Adjustment Disorder

Question 1

Define

Answer 1

ICD-10: states of subjective distress and emotional disturbance, usually interfering with social functioning and performance, arising in the period of adaptation to a significant life change * or a stressful life event

• Beginning within 1 month of the stressful event
• Not lasting longer than 6 months * doesn’t need to be a death, could be going to university

I.E. prolonged abnormal response to stress starting within 1 month of stressful event, not lasting over than 6m

Question 2

Epidemiology

Answer 2

Epidemiology

Common in children and adolescents where the response tends to be behavioural (e.g. acting out) rather than emotional

Young and single women

Question 3

Aetiology

Answer 3

Experiencing stressful or traumatic life events or stressors (less life threatening than acute stress reaction stressors)

Vulnerability may contribute

Question 4

Symptoms

Answer 4

Symptoms are out of proportion with stressor

Depressed mood, anxiety or worry, or a mixture of both

PREDOMINANT feature: brief or prolonged depressive reaction or disturbance of other emotions and conduct

Feeling of inability to cope, plan ahead or continue in the present situation

Some degree of disability in the performance of daily routine

Conduct disorders can be associated e.g. reckless driving, aggressive behaviour

Physical symptoms- e.g. palpitations, rapid breathing, tremor, diarrhoea

Behavioural symptoms- e.g. aggression, alcohol abuse etc.

Symptoms should NOT be of sufficient specificity or severity to justify a diagnosis of another mental and behavioural disorder

Symptoms typically resolve within 6 months unless the stressor persists for a longer duration

Pseudo hallucinations can form part of the normal grieving process. Sufferers describe hearing, visualising, or even smelling their deceased loved one. These phenomena are often associated with acute grief, though can occur at any stage of bereavement.

Question 5

Investigations

Answer 5

Rule out organic pathology: U&Es, LFTs, TFTs, urine drug screen

 

Question 6

Management

Answer 6

Support, reassurance and problem-solving are often all that is required

Psychological Therapy
- Supportive counselling - Can be individual, group or family
- Provide emotional support
- Understand why it affected the person so much
- Learn stress management and coping skills

Biological Treatment
- Often RESOLVE WITHOUT medication!
- Antidepressants (SSRIs) may help with symptoms of anxiety or depression
- Social Interventions
- Eat well
- Reduce or avoid alcohol and coffee
- Increasing exercise (and breathing exercises)
- Offer support helplines (e.g. Samaritans, Campaign Against Living Miserably (CALM – only for men))

Referral to CAHMS for children if:
- Child is currently displaying signs of depression and has 2+ rf for developing depression
- Prolonged grief –> Interpersonal therapy can be useful +/- antidepressants

Question 7

Complications/ paces

Answer 7

Complications

Increased risk of self-harm and suicide

Increased risk of self-neglect

 

Prognosis

Can resolve after several months

Rarely, they can become long-term

PACES

Grief is processed differently by everyone

Can take up to 6m - so offer therapy after pot