Adjustment Disorder Definition/description • • Excessive reactions to stress that involve negative thoughts, strong emotions and changes on behaviour. Involve a maladaptive emotion (inc. anxiety) or behaviour Aetiology • A combination of intrinsic and extrinsic factors - E.g. divorce, losing a job, academic failure, difficulties with peer group etc. Diagnosis DSM-V A. B. C. D. E. • Emotional/behavioural symptoms within 3 months of stressors Symptoms out of proportion to severity and cause clinically significant impairment Exclude another mental disorder Exclude normal bereavement Symptoms not presenting for an additional 6 months when stressor is terminated. Specify if: - With depressed mood - With anxiety - With mixed anxiety and depressed mood - With disturbance of conduct - With mixed disturbance of emotions and conduct - Unspecified: for maladaptive reactions that are not classifiable as one of the specific subtypes of adjustment disorders Treatment and management • • Psychotherapy: - Analyse the stressors affecting the patient and determine whether they can be eliminated or minimised - Explore the meaning of the stressors - Illuminate the concerns and conflicts the patient experiences - Identify way of reducing stressors - Teach or reinforce coping skills - Help patients gain perspective on the strong, establish relationships and attend support groups and manage themselves. Pharmacotherapy - Goal is to amerlirate symptoms of insomnia, anxiety and panic attacks rather than treatment of the disorder itself - Most commonly prescribed medications: ➔ Benzodiazepine ➔ Anti-depressants - Could consider etifoxine ➔ Non-benzodiazepine anxiolytic -> some studies suggest patients respond to better than lorazepam