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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 -
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 -
Dialogues in Clinical Neuroscience Jun 2012The loss of an infant through stillbirth, miscarriage, or neonatal death is recognized as a traumatic life event. Predictors of development of complicated grief after... (Review)
Review
The loss of an infant through stillbirth, miscarriage, or neonatal death is recognized as a traumatic life event. Predictors of development of complicated grief after prenatal loss include lack of social support, pre-existing relationship difficulties, or absence of surviving children, as well as ambivalent attitudes or heightened perception of the reality of the pregnancy. Risk of complicated grief was found to be especially high after termination of a pregnancy due to fetal abnormality. Studies have revealed that men and women show different patterns of grief, potentially exacerbating decline in a relationship. Although it is clear that prenatal loss has a large psychological impact, it is concluded that there is a substantial lack of randomized controlled studies in this field of research.
Topics: Abortion, Spontaneous; Adaptation, Psychological; Adjustment Disorders; Adult; Bereavement; Female; Fetal Death; Grief; Humans; Male; Pregnancy; Social Support; Stillbirth
PubMed: 22754291
DOI: 10.31887/DCNS.2012.14.2/akersting -
American Journal of Clinical Dermatology Nov 2021Patients with vitiligo experience reduced quality of life.
BACKGROUND
Patients with vitiligo experience reduced quality of life.
OBJECTIVE
To comprehensively describe the available evidence for psychosocial burden in vitiligo.
METHODS
A systematic review of observational studies and clinical trials identified using PubMed, EMBASE, Scopus, and the Cochrane databases was performed through 1 March, 2021, to assess psychosocial comorbidities in vitiligo. Two independent reviewers performed an assessment of articles and extracted data for qualitative synthesis.
RESULTS
Included studies (N = 168) were published between 1979 and 1 March, 2021; 72.6% were published since 2010. Disorders including or related to depression (41 studies, 0.1-62.3%) and anxiety (20 studies, 1.9-67.9%) were the most commonly reported. The most prevalent psychosocial comorbidities were feelings of stigmatization (eight studies, 17.3-100%), adjustment disorders (12 studies, 4-93.9%), sleep disturbance (seven studies, 4.6-89.0%), relationship difficulties including sexual dysfunction (ten studies, 2.0-81.8%), and avoidance or restriction behavior (12.5-76%). The prevalence of most psychosocial comorbidities was significantly higher vs healthy individuals. Factors associated with a significantly higher burden included female sex, visible or genital lesions, age < 30 years (particularly adolescents), and greater body surface area involvement, among others. The most commonly reported patient coping strategy was lesion concealment.
LIMITATIONS
Available studies were heterogeneous and often had limited details; additionally, publication bias is possible.
CONCLUSIONS
The results of this systematic review show that vitiligo greatly affects psychosocial well-being. The extent of psychosocial comorbidities supports the use of multidisciplinary treatment strategies and education to address the vitiligo-associated burden of disease.
PROTOCOL REGISTRATION
PROSPERO (CRD42020162223).
Topics: Adaptation, Psychological; Adjustment Disorders; Age Factors; Body Surface Area; Clinical Trials as Topic; Comorbidity; Female; Humans; Male; Observational Studies as Topic; Personality Disorders; Prevalence; Quality of Life; Risk Factors; Severity of Illness Index; Social Stigma; Vitiligo
PubMed: 34554406
DOI: 10.1007/s40257-021-00631-6 -
BMJ Open Sport & Exercise Medicine 2022Few studies have evaluated the prevalence of psychiatric disorders among treatment-seeking elite athletes (EA) or high-performance coaches (HPC) in psychiatric...
OBJECTIVES
Few studies have evaluated the prevalence of psychiatric disorders among treatment-seeking elite athletes (EA) or high-performance coaches (HPC) in psychiatric outpatient settings.
METHODS
Descriptive overview of EA and HPC with psychiatric disorders at two publicly funded psychiatric outpatient treatment clinics in Stockholm and Malmö, Sweden. Co-occurring psychiatric disorders were illustrated using Venn diagrams for EA and HPC, and male and female EA separately, among patients from the Stockholm clinic (SC) that used standardised diagnostic interviews.
RESULTS
Overall, most patients were EA (n=221) compared with HPC (n=34). The mean age was 23.5 (±5.9) years for EA and 42.8 (±8.8) for HPC. Anxiety disorders were most common at the SC in EA and HPC (69% vs 91%, respectively). Stress-related disorders were found in 72% of HPC compared with 25% of EA. Affective disorders were found in 51% of EA and 52% of HPC. Eating disorders were common among EA (26%), especially females (37%). Substance use disorders were found in 17% of HPC. Comorbidity was generally common between affective and anxiety disorders.
CONCLUSION
Stress and adjustment disorders were found in nearly three of the four HPC compared with one in four EA. Eating disorders were prevalent in around one in four athletes and about one in six HPC had a substance use disorder.
PubMed: 35444812
DOI: 10.1136/bmjsem-2021-001264 -
Brain, Behavior, & Immunity - Health Feb 2022Immune mechanisms are part of the pathophysiology of mental disorders, although their role remains controversial. In depressive disorders a chronic low-grade...
BACKGROUND
Immune mechanisms are part of the pathophysiology of mental disorders, although their role remains controversial. In depressive disorders a chronic low-grade inflammatory process is observed, with higher interleukin-6 (IL-6) values. Furthermore, in SARS-CoV2 infection, which is closely related to depressive disorders, there is a proinflammatory cascade of cytokines that causes systemic inflammation.
METHODS
The present study evaluates the relationship between IL-6 and C-reactive protein (CRP) serum levels and the presence of depressive and adjustment disorders in a sample of 1851 patients admitted to hospital for SARS-CoV2 infection from March to November 2020. Concentrations of IL-6 and CRP were determined within the first 72 h at admission and compared among groups of patients according to previous history and current presence of depression or adjustment disorders.
RESULTS
IL-6 serum levels were significantly higher in the group of patients with depression and adjustment disorders compared to patients without such disorders (114.25 pg/mL (SD, 225.44) vs. 86.41 (SD, 202.97)), even after adjusting for several confounders. Similar results were obtained for CRP (103.94 mg/L (SD, 91.16) vs. 90.14 (SD, 85.73)). The absolute levels of IL-6 and CRP were higher than those of previous depression studies, and differences were only found for the subgroup of depressive or adjustment disorders.
CONCLUSIONS
Serum concentrations of IL-6 and CRP are higher in COVID-19 patients with but not persistent depressive or adjustment disorders. Clinical features such as fatigue, asthenia, anhedonia, or anxiety can be the basis for this finding.
PubMed: 34927104
DOI: 10.1016/j.bbih.2021.100405 -
Clinical Schizophrenia & Related... 2022Dysexecutive syndrome is a prominent and functionally significant cognitive feature of schizophrenia. This study assesses and correlates executive function (EF) deficits...
BACKGROUND
Dysexecutive syndrome is a prominent and functionally significant cognitive feature of schizophrenia. This study assesses and correlates executive function (EF) deficits and dysexecutive behavior (DB) in first-episode schizophrenia (FES) patients and healthy participants.
METHODS
We evaluated 22 FES patients (aged 17-29 years, history of single episode of schizophrenia, treated with atypical antipsychotics) and 20 controls matched for gender, age, and education. EF was evaluated using the Modified Six Elements Test (MSET), Modified Wisconsin Card Sorting Test (M-WCST), and Frontal Assessment Battery (FAB). DB was evaluated using the Dysexecutive Questionnaire (DEX) and Behavioral Dysexecutive Syndrome Inventory (BDSI).
RESULTS
FES patients had marked dysexecutive behaviors and executive function impairments as compared to controls. Our findings suggest that executive function scores on standardized neuropsychological tests may be ecologically valid predictors of dysexecutive behavior.
CONCLUSION
DB is common during first-episode schizophrenia and may be a primary impairment throughout disease progression. The present results inform clinical practice by providing insight into first-episode schizophrenia specific features of dysexecutive behavior. Understanding the associations between executive function tests and dysexecutive behaviors helps to explain the social adjustment disorders associated with schizophrenia. This knowledge may be used to improve diagnostic and therapeutic tools; for example, clarifying the implications of specific DEX and BDSI dimensions could increase the efficacy of individual or familial psychotherapy and cognitive rehabilitation interventions.
Topics: Humans; Cognition Disorders; Executive Function; Neuropsychological Tests; Schizophrenia; Surveys and Questionnaires
PubMed: 37101576
DOI: No ID Found