Considering changes in adjustment disorder.
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Adaptation, Psychological↗
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Adjustment disorder: intergenerational conflict in a Chinese immigrant family.
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Acculturation↗
Critical issues in the review of diagnostic criteria for "adjustment disorders" and "psychological factors affecting physical condition".
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Adjustment Disorders↗
Stress-response syndromes: a review of posttraumatic and adjustment disorders.
The signs and symptoms of response to a stressful life event are expressed in two predominant phases: the intrusive state, characterized by unbidden ideas and feelings and even compulsive actions, and the denial state, characterized by emotional numbing and constriction of ideation. In this review of stress-response syndromes, the author outlines those phases, discusses the DSM-III diagnoses for stress-response disorders, and considers the mutual etiologic effects of stressful life events, psychiatric disorders, and preexisting conflicts or functional deficits. Guidelines for brief dynamic psychotherapy for patients who need more than transient support are presented.
Adaptation, Psychological↗
The course of adjustment disorder in Danish male conscripts.
Conscription has been employed for more than a century. To evaluate the course and fate of conscripts deemed mentally unfit for immediate continued service, a prospective questionnaire study of conscripts referred for mental evaluation was conducted. Questionnaires were completed at the time of enrollment, time of admittance for evaluation, time of discharge from their evaluation and at 1-year follow-up. Out of a class of 6949 conscripts, 93 were referred for psychiatric evaluation and 69 of those referred decided to enter the study (60 of these were in time deemed unfit for further military service). At the time of admittance, on average after 79 days of service, there was a significant 36%, 34%, 20% and 20% increase in depression, sleep, somatization and interpersonality scores, respectively. At the time of discharge 14 days after admittance, the symptom scores had dropped to a level comparable to scores at the time of enrollment. At 1-year follow-up, the descending trend in scores was maintained, though not reaching statistical significance compared with scores at time of discharge. The scores at 1-year follow-up were also, except for a higher depression score, comparable with the scores of a control group of conscripts evaluated 1 year after service. The psychological profile of conscripts referred for evaluation was different at the time of enrollment compared with conscripts in general, the scores being between 9% (interpersonality) and 29% (depression) higher. They also had a higher prevalence of adverse family events in their history. The course observed is indifferent from other situations of enforced stress.
Adjustment Disorders↗
[Adjustment disorder of adolescence].
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Adolescent↗
[Adjustment disorders in children and adolescents in the light of catamnesis].
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Adolescent↗
[Adjustment disorders with developmental risk in children after inpatient treatment].
The relatively broad spectrum of symptoms in child psychiatry (disturbances of behaviour and of anxiety and others) was examined in order to find smaller diagnostic groups. Two selected groups of probands of the Department of Child and Adolescent Psychiatry at the University Hospital for Children in Jena were analysed. This analysis was made by recording journals of treatment and a questionnaire. Both groups differed significantly in 33 out of 128 characteristics. The following factor analysis resulted in 10 anxiety- and non-anxiety-syndromes leading back to basic disturbances of affect, psychomotoricity and thinking as well as to exogenous variables like social surroundings and conditions in varieties in upbringing and education. A proof and reliable classification is not possible because of individually and qualitatively different symptoms. The results of the study show the necessity of an effective and improved dispensary care.
Adolescent↗
Depression as a spreading neuronal adjustment disorder.
The outlines of a theory of the pathophysiology of depression are presented. The classic monoamine theory of depression as well as its more recent elaborations suggests that a deficit in monoamine neurotransmitters in the synaptic cleft is the primary cause of depression. We suggest that the primary defect emerges in the regulation of firing rates in brainstem monoaminergic neurons, which brings about a decrease in the tonic release of neurotransmitters in their projection areas, an increase in postsynaptic sensitivity and, concomitantly, exaggerated responses to acute increases in presynaptic firing rate and transmitter release. We propose that the initial defect involves, in particular, the noradrenergic innervation from the locus coeruleus, which in turn leads to dysregulation of 5-HT-ergic and dopaminergic neurotransmission.
Brain Stem↗
Depression as a spreading adjustment disorder of monoaminergic neurons: a case for primary implication of the locus coeruleus.
A model for the pathophysiology of depression is discussed in the context of other existing theories. The classic monoamine theory of depression suggests that a deficit in monoamine neurotransmitters in the synaptic cleft is the primary cause of depression. More recent elaborations of the classic theory also implicitly include this postulate, other theories of depression frequently prefer to depart from the monoamine-based model altogether. We suggest that the primary defect emerges in the regulation of firing rates in brainstem monoaminergic neurons, which brings about a decrease in the tonic release of neurotransmitters in their projection areas, an increase in postsynaptic sensitivity, and concomitantly, exaggerated responses to acute increases in the presynaptic firing rate and transmitter release. It is proposed that the initial defect involves, in particular, the noradrenergic innervation from the locus coeruleus (LC). Dysregulation of the LC projection activities may lead in turn to dysregulation of serotonergic and dopaminergic neurotransmission. Failure of the LC function could explain the basic impairments in the processing of novel information, intensive processing of irrational beliefs, and anxiety. Concomitant impairments in the serotonergic neurotransmission may contribute to the mood changes and reduction in the mesotelencephalic dopaminergic activity to loss of motivation, and anhedonia. Dysregulation of CRF and other neuropeptides such as neuropeptide Y, galanin and substance P may reinforce the LC dysfunction and thus further weaken the adaptivity to stressful stimuli.
Animals↗
[Social competence in children with social adjustment disorders].
Teachers and parents of a sample of 1774 students at three grade levels (4th, 6th and 8th grades) were asked to judge the social competence of the children by means of the social competence questionnaire by Buhrmester et al. (1988). These ratings were correlated with the social status of the pupils, with peer statements on aggressive behavior and victimization and with the teachers' ratings of behavior in class and towards fellow pupils. Teachers proved to be more critical than parents, crediting boys with less social competence than girls, though this difference diminished in the higher grades. Ratings of social competence differed significantly both with regard to respective social status, as well as to frequent involvement in aggressive disputes as reported by peers. Children rated by the teachers as hyperactive were no less socially competent than aggressive or aggressive-hyperactive children. Victims of peer aggression and particularly shy and withdrawn children were rated the least socially competent by parents and teachers. Implications for the training of the social skills of children with peer relationship problems are discussed.
Adolescent↗
Depression and Adjustment Disorder in Patients With HIV Disease.
Depressive symptoms are common in patients with HIV disease, reflecting in part the contribution of preexisting depressive illness to risk behaviors for acquisition of HIV infection. Depression complicates management of HIV disease by increasing the likelihood of nonadherence to antiretroviral treatment regimens. HIV-infected patients with depressive symptoms may also be more likely to engage in behaviors that put others at risk of infection. These issues and approaches to diagnosis and treatment of depression in HIV-infected patients were discussed by Andrew F. Angelino, MD, at the Clinical Pathway of the Ryan White CARE Act 2002 All Grantee Conference held in Washington, DC, in August 2002.
Journal Article↗
[Experience of a centre for the study of occupational adjustment disorders referred to psychological harassment-related diseases at the workplace].
BACKGROUND: The rising awareness of psychological harassment at the workplace means that it is ever more important to collect clinical data and test tools to assess psychiatric disease connected with this phenomenon. OBJECTIVES: The aim of the study was to assess the experience gained by the centre for work maladjustment of the University Hospital of Pisa on a sample of patients, using the methods proposed by the centre at the Clinica del Lavoro "Luigi Devoto". MATERIALS AND METHODS: The patients were submitted to a diagnostic protocol consisting of work history, medical examination, psychological assessment, psychiatric examination, subjective questionnaires, mood scale and Neutest. The analysis was made in two phases in which 109 subjects were examined to check occupational stress effects in the period March 2002 - July 2004, after which 50 subjects were selected (45.9%) with the adaptation disorder and a history of adverse working conditions. RESULTS: The data gathered showed a slight predominance of workers from the public administration sector. The most representative range of duration of the psychological violence varied from 6 months to 2 years (46%). From close examination of the causes of the maladjustment disorders, structural changes in organization appeared to be the most frequent (13 cases). Among patients with positive diagnosis of disorder caused by psychological violence at the workplace, three situations were prominent: attitude to being a social outcast, behaviour to ignore proposals, and professional declassing. CONCLUSIONS: The multidisciplinary approach was culturally very stimulating and fundamental in reaching a final diagnosis of occupational disease: diagnosis of bullying at work and related disease was possible only thanks to the fact that three specialists agreed on the aetiological role of psychological harassment at the workplace. Our experience confirms that psychological harassment can cause health impairment and the most common diagnosis is maladjustment disorder.
Adult↗
[Psychogenic reaction: course and prognostic factors].
A follow-up was made of ninety patients with a diagnosed psychogenic reaction (adjustment disorder) fourteen years after the index hospitalisation. Contrary to expectation, at the follow-up only half of the patients showed no symptoms of the illness. Approximately a quarter of the patients suffered from a more serious illness (drug dependence, schizophrenia or organic mental disorder) than the index diagnosis. The other quarter showed symptoms of a psychogenic disorder (neurotic disorder, personality disorder, adjustment disorder). A number of factors which describe the course of the illness leading to the index hospitalisation permit a prediction of the outcome of the disease.
Adjustment Disorders↗
Suicide among adolescents. A psychological autopsy study of psychiatric, psychosocial and personality-related risk factors.
BACKGROUND: The suicide rate among young males in Belgium has doubled over the last decade. As more knowledge about risk factors is required to develop national prevention strategies, we investigated adolescent suicides using the psychological autopsy method. METHODS: A total of 32 informants were interviewed regarding 19 suicide cases (aged 15-19). A semi-structured interview schedule, constructed by Houston et al. (J Affect Disord 63:159-170, 2001), was used. RESULTS: All adolescents were suffering from one or more mental disorder(s) at the time of their death, and almost half of them were diagnosed with personality disorders. Adjustment disorders were diagnosed in one fifth of the sample, which appears to be relevant in view of the multiple life events and other psychosocial problems which adolescents were facing shortly before death. This suggests that difficulties in coping with stressful psychosocial problems are important in the course of the suicidal process. Only a small minority was receiving treatment for their disorders. CONCLUSIONS: Mental disorders, commonly untreated and combined with personality disorders and psychosocial problems, are frequently found in young suicide victims. This study suggests that education in the diagnosis and treatment of depression, adjustment disorders and suicide is important in the prevention of suicide.
Adolescent↗
Suicidal behaviors in adult psychiatric outpatients, I: Description and prevalence.
OBJECTIVE: Because the findings of previous studies of suicidal behaviors in psychiatric outpatients may not necessarily generalize to outpatients with a wide spectrum of psychiatric diagnoses, the authors evaluated the prevalence of suicidal behaviors in a large general psychiatric outpatient clinic whose patients represented a full spectrum of psychiatric illness. METHOD: A total of 651 patients participated in the study between 1987 and 1989. These patients had sought treatment at the outpatient psychiatry department of a private nonprofit hospital. Before being interviewed for treatment, all patients were given a comprehensive self-rating survey packet that included the Harkavy Asnis Suicide Survey and the Hopkins Symptom Checklist-90. The Harkavy Asnis Suicide Survey is a self-report questionnaire that assesses demographic variables, current and past history of suicidal behaviors of the patient as well as family members and peers, and a detailed description of each previous attempt. RESULTS: Fifty-five percent of the patients had a history of suicidal ideation, and 25% reported at least one previous suicide attempt. Approximately half of the suicide attempters reported multiple attempts. The predominant methods of attempt were overdose (53%), jumping (17%), and wrist cutting (17%). Suicidal behavior was prevalent in most diagnostic groups. The rates of suicidal ideation among patients with mood disorders (major depression, dysthymia, and bipolar disorder), adjustment disorders, and alcohol/substance abuse were significantly greater than that of the patients with generalized anxiety disorder. CONCLUSIONS: The authors conclude that suicidal behavior is prevalent among patients who seek treatment in a general outpatient department.
Adjustment Disorders↗
Emergence of childhood psychiatric disorders: a multivariate probit analysis.
We applied a computationally practical form of probit analysis for multiple response variables to data on early childhood development of four psychiatric disorders: disruptive disorders (DD-attention deficit disorders, oppositional defiant disorder, conduct disorder); adjustment disorders (ADJ); emotional disorders (ED-all anxiety disorders, depression); and other DSM-III-R Axis I disorders (OTHER). In addition to estimating the intercept slope and higher order polynomial terms for each age versus diagnosis regression, we estimated simultaneously the correlation among the four diagnostic categories. We then took into account the correlation found among these four diagnostic categories when testing the hypothesis of no age effect, which would have been ignored in a piecemeal univariate approach. Regression lines for diagnostic prevalence indicate a linear increase for OTHER disorders, and a curvilinear increase for ED. We then used expected frequencies of individual response patterns (that is, the 2(4) = 16 possible diagnostic combinations) in obtaining more precise estimates of diagnostic comorbidity and its relation to age. We further generalize the Bock and Gibbons model to alternative specification of the random-effects distribution (that is, they assumed multivariate normality), illustrate how one can estimate the random-effects distribution empirically, and study the robustness of parameter estimates to specification of the random-effects distribution.
Adjustment Disorders↗
Male and female chronic pain patients categorized by DSM-III psychiatric diagnostic criteria.
Two hundred and eighty-three chronic pain patients, consecutive admissions to the Comprehensive Pain Center of the University of Miami School of Medicine, received an extensive psychiatric evaluation based upon the American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders (DSM-III) criteria and flowsheets. All patients received the following type of diagnoses: DSM-III axis I; DSM-III axis II, and personality type. The distribution of assigned diagnoses for the entire patient sample was reviewed and a statistical comparison between male and female patients was performed with regards to the prevalence of each diagnosis. Anxiety syndromes and depression of various diagnostic types were the most frequently assigned axis I diagnoses with over half the patient sample receiving each of these diagnoses. Males were significantly overrepresented in the axis I diagnoses of intermittent explosive disorders, adjustment disorders with work inhibitions, and alcohol abuse and other drug dependence, while females were significantly overrepresented in disorders of current depression of various diagnostic types and somatization disorders. 58.4% of the patients fulfilled criteria for axis II personality disorder diagnoses. The most frequently personality disorders found in the patient group were dependent (17.4%), passive aggressive (14.9%), and histrionic (11.7%). Males were significantly overrepresented in paranoid and narcissistic disorders while females were overrepresented in histrionic disorder. The most frequent personality types found in the patient group were compulsive (24.5%) and dependent (10.6%). All personality types were similarly distributed between the sexes. The results of the present study were compared to a previous study of DSM-III diagnoses in chronic pain patients and are discussed in terms of the prevalence of DSM-III diagnoses in the general population. Questions are raised as to the applicability of certain DSM-III diagnoses in the chronic pain population.
Adjustment Disorders↗