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PubMed2004

[Post-traumatic embitterment disorder (PTED). Differentiation of a specific form of adjustment disorders].

Adaptation disorders are a heterogeneous group of mental disorders. Although they play a major role in clinical practice, are difficult to treat, and often lead to chronicity and disability, diagnostic algorithms are vague and scientific research is rare. Clinical practice has shown a subtype of adaptation disorder that is characterized primarily by lasting embitterment after exceptional though normal life events which violate basic beliefs. This disorder can be called post-traumatic embitterment disorder (PTED). A case vignette and results of a pilot study are reported. Critical life events were found to be job loss in 38%, conflicts at work in 24%, death of a loved one in 14%, familial strain in 14%, and other events in 10%. When reminded of the critical event, patients report feelings of embitterment (85.7%), sadness (81.0%), anger (76.2%), or helplessness (75.0%). When standardized assessments are made, they fulfill criteria of various comorbid disorders such as GAD (38.1%), depression (33.3%) and dysthymia (33.3%), agoraphobia (28.6%), or panic (19.0%). Of the patients, 81% said they avoid places which remind them of the critical events. Impairments were suffered in work (70%), leisure (65%), and familial relations (57.1%).

Adjustment Disorders↗
PubMed1997

Clinical evaluation of the efficacy of pivagabine in the treatment of mood and adjustment disorders.

Depression and distress have in common hypercortisolism, a high turn-over of cerebral monoamines and a wide clinical variability. Results of a clinical open trial with pivagabine (4-[(2,2-dimethyl-1-oxopropyl) amino]butanoic acid, CAS 69542-93-4, Tonerg) on 22 young patients affected by dysthymic disorders and on 38 older patients affected by adjustment disorders following different stressors (mourning, retirement and recovery in institutions of assistance) are reported. Oral treatment with 1800 mg pivagabine lasting 30 days showed in both groups a significant improvement of the psychic state with variations from 50 to 80% of the criteria reported in the Hamilton Rating Scale for Depression (HDRS) and for anxiety (HARS) and in the Self-rating Anxiety Scale (SAS). Good tolerance of the drug and the complete absence of serious side effects considerably contributed to the clinical success.

Adjustment Disorders↗
PubMed1997

A combination of plant extracts in the treatment of outpatients with adjustment disorder with anxious mood: controlled study versus placebo.

Euphytose (EUP) is a combination of six extracts: Crataegus, Ballota, Passiflora and Valeriana, which have mild sedative effects, and Cola and Paullinia, which mainly act as mild stimulants. This multicenter, double-blind, placebo-controlled general practice study was carried outpatients with adjustment disorder with anxious mood. The study was coordinated by psychiatrists. Ninety-one patients were included in the EUP group and 91 patients in the placebo group. They all received two tablets three times a day over 28 days (D). Evaluation using the Hamilton-anxiety (HAM-A) rating scale were carried out on D0, D7, D14 and on D28. Comparing the two groups, 42.9% of the patients (EUP group) had a HAM-A score of less than 10 at D28 versus 25.3% in the placebo group (P = 0.012). Changes in the HAM-A score between D0 and D28 were as follows: D0 (EUP: 26.12 +/- 4.0, placebo: 26.27 +/- 4.5), D7 (EUP: 19.65 +/- 5.7, placebo: 21.37 +/- 5.6), D14 (EUP: 15.36 +/- 5.7, placebo: 17.48 +/- 6.7), D28 (EUP: 12.63 +/- 7.3, placebo: 15.2 +/- 8.1). From D7 to D28 there was a statistically significant difference (P = 0.042) between the two treatments, indicating that EUP is better than placebo in the treatment of adjustment disorder with anxious mood.

Adjustment Disorders↗
PubMed2006

Efficacy of etifoxine compared to lorazepam monotherapy in the treatment of patients with adjustment disorders with anxiety: a double-blind controlled study in general practice.

Adjustment Disorders With Anxiety (ADWA) account for almost 10% of psychologically motivated consultations in primary care. The aim of this double-blind randomised parallel group study was to compare (non-inferiority test) the efficacies of etifoxine, a non-benzodiazepine anxiolytic drug, and lorazepam, a benzodiazepine, for ADWA outpatients followed by general practitioners. 191 outpatients (mean age: 43, female: 66%) were assigned to receive etifoxine (50 mg tid) or lorazepam (0.5-0.5-1 mg /day) for 28 days. Efficacy was evaluated on days 7 and 28 of the treatment. The main efficacy assessment criterion was the Hamilton Rating Scale for Anxiety score (HAM-A) on Day 28 adjusted to Day 0. The anxiolytic effect of etifoxine was found not inferior to that of lorazepam (HAM-A score decrease: 54.6% vs 52.3%, respectively, p=0.0006). The two drugs were equivalent on Day 28. However, more etifoxine recipients responded to the treatment (HAM-A score decreased by >or=50%, p=0.03). Clinical improvement (based on Clinical Global Impression scale CGI, Social Adjustment Scale Self-Report SAS-SR, and Sheehan scores) was observed in both treatment arms, but more etifoxine patients improved markedly (p=0.03) and had a marked therapeutic effect without side effects as assessed by CGI, p=0.04. Moreover, 1 week after stopping treatment, fewer patients taking etifoxine experienced a rebound of anxiety, compared to lorazepam (1 and 8, respectively, p=0.034).

Adjustment Disorders↗
PubMed2005

Suicidality in adjustment disorder--clinical characteristics of adolescent outpatients.

OBJECTIVE: Although a remarkable proportion of adolescents suffering from adjustment disorder (AD) are suicidal, few studies have documented the characteristics of suicidal AD patients. We examined background, psychopathology and treatment-related factors among suicidal adolescent AD outpatients. METHOD: Data on 302 consecutively referred psychiatric outpatient adolescents, aged 12-22 years, were collected. DSM-III-R diagnoses were assigned at the end of treatment based on all available data. Of the patients 89 received a diagnosis of AD, 25% of whom showed suicide attempts, suicidal threats or ideation. RESULTS: Compared with non-suicidal AD patients, suicidal AD patients were characterized by previous psychiatric treatment (OR = 6.1), poor psychosocial functioning at treatment entry (OR = 16.2), suicide as a stressor (OR = 33.3), dysphoric mood (OR = 6.9) and psychomotor restlessness (OR = 3.7). CONCLUSIONS: Common risk factors for suicidality in major psychiatric disorders characterized suicidal AD patients. Psychiatric assessment of AD patients should include careful monitoring of both symptomatology and exposure to suicide of significant others.

Adjustment Disorders↗
PubMed1989

Treatment of adjustment disorders: a comparative evaluation.

With the aim of assessing four forms of therapy with adjustment-disordered outpatients, we randomly assigned 70 subjects to the following treatments: supportive psychotherapy (psychoanalytically oriented), viloxazine (an antidepressant), lormetazepam (a benzodiazepine), and S-adenosylmethionine (a methyl donor with antidepressive properties). A further group of 15 subjects received a placebo, orally administered. The trial lasted 4 wk. None of the treatments had clearly superior effects over others on scores on the Zung Self-rating Depression Scale. All produced a significant improvement. However, groups given S-adenosylmethionine and supportive psychotherapy had the highest mean scores.

Adjustment Disorders↗
PubMed2006

Can adjustment disorder and depressive episode be distinguished? Results from ODIN.

BACKGROUND: No large-scale epidemiological study has included adjustment disorders (AD) for consideration yet it is considered to be a common psychiatric diagnosis. METHODS: Using a two stage screening method, those above a threshold score for possible caseness on the Beck Depression Inventory (BDI), were interviewed using SCAN to identify those with depressive episode and AD. Variables that might distinguish AD from depressive episode were examined. RESULTS: The prevalence of AD was extremely low with one centre having no cases. Finland, the country with the highest prevalence, only achieved a frequency of 0.8% and 1%, respectively, for urban and rural sites. Logistic regression failed to identify any variables that independently differentiated AD from depressive episode. Findings relating to severity of symptoms using BDI were robust. LIMITATIONS: The small sample size might have contributed to a failure to identify distinguishing features between AD and other disorders. CONCLUSIONS: Reasons for the failure of even robust results, such as BDI severity, to distinguish AD from depressive episode are considered of which problems in conceptualising AD are the most likely. Further studies are required.

Adjustment Disorders↗
PubMedDate not supplied

Selection of psychotherapeutic treatment for adjustment disorder with depressive mood due to acute myocardial infarction.

BACKGROUND: There is a lack of specific emotional treatment in patients with adjustment disorder (AD) with depressed mood (DSM-IV-TR: 309.0) as a consequence of acute myocardial infarction (AMI) (ICD 10: 410.0-9), which renders treatment even more difficult. The present study proposed a new therapeutic technique (mirror therapy) to compare this with other therapies. Our objective was to select among three different treatment types the most effective treatment against AD in patients with AMI. METHODS: We used a quasi-experimental design for four groups with three evaluations each, which we carried out at three Mexican Social Security Institute (IMSS) hospitals in the metropolitan zone of Mexico City. We conducted a random test of 144 patients of both genders between 30 and 60 years of age diagnosed with AMI and AD and selected by means of the Minnesota multiphasic personality inventory (MMPI-2) neurotic depressive scale. Treatment evaluation was carried out with depressive description test (DDT) and MMPI-2 test, and depression (DEP) and health concerns (HEA) content scales. RESULTS: We observed in post-test evaluation a significant difference between patients in the psychotherapy mirror group and the remaining groups (p<0.05). During the 6-month follow-up evaluation, we observed in HEA content scale a significant difference between control group and remaining groups (p<0.05). CONCLUSIONS: Mirror psychotherapy treatment is more effective in AD symptom decrease. Patients with AMI and AD not receiving emotional support treatment in conjunction with medical treatment continue to experience emotional disorders and show greater apprehension with regard to medical treatments.

Adjustment Disorders↗
PubMed1993

Prevention of adjustment disorders and anticipatory nausea secondary to adjuvant chemotherapy: a double-blind, placebo-controlled study assessing the usefulness of alprazolam.

PURPOSE AND METHODS: Although a high prevalence of adjustment disorders and anticipatory nausea secondary to adjuvant chemotherapy (CT) has been reported, little has been done to develop strategies to prevent these problems. A double-blind, placebo-controlled study was therefore designed to assess the usefulness of adding low-dose alprazolam (0.5 mg to 2 mg per day) to a psychologic support program including progressive relaxation training designed to prevent the aforementioned conditions. Fifty-seven women undergoing adjuvant CT for stage II primary breast cancer agreed to participate in the assessment, which was conducted at four time points: before starting CT, 6 weeks after CT, before the fourth CT, and after the fourth CT. The Hospital Anxiety and Depression Scale (HADS), Montgomery and Asberg Depression Rating Scale (MADRS), Hamilton Anxiety Scale (HAS), Revised Symptom Checklist (SCL-90-R), Morrow Assessment of Nausea and Emesis (MANE), and World Health Organization (WHO) grading of acute and subacute toxicities were used to compare the alprazolam (AA) and placebo (PA) arms of the study. RESULTS: At the second evaluation, the results showed a higher rate of anticipatory nausea (18% v 0%) in the PA compared with the AA arm (P = .038). These differences were no more significant at each of the further assessments. Significant differences were found for the intake of hypnotics at each assessment visit, with the rate of hypnotic users being significantly higher in the PA (19%) compared with the AA (0%) arm at the fourth assessment (P < .05). Anxiety and depression scores of self- and observer-report were similar in the two arms. A significant relationship was found between the development of anticipatory nausea and the self-report of anxiety and depression score measured by HADS at baseline. The average HADS total score at baseline was 15.33 (SD = 6.56) for patients who developed anticipatory nausea and 11.23 (SD = 6.67) for other patients. CONCLUSION: The adjunct of alprazolam to a psychologic support program delays the occurrence of anticipatory nausea and controls sleeping problems secondary to adjunct CT. Although studies are needed to improve the efficacy reported here, physicians may already consider the use of alprazolam for cancer patients undergoing CT.

Adjustment Disorders↗
PubMed1987

Adjustment disorder as a marginal or transitional illness category in DSM-III.

This study examines the resources of DSM-III for dealing with conditions that fall outside the domain of illnesses with specific, recognized, and clearly delineated symptom profiles. In discussing some of the theoretical and problematic aspects of the categories "Adjustment Disorder" (AD) and "not ill" (NI), AD is viewed as an example of a marginal or transitional illness category. Clinical psychopathologic features of subjects in the AD and NI categories are compared with those in the logical complementary category composed of all other specific diagnosis categories of DSM-III. The results support the descriptive validity of AD and NI in DSM-III.

Adjustment Disorders↗
PubMed1998

Adjustment disorder: a multisite study of its utilization and interventions in the consultation-liaison psychiatry setting.

The consultation-liaison (C-L) psychiatry services of seven university teaching hospitals in the United States, Canada, and Australia (the MICRO-CARES Consortium) used a common clinical database to examine 1039 consecutive referrals. A diagnosis of adjustment disorder (AD) was made in 125 patients (12.0%); as the sole diagnosis, in 81 (7.8%); and comorbidly with other Axis I and II diagnoses in 44 (4.2%). It had been considered as a rule-out diagnosis in a further 110 (10.6%). AD with depressed mood, anxious mood, or mixed emotions were the commonest subcategories used. AD was diagnosed comorbidly most frequently with personality disorder and organic mental disorder. Sixty-seven patients (6.4%) were assigned a V code diagnosis only. Patients with AD were referred significantly more often for problems of anxiety, coping, and depression; had less past psychiatric illness; and were rated as functioning better--all consistent with the construct of AD as a maladaptation to a psychosocial stressor. Interventions were similar to those for other Axis I and II diagnoses, in particular, the prescription of antidepressants. Patients with AD required a similar amount of clinical time and resident supervision. It is concluded that AD is an important and time-consuming diagnostic category in C-L psychiatry practice.

Adjustment Disorders↗
PubMed1990

Psychosocial stressors and adjustment disorder: van Gogh's life chart illustrates stress and disease.

The life of Vincent van Gogh is illustrative of the natural history of psychosocial stressors and their relationship to a person's states of health and disease. In the author's opinion, there is a lack of such understanding in the current, established criteria for psychosocial stressors in the diagnosis of adjustment disorder. By use of a life chart, which chronologically documents a person's major life events and concomitant health status over his or her life span, a fuller understanding can be reached regarding why an individual becomes ill at a particular time.

Adjustment Disorders↗
PubMed2000

Neurochemical variables in subjects with adjustment disorder after suicide attempts.

The investigation of biological correlates of suicidal behavior is important for identifying high-risk subjects. The objective of this study was to examine the neurochemical variables' platelet MAO activity and urinary MHPG, 5HIAA and HVA, the main metabolites of noradrenaline, serotonin and dopamine, neurotransmitters that are considered to be involved in the pathophysiology of suicidal behavior, as well as plasma cortisol, in a group of subjects with adjustment disorder after a suicide attempt. Fifty-three patients, 42 females and 11 males, were included in the study and were compared to a group of 50 healthy controls, 25 females and 25 males. Platelet MAO activity was found to be significantly lower in both male and female patients compared to controls of the same sex (P < 0. 001 for both comparisons). 5HIAA and HVA were not different between patients and controls, but MHPG was significantly higher in the patients group (P = 0.008). Moreover, plasma levels of cortisol were significantly higher in the patients compared to the controls (P < 0. 001). Our results confirm the hypothesis of low platelet MAO activity as a biological characteristic of patients who attempt suicide. They also point to a possible parallel activation of the noradrenergic system.

Adjustment Disorders↗
PubMed1999

Comparative study of the efficacy and safety of trazodone versus clorazepate in the treatment of adjustment disorders in cancer patients: a pilot study.

The efficacy of trazodone (mean once-daily dose 111.5 +/- 36.3 mg) versus clorazepate (mean once-daily dose 17.5 +/- 7.5 mg) to relieve anxious and depressive symptoms in 18 patients undergoing treatment for breast cancer was investigated in a 28-day randomized, double-blind study. Efficacy was evaluated using the Hospital Anxiety and Depression Scale, the Revised Symptom Checklist and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire. A successful response to treatment was achieved in 91% (10/11) of patients who received trazodone and 57% (four of seven) of patients who were administered clorazepate (P = 0.1373). Bayesian analysis revealed that the prior probability of making a wrong decision in prescribing trazodone rather than clorazepate reduced from 26% to 8%. Assessment of the clinical scales suggested a benefit of trazodone compared with clorazepate, although the differences were not significant. Safety of both treatments was similar. Trazodone is devoid of an abuse risk and dependence and, therefore, could be a valuable alternative to clorazepate in the treatment of adjustment disorders in cancer patients.

Adjustment Disorders↗
PubMed2004

Major depression, adjustment disorders, and post-traumatic stress disorder in terminally ill cancer patients: associated and predictive factors.

PURPOSE: Few studies have been conducted to elucidate the psychological distress of terminally ill cancer patients. This study attempted to determine the prevalence of adjustment disorders (AD), major depression (MD), and post-traumatic stress disorder (PTSD) among terminally ill cancer patients, to identify factors that contribute to them, and to determine how they change longitudinally. PATIENTS AND METHODS: Consecutive terminally ill cancer patients were recruited. Patients were assessed for psychiatric disorders by structured clinical interview twice: once at the time of their registration with a palliative care unit (baseline), and again at the time of their palliative care unit admission (follow-up). Possible contributed biomedical and psychosocial factors were evaluated. RESULTS: The proportions of patients diagnosed with AD, MD, and PTSD at baseline (n = 209) were 16.3%, 6.7%, and 0% respectively, whereas at follow-up (n = 85), 10.6% were diagnosed with AD and 11.8% with MD. Lower performance status, concern about being a burden to others, and lower satisfaction with social support were significantly associated with AD/MD at baseline. There were changes in the diagnosis of AD and MD in 30.6% of the patients. Only the Hospital Anxiety and Depression Scale at the baseline was significantly predictive of AD/MD at follow-up. CONCLUSION: The factors underlying psychological distress are multifactorial. Early intervention to treat subclinical anxiety and depression may prevent subsequent psychological distress.

Adult↗