Title Adjustment Disorders.pdf ✅

TRANSCRIBER 1 Psychiatry III DR. ETHEL PAGADDU SEPTEMBER 2019 EXIMIUS ADJUSTMENT DISORDERS 2021 GROUP 1 OVERVIEW • characterized by an emotional response to a stressful event • the stressor involves financial issues, a medical illness, or a relationship problem • may involve anxious or depressive affect or may present with a disturbance of conduct • the symptoms must begin within 3 months of the stressor and must remit within 6 months of removal of the stressor EPIDEMIOLOGY • Prevalence is estimated to be from 2-8% of the general population • W > M, 2x • single women are most at risk • in children and adolescents, boys and girls are equally diagnosed with adjustment disorders • occur at any age, but are most frequently diagnosed in adolescents. • among adolescents of either sex, common precipitating stresses are school problems, parental rejection and divorce, and substance abuse. • among adults, common precipitating stresses are marital problems, divorce, moving to a new environment, and financial problems ETIOLOGY • the severity of the stressor or stressors does not always predict the severity of the disorder; the stressor severity is a complex function of degree, quantity, duration, reversibility, environment, and personal context • stressors may be single or multiple; may be recurrent or continuous • it can occur in a group or community setting • specific developmental stages, such as beginning school, leaving home, getting married, becoming a parent, failing to achieve occupational goals, having the last child leave home, and retiring, are often associated with adjustment disorders PSYCHODYNAMIC FACTORS • understanding of three factors: (1) the nature of the stressor, (2) the conscious and unconscious meanings of the stressor, and (3) the patient's preexisting vulnerability • has emphasized the role of the mother and the rearing environment in a person's later capacity to respond to stress • Donald Winnicott's concept of the good-enough mother: a person who adapts to the infant's needs and provides sufficient support to enable the growing child to tolerate the frustrations in life • current events may reawaken past traumas or disappointments from childhood, so patients should be encouraged to think about how the current situation relates to similar past events • Throughout early development, each child develops a unique set of defense mechanisms to deal with stressful events • Because of greater amounts of trauma or greater constitutional vulnerability, some children have less mature defensive constellations than other children • Resilience is also crucially determined by the nature of children's early relationships with their parents • Studies of trauma repeatedly indicate that supportive, nurturant relationships prevent traumatic incidents from causing permanent psychological damage. FAMILY AND GENETIC FACTORS • life events and stressors are modestly correlated in twin pairs, with monozygotic twins showing greater concordance than dizygotic twins • concluded that the likelihood of developing symptoms in response to traumatic life events is partially under genetic control DIAGNOSIS and CLINICAL FEATURES • the symptoms do not necessarily begin immediately after the stressor • up to 3 months may elapse between a stressor and the development of symptoms • symptoms do not always subside as soon as the stressor ceases; if the stressor continues, the disorder may be chronic DSM-5 DIAGNOSTIC CRITERIA FOR ADJUSTMENT DISORDERS A. The development of emotional or behavioral symptoms in response to an identifiable stressor(s) occurring within 3 months of the onset of the stressor(s). B. These symptoms or behaviors are clinically significant as evidenced by either of the following: a. marked distress that is in excess of what would be expected from exposure to the stressor, taking into account the external context and the cultural factors that might influence symptom severity and presentation. b. significant impairment in social or occupational (academic) functioning C. The stress-related disturbance does not meet the criteria for another specific Axis I disorder and is not merely an exacerbation of a preexisting mental disorder. D. The symptoms do not represent bereavement. E. Once the stressor (or its consequences) has terminated, the symptoms do not persist for more than an additional 6 months. ADJUSTMENT DISORDER WITH DEPRESSED MOOD • predominant manifestations are depressed mood, tearfulness, and hopelessness • must be distinguished from MDD and uncomplicated bereavement. • Adolescents with this type of adjustment disorder are at increased risk for major depressive disorder in young adulthood. ADJUSTMENT DISORDER WITH ANXIETY • symptoms of anxiety, such as palpitations, jitteriness, and agitation, are present in adjustment disorder with anxiety, which must be differentiated from anxiety disorders ADJUSTMENT DISORDER WITH MIXED ANXIETY & DEPRESSED MOOD • patients exhibit features of both anxiety and depression that do not meet the criteria for an already established anxiety disorder or depressive disorder ADJUSTMENT DISORDER WITH DISTURBANCE OF CONDUCT • the predominant manifestation involves conduct in which the rights of others are violated or age-appropriate societal norms and rules are disregarded • Ex.: truancy, vandalism, reckless driving, and fighting • be differentiated from conduct disorder and antisocial personality disorder.