Transcript Adjustment Disroders - Roger Peele: Introduction

Adjustment Disorders
Unless otherwise specified, all answers are
from DSM-IV-TR or from First and Tasman
As of 13Sep08.
Criteria for adjustment disorder
Q. What is the criteria for adjustment
disorder?
Criteria for adjustment disorders
Ans.
Within three months of the stressor, there is
marked distress that is in excess of what
one would expect and
Does not meet the criteria of another Axis I
disorder, more specifically does not meet
the criteria of PTSD or Bereavement.
Does not last longer than 6 months unless
the stressor so lasts.
Bereavement
Q. What is the criteria of bereavement?
Bereavement
Ans.
Normal reaction to the death of a loved one:
-- not lasting more than two months
[although there can be cultural variations].
Differential of bereavement
MDD
Q. Besides the 2 months, what signs would
tilt you to toward MDD instead of
bereavement?
Differential of bereavement
and MDD
Ans.
1] feelings of unreasonable guilt
2] thoughts of death, excluding feeling she/he
would be better off dead
3] morbid preoccupation with feeling worthless
4] motor retardation
5] prolonged, marked functional impairment
6] hallucinations other than those related to seeing
or hearing the deceased.
Types
Q. DSM-IV list six overlapping types of
adjustment, name the five other besides
“unspecified.” [There are two “mixed
types.”]
Types
Ans.
-- With depressed mood
-- With anxiety
-- With Mixed anxiety and depressed mood
-- With Disturbance of conduct
-- With Mixed disturbance of emotions and
conduct
-- Unspecified
Nature of stressors
Q. What does DSM say as to the nature of
the stressors that qualify?
Nature of stressors
Ans. Single event or series of events, past
or current stress, event that only effect the
individual or broad events, such as 9/11.
[So, examiners question probably will
allow anything.]
Acute v. chronic
Q. What is length of time the pt has
symptoms that crosses over from “acute”
to “chronic”?
Acute v. chronic
Ans. 6 months. Six months can only fit the
definition of adjustment disorder if the
stress last longer than 6 months. So, could
use “chronic” for pt living in very fearful
neighborhood.
Prevalence
Q. What is the prevalence of adjustment
disorder following cardiac surgery [DSM-IV
has a number of comments about
prevalence, but the percentages are
broad, e.g., 2 to 8 %] except for this
question -- which is a lot more than 8%.
Prevalence
Ans. 50%
Psychological factors affecting a
general medical condition
Q. How does Adjustment Disorder and
Psychological Factors Affecting Medical
Condition differ?
Psychological factors affecting
general medical condition
Ans. They are opposites in that Adjustment
Disorder can be depression, anxiety or
conduct abnormalities that result from a
General Medical Condition whereas
Psychological Factors Affecting General
Medical Condition and depression and
anxieties that exacerbate the medical
condition.
Need treatment?
Q. Since Adjustment disorder is self-limited
as to definition, can we assume that these
people do not need treatment?
Need treatment
Ans. No, they need treatment, to reduce
suffering, to enhance functioning and to
prevent the disorder leading to a more
severe or chronic condition.
Treatment -- general
Q. Very generally, what is the focus of the
treatment?
Treatment - general
Ans. Reduce the stressor and use
Psychosocial approaches
Or
Medications
Or
Both.
First goal
Q. First goal of psychosocial approaches is
to?
First goal
Ans. First goal is to remove or reduce the
stressor.
Psychotherapies Used
Q. First and Tasman list a number of
psychotherapies for Adjustment Disorder.
Name as many as you can.
Psychotherapies used
Ans.
- Counseling
- CBT
- Interpersonal Psychotherapy
- Psychodynamic
[also several forms of brief psychotherapies
can be used.]
Medications
Q. What medications might be used?
Medications
Ans.
Depending on the type of Adjustment
disorder, antidepressants and anxiolytic
meds are used.