ADJUSTMENT DISORDER Dr shakeel Adjustment Disorder Short term

ADJUSTMENT DISORDER Dr shakeel

Adjustment Disorder Short term maladaptive reactions to psychological stressor Symptoms must appear within 3 months of a stressor’s onset Stressors are not specified, mostly everyday events (loss of loved one, change of employment, financial situation) Symptoms usually resolved within 6 months (may be longer if produced by a chronic stressor)

COMMON SYMPTOMS � � Anxiety, depression, deliberate self harm, worry, decreased concentration, aggression, irritability with substance abuse. ANS arousal symptoms such as palpitations , tremor. Gradual onset, prolonged course. Impairment in social , occupational functioning and intense distress.

Specifies in adjustment disorder Acute: if the disturbance lasts for less than 6 months Chronic: if the disturbance lasts for 6 months or longer Subtypes: With depressed mood, With anxiety, With mixed anxiety and depressed mood, With disturbance of conduct, With mixed disturbance of emotions and conduct, Unspecified

Common causes � � � Sexual and physical abuse Divorce and separation Change of job, school shifting Migration or status change Birth of a handicap child. Terminal illness.

Epidemiology Prevalence: 2 % of general population In inpatient settings =12 -13% Women : man ratio - 2: 1 Most frequently diagnosed in adolescents High rates seen in patients having suicidal attempts. One of the most common psychiatric diagnoses (50%) for disorders of patients hospitalized for medical and surgical problems

Risk Factors � � � Individual social support system, marital status (unmarried) also predispose him vulnerable for a stressor. Medically ill children are more likely to acquire AD when their families are malfunctioning. A positive child-parent relationship has a protective value, while previous mental or physical disorders increase the risk.

Risk Factors � � � Protective factors are good intellectual functioning, effective self-regulation of emotions and attachment behaviors, a positive selfconcept, optimism, altruism, and a capacity to convert traumatic helplessness into learned helpfulness. resilience to stress includes ability to bond with a group, altruism and teamwork. The underlying neurobiological mechanisms include brain circuits that are in charge of reward and fear.

Genetic factors � One study found a slightly greater prevalence of AD in monozygotic twins than dizygotic twins.

OTHER RISK FACTORS � � � � age (adolescents may not be able to cope with stressors as well as adults) a lack of emotional development a lack of flexibility for life changes a lack of good coping skills a lack of social skills a lack of a support system past experiences other mental health problems

Neurotransmitters � � � In adjustment disorder main principle is complex feedback between the various mediators including cortisol, corticotropin-releasing hormone, norepinephrine, serotonin, and gonadal steroids.

Differential Diagnosis Grief reaction Acute stress reaction/disorder GAD/panic attack PTSD Acute and transient psychotic disorder Conversion/dissociation. Substance-related disorder Somatization disorder depressive illness Personality disorder

Co-morbidity � � � 70% patients have another co morbid disorder. substance abuse and dependence. personality disorders.

Course and Prognosis Generally favorable prognosis Symptoms of AD usually disappear within 6 months. one-third of patients do not remit after 6 months, and one-fourth still have the disorder after a year. Recovery seen in more than 90% patients, Some patients (30 -40%) receive later a diagnosis of mood disorder, antisocial personality or substance related disorder. 30% have suicidal thoughts and 20% have completed suicide.

Treatment (psychotherapy) M Carta BMC-2009 Psychotherapy – the treatment of choice solution-focused therapy, that help the individual deal more effectively with the specific life problem solving therapy. Dynamic supportive therapy, cognitive-behavioral therapy, hypnosis and relaxation techniques.

Pharmacological treatment � � The recommended pharmacologic treatment period is shorter than 3 months. Occasionally an anxiolytic or hypnotic is used for few days and tricyclic antidepressants and methylphenidate have efficacy in medically ill patients