[20] Adjustment Disorders

Question 1

What are adjustment disorders?

Answer 1

Adjustment disorders are stress related conditions, where a patient experiences more stress than would normally be expected in response to a stressful or unexpected event, and the stress causes significant problems with social functioning.

Question 2

What causes adjustment disorders?

Answer 2

Stressful life events, both positive and negative, may cause an adjustment disorder

Question 3

Give some examples of stressful life events that might cause an adjustment disorder

Answer 3

• Divorce or marital problems
• Relationship or interpersonal problems
• Changes in situation, such as retirement, having a baby, or changing school
• Loss of job
• Loss of loved one
• Ongoing stressors, such as medical illness

Question 4

How are previous life events important in the aetiology of adjustment disorders? af

Answer 4

They affect how a person deals with stress, and some may increase the risk of development of an adjustment disorder

Question 5

What previous life events may increase the risk of the development of an adjustment disorder?

Answer 5

• Significant stress experienced in childhood
• Other mental health problems
• A number of difficult life circumstances

Question 6

What are the symptoms of adjustment disorders?

Answer 6

Symptoms are variable, but can be of the types found within affective disorders or neurotic disorders (but not severe enough to be classified as a specific psychiatric disorder). Examples include;

• Low mood
• Anhedonia
• Frequent crying
• Anxiety
• Insomnia
• Lack of appetite
• Difficulty concentrating
• Difficulty functioning in daily activities
• Suicidal thoughts or behaviour

Question 7

Describe the timeline of symptoms of adjustment disorders

Answer 7

Symptoms start within a month of the stressful event, and last no longer than 6 months after the event

Question 8

How are adjustment disorders investigated?

Question 9

What is the main goal of treatment of adjustment disorders?

Answer 9

To relieve symptoms and help the patient return to a similar level of functioning as before the stressful event occured

Question 10

What is the mainstay treatment of adjustment disorder?

Answer 10

CBT

Question 11

Other than CBT, what treatment options are available in adjustment disorders?

Answer 11

• Long-term therapy
• Family therapy
• Self-help groups
• Medications

Question 12

What medications are used in adjustment disorder?

Answer 12

• Anxiolytic medications
• Sleeping tablets (hypnotics)
• Antidepressants

Question 13

Describe the use of medication in adjustment disorders

Answer 13

They are only used alongside talking therapies

Question 14

What are the groups of hypnotics?

Answer 14

• Benzodiazepines
• Nonbenzodiazepines

Question 15

Give 3 examples of benzodiazepine hypnotics

Answer 15

• Temazepam
• Lormatezepam
• Nitrazepam

Question 16

Give 2 examples of non-benzodiazepine hypnotics

Answer 16

• Zopiclone
• Zolpidem

Question 17

How do benzodiazepine and non-benzodiazepine hypnotics differ?

Answer 17

They act in a very similar way, but are structurally different. Practically, there is not much difference between the two groups

Question 18

What group of hypnotics is usually favoured?

Answer 18

Non-benzodiazepines

Question 19

What are the problems with hypnotics?

Answer 19

There is significant potential for misuse, dependence, and rebound insomnia

Question 20

How is the potential for dependance to hypnotics reduced?

Answer 20

They should only be used for 2 weeks, and taken for only 5 days in a week to reduce the potential for tolerance