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Results for “Adjustment Disorders”

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At least 19 recordsLinked to original sources

PubMed1992

Structured ambiguity and the definition of psychiatric illness: adjustment disorder among medical inpatients.

Adjustment disorder is one of the most common psychiatric diagnoses given to patients hospitalized for medical and surgical problems. This article argues that the diagnosis, in this context, often serves strategic, non-clinical ends for consultation-liaison psychiatrists, who must negotiate their interstitial position through an essentially ambiguous diagnosis. In these cases, 'adjustment disorder' emerges from and reproduces tensions between such cultural dichotomies as mind/body and social/individual that marginalize psychiatry in medical settings.

Adjustment Disorders↗

PubMed1992

Adjustment disorder in children and adolescents.

The literature on adjustment disorder in children and adolescents is reviewed to evaluate the empirical and conceptual basis of this disorder as defined in DSM-III-R, and to determine whether revisions, are indicated in DSM-IV. Existing studies suggest that adjustment disorder is a disorder of high prevalence in all settings, which carries significant morbidity and poor outcome in children and adolescents. Problems identified with the DSM-III-R definition include low reliability, the predominance of mixed rather than discrete symptom presentations in children and adolescents, and the persistence of symptoms in excess of 6 months in a significant number of cases.

Adjustment Disorders↗

PubMed1992

[Adjustment disorders with developmental risk in children after inpatient treatment].

The relatively broad spectrum of symptoms in child psychiatry (disturbances of behaviour and of anxiety and others) was examined in order to find smaller diagnostic groups. Two selected groups of probands of the Department of Child and Adolescent Psychiatry at the University Hospital for Children in Jena were analysed. This analysis was made by recording journals of treatment and a questionnaire. Both groups differed significantly in 33 out of 128 characteristics. The following factor analysis resulted in 10 anxiety- and non-anxiety-syndromes leading back to basic disturbances of affect, psychomotoricity and thinking as well as to exogenous variables like social surroundings and conditions in varieties in upbringing and education. A proof and reliable classification is not possible because of individually and qualitatively different symptoms. The results of the study show the necessity of an effective and improved dispensary care.

Adolescent↗

PubMed1991

[Psychogenic reaction: course and prognostic factors].

A follow-up was made of ninety patients with a diagnosed psychogenic reaction (adjustment disorder) fourteen years after the index hospitalisation. Contrary to expectation, at the follow-up only half of the patients showed no symptoms of the illness. Approximately a quarter of the patients suffered from a more serious illness (drug dependence, schizophrenia or organic mental disorder) than the index diagnosis. The other quarter showed symptoms of a psychogenic disorder (neurotic disorder, personality disorder, adjustment disorder). A number of factors which describe the course of the illness leading to the index hospitalisation permit a prediction of the outcome of the disease.

Adjustment Disorders↗

PubMedDate not supplied

Natural history of symptoms of depression and anxiety during inpatient treatment on general medicine wards.

OBJECTIVE: To establish the frequency of criteria-based depression and anxiety in newly admitted medical inpatients and to determine the natural history of depressive and anxiety symptoms during hospitalization. DESIGN: Prospective structured assessment of criteria-based depression and anxiety diagnoses within 24 hours of hospitalization with routine follow-up depression and anxiety questionnaires until discharge. SETTING: A tertiary care university hospital and an affiliated Veterans Administration hospital. PATIENTS: One hundred twenty-eight adult patients admitted to internal medicine inpatient units between May 1990 and August 1990. MAIN RESULTS: On admission, 43 of the 128 patients inducted met the DSM-III criteria for major depression, while an additional six met the criteria for adjustment disorder with depressed mood. Only six patients met the criteria for panic disorder, generalized anxiety disorder, or adjustment disorder with anxious mood at the time of admission to the study. Patients with high symptom scores on the anxiety and depression scales showed significant decreases in these scores without specific psychiatric intervention. Those who remained in the hospital 20 days or longer showed initial improvement and subsequently returned to baseline symptom levels of depression and anxiety. In approximately 9% of patients, symptoms of depression persisted or worsened. CONCLUSIONS: Major depression occurs more commonly than anxiety disorder in newly admitted medical inpatients but both resolve spontaneously in the majority during the course of hospitalization without specific psychiatric intervention unless the hospitalization is prolonged. One in ten will continue to show symptoms of depression.

Anxiety↗

PubMed1992

Patterns of affective comorbidity in a clinical population of dually diagnosed adolescent substance abusers.

Patterns of affective comorbidity with substance abuse are examined in a sample of 156 adolescent psychiatric inpatients, ages 13 to 18 years old. Affective disorders, including adjustment disorder with depressed mood, were observed in 51.3% of patients. A total of 30.7% of patients had comorbid major depression. In both males and females, secondary major depressive disorder was more common than its primary form. In this population, the primary-secondary paradigm did not predict either acute remission for depressive symptoms or distinct family history of comorbid disorders. Consistent with previous studies of adults, significantly more females had comorbid affective disorder and significantly more males had conduct disorder.

Adolescent↗

PubMed1992

Relaxation therapy reduces anxiety in child and adolescent psychiatric patients.

The immediate effects of relaxation therapy (RT) were assessed in 40 hospitalized children and adolescents with diagnoses of adjustment disorder and depression. These effects were assessed using a within subjects pre-test/post-test design and by comparison with a control group of 20 depressed and adjustment disorder patients who watched a 1-h relaxing videotape. The 1-h RT class consisted of yoga exercise, a brief massage and progressive muscle relaxation. Decreases were noted in both self-reported anxiety and in anxious behavior and fidgeting as well as increases in positive affect in the RT but not the video group. In addition, adjustment disorder patients and a third of the depressed patients showed decreases in cortisol levels following RT, while no changes were noted in the video group. Thus, both diagnostic groups appeared to benefit from the RT class.

Adjustment Disorders↗

PubMedDate not supplied

Neuropsychological screening in the psychiatric emergency room.

In a pilot study, a neuropsychological minibattery of tests consisting of Trail-Making Test A (TMA), Trail-Making Test B (TMB), and the Visual Reproduction subtest (VR) of the Wechsler Memory Scale was administered to patients with common psychiatric diagnoses in a psychiatric emergency room (ER). Patients with adjustment disorders were not distinguishable from normal controls, while patients with affective disorders and schizophrenia were more impaired than both of these samples. It is suggested that this or a similar minibattery of tests can be of use as an adjunct screening device for differential diagnosis of adjustment disorder versus more serious psychopathology in psychiatric ERs.

Adjustment Disorders↗

PubMed1992

Depressive symptoms and depression among elderly people in Athens.

A total of 251 elderly residents of 2 boroughs of greater Athens were examined by a psychiatrist. For the assessment of depressive symptoms, the Center for Epidemiological Studies Depression (CES-D) Scale was used. Cognitive functioning was also evaluated. The prevalence of affective disorders of any type was estimated by a clinical examination with a semistructured psychiatric interview (PEF) supplemented by DSM-III criteria. A total of 27.1% of the elderly respondents reported a significant number of dysphoric or depressive symptoms and were identified as depressed cases. Respondents who had lower socioeconomic status, were widowed, were experiencing stressful life events or were living alone exhibited a significant degree of depressive psychopathology. An association between depressed mood and cognitive impairment was also found. A total of 9.5% of the sample was diagnosed as suffering from any type of affective disorder (1.6% major depression, 0.6% bipolar, 5.5% dysthymic disorder and 2.0% adjustment disorder with depressed mood). Affective disorders constitute nearly half of the total number of psychiatric diagnoses (20.3% at the sample). It is interesting that, of the 27.1% of the sample with depressed mood (> or = 16 score on CES-D Scale), only 9.5% of the sample were diagnosed as suffering from clinical types of depression.

Aged↗

PubMed1992

Psychiatric morbidity in patients with HIV infection.

A psychiatric examination was conducted on 144 patients at various stages of HIV infection and on 29 controls found to be seronegative. One-half of the control group had at least one DSM-III-R Axis I diagnosis, most commonly cannabis abuse, alcohol abuse, or adjustment disorder. Compared to this baseline, HIV-infected subjects had higher rates of adjustment disorder. AIDS patients were also more likely to suffer from organic mental disorder. The rate of unemployment increased as the disease progressed. Major depression was seen in only ten patients, and there were no differences between controls and HIV-infected subjects. Formal assessment of mood state and feelings of pessimism also showed no differences among the groups. The importance of helping improve the patient's lifestyle through the control of alcohol and drug abuse is underscored.

Acquired Immunodeficiency Syndrome↗

PubMed1992

Attentional processing in cervical spine syndromes.

Fifty-four patients suffering from "common whiplash" were compared with 28 patients complaining of cervical spine syndrome caused by rheumatism (Barré-Lieou syndrome). All patients underwent clinical interview and formal testing. Formal testing included personality profile, self ratings of cognitive impairment and well-being, and tasks on divided attention and speed of information processing. In the "common whiplash" group higher relative incidences of adjustment disorder were found. In both groups scoring for divided attention was low. With regard to self-ratings, the group suffering from Barré-Lieou syndrome hardly indicated any problems while the "common whiplash" group showed significant impairment. This difference of self-ratings was assumed to reflect the different modes of development of the investigated syndromes: in the group with cervical syndrome due to rheumatism the condition gradually developed giving the patient the possibility to adapt, while in the "common whiplash" group cervical pathology emerged abruptly by impact injury. Adaptation in the latter group was inadequate which in particular explains the appearance of adjustment disorders amongst "common whiplash" patients. Results indicated that headache due to cervical pathology is likely to be responsible for impaired attentional functioning of "common whiplash" patients.

Adjustment Disorders↗

PubMed1992

Psychiatric problems among Iranian immigrants in Canada.

The number of Iranian immigrants in Canada has been increasing since 1979. This study is the result of a review of 111 charts of Iranian patients who were referred for psychiatric treatment between 1985 and 1988. Ninety-eight percent of them arrived in Canada after the Iranian revolution, which started in 1979, and the Iran-Iraq war of 1980. Ten percent were experiencing trauma as a result of their involvement with the revolutionary government or the war. The symptoms were in accordance with the DSM-III-R criteria for post-traumatic stress disorder. Sixty percent met the criteria for adjustment disorder with depressed or anxious mood. Six percent had been subjected to physical and psychological torture and confinement. This is the first study that looks at the prevalence of psychiatric illness among Iranians and illustrates the effect of migration and displacement in the integrity of the psychic life of this population.

Canada↗

PubMed1992

The effects of cortisol infusion upon hormone secretion from the anterior pituitary and subjective mood in depressive illness and in controls.

The aims of this study were to determine whether the administration of cortisol has a significant effect on mood in patients with depression and whether the effects of cortisol on changes in plasma hormone concentrations are like those of synthetic corticosteroids. Twelve patients had major depression and one each had dysthymic disorder and a depressive adjustment disorder. Five were male and nine were female. All were in-patients. Eight normal subjects, two females and six males, were used as controls. Basal beta-endorphin concentrations were 2- to 3-fold higher in depressed patients than in control subjects, but there were no significant differences between the patient and control groups in the basal (pre-infusion) plasma concentrations of ACTH, cortisol, growth hormone or prolactin. Cortisol, but not saline infusion resulted in a significant improvement in self rated mood. Surprisingly, cortisol infusion at first increased plasma beta-endorphin concentrations. At later times after cortisol infusion, plasma beta-endorphin concentrations decreased as did the plasma concentrations of ACTH and growth hormone; prolactin levels were increased. These results show (i) that cortisol infusion raises mood significantly in major depression, (ii) that plasma beta-endorphin concentration is a potential marker of major depression (iii) that rather than blunting of corticosteroid effects, responses to cortisol may even be enhanced in depressive illness. The unexpected, initial increase in beta-endorphin stimulated by cortisol, suggests that the action of cortisol is not simply one of negative feedback inhibition, but may involve mineralocorticoid, as well as glucocorticoid receptors.

Adrenocorticotropic Hormone↗

PubMed1992

Comparison between treatment completers and noncompleters among dually diagnosed substance-abusing adolescents.

The psychiatric and demographic characteristics that may distinguish treatment completers from noncompleters among hospitalized adolescents with substance abuse and comorbid psychiatric disorders were examined. Affective and adjustment disorders were more prevalent among treatment completers whereas non-completers were more likely to be assigned a conduct disorder diagnosis. There were no differences between the groups with respect to demographic and legal status, education level and lifetime psychiatric diagnosis in the parents or caretakers, living arrangements, treatment history, and perception of treatment benefits. A higher percentage of treatment completers than noncompleters received psychotropic medications. The factors contributing to treatment termination as well as the clinical and research implications of the findings are discussed.

Adolescent↗

PubMed1992

Assessment and treatment strategies for depressive disorders commonly encountered in primary care settings.

Frequently overlooked, depression is a very common complex disorder that causes significant morbidity and mortality. This article provides a review of three commonly encountered depressive disorders in primary care settings: adjustment disorder with depressed mood, dysthymia and major depression. Since many individuals minimize the affective symptoms of depression, clinicians must maintain a high index of suspicion when clients present with vague somatic complaints, such as fatigue, headache, constipation and difficulty sleeping. To reach an accurate diagnosis, a thorough history, physical examination and appropriate laboratory studies should be performed. Numerous rating scales are presented to aid assessment. Common intervention strategies for the treatment of depressive disorders include education, drug therapy, and supportive individual and family counseling.

Antidepressive Agents↗

PubMed1992

The concept of psychosomatic disorder.

The clinical concepts related to the assessment of psychosocial factors in the medically ill are reviewed, with particular reference to the DSM-III-R categories of adjustment disorders, psychological factors affecting physical conditions, and somatoform disorders. The clinical and heuristic value of the concepts of psychosomatic disorder and abnormal illness behavior is underscored.

Adaptation, Psychological↗

PubMed1992

Relationships between the MAPI and the MMPI in the assessment of adolescent psychopathology.

Although the Minnesota Multiphasic Personality Inventory (MMPI) and the Millon Adolescent Personality Inventory (MAPI) are both widely used in the clinical assessment of adolescents, no research has examined the interrelationship between these two instruments. We investigated MMPI and MAPI responses from 199 adolescents assessed at entrance to inpatient or outpatient psychiatric programs in Florida and Virginia. Univariate correlation analyses identified areas of significant associations between these measures, with coefficients ranging widely from -.70 to .72. Substantial diagnostic differences were found between these instruments. The MAPI, for example, yielded no depression-related diagnoses, but produced many more adjustment disorder and personality disorder diagnoses than the MMPI. The rates of diagnostic assignment agreements between diagnoses produced by clinical judgment, MMPI findings, and MAPI interpretive reports were typically quite low.

Adjustment Disorders↗

PubMed1992

DSM-III-R brief reactive psychosis among Air Force recruits.

BACKGROUND: Clinical characteristics of patients diagnosed with brief reactive psychosis based on DSM-III-R criteria and the incidence of this disorder in a defined population have not been sufficiently studied. Some military recruits who are subjected to relatively uniform levels of stress in a monitored environment over a specified time period develop transient, severe psychotic symptoms consistent with a diagnosis of brief reactive psychosis. METHOD: We retrospectively reviewed all cases of brief reactive psychosis that occurred among 139,360 Air Force recruits during 6-week basic training experiences over a 3-year period. Brief case descriptions, including clinical courses, are provided. RESULTS: Six cases were found among 557 consecutive psychiatric admissions between January 1, 1988, and January 1, 1991 (annual incidence = 1.43 cases per 100,000 recruits). An apparent temporal relationship was found between the onset of the stressor (basic military training) and the development of psychosis. Paranoid symptomatology, including persecutory delusions, was present in all cases. Adjustment disorders were the most common diagnoses in patients admitted from the training environment (N = 464). CONCLUSION: Brief reactive psychosis is a rare discharge diagnosis in this large population of young Air Force recruits. Prospective studies are warranted to evaluate the usefulness of DSM-III-R criteria for this disorder and to determine the longitudinal course of patients who have received this diagnosis.

Adjustment Disorders↗