Diagnosis Of Adjustment Disorder Research Articles

Diagnosing adjustment disorder in patients with cancer: evaluation of the adherence, interrater agreement, and content of a guideline-based interview

Abstract Background: The aim of this study was to evaluate the adherence, interrater agreement, and content of a guideline-based semistructured interview for adjustment disorder (AD) in patients with cancer. Methods: In total, 120 AD interviews with patients with cancer were performed by 9 trained psychologists. The interview contained topics related to stressors, resilience, and symptoms and complaints. Audiotaped interviews of 72 patients were available. Adherence to the interview manual was scored by two researchers independently, and the average adherence was calculated per topic. Interrater agreement was calculated using Cohen's Kappa. The content of the interviews was evaluated using thematic analysis of the transcribed interviews of patients with an AD diagnosis. Results: In the interviews, 97% of the topics were covered at least briefly and 78% of all topics were addressed at least adequately. Interviewers asked questions regarding stressors and symptoms and complaints more thoroughly compared with resilience. The interrater agreement regarding the AD diagnosis was moderate (Kappa 0.55). The content analysis showed that stressors and resilience can be additionally specified into physical, psychological, spiritual, and social themes, which are relevant to explore in the context of an AD diagnosis after cancer. Conclusion: The guideline-based interview for AD identifies problems and protective factors with adequate adherence and moderate agreement. A balanced investigation of stressors, resilience, and symptoms is important for optimal clinical decision-making regarding AD in the context of cancer.

The Prevalence and Treatment of Adjustment Disorders Among Children at Outpatient Mental Health Clinics

ABSTRACT Adjustment disorder is commonly diagnosed in children, yet few studies have explored the types of treatment and outcomes for this disorder in routine clinical care. Cognitive-behavioral therapies (CBT) are evidence-based treatments (EBTs) for many mental health disorders but there is limited research evaluating the use of CBT in usual care for children with adjustment disorders. This study used administrative data from a statewide system of outpatient clinics to examine 1) intake differences between children with adjustment disorders and other common diagnoses, 2) how often children with adjustment disorders received CBT, and 3) outcome differences amongst children with adjustment disorders who received CBT, non-cognitive-behavioral EBTs, or no EBT. The sample included 22,353 children ages 3–17 with a primary diagnosis of adjustment disorder, conduct problem, depression, anxiety, or post-traumatic stress disorder. Data were collected as part of routine care, including child demographic characteristics, diagnosis, treatment type, and problem severity and functioning based on the Ohio Scales. Children with adjustment disorders had lower problem severity and higher functioning at intake, and were less likely to receive cognitive-behavioral EBTs than children with other disorders. However, in the subsample of children diagnosed with adjustment disorders (n = 8,966), those who received cognitive-behavioral EBTs improved the most, highlighting the applicability of cognitive-behavioral therapies for children with adjustment disorders.

Assessment of Inpatient Mortality in the Peri-Transplant Period in Elderly Allogeneic Stem Cell Transplant Recipients with Co-Existing Mental Health Illnesses

Background Allogeneic hematopoietic stem cell transplant (alloHCT) is a potentially curative treatment for patients with hematological malignancies and nonmalignant conditions. AlloHCT involves invasive procedures, conditioning chemotherapy regimens, and prolonged isolation during hospitalization, which is physically and emotionally challenging. Transplant related mortality is higher in older individuals. Careful assessment of mortality risk before transplant is essential for optimal patient selection and informed decision-making, especially in elderly patients. Hematopoietic cell transplantation-specific comorbidity index (HCT-CI), an important prognostic scoring tool used in patients before alloHCT, includes psychiatric comorbidity as one of the scoring criteria. Patients with depression or anxiety disorders receive one point on the scoring scale, with the assumption that the two groups of patients are at an equivalent risk. However, there is literature showing decreased overall survival and worse inpatient outcomes in patients receiving alloHCT with co-morbid depression. Our primary objective was to evaluate the inpatient outcomes of elderly patients undergoing allogeneic stem cell transplant with a concurrent diagnosis of depression and patients with anxiety and adjustment disorders. Methods: Patients of ages ≥ 60 years, admitted with a principal procedure code of allogeneic stem cell transplant, were recruited from the 2016-2020 National Inpatient Sample. Three cohorts were created based on ICD-10 diagnostic codes for Depression and Anxiety and adjustment disorders: patients without depression and anxiety disorders, patients with depression only, and patients with anxiety and adjustment disorders only. Patients with diagnoses of other mental illnesses were excluded. The patient characteristics between the three cohorts were evaluated. Multiple Logistic Regression models were used to determine the impact of depression and anxiety disorders on inpatient mortality. Results: We evaluated 11655 hospital admissions with the primary procedure code for Allogeneic Stem Cell Transplant in patients aged 60 years and above. 8375 patients did not have any mental illness. 800 patients (9.5%) had a diagnosis of Depression, and 1640 patients (19.5%) had a diagnosis of Anxiety and adjustment disorders. Comparing the primary outcomes in patients with and without Depression, the length of stay was 31.3 days vs 28.2 days (p<0.01), the mean hospital charge was 558398.01 USD vs 498971.9 USD (p <0.01), and in-patient mortality was 8.1% vs 5.9% (aOR = 1.359, 95% CI 1.010-1.829, p=0.04). Utilization of mechanical ventilation was more prevalent in patients with depression (8.8 %vs 5.8 %, p <0.01). Out of different infectious complications, pneumonia was more common in patients with depression (14.4 % vs 9.8 %, p <0.01) (Table 1a). Baseline socio-demographic characteristics that were associated with having depression included: Female gender, White race, and Medicare insurance. Patients with depression had an increased prevalence of congestive heart failure, prior stroke, Obesity with BMI >= 35, chronic kidney disease, and COPD compared to patients without depression (p<0.01). For the primary outcomes in patients with and without anxiety and adjustment disorders, the length of stay was 29.15 days vs 28.2 days (p <0.01), the mean hospital charge was 474274.71 USD vs 498971.94 USD (p 0.612), and the in-patient mortality was 4% vs 5.9 % (aOR=0.61, 95% CI 0.45-0.83, p<0.01). Baseline socio-demographic characteristics that were prevalent in patients with anxiety and adjustment disorders were: female gender, white race, and Medicare as the most common insurance (P<0.01) (Table 1b). Conclusion We found that in elderly patients admitted for alloHCT, depression was independently associated with worse inpatient outcomes, while anxiety was not. Patients with depression were noted to have an increased incidence of infectious complications as compared to those without depression, possibly accounting for their increased mortality. Prognostic scoring systems like HCT-CI may need to be modified to assign more weight to depression as a psychiatric co-morbidity. Elderly transplant recipients with depressive disorders are a vulnerable group and multidisciplinary teams such as psychiatry and palliative care should be involved in their care.

Meta-analysis of clinical risk factors for suicide among people presenting to emergency departments and general hospitals with suicidal thoughts and behaviours.

Suicidal thoughts and behaviours (STB) are a common reason for presentation to emergency departments and general hospitals. A meta-analysis of the strength of clinical risk factors for subsequent suicide might aid understanding of suicidal behaviour and help suicide prevention. We conducted a meta-analysis of cohort and controlled studies on clinical risk factors and later suicide among people presenting to emergency departments and general hospitals with STB. Data were extracted from papers meeting inclusion criteria, published in Medline, PsycINFO, and Embase between 1 January 1960 and 10 October 2022 using papers located with the search terms ((suicide*).m_titl AND (emergency* OR accident and emergency OR casualty OR general hospital OR toxicology service).mp) or were indexed in PubMed and had titles located with the search terms (suicide* OR self-harm OR self-harm OR self-injury OR self-injury OR self-poisoning OR self-poisoning OR overdose OR para-suicide OR parasuicide [title/abstract]) AND (Emergency department OR emergency room OR Casualty OR general hospital OR toxicology OR accident and emergency [all fields]). Data about the association between clinical risk factors and suicide extracted from three or more studies were included in a random-effects meta-analysis of the odds of later death by suicide. The study was registered in PROSPERO and conducted according to MOOSE and PRISMA guidelines. Seventy-five studies reported on 741,624 people, of which 19,649 died by suicide (2.65%). Male sex (odds ratio (OR) = 1.99) and age (OR = 2.01) were the most consistently reported risk factors. The strongest associations with subsequent death by suicide related to violent self-harm methods at the hospital presentation, including: unspecified violent method (OR = 4.97), any violent method (OR = 4.57) and the specific violent methods of drowning (OR = 4.32), hanging (OR = 4.26), and use of firearms (OR = 10.08). Patients categorised as higher risk using suicide prediction scales or any other method that combined risk factors had moderately increased odds of suicide (OR = 2.58). Younger age, Black and Hispanic ethnicity, overdose, a diagnosis of adjustment disorder, and the absence of any psychiatric diagnosis were protective against suicide. Most risk factors for suicide among people who have presented with STB are not strongly associated with later suicide. The strongest risk factors relate to self-harm methods. In the absence of clear indicators of future suicide, all people presenting with suicidality warrant a thorough assessment of their needs, and further research is needed before we can meaningfully categorise people with STB according to suicide risk.

VA family service access and utilization in a national sample of veterans.

Relationship and family difficulties are common experiences for military veterans, who are able to access family services (i.e., couple and family therapy) through the Veterans Affairs (VA) Healthcare System. This study examines demographic, mental health, military, and referral source variables associated with referral to and utilization of family services using a large national VA dataset of 22,969 veterans who were referred to couple or family therapy from 2016 to 2019. Of those referred, 44.39% had a completed referral; among those who initiated therapy, 31.11% attended five or more sessions. Logistic regression was used to evaluate predictors of completed referrals and of attending five or more sessions of couple or family therapy. Veterans identifying as Black/African American, American Indian or Alaska Native were less likely to have a completed referral than non-Hispanic White veterans; moreover, veterans identifying as Black/African American or Hispanic were less likely to attend five or more sessions. Lower likelihood of a completed referral was also associated with rural county residence, being separated, post-9/11 service era, a substance use disorder diagnosis, and being referred by a psychiatrist, neurologist, physician, or nursing staff rather than a psychologist. Lower likelihood of attending five or more sessions was associated with a delay of 22 or more days to intake, an adjustment disorder diagnosis, and being referred from VA specialty care, or by a psychiatrist or neurologist. These findings may help inform efforts for outreach and service retention within VA family services in order to ensure equity in access to care and healthcare utilization. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Experience of Miscarriage versus Stillbirth: Differences in Fear of Childbirth, Adjustment Disorder, and Optimism

Associations between fear of childbirth (FOC), diagnosis and symptoms of adjustment disorder (AD), and dispositional optimism as a personal resource were compared between women who experienced miscarriage versus stillbirth (N = 204). Severity of AD symptoms was higher among the women following stillbirth Severity of FOC components did not differ between the two groups. No differences were found between the women who experienced miscarriage versus stillbirth in the associations between dispositional optimism and FOC or between dispositional optimism and AD. Healthcare providers should acknowledge that although types of reproductive losses may differ, FOC did not differ following both miscarriage and stillbirth.

Evaluating time-limited and persistent symptoms of adjustment disorder in cancer patients after a colorectal cancer diagnosis: a longitudinal observational study

Abstract Background: Patients with colorectal cancer (CRC) may experience symptoms of adjustment disorder (AD) after cancer diagnosis and treatment. Time-limited symptoms of AD may become persistent if the stressor or its consequences have not disappeared after 6 months, but evidence on the course of AD symptoms is scarce. This longitudinal observational study investigates the proportion of patients with CRC with time-limited and persistent AD symptoms within the first year after diagnosis, in relation to demographic, clinical, and psychological factors and health-related quality of life (HRQoL). Methods: Informed consent was retrieved from 232 participants, and 194 participants completed questionnaires at baseline, 3, 6, and 12 months postdiagnosis. Hospital Anxiety and Depression Scale total scores (HADS-T) were categorized as indication for no symptoms of a mental disorder (MD) (HADS-T ≤10), AD symptoms (HADS-T 11–14), and other MD symptoms (HADS-T ≥15). Symptom subgroups over time were a priori defined: no MD, time-limited AD, persistent AD, other MD, and fluctuating symptoms. Results: Complete data were available for 81 participants (41.4%). Over time, 38.3% had no MD symptoms, 8.6% had time-limited AD symptoms, 1.2% had persistent AD symptoms, 4.9% had other MD symptoms, and 46.9% had fluctuating symptoms. Participants with AD and fluctuating symptoms reported higher fear of cancer recurrence, lower HRQoL, and higher cancer-specific distress than participants without MD symptoms (P < .5). Conclusions: During the first year after CRC diagnosis, only a small proportion of the patients showed time-limited and persistent AD symptoms and most showed fluctuating symptoms. More prospective research is needed to determine how repeated assessments for elevated AD symptoms relate to an AD diagnosis established with a diagnostic interview.

Psychiatric Morbidity Is Common Among Children With Juvenile Idiopathic Arthritis: A National Matched Cohort Study.

Juvenile idiopathic arthritis (JIA) is a chronic rheumatic disease that causes joint inflammation and pain. Previous studies have indicated affected mental health and increased risk of psychiatric conditions among patients with JIA. We aimed to explore differences in psychiatric morbidity between children with JIA and their peers. We further studied if parental socioeconomic status (SES) influences the association between JIA and the risk of psychiatric morbidity. We used a matched cohort design to estimate the association between JIA and psychiatric disease. Children with JIA, born between 1995 and 2014, were identified in Danish national registers. Based on birth registers, we randomly selected 100 age- and sex-matched children per index child. Index date was the date of the fifth JIA diagnosis code or the date of matching for reference children. End of follow-up was the date of psychiatric diagnosis, death, emigration, or December 31, 2018, whatever came first. Data were analyzed using a Cox proportional hazard model. We identified 2086 children with JIA with a mean age at diagnosis of 8.1 years. Children with JIA had a 17% higher instantaneous risk of a psychiatric diagnosis when compared with the reference group, with an adjusted hazard ratio of 1.17 (95% CI 1.02-1.34). Relevant associations were found only for depression and adjustment disorders. Stratifying our analysis for SES showed no modifying effect of SES. Children with JIA had a higher risk of psychiatric diagnoses compared to their peers, especially diagnoses of depression and adjustment disorders. The association between JIA and psychiatric disease did not depend on parental SES.

The impact of COVID-19 on psychiatric clinical encounters among low-income racially-diverse children.

There is a lack of longitudinal data to examine the impact of COVID-19 on all types of clinical encounters among United States, underrepresented BIPOC (Black, Indigenous, and people of color), children. This study aims to examine the changes in all the outpatient clinical encounters during the pandemic compared to the baseline, with particular attention to psychiatric encounters and diagnoses. This study analyzed 3-year (January 2019 to December 2021) longitudinal clinical encounter data from 3,394 children in the Boston Birth Cohort, a US urban, predominantly low-income, Black and Hispanic children. Outcomes of interest were completed outpatient clinical encounters and their modalities (telemedicine vs. in person), including psychiatric care and diagnoses, primary care, emergency department (ED), and developmental and behavioral pediatrics (DBP). The study children's mean (SD) age is 13.9 (4.0) years. Compared to 2019, psychiatric encounters increased by 38% in 2020, most notably for diagnoses of adjustment disorders, depression, and post-traumatic stress disorders (PTSD). In contrast, primary care encounters decreased by 33%, ED encounters decreased by 55%, and DBP care decreased by 16% in 2020. Telemedicine was utilized the most for psychiatric and DBP encounters and the least for primary care encounters in 2020. A remarkable change in 2021 was the return of primary care encounters to the 2019 level, but psychiatric encounters fluctuated with spikes in COVID-19 case numbers. Among this sample of US BIPOC children, compared to the 2019 baseline, psychiatric encounters increased by 38% during 2020, most notably for the new diagnoses of adjustment disorder, depression, and PTSD. The 2021 data showed a full recovery of primary care encounters to the baseline level but psychiatric encounters remained sensitive to the pandemic spikes. The long-term impact of the pandemic on children's mental health warrants further investigation.

Pregnancy-Specific Anxiety Tool (PSAT): Instrument Development and Psychometric Evaluation.

Objective: Pregnancy-specific anxiety (PSA) is a distinct construct from general anxiety and depression. The purpose of this study was to develop, evaluate, and validate the Pregnancy-Specific Anxiety Tool (PSAT), to measure PSA and its severity.Methods: The study was carried out in 2 stages. Stage 1 involved item development and content and face validation. Stage 2 included psychometric evaluation to examine item distributions and correlational structure, dimensionality, internal consistency reliability, stability, and construct, convergent, and criterion validity, using 2 independent samples (initial sample N = 494, May-October 2018; validation sample N = 325, July 2019-May 2020).Results: Eighty-two items were evaluated for face validity and 41 items were considered in stage 2 based on feedback from participants and experts. Model fit from exploratory factor analysis and patterns of item-factor loadings suggested a 6-factor model with 33 items. The 6 factors included items pertaining to health and well-being of the baby, labor and the pregnant person's well-being, postpartum, support, career and finance, and indicators of severity. Confirmatory factor analysis carried out using the initial sample showed good fit with the validation sample. The area under the curve (AUC) for the diagnosis of adjustment disorders (AD) was 0.73 (95% CI, 0.67-0.79), and for AD/any anxiety disorders, the AUC was 0.80 (95% CI, 0.75-0.85).Conclusions: The PSAT can be useful for screening and monitoring of PSA, and pregnant people with scores higher than 10 should be considered for further assessment.

Parents of children who are victims of trauma, allies or adversaries?

Introductiontrauma affects not the child but the whole family. how would the parents’ reaction to trauma influence the child’s resilience capacities?Objectivesstudy the mental health status of parents of children consulting the trauma and resilience unit.MethodsDescriptive and retrospective study of 20 consultants in the trauma and resilience unit at Mongi Slim hospital between January and April 2022. The evaluation of depressive symptoms in children was made by Children's Depression Inventory (CDI). The Hamilton Depression and Anxiety Scales were used to assess anxiety and depressive symptomatology in the parents of the consultants.ResultsThe mean age of the children was 10.46±3.24.The traumatic event was related to an assault in 75% of cases, 45% of which were intrafamilial, road accident and death of a relative in 10% respectively, 5% domestic violence.Five consultants had a CDI score ≥8 and 15 had a score >10. Only parents of children with a CDI score>19 had moderate to severe symptoms according to hamilton scales.The diagnosis of adjustment disorder was made in 45% of cases, post-traumatic stress disorder 20%, acute stress disorder 10% other 15%ConclusionsThe parents’ reaction to the tragedy would play a modulating role on the children’s resilience capacities. less anxious and depressed parents would help their child build his/her coping mecanisms.Disclosure of InterestNone Declared

Initiation of distress screening in oral cancer clinics in SriLanka.

This paper describes the initiation of distress screening in oral cancer clinics, among patients with oral cancer in Sri Lanka, addressing the service gap of lack of psychosocial oncology services. This involved validation of the Sinhala version of the Distress Thermometer (DT) and Problem List (PL) as an adjustment disorder (AD) screening tool. The DT and PL were translated into the Sinhala language and cross-culturally adopted by the "modified Delphi" technique. The judgment validity was obtained through face, content, and consensual validation. The criterion validation of DT was performed among 95 oral cancer patients from two oro-maxillofacial-oncological hospitals in Sri Lanka, against the AD diagnosis of two consultant psychiatrists. The DT and the PL revealed good judgment validity. The optimal cut-off point of DT was 4 with a sensitivity of 91.8% (95% CI=80.8%-96.8%), specificity of 78.3% (95% CI=64.4%-87.7%), positive predictive value of 0.81 (95% CI=0.53%-1.1%) and negative predictive value of 0.90 (95% CI=0.2%-1.7%). The test re-test reliability of DT was excellent (Kappa coefficient 0.894). The area under the curve was 0.843. The PL demonstrated poor internal consistency in practical problems (KD-20=0.4), social problems (KD-20=0.3) and spiritual problems (KD-20=0.6). The Sinhala version of DT and PL were deemed a valid AD screening tool for patients with oral cancer in Sri Lanka to initiate distress screening in busy oral cancer clinics. However, further validation for the full spectrum of distress is needed, preferably with improvements to PL.

Comparison of COVID-19-Related Suicidal Ideation Prevalence in SMI and Non-SMI Psychiatric Populations

This study investigates differences in the prevalence of COVID-19-associated suicidal ideation in individuals with psychiatric diagnoses at opposite ends of the DSM diagnostic severity spectrum. These opposite poles were represented by Adjustment Disorder (AjD) at one end and disorders categorized as Serious Mental Illness (SMI) at the other. The study hypothesized that persons with SMI disorders would be more likely to report Covid-19-related suicidal ideation compared to individuals with non-SMI disorders. Methods: An observational, cross-sectional model was used to collect data from new client intake forms completed between April 2020 and December 2020. Participants were 24 male and 26 female U.S. citizens (mean age = 32) diagnosed with either SMI or Adjustment Disorder. COVID- related suicidal ideation was assessed by a licensed behavioral health professional during the initial 50-minute client intake interview. Clients were placed in one of two categories: ‘suicidal ideation reported’ or ‘suicidal ideation denied’. Results: A total of 5 (18.5%) of the 27 patients diagnosed with serious mental illness reported COVID-19-associated suicidal ideation compared to only one (4.3%) of the 23 patients with a diagnosis of Adjustment Disorder. Due to the small sample of patients with suicidal ideation, a Fisher's exact test was required in lieu of a chi-square test. The difference was not statistically significant (p = .199). Conclusion: The results of this current study are best considered inconclusive. The fact that persons in the SMI group were 4.3 times more likely to report suicidal ideation compared to persons in the Adjustment Disorder group, yet this difference did not meet statistical significance is discussed. An alternate explanation is offered that the sample size was too small for statistical significance to be accurately measured. The need for the study to be replicated using a larger sample size is discussed and recommended.

Examining Mental Health Disorders in Overweight and Obese Pediatric Patients

We investigated the frequency and variation in three mental health diagnoses among obese or overweight children and adolescents. Logistic regression was used to examine the association between the outcome variables-anxiety, depression, and adjustment disorders-with the following covariates: overweight/obesity status, sex, age, and race. Findings show anxiety, depressive, and adjustment disorder diagnoses were significantly higher for overweight or obese youth in our sample. In addition, diagnosis rates for one or more of these disorders increase as children grow into adolescence. Furthermore, we found significantly higher rates of depression and significantly lower rates of anxiety among youth who live in places with higher rates of poverty. Findings indicate a target age for providers to focus on mental health screening among overweight/obese patients: (1) early adolescence (aged 11-14 years) for depressive and adjustment disorders and (2) early childhood (aged 2-4 years) for anxiety disorder.

The utilization of a three‐dimensional interactive virtual dissection model as an alternative approach in the education of post‐traumatic stress students

Human gross anatomy has evolved as the central course in the curriculum of first year Allied health students. Cadaveric dissection is the primary teaching modality of this course. Traditional teaching methods of dissection, prosection, tutorials and lectures are now supplemented by anatomical models and e‐learning. Although the traditional approach in anatomy instruction provides students with a comprehensive understanding of the three‐dimensional organization of the human body, the cadaveric approach in anatomy education fails to appreciate the profound psychological effects on students with existing psychological disorders. This case report is a presentation of a psychological effect of a cadaveric approach on a post‐traumatic stress disorder (PTSD) student. In this case study, we used a student who served in the United States Army in Afghanistan and was given an honorable discharge due to diagnosis of tinnitus and adjustment disorder. The student was also assigned a disability rating of 40%. This student was diagnosed as PTSD due to exposure of a high‐stress environment. The cadaveric approach to the student’s anatomy education only exacerbated his condition, triggering his stress disorder. Beside this, since the student had a history of losing a relative due to colon cancer, this made abdominal dissection difficult to perform. We considered an alternative approach to accommodate the student, while still maintaining the sufficiency needed to provide the standard of education for a health sciences student. The virtual approach of cadaveric dissections, with benefits impossible for a traditional dissection, also strives to provide students with the opportunity to improve the understanding of the three‐dimensional and spatial relationships of human gross anatomy. This case is presented to those who teach anatomy to identify this modality of education as an alternative approach to sufficient and comprehensive anatomy education.

New mental health diagnoses in parents of infants admitted to a neonatal intensive care unit-a retrospective review of the Military Health System database.

Studies suggest that parents of NICU infants are at increased risk of mental health disorders. We sought to characterize this risk using a large database. The Military Health System was used to retrospectively link records between parents and infants admitted to a NICU over 5 years and were matched to similar families without NICU exposure. The total study population included 35,012 infants. Logistic regression was used to estimate the association between NICU exposure and parental mental health diagnoses within 5 years of infant birth. Maternal NICU exposure was associated with incident diagnoses of depression (OR: 1.18-1.27, p < 0.0001), anxiety (OR: 1.06-1.18, p = 0.0151), alcohol/opiate dependence (OR: 1.29-1.52, p = 0.0079), and adjustment disorder (OR: 0.97-1.18, p = 0.0224). Paternal NICU exposure was associated with alcohol/opiate dependence (OR: 0.78-1.42, p = 0.0339). Parents of NICU infants are at risk of developing mental health disorders. Future work should identify characteristics that predict highest risk to develop effective interventions.

The Network Structure of ICD-11 Disorders Specifically Associated with Stress: Adjustment Disorder, Prolonged Grief Disorder, Posttraumatic Stress Disorder, and Complex Posttraumatic Stress Disorder

Introduction: The ICD-11 includes a new grouping for “disorders specifically associated with stress” that contains revised descriptions of posttraumatic stress disorder (PTSD) and adjustment disorder (AjD) and new diagnoses in the form of complex PTSD (CPTSD) and prolonged grief disorder (PGD). These disorders are similar in that they each require a life event for the diagnosis; however, they have not yet been assessed together for validity within the same sample. We set out to test the distinctiveness of the four main ICD-11 stress disorders using a network analysis approach. Methods: A population-based, cross-sectional design. A nationally representative sample of adults from the Republic of Ireland aged 18 years and older (N = 1,020) completed standardized measures of PTSD, CPTSD, AjD, and PGD. A network analysis was conducted at the symptom level. Outcome measures included the International Trauma Questionnaire, the Inventory of Complicated Grief, and the International Adjustment Disorder Questionnaire. Results: Consistent with the taxonomic structure of the ICD-11, our results showed that although the four conditions clustered independently at the disorder level, the specific symptoms of PTSD, CPTSD, PGD, and AjD clustered together very strongly but more strongly than with symptoms of the other disorders. The majority (61%) of the variation in each symptom could be explained by its neighboring symptoms. The strongest transdiagnostically connecting symptom was “startle response.” Discussion/Conclusion: Mental health professionals caring for people who have experienced a range of stressors and traumatic life events can be confident in diagnosing these conditions that have clear diagnostic boundaries. Interventions addressing stress-associated disorders should be based on diagnostic assessment to ensure close fit between symptoms and treatment.

When Is Being Sad on the Burn Unit Pathological? Differential Diagnosis of Demoralization, Adjustment Disorder and Major Depressive Disorder in Burn Survivors

Many burn survivors have pre-existing psychiatric conditions or develop psychological or psychiatric symptoms over the course of their hospital stay. Patients often present with low mood and neurovegetative symptoms which can be conceptualized as demoralization, adjustment disorder, or major depressive disorder. We review the literature on these syndromes in burn survivors and present three cases that highlight the continuum of these syndromes for patients who present with symptoms of depression following a burn injury. We discuss the clinical challenges of differentiating these syndromes as well as psychotherapeutic and psychopharmacologic considerations and recommendations.

Correlations between Psychiatric Symptoms and Quality of Life in Patients with Psychological Disorders: Hospital-Based Retrospective Study

Little research has been conducted on the relationship between the five-item Brief Symptom Rating Scale (BSRS-5) and quality of life in patients with mood disorders. The purpose of this study was to investigate potential effects of psychological symptoms on quality of life in patients with psychological disorders. We recruited 124 patients with psychological disorders from a psychological teaching hospital in northern Taiwan. Data were obtained from medical records of all patients with a diagnosis of mood or adjustment disorder. We assessed psychological symptoms on the BSRS-5 and examined quality of life by using the Taiwanese version of the abbreviated World Health Organization Quality of Life Questionnaire (WHOQOL-BREF). We performed hierarchical linear regression analysis to explore the relationship between psychological symptoms and quality of life. The analysis revealed a significant correlation between the items on the BSRS-5 and WHOQOL and their correlations with the total scores on these assessments (p < 0.01 and p < 0.05). Our findings indicated that scores on the BSRS-5 can predict scores on quality of life. This suggests that psychometrically measured psychological symptoms constitute critical determinants of quality of life.

INABILITY TO CONTROL RECURRING AGGRESSIVE IMPULSES: PSYCHOLOGICAL MANAGEMENT. A CASE REPORT

Background: Intermittent explosive disorder is recurrent behavioral outburst with failure to control aggressive impulses. A case of intermittent explosive disorder with differential diagnosis of Adjustment disorder and Borderline Personality traits. Mental Status Examination reflected guilt, regret and distress due to inability to control anger followed by aggressive action. Millon Clinical Multiaxial Inventory III (MCMI-III) and Rorschach Ink Blot Test were used for psychological evaluation. Assessments results indicates traits of lower stress tolerance, feels uncomfortable about her ability to deal adequately with negative feelings and often have problems modulating her own affective displays and impulsive. Methodology: A re-educative approach of treatment was planned with short term goals to increase awareness of anger, avoidance and escape, managing physical arousal, relaxation skill development. The long term goals were focused on cognitive restructuring, assertive training, self-instructional and self-regulation training. Treatment Outcome: After psychological management, patient reported more satisfied and better aware of physiological arousal when angry, use distraction technique when required and regulate anger. There was improvement in daily functioning, coping and problem solving and in relationship with his parents and peer. Future plan is focused on providing Neurofeedback training to enhance her self-regulation. Implication and Recommendation: In cases like Intermitted explosive disorder and other conditions of Impulse control disorder, along with psychotherapy or pharmacotherapy, effect of neurofeedback training could be explored.