Tn: Psychiatry - 6B

Front 1

Adjustment disorder criteria A

Back 1

• the development of emotional or behavioral symptoms in response to an identifiable stressor(s)occurring within 3 mo of the onset of the stressor(s)
  

Front 2

Adjustment Disorder criteria B

Back 2

B. these symptoms or behaviors are clinically significant as evidenced by either of the following:

• marked distress that is in excess of what would be expected from exposure to the stressor
  
• significant impairment in social or occupational (academic) functioning
  

Front 3

Adjustment Disorder criteria C

Back 3

the stress-related disturbance does not meet criteria for another mental disorder and is notmerely an exacerbation of a pre-existing mental disorder

Front 4

Adjustment Disorder criteria D

Back 4

the symptoms do not represent normal bereavement

Front 5

Adjustment disorder criteria E

Back 5

once the stressor (or its consequences) has terminated, the symptoms do not persist for more than an additional 6 mo

Front 6

Adjustment disorder specifiers

Back 6

• depressed mood,
  
• anxiety,
  
• mixed anxiety/depression,
  
• conduct disturbance,
  
• mixed disturbance of conduct/emotions,
  
• unspecified
  

Front 7

Types of stressors in adjustment disorder?

Back 7

• Single
  
• Multiple
  
• Recurrent
  
• Continuous
  
• Developmental events
  

Front 8

Example of single stressor?

Back 8

Termination of romantic relationship

Front 9

Example of multiple stressors?

Back 9

Marked business difficulties and marital problems

Front 10

Example of recurrent stressors?

Back 10

Seasonal business crises

Front 11

Example of continuous stressors?

Back 11

Living in a crime-ridden neighbourhood

Front 12

Developmental event stressor example?

Back 12

• Going to school
  
• Leaving parental home
  
• Getting married
  
• Becoming a parent
  
• Failing to attain occupational goals
  
• retirement
  

Front 13

Subtypes of adjustment disorder?

Back 13

• Adjustment disorder with:
  
• depressed mood
  
• anxiety
  
• mixed anxiety and depressed mood
  
• disturbance of conduct
  
• mixed disturbance of emotions and conduct
  
• unspecified
  

Front 14

Epidemiology of adjustment disorder?

Back 14

M=F

Front 15

Treatment of adjustment disorder?

Back 15

• brief psychotherapy
  
• crisis intervention
  
• biological therapy
  

Front 16

Describe brief psychotherapy?

Back 16

• can be in groups or individual
  
• crisis intervention
  

Front 17

Biological treatment for adjustment disorder?

Back 17

• Benzos may be used for those with anxiety symptoms (short-term, low dose, regular schedule)
  
• SSRIs for both depression and anxiety symptoms
  

Front 18

How long is normal bereavement?

Back 18

length and characteristics of normal bereavement are variable between individuals and cultures

Front 19

Does bereavement always present with symptoms of MDE/MDD?

Back 19

No, but individual regards depressed mood as normal

Front 20

When to diagnose MDD after loss?

Back 20

> 2 months after loss

Front 21

What are some risk factors for poor bereavement?

Back 21

• Poor social supports
  
• Unanticipated death or lack of preparation for death
  
• Highly dependent relationship with deceased
  
• High initial distress
  
• Other concurrent stresses and losses
  
• Death of a child
  
• Pre-existing psychiatric disorders, especially depression and separation anxiety
  

Front 22

What would indicate abnormal grief?

Back 22

• Guilt
  
• Thoughts of death other than the survivor feeling that they would be better off dead or should have died with the deceased person
  
• Morbid preoccupation with worthlessness
  
• Marked psychomotor retardation
  
• Prolonged/marked functional impairment
  
• Hallucinatory experiences other than thinking survivor hears the voice of or transiently sees the image of the deceased person
  

Front 23

Note about bereavement clinical presentation?

Back 23

• after 12 mo, if patient continues to yearn/long for the deceased, experience intense sorrow/ emotional pain in response to the death, remain preoccupied with the deceased or withtheir circumstance of death, then may start to consider a diagnosis of “persistent complexbereavement disorder”