Adjustment disorder diagnosis: Improving clinical utility

Maercker, Andreas; Lorenz, Louisa

doi:10.1080/15622975.2018.1449967

Cited by 28 publications

(32 citation statements)

References 49 publications

(45 reference statements)

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“…According to DSM-V, AD is characterized by: (A) emotional or behavioral symptoms in response to an identifiable stressor that (B) are of clinical significance and (C) do not meet the criteria for another mental disorder, and (D) do not represent normal bereavement. Typically, AD remits within 6 months if the stressor is terminated; however, a persistent form of AD has been described if the stressor persists (First, 2013;Maercker and Lorenz, 2018). Furthermore, untreated AD poses the risk of persistent AD, and may pave the way for psychiatric disorders other than AD, particularly major depressive disorder and anxiety disorders (O'Donnell et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

Metacognitive Therapy for Adjustment Disorder in a Patient With Newly Diagnosed Pulmonary Arterial Hypertension: A Case Report

et al. 2020

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Adjustment disorders (ADs) belong to the worldwide most diagnosed mental disorders and are particularly frequent in patients with an underlying physical illness. Pulmonary arterial hypertension (PAH) is a severe and disabling disease, which significantly impacts on quality of life and has high mortality rates. The authors here present the case of a young female who developed a severe adjustment disorder with both anxious and depressive symptoms after a diagnosis of PAH requiring intensive care treatment due to right heart failure. Psychosocial functioning was severely impaired, and physical health reduced. Following hemodynamic stabilization and the establishment of PAH treatment, the patient was admitted to the Department of Psychiatry, Social Psychiatry and Psychotherapy and received metacognitive therapy (MCT). AD with mixed anxiety and depressed mood was diagnosed according to DSM-V criteria. At the start of treatment, she reported significant mental distress, indicated by a total sum score of the Hospital Anxiety and Depression Scale (HADS) of 20 points. The 6-min walking distance was only 358 m before the patient was exhausted. She then was treated with MCT without further psychopharmacological drugs. After only four MCT sessions, she fully remitted from AD which was accompanied by an 11-point reduction in the HADS (to 9 points). MCT specific scores also improved (MCQ-30 sum score decreased from 77 to 35). Notably, physical capacity improved as well, documented by an improved walking distance (439 m; +22%). This is the first case of a patient with AD in the context of PAH treated with MCT. The case report suggests that MCT is a possible psychotherapeutic treatment option for AD in the context of a potentially life-threatening disease. The study design does not permit an attribution of outcome to MCT but it suggests MCT is a potentially viable and acceptable treatment option.

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Section: Introductionmentioning

confidence: 99%

Metacognitive Therapy for Adjustment Disorder in a Patient With Newly Diagnosed Pulmonary Arterial Hypertension: A Case Report

et al. 2020

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“…Of patients diagnosed with major depression, 57.5% also met the criteria for at least one anxiety disorder,11 and 59.0% of individuals suffering from generalised anxiety disorder fulfil the criteria for major depression 12. Finally, adjustment disorder is a maladaptive reaction to an identifiable psychosocial stressor 13. It is among the most frequently diagnosed mental disorders,14–16 but data on its prevalence are limited.…”

Section: Introductionmentioning

confidence: 99%

Attachment-based compassion therapy and adapted mindfulness-based stress reduction for the treatment of depressive, anxious and adjustment disorders in mental health settings: a randomised controlled clinical trial protocol

et al. 2019

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IntroductionDepressive, anxiety and adjustment disorders are highly prevalent among mental health outpatients. The lack of funding for mental health problems produces inefficient results and a high burden of disease. New cost-effective group interventions aimed at treating these symptoms might be an appropriate solution to reduce the healthcare burden in mental health units. Mindfulness-based interventions (MBIs) have shown significant reductions in anxious, depressive and adjustment symptomatology. Recent research highlights the influence of compassion as a key mechanism of change. However, MBIs only address compassion implicitly, whereas compassion-based protocols consider it a core aspect of psychotherapy. In this randomised controlled trial, we hypothesise that the provision of attachment-based compassion therapy (ABCT), which is a compassion-based protocol, will be more effective than mindfulness-based stress reduction (MBSR), which is a conventional MBI programme, for the treatment of depressive, anxious and adaptive symptoms in patients in mental health settings.Methods and analysisApproximately 90 patients suffering from depressive, anxious or adjustment disorders recruited from Spanish mental health settings will be randomised to receive 8 weekly 2 hours group sessions of ABCT, 8 weekly 2.5 hours group sessions of adapted MBSR (with no full-day silent retreat) or treatment as usual (TAU), with a 1:1:1 allocation rate. Patients in the ABCT and adapted MBSR groups will also receive TAU. The main outcome will be general affective distress measured by means of the ‘Depression Anxiety Stress Scales-21’ at post-test as primary endpoint. Other outcomes will be quality of life, mindfulness, self-compassion and the use of healthcare services. There will be a 6-month follow-up assessment. Intention-to-treat analysis will be conducted using linear mixed models. Per-protocol and secondary outcome analyses will be performed. A data monitoring committee comprising the trial manager, the ABCT and MBSR teachers and an independent clinical psychologist will monitor for possible negative side effects.Ethics and disseminationApproval was obtained from the Ethics Committee of the General University Hospital of Castellón, Spain. The results will be submitted to peer-reviewed specialised journals, and brief reports will be sent to participants on request.Trial registration number NCT03425487

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“…Die Diagnose der Anpassungsstörung fokussiert sich auf Veränderung aufgrund psychosozialer Stressoren, die hauptsächlich im Rahmen des normalen Erlebens liegen. Von einer globalen Gesundheitsperspektive ist damit eine maladaptive Reaktion auf einen Ressourcenverlust gemeint, die sich in industriellen Ländern meistens durch Konflikte in der Familie, Verlust der Arbeitsplatzes oder die Diagnose einer Krankheit niederschlägt [5]. Es handelt sich um ein Krankheitsbild, dass aufgrund der Intensität und Dauer nicht für ein anderes Störungsbild qualifiziert [6].…”

Section: Die Anpassungsstörungunclassified

“…Es handelt sich um ein Krankheitsbild, dass aufgrund der Intensität und Dauer nicht für ein anderes Störungsbild qualifiziert [6]. Hinweise zum diagnostischen Vorgehen sowie Fallbeispiele zur Anpassungsstörung nach ICD-11 sind bei [5] zu finden. Die Prävalenz im deutschsprachigen Raum liegt bei etwa 2 % nach den ICD-11 Kriterien [7].…”

Section: Die Anpassungsstörungunclassified

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Spezifisch belastungsbezogene psychische Störungen im neuen ICD-11: Ein Überblick

Augsburger

Maercker

2018

Fortschr Neurol Psychiatr

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The release of upcoming ICD-11 results in important changes to the classification of stress-related mental disorders. With the aim to improve clinical utility there is a new organizational structure for the different disorders as they are now categorized by the response to specific types of stressors. These range from reactions based on the experience of psychosocial strains (adjustment disorder), to grief reactions with a need for treatment (prolonged grief disorder) and reactions after exposure to traumatic events (posttraumatic stress disorder), also with more complex clinical picture (complex posttraumatic stress disorder). This article gives an overview of the major changes in the shift in disorder categorization from ICD-10 to ICD-11. This includes prevalence rates, if available, as well as suggestions of measurement instruments for the purpose of clinical diagnostics. Furthermore, ongoing discussions among the research community will be considered.

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Adjustment disorder diagnosis: Improving clinical utility

Abstract: This nosological specification opens new avenues for neurobiological and psychological research on AD and for developing novel therapies.

Cited by 28 publications

References 49 publications

Metacognitive Therapy for Adjustment Disorder in a Patient With Newly Diagnosed Pulmonary Arterial Hypertension: A Case Report

Metacognitive Therapy for Adjustment Disorder in a Patient With Newly Diagnosed Pulmonary Arterial Hypertension: A Case Report

Attachment-based compassion therapy and adapted mindfulness-based stress reduction for the treatment of depressive, anxious and adjustment disorders in mental health settings: a randomised controlled clinical trial protocol

Spezifisch belastungsbezogene psychische Störungen im neuen ICD-11: Ein Überblick

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