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Zapata-Ospina JP, Sierra-Muñoz JS, Martínez PM, Enrique Yepes-Delgado C. The adjustment disorder is not a wastebasket diagnosis: a grounded theory study of psychiatrists' and psychologists' clinical reasoning. Eur J Psychotraumatol 2024; 15:2390332. [PMID: 39166284 PMCID: PMC11340213 DOI: 10.1080/20008066.2024.2390332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 07/23/2024] [Accepted: 08/02/2024] [Indexed: 08/22/2024] Open
Abstract
Background: the aim of this study is to understand the diagnostic process undertaken by psychiatrists and psychologists regarding adjustment disorder (AD) in their clinical practice and how they differentiate it from major depressive episode (MDE).Methods: A hermeneutic study using grounded theory techniques was carried out. Semi-structured interviews were conducted with twelve psychiatrists and eight psychologists in Colombia, and transcribed verbatim. Initial line-by-line coding was performed, followed by focused and axial coding to construct categories explaining the professionals' reasoning process.Results: The clinical reasoning of professionals regarding AD was understood through four major categories. (1) Difficulty in addressing the experience of stressful events, as there is a risk of pathologizing and medicalizing them. (2) Mental health diagnoses are necessary but not apodictic. (3) The diagnostic category of AD allows for the description of a fluctuating depressive and anxious syndrome occurring in reaction to a stressful event, whose abnormality criteria are based on intersubjective knowledge of the patient's life history and consequential reasoning regarding the need for professional support. (4) The AD label could potentially protect against overdiagnosis of MDE and overuse of antidepressants. Many clinicians in their practice thus subordinate the diagnosis of MDE to ensuring it is not AD, contrary to what is outlined in diagnostic manuals.Conclusion: This study allowed us to understand the clinical reasoning of psychiatrists and psychologists about AD as a diagnosis that inherently indicates the need to work on coping and intervene in the stressor and should be considered as a diagnostic possibility in the same hierarchy as MDE in reactive syndromes, rather than a residual category.
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Affiliation(s)
- Juan Pablo Zapata-Ospina
- Institute of Medical Research, Faculty of Medicine, University of Antioquia, Academic Group in Clinical Epidemiology (GRAEPIC), Medellín, Colombia
| | | | | | - Carlos Enrique Yepes-Delgado
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Antioquia, Medellín, Colombia
- Department of Research, Pablo Tobón Uribe Hospital, Medellín, Colombia
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Zapata-Ospina JP, Jiménez-Benítez M, Fierro M. "I was very sad, but not depressed": phenomenological differences between adjustment disorder and a major depressive episode. Front Psychiatry 2023; 14:1291659. [PMID: 38146279 PMCID: PMC10749326 DOI: 10.3389/fpsyt.2023.1291659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 11/21/2023] [Indexed: 12/27/2023] Open
Abstract
Introduction Adjustment disorder (AD) is a diagnosis that must be differentiated from major depressive episode (MDE) because of the therapeutic implications. The aim of this study is to understand the experience of patients who in their lifetime have been diagnosed with AD as well as MDE to establish the characteristics of each disorder. Methods A descriptive phenomenological approach was used with in-depth interviews to four patients and the method proposed by Colaizzi to understand the experiences and reach the description of both disorders. Results Three women and one man, with advanced schooling were interviewed. The participants emphasized the existence of differences that were grouped in: the attribution made by the individual, the theme of cognitions, the variability in the course, the possibility of mood modulation, the syndrome severity, the presence of hopelessness and the perceived course. Conclusion Phenomenological differences were found in the subjective experience of MDE and AD. The MDE would be described as an intense state of generalized shutdown of the subject's own life, with little response to events, and the AD, as a dynamic reaction attributed to a stressful event, with high variability in the course of symptoms due to the dependence on such event, with the preserved hope that it will end.
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Affiliation(s)
- Juan Pablo Zapata-Ospina
- Institute of Medical Research, School of Medicine, Universidad de Antioquia, Academic Group of Clinical Epidemiology (GRAEPIC), Medellín, Colombia
- Hospital Alma Máter de Antioquia, Medellín (Antioquia), Medellín, Colombia
| | - Mercedes Jiménez-Benítez
- Department of Psychology, Faculty of Social and Human Sciences, University of Antioquia, Medellín, Colombia
| | - Marco Fierro
- Department of Psychiatry, School of Medicine, Fundación Universitaria Sanitas, Psychopathology and Society Research Group, Bogotá, Colombia
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Arbus C, Hergueta T, Duburcq A, Saleh A, Le Guern ME, Robert P, Camus V. Adjustment disorder with anxiety in old age: Comparing prevalence and clinical management in primary care and mental health care. Eur Psychiatry 2020; 29:233-8. [DOI: 10.1016/j.eurpsy.2013.04.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 03/18/2013] [Accepted: 04/17/2013] [Indexed: 10/26/2022] Open
Abstract
AbstractPurpose:Adjustment disorder with anxiety (AjD-A) is a common cause of severe anxiety symptoms, but little is known about its prevalence in old age.Methods:This cross-sectional study examined the prevalence of AjD-A in outpatients over the age of 60 who consecutively consulted 34 general practitioners and 22 psychiatrists during a 2-week period. The diagnosis of AjD-A was obtained using the optional module for diagnostic of adjustment disorder of the Mini International Neuropsychiatric Interview (MINI). The study procedure also explored comorbid psychiatric conditions and documented recent past stressful life events, as well as social disability and current pharmacological and non-pharmacological management.Results:Overall, 3651 consecutive subjects were screened (2937 in primary care and 714 in mental health care). The prevalence rate of AjD-A was 3.7% (n = 136). Up to 39% (n = 53) of AjD-A subjects had a comorbid psychiatric condition, mostly of the anxious type. The most frequently stressful life event reported to be associated with the onset of AjD-A was personal illness or health problem (29%). More than 50% of the AjD-A patients were markedly to extremely disabled by their symptoms. Compared to patients who consulted psychiatrists, patients who were seen by primary care physicians were older, had obtained lower scores at the Hamilton Anxiety Rating Scale, benefited less frequently from non-pharmacological management and received benzodiazepines more frequently.Conclusions:AjD-A appears to be a significantly disabling cause of anxiety symptoms in community dwelling elderly persons, in particular those presenting personal health related problems. Improvement of early diagnosis and non-pharmacological management of AjD-A would contribute to limit risks of benzodiazepine overuse, particularly in primary care settings.
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Fava GA, McEwen BS, Guidi J, Gostoli S, Offidani E, Sonino N. Clinical characterization of allostatic overload. Psychoneuroendocrinology 2019; 108:94-101. [PMID: 31252304 DOI: 10.1016/j.psyneuen.2019.05.028] [Citation(s) in RCA: 137] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 05/28/2019] [Accepted: 05/29/2019] [Indexed: 11/19/2022]
Abstract
Allostatic load reflects the cumulative effects of stressful experiences in daily life and may lead to disease over time. When the cost of chronic exposure to fluctuating or heightened neural and systemic physiologic responses exceeds the coping resources of an individual, this is referred to as "toxic stress" and allostatic overload ensues. Its determination has initially relied on measurements of an interacting network of biomarkers. More recently, clinical criteria for the determination of allostatic overload, that provide information on the underlying individual experiential causes, have been developed and used in a number of investigations. These clinimetric tools can increase the number of people screened, while putting the use of biomarkers in a psychosocial context. The criteria allow the personalization of interventions to prevent or decrease the negative impact of toxic stress on health, with particular reference to lifestyle modifications and cognitive behavioral therapy.
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Affiliation(s)
- Giovanni A Fava
- Department of Psychology, University of Bologna, Bologna, Italy; Department of Psychiatry, State University of New York at Buffalo, Buffalo, NY, USA.
| | - Bruce S McEwen
- Laboratory of Neuroendocrinology, The Rockefeller University, New York, NY, USA
| | - Jenny Guidi
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Sara Gostoli
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Emanuela Offidani
- Department of Behavioral Science and Education, Pennsylvania State University, Schuylkill Haven, PA, USA
| | - Nicoletta Sonino
- Department of Psychiatry, State University of New York at Buffalo, Buffalo, NY, USA; Department of Statistical Sciences, University of Padova, Padova, Italy
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Abstract
OBJECTIVES Adjustment disorder (AD) is a frequent diagnosis in clinical practice worldwide. After long neglect in mental health research, the new DSM definition and in particular the ICD-11 model of AD is about to create a fresh impulse for research on AD and for refined clinical use of the diagnosis. METHODS This paper outlines the clinical features of AD according to the ICD-10, ICD-11 and DSM-5 definitions, and provides case vignettes of patients with AD with clinical presentations of dominating anxiety, depressed mood or mixed symptom presentations. The available clinical assessments and diagnostic tools are described in detail, together with findings on their psychometric properties. RESULTS The current AD definitions are consistent with a new nosological grouping of AD with posttraumatic stress disorder in the chapter on trauma- and stressor-related disorders, or stress response syndromes. CONCLUSIONS This nosological specification opens new avenues for neurobiological and psychological research on AD and for developing novel therapies.
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Affiliation(s)
- Andreas Maercker
- a Department of Psychology , University of Zurich , Zurich , Switzerland
| | - Louisa Lorenz
- a Department of Psychology , University of Zurich , Zurich , Switzerland
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Grass L, de Figueiredo J. Advances in the Understanding of Demoralization in Oncology and Palliative Care. PSYCHO-ONCOLOGIE 2018. [DOI: 10.3166/pson-2018-0049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Oh DJ, Lee DH, Kim EY, Kim WJ, Baik MJ. Altered autonomic reactivity in Korean military soldiers with adjustment disorder. Psychiatry Res 2018; 261:428-435. [PMID: 29353770 DOI: 10.1016/j.psychres.2017.12.065] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 12/21/2017] [Accepted: 12/30/2017] [Indexed: 10/18/2022]
Abstract
Only few studies addressing the biological background of adjustment disorder (AD) exist. We examined the psychophysiological correlates indicative of autonomic regulation in AD. Heart rate variability (HRV), skin conductance, skin temperature, electromyography, and respiration were measured during serial stress tasks in 33 soldiers with AD and 60 healthy controls (HC). Patients with AD displayed lower relative power of high frequency (rHF) HRV and higher relative power of very low frequency (rVLF) HRV compared with HC at baseline. Inversely, the rHF of patients with AD remained higher and their rVLF remained lower compared with HC parameters after the single stress task, which suggests a reversed sympathovagal balance in AD. Mean heart rate and skin conductance increased during stress tasks in patients, although to a lesser extent than in HC. Skin temperature remained unchanged in all tasks in patients with AD. The tension of the frontalis muscle was higher in patients compared with HC from the second stress task onward. Thoracic breathing was more prevalent in patients with AD. Our study suggests altered autonomic reactivity in AD, which leads to a lack of sympathetic response to stress. We conclude that the distinctive biological mechanisms underlying AD are different from normal stress reactions.
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Affiliation(s)
- Dae Jong Oh
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Psychiatry, Naval Pohang Hospital, Pohang, Republic of Korea
| | - Do Hyeong Lee
- Department of Psychiatry, Armed Forces Capital Hospital, Seongnam, Republic of Korea
| | - Eun Young Kim
- Department of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Woo Jung Kim
- Department of Psychiatry, Myongji Hospital, Goyang, Republic of Korea
| | - Myung Jae Baik
- Department of Psychiatry, Armed Forces Capital Hospital, Seongnam, Republic of Korea.
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Bachem R, Casey P. Adjustment disorder: A diagnosis whose time has come. J Affect Disord 2018; 227:243-253. [PMID: 29107817 DOI: 10.1016/j.jad.2017.10.034] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 10/06/2017] [Accepted: 10/19/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Adjustment disorder is among the most frequently diagnosed mental disorders in clinical practice although it has received little academic attention and been the subject of substantial criticism over the past decades. While those suffering with adjustment disorders are often treated by mental health professionals, research interest in the origin of the disorder or the effectiveness of psychotherapeutic and medical interventions has only recently begun to emerge. This article summarizes the empirical literature published on adjustment disorder and points out current diagnostic developments in DSM-5 and ICD-11. METHODS Literature for this review was identified through established online search tools, including publications in English, German, and Spanish. RESULTS This paper reviews literature on the evolution of adjustment disorder, and highlights the current state of research with regard to genesis and treatment. Importantly, for the first time ICD-11 intends to define adjustment disorder by explicit symptom groups, unlike DSM-5. LIMITATIONS Publications without an English abstract were not included. CONCLUSIONS Key directions for future research include investigating the concordance of the ICD-11 and DSM-5 concepts and the effect that the diverging conceptualizations may have. Risk and protective factors specific to AD should be identified and the biological underpinnings of the disorder should be explored. Finally, given the high prevalence of AD in certain clinical settings effective disorder-specific interventions should be developed and evaluated.
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Affiliation(s)
- Rahel Bachem
- Bob Shapell School of Social Work, Tel Aviv University, Chaim Levanon 30, Tel Aviv 699780, Israel.
| | - Patricia Casey
- University College Dublin, School of Medicine, Mater Misericordiae Hospital, 62/63 Eccles Street, Dublin 7, Ireland
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9
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Abstract
Adjustment disorder (AjD) is among the most often diagnosed mental disorders in clinical practice. This paper reviews current status of AjD research and discusses scientific and clinical issues associated with AjD. AjD has been included in diagnostic classifications for over 50 years. Still, the diagnostic criteria for AjD remain vague and cause difficulties to mental health professionals. Controversies in definition resulted in the lack of reliable and valid measures of AjD. Epidemiological data on prevalence of AjD is scarce and not reliable because prevalence data are biased by the diagnostic algorithm, which is usually developed for each study, as no established diagnostic standards for AjD are available. Considerable changes in the field of AjD could follow after the release of the 11th edition of International Classification of Diseases (ICD-11). A new AjD symptom profile was introduced in ICD-11 with 2 main symptoms as follows: 1) preoccupation and 2) failure to adapt. However, differences between the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition and ICD-11 AjD diagnostic criteria could result in diverse research findings in the future. The best treatment approach for AjD remains unclear, and further treatment studies are needed to provide AjD treatment guidelines to clinicians.
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Affiliation(s)
- Paulina Zelviene
- Department of Clinical and Organizational Psychology, Vilnius University, Vilnius, Lithuania
| | - Evaldas Kazlauskas
- Department of Clinical and Organizational Psychology, Vilnius University, Vilnius, Lithuania
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Keeley JW, Reed GM, Roberts MC, Evans SC, Robles R, Matsumoto C, Brewin CR, Cloitre M, Perkonigg A, Rousseau C, Gureje O, Lovell AM, Sharan P, Maercker A. Disorders specifically associated with stress: A case-controlled field study for ICD-11 mental and behavioural disorders. Int J Clin Health Psychol 2016; 16:109-127. [PMID: 30487855 PMCID: PMC6225017 DOI: 10.1016/j.ijchp.2015.09.002] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 09/22/2015] [Indexed: 11/16/2022] Open
Abstract
As part of the development of the Eleventh Revision of International Classification of Diseases and Related Health Problems (ICD-11), the World Health Organization Department of Mental Health and Substance Abuse is conducting a series of case-controlled field studies using a new and powerful method to test the application by clinicians of the proposed ICD-11 diagnostic guidelines for mental and behavioural disorders. This article describes the case-controlled field study for Disorders Specifically Associated with Stress. Using a vignette-based experimental methodology, 1,738 international mental health professionals diagnosed standardized cases designed to test key differences between the proposed diagnostic guidelines for ICD-11 and corresponding guidelines for ICD-10. Across eight comparisons, several proposed changes for ICD-11, including the addition of Complex PTSD and Prolonged Grief Disorder, produced significantly improved diagnostic decisions and clearer application of diagnostic guidelines compared to ICD-10. However, several key areas were also identified, such as the description of the diagnostic requirement of re-experiencing in PTSD, in which the guidelines were not consistently applied as intended. These results informed specific revisions to improve the clarity of the proposed ICD-11 diagnostic guidelines. The next step will be to further test these guidelines in clinic-based studies using real patients in relevant settings.
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Affiliation(s)
| | - Geoffrey M. Reed
- World Health Organization, Switzerland
- Universidad Autónoma de México (UNAM), Mexico
- Instituto Nacional de Psiquiatría “Ramón de la Fuente Muñiz”, Mexico
| | | | | | - Rebeca Robles
- Instituto Nacional de Psiquiatría “Ramón de la Fuente Muñiz”, Mexico
| | | | | | - Marylène Cloitre
- National Center for PTSD, USA
- New York University Langone Medical Center, USA
| | | | | | | | - Anne M. Lovell
- National Institute of Health and Medical Research (INSERM), France
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de Figueiredo JM, Griffith JL. Chronic Pain, Chronic Demoralization, and the Role of Psychotherapy. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2016. [DOI: 10.1007/s10879-016-9331-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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12
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Myung W, Na KS, Ham BJ, Oh SJ, Ahn HW, Jung HY. Decreased medial frontal gyrus in patients with adjustment disorder. J Affect Disord 2016; 191:36-40. [PMID: 26630395 DOI: 10.1016/j.jad.2015.11.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 11/02/2015] [Accepted: 11/15/2015] [Indexed: 12/24/2022]
Abstract
BACKGROUNDS Adjustment disorder is a frequent mental illness that occurs under various stressful situations. Whereas adjustment disorder has distinct clinical manifestations and diagnostic entity, few studies have investigated its underlying neural substrate. This study aimed to identify brain structural abnormalities among patients with adjustment disorder. METHODS Twenty-five patients with adjustment disorder and 25 healthy controls participated in the study. Structural magnetic resonance imaging was performed, and a voxel-based morphometry was applied. Family-wise error-corrected p values for statistical analysis of comparative gray matters between patients with adjustment disorder and healthy controls were used. RESULTS Patients with adjustment disorder had decreased gray matter volume in the right medial frontal gyrus as compared to healthy controls. There were no brain regions that were decreased in the healthy controls as compared to patients with adjustment disorder. LIMITATIONS This study was a cross-sectional design. CONCLUSIONS Our results suggest that adjustment disorder arises from characteristic neural abnormalities, contrary to previous notions suggesting that adjustment disorder is a non-specific and/or residual diagnostic term. Moreover, future studies should examine the underlying neural substrates responsible for successful adaptation to unfamiliar and stressful situations.
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Affiliation(s)
- Woojae Myung
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyoung-Sae Na
- Department of Psychiatry, Gachon University Gil Medical Center, Incheon, Republic of Korea.
| | - Byung-Joo Ham
- Department of Psychiatry, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Sei-Joong Oh
- Department of Psychiatry, Jecheon Hospital, Jecheon, Republic of Korea
| | - Hyun-Woong Ahn
- Department of Psychiatry, Chungmu Sarang Hospital, Cheonan, Republic of Korea
| | - Han-Yong Jung
- Department of Psychiatry, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
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Anastasia A, Colletti C, Cuoco V, Quartini A, Urso S, Rinaldi R, Bersani G. Demographic variables, clinical aspects, and medicolegal implications in a population of patients with adjustment disorder. Neuropsychiatr Dis Treat 2016; 12:737-43. [PMID: 27099504 PMCID: PMC4824367 DOI: 10.2147/ndt.s92637] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Although adjustment disorder (AD) is considered as residual diagnosis and receives little attention in research, it plays an important role in clinical practice and also assumes an increasingly important role in the field of legal medicine, where the majority of diagnostic frameworks (eg, mobbing) often refer to AD. Our study aimed to look for specific stressor differences among demographic and clinical variables in a naturalistic setting of patients with AD. METHODS A restrospective statistical analysis of the data of patients diagnosed with AD from November 2009 to September 2012, identified via manual search from the archive of the outpatient setting at the University Unit of Psychiatry "A. Fiorini" Hospital, Terracina (Latina, Italy), was performed. RESULTS The sample consisted of 93 patients (46 males and 47 females), aged between 26 and 85, with medium-high educational level who were mainly employed. In most cases (54.80%), a diagnosis of AD with mixed anxiety and depressed mood was made. In all, 72% of the sample reported a negative family history for psychiatric disorders. In 22.60%, a previous history of psychopathology, especially mood disorders (76.19%), was reported. The main stressors linked to the development of AD were represented by working problems (32.30%), family problems (23.70%), and/or somatic disease (22.60%) with significant differences with respect to age and sex. Half of the patients were subjected to a single first examination; 24.47% requested a copy of medical records. CONCLUSION Confirming previous data from previous reports, our results suggest that AD may have a distinct profile in demographic and clinical terms. Increased scientific attention is hoped, particularly focused on addressing a better definition of diagnostic criteria, whose correctness and accuracy are critical, especially in situations with medicolegal implications.
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Affiliation(s)
- Annalisa Anastasia
- Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Rome, Italy
| | - Chiara Colletti
- Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Rome, Italy
| | - Valentina Cuoco
- Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Rome, Italy
| | - Adele Quartini
- Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Rome, Italy
| | - Stefania Urso
- Department of Anatomical, Istological, Forensic and Locomotor System Sciences, Sapienza University of Rome, Rome, Italy
| | - Raffaella Rinaldi
- Department of Anatomical, Istological, Forensic and Locomotor System Sciences, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Bersani
- Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Rome, Italy
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Abstract
BACKGROUND Demoralization has been described as a psychological state characterized by helplessness, hopelessness, a sense of failure and the inability to cope. METHODS We conducted a systematic review with qualitative data analysis following PRISMA criteria with the following aims: to review validated assessment instruments of the demoralization syndrome, report main findings regarding demoralization as measured by validated instruments that emerge in the literature, compare and report evidence for the clinical utility of the identified instruments. Utilizing the key word 'demoralization' in PubMed and PsycINFO databases, an electronic search was performed, supplemented by Web of Science and manual searches. Study selection criteria included the assessment of medical patients and use of instruments validated to assess demoralization. Seventy-four studies were selected. RESULTS Four instruments emerged in the literature. Main findings concern prevalence rates of demoralization, evidence of discriminant validity from major depression, factors associated with demoralization and evidence of clinical utility. The instruments vary in their definition, the populations they aim to assess, prevalence rates they estimate and their ability to discriminate between different conditions. Nonetheless, demoralization appears to be a distinctive psychological state characterized by helplessness, hopelessness, giving up and subjective incompetence. It is not limited to life-threatening diseases such as cancer, but may occur in any type of clinical situation. It is associated with stress and adverse health outcomes. CONCLUSIONS Studies addressing the incremental value of demoralization in psychiatry and psychology are needed. However, demoralization appears to entail specific clinical features and may be a distinct condition from major depression.
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Affiliation(s)
- L Tecuta
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology,University of Bologna,Bologna,Italy
| | - E Tomba
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology,University of Bologna,Bologna,Italy
| | - S Grandi
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology,University of Bologna,Bologna,Italy
| | - G A Fava
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology,University of Bologna,Bologna,Italy
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Bos EH, Merea R, van den Brink E, Sanderman R, Bartels-Velthuis AA. Mindfulness training in a heterogeneous psychiatric sample: outcome evaluation and comparison of different diagnostic groups. J Clin Psychol 2013; 70:60-71. [PMID: 23801545 DOI: 10.1002/jclp.22008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To examine outcome after mindfulness training in a heterogeneous psychiatric outpatient population and to compare outcome in different diagnostic groups. METHOD One hundred and forty-three patients in 5 diagnostic categories completed questionnaires about psychological symptoms, quality of life, and mindfulness skills prior to and immediately after treatment. RESULTS The mixed patient group as a whole improved significantly on all outcome measures. Differential improvement was found for different diagnostic categories with respect to psychological symptoms and quality of life: Bipolar patients did not improve significantly on these measures. This finding could be explained by longer illness duration and lower baseline severity in the bipolar category. CONCLUSION Mindfulness training is associated with overall improvement in a heterogeneous outpatient population. Differences in outcome between diagnostic categories may be ascribed to differences in illness duration and baseline severity.
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Affiliation(s)
- Elisabeth H Bos
- Lentis Mental Health Organization, Center for Integrative Psychiatry, Groningen, the Netherlands; University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Groningen, the Netherlands
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Maercker A, Brewin CR, Bryant RA, Cloitre M, Reed GM, van Ommeren M, Humayun A, Jones LM, Kagee A, Llosa AE, Rousseau C, Somasundaram DJ, Souza R, Suzuki Y, Weissbecker I, Wessely SC, First MB, Saxena S. Proposals for mental disorders specifically associated with stress in the International Classification of Diseases-11. Lancet 2013; 381:1683-5. [PMID: 23583019 DOI: 10.1016/s0140-6736(12)62191-6] [Citation(s) in RCA: 316] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Andreas Maercker
- Department of Psychology, Division of Psychopathology, University of Zurich, Zurich, Switzerland.
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Jeong HG, Ko YH, Han C, Kim YK, Joe SH. Distinguishing Quantitative Electroencephalogram Findings between Adjustment Disorder and Major Depressive Disorder. Psychiatry Investig 2013; 10:62-8. [PMID: 23482820 PMCID: PMC3590432 DOI: 10.4306/pi.2013.10.1.62] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 07/18/2012] [Accepted: 07/25/2012] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Adjustment disorder (ADJ) is a common diagnosis. However, it is difficult to distinguish ADJ from other major Axis I disorders, such as major depressive disorder (MDD). The aim of this study was to determine the distinguishing neurophysiological characteristics between ADJ and MDD using quantitative analysis of an electroencephalogram (QEEG). METHODS The study included 30 patients with ADJ and 51 patients with MDD. Resting (eye closed) vigilance controlled EEG recordings were assessed at 19 electrode sites according to the international 10/20 system. QEEG absolute power and coherence were calculated for the delta, theta, alpha and beta bandwidths. RESULTS Absolute powers of alpha and high beta bands, particularly at the frontocentral area, differed between MDD and ADJ group (p<0.05). Interhemispheric coherence values for the delta and beta bands were lower in the ADJ group than in the MDD group (p<0.05). Intrahemispheric coherence values for the alpha band were also lower in the ADJ group (p<0.05). CONCLUSION The differences in QEEG power and coherence in our investigation suggest that underlying pathophysiologic mechanisms may be different between ADJ and MDD.
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Affiliation(s)
- Hyun-Ghang Jeong
- Department of Psychiatry, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Young-Hoon Ko
- Department of Psychiatry, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
| | - Changsu Han
- Department of Psychiatry, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
| | - Yong-Ku Kim
- Department of Psychiatry, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
| | - Sook-Haeng Joe
- Department of Psychiatry, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
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Maercker A, Forstmeier S, Pielmaier L, Spangenberg L, Brähler E, Glaesmer H. Adjustment disorders: prevalence in a representative nationwide survey in Germany. Soc Psychiatry Psychiatr Epidemiol 2012; 47:1745-52. [PMID: 22407021 DOI: 10.1007/s00127-012-0493-x] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Accepted: 02/25/2012] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This is the first study to estimate the prevalence of adjustment disorder (AjD) in the general population. A new conceptualisation of AjD as a stress response syndrome was applied, which allowed AjD to be assessed directly from its symptom profile, including intrusive, avoidance and failure-to-adapt symptoms (Maercker et al., Psychopathology 40:135-146, 2007). METHODS Prevalence rates of distressing life events and AjD were estimated from a representative sample of the German general population (n = 2,512) with a broad age range (14-93 years). A questionnaire including a life events checklist and self-rating questions that assessed AjD symptoms and symptom duration were personally handed out by an interviewer. RESULTS The prevalence of AjD fulfilling the criterion of clinically significant impairment was 0.9%; a further 1.4% of the sample was diagnosed with AjD without fulfilling the impairment criterion. In ~72.5% of AjD cases, symptoms had developed 6-24 months prior to assessment. AjD was most often associated with acute events such as moving or chronic stressors such as serious illness, conflicts at the respondent's job or with friends or neighbours (with ~5% conditional probability each). CONCLUSIONS The results correspond with the few other studies that have examined the prevalence of AjD, even though a new conceptualisation of the disorder was used. Explorative results regarding the duration of AjD syndromes and symptoms call for further redefinition and empirical investigation of this under-researched mental condition.
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Affiliation(s)
- Andreas Maercker
- Department of Psychology, University of Zurich, Binzmuhlestr. 14, 8050 Zurich, Switzerland.
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Harald B, Gordon P. Meta-review of depressive subtyping models. J Affect Disord 2012; 139:126-40. [PMID: 21885128 DOI: 10.1016/j.jad.2011.07.015] [Citation(s) in RCA: 212] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Revised: 05/11/2011] [Accepted: 07/15/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Increasing dissatisfaction with the non-specificity of major depression has led many to propose more specific depressive subtyping models. The present meta-review seeks to map dominant depressive subtype models, and highlight definitions and overlaps. METHODS A database search in Medline and EMBASE of proposed depressive subtypes, and limited to reviews published between 2000 and 2011, was undertaken. Of the more than four thousand reviews, 754 were judged as potentially relevant and provided the base for the present selective meta-review. RESULTS Fifteen subtype models were identified. The subtypes could be divided into five molar categories of (1) symptom-based subtypes, such as melancholia, psychotic depression, atypical depression and anxious depression, (2) aetiologically-based subtypes, exemplified by adjustment disorders, early trauma depression, reproductive depression, perinatal depression, organic depression and drug-induced depression, (3) time of onset-based subtypes, as illustrated by early and late onset depression, as well as seasonal affective disorder, (4) gender-based (e.g. female) depression, and (5) treatment resistant depression. An overview considering definition, bio-psycho-social correlates and the evidence base of treatment options for each subtype is provided. LIMITATIONS Despite the large data base, this meta-review is nevertheless narrative focused. CONCLUSIONS Subtyping depression is a promising attempt to overcome the non-specificity of many diagnostic constructs such as major depression, both in relation to their intrinsic non-specificity and failure to provide treatment-specific information. If a subtyping model is to be advanced it would need, however, to demonstrate differential impacts of causes and treatments.
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Guidi J, Fava GA, Picardi A, Porcelli P, Bellomo A, Grandi S, Grassi L, Pasquini P, Quartesan R, Rafanelli C, Rigatelli M, Sonino N. Subtyping depression in the medically ill by cluster analysis. J Affect Disord 2011; 132:383-8. [PMID: 21458076 DOI: 10.1016/j.jad.2011.03.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2010] [Revised: 02/28/2011] [Accepted: 03/01/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is increasing awareness of the need of subtyping major depressive disorder, particularly in the setting of medical disease. The aim of this investigation was to use both DSM-IV comorbidity and the Diagnostic Criteria for Psychosomatic Research (DCPR) for characterizing depression in the medically ill. METHODS 1700 patients were recruited from 8 medical centers in the Italian Health System and 1560 agreed to participate. They all underwent a cross-sectional assessment with DSM-IV and DCPR structured interviews. 198 patients (12.7%) received a diagnosis of major depressive disorder. Data were submitted to cluster analysis. RESULTS Two clusters were identified: depressed somatizers and irritable/anxious depression. The somatizer cluster included 58.6% of the cases and was characterized by DCPR somatization syndromes (persistent somatization, functional somatic symptoms secondary to a psychiatric disorder, conversion symptoms, and anniversary reactions) and DCPR alexithymia. The anxious/irritable cluster had 41.4% of the total sample and included DCPR irritable mood and type A behavior and DSM-IV anxiety disorders. LIMITATIONS The study has limitations due to its cross-sectional nature. Further, these findings require additional validation in another sample. CONCLUSIONS The findings indicate the need of expanding clinical assessment in the medically ill to include the various manifestations of somatization, irritable mood, type A behavior and alexithymia, as encompassed by the DCPR. Subtyping major depressive disorder may yield improved targets for psychosomatic research and treatment trials.
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Affiliation(s)
- Jenny Guidi
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Bologna, Italy.
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Stagg EK, Lazenby M. Best Practices for the Nonpharmacological Treatment of Depression at the End of Life. Am J Hosp Palliat Care 2011; 29:183-94. [DOI: 10.1177/1049909111413889] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Mark Lazenby
- Yale School of Nursing, South New Haven, CT, USA
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Comorbid mental disorders and psychosocial distress in patients with brain tumours and their spouses in the early treatment phase. Support Care Cancer 2010; 19:1797-805. [PMID: 20953802 DOI: 10.1007/s00520-010-1021-8] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Accepted: 10/04/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE The aim of this study was to examine the prevalence of comorbid mental disorders as well as the extent of psychosocial distress in patients with intracranial tumours and their partners during the early treatment phase. Moreover, we aimed to identify which events are experienced as most distressing in the context of the early diagnosis of brain cancer by patients and spouses. METHODS Structured clinical interviews for DSM-IV (SCID-IV) were conducted with 26 patients and their partners after the first neurosurgical treatment within the first 3 months after the detection of a brain tumour. Screening measures (NCCN distress thermometer, HADS, IES-R) were used to assess the extent of psychosocial distress as well as anxiety, depression and traumatic stress responses. Distressing experiences were assessed via a structured questionnaire and interview. RESULTS Thirty-eight per cent of the patients and 47% of the partners suffered from a psychiatric disorder. Most frequent diagnoses were adjustment disorder and acute stress disorder. The majority of the participants suffered from elevated psychosocial distress. Partners were equally or even more affected than the patients. For the patients, the experience most frequently described as distressing was the first detection of the tumour. The majority of the partners reported to be distressed by the fear of surgery outcomes. CONCLUSIONS This study revealed that during this very first treatment phase, both brain tumour patients and their spouses show a high prevalence of comorbid mental disorders and psychosocial distress. The findings suggest that research and clinical efforts are needed to address the psychosocial concerns of these populations.
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