ADJUSTMENT DISORDERS.pptx

ADJUSTMENT DISORDERS.pptx

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  ADJUSTMENT DISORDERS UNIT :-XV PRESENTED BY :- DR. SUKHBIR KAUR MENTAL HEALTH (PSYCHIATRIC) NURSING. SGRD COLLEGE OF NURSING, AMRITSAR
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  Introduction:- • An adjustmentdisorder is a distressing reaction to a difficult situation that lasts longer than what’s usually expected or is more excessive than what’s usually expected.
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  Definition:- • The adjustmentdisorders are a diagnostic category characterized by an emotional response to a stressful event. Typically, the stressor involves financial issues, a medical illness, or a relationship problem.
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  • By definition,the symptoms must begin within 3 months of the stressor and must remit within 6 months of removal of the stressor. If the symptom complex is less than 6 months in duration, it is deemed acute. Symptoms lasting beyond 6 months of the initial event are coded as a chronic adjustment disorder.
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  • An adjustmentdisorder will begin within three months of experiencing a stressful situation and will usually disappear after six months. However, if the stressful situation is ongoing, such as a chronic illness, a difficult divorce, or continuing financial problems, the disorder might last for as long as the situation remains unchanged.
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  Historical aspects:- • Thefirst edition of the DSM (DSM-I) in 1952 described the category of transient situational personality disorder. • The diagnosis was modified somewhat in the second edition of the DSM (DSM-II), which changed the diagnosis to transient situational disorder.
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  • The thirdedition of the DSM (DSM-III) introduced the diagnosis of adjustment disorder. The developmental periods of the earlier diagnostic systems • The revised third edition of the DSM (DSM-III-R) retained these diagnostic subtypes and added an additional one involving physical complaints. The DSM- III-R also specified that symptoms of an adjustment disorder could not exceed 6 months were eliminated.
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  • The fourthedition of the DSM (DSM-IV) modified the diagnosis of adjustment disorder in several ways. The subtypes of mixed emotional features, work inhibition, withdrawal, and physical complaints were eliminated. • The stressor was allowed to persist for an indefinite period of time. A descriptor of chronicity was specified, whereby symptoms persisting for longer than 6 months were deemed chronic
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  Epidemiology:- • Diagnosis ofadjustment disorder is quite common; there is an estimated incidence of 5-21% among psychiatric consultation services for adults. In adult clinical samples, women are twice as often as men to be diagnosed, though children and adolescents (girls or boys) are equally likely to receive this diagnosis.
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  • Adjustment disorderappears to be fairly common in the American population; recent figures estimate that 5%–20% of adults seeking outpatient psychological treatment suffer from one of the subtypes of this disorder. As many as 70% of children in psychiatric inpatient settings may be diagnosed with an adjustment disorder.
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  Etiological Theories:- • 1.Psychodynamics. • 2. Biological. • 3. Family Dynamics
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  Other causes:- • Familyconflict • School problems • Sexuality issues
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  • Death ofa loved one • General life changes • Unexpected catastrophes
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  STRESS AS MAINCAUSE…… • Stress has been described as the etiological agent for AD. Vulnerability to stress is another risk factor. Diverse variables and modifiers are involved regarding who will experience AD following a stress.
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  • Obviously, thestressor and its effect are central to the AD diagnosis. The second major confound emanates from the fact that the DSM-IV presents no criteria or ‘guidelines' to quantify stressors or to assess their effect or meaning for a particular individual at a given time
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  • Mezzich etal. attempted to classify and quantify the psychosocial stressors in 13 specific domains: health, bereavement, love and marriage, parental, family stressors for children and adolescents, other familial relationships, other relationships outside the family, work, school, financial, legal, housing, and miscellaneous.
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  • The timecourse and chronicity of both stressors and their consequent symptoms were left vague in DSM-IIIR and were not consistent with the clinical situation.
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  Diagnostic criteria andsymptoms :- • DSM-IV-TR states that the symptoms of an adjustment disorder must appear within three months of a stressor; and that they must meet at least one of the following criteria: • 1) the distress is greater than what would be expected in response to that particular stressor;
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  2) the patientexperiences significant impairment in social relationships or in occupational or academic settings. Moreover, the symptoms cannot represent bereavement, as normally experienced after the death of a loved one.
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  DSM-IV-TR specifies sixsubtypes of adjustment disorder, each with its own predominant symptoms: With depressed mood With anxiety With mixed anxiety and depressed mood With disturbance of conduct With mixed disturbance of emotions and conduct Unspecified
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  • Adjustment disordersmay lead to suicide or suicidal thinking. • They may also complicate the treatment of other diseases when, for instance, a sufferer loses interest in taking medication as prescribed or adhering to diets or exercise regimens
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  • Agitation • Conductdisturbances • Depressed mood • Palpitations • Physical complaints • Trembling or twitching
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  PREVENTION OF ADJUSTMENT DISORDER
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  24 Prevention Activities • Screening •Safe schools • Pre-referral • Suicide • Social skills • Bully-proofing • Parent training • Consultation • Early literacy • Social competency • Resiliency classrooms • Counseling • Drug education • Violence prevention • Health promotion • Character education • School reform • Mental health
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  Treatment : - •1. Psychological and social interventions. • Psychodynamic psychotherapy. • Support groups. • Group therapy. • Family therapy • Cognitive-behavioral therapy. • Interpersonal therapy.
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  Medications • Some arguethat medication is not necessary for adjustment disorders because of their brief duration. In addition, they maintain that medications may be counterproductive by undercutting the patient's sense of responsibility and his or her motivation to find effective solutions
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  Alternative therapies 1. DialecticalBehavior Therapy for Adjustment Disorder. • The basic DBT treatment is usually composed of six steps: • Conduct an assessment and provide education • Develop distress tolerance skills • Develop mindfulness skills
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  • Develop emotionregulation skills • Develop interpersonal regulation skills • Prevent relapse
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  2.Acceptance and Commitment Therapyfor Adjustment Disorder • The ACT treatment for adjustment disorder generally includes eight steps: • Educate about adjustment disorder and ACT • Develop creative hopelessness
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  • Clarify values •Commit to taking action • Develop acceptance • Focus on contact with the present moment • Utilize cognitive defusion • Stay committed to values and actions
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  Prognosis • For mostpeople, an adjustment disorder is temporary and will either resolve by itself or respond to treatment. For some, however, the stressor will remain chronic and the symptoms may worsen. Still other patients may develop a major depressive disorder even in the absence of an additional stressor.
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  Prevention • In manycases, there is little possibility of preventing the stressors that trigger adjustment disorders. One preventive strategy that is helpful to many patients, however, is learning to be proactive in managing ordinary life stress, and maximizing their problem-solving abilities when they are not in crisis.
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  Nursing management:- • CLIENTASSESSMENT DATABASE • DIAGNOSTIC STUDIES • NURSING PRIORITIES
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  • DISCHARGE GOALS.