Pharmacotherapy of adjustment disorder: A review

Stein, Dan J.

doi:10.1080/15622975.2018.1492736

Cited by 22 publications

(11 citation statements)

References 36 publications

(41 reference statements)

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“…Psychotherapeutic and psychopharmacological treatment options for AD have recently been summarized in three review articles (Domhardt and Baumeister, 2018;O'Donnell et al, 2018;Stein, 2018). They found that the quality of evidence has been ranked low to very low (O'Donnell et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

“…Treatment options include the use of benzodiazepines (alprazolam, diazepam, clorazepat, lormetazepam), antidepressants (mianserin, tianeptine, trazodone, viloxazine), plant extracts/ herbals (euphytose, Ginko-Biloba, Kava-Kava), anxiolytics (etifoxine), 5-HT1A agonists (buspiron), and neutraceuticals (s-adenosylmethionine). However, only 11 randomized-controlled trials including 1,195 AD patients have been documented, yielding in part contradictory results (Stein, 2018). Furthermore, psychopharmacological treatment may be limited by drug-induced side effects, including pharmacokinetic and pharmacodynamics alterations such as drug-drug interactions, induction/inhibition of the cytochrome-P-450 system, or indirect drug effects that all may interact with the drugs necessary for treating the underlying disease (Huang et al, 2008;Kahl, 2018;Kahl et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

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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: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

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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“…They also highlight the good tolerability profile of etifoxine, particularly its preservation of cognitive function and vigilance. Moreover, etifoxine is not associated with either rebound anxiety or withdrawal symptoms following treatment cessation 60…”

Section: Anxiolytic Activity Of Etifoxine: Clinical Trials and Practicementioning

confidence: 95%

<p>An update on the anxiolytic and neuroprotective properties of etifoxine: from brain GABA modulation to a whole-body mode of action</p>

Nuss¹,

Ferreri²,

Bourin³

2019

NDT

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Treating the signs and symptoms of anxiety is an everyday challenge in clinical practice. When choosing between treatment options, anxiety needs to be understood in the situational, psychiatric, and biological context in which it arises. Etifoxine, a non-benzodiazepine anxiolytic drug belonging to the benzoxazine class, is an effective treatment for anxiety in response to a stressful situation. In the present review, we focused on several aspects of the cerebral and somatic biological mechanisms involved in anxiety and investigated the extent to which etifoxine’s mode of action can explain its anxiolytic activity. Its two mechanisms of action are the modulation of GABAergic neurotransmission and neurosteroid synthesis. Recent data suggest that the molecule possesses neuroprotective, neuroplastic, and anti-inflammatory properties. Etifoxine was first shown to be an effective anxiolytic in patients in clinical studies comparing it with clobazam, sulpiride, and placebo. Randomized controlled studies have demonstrated its anxiolytic efficacy in patients with adjustment disorders (ADs) with anxiety, showing it to be superior to buspirone and comparable to lorazepam and phenazepam, with a greater number of markedly improved responders and a better therapeutic index. Etifoxine’s noninferiority to alprazolam has also been demonstrated in a comparative trial. Significantly less rebound anxiety was observed after abrupt cessation of etifoxine compared with lorazepam or alprazolam. Consistent with this finding, etifoxine appears to have a very low dependence potential. Unlike lorazepam, it has no effect on psychomotor performance, vigilance, or free recall. Severe adverse events are in general rare. Skin and subcutaneous disorders are the most frequently reported, but these generally resolve after drug cessation. Taken together, its dual mechanisms of action in anxiety and the positive data yielded by clinical trials support the use of etifoxine for treating the anxiety signs and symptoms of individuals with ADs.

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“…Controlled (but mostly small) trials in adjustment disorders exist with benzodiazepines for short-term anxiolysis (notably, alprazolam, lorazepam, or diazepam) and sleep aids (especially trazodone). 3 Apart from performing clinical assessments as described above, the fundamental treatment foci of crisis work involve helping people (a) manage immediate physical or emotional distress by providing verbal support, education, skills, and targeted pharmacotherapies when appropriate and (b) identify and implement strategies to better cope and solve tangible problems. "Distress" from crises commonly entails anxiety, agitation, insomnia, preoccupation, grief, feared loss of health, and isolation/loneliness.…”

Section: Pandemic Adjustment Disordersmentioning

confidence: 99%

Psychiatry’s Niche Role in the COVID-19 Pandemic

Goldberg¹

2020

J. Clin. Psychiatry

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Pharmacotherapy of adjustment disorder: A review

Abstract: The work done has been useful insofar as it provides clinicians with some insights into the advantages and disadvantages of a number of pharmacotherapy options. Additional rigorously designed trials are needed to further advance the field.

Cited by 22 publications

References 36 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

<p>An update on the anxiolytic and neuroprotective properties of etifoxine: from brain GABA modulation to a whole-body mode of action</p>

Psychiatry’s Niche Role in the COVID-19 Pandemic

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