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Adjustment Disorder: epidemiology, diagnosis and treatment.

Carta MG, Balestrieri M, Murru A, Hardoy MC - Clin Pract Epidemiol Ment Health (2009)

Bottom Line: Comorbidity of AD with other conditions, and outcome of AD are then analyzed.This may be caused by a difficulty in facing, with a purely descriptive methods, a "pathogenic label", based on a stressful event, for which a subjective impact has to be considered.We lack efficacy surveys concerning treatment.

View Article: PubMed Central - HTML - PubMed

Affiliation: Centro per la Ricerca e la Terapia in Salute Mentale, Department of Public Health, University of Cagliari, Italy. mgcarta@tiscali.it.

ABSTRACT

Background: Adjustment Disorder is a condition strongly tied to acute and chronic stress. Despite clinical suggestion of a large prevalence in the general population and the high frequency of its diagnosis in the clinical settings, there has been relatively little research reported and, consequently, very few hints about its treatments.

Methods: the authors gathered old and current information on the epidemiology, clinical features, comorbidity, treatment and outcome of adjustment disorder by a systematic review of essays published on PUBMED.

Results: After a first glance at its historical definition and its definition in the DSM and ICD systems, the problem of distinguishing AD from other mood and anxiety disorders, the difficulty in the definition of stress and the implied concept of 'vulnerability' are considered. Comorbidity of AD with other conditions, and outcome of AD are then analyzed. This review also highlights recent data about trends in the use of antidepressant drugs, evidence on their efficacy and the use of psychotherapies.

Conclusion: AD is a very common diagnosis in clinical practice, but we still lack data about its rightful clinical entity. This may be caused by a difficulty in facing, with a purely descriptive methods, a "pathogenic label", based on a stressful event, for which a subjective impact has to be considered. We lack efficacy surveys concerning treatment. The use of psychotropic drugs such as antidepressants, in AD with anxious or depressed mood is not properly supported and should be avoided, while the usefulness of psychotherapies is more solidly supported by clinical evidence. To better determine the correct course of therapy, randomized-controlled trials, even for the combined use of drugs and psychotherapies, are needed vitally, especially for the resistant forms of AD.

No MeSH data available.


Related in: MedlinePlus

WHO criteria.
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Figure 1: WHO criteria.

Mentions: Essentially, the core feature in the AD diagnosis (using either WHO [figure 1] or APA [figure 2] criteria) is clinically significant emotional or behavioral symptoms, often depressive in nature, that develop after an identifiable stressor [8]. The two main classifications differ in terms of the severity of impairment: ICD-10 points to "usually interfering with social functioning and performance" and "some degree of disability in the performance of daily routines" whereas DSM-IV points to "marked distress that is in excess of what would be expected given the nature of the stressor by significant impairment in social or occupational functioning" [9].


Adjustment Disorder: epidemiology, diagnosis and treatment.

Carta MG, Balestrieri M, Murru A, Hardoy MC - Clin Pract Epidemiol Ment Health (2009)

WHO criteria.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2710332&req=5

Figure 1: WHO criteria.
Mentions: Essentially, the core feature in the AD diagnosis (using either WHO [figure 1] or APA [figure 2] criteria) is clinically significant emotional or behavioral symptoms, often depressive in nature, that develop after an identifiable stressor [8]. The two main classifications differ in terms of the severity of impairment: ICD-10 points to "usually interfering with social functioning and performance" and "some degree of disability in the performance of daily routines" whereas DSM-IV points to "marked distress that is in excess of what would be expected given the nature of the stressor by significant impairment in social or occupational functioning" [9].

Bottom Line: Comorbidity of AD with other conditions, and outcome of AD are then analyzed.This may be caused by a difficulty in facing, with a purely descriptive methods, a "pathogenic label", based on a stressful event, for which a subjective impact has to be considered.We lack efficacy surveys concerning treatment.

View Article: PubMed Central - HTML - PubMed

Affiliation: Centro per la Ricerca e la Terapia in Salute Mentale, Department of Public Health, University of Cagliari, Italy. mgcarta@tiscali.it.

ABSTRACT

Background: Adjustment Disorder is a condition strongly tied to acute and chronic stress. Despite clinical suggestion of a large prevalence in the general population and the high frequency of its diagnosis in the clinical settings, there has been relatively little research reported and, consequently, very few hints about its treatments.

Methods: the authors gathered old and current information on the epidemiology, clinical features, comorbidity, treatment and outcome of adjustment disorder by a systematic review of essays published on PUBMED.

Results: After a first glance at its historical definition and its definition in the DSM and ICD systems, the problem of distinguishing AD from other mood and anxiety disorders, the difficulty in the definition of stress and the implied concept of 'vulnerability' are considered. Comorbidity of AD with other conditions, and outcome of AD are then analyzed. This review also highlights recent data about trends in the use of antidepressant drugs, evidence on their efficacy and the use of psychotherapies.

Conclusion: AD is a very common diagnosis in clinical practice, but we still lack data about its rightful clinical entity. This may be caused by a difficulty in facing, with a purely descriptive methods, a "pathogenic label", based on a stressful event, for which a subjective impact has to be considered. We lack efficacy surveys concerning treatment. The use of psychotropic drugs such as antidepressants, in AD with anxious or depressed mood is not properly supported and should be avoided, while the usefulness of psychotherapies is more solidly supported by clinical evidence. To better determine the correct course of therapy, randomized-controlled trials, even for the combined use of drugs and psychotherapies, are needed vitally, especially for the resistant forms of AD.

No MeSH data available.


Related in: MedlinePlus