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At least 19 recordsLinked to original sources
PubMed1990

Anxiety and adjustment disorder: a treatment approach.

Adjustment disorder with anxious mood can be difficult to differentiate from other anxiety disorders or personality disorders. Particular care must be taken to distinguish between the reasonable, expected response to psychosocial stressors and the inordinate response that may indicate the diagnosis of adjustment disorder. Once the diagnosis has been established, options for the management of these patients include nonpharmacologic approaches, pharmacotherapy, and combinations of both. The ultimate goals of treatment are to mobilize the patient's stress-coping mechanisms and to prevent the adjustment disorder from developing into another, more chronic condition, such as generalized anxiety disorder.

Adjustment Disorders↗
PubMed1991

Childhood experiences of loss and suicide attempts: significance in depressive states of major depressed and dysthymic or adjustment disordered patients.

Three hundred and twenty-eight patients aged 45 years and over with major depression, dysthymic disorder or adjustment disorder with depressed mood (according to DSM-III) were asked about childhood loss experiences (death of one or both parents or at least 1 year's separation) and their current state of health. No statistically significant relationships were found between experiences of loss in childhood and type of depression, sex and age at first episode. However, there was an increased incidence of suicide attempts in patients with experiences of loss in childhood, both by separation and by death of parents. The increased suicidal tendency could mainly be attributed to loss of the father.

Adjustment Disorders↗
PubMed1992

Structured ambiguity and the definition of psychiatric illness: adjustment disorder among medical inpatients.

Adjustment disorder is one of the most common psychiatric diagnoses given to patients hospitalized for medical and surgical problems. This article argues that the diagnosis, in this context, often serves strategic, non-clinical ends for consultation-liaison psychiatrists, who must negotiate their interstitial position through an essentially ambiguous diagnosis. In these cases, 'adjustment disorder' emerges from and reproduces tensions between such cultural dichotomies as mind/body and social/individual that marginalize psychiatry in medical settings.

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↗
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↗
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↗
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↗
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↗
PubMed1991

Adjustment disorders of sleep: the sleep effects of a major stressful event and its resolution.

Seventy volunteers had 3 nights of sleep recordings during a period of marital separation, and 61 returned for repeat studies 1 year later. At that time, the divorce was final for 42. Forty of the volunteers were depressed when first screened, and 30 were not. Initially all those undergoing marital separation had less delta sleep than an age-matched married comparison sample. Delta increased at followup for those whose divorce was completed. Rapid eye movement (REM) latency was reduced and REM percent was elevated only in the depressed. Among the not depressed, those whose divorces remained incomplete at the followup had lower delta, higher REM percent, and shorter REM latency than did those whose divorces were finalized. This suggests that prolonged emotional stress may put these subjects at some risk for a mood disorder.

Adaptation, Psychological↗
PubMed1992

[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↗
PubMed1991

[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↗
PubMed1990

Biopsychosocial approach to the human immunodeficiency virus epidemic. A clinician's primer.

The human immunodeficiency virus (HIV) epidemic has created a multidimensional crisis that is challenging the health care system. Individuals with or without risk behaviors have anxieties about acquired immunodeficiency syndrome (AIDS) and need support and counseling. Once symptoms of HIV infection develop, crisis intervention and support need to be integrated into ongoing medical care. A biopsychosocial approach enables persons with AIDS to develop strategies for coping, to improve adherence, and to prevent transmission and suicide. Persons with AIDS are confronted with severe illnesses, neuropsychiatric disorders, discrimination, and death. Each person deserves the best medical and psychologic care available and the services of other disciplines where indicated. Caregivers, anxious about contagion, are devastated by the complexity, severity, and multiplicity of the illnesses that comprise AIDS and the lack of adequate resources to combat the epidemic. AIDS is a paradigm of a medical illness that requires a biopsychosocial approach. Psychiatric sequelae complicate the HIV epidemic, affecting both the uninfected and infected. The psychiatric manifestations of the uninfected include anxiety, phobia, factitious disorder, delusions, and Munchausen's AIDS. Psychiatric disorders associated with HIV infection include organic mental disorders, substance abuse disorder, affective disorders, adjustment disorders, anxiety disorders, and personality disorders. The consultation-liaison (C-L) psychiatrist is in a unique position to clarify and treat the psychiatric complications and to provide leadership for multidisciplinary programs. The biopsychosocial approach enables persons with HIV infection, their loved ones, and caregivers to meet the challenges of the HIV epidemic with compassion, optimism, and dignity.

AIDS Dementia Complex↗
PubMed1991

Psychometric assessment of psychiatric disorders in people with learning difficulties (mental handicap): a review of measures.

Instruments designed to assess psychiatric disorders in people with learning difficulties (mental handicap) were critically reviewed from a psychometric perspective. Major trends were found in the assessment of psychopathology related to DSM-III and depressive disorders although research in other areas was patchy. Although some psychometrically sophisticated measures were identified the area was characterized by an absence of important psychometric data for many measures. Future research should attend to developing assessments of schizophrenia, psycho-sexual disorders, adjustment disorders and the validation of screening procedures and instrument formats. Future studies should include more people with severe and profound learning difficulties.

Humans↗
PubMedDate not supplied

Natural history of symptoms of depression and anxiety during inpatient treatment on general medicine wards.

OBJECTIVE: To establish the frequency of criteria-based depression and anxiety in newly admitted medical inpatients and to determine the natural history of depressive and anxiety symptoms during hospitalization. DESIGN: Prospective structured assessment of criteria-based depression and anxiety diagnoses within 24 hours of hospitalization with routine follow-up depression and anxiety questionnaires until discharge. SETTING: A tertiary care university hospital and an affiliated Veterans Administration hospital. PATIENTS: One hundred twenty-eight adult patients admitted to internal medicine inpatient units between May 1990 and August 1990. MAIN RESULTS: On admission, 43 of the 128 patients inducted met the DSM-III criteria for major depression, while an additional six met the criteria for adjustment disorder with depressed mood. Only six patients met the criteria for panic disorder, generalized anxiety disorder, or adjustment disorder with anxious mood at the time of admission to the study. Patients with high symptom scores on the anxiety and depression scales showed significant decreases in these scores without specific psychiatric intervention. Those who remained in the hospital 20 days or longer showed initial improvement and subsequently returned to baseline symptom levels of depression and anxiety. In approximately 9% of patients, symptoms of depression persisted or worsened. CONCLUSIONS: Major depression occurs more commonly than anxiety disorder in newly admitted medical inpatients but both resolve spontaneously in the majority during the course of hospitalization without specific psychiatric intervention unless the hospitalization is prolonged. One in ten will continue to show symptoms of depression.

Anxiety↗
PubMed1990

Physical contact experience and depression.

Out of a consideration of the relevance of interpersonal physical contact to mental health is developed the hypothesis that unsatisfactory physical contact experience predisposes to depression. This hypothesis is then systematically explored using self-ratings of depression and physical contact (and love) experience obtained on admission and at discharge from 254 unselected psychiatric in-patients. Following the demonstration of a strong association between unsatisfactory physical contact experience and depression a significant relationship is also found between depression and the experience of being not loved. These two relationships are shown to exist independently of one another and when direction of causation is investigated both unsatisfactory physical contact experience and the experience of being not loved are seen to be causal of depression rather than vice versa. Unsatisfactory physical contact experience, however, clearly has the greater utility as an indicator of depression-proneness. Different categories and different kinds of physical contact experience are explored, first in relation to depression generally and then to each of the three major forms of depressive illness. Considered too is the patterning of physical contact experience and love experience for each of these latter. The results suggest that depression generally tends to be more closely linked with stable than unstable unsatisfactory physical contact experience and with present rather than childhood such experience. In addition endogenous depression is seen to be characterised by an absence of any physical contact experience in the present, while manic-depressive psychosis combines unsatisfactory physical contact experience with the experience of being loved and shows a relative lack of exclusively bad physical contact experience in childhood. Reactive depression, however, emerges with no distinguishing features of this kind. There follows an examination of the relationships between unsatisfactory physical contact experience and those psychiatric conditions other than depression represented in the subject sample. This raises the possibility that unsatisfactory physical contact experience could also be closely linked with schizophreniform disorder and adjustment disorder. Finally it is suggested that, above all, physical contact experience may be a major determinant of the capacity to cope with stress. Unsatisfactory such experience might then be predisposing to a wide range of psychiatric disorders, with depression seen as a commonly occurring symptom of inadequate coping.

Adaptation, Psychological↗
PubMed1989

Psychiatric aspects of patients with HIV infection in the general hospital.

The study describes the psychiatric disorders found in 100 HIV-positive patients, in different stages of the illness, at the psychiatric consultation service of a general hospital in Madrid. Eighty-five percent of the sample fell within the intravenous drug addicts risk group, which coincides with the epidemiological characteristics of Spain's HIV-positive population. The most frequently noted psychiatric diagnosis was substance dependence disorder (41%), followed by organic mental disorder (29%), adjustment disorder (15%), and affective disorder (5%). Fifteen percent of the subjects had depressive symptoms, and 11% expressed suicidal ideation. A follow-up conducted on part of the sample showed a development towards dementia, emphasizing diagnostic difficulties in the initial evaluation of these patients.

AIDS Dementia Complex↗