Treatment Of Adjustment Disorders Research Articles

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.

Treatment of adjustment disorders in mental health crisis care: a reflective case study

Clinical decision-making is an integral part of the nursing process, as well as a study requirement at Master's level for the advanced professional practice pathway. This article uses Gibbs' reflective cycle as a framework to explore a clinical decision made in practice. Through presentation of a case study of a patient with an adjustment disorder, the authors explore the process of prescribing appropriate treatment in the context of an uncertain evidence base. The authors will examine decision-making and communication theories and consider any biases, as well as ethical, organisational and professional factors that may influence the decision-making process. The individual and organisational steps needed to embed robust decision-making into practice will be discussed.

Treatment of adjustment disorders in mental health crisis care: a reflective case study

Clinical decision-making is an integral part of the nursing process, as well as a study requirement at Master's level for the advanced professional practice pathway. This article uses Gibbs' reflective cycle as a framework to explore a clinical decision made in practice. Through presentation of a case study of a patient with an adjustment disorder, the authors explore the process of prescribing appropriate treatment in the context of an uncertain evidence base. The authors will examine decision-making and communication theories and consider any biases, as well as ethical, organisational and professional factors that may influence the decision-making process. The individual and organisational steps needed to embed robust decision-making into practice will be discussed.

Management of Psychiatric Disorders with HIV and Dermatological Disorders.

Management of Psychiatric Disorders with HIV and Dermatological Disorders.

Clinical features of asthenia in the context of adjustment disorders

To study asthenic symptoms in patients with adjustment disorders and to assess the efficacy of cytoflavin in their treatment. The study included 100 patients, aged 20 to 43 years, with a diagnosis of adjustment disorder. Clinical, neurophysiological and parametric methods were used. An asthenic state scale, the Multidimensional Fatigue Inventory (MFI-20), a digital rating scale (a 10-point variant) and the Headache Impact Test (HIT-6), the Psychological Stress Measure (PSM-25), the Cognitive Emotion Regulation Questionnaire, the Test of Variables of Attention (TOVA) were administered. Cytoflavin was used in a dose of 2 tab. 2 times a day for 25 days for the treatment of patients from the study group. In the study group, 48.0% of patients had a pronounced degree of asthenia, and 52% had a moderate one. The clinical improvement was achieved in 73.0%. In the subgroup with moderate asthenia, the improvement was recorded in 88.5% of cases, in the subgroup of patients with severe asthenia in 56.3% of patients. There was a significant decrease in the severity of indicators on the scales of general asthenia, decreased activity and mental asthenia; a significant decrease in the integral indicator of mental tension, a significant improvement in the indicator of attention, a decrease in the frequency and intensity of headache. The improvement in the functional state of the brain in the form of a decrease in the power of the alpha rhythm in the anterior cerebral cortex was shown. The results of the study allow us to conclude that the use of cytoflavin is effective in the treatment of adjustment disorders.

Diagnóstico y tratamiento del trastorno de adaptación en Atención Primaria

Adjustment disorder (AD) corresponds to the combination of affective, cognitive and behavioral symptoms that appear after a stressful event. It is a frequent reason for consultation in primary care and is one of the most common diagnoses in suicide attempts attended in the emergency department. Its essential feature is that the symptoms must appear in direct relation to an event perceived as stressful, so it tends to be transitory if the event ceases or the patient adapts. The mainstay of treatment are psychosocial interventions, aimed at modifying the event or its consequences, supporting adaptation and optimizing resources to cope with the event. However, prescription of psychotropic drugs is favored in practice, when its use should be limited to symptomatic relief. This highlights the need to properly identify and treat it. This article presents the strategies for diagnosis and treatment of AD in primary care.

Can Between-Session Homework Be Delivered Digitally? A Pilot Randomized Clinical Trial of CBT for Adjustment Disorders.

Adjustment disorder (AjD) is one of the most common disorders in clinical practice, and its symptoms are severe enough to cause great distress and functional impairment. The AjD CBT protocol specifically developed for this disorder has shown positive results when delivered face to face and through virtual reality. Despite existing evidence supporting the benefits of therapeutic homework as part of a psychological intervention, little is known about how to increase homework engagement in psychotherapy. This study examines the feasibility (doability, initial efficacy and acceptability) of a digital support system to deliver homework via the Internet in the treatment of AjD. Participants were randomly assigned to a traditional homework condition or a digital support system condition. Both interventions resulted in statistically significant improvements, with large effect sizes, in all the outcome measures at post-treatment, with no significant differences between groups. At 12-month follow-up, these therapeutic gains were maintained, and an improvement was even observed in both conditions, with no significant differences between groups. Additionally, treatment satisfaction predicted efficacy in both groups separately and when the whole group was considered. This is the first study to explore the feasibility an initial efficacy of delivering a therapeutic homework component for AjD through the Internet.

A Systematic Review of Psychological and Pharmacological Treatments for Adjustment Disorder in Adults.

Adjustment disorder is a common psychiatric disorder, yet knowledge of the efficacious treatments for adjustment disorder is limited. In this systematic review, we aimed to examine psychological and pharmacological interventions that target adjustment disorder in adults to determine which interventions have the best evidence for improving adjustment disorder symptoms. We performed database searches for literature published between January 1980 and September 2016 and identified studies that included both a sample majority of individuals diagnosed with adjustment disorder and findings on adjustment disorder symptom outcomes. There were 29 studies that met the inclusion criteria for qualitative synthesis; the majority of studies (59%) investigated psychological therapies rather than pharmacological treatments (35%). The range of psychological therapies tested was diverse, with the majority containing cognitive behavioral therapy (CBT) components (53%), followed by three studies that were psychodynamic-related, three studies that were behavioral therapy-based, and two studies that involved relaxation techniques. We rated individual studies using a modified National Health and Medical Research Council quality and bias checklist and then used the Grading of Recommendations Assessment, Development and Evaluation (GRADE; Grade Working Group, 2004) system to rate the overall quality of the evidence. Despite several randomized controlled trials, the quality of the evidence for positive effects of all psychological and pharmacological treatments on symptoms of adjustment disorder was ranked as low to very low. Future high-quality research in the treatment of adjustment disorder has the potential to make a significant difference to individuals who struggle to recover after stressful events.

The effectiveness of selank in the treatment of adjustment disorder

Background Adjustment disorder (AD) is one of the most common mental disorders. Considering the social and economic situation in Ukraine at present, in almost 50% of the population, there are non-psychotic mental health disorders, and this number tends to increase. Individual risk factors that are particularly important for the AD development include the experience of a significant stress in childhood, problems with mental health in the past, difficult life circumstances, etc. At the same time, pathogenetically approaches to AD therapy are not fully understood. Pathogenetically oriented therapy of AD should be based on neurotransmitter causes and systemic therapeutic approach. The neurometabolic, anxiolytic, and psycho-stimulating action of the regulatory peptide allows it to be used in the therapy of psychogenic adaptation disorders. Methods Clinical manifestations of the AD were studied in different age groups - 21-34 years (n=153), 35-50 years (n=257), 51-65 years (n=167) using the Patient Health Questionnaire (PHQ) and Questionnaire of Stress Resistance (QSR). For the study on the effectiveness of the selank (a synthetic analogue of the immunomodulatory peptide tuftsin) were included 30 patients with the AD. Main (experimental group) received selank for two weeks; the control group didn’t receive any treatment (wait list). Patients were monitored for additional two weeks after the treatment with an assessment at the end of follow-up. Results According to the study results, selank significantly reduced PHQ score in patients with AD compared to control group. PHQ scores in the selank group after 2 weeks of follow-up were significantly lower for somatic symptoms (mean score 1.2 vs. 3.6; p<0.05), nutritional problems (0.1 vs. 3.4; p<0.05), and alcohol misuses (0.3 vs. 1.5; p<0.05). Conclusion The use of the synthetic analogue of the immunomodulatory peptide tuftsin has a therapeutic effect on the somatic and mental symptoms of the adjustment disorder.

Using Symbolic-Experiential Family Therapy to Treat Adjustment Disorder: A Case Study

ABSTRACTDespite studies claiming Adjustment Disorders (AD) affect up to 10% of the general population, research is severely lacking for effective treatment recommendations and screening tools. This article presents the treatment of a 30-year old Caucasian male diagnosed with AD - mixed anxiety and depression subtype. After 12 standard 60-minute sessions, treatment using a Symbolic-Experiential Family Therapy (SEFT) approach resulted in the alleviation of depression and anxiety symptoms. This case study provides preliminary evidence for the effectiveness of SEFT using a mixed methods case study. Implications for further study, and the usefulness of SEFT for the treatment of AD, is presented.

Review: Management of Adjustment Disorder in the Deployed Setting

Adjustment disorder is a maladaptive response to a stressor that causes functional impairment. The contribution of deployment stress on the diagnosis and treatment of adjustment disorder has not been previously explored. Despite the high cost and commonality of adjustment disorder as a behavioral health condition diagnosed during deployment, there are few clinical trials and no standardized recommendations found in this review related to treatment of military service members in the deployed setting. This manuscript reviews the best practices for adjustment disorder management and applies these principles to create clinical guidelines and an algorithm for treatment in the deployed setting.

Adjustment disorders in primary care: prevalence, recognition and use of services

Within the ICD and DSM review processes there is growing debate on the future classification and status of adjustment disorders, even though evidence on this clinical entity is scant, particularly outside specialised care. To estimate the prevalence of adjustment disorders in primary care; to explore whether there are differences between primary care patients with adjustment disorders and those with other mental disorders; and to describe the recognition and treatment of adjustment disorders by general practitioners (GPs). Participants were drawn from a cross-sectional survey of a representative sample of 3815 patients from 77 primary healthcare centres in Catalonia. The prevalence of current adjustment disorders and subtypes were assessed face to face using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). Multilevel logistic regressions were conducted to assess differences between adjustment disorders and other mental disorders. Recognition and treatment of adjustment disorders by GPs were assessed through a review of patients' computerised clinical histories. The prevalence of adjustment disorders was 2.94%. Patients with adjustment disorders had higher mental quality-of-life scores than patients with major depressive disorder but lower than patients without mental disorder. Self-perceived stress was also higher in adjustment disorders compared with those with anxiety disorders and those without mental disorder. Recognition of adjustment disorders by GPs was low: only 2 of the 110 cases identified using the SCID-I were detected by the GP. Among those with adjustment disorders, 37% had at least one psychotropic prescription. Adjustment disorder shows a distinct profile as an intermediate category between no mental disorder and affective disorders (depression and anxiety disorders).

The Effectiveness of Brief Versus Intermediate Duration Psychodynamic Psychotherapy in the Treatment of Adjustment Disorder

Treatment studies and particularly psychotherapeutic treatment studies of patients suffering from an adjustment disorder are very scarce, leading to insufficient evidence regarding the efficacy of treatment in this population. Whereas timely psychotherapy is known to be of benefit in the treatment of adjustment disorders, the ideal duration of psychotherapeutic interventions is not known. This study examined whether a brief 12-session focused psychodynamic psychotherapy may be as efficient as a longer intermediate-term (1 year) psychodynamic psychotherapy in treating patients suffering from an adjustment disorder. Subjects (n = 66) were randomly assigned to either brief or intermediate psychotherapy. They were assessed by self-report measures and clinician’s evaluation at baseline, end of therapy, and 9 months after therapy was terminated. The results showed a good overall improvement in the whole group. Furthermore, brief psychotherapy was found to be as good as intermediate psychotherapy both at the end of treatment and at follow-up. Although our study was not designed to confirm the efficacy of dynamic psychotherapy in the treatment of adjustment disorders, our results suggest that brief interventions may be good enough in adjustment disorder, thus allowing treatment of a greater number of patients without compromising for the quality and suitability of treatment.

Usefulness of pharmacist‐assisted screening and psychiatric referral program for outpatients with cancer undergoing chemotherapy

Major depressive disorder (MDD) and adjustment disorder (AD) are common psychiatric disorders in cancer patients but are often overlooked in clinical oncology settings. We introduced a clinical screening program utilizing the Distress and Impact Thermometer (DIT) to identify MDD and AD in cancer outpatients receiving chemotherapy. This study assessed the usefulness of the screening program. Pharmacists administered the DIT to consecutive patients undergoing chemotherapy at an outpatient clinic. Psychiatric treatment was recommended to all the patients with positive screening results. The proportion of patients referred to the Psychiatric Service during the program period was then compared with that during a usual care period. Of the 520 patients who started chemotherapy during the 6-month program period, 5.0% (26/520) were referred to the Psychiatric Service and 2.7% (15/520) were diagnosed as having MDD or AD. No statistically significant difference in the referral rates was observed between the two periods (2.7 vs 1.0%, p = 0.46). However, the period from the first chemotherapy treatment until the visit to the Psychiatric Service was significantly shorter during the program period than during the period of usual care (12.9±13.2 days vs 55.6±17.6 days, p<0.001). The proportion of patients referred to the Psychiatric Service for the treatment of MDD or AD during the program period was not different from that during the usual care period. However, the program was useful for introducing psychiatric treatment at an earlier stage. Further modifications to the program to improve the referral rate are necessary.

A Social Work Perspective on the Adjustment Disorders

The adjustment disorders are controversial DSM diagnoses because of their relative lack of diagnostic validity and reliability. Many social workers feel relatively comfortable using these diagnoses, however, because they acknowledge a client's problematic reaction to environmental stress rather than assuming an internal functioning deficit. There is relatively little professional literature about the nature and treatment of adjustment disorders. The purposes of this article are to explore their suitability as clinical diagnoses, and to provide, through two case illustrations, intervention guidelines for social workers.

W01-01 Training workshop: cognitive psychotherapy and wisdom strategies in the treatment of adjustment disorders

The goal of this training workshop is to give an introduction in recent developments of wisdom psychology and their bearing for cognitive psychotherapy of adjustment disorders.Negative life events like divorce, dead of a beloved one, job loss etc. require enhanced coping. If this is not sufficient it can result in adjustment or other mental disorders. One factor which often contributes to pathological developments in the context of negative life events is embitterment because of the feeling of having been treated unfair, been let down or been humiliated. If embitterment is present then there is a tendency not to recover spontaneously but rather to take a chronic course.There is a new approach in the treatment for such adjustment disorders which is based on recent developments in wisdom psychology. Wisdom has been defined as the capacity to cope with unsolvable and serious problems and questions in life. It has been shown:a.that persons who are not successful in coping with negaive life events lack wisdom capacities,b.that wisdom capacities can be trained, andc.that cognitive treatment which uses wisdom strategies is helpful in the treatment of adjustment disorders and especially those with prolonged embitterment reactions.This training workshop will:•inform about the clincial features of adjustment disorders and especially posttraumatic embitterment disorders;•give an introduction in recent developments of wisdom psychology;•teach the esentials of wisdom psychotherapy.

Psycho-Oncology: A Review for the General Psychiatrist

This article provides an overview of psycho-oncology, including epidemiology of common psychiatric conditions in cancer, effects of cancer and chemotherapy on the brain, and effects of coping styles and other psychosocial factors on cancer treatment. It describes the assessment, differential diagnosis, and treatment of adjustment disorders, anxiety, depression, delirium, chemotherapy- and radiotherapy-induced cognitive dysfunction, character disorders, substance disorders, and major mental illness in oncology patients. Survivorship and bereavement are addressed, as are future directions for this growing field.

It is too early for adjusting the adjustment disorder category

Despite the relative frequency with which the diagnosis of adjustment disorder is made, there is a very limited research literature in regard to its cause, epidemiology and treatment. This review summarizes recent papers and findings in relation to this diagnostic category. The conceptual underpinnings of the diagnosis adjustment disorder is the subject of ongoing debate as is its differentiation from other psychiatric disorders such as depressive disorders. One group has proposed and tested a diagnostic model of adjustment disorder as a stress-response syndrome, related to posttraumatic stress disorder, which is a distinct psychopathological entity rather than a diagnosis of exclusion. Initial neuroimaging work in adjustment disorder indicates that this may be a helpful approach for increasing understanding of the biology of the disorder. Recent studies support the use of brief psychotherapy in the treatment of adjustment disorder. Although the studies and articles described in this review raise some interesting questions in relation to the diagnosis, cause, epidemiology and treatment of adjustment disorder, much more research is needed before we can draw some firm conclusions about the need for the redefinition and reclassification of this diagnostic category.

Bupropion in the treatment of adjustment disorder

Bupropion in the treatment of adjustment disorder

Étifoxine : pharmacologie comportementale

Etifoxine, a benzodiazepine anxiolytic, exerts an autonomic regulatory activity. Two clinical studies have shown that etifoxine is effective in the treatment of adjustment disorder with anxiety. In view of the diversity of disorders associated with anxiety, with or without various autonomic manifestations, we were interested in the behavioural effects of etifoxine in animal models, particularly when animals exposed to stressful stimuli exhibit exaggerated autonomic signs other than those of cardiovascular origin. The effects of etifoxine were first evaluated in a stress-induced hyperthermia model in the rat. Manipulation of this animal causes an elevation of rectal temperature corresponding to a state of anticipatory anxiety. Again in the rat, etifoxine was evaluated in a conditioned fear test during which a more stressful stimulus constituted by the presentation of unavoidable, unpleasant electric shocks was applied. Behavioural blockade or freezing in response to this stress and the amplitude of colonic motor activity quantified by recording myoelectrical activity were measured. Subsequently, given the importance of the role played by corticoliberin or CRF, a hypothalamic neurohormone and/or neurotransmitter, in the co-ordination and mediation of autonomic responses to stress, we used a mouse model in which intracerebral administration of CRF mimics a major stress state, evidenced by a reduction in gastric emptying of a solid meal. The effects of etifoxine were evaluated in this model. A benzodiazepine (bromazepam or diazepam) was chosen as a positive control in each experiment. The elevation of rectal temperature following manipulation is significantly reduced in the presence of etifoxine (50 mg/kg). Likewise, etifoxine significantly and dose-dependently (12.5-50 mg/kg) reduces the duration of behavioural blockade or freezing following the application of unavoidable electric shocks. At the same time, the same stimulus causes an increase in the number of myoelectrical signals in the colon, which are significantly reduced by etifoxine. In the mouse, centrally administered CRF (0.35 μg/animal) reduces gastric emptying of a solid meal. This effect of CRF is dose-dependently antagonised by etifoxine. This series of results shows that etifoxine reduces the amplitude of autonomic manifestations in response to a stressful stimulus of variable intensity, such as hyperthermia, increased colonic motor activity or reduced gastric emptying. The anxiolytic properties of etifoxine are therefore exerted on both the behavioural and the autonomic aspects. These results provide a basis for evaluating this drug in anxious patients in whom autonomic nervous system manifestations constitute pathological symptoms.