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Atmaca M, Bibar A, Tabara MF, Koc M, Gurok MG, Korkmaz S, Mermi O, Yildirim H. Pituitary volumes in patients with adjustment disorder. Cereb Cortex 2024; 34:bhae148. [PMID: 38610089 DOI: 10.1093/cercor/bhae148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 03/11/2024] [Accepted: 03/12/2024] [Indexed: 04/14/2024] Open
Abstract
The pituitary gland plays an important role in the stress response mechanism. Given the direct link between adjustment disorder and stress, we hypothesized that there might be changes in the pituitary gland in these patients. The study comprised a patient group of 19 individuals with adjustment disorder according to the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition, and 18 healthy controls. The mean pituitary gland volumes of the patient group were not statistically significantly different from those of the healthy control group (80.81 ± 1.82 mm3 in patients with adjustment disorder vs. 81.10 ± 7.04 mm3 in healthy controls, with a statistically nonsignificant difference of P > 0.05). This finding is contrary to our previous findings in anxiety-related disorders. In this regard, adjustment disorder is not similar to anxiety-related disorders in terms of pituitary gland volumes. We should also clearly state that our study is a pioneering study and that studies with large samples are needed to support our findings. The limitations of our study can be attributed to the small sample size, the utilization of a cross-sectional design, and the inclusion of patients using psychotropic drugs.
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Affiliation(s)
- Murad Atmaca
- Department of Psychiatry University, Firat University, School of Medicine, District Yahya Kemal Street No: 25 23119 Merkez/Elazig, Turkey
| | - Alper Bibar
- Department of Psychiatry University, Firat University, School of Medicine, District Yahya Kemal Street No: 25 23119 Merkez/Elazig, Turkey
| | - Muhammed Fatih Tabara
- Department of Psychiatry University, Firat University, School of Medicine, District Yahya Kemal Street No: 25 23119 Merkez/Elazig, Turkey
| | - Mustafa Koc
- Department of Radiology University, Firat University, School of Medicine, District Yahya Kemal Street No: 25 23119 Merkez/Elazig, Turkey
| | - Mehmet Gurkan Gurok
- Department of Psychiatry University, Firat University, School of Medicine, District Yahya Kemal Street No: 25 23119 Merkez/Elazig, Turkey
| | - Sevda Korkmaz
- Department of Psychiatry University, Firat University, School of Medicine, District Yahya Kemal Street No: 25 23119 Merkez/Elazig, Turkey
| | - Osman Mermi
- Department of Psychiatry University, Firat University, School of Medicine, District Yahya Kemal Street No: 25 23119 Merkez/Elazig, Turkey
| | - Hanefi Yildirim
- Department of Radiology University, Firat University, School of Medicine, District Yahya Kemal Street No: 25 23119 Merkez/Elazig, Turkey
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Lindsäter E, Svärdman F, Wallert J, Ivanova E, Söderholm A, Fondberg R, Nilsonne G, Cervenka S, Lekander M, Rück C. Exhaustion disorder: scoping review of research on a recently introduced stress-related diagnosis. BJPsych Open 2022; 8:e159. [PMID: 36458830 PMCID: PMC9438479 DOI: 10.1192/bjo.2022.559] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Symptoms related to chronic stress are prevalent and entail high societal costs, yet there is a lack of international consensus regarding diagnostics and treatment. A new stress-related diagnosis, exhaustion disorder, was introduced into the Swedish version of ICD-10 in 2005. Since then, use of the diagnosis has increased rapidly. AIMS To create the first comprehensive synthesis of research on exhaustion disorder to report on the current state of knowledge. Preregistration: Open Science Framework (http://www.w3.org/1999/xlink">osf.io), doi 10.17605/OSF.IO/VFDKW. METHOD A PRISMA-guided scoping review of all empirical studies of exhaustion disorder was conducted. Searches were run in the MEDLINE, PsycInfo and Web of Science databases. Data were systematically charted and thematically categorised based on primary area of investigation. RESULTS Eighty-nine included studies were sorted into six themes relating to lived experience of exhaustion disorder (n = 9), symptom presentation and course (n = 13), cognitive functioning (n = 10), biological measures (n = 24), symptom measurement scales (n = 4) and treatment (n = 29). Several studies indicated that individuals with exhaustion disorder experience a range of psychiatric and somatic symptoms beyond fatigue, but robust findings within most thematic categories were scarce. The limited number of studies, lack of replication of findings and methodological limitations (e.g. small samples and scarcity of specified primary outcomes) preclude firm conclusions about the diagnostic construct. CONCLUSIONS More research is needed to build a solid knowledge base for exhaustion disorder. International collaboration regarding the conceptualisation of chronic stress and fatigue is warranted to accelerate the growth of evidence.
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Affiliation(s)
- Elin Lindsäter
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Stockholm, Sweden; and Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Frank Svärdman
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; and Stockholm Health Care Services, Stockholm, Sweden
| | - John Wallert
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; and Stockholm Health Care Services, Stockholm, Sweden
| | - Ekaterina Ivanova
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; and Stockholm Health Care Services, Stockholm, Sweden
| | - Anna Söderholm
- Department of Psychology, Umeå Universitet, Umeå, Sweden
| | - Robin Fondberg
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; and Stockholm Health Care Services, Stockholm, Sweden
| | - Gustav Nilsonne
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; and Stress Research Institute, Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Simon Cervenka
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Stockholm, Sweden; and Department of Medical Sciences, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Mats Lekander
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stress Research Institute, Department of Psychology, Stockholm University, Sweden; and Osher Center for Integrative Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Christian Rück
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; and Stockholm Health Care Services, Stockholm, Sweden
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An Integrative Neuro-Psychotherapy Treatment to Foster the Adjustment in Acquired Brain Injury Patients-A Randomized Controlled Study. J Clin Med 2020; 9:jcm9061684. [PMID: 32498240 PMCID: PMC7355481 DOI: 10.3390/jcm9061684] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/25/2020] [Accepted: 05/28/2020] [Indexed: 12/18/2022] Open
Abstract
Adjustment disorders (AjD) with depressive symptoms following an acquired brain injury (ABI) is a common phenomenon. Although brain injuries are increasing more and more, research on psychological therapies is comparably scarce. The present study compared, by means of a randomized controlled trial (RCT), a newly developed integrative treatment (Standard PLUS) to a standard neuropsychological treatment (Standard). Primary outcomes were depressive symptoms assessed with the Beck Depression Inventory (BDI-II) at post-treatment and 6-month follow-up assessment. In total, 25 patients (80% after a stroke) were randomized to one of the two conditions. Intention-to-treat analyses showed that the two groups did not significantly differ either at post-treatment nor at follow-up assessment regarding depressive symptoms. Both treatments showed large within-group effect sizes on depressive symptoms. Regarding secondary outcomes, patients in the Standard PLUS condition reported more emotion regulation skills at post-assessment than in the control condition. However, this difference was not present anymore at follow-up assessment. Both treatments showed medium to large within-group effects sizes on most measures for patients suffering from an AjD after ABI. More research with larger samples is needed to investigate who profits from which intervention.
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Weber G, Michaud L, Weber O, Stiefel F, Krenz S. Les facteurs de rémission du trouble de l’adaptation : la parole aux patients. Une étude qualitative. ANNALES MEDICO-PSYCHOLOGIQUES 2018. [DOI: 10.1016/j.amp.2017.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Britt TW, McGhee JS, Quattlebaum MD. Common mental disorders among US army aviation personnel: Prevalence and return to duty. J Clin Psychol 2018; 74:2173-2186. [PMID: 30088828 DOI: 10.1002/jclp.22688] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 05/21/2018] [Accepted: 06/19/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Assess the prevalence of US Army aviation personnel with common mental disorders, the percentage that return to duty following mental health treatment, and predictors of return to duty. METHODS Examined the prevalence over a 5-year period. The percentage of personnel who were granted a waiver to return to flying duty following treatment was also determined. RESULTS The results revealed a 5-year prevalence of 0.036 (95% CI = 0.034-0.038) for personnel experiencing one or more of the mental disorders (N = 1,155). Prevalence was highest for adjustment disorders and for nonpilot participants. Overall, personnel were granted a waiver 55.3% of the time and suspended or disqualified 44.7% of the time. Waivers were more likely to be granted for an adjustment disorder and for pilots. CONCLUSIONS Discussion focuses on the importance of aviation personnel receiving mental health treatment when problems are not severe to maximize the likelihood of returning to duty.
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Affiliation(s)
- Thomas W Britt
- United States Army Aeromedical Research Laboratory, Fort Rucker, Alabama
| | - James S McGhee
- United States Army Aeromedical Research Laboratory, Fort Rucker, Alabama
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Caruso R, GiuliaNanni M, Riba MB, Sabato S, Grassi L. Depressive Spectrum Disorders in Cancer: Diagnostic Issues and Intervention. A Critical Review. Curr Psychiatry Rep 2017; 19:33. [PMID: 28488207 PMCID: PMC5423924 DOI: 10.1007/s11920-017-0785-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Depressive spectrum disorders, including major depression, persistent depression, minor and sub-syndromal depression, and other forms of depressive conditions, such as demoralization, are among the most common psychiatric consequences of cancer patients, affecting up to 60% of patients. In spite of the negative effects and the burden for cancer patients and their families, these disorders often remain under-recognized and undertreated. The present review aims at summarizing the relevant data concerning the diagnostic challenges within the depressive spectrum disorders among cancer patients. Also, the most relevant data relative to integrated intervention, including psychopharmacological and psychosocial treatment, for depression in cancer patients are critically evaluated. It is mandatory that health care professionals working in oncology (e.g., oncologists, surgeons, radiation oncologists, primary care physicians, nurses, social workers, psychologists) receive training in the diagnosis and integrated management of the different types of disorder within the spectrum of clinical depression.
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Affiliation(s)
- Rosangela Caruso
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Via Fossato di Mortara 64a, 44121, Ferrara, Italy
- University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Disorders, S. Anna University Hospital and Health Authorities, Ferrara, Italy
| | - Maria GiuliaNanni
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Via Fossato di Mortara 64a, 44121, Ferrara, Italy
- University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Disorders, S. Anna University Hospital and Health Authorities, Ferrara, Italy
| | - Michelle B Riba
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA
- Psycho-oncology Program, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA
| | - Silvana Sabato
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Via Fossato di Mortara 64a, 44121, Ferrara, Italy
| | - Luigi Grassi
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Via Fossato di Mortara 64a, 44121, Ferrara, Italy.
- University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Disorders, S. Anna University Hospital and Health Authorities, Ferrara, Italy.
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Appart A, Lange AK, Sievert I, Bihain F, Tordeurs D. [Adjustment disorder and DSM-5: A review]. L'ENCEPHALE 2016; 43:41-46. [PMID: 27216596 DOI: 10.1016/j.encep.2015.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 05/26/2015] [Accepted: 06/29/2015] [Indexed: 10/21/2022]
Abstract
INTRODUCTION This paper exposes the complexity and discrete characteristic of the adjustment disorder with reference to its clinical and scientific diagnosis. Even though the disorder occurs in frequent clinical circumstances after important life events, such as mobbing, burn-out, unemployment, divorce or separation, pregnancy denial, surgical operation or cancer, the adjustment disorder is often not considered in the diagnosis since better known disorders with similar symptoms prevail, such as major depression and anxiety disorder. Ten years ago, Bottéro had already noticed that the adjustment disorder diagnosis remained rather uncommon with reference to patients he was working with while Langlois assimilated this disorder with an invisible diagnosis. METHODOLOGY In order to maximize the data collection, we used the article review below and challenged their surveys and results: National Center for Biotechnology Information (NBCI - Pubmed) for international articles and Cairn.info for French literature. Moreover, we targeted the following keywords on the search engine and used articles, which had been published from 1 February 1975 to 31 January 2015: "adjustment", "adjustment disorder" and the French translation "trouble de l'adaptation". RESULTS One hundred and ninety-one articles matched our search criteria. However, after a closer analysis, solely 105 articles were selected as being of interest. Many articles were excluded since they were related to non-psychiatric fields induced by the term "adaptation". Indeed, the number of corresponding articles found for the adjustment disorder literally pointed-out the lack of existing literature on that topic in comparison to more known disorders such as anxiety disorder (2661 articles) or major depression (5481 articles). This represents up to 50 times more articles in comparison to the number of articles we found on adjustment disorder and up to 20 times more articles for the eating disorder (1994), although the prevalence is not significantly higher than for the adjustment disorder. According to their relevance and their content, we have split the articles into seven subcategories: 1. General description: most scientific articles generally describe the adjustment disorder as being a transition diagnosis, which is ambiguous, marginal and difficult to detect. The findings claim that only a few studies have been conducted on the adjustment disorder despite a high prevalence in the general population and in the clinical field. 2. CLASSIFICATION the DSM-5 defined the adjustment disorder as a set of different outcomes and syndromes induced by stress after a difficult life event. While the link to other disorders has not been mentioned, the diagnosis of this disorder is no longer excluded or perceived as a secondary diagnosis. The DSM-5 faced criticism from three points of view: the operationalization of the concept of stress, the differential diagnosis and the description. 3. Prevalence: different samples have shown a significantly high prevalence of the adjustment disorder within the population. In addition to the psychiatric pain induced by difficult life events we need to emphasize the fact that 12.5 to 19.4 percent of the patients faced heavy and severe pathologies and depended on clinical care and treatment. 4. Etiology, comorbidity or associated symptomatology: the literature identified the tendency to commit suicide and stressful life events as being two fundamental characteristics of adjustment disorder. The third one is the personality profile. 5. DIFFERENTIAL DIAGNOSIS that motivates researchers to focus on the adjustment disorder: the differentiation approach as to the major depression. Indeed, the aetiology, the symptomatology and the treatment differ from the adjustment disorder. 6. ASSESSMENT very recently, Dutch researchers have developed and validated the Diagnostic Interview Adjustment Disorder (DIAD). 7. TREATMENT in 2014, no data or meta-analysis recommended drug treatment in addition to therapy. In fact, several authors have demonstrated the ineffectiveness of drug therapy. The literature suggests a psychotherapeutic approach to treat adjustment disorder. CONCLUSION Emotional reactions triggered by life events are responsible for full therapy agendas and for the rush in emergency rooms and hospitals. The reflex when faced with crying, insomnia or suicidal thoughts to give a diagnostic of major depressive disorder s is generally accepted by everyone. The elevated risk to commit suicide and the approved success of remission or healing through treatment (psychotherapy) are two major reasons why several studies promote the importance and the need to identify the adjustment disorder of our patients.
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Affiliation(s)
- A Appart
- Service de psychiatrie, clinique Saint-Luc, rue Saint-Luc 8, 5004 Bouge, Belgique
| | - A-K Lange
- Université Libre de Bruxelles, Bruxelles, Belgique
| | - I Sievert
- Service de psychiatrie, clinique Saint-Luc, rue Saint-Luc 8, 5004 Bouge, Belgique
| | - F Bihain
- Service de psychiatrie, clinique Saint-Luc, rue Saint-Luc 8, 5004 Bouge, Belgique
| | - D Tordeurs
- Service de psychiatrie, clinique Saint-Luc, rue Saint-Luc 8, 5004 Bouge, Belgique; Université Libre de Bruxelles, Bruxelles, Belgique; CHU Namur, site Dinant, rue Saint-Jacques 501, 5500 Dinant, Belgique.
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Hund B, Reuter K, Härter M, Brähler E, Faller H, Keller M, Schulz H, Wegscheider K, Weis J, Wittchen HU, Koch U, Friedrich M, Mehnert A. STRESSORS, SYMPTOM PROFILE, AND PREDICTORS OF ADJUSTMENT DISORDER IN CANCER PATIENTS. RESULTS FROM AN EPIDEMIOLOGICAL STUDY WITH THE COMPOSITE INTERNATIONAL DIAGNOSTIC INTERVIEW, ADAPTATION FOR ONCOLOGY (CIDI-O). Depress Anxiety 2016; 33:153-61. [PMID: 26474266 DOI: 10.1002/da.22441] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 09/11/2015] [Accepted: 09/19/2015] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND We aimed to investigate type and frequency of stressors, predominant symptom profiles, and predictors of adjustment disorders (AD) in cancer patients across major tumor entities. METHODS In this epidemiological study, we examined 2,141 cancer patients out of 4,020 screened with the Composite International Diagnostic Interview, adaptation for oncology (CIDI-O). AD were operationalized as subthreshold disorders according to DSM-IV criteria. RESULTS In our sample, 265 out of 2,141 patients (12.4%) met all criteria for AD (unweighted 4-week prevalence). The disclosure of the cancer diagnosis, relapse or metastases, and cancer treatments were most frequently described as stressors associated with depressive or anxious symptoms. With regard to AD symptom profiles, patients showed high prevalence rates of affective symptoms according to the DSM-IV criteria of Major Depression: The highest prevalence rates were found for cognitive disturbances (concentration and memory problems) (88%), sleeping disturbances (86%), and depressive mood (83%). We found sex, education, and metastasis as significant predictors for AD. Higher education was the most influential predictor. Men were half as likely to report symptoms fulfilling the AD criteria as women. Patients with metastasized tumors had a more than 80% higher risk of AD than those without metastasis. However, the explained variance of our model is very small (Nagelkerke's R² = 0.08). CONCLUSIONS Patients with AD can be identified using a standardized instrument and deserve clinical attention, as they often show severe clinical symptoms and impairments. Improving the clinical conceptualization of AD by the adding-on of potential stress-response-symptoms is necessary to identify severe psychological strain.
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Affiliation(s)
- Bianca Hund
- Rhein-Jura-Klinik, Bad Säckingen, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany
| | - Katrin Reuter
- Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany
| | - Martin Härter
- Department and Outpatient Clinic of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Elmar Brähler
- Department of Medical Psychology and Medical Sociology, Division of Psychosocial Oncology, University Medical Center Leipzig, Leipzig, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Universal Medical Center Mainz, Mainz, Germany
| | - Hermann Faller
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, and Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany
| | - Monika Keller
- Division of Psychooncology, Department for Psychosomatic and General Clinical Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Holger Schulz
- Department and Outpatient Clinic of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karl Wegscheider
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Joachim Weis
- Department of Psychooncology, Tumor Biology Center, University of Freiburg, Freiburg, Germany
| | - Hans-Ulrich Wittchen
- Institute of Clinical Psychology and Psychotherapy and Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technical University Dresden, Dresden, Germany
| | - Uwe Koch
- Department and Outpatient Clinic of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Friedrich
- Department of Medical Psychology and Medical Sociology, Division of Psychosocial Oncology, University Medical Center Leipzig, Leipzig, Germany
| | - Anja Mehnert
- Department of Medical Psychology and Medical Sociology, Division of Psychosocial Oncology, University Medical Center Leipzig, Leipzig, Germany
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Alvarado-Esquivel C, Sifuentes-Alvarez A, Salas-Martinez C. Adjustment Disorder in Pregnant Women: Prevalence and Correlates in a Northern Mexican City. J Clin Med Res 2015; 7:775-80. [PMID: 26346070 PMCID: PMC4554217 DOI: 10.14740/jocmr2275w] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2015] [Indexed: 12/02/2022] Open
Abstract
Background The epidemiology of adjustment disorder in pregnant women is largely unknown. We sought to determine the prevalence and correlates of adjustment disorder in pregnant women in Durango City, Mexico. Methods Pregnant women (n = 300) attending in a public hospital in Durango City, Mexico were studied. All enrolled pregnant women had a psychiatric interview to evaluate the presence of adjustment disorder using the DSM-IV criteria. A questionnaire was submitted to obtain general epidemiological data of the pregnant women studied. Bivariate and multivariate analyses were used to assess the association of adjustment disorder with the epidemiological data of the women studied. Results Fifteen (5.0%) of the 300 women studied had adjustment disorder according to the DSM-IV criteria. Adjustment disorder was not associated with age, occupation, marital status, or education of pregnant women. In contrast, multivariate analysis of socio-demographic, clinical and psychosocial variables showed that adjustment disorder was associated with the variables lack of support from her couple (odds ratio (OR) = 3.83; 95% confidence interval (CI): 1.00 - 14.63; P = 0.04) and couple living abroad (OR = 10.12; 95% CI: 1.56 - 65.50; P = 0.01). Conclusions This is the first report about the epidemiology of adjustment disorder in pregnant women in Mexico. Results provide evidence of the presence of adjustment disorder and contributing psychosocial factors associated with this disorder in pregnant women in Mexico. Results point towards further clinical and research attention should be given to this neglected disorder in pregnant women.
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Affiliation(s)
- Cosme Alvarado-Esquivel
- Biomedical Research Laboratory, Faculty of Medicine and Nutrition, Juarez University of Durango State, Durango, Mexico
| | - Antonio Sifuentes-Alvarez
- Biomedical Research Laboratory, Faculty of Medicine and Nutrition, Juarez University of Durango State, Durango, Mexico ; Mothers and Children's Hospital, Secretary of Health, Durango, Mexico
| | - Carlos Salas-Martinez
- Biomedical Research Laboratory, Faculty of Medicine and Nutrition, Juarez University of Durango State, Durango, Mexico ; Mothers and Children's Hospital, Secretary of Health, Durango, Mexico
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Fleury MJ, Grenier G, Bamvita JM. Help received from relatives and services to satisfy needs of adults with severe mental disorders. Health (London) 2013. [DOI: 10.4236/health.2013.52028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Adjustment disorder is a common diagnosis in psychiatric settings and carries a significant rate of morbidity. However, diagnostic criteria are vague and not much helpful in clinical practice. Also there has been relatively little research done on this disorder. In this article, we review the information that is available on the epidemiology, clinical features, validity, and current diagnostic status of adjustment disorder. In this article, the controversy surrounding the diagnosis is also highlighted. It also discusses the differential and comorbid diagnosis. The various recommendations for DSM-V and ICD-11 conclude the article.
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Affiliation(s)
- Bichitra Nanda Patra
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, Haryana and Punjab, India
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Pierre JM. Mental illness and mental health: is the glass half empty or half full? CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2012; 57:651-8. [PMID: 23149280 DOI: 10.1177/070674371205701102] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
During the past century, the scope of mental health intervention in North America has gradually expanded from an initial focus on hospitalized patients with psychoses to outpatients with neurotic disorders, including the so-called worried well. The Diagnostic and Statistical Manual of Mental Disorders (DSM), Fifth Edition, is further embracing the concept of a mental illness spectrum, such that increasing attention to the softer end of the continuum can be expected in the future. This anticipated shift rekindles important questions about how mental illness is defined, how to distinguish between mental disorders and normal reactions, whether psychiatry is guilty of prevalence inflation, and when somatic therapies should be used to treat problems of living. Such debates are aptly illustrated by the example of complicated bereavement, which is best characterized as a form of adjustment disorder. Achieving an overarching definition of mental illness is challenging, owing to the many different contexts in which DSM diagnoses are used. Careful analyses of such contextual utility must inform future decisions about what ends up in DSM, as well as how mental illness is defined by public health policy and society at large. A viable vision for the future of psychiatry should include a spectrum model of mental health (as opposed to exclusively mental illness) that incorporates graded, evidence-based interventions delivered by a range of providers at each point along its continuum.
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Israelashvili M. Should adjustment disorder be conceptualized as transitional disorder? In pursuit of adjustment disorders definition. J Ment Health 2012; 21:579-88. [DOI: 10.3109/09638237.2012.670881] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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The Effectiveness of Brief Versus Intermediate Duration Psychodynamic Psychotherapy in the Treatment of Adjustment Disorder. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2012. [DOI: 10.1007/s10879-012-9208-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Flach PA, Groothoff JW, Krol B, Bultmann U. Factors associated with first return to work and sick leave durations in workers with common mental disorders. Eur J Public Health 2011; 22:440-5. [DOI: 10.1093/eurpub/ckr102] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Suzuki N, Ninomiya M, Maruta T, Hosonuma S, Yoshioka N, Ohara T, Nishigaya Y, Kobayashi Y, Kiguchi K, Ishizuka B. Clinical study on the efficacy of fluvoxamine for psychological distress in gynecologic cancer patients. Int J Gynecol Cancer 2011; 21:1143-9. [PMID: 21792017 DOI: 10.1097/igc.0b013e3181ffbeb9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Diagnosis of cancer causes psychological distress. The present study investigated the safety and efficacy of fluvoxamine therapy in gynecologic cancer patients with either adjustment disorder or major depression after cancer was diagnosed. METHODS Screening with the Hospital Anxiety and Depression Scale (HADS) was conducted at least 2 weeks after notification of the diagnosis of cancer in 214 gynecologic cancer patients hospitalized between January 2007 and December 2008. The HADS cutoff score was set at 11 points or greater. Informed consent to the study was obtained from 10 patients, and fluvoxamine was administered for 8 weeks. As primary end points, the safety and efficacy of fluvoxamine were evaluated using the HADS and the SF-36. As a secondary end point, the Clinical Global Impression was determined. RESULTS The total HADS score, the anxiety score, and the depression score were significantly reduced after 6, 4, and 6 weeks of treatment, respectively. The SF-36 revealed significant improvement in vitality, mental health, and role (emotional) after 8 weeks of treatment. In the 5 patients with adjustment disorder, only the HADS anxiety score was significantly reduced after 4 weeks. In the 5 patients with major depression, the total HADS score, the anxiety score, and the depression score were significantly reduced after 6, 8, and 6 weeks, respectively. According to the SF-36, the adjustment-disorder groups showed significant improvement in mental health after 8 weeks of treatment, whereas the major-depression group showed significant improvement in vitality and role (emotional) after 8 weeks. No adverse events occurred in any subject. Assessment of the Clinical Global Impression suggested that fluvoxamine improved psychological distress in all 10 subjects. CONCLUSIONS The present findings suggest that fluvoxamine is useful for alleviating psychological distress, including adjustment disorder and major depression, in gynecologic cancer patients. Management of psychological distress after diagnosis of cancer is important.
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Affiliation(s)
- Nao Suzuki
- Department of Obstetrics and Gynecology, St Marianna University School of Medicine, Kanagawa, Japan.
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Ponizovsky AM, Levov K, Schultz Y, Radomislensky I. Attachment insecurity and psychological resources associated with adjustment disorders. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2011; 81:265-276. [PMID: 21486268 DOI: 10.1111/j.1939-0025.2011.01095.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This study examined the adult attachment styles, interpersonal distance from potential attachment figures and strangers, coping strategies, perceived social support, and stress-related self-variables among patients diagnosed with adjustment disorders (AJD). Seventy patients at an outpatient clinic and 61 matched controls completed a battery of standardized questionnaires. Univariate and multivariate statistical analyses were used to evaluate the parameters of interest. Using attachment theory (J. Bowlby, 1988) and the dynamic stress-vulnerability model of depressive disorder (G. W. Brown & T. O. Harris, 1989) as the analytical frameworks, the authors hypothesized that participants with AJD would: (a) display more insecure attachment styles, (b) be less tolerant of close interpersonal proximity, (c) use more emotion-oriented coping strategies, (d) display lower self-efficacy and self-esteem, and (e) perceive less social support from family, friends, and significant others. We further hypothesized that these variables would be predictive of depressive symptoms. All of the hypotheses were confirmed. The results suggest that the insecure fearful-avoidant attachment style is associated with severe depressive symptoms in patients with AJD. However, other psychosocial factors, such as low self-esteem and poor social support from friends, were more predictive of AJD symptoms. The findings warrant further studies on the risk and protective effects of these factors in the development of AJD and other stress-induced disorders.
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Presicci A, Lecce P, Ventura P, Margari F, Tafuri S, Margari L. Depressive and adjustment disorders - some questions about the differential diagnosis: case studies. Neuropsychiatr Dis Treat 2010; 6:473-81. [PMID: 20856910 PMCID: PMC2938296 DOI: 10.2147/ndt.s8134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Diagnosis and treatment of mood disorders in youth are still problematic because in this age the clinical presentation is atypical, and the diagnostic tools and the therapies are the same as that used for the adults. Mood disorders are categorically divided into unipolar disorders (major depressive disorder and dysthymic disorder) and bipolar disorder in Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision), but mood symptoms are also comprised in the diagnostic criteria of the adjustment disorder (AD), which occur in many different psychiatric disorders, and may also be found in some physical conditions. The differential diagnosis is not much addressed in the midst of clinical investigation and so remains the major problem in the clinical practice. AIMS The associations between some variables and the depressive disorder and AD were analyzed to make considerations about differential diagnosis. PATIENTS AND METHODS We reported a retrospective study of 60 patients affected by depressive disorder and AD. The analysis has evaluated the association between some variables and the single diagnostic categories. We have considered 10 variables, of which 6 are specific to the disorders, and 4 have been considered related problems. RESULTS The statistical analysis showed significant results for the associations of 3 variables (prevalent symptoms, treatment, and family history) with the single diagnostic categories. CONCLUSION The discriminate analysis resulted in statistically significant differences between patients with depressive disorders and those with AD on 3 variables, of which 2 are specific to the disorders, and 1 is included in the related problems. The other variables were weakly associated with the single diagnostic categories without any statistically significant differences. The 3 variables that were associated with the single diagnostic categories support the distinct construct validity of the 2 diagnostic categories, but, to date, it is difficult to establish if these variables can be considered diagnostic predictors. On the other hand, the other variables did not support the distinct construct validity of the 2 diagnostic categories, which suggest an overlapping and dimensional concept. The spectrum approach could unify categorical classification that is essential with a dimensional view. Combination of dimensional and categorical principles for classifying mood disorders may help to reduce the problems of underdiagnosis and undertreatment.
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Affiliation(s)
- A Presicci
- Child Neuropsychiatric Unit, Department of Neurologic and Psychiatric Science, Aldo Moro University of Bari, Bari, Italy
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Nosek MA, Hughes RB, Robinson-Whelen S. The complex array of antecedents of depression in women with physical disabilities: Implications for clinicians. Disabil Rehabil 2009; 30:174-83. [PMID: 17852240 DOI: 10.1080/09638280701532219] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE This article discusses the complex interrelation of elements of the physical, psychological, social, and environmental life context of women with physical disabilities and the association of these elements with significant disparities in rates of depression and access to mental health care for this population. METHODS Literature and concept review. RESULTS High rates of depression in women with physical disabilities are well documented in the literature. Many elements that are disproportionately common in the lives of women with physical disabilities, including socio-economic disadvantage, functional limitations, pain and other chronic health conditions, poor diet, physical inactivity, smoking, violence, low self-esteem, sexuality problems, chronic stress, environmental barriers, and barriers to health care, have also been linked with higher rates of depression and depressive symptomatology. Depression self-management interventions tailored for women with disabilities have been developed and proven effective. CONCLUSIONS Many women who must deal with the stresses surrounding an array of health problems may experience symptoms of depression without necessarily meeting the criteria for clinical depression. Psychologists, counselors, primary care physicians, specialists, and other medical and rehabilitation professionals are challenged to recognize the symptoms of depression in women with physical disabilities and assist them in obtaining appropriate psychological and pharmacological interventions.
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Affiliation(s)
- Margaret A Nosek
- Center for Research on Women with Disabilities, Baylor College of Medicine, PO Box 890286, Houston, Texas 77289, USA.
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Carta MG, Balestrieri M, Murru A, Hardoy MC. Adjustment Disorder: epidemiology, diagnosis and treatment. Clin Pract Epidemiol Ment Health 2009; 5:15. [PMID: 19558652 PMCID: PMC2710332 DOI: 10.1186/1745-0179-5-15] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Accepted: 06/26/2009] [Indexed: 05/28/2023]
Abstract
BACKGROUND Adjustment Disorder is a condition strongly tied to acute and chronic stress. Despite clinical suggestion of a large prevalence in the general population and the high frequency of its diagnosis in the clinical settings, there has been relatively little research reported and, consequently, very few hints about its treatments. METHODS the authors gathered old and current information on the epidemiology, clinical features, comorbidity, treatment and outcome of adjustment disorder by a systematic review of essays published on PUBMED. RESULTS After a first glance at its historical definition and its definition in the DSM and ICD systems, the problem of distinguishing AD from other mood and anxiety disorders, the difficulty in the definition of stress and the implied concept of 'vulnerability' are considered. Comorbidity of AD with other conditions, and outcome of AD are then analyzed. This review also highlights recent data about trends in the use of antidepressant drugs, evidence on their efficacy and the use of psychotherapies. CONCLUSION AD is a very common diagnosis in clinical practice, but we still lack data about its rightful clinical entity. This may be caused by a difficulty in facing, with a purely descriptive methods, a "pathogenic label", based on a stressful event, for which a subjective impact has to be considered. We lack efficacy surveys concerning treatment. The use of psychotropic drugs such as antidepressants, in AD with anxious or depressed mood is not properly supported and should be avoided, while the usefulness of psychotherapies is more solidly supported by clinical evidence. To better determine the correct course of therapy, randomized-controlled trials, even for the combined use of drugs and psychotherapies, are needed vitally, especially for the resistant forms of AD.
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Affiliation(s)
- Mauro Giovanni Carta
- Centro per la Ricerca e la Terapia in Salute Mentale, Department of Public Health, University of Cagliari, Italy
| | - Matteo Balestrieri
- Clinica di Psichiatria e PMD, Dipartimento di Patologia e Medicina Sperimentale, University of Udine, Udine, Italy
| | - Andrea Murru
- Centro per la Ricerca e la Terapia in Salute Mentale, Department of Public Health, University of Cagliari, Italy
| | - Maria Carolina Hardoy
- Centro per la Ricerca e la Terapia in Salute Mentale, Department of Public Health, University of Cagliari, Italy
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Reschke K, Teichmann K. Entwicklung und Evaluation eines kognitiv-behavioralen Therapieprogramms für Patienten mit Anpassungsstörung. ACTA ACUST UNITED AC 2008. [DOI: 10.1007/s11800-008-0099-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Strain JJ, Diefenbacher A. The adjustment disorders: the conundrums of the diagnoses. Compr Psychiatry 2008; 49:121-30. [PMID: 18243883 DOI: 10.1016/j.comppsych.2007.10.002] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2007] [Revised: 10/04/2007] [Accepted: 10/07/2007] [Indexed: 12/22/2022] Open
Abstract
This article discusses the conundrums and the dilemmas of the conceptual framework of the diagnoses of the adjustment disorders (ADs). The psychiatric diagnoses that arise between normal behavior and the major psychiatric morbidities constitute the problematic subthreshold disorders. These subthreshold entities are also juxtaposed between problem-level diagnoses and more clearly defined major disorders. They present important taxonomic and diagnostic dilemmas in that they are often poorly defined, overlap with other diagnostic groupings, and have indefinite symptomatology. ADs were designed as a "wild card" to allow the coding of a psychiatric "diagnosis" for work done by psychiatrists and other mental health care specialists when the patient's symptoms do not reach the criterion of a major mental disorder. It is therefore not surprising that issues of reliability and validity prevail. The issues of diagnostic rigor and clinical utility seem at odds for the AD. Clinicians need a wild card, and field studies need to use reliable and valid concepts of AD and assessments instruments to determine more exact specification of the parameters of the diagnosis. Finally, appropriate and timely treatment is essential for patients with AD so that their symptoms do not worsen; their important relationships are not further impaired; or their capacity to work, study, or be active in their essential interpersonal pursuits is not compromised.
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Lindqvist D, Träskman-Bendz L, Vang F. Suicidal intent and the HPA-axis characteristics of suicide attempters with major depressive disorder and adjustment disorders. Arch Suicide Res 2008; 12:197-207. [PMID: 18576201 DOI: 10.1080/13811110802100775] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The main purpose of the study was to investigate Hypothalamic-Pituitary-Adrenal (HPA) axis characteristics in relation to suicidal intent among suicide attempters with Major Depressive Disorder (MDD) and Adjustment Disorders (AD). The relationship between suicidal intent, assessed by means of the Suicidal Intent Scale (SIS), and serum cortisol after a Dexamethasone Suppression Test (DST) was investigated in 78 suicide attempters, divided into diagnostic subgroups. There was a significant negative correlation between suicidal intent and post DST cortisol in patients with MDD. Our findings may be attributed to pathophysiological processes, where a high suicidal intent is revealed during a potential chronic course of MDD, which in turn results in a seemingly normal stress system.
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Affiliation(s)
- Daniel Lindqvist
- Department of Clinical Sciences, Section of Psychiatry, Lund University Hospital, Sweden.
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Takei N, Sugihara G. Diagnostic ambiguity of subthreshold depression: minor depression vs. adjustment disorder with depressive mood. Acta Psychiatr Scand 2006; 114:144; author reply 145. [PMID: 16836604 DOI: 10.1111/j.1600-0447.2006.00802.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hameed U, Schwartz TL, Malhotra K, West RL, Bertone F. Antidepressant treatment in the primary care office: outcomes for adjustment disorder versus major depression. Ann Clin Psychiatry 2005; 17:77-81. [PMID: 16075660 DOI: 10.1080/10401230590932344] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Antidepressants are widely used by primary care physicians. Very little comparative data exists regarding the newer antidepressants in regards to efficacy in naturalistic primary care outpatient settings where the treatment of adjustment disorder and major depressive disorder is concerned. Our objective was to determine if there is a difference in antidepressant effectiveness between disorders in the newer antidepressants (SSRIs) in a primary care setting when a formal systematic depression treatment protocol is used. METHOD A retrospective review of 63 major depression patients and 33 adjustment disorder patients in a primary care setting was undertaken. Patients had been prescribed mostly SSRIs. DSM-IV symptoms, PHQ-9 depression rating scale scores, and functional disability reports were systematically used to evaluate partial and full remission from patients' depressive states. RESULTS Neither depressed patients, nor adjustment disordered patients demonstrated a difference in clinical response to any particular antidepressant. The main statistical difference was in response rates, where patients diagnosed with adjustment disorder were twice as likely to respond to standard antidepressant treatment as depressed patients. This retrospective database design with moderate sample size limits the statistical power of this study. CONCLUSION Antidepressants are very effective in treating depression in the primary care setting and may even be an effective and efficient treatment for adjustment disorder with depressed mood.
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Affiliation(s)
- Usman Hameed
- Department of Psychiatry, Upstate Medical University, 750 E Adams Street, Syracuse, NY 13210, USA
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