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Psychological Services May 2022Adjustment disorders are among the most commonly diagnosed mental health disorders in both civilian and military clinical settings. Despite their high prevalence,...
Adjustment disorders are among the most commonly diagnosed mental health disorders in both civilian and military clinical settings. Despite their high prevalence, adjustment disorders have received little research attention. The many gaps in our understanding of this group of disorders hinder the development of adequate, evidence-based treatment protocols. This study utilizes a systematic methodology to identify and prioritize research gaps in adjustment disorders. We used authoritative source reports to identify gaps in research domains from foundational science to services research. Subject-matter experts conducted literature searches to substantiate and refine research gaps, and stakeholders assessed the importance and impact of this work for researchers and policy-makers. We identified 254 possible research-needs statements, which were ultimately reduced to 11 final, prioritized research gaps. Two gaps addressed prevention and screening and three addressed treatment and services research. Six gaps addressed foundational science, epidemiology, and etiology research domains, highlighting the need for basic research. Until some of the basic science questions are resolved (e.g., diagnostic clarity, valid screening, and assessment measures) about adjustment disorders, we may not be able to develop adequate evidence-based interventions for the disorders, and it will be difficult to understand the trajectory of these disorders throughout treatment. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
Topics: Adjustment Disorders; Humans
PubMed: 33507770
DOI: 10.1037/ser0000517 -
International Journal of Environmental... Jul 2019Despite its high prevalence in clinical and consultant liaison psychiatry populations, adjustment disorder research has traditionally been hindered by its lack of clear... (Review)
Review
Despite its high prevalence in clinical and consultant liaison psychiatry populations, adjustment disorder research has traditionally been hindered by its lack of clear diagnostic criteria. However, with the greater diagnostic clarity provided in the Diagnostic and Statistical Manual of Mental Disorders - fifth edition (DSM-5) and the International Statistical Classification of Diseases and Related Health Problems, 11th edition (ICD-11), adjustment disorder has been increasingly recognised as an area of research interest. This paper evaluates the commonalities and differences between the ICD-11 and DSM-5 concepts of adjustment disorder and reviews the current state of knowledge regarding its symptom profile, course, assessment, and treatment. In doing so, it identifies the gaps in our understanding of adjustment disorder and discusses future directions for research.
Topics: Adjustment Disorders; Diagnostic and Statistical Manual of Mental Disorders; Humans; International Classification of Diseases
PubMed: 31315203
DOI: 10.3390/ijerph16142537 -
CNS Drugs Nov 2009Adjustment disorder was introduced into the psychiatric classification systems almost 30 years ago, although the concept was recognized for many years before that. In... (Review)
Review
Adjustment disorder was introduced into the psychiatric classification systems almost 30 years ago, although the concept was recognized for many years before that. In DSM-IV, six subtypes are described based on the predominant symptoms, but no further diagnostic criteria are offered to assist the clinician. These are common conditions, especially in primary care and in consultation liaison psychiatry, where the prevalence ranges from 11% to 18% and from 10% to 35%, respectively. Yet they are under-researched, possibly due to the failure of some of the common diagnostic tools to allow for the diagnosis of adjustment disorder. Among the tools that incorporate adjustment disorder, the concordance between the clinical and interview diagnosis is very poor, with the diagnosis being made more commonly in clinical practice than the diagnostic tools allow for. Adjustment disorder is found in all cultures and in all age groups. The presence of a causal stressor is essential before a diagnosis of adjustment disorder can be made, while the symptoms vary and include those that are found in other common psychiatric disorders. It is also important to distinguish adjustment disorder from normal reactions to stressful events. Adjustment disorders are difficult to distinguish from normal responses to life's stressors, while the distinction from major depression also poses a classificatory conundrum since both are conceptually different. Adjustment disorder is a diagnosis based on the longitudinal course of symptoms in the context of a stressor, while a diagnosis of major depression is a cross-sectional one based on symptom numbers. Treatments consist mainly of brief interventions, while pharmacotherapy is limited to the symptomatic management of anxiety or insomnia. There are no robust studies demonstrating benefits from antidepressants. However, the number of studies of either type of intervention is very limited.
Topics: Adjustment Disorders; Diagnostic and Statistical Manual of Mental Disorders; Humans; Prevalence; Psychotherapy; Stress, Psychological
PubMed: 19845414
DOI: 10.2165/11311000-000000000-00000 -
Journal of Affective Disorders May 2022The diagnosis of adjustment disorder is common in clinical practice, yet there is lack of research on the etiology and epidemiology of adjustment disorders. The goal of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The diagnosis of adjustment disorder is common in clinical practice, yet there is lack of research on the etiology and epidemiology of adjustment disorders. The goal of this systematic review was to evaluate predictors of adjustment disorders in adults.
METHODS
We conducted systematic searches in MEDLINE, EMBASE, and PsycINFO. We included 70 studies that examined thirteen theoretically-derived and predefined predictors of adjustment disorders with a total of 3,449,374 participants.
RESULTS
We found that female gender, younger age, unemployed status, stress, physical illness and injury, low social support, and a history of mental health disorders predicted adjustment disorders. Most of these predictors differentiated individuals with adjustment disorders from individuals with no mental health disorders. Participants with adjustment disorders were more likely to have experienced accidents than were those with posttraumatic stress disorder but were less likely to have experienced assaults and abuse, neglect, and maltreatment. More research is needed to identify factors that differentiate adjustment disorders from other mental health disorders.
LIMITATIONS
Because very few studies adjusted for confounders (e.g., demographic variables, mental health histories, and a variety of stressors), it was not possible to identify independent associations between predictors and adjustment disorders.
CONCLUSIONS
We identified a number of factors that predicted adjustment disorders compared to no mental health diagnosis. The majority of studies were rated as moderate or high in risk of bias, suggesting that more rigorous research is needed to confirm the relationships we detected.
Topics: Adjustment Disorders; Adult; Female; Humans; Mental Disorders; Mental Health; Stress Disorders, Post-Traumatic
PubMed: 35176345
DOI: 10.1016/j.jad.2022.02.038 -
Primary Care Mar 2023Adjustment disorder is a disorder characterized by an extreme emotional reaction to a stressor. It is defined diagnostically with either the Diagnostic and Statistical... (Review)
Review
Adjustment disorder is a disorder characterized by an extreme emotional reaction to a stressor. It is defined diagnostically with either the Diagnostic and Statistical Manual V or ICD-11 definitions. There is currently a diagnostic tool that is still being validated to assist with diagnosing adjustment disorder. The prevalence of this disorder ranges from 0.2% to 40%, depending on the stressful circumstances that the patient experiences. There are several treatments available for adjustment disorder, ranging from psychological interventions, natural therapies to pharmacotherapies.
Topics: Humans; Adjustment Disorders; Diagnostic and Statistical Manual of Mental Disorders; International Classification of Diseases; Prevalence; Primary Health Care
PubMed: 36822730
DOI: 10.1016/j.pop.2022.10.006 -
The World Journal of Biological... 2018This paper focuses on the psychobiology of stress, depression, adjustment disorders (ADs), and resilience. Since the ADs fall under the rubric in DSM-5 of Trauma and... (Review)
Review
OBJECTIVES
This paper focuses on the psychobiology of stress, depression, adjustment disorders (ADs), and resilience. Since the ADs fall under the rubric in DSM-5 of Trauma and Stressor-Related Disorders, essentials of the psychobiology of stress-response syndromes will be reviewed.
METHODS
A narrative review of the psychobiology of stress-response syndromes is undertaken, and the implications for our understanding of ADs are discussed.
RESULTS
Advances in our understanding of the psychobiology of stress-response syndromes provide an important foundation for understanding ADs, and for conceptualizing their diagnosis, as well as issues of resilience.
CONCLUSIONS
Future investigations of the psychobiology of trauma- and stressor-related disorders may shed additional light on ADs, and ultimately improve their treatment.
Topics: Adjustment Disorders; Allostasis; Depressive Disorder; Humans; Resilience, Psychological; Stress, Psychological
PubMed: 30204561
DOI: 10.1080/15622975.2018.1459049 -
Asian Journal of Psychiatry Feb 2014In the DSM-5, adjustment disorders have undergone a conceptual shift with a new designation as a constellation of stress-related conditions in response to exposure to a... (Review)
Review
In the DSM-5, adjustment disorders have undergone a conceptual shift with a new designation as a constellation of stress-related conditions in response to exposure to a distressing event which may be perceived as traumatic or non-traumatic. This is in contrast to its previous description in DSM-IV-TR, which focused on the presence of significant distress following a crisis event, but did not require the individual to meet the criteria for a more serious disorder. This paper will present a brief overview of the clinical nosology, etiology, and treatment modalities for adjustment disorders with Asian and Asian American populations.
Topics: Adjustment Disorders; Asian; Asian People; Diagnostic and Statistical Manual of Mental Disorders; Humans
PubMed: 24524713
DOI: 10.1016/j.ajp.2013.12.002 -
Comprehensive Psychiatry 2008This article discusses the conundrums and the dilemmas of the conceptual framework of the diagnoses of the adjustment disorders (ADs). The psychiatric diagnoses that... (Review)
Review
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.
Topics: Adjustment Disorders; Drug Therapy; Humans; Psychiatric Status Rating Scales; Referral and Consultation
PubMed: 18243883
DOI: 10.1016/j.comppsych.2007.10.002 -
CNS Spectrums Jun 2010The clinical value of the current Diagnostic and Statistical Manual of Mental Disorders diagnosis of adjustment disorder is controversial. The aim of this article is to... (Review)
Review
The clinical value of the current Diagnostic and Statistical Manual of Mental Disorders diagnosis of adjustment disorder is controversial. The aim of this article is to review the literature on adjustment disorder and to present suggestions for the improvement of this diagnostic category in future classification systems. The literature utilized for this review was retrieved by MEDLINE (1967 until May 2009) and was supplemented by a manual search of the literature. The analysis of the literature indicates that the diagnosis of adjustment disorder is not characterized by consistent clinical description and prognosis, adequate differentiation from other disorders, or specific psychometric and neurobiologic features. The spectrum of affective disturbances entailed by the diagnosis of adjustment disorder appears to be too broad. A major problem seems to lie in the fact that it is an exclusion diagnosis that overlaps with subthreshold manifestations of mood and anxiety disorders. More precise characterizations of stress-related disturbances are available.
Topics: Adjustment Disorders; Family Health; Follow-Up Studies; Humans; MEDLINE; Neurobiology; Psychometrics
PubMed: 20625371
DOI: 10.1017/s1092852900029254 -
Current Psychiatry Reports Nov 2013Bereavement is a common experience in adults aged 60 and older. Loss of a loved one usually leads to acute grief characterized by yearning and longing, decreased... (Review)
Review
Bereavement is a common experience in adults aged 60 and older. Loss of a loved one usually leads to acute grief characterized by yearning and longing, decreased interest in ongoing activities, and frequent thoughts of the deceased. For most, acute grief naturally evolves into a state of integrated grief, where the bereaved is able to reengage with everyday activities and find interest or pleasure. About 7 % of bereaved older adults, however, will develop the mental health condition of Complicated Grief (CG). In CG, the movement from acute to integrated grief is derailed, and grief symptoms remain severe and impairing. This article reviews recent publications on the diagnosis of CG, risk factors for the condition and evidenced-based treatments for CG. Greater attention to CG detection and treatment in older adults is needed.
Topics: Adjustment Disorders; Age Factors; Aged; Bereavement; Evidence-Based Medicine; Grief; Humans; Middle Aged; Risk Factors
PubMed: 24068457
DOI: 10.1007/s11920-013-0406-z