Adjustment Disorder Flashcards
Adjustment disorder: diagnostic criteria
- Identifiable stressor→Emotional or behavioral sx
- Within 3 months after onset of stressor
- Clinically significant:
- Distress in excess of what would be expected
- Significant impairment (social or work)
Adjustment disorders do not meet the criteria for other psychiatric disorders or bereavement. Once the stressor or its consequences has terminated the symptoms do not persist more than ______.
6 months
(adjustment disorder sx appear within 3 months of stressor)
Adjustment disorder course of illness
- Days to weeks
- No longer than 6 months after stressor is gone
(stressor could be chronic (married to an alcoholic spouse), but to be adjustment disorder sx will stop 6 months after stressor is gone)
Adolescents with adjustment disorder are more likely to be suicidal. _____% Of outpatient mental health patients have this diagnosis. _____ of ER patients w/self-harm
- 35%
- 1/3
(most adolescents w/adjustment disorder → psychiatric condition dx later in life)
Adjustment disorder is most common in patietns w/ ______.
- maladaptive styles, such as those with personality disorders (borderline)
(Threshold of stress required to cause psychiatric symptoms varies by individual)
Event if a patient has a stressor that may cause adjustment disorder, if the symptoms meet criteria for another major psychiatric disorder, which would be diagnosed?
psychiatric disorder
(suicide is a high risk in adjustment disorder)
Adjustment disorder prognosis
Most recover within 3 months and learn from the experience
Adjustment disorder treatment involves (4)
- Symptomatic treatment of anxiety and insomnia
- Search for the meaning of the stressor to the patient
- Coping strengths
- Community resources
Define bereavement
“To be robbed by Death”
Define grief
- Grief: the physical and emotional pain precipitated by a significant loss
(Can be due to the loss of a person, place, pet, job, object, health, independence, amputation)
Define mourning:
Behaviors, rituals and observances reflecting a culture’s/religion’s views about the meaning of death and the role of the survivor
List the different types of grief (4)
- Anticipatory
- Acute
- Delayed
- Complicated
Define anticipatory grief
anticipating impending loss
Define acute grief
1st stage of the bereavement process
Define Delayed grief
Absence of expression of grief at the time of the loss
Define Unresolved grief
Extreme grief symptoms
(more intense & last longer than expected)
Define Complicated grief
unresolved grief + physical sx
(interferes w/function)
What symptoms are typically seen in patients in the mourning stage of bereavement (5).
- Decreased appetite
- Decreased concentration
- Hallucinations of the deceased
- Self-reproach
- Sleep disturbances
Stages of normal bereavement (3)
- Shock and denial
- Mourning: physical, emotional sx & social isolation
- Reorganization of life that acknowledges the loss
Difference between mourning & MDD
Symptoms of mourning only last a few days
Examples of reorganization of life that is experienced in normal bereavement
- different relationships
- new identity (widow, orphan, only child)
Biggest differentiating factors between MDD & complex bereavement
MDD has neurovegitative sx (not eating, drinking, unable to care for themselves)
Duration of normal bereavement
Indeterminate: typically do not diagnose MDD immediately following a death
Factors for poor bereavement outcome (4)
- Type of death: sudden or suicide (stigma)
- Who: child, relationship of dependency or ambivalence w/decedent
- Current psychological state: social support, concurrent crisis, low socioeconomic status
- Current health: age or health
Complicated grief (5)
- Anger, resentment, bitterness
- Regression
- Pangs of uncomfortable emotions
- Preoccupation (thoughts of bereaved)
- Clinical complications: anxiety, physical morbidity, social/occupational, family dysfunction, health compromising behaviors
Proposed criteria (DSM 5) for persistent complex bereavement disorder: within 12 months (6 months for children) more days than not:
- Death of someone close
- Since the death, at least one : experienced
- Persistent yearning for them
- Intense sorrow and emotional pain
- Preoccupation with the death
- Preoccupation w/circumstances of the death
- Reactive distress to death
- Social/identity disruption
Describe the reactive distress to death in someone with persistent complex bereavement disorder (6).
(not in DSM 5 yet)
- Marked difficulty accepting the death
- Emotional numbness over the loss
- Difficulty reminiscing positively
- Bitterness or anger related to the loss
- Avoidance of reminders of the loss
- Self-blame
Describe the social/identity disruption in someone with persistent complex bereavement disorder: since the death of bereft: (5)
(not in DSM 5 yet)
- Want to die to be w/deceased
- Difficulty trusting others
- Feeling alone or detached
- Confusion about one’s role in life
- Difficulty or reluctance to pursue interests
Treatment of grief (3)
- Maintain stability of pre-existing psychiatric conditions
- Group psychotherapy: interpretive and supportive
- Medication: symptomatic for anxiety and sleep
(psychotherapy may help to establish new roles and activities; some things you don’t get over, you just get through)
Depression and dying patient: wish to die may be an existential signal that the patient feels their ______.
- potential for being someone who matters is exhausted
(Depressed patients make more restrictive advanced directives than nondepressed patients, and change them when the depression resolves)
What is the difference between suicidal ideation and the wish hasten death in a dying patient?
- When wish to hasten death is present, it may result from untreated psychological or physical symptoms
Treatment for depression in a dying patient (anticipatory grief)
psychotherapy, antidepressants and stimulants
Dealing with dying patients
- Cheerfulness: be open to humor
- Competence: know about the illness and treatment
- Caring: attend to every question
- Comfort: address the discomforts of the condition
- Communication: what can you do to allow the patient to speak openly
- Control: pain
- Respect: defenses (let them be in denial)
- Touch: may offer comfort
- Visits: maintain frequency
- Hope: one day at a time
Primary agent of treatments when dealing with dying patients
- Physician and their relationship w/patient is the primary agent of treatment
- Help patient separate symptoms related to their life-threatening illness from others (ex: Is their HA part of the cancer?)
Family-centered care: well-functioning families demonstrate:
- Supportive: high levels of cohesion
- Conflict resolvers: tolerate differences of opinion and deal with conflict constructively
Family-centered care: dysfunctional families will demonstrate (3)
- Hostile: high conflict, low cohesion, and poor expressiveness
- Sullen: muted anger
- Both have high rates of morbidity
Psychological stages of dying
- Stage of Denial: “It can’t be true.”
- Stage of Anger: “Why me?”
- Stage of Bargaining: Often related to religious beliefs
- Stage of Depression: anticipatory grief
- Stage of Acceptance: patients may be emotionally neutral or euphoric
Goals of treatment in dying patients (3).
-
Give patients a sense of control over their fate:
- Disease manifestation (as much as you can)
- Symptoms (teach them how to manage)
- Attempt to predict what symptoms will occur, their timing, and their response to treatment
- Attempt to smooth relations within the family so that family members are better able to deal with dying person
Reasons for telling the truth to a dying patient (3)
- Improve the doctor-patient relationship
- Reduce the patient’s uncertainty
- Improve the patient’s ability to act in their own best interest
Modern medicine respects a competent patient’s right to autonomy, complications arise when _____.
- a patient is not able to express their wishes
Settings for death (3)
- home
- hospital
- hospice
Life-prolonging treatment includes (4):
- Mechanical ventilation
- CPR
- Nutrition
- Hydration
Physicians do not have to provide life-sustaining treatment that is considered _______.
futile
