Abstract
Adjustment disorders (ADs) have been included in the psychiatric classifications since 1952 although their name has changed over time. In DSM 5 they have been classified under the trauma and stress related disorders for the first time. Despite this positive step, there are still problems with the classification of ADs. There is no guidance on the distinction from normal stress reactions, it remains a subthreshold category, and the subtypes are not strongly underpinned by research. There are no specific diagnostic criteria in terms of symptom numbers or combinations of these, unlike most other conditions classified in DSM. Apart from epidemiological studies in those with medical illnesses, recent prevalence studies in other populations are scarce. Research is lacking in many aspects of AD, especially their biological underpinnings and treatments. One factor contributing to this is the absence of adequate diagnostic interview schedules. Interest in ADs may increase now that they are classified with the trauma-related group of disorders.
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American Psychiatric Association: The Diagnostic and Statistical Manual of Mental Disorders: DSMI, Ed 1. Washington, DC, American Psychiatric Association, 1952.
American Psychiatric Association. Washington DC: APA Diagnostic and Statistical Manual of Mental Disorders (2nd edition). 1968.
American Psychiatric Association. Washington DC: APA Diagnostic and Statistical Manual of Mental Disorders (3rd edition). 1980.
American Psychiatric Association. Washington DC: APA Diagnostic and Statistical Manual of Mental Disorders (5th edition). 2013
American Psychiatric Association. Washington DC: APA Diagnostic and Statistical Manual of Mental Disorders (4th edition). 1994.
World Health Organization: Mental disorders: Glossary and guide to their classification in accordance with the Ninth Revision of the International Classification of Diseases. 1978. Albany, NY, US, World Health Organization.
World Health Organisation World Health Organisation. The ICD-10 classification of mental and behavioural disorders: Clinical description and diagnostic guidelines (ICD-10). 1992. Geneva, WHO.
Maercker A, Brewin CR, Bryant RA, et al. Proposals for mental disorders specifically associated with stress in the International Classification of Diseases-11. Lancet. 2013;381:1683–5.
Evans SC, Reed GM, Roberts MC, et al. The International Union of Psychological Science and WHO global survey of psychologists' attitudes towards the classification of mental disorders. Cape Town, South Africa: International Congress of Psychology; 2012.
Fernandez A, Mendive JM, Salvador-Carulla L, et al. Adjustment disorders in primary care: prevalence, recognition and use of services. Br J Psychiatry. 2012;201:137–42. One of the few studies in primary care examining the prevalence of AD and demonstrating its under-recognition.
Arbus C, Herqueta T, Duburcq A. Adjustment disorder with anxiety in old age: Comparing prevalence and clinical management in primary care and mental health care. Eur Psychiatry. 2013; June epub ahead of print.
Zimmerman M, Martinez JH, Dalrymple K, et al. Is the distinction between adjustment disorder with depressed mood and adjustment disorder with mixed anxious and depressed mood valid? Ann Clin Psychiatry. 2013;25:257–165. The first study to examine some of the subtypes of AD and their validity.
Pelkonen M, Marttunen M, Henriksson M, et al. Suicidality in adjustment disorder, clinical characteristics of adolescent outpatients. Eur Child Adolesc Psychiatry. 2005;14:174–80.
Kryzhananovskaya L, Canterbury R. Suicidal behaviour in patients with adjustment disorders. Crisis. 2001;22(3):125–31.
Lonnqvist JK, Henriksson MM, Isometsa ET, et al. Mental disorders and suicide prevention. Psychiatry Clin Neurosci. 1995;49:S111–6.
Manoranjitham SD, Rajkumar AP, Thangadurai P, et al. Risk factors for suicide in rural south India. Br J Psychiatry. 2010;196:26–30.
Casey P, Maracy M, Kelly BD, et al. Can adjustment disorder and depressive episode be distinguished? Results from ODIN. J Affect Disord. 2006;92:291–7.
Baumeister H, Maercker A, Casey P. Adjustment disorders with depressed mood: A critique of its DSM-IV and ICD-10 conceptualization and recommendations for the future. Psychopathology. 2009;42:139–47.
Zimmerman M, Martinez JH, Dalrymple K, et al. Subthreshold depression: is the distinction between depressive disorder not otherwise specified and adjustment disorder valid? J Clin Psychiatry. 2013;74:470–6.
Despland JN, Monod L, Ferrero F. Clinical relevance of adjustment disorder in DSM-III-R and DSM-IV. Compr Psychiatry. 1995;36:454–60.
Dobricki M, Komproe IH, de Jong JTV, et al. Adjustment disorders after severe life-events in four post-conflict settings. Soc Psychiatry Psychiatr Epidemiol. 2010;45(1):39–46.
Casey PR, Dowrick C, Wilkinson G. Adjustment disorders: fault line in the psychiatric glossary. B J Psychiatry. 2001;179:479–81.
Maercker A, Forstmeier S, Pielmaier L, et al. Adjustment disorders: prevalence in a representative nationwide survey in Germany. Soc Psychiatry Psychiatr Epidemiol. 2012;47:1745–52.
Einsle F, Kollner V, Bly S, Maercker A. Development and validation of a questionnaire for the screening of adjustment disorder (ADNM). Psychol Health Med. 2010;15(5):584–95. The first questionnaire to screen for AD. Based on a new theoretical model of AD.
Maercker A, Forstmeier S, Enzler A, et al. Adjustment disorder, post-traumatic stress disorder, and depressive disorders in old age: findings from a community survey. Compr Psychiatry. 2008;49(2):113–20.
Ayuso-Mateos JL, Vazquez-Barquero JL, Dowrick C, et al. Depressive disorders in Europe: prevalence figures from the ODIN study. B J Psychiatry. 2001;179:308–16.
First MB, Spitzer RL, Williams JW, et al. Structured Clinical Interview for DSM-IV (SCID 1). USA: New York Biometric Research Department, New York State Psychiatric Institute; 1995.
Mitchell AJ, Chan M, Bhatti H, et al. Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: a meta-analysis of 94 interview-based studies. Lancet Oncol. 2011;12(2):160–74. A systematic review comparing the prevalence of common mental disorders, including AD, in a medically ill population. Shows the high prevalence of AD.
Lewis G, Pelosi AJ, Araya R, Dunn G. Measuring psychiatric disorders in the community: a standardised assessment for use by lay interviewers. Psychol Med. 1992;22:465–86.
Kessler RC, Ustun TB. The World Mental Health (WMH) survey initiative Version of the World Health Organisation (WHO) Composite International Diagnostic Interview (CIDI). Int JMethods Psychiatr Res. 2004;13:93–121.
Wing JK, Babor T, Brugha T, et al. SCAN: Schedules for clinical assessment in neuropsychiatry. Arch General Psychiatry. 1990;47:589–93.
Sheehan D, Lecrubier Y, Sheehan KH, et al. The Mini-International Neuropsychiatric Interview (MINI): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998;59(S20):22–33.
Bert C, Brouwer S, de Boer M et al. Developemnt and validation of the diagnostic interview for adjustment disorder (DIAD). Int J Methods Psychiatr Res. 2014. In press. The first diagnostic interview for AD but it remains to be seen how it performs in clinical studies.
Strain JJ, Diefenbacher A. The adjustment disorders: the conundrums of the diagnoses. Compr Psychiatry. 2008;49(2):121–30.
Selye H. The stress of life. New York: McGraw-Hill; 1956.
Strain J, Friedman M. Considering adjustment disorders as stress response syndromes for DSM 5. Depress Anxiety. 2011;28:818–23.
Rocco A, Martocchia A, Frugoni P, et al. Inverse correlation between morning cortisol levels and MMPI psychaesthenia and depression scale scores in victims of mobbing with adjustment disorders. Neurol Endocrinol Lett. 2007;28(5):610.
Lindqvist D, Traskman-Bendzl L, Vang F. Suicidal intent and the HPA axis characteristics of suicide attempters with major depression and adjustment disorders. Arch Suicide Res. 2008;12(3):197–207.
Di Rossa AE, Gangemi S, Cristani M, et al. Serum levels of carbonylated and nitrosylated proteins in mobbing victims with workplace adjustment disorders. Biol Psychiatry. 2009;82:308–11.
Olfson M, Marcus SC. National patterns in antidepressant medication treatment. Arch Gen Psychiatry. 2009;66(8):848–56.
Casey P, Pillay D, Wilson L, Maercker A, Rice A, Kelly B. Pharmacological interventions for adjustment disorders in adults (Protocol). Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD010530. doi: 10.1002/14651858.CD010530.
De Leo D. Treatment of adjustment disorders: a comparative evaluation. Psychol Rep. 1989;64(1):51–4.
Nguyen N, Fakra E, Pradel V, et al. Efficacy of etifoxine compared to lorazepam monotherapy in the treatment of patients with adjustment disorders with anxiety: a double-blind controlled study in general practice. Human Psychopharmacol. 2006;21(3):139–49.
Ansseau M, Bataille M, Briole G, et al. Controlled comparison of tianeptine, alprazolam and moanserin in the treatment of adjustment disorders with anxiety and depression. Human Psychopharmacol. 1996;11:293–98.
Razavi D, Kormoss N, Collard A, et al. Comparative study of the efficacy and safety of trazadone versus clorazepate in the treatment of adjustment disorders in cancer patients: a pilot study. J Int Med Res. 1999;27:264–72.
Hameed U, Schwartz TL, Malhotra K, et al. Antidepressant treatment in the primary care office: outcomes for adjustment disorder versus major depression. Ann Clin Psychiatry. 2005;17(2):77–81.
Woelk H, Arnoldt KH, Kieser M, Hoerr R. Ginkgo biloba special extract EGb 761 in generalized anxiety disorder and adjustment disorder with anxious mood: a randomized, double-blind, placebo-controlled trial. J Psychiatr Res. 2007;41(6):472–80.
Voltz HP, Kieser M. Kava-kava extract WS 1490 versus placebo in anxiety disorders: a randomised placebo-controlled 25 week outpatient trial. Pharmacopsychiatry. 1997;30:1–5.
Bourin M, Bougerol T, Guitton B, et al. A combination of plant extracts in the treatment of outpatients with adjustment disorder and anxious mood: controlled study versus placebo. Fundam Clin Pharmacol. 1994;11:127–32.
Srivastava M. Talukdar and Lahan V. Meditation for the management of adjustment disorder, anxiety and depression. Complement Ther Clin Pract. 2011;17:241–45.
Strain J. Adjustment Disorders. In “Gabbard’s Treatments of Psychiatric Disorders” Gabbard GO. 5th edition. 2014. American Psychiatric Publishing. Washington DC.
Castro CA, Adler AB, McGurk, et al. Mental health training with soldiers four months after returning from Iraq: Randomization by platoon. Journal of Traumatic Stress. 2012;25:376–83.
Arends I, Bruinvels DJ, Rebergen DS, et al. Interventions to facilitate return to work in adults with adjustment disorder. Cochrane Database Systematic Review. 2012;12(12):CD006389. The first systematic review examining psychological interventions for those out of work due to AD.
Quero S, Moles M, Perez-Ara MA, et al. An online emotional regulation system to deliver homework assignments for treating adjustment disorders. Stud Health Technol Inform. 2012;181:273–7.
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Patricia Casey has received honoraria and paid travel accommodations from Lundbeck.
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Casey, P. Adjustment Disorder: New Developments. Curr Psychiatry Rep 16, 451 (2014). https://doi.org/10.1007/s11920-014-0451-2
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DOI: https://doi.org/10.1007/s11920-014-0451-2