied subjects undertook the suicidal attempt impulsively. Suicidal thoughts after deliberate self-poisoning persist in only 11% of the patients. The suicidal risk measured by Pöldinger's risk list for assessment of suicidality was negligible in 4/5 of the cases. The suicidal risk was higher in patients with chronic adjustment disorder and in patients with previous suicide attempts. The most represented age group - from 15 to 19 years old showed the highest suicidal risk. In women the suicidal risk increased with age. Women with impulsive suicide attempt showed a lower suicidal risk than women with a non-impulsive suicide attempt. A cathartic and abreactive effect of the suicide attempt was detected, but this effect only partially accounts for the relatively low percentage of suicidal thoughts after the suicidal act and the insignificant suicidal risk in 4/5 of the studied subjects.

Adjustment Disorders↗
PubMed1993

Recent stressful life events among Bahraini adolescents with adjustment disorder.

Adolescents from two time periods, diagnosed with adjustment disorder (n = 72), were examined retrospectively for the type of life stressors that initiated their referrals to a child psychiatry unit. They were compared with a control group of adolescents (n = 42) who were referred to the unit during the same time periods and who received a diagnosis of "no psychopathology." Disappointment in relationships with a family member or with a friend of the opposite sex was found to be the main stressor. Frequency of distribution of the stressors was almost the same in the two time periods. Patients were more often females from nonintact families and referred mainly by medical personnel. The different presenting symptoms and the contribution of the stressors to the adolescents' difficulties are discussed.

Adjustment Disorders↗
PubMed1987

Adjustment disorder and psychiatric practice: cultural and historical aspects.

A universal concern of healers and health practitioners of all social groups is that of caring for individuals reacting to social and interpersonal hardships. One could view individuals experiencing such hardships as prototypical patients of a society's health profession, however this may be defined. In contemporary psychiatry, such individuals are diagnosed as showing an "adjustment disorder." In view of the time-honored legitimacy of caring for individuals meeting criteria for an adjustment disorder, it is ironic that the status of this "disorder" in the discipline's contemporary nosology is controversial and anomalous. In this paper, these and related issues are discussed. Emphasis is given to some of the cultural, historical and clinical-epidemiologic factors that render disturbances that can be diagnosed as adjustment disorder important in psychiatry and, indeed, worthy of inclusion in DSM-III. Theoretical and empirical problems that would render this entity a more legitimate one in contemporary biomedical psychiatry are reviewed.

Adjustment Disorders↗
PubMedDate not supplied

[Adjustment disorders in oncology: a conceptual framework to be refined].

The use of stringent sets of diagnostic criteria often represents a daily clinical challenge for mental health professionals caring for cancer patients. Many nosological classification systems were not specifically developed to meet the peculiarities associated with the emotional experience of cancer. In particular, the diagnosis of adjustment disorder according to the Diagnostic and Statistical Manual of mental disorders appears inappropriate in this context. It is questionable, indeed, how to assess the "excessive" nature of psychological distress ari-sing in response to such a burdening event as a cancer diagnosis. Furthermore, the conceptual validity of the adjustment disorder construct may be of poor clinical relevance in patients suffering from a life-threatening medical condition and its widespread consequences. In this paper, we intend to offer an operational definition of adjustment and we argue that a vast majority of cancer patients currently receiving a diagnosis of adjustment disorder actually suffer from either subthreshold depression or from full or partial presentation of post-traumatic stress disorder. We first briefly review some available models of psychological adaptation. We also argue that trying to explain the experience of cancer alongside a continuum of psychological distress does not help us to better understand underlying adjustment processes and to treat emotional disturbances more effectively. The literature is currently scanty about the critical role of a psychological trauma, namely the diagnosis of cancer, in generating emotional, cognitive and behavioral responses. The very fact that an average of 10% of cancer patients have been shown to meet criteria for PTSD might suggest that the existence of a specific trauma stress adaptation process in this particular patient population. The confirmation of these hypotheses by clinical observation, experimental psychology paradigms or functional brain imagery studies could have substantial implications for the treatment of psychological distress in patients with cancer. Issues such as the relevance of pharmacological treatment of subthreshold depression--which has received little attention in the general literature--or the role of psychodynamic approaches in the management of cancer-related traumatic dimensions, should be addressed systematically.

Adjustment Disorders↗
PubMed2005

Decreased sensitivity to experimental pain in adjustment disorder.

An altered perception of pain has been described for several psychiatric disorders. To date the influence of adjustment disorders (AD) on pain perception has not been described. Here, we investigated perception of experimentally induced pain in 15 patients suffering from AD (subtype with depressive symptoms) and controls matched for age and sex. Thresholds and tolerances were assessed for thermal and electrical pain on both sides of the body. We found an overall increase of pain thresholds and tolerances in AD patients as compared to controls, predominately on the right side of the body. Analogue findings have been reported for pain perception in major depressive disorder (MDD). Of the data obtained, only thermal pain threshold on the right arm correlated with the severity of depressive symptoms. Although the underlying pathology is elusive it is likely that the mechanisms for reduced pain sensitivity are comparable in MDD and AD.

Adjustment Disorders↗
PubMed1990

Screening for adjustment disorders and major depressive disorders in cancer in-patients.

The Hospital Anxiety and Depression Scale (HADS), a four-point, 14-item questionnaire, was tested as a screening method for adjustment disorders and major depressive disorders in a sample of 210 cancer in-patients. A receiver operating characteristic (ROC) analysis was performed, giving the relationship between the true positive rate (sensitivity) and the false positive rate (1-specificity). This makes it possible to choose an optimal cut-off point that takes into account the costs and benefits of treatment of psychological distress. For screening for major depressive disorders only, a cut-off score of 19 gave 70% sensitivity and 75% specificity. For screening for adjustment disorders and major depressive disorders taken together, a cut-off score of 13 gave 75% sensitivity and 75% specificity. HADS appears in this study to be a simple, sensitive and specific tool for screening for psychiatric disorders in an oncology in-patient population.

Adaptation, Psychological↗
PubMedDate not supplied

Efficacy and safety of trazodone versus clorazepate in the treatment of HIV-positive subjects with adjustment disorders: a pilot study.

The efficacy of trazodone and clorazepate to relieve anxiety and depressive symptoms in 21 HIV-positive subjects with adjustment disorders was determined in a 28-day single-centre, randomized, double-blind study. Subjects were evaluated using the Hospital Anxiety and Depression Scale, the Revised Symptom Checklist, the European Organization for Research and the Treatment of Cancer Quality of Life Questionnaire, and a binary criterion based on the Clinical Global Impression. The incidence of successful treatment was 80% for trazodone compared with 64% for clorazepate; the sample number was too small to establish a significant difference. Bayesian analysis revealed the probability of making a wrong decision in prescribing trazodone rather than clorazepate reduced from 35% to 18% in this small sample. Clinical evaluations using the different scales suggest some benefit from trazodone, although this was not significant. Safety of both treatments was similar. Trazodone is devoid of the risk of abuse and dependence, and may be a valuable alternative to benzodiazepines for the treatment of HIV-related adjustment disorders.

Adjustment Disorders↗
PubMed2004

Difficulties in screening for adjustment disorder, Part II: An attempt to develop a novel self-report screening instrument in cancer patients undergoing bone marrow transplantation.

OBJECTIVE: Screening for adjustment disorder (AD) in cancer patients presents a significant clinical challenge. As seen in Part I of this research, conventional, existing measures are rather poor at detecting this most common of psychiatric diagnoses. Bone marrow transplantation (BMT) has a high level of morbidity that can cause significant stress for patients faced with the procedure. METHODS: A sample of 95 BMT patients completed a semistructured interview and a novel self-report instrument, the Coping Flexibility Scale for Cancer (C-Flex), to determine if it could identify patients with adjustment disorder in need of further assessment and intervention. RESULTS: The screen yielded four factors but was not predictive of AD. However, the C-Flex was significantly related to the presence of any disorder (r = -0.44, p < 0.001) in this sample. In addition, Factor I of the screen was found to be correlated to the presence of any diagnosis (r = -0.44, p < 0.001) and to have adequate sensitivity (81.63%) and specificity (76.09%). SIGNIFICANCE OF RESULTS: Either because of problems with the scale or the amorphous nature of the AD category, or both, rapid identification of patients with this common problem has proven to be elusive.

Adjustment Disorders↗
PubMed1982

The predictive value of adjustment disorders: a follow-up study.

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.

Adjustment Disorders↗
PubMedDate not supplied

[Adjustment disorders: apropos of an epidemiologic survey. Epidemiology and Psychiatry Group].

An epidemiologic survey performed in France in 1990 allowed us to analyze the epidemiologic characteristics of adjustment disorders (AD). AD were defined according to the DSM III-R guidelines. AD are strongly correlated to personality disorders. The study population was young (mean age: 39 years) and predominantly female (60.3%). Marriage or life with a partner, living in the country or in small towns, liberal profession and a high level of schooling are the most significant social and demographic characteristics that emerge from this study. These patients tend to have multiple medical contacts, seeing many doctors but consuming little medication (25% of them). Comorbidity with associated personality disorders (15%) and dependency behaviors (alcohol, drugs) are frequent (9.3%), although no causative link was found between these disorders. Alcoholism may have a tendency to protect against AD. There is no seasonal factor. The patients mostly see private physicians; their geographic distribution is the inverse of the distribution of alcoholism. Numerous social and demographic risk factors for AD were found. Among the personal psychiatric history, disorders of feeding behavior and early adjustment problems were prominent. The family history often shows the existence of mental disorders in the parents. The treatment history points to a lesser consummation of psychotropic drugs, mostly limited for two classes, i.e. antidepressants (50%) and tranquilizers (40.9%), although a different pattern of behaviour was found according to the clinical types of AD. The present therapeutic approach is recent and based on psychotherapy. It differs little according to the clinical forms, with the possible exception of co-prescribed medication. This study has thus allowed us to observe the epidemiologic characteristics of AD. Adjustment disorders appear to be frequent, but their particularities do not differentiate them significantly from other types of mental disorders.

Adjustment Disorders↗