Adjustment Disorders Unless otherwise specified, all answers are from DSM-IV-TR or from First and Tasman As of 13Sep08.

Criteria for adjustment disorder Q. What is the criteria for adjustment disorder?

Criteria for adjustment disorders Ans. Within three months of the stressor, there is marked distress that is in excess of what one would expect and Does not meet the criteria of another Axis I disorder, more specifically does not meet the criteria of PTSD or Bereavement. Does not last longer than 6 months unless the stressor so lasts.

Bereavement Q. What is the criteria of bereavement?

Bereavement Ans. Normal reaction to the death of a loved one: -- not lasting more than two months [although there can be cultural variations].

Differential of bereavement MDD Q. Besides the 2 months, what signs would tilt you to toward MDD instead of bereavement?

Differential of bereavement and MDD Ans. 1] feelings of unreasonable guilt 2] thoughts of death, excluding feeling she/he would be better off dead 3] morbid preoccupation with feeling worthless 4] motor retardation 5] prolonged, marked functional impairment 6] hallucinations other than those related to seeing or hearing the deceased.

Types Q. DSM-IV list six overlapping types of adjustment, name the five other besides “unspecified.” [There are two “mixed types.”]

Types Ans. -- With depressed mood -- With anxiety -- With Mixed anxiety and depressed mood -- With Disturbance of conduct -- With Mixed disturbance of emotions and conduct -- Unspecified

Nature of stressors Q. What does DSM say as to the nature of the stressors that qualify?

Nature of stressors Ans. Single event or series of events, past or current stress, event that only effect the individual or broad events, such as 9/11. [So, examiners question probably will allow anything.]

Acute v. chronic Q. What is length of time the pt has symptoms that crosses over from “acute” to “chronic”?

Acute v. chronic Ans. 6 months. Six months can only fit the definition of adjustment disorder if the stress last longer than 6 months. So, could use “chronic” for pt living in very fearful neighborhood.

Prevalence Q. What is the prevalence of adjustment disorder following cardiac surgery [DSM-IV has a number of comments about prevalence, but the percentages are broad, e.g., 2 to 8 %] except for this question -- which is a lot more than 8%.

Prevalence Ans. 50%

Psychological factors affecting a general medical condition Q. How does Adjustment Disorder and Psychological Factors Affecting Medical Condition differ?

Psychological factors affecting general medical condition Ans. They are opposites in that Adjustment Disorder can be depression, anxiety or conduct abnormalities that result from a General Medical Condition whereas Psychological Factors Affecting General Medical Condition and depression and anxieties that exacerbate the medical condition.

Need treatment? Q. Since Adjustment disorder is self-limited as to definition, can we assume that these people do not need treatment?

Need treatment Ans. No, they need treatment, to reduce suffering, to enhance functioning and to prevent the disorder leading to a more severe or chronic condition.

Treatment -- general Q. Very generally, what is the focus of the treatment?

Treatment - general Ans. Reduce the stressor and use Psychosocial approaches Or Medications Or Both.

First goal Q. First goal of psychosocial approaches is to?

First goal Ans. First goal is to remove or reduce the stressor.

Psychotherapies Used Q. First and Tasman list a number of psychotherapies for Adjustment Disorder. Name as many as you can.

Psychotherapies used Ans. -Counseling -CBT -Interpersonal Psychotherapy -Psychodynamic [also several forms of brief psychotherapies can be used.]

Medications Q. What medications might be used?

Medications Ans. Depending on the type of Adjustment disorder, antidepressants and anxiolytic meds are used.