Adjustment Disorder

1. Adjustment Disorder • A PowerPoint Presentation by Jessica Way, RN

2. Objectives: What’s it all about? • To learn more about Adjustment Disorder • To learn the who, what, where, why and how of Adjustment Disorder • To learn how to treat Adjustment Disorder

3. What is Adjustment Disorder? • Adjustment Disorder is a condition of emotional distress triggered by significant subjective events in an individual’s life. • According to the World Health Organization 10 Classification of Diseases (ICD-10), Adjustment Disorder (AD) is defined as “a state 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 stressful event.” • According to Taber’s Cyclopedic Medical Dictionary, AD is “a maladaptive reaction to an identifiable psychological or social stress that occurs within three months of the stressful situation.” • According to the Diagnostic and Statistical Manual of Mental Disorders (DSM IV-TR), “the development of emotional or behavioral symptoms in response to an identifiable stressor occurring within three months of the onset of the stressor.”

4. It is important to note... • ....that Adjustment Disorder is different from depression in that the symptoms must resolve within six months of the onset of the stressor. • According to DSM IV-TR, “the symptoms must resolve within six months of the termination of the stressor (or its consequences)” and the diagnosis of Adjustment Disorder “should not be made when the symptoms represent bereavement.” • And, according to WHO ICD-10, “the acute stress reactions occur within one month of a psychosocial stressor that is not of an unusual or catastrophic type.”

5. Pathophysiology of Adjustment Disorder • Pathophysiology may be defined as the functional changes associated with, or resulting from, a particular injury or disease. • With Adjustment Disorder, the “disease” or “injury” would be a subjective stressor in an individual’s life. • The stressor is any event in an individual’s life that is perceived as stressful by that individual....and it can be eustress, too! (Good stress is still stress!)

6. Who’s at Risk for Adjustment Disorder? • Anyone and everyone! Each one of us has had plenty of stressful events in our lives (remember, good stress is still stress) and each one of us reacts differently to each stressor. For instance, the loss of a pet is devastating for some people, whereas other people may not be affected at all. • Different life/developmental stages may play a part in being at-risk for AD. As we age, we learn different coping skills in response to various life events, and can reflect on and use them to “get through” major events that cause stress. • We may not have learned those coping mechanisms at certain stages in life (i.e., adolescence, older adults) and we may not have encountered certain stressors yet (i.e., changes associated with aging).

7. Manifestations of Adjustment Disorder • According to the DSM IV-TR, some emotional signs of AD are crying spells, sadness, hopelessness, lack of enjoyment, nervousness, anxiety, worry, difficulty sleeping or concentrating, feeling overwhelmed and in extreme cases, thoughts of or attempts of suicide. • Behavioral signs may include avoidance of important tasks (i.e., not paying bills, not completing homework), fighting, reckless or risk-taking activities (i.e., reckless driving), calling in sick to work excessively, isolation of oneself from family and friends.

8. Some illustrations of typical manifestations of Adjustment Disorder

9. What Diagnostic Tests Are Involved? • Adjustment Disorder is a psychological or mental health issue and according to the Mayo Clinic’s website, AD is diagnosed based on signs and symptoms and a thorough psychological evaluation. To be diagnosed with adjustment disorder, someone must meet criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM IV-TR). • These signs and symptoms are listed in the previous slide.

10. =Most cases of Adjustment Disorder are effectively treated with psychotherapy. How do we treat Adjustment Disorder?

11. Pharmacotherapy for Adjustment Disorder • Pharmacotherapy is sometimes used in adjunct to psychotherapy treat Adjustment Disorder. • Antidepressants such as imipramine (Tofranil), sertraline (Zoloft) or bupropion (Wellbutrin) and anxiolytics like buspirone (BuSpar) or paroxetine hydrochloride (Paxil) can be very helpful. • Benzodiazepines like alprazolam (Xanax) or chlordiazepoxide (Librium) can be used for severe cases.

12. You may be thinking, “I’m a nurse, not a psychotherapist. How can I help in ways other than just passing meds to my patient?” • Offer support, reassurance, and understanding. • Let your patient know their reactions are normal. • Giving patients choices helps empower them • Encourage them to express their feelings. • LISTEN.

13. Don’t believe me? • We all know they can’t put anything that isn’t true on the Internet (haha) so here’s a YouTube video about Adjustment Disorder: • http://www.youtube.com/watch?v=f-8gnXuX-VQ • According to the DSM IV-TR, Dr. Spiegel is incorrect at 0:32 when he states “loss of a loved one.” (Please refer to slide #3.)

14. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders fourth edition text revision. Washington D.C.: American Psychiatric Association. Carta, M. G. (2009). Adjustment disorder: Epidemiology, diagnosis and treatment . Clinical Practice and Epidemiology in Mental Health, 5(15), doi: 10.1186/1745-0179-5-15 (2009). D. Venes (Ed.), Taber's Cyclopedic Medical Dictionary (21st ed.). Philadelphia: F.A. Davis Company. Mayo Clinic Staff. (2011, March 17). Adjustment disorders: Tests and diagnosis. Retrieved from http://www.mayoclinic.com/health/adjustment-disorders/DS00584/DSECTION=tests-and-diagnosis World Health Organisation, (1994). The ICD-10 classification of mental and behavioural disorders. Retrieved from website: http://www.who.int/classifications/icd/en/bluebook.pdf References