Special Issue "Adjustment Disorder in Liaison Psychiatry"

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Behavior, Chronic Disease and Health Promotion".

Deadline for manuscript submissions: closed (31 August 2019).

Special Issue Editor

Prof. Dr. Patricia Casey
E-Mail Website
Guest Editor
University College Dublin, School of Medicine, Department of Psychiatry, Dublin, IrelandConsultant Psychiatrist in the Mater Misericordiae University Hospital
Interests: adjustment disorders; suicidal behaviour

Special Issue Information

Dear Colleagues,

Adjustment Disorder (AD) is a common but under-researched area of study with no specific diagnostic criteria. In DSM-5 it is regarded a sub-threshold disorder that cannot be diagnosed when the threshold for another disorder (either in respect to symptom duration or number) is met. This is anticipated to change when the ICD-11 is introduced in 2011, at which point it will be regarded as full threshold condition with its own specific diagnostic criteria. One of the controversies that arise in the context of AD is whether this is conflated with major depression, leading to an excess of false positives in the latter and, in turn, leading to an under-diagnosis of AD. Despite the shortcomings and debate about the diagnosis, it is one that has found huge utility in certain areas of clinical practice. 

In particular, liaison psychiatry is the setting where AD is the most common diagnosis. Included in this is the very high prevalence of the diagnosis in those presenting to the Emergency Departments of General Hospitals either with emotional crises or after episodes of self-harm.

This Special Issue will examine the prevalence of, and associated relationships with, a diagnosis of AD in a variety of diagnostic groups. These include AD in cancer patients, in those with myocardial infarcts, among transplant patients (of various organs), in those with chronic pain, with burn injuries, in perinatal psychiatry, and in a variety of other groups seen in non-psychiatric settings. AD in self-harm patients will also be considered. In many of these areas the number of quality studies will be limited, but it is important to highlight this deficiency and to identify areas for further research.    

This issue will also examine the diagnostic conundrums that are associated with an AD diagnosis, particularly with respect to the differentiation of AD from anxiety disorders and from major depression.

A range of papers will be considered including narrative and systematic reviews, RTCs, and observational studies.  All papers, even those papers that have been commissioned from experts in the area, will be subject to rigorous peer review.

Prof. Dr. Patricia Casey
Guest Editor

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Keywords

  • adjustment disorder
  • adjustment disorder with anxiety
  • adjustment disorder with depression
  • adjustment disorder with other emotions (anger)
  • diagnostic conundrums
  • distinction from PTSD
  • distinction from major depression
  • distinction from anxiety

Published Papers (8 papers)

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Research

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Open AccessArticle
The Adjustment Disorder Diagnosis, Its Importance to Liaison Psychiatry, and its Psychobiology
Int. J. Environ. Res. Public Health 2019, 16(23), 4645; https://doi.org/10.3390/ijerph16234645 - 22 Nov 2019
Cited by 2 | Viewed by 1021
Abstract
Adjustment Disorder (AD) is one of the most common psychiatric diagnoses employed. In fact, it is the most frequent diagnosis utilized for psychiatric disorders in the military and in children, and is often utilized in the consultation-liaison medical setting. However, it is acknowledged [...] Read more.
Adjustment Disorder (AD) is one of the most common psychiatric diagnoses employed. In fact, it is the most frequent diagnosis utilized for psychiatric disorders in the military and in children, and is often utilized in the consultation-liaison medical setting. However, it is acknowledged that the diagnosis is not reliable, it cannot be validated, and it has an important degree of subjective consideration in its use. Commonly used screening tools like the Hamilton and Beck Depression Scales do not give an assessment of AD. Furthermore, its use is accompanied with descriptors of depression, anxiety, mixed affects, etc., so that it crosses over several areas of psychiatric dysfunction. It does allow the placement of a patient within a psychiatric diagnosis when they do not reach criteria for a major psychiatric nomenclature. To date, biological studies have not been reported. It is not known if AD with depression is closer to the biological characteristics of depression, or AD with anxiety would have similar characteristics to that seen with major anxiety. It is also not known if AD has a biological signature that would make them an entity with common features, or if they may be more closely allied biologically with the descriptor that accompanies them. Nevertheless, AD is an important category in any psychiatric lexicon and warrants further study and biological understanding. Full article
(This article belongs to the Special Issue Adjustment Disorder in Liaison Psychiatry)
Open AccessArticle
Can Between-Session Homework Be Delivered Digitally? A Pilot Randomized Clinical Trial of CBT for Adjustment Disorders
Int. J. Environ. Res. Public Health 2019, 16(20), 3842; https://doi.org/10.3390/ijerph16203842 - 11 Oct 2019
Cited by 2 | Viewed by 1127
Abstract
Adjustment disorder (AjD) is one of the most common disorders in clinical practice, and its symptoms are severe enough to cause great distress and functional impairment. The AjD CBT protocol specifically developed for this disorder has shown positive results when delivered face to [...] Read more.
Adjustment disorder (AjD) is one of the most common disorders in clinical practice, and its symptoms are severe enough to cause great distress and functional impairment. The AjD CBT protocol specifically developed for this disorder has shown positive results when delivered face to face and through virtual reality. Despite existing evidence supporting the benefits of therapeutic homework as part of a psychological intervention, little is known about how to increase homework engagement in psychotherapy. This study examines the feasibility (doability, initial efficacy and acceptability) of a digital support system to deliver homework via the Internet in the treatment of AjD. Participants were randomly assigned to a traditional homework condition or a digital support system condition. Both interventions resulted in statistically significant improvements, with large effect sizes, in all the outcome measures at post-treatment, with no significant differences between groups. At 12-month follow-up, these therapeutic gains were maintained, and an improvement was even observed in both conditions, with no significant differences between groups. Additionally, treatment satisfaction predicted efficacy in both groups separately and when the whole group was considered. This is the first study to explore the feasibility an initial efficacy of delivering a therapeutic homework component for AjD through the Internet. Full article
(This article belongs to the Special Issue Adjustment Disorder in Liaison Psychiatry)
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Open AccessArticle
ICD-11 Adjustment Disorder among Organ Transplant Patients and Their Relatives
Int. J. Environ. Res. Public Health 2019, 16(17), 3030; https://doi.org/10.3390/ijerph16173030 - 21 Aug 2019
Cited by 2 | Viewed by 987
Abstract
Adjustment disorder (AD) is one of the most frequent mental health conditions after stressful life experiences in the medical setting. The diagnosis has been conceptually redefined in International Classification of Diseases (ICD-11) and now includes specific symptoms of preoccupations and failure to adapt. [...] Read more.
Adjustment disorder (AD) is one of the most frequent mental health conditions after stressful life experiences in the medical setting. The diagnosis has been conceptually redefined in International Classification of Diseases (ICD-11) and now includes specific symptoms of preoccupations and failure to adapt. The current study assesses the prevalence of self-reported ICD-11 AD among organ transplantation patients and their relatives, explores the association of patients’ demographic-, transplant-, and health-related characteristics and ICD-11 AD symptoms, and evaluates the role of social support in the post- transplant context. A total of N = 140 patient-relative dyads were examined cross-sectionally. Hierarchical linear regression analyses were conducted to explore potential predictive factors of AD. The results revealed an AD prevalence of 10.7% among patients and 16.4% among relatives at an average of 13.5 years after the transplantation. The time that had passed since the transplantation was unrelated to AD symptom severity. Women tended to be at a higher risk in both groups. Somatic issues were predictive for AD only among patients and social support was predictive mainly among relatives. The results suggest that ICD-11 AD is a relevant diagnosis after organ transplantations for patients and relatives and its specific symptom clusters may provide important information for developing intervention strategies. Full article
(This article belongs to the Special Issue Adjustment Disorder in Liaison Psychiatry)
Open AccessFeature PaperArticle
The Role of Religion in Buffering the Impact of Stressful Life Events on Depressive Symptoms in Patients with Depressive Episodes or Adjustment Disorder
Int. J. Environ. Res. Public Health 2019, 16(7), 1238; https://doi.org/10.3390/ijerph16071238 - 08 Apr 2019
Cited by 5 | Viewed by 1567
Abstract
Most studies into the role of religiousness in relation to depression severity have mainly found an inverse relationship between greater religiousness and lower levels of depressive symptoms. There is reason to assume that religiousness has a buffering effect on the relationship between stressful [...] Read more.
Most studies into the role of religiousness in relation to depression severity have mainly found an inverse relationship between greater religiousness and lower levels of depressive symptoms. There is reason to assume that religiousness has a buffering effect on the relationship between stressful life events and depressive symptoms. The aim of this study was to investigate the role of religiousness in moderating the impact of stressors on depressive symptoms. n = 348 patients with either a depressive episode or adjustment disorder were assessed at referral to the liaison psychiatry services in three Dublin hospitals and n = 132 patients were followed up six months later. We assessed depressive symptoms, life events, social support, and religiosity, and used hierarchical and multiple linear regression for data analysis. The interaction of organised religious activity and the amount of life events was significant (β = −0.19, p = 0.001) in the cross-sectional prediction of depressive symptoms while non-organised religious activity (β = −0.23, p = 0.001) and intrinsic religiousness (β = −0.15, p = 0.033) interacted significantly with life events in the longitudinal analysis. This study demonstrated that various dimensions of religiousness buffered the impact of life events on outcome. Full article
(This article belongs to the Special Issue Adjustment Disorder in Liaison Psychiatry)
Open AccessArticle
Sleep Disturbance in Adjustment Disorder and Depressive Episode
Int. J. Environ. Res. Public Health 2019, 16(6), 1083; https://doi.org/10.3390/ijerph16061083 - 26 Mar 2019
Viewed by 1212
Abstract
Background: In this paper, we aimed to examine the patterns of sleep disturbance in adjustment disorder (AD) and depressive episode (DE), to examine the variables associated with sleep disturbance in AD and DE and associated impairment in functioning. Methods: This is a multi-centre [...] Read more.
Background: In this paper, we aimed to examine the patterns of sleep disturbance in adjustment disorder (AD) and depressive episode (DE), to examine the variables associated with sleep disturbance in AD and DE and associated impairment in functioning. Methods: This is a multi-centre case-control study of 370 patients: 185 patients with AD and 185 patients with a diagnosis of DE, recruited from the liaison psychiatry services of three Dublin hospitals. We examined the participants’ sleep pathology using the sleep disturbance items on the Schedule for Clinical Assessment in Neuropsychiatry, and the Inventory of Depressive Symptoms—Clinician-rated-30. Results: Patients with a diagnosis of AD were less likely to report disturbed sleep than those with a diagnosis of DE (p = 0.002). On multivariate analysis, sleep disturbance was significantly associated with greater severity of certain depressive symptoms: decreased appetite (p < 0.001) and psychomotor agitation (p = 0.009). Decreased appetite, younger age and single marital status were significantly associated with sleep disturbance in male patients, and decreased appetite and psychomotor agitation were significantly associated with sleep disturbance in female participants. Conclusions: This is the largest study to date which has examined sleep disturbance in adjustment disorder. Disturbance of sleep is a significant symptom in AD and may represent a potential target for treatment. With further research, patterns of sleep disturbance may be useful in differentiating AD from DE. Full article
(This article belongs to the Special Issue Adjustment Disorder in Liaison Psychiatry)

Review

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Open AccessReview
Adjustment Disorder and Suicidal Behaviours Presenting in the General Medical Setting: A Systematic Review
Int. J. Environ. Res. Public Health 2019, 16(16), 2967; https://doi.org/10.3390/ijerph16162967 - 18 Aug 2019
Cited by 5 | Viewed by 1532
Abstract
Background: Adjustment disorder (AD) is a condition commonly encountered by clinicians in emergency departments and liaison psychiatry settings and has been frequently reported among patients presenting with suicidal behaviours. A number of previous studies have noted the strong association between suicidal ideation and [...] Read more.
Background: Adjustment disorder (AD) is a condition commonly encountered by clinicians in emergency departments and liaison psychiatry settings and has been frequently reported among patients presenting with suicidal behaviours. A number of previous studies have noted the strong association between suicidal ideation and behaviours, and AD. In this paper, we aimed to explore this relationship, by establishing the incidence of AD in patients who present with self-harm and suicidal ideation, and the rates of self-harm among patients with a diagnosis of AD. Methods: We conducted a review of the literature of well-established databases using specific key words then synthesised the results into a descriptive narrative as well as representing it in table form. Results: Sample sizes and study methods varied significantly across the review. A majority of studies were retrospective chart-based reviews, and only three used structured diagnostic instruments. A high prevalence of AD (ranging from 9.8 to 100%) was found, with self-poisoning representing the most common form of suicide attempt in the majority of studies. Interpersonal difficulties were the main precipitant in studies which examined this. Conclusions: This study suggests there is a strong association between AD and suicidal behaviours. Given the paucity of research in the area, there is a need to build the evidence base for effective treatment strategies. Full article
(This article belongs to the Special Issue Adjustment Disorder in Liaison Psychiatry)
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Open AccessFeature PaperReview
Adjustment Disorder: Current Developments and Future Directions
Int. J. Environ. Res. Public Health 2019, 16(14), 2537; https://doi.org/10.3390/ijerph16142537 - 16 Jul 2019
Cited by 8 | Viewed by 4331
Abstract
Despite its high prevalence in clinical and consultant liaison psychiatry populations, adjustment disorder research has traditionally been hindered by its lack of clear diagnostic criteria. However, with the greater diagnostic clarity provided in the Diagnostic and Statistical Manual of Mental Disorders – fifth [...] Read more.
Despite its high prevalence in clinical and consultant liaison psychiatry populations, adjustment disorder research has traditionally been hindered by its lack of clear diagnostic criteria. However, with the greater diagnostic clarity provided in the Diagnostic and Statistical Manual of Mental Disorders – fifth edition (DSM-5) and the International Statistical Classification of Diseases and Related Health Problems, 11th edition (ICD-11), adjustment disorder has been increasingly recognised as an area of research interest. This paper evaluates the commonalities and differences between the ICD-11 and DSM-5 concepts of adjustment disorder and reviews the current state of knowledge regarding its symptom profile, course, assessment, and treatment. In doing so, it identifies the gaps in our understanding of adjustment disorder and discusses future directions for research. Full article
(This article belongs to the Special Issue Adjustment Disorder in Liaison Psychiatry)
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Other

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Open AccessBrief Report
Suicidality in Women with Adjustment Disorder and Depressive Episodes Attending an Irish Perinatal Mental Health Service
Int. J. Environ. Res. Public Health 2019, 16(20), 3970; https://doi.org/10.3390/ijerph16203970 - 18 Oct 2019
Viewed by 869
Abstract
Depression is common in the perinatal period, with prevalence rates of 14.4%, but prevalence rates of adjustment disorder in this period have not been established. We aimed to examine the characteristics of women attending a perinatal psychiatry service diagnosed with adjustment disorder (AD) [...] Read more.
Depression is common in the perinatal period, with prevalence rates of 14.4%, but prevalence rates of adjustment disorder in this period have not been established. We aimed to examine the characteristics of women attending a perinatal psychiatry service diagnosed with adjustment disorder (AD) or depressive episodes (DE). The data were collected as part of a multicentre case-control study of 370 patients, 45 of whom were recruited from perinatal psychiatry service at a maternity hospital. We recruited 45 patients with AD or DE diagnosed in the perinatal period and compared them to a matched sample of 109 non-perinatal women. Almost half, 22 (48.9%) perinatal women had a diagnosis of AD and 23 (51.1%) had a diagnosis of DE. Of the perinatal participants, those with AD had more stressful life events, and suicidal ideation and behaviours were three times more common (31.8%) in AD than in DE (8.7%). There were no significant differences in levels of suicidality between the perinatal and the non-perinatal groups. In our cohort, AD is associated with symptoms of depression including suicidal ideation during the perinatal period. Further study is required to examine the relationship between stressors and suicidality in this population. Full article
(This article belongs to the Special Issue Adjustment Disorder in Liaison Psychiatry)
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