Adjustment disorder

F43.2 Adjustment disorders. 20 Brief depressive reaction. 21 Prolonged depressive reaction. 22 Mixed anxiety and depressive reaction. 23 With predominant disturbance of other emotions. 24 With predominant disturbance of conduct. 25 With mixed disturbance of emotions and conduct. 28 With other specified predominant symptoms... 

Panic disorder Agoraphobia with panic disorder Agoraphobia without panic disorder Specific phobia Social phobia Generalised anxiety disorder Mild anxiety and depression disorder Obsessive compulsive disorder Acute stress disorder Post-traumatic stress disorder (PTSD) Adjustment disorder Panic disorder without agoraphobia Panic disorder with agoraphobia Agoraphobia Specific phobia Social phobia (also called social anxiety disorder) Generalised anxiety disorder Obsessive compulsive disorder Acute stress disorder Post-traumatic stress disorder (PTSD)... 

Bourin M, Bougerol T, Guitton B, Broutin E. (1997). A combination of plant extracts in the treatment of outpatients with adjustment disorder with anxious mood controlled study versus placebo. Fundam Clin Pharmacol. 11(2) 127-32. 

When is medication indicated in the treatment of psychiatric illness There is no short answer to this question. At one end of the continuum, patients with schizophrenia and other psychotic disorders, bipolar disorder, and severe major depressive disorder should always be considered candidates for pharmacotherapy, and neglecting to use medication, or at least discuss the use of medication with these patients, fails to adhere to the current standard of mental health care. Less severe depressive disorders, many anxiety disorders, and binge eating disorders can respond to psychotherapy and/or pharmacotherapy, and different therapies can target distinct symptom complexes in these situations. Finally, at the opposite end of the spectrum, adjustment disorders, specific phobias, or grief reactions should generally be treated with psychotherapy alone. 

The differential diagnosis of depression is organized along both symptomatic and causative lines. Symptomatically, major depression is differentiated from other disorders by its clinical presentation or its long-term history. This is, of course, the primary means of distinguishing psychiatric disorders in DSM-1V. The symptomatic differential of major depression includes other mood disorders such as dysthymic disorder and bipolar disorder, other disorders that frequently manifest depressed mood including schizoaffective disorder, schizophrenia, dementia, adjustment disorder, and post-traumatic stress disorder, and, finally, other nonpsychiatric conditions that resemble depression such as bereavement and medical illnesses like cancer or AIDS. 

Adjustment Disorder. Like PTSD, an adjustment disorder is a maladaptive... 

The analyses reviewed thus far are all observational studies using econometric procedures. In contrast, Kravitz et al. (2005) examined prescribing behavior of antidepressant drugs in a randomized controlled trial setting. Mostly professional actors, middle-aged, white, nonobese women, called standardized patients, were trained to depict to physicians two types of patients with differing severity of symptoms one with symptoms of major depression of moderate severity, and the other having an adjustment disorder with depressed mood. 

Primary care physicians were recruited in four physician networks by mail with telephone follow-up, and were told only that the study would involve seeing two standardized patients several months apart, that each patient would present with a combination of common symptoms, and that the purpose of the study was to assess social influences on practice and the competing demands of primary care. The physician visits were surreptitiously audiotaped. Eighteen standardized patients completed a total of 149 encounters presenting with major depressive disorder, and another 149 with adjustment disorder, with each split approximately evenly among the three patient request types. 

Antidepressant prescribing was less common (34%) when standardized patients presented with adjustment disorder symptoms. However, here the role of brand-specific DTCA was more powerful. Physicians prescribed an antidepressant for 55% of patient encounters involving a brand-specific... 

Using a different set of statistical procedures, Kravitz et al. (2005) found that prescribing an antidepressant drug was 2.92 times more likely when a standardized patient presented with major depressive rather than adjustment disorder symptoms, and 8.50 and 10.3 times more likely when the patient made a brand-specihc or a general medication request, relative to no specific medication request, respectively. Physicians varied systematically in their propensity to prescribe an antidepressant, regardless of the type of patient presenting. But none of the standardized patients was systematically more or less likely than other patients to receive an antidepressant drug prescription. 

Approximately three-quarters of children with OCD have comorbid diagnoses. These include tic disorders (24%-30%) and mood disorders, especially major depression (26%-29%). Riddle and colleagues (1990) found that 38% of children with OCD have other anxiety disorders, while Swedo (1989) more specifically identified increased rates of simple phobias (17%), overanxious disorder (16%), and separation anxiety disorder (7%). Other reported comorbidities include specific developmental disabilities, adjustment disorder with depressed mood, oppositional defiant disorder, attention-deficit hyperactivity disorder (ADHD), conduct disorder, and enuresis/encopresis (Swedo et ah, 1989b Riddle et ah, 1990). 

A typical example of diagnostic splintering provides the group of mood disorders. One reads about major depression, minor depression, double depression, dysthymia, unipolar and bipolar depression, depressive personality, depression not otherwise specified, brief recurrent depression, subsyndromal symptomatic depression, mixed anxiety depression disorder, seasonal depression, and adjustment disorder with depressive mood. 

Adjustment disorder with anxious mood (characterized by lack of full symptom criteria for GAD and the presence of a recognized psychosocial stressor)... 

The most common diagnosis given to these patients is an adjustment disorder with mixed emotional features however, one must always be cognizant of the potential for an underlying, but as yet unrecognized, organic process. The typical neuropsychiatric complications can be divided into four major categories ... 

Reactive depressive syndromes, including adjustment disorders... 

Using benzodiazepines to treat anxiety requires knowledge of how to balance the risks of these agents rationally against their benefits and to compare this with other available therapeutic interventions. For short-term anxiety-related conditions, such as an adjustment disorder with onset after a stressful life event, benzodiazepines can provide rapid relief with little risk of dependence or withdrawal if use is limited to several weeks to a few months. However, for conditions likely to require treatment... 

Insomnia may also be classified according to its duration as a symptom. Thus, transient insomnia occurs in normal sleepers who have traveled to another time zone (jet lag), who are sleeping in an unfamiliar surrounding, or who are under acute situational stress. Often treatment is not required, and insomnia is reversed with time alone. Short-term insomnia can be experienced by one who is generally a normal sleeper but is under a stress that does not resolve within a few days, such as divorce, bankruptcy, or a lawsuit. Such individuals may not meet the criteria for a psychiatric disorder other than an adjustment disorder and yet may require short-term symptomatic relief of their insomnia in order to function optimally. 

In addition, Nakao et al. have examined the effects of mood states on persistent versus temporary hypercholesterolemia in students entering a university [29]. They found that depressive mood appeared to relate to hypercholesterolemia when the university students were screened with tension-anxiety, depression, anger-hostility, vigor, fatigue, and confusion scales [29]. In children, after covariance adjustment for age, race, and sex, Glueck et al. pointed out that children having adjustment disorders with depression had much lower covariance-adjusted TC values than control... 

Social phobia Posttraumatic stress disorder Obsessive-compulsive disorder Adjustment disorder with anxious features Acute stress disorder... 

If symptoms of despair and hopelessness are sufficiently severe, an additional diagnosis of major depressive disorder may be warranted. If the symptom pattern does not meet criteria for ASD, however, a diagnosis of adjustment disorder should be considered in lieu of PTSD. 

Many types of psychiatric disorders can be seen in the aftermath of a disaster. One of the most common is PTSD others include adjustment disorders, substance use disorders, major depression, complicated... 

For the diagnosis of major depressive disorder, a person must have either symptom 1 or 2, plus five out of nine symptoms, and these symptoms must occur most of the day, nearly every day, for at least two weeks. Major depressive disorder is differentiated from other depressive disorders, including minor depression (dysthymia), recurrent brief depression, and adjustment disorder with depressed mood. 

Classic reactive depressions (sometimes referred to as psychological depressions) can range in intensity from mild or moderate (for example, adjustment disorders with depressed mood) to severe (major depression). These disorders occur in response to identifiable psychosocial stressors. These stressors may be acute and intense (such as loss of a loved one), insidious (as in the case of a gradual deterioration in the quality of marital relationship), or in the distant past (for example, the emotions experienced by a survivor of child abuse who in adulthood begins to recall long-forgotten abusive events). 

Anxiety associated with psychological stress (adjustment disorder with anxiety)... 

A randomized, 25-week, placebo-controlled study by Volz and Kieser showed a significant benefit from the use of kava-kava extract WS 1490 over placebo in treating anxiety disorders of nonpsychotic origin. The study included 101 patients suffering from agoraphobia, specific phobia, generalized anxiety disorder, or adjustment disorder with anxiety—as per the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised— who... 

Is the child s problem a reaction to a specific and identifiable stressor This helps the clinician to rule out adjustment disorders and posttraumatic stress disorders. 

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