Adjustment Disorder and Its Clinical Management

2017 ◽  
Author(s):  
Mauro Giovanni Carta ◽  
Antonio Preti
Keyword(s):  
Adjustment Disorder ◽  
Operational Definition ◽  
Clinical Settings ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Key Words Adaptation ◽  
The One ◽  
Definition Of ◽  
Anxiety Depression

Adjustment disorder is a condition of subjective emotional distress triggered as a consequence of a meaningful change in life. The diagnosis of adjustment disorder is hindered by the difficult operational definition of stress and of its related concept of “vulnerability,” by the problem of disentangling symptoms of adjustment disorder from those attributable to comorbid anxiety and mood disorders, and by the poor boundaries of the disorder with other stress-related conditions on the one hand and with common adaptation to life events on the other. Despite the high frequency of its diagnosis in clinical settings, there has been relatively little research on the adjustment disorder and, consequently, very few hints about its treatments. Several psychotherapies have been developed to deal with patients diagnosed with adjustment disorder, with inconclusive evidence on their effectiveness. Antidepressants may abate the symptoms and help patients reacquire occupational and social functioning. The medium-term outcome of adjustment disorder is good, with 70 to 80% of those diagnosed with it showing no evidence of psychopathology when reassessed 5 years from the episode. However, when comorbid with a personality disorder or a substance use disorder, the short-term risk of suicide may be increased. The long-term outcome of adjustment disorder seems to be worse in children and adolescents than in adults. In particular, adolescents diagnosed with adjustment disorder were more likely than adults to have received a diagnosis of a severe mental disorder at the 5-year follow-up, including schizophrenia, schizoaffective disorder, and bipolar disorder. This review contains 1 figure, 6 tables, and 52 references. Key words: adaptation, adjustment disorder, anxiety, depression, stress, trauma, treatment, vulnerability

Adjustment Disorder and Its Clinical Management

2017 ◽  
Author(s):  
Mauro Giovanni Carta ◽  
Antonio Preti
Keyword(s):  
Adjustment Disorder ◽  
Operational Definition ◽  
Clinical Settings ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Key Words Adaptation ◽  
The One ◽  
Definition Of ◽  
Anxiety Depression

Adjustment disorder is a condition of subjective emotional distress triggered as a consequence of a meaningful change in life. The diagnosis of adjustment disorder is hindered by the difficult operational definition of stress and of its related concept of “vulnerability,” by the problem of disentangling symptoms of adjustment disorder from those attributable to comorbid anxiety and mood disorders, and by the poor boundaries of the disorder with other stress-related conditions on the one hand and with common adaptation to life events on the other. Despite the high frequency of its diagnosis in clinical settings, there has been relatively little research on the adjustment disorder and, consequently, very few hints about its treatments. Several psychotherapies have been developed to deal with patients diagnosed with adjustment disorder, with inconclusive evidence on their effectiveness. Antidepressants may abate the symptoms and help patients reacquire occupational and social functioning. The medium-term outcome of adjustment disorder is good, with 70 to 80% of those diagnosed with it showing no evidence of psychopathology when reassessed 5 years from the episode. However, when comorbid with a personality disorder or a substance use disorder, the short-term risk of suicide may be increased. The long-term outcome of adjustment disorder seems to be worse in children and adolescents than in adults. In particular, adolescents diagnosed with adjustment disorder were more likely than adults to have received a diagnosis of a severe mental disorder at the 5-year follow-up, including schizophrenia, schizoaffective disorder, and bipolar disorder. This review contains 1 figure, 6 tables, and 52 references. Key words: adaptation, adjustment disorder, anxiety, depression, stress, trauma, treatment, vulnerability

Adjustment Disorder and Its Clinical Management

2017 ◽  
Author(s):  
Mauro Giovanni Carta ◽  
Antonio Preti
Keyword(s):  
Adjustment Disorder ◽  
Operational Definition ◽  
Clinical Settings ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Key Words Adaptation ◽  
The One ◽  
Definition Of ◽  
Anxiety Depression

Adjustment disorder is a condition of subjective emotional distress triggered as a consequence of a meaningful change in life. The diagnosis of adjustment disorder is hindered by the difficult operational definition of stress and of its related concept of “vulnerability,” by the problem of disentangling symptoms of adjustment disorder from those attributable to comorbid anxiety and mood disorders, and by the poor boundaries of the disorder with other stress-related conditions on the one hand and with common adaptation to life events on the other. Despite the high frequency of its diagnosis in clinical settings, there has been relatively little research on the adjustment disorder and, consequently, very few hints about its treatments. Several psychotherapies have been developed to deal with patients diagnosed with adjustment disorder, with inconclusive evidence on their effectiveness. Antidepressants may abate the symptoms and help patients reacquire occupational and social functioning. The medium-term outcome of adjustment disorder is good, with 70 to 80% of those diagnosed with it showing no evidence of psychopathology when reassessed 5 years from the episode. However, when comorbid with a personality disorder or a substance use disorder, the short-term risk of suicide may be increased. The long-term outcome of adjustment disorder seems to be worse in children and adolescents than in adults. In particular, adolescents diagnosed with adjustment disorder were more likely than adults to have received a diagnosis of a severe mental disorder at the 5-year follow-up, including schizophrenia, schizoaffective disorder, and bipolar disorder. This review contains 1 figure, 6 tables, and 52 references. Key words: adaptation, adjustment disorder, anxiety, depression, stress, trauma, treatment, vulnerability

scholarly journals Thirty-year outcome of anxiety and depressive disorders and personality status: comprehensive evaluation of mixed symptoms and the general neurotic syndrome in the follow-up of a randomised controlled trial

2021 ◽  
pp. 1-10
Author(s):  
Peter Tyrer ◽  
Helen Tyrer ◽  
Tony Johnson ◽  
Min Yang
Keyword(s):  
Randomised Controlled Trial ◽  
Panic Disorder ◽  
Controlled Trial ◽  
Anxiety And Depression ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Personality Dysfunction ◽  
Randomised Controlled ◽  
Anxiety Depression

Abstract Background Cohort studies of the long-term outcome of anxiety, depression and personality status rarely join together. Methods Two hundred and ten patients recruited with anxiety and depression to a randomised controlled trial between 1983 and 1987 (Nottingham Study of Neurotic Disorder) were followed up over 30 years. At trial entry personality status was assessed, together with the general neurotic syndrome, a combined diagnosis of mixed anxiety–depression (cothymia) linked to neurotic personality traits. Personality assessment used a procedure allowing conversion of data to the ICD-11 severity classification of personality disorder. After the original trial, seven further assessments were made. Observer and self-ratings of psychopathology and global outcome were also made. The primary outcome at 30 years was the proportion of those with no Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnosis. Data were analysed using multilevel repeated measures models that adjusted for age and gender. Missing data were assumed to be missing at random, and the models allowed all subjects to be included in the analysis with missing data automatically handled in the model estimation. Results At 30 years, 69% of those with a baseline diagnosis of panic disorder had no DSM diagnosis compared to 37–47% of those with generalised anxiety disorder, dysthymia or mixed symptoms (cothymia) (p = 0.027). Apart from those with no personality dysfunction at entry all patients had worse outcomes after 30 years with regard to total psychopathology, anxiety and depression, social function and global outcome. Conclusions The long-term outcome of disorders formerly called ‘neurotic’ is poor with the exception of panic disorder. Personality dysfunction accentuates poor recovery.

The Role of ECT in Schizophrenia

2002 ◽  
Vol 10 (4) ◽  
pp. 385-388 ◽  
Author(s):  
Richard Keuneman ◽  
Rajiv Weerasundera ◽  
David Castle
Keyword(s):  
Acute Onset ◽  
Clinical Settings ◽  
Limited Data ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Affective Symptoms ◽  
Maintenance Ect ◽  
The Subject

Objective: To review the place of electroconvulsive therapy (ECT) in the treatment of schizophrenia. Conclusions: ECT is as effective, if not more so, than the antipsychotic drugs in certain clinical settings. It can be rapidly effective in acute episodes. When used alone, antipsychotics have comparable or superior efficacy to ECT alone in the short term. However, ECT possibly confers better long-term outcome. Combination treatment with antipsychotic medications and ECT is superior to either treatment alone, and is safe and effective, notably in medication resistant schizophrenia. Benefits of acute courses of ECT may be short-lived unless maintenance ECT is instituted, although there are limited data on the subject. Clinically, patients with acute onset, shorter episodes are more likely to respond to ECT. Catatonia, preoccupation with delusions and hallucinations, and a relative absence of premorbid schizoid and paranoid personality traits, are other clinical factors less strongly predictive of positive response. The presence of affective symptoms is often thought to be predictive of clinical response. However, there is little research evidence for this. While medications remain the mainstay of treatment in schizophrenia, ECT does have a clear and increasingly recognised role which requires further evaluation.

scholarly journals Long-term neurodevelopment in children born with esophageal atresia: a systematic review

2021 ◽  
Author(s):  
Camille E van Hoorn ◽  
Chantal A ten Kate ◽  
Andre B Rietman ◽  
Leontien C C Toussaint-Duyster ◽  
Robert Jan Stolker ◽  
...  
Keyword(s):  
Cognitive Development ◽  
Motor Function ◽  
Esophageal Atresia ◽  
Current Knowledge ◽  
Neurodevelopmental Outcome ◽  
Cognitive Outcome ◽  
Term Outcome ◽  
Long Term Outcome ◽  
The One

Summary Background Although the survival rate of esophageal atresia (EA) has increased to over 90%, the risk of functional long-term neurodevelopmental deficits is uncertain. Studies on long-term outcomes of children with EA show conflicting results. Therefore, we provide an overview of the current knowledge on the long-term neurodevelopmental outcome of children with EA. Methods We performed a structured literature search in Embase, Medline Ovid, Web of Science, Cochrane CENTRAL, and Google scholar on November 8, 2020 with the keywords ‘esophageal atresia’, ‘long-term outcome’, ‘motor development’, ‘cognitive development’, and ‘neurodevelopment’. Results The initial search identified 945 studies, of which 15 were included. Five of these published outcomes of multiple tests or tested at multiple ages. Regarding infants, one of six studies found impaired neurodevelopment at 1 year of age. Regarding preschoolers, two of five studies found impaired neurodevelopment; the one study assessing cognitive development found normal cognitive outcome. Both studies on motor function reported impairment. Regarding school-agers, the one study on neurodevelopmental outcome reported impairment. Cognitive impairment was found in two out of four studies, and motor function was impaired in both studies studying motor function. Conclusions Long-term neurodevelopment of children born with EA has been assessed with various instruments, with contrasting results. Impairments were mostly found in motor function, but also in cognitive performance. Generally, the long-term outcome of these children is reason for concern. Structured, multidisciplinary long-term follow-up programs for children born with EA would allow to timely detect neurodevelopmental impairments and to intervene, if necessary.

scholarly journals The metabolic syndrome: setting the scene. The pros

2007 ◽  
Vol 4 (2_suppl) ◽  
pp. S1-S3 ◽  
Author(s):  
Sir George Alberti
Keyword(s):  
Metabolic Syndrome ◽  
Outcome Studies ◽  
Term Outcome ◽  
Long Term Outcome ◽  
The Metabolic Syndrome ◽  
Differences Of Opinion ◽  
Definition Of

Conclusion: The definition of metabolic syndrome needs further refinement and it requires long-term outcome studies to evaluate the various criteria definitively. In general, however, differences of opinion surrounding the syndrome are minor.

Primum Nocere (First to Harm) Countertransference and Poisonous Pedagogy: A Hypothesis to Explain Why Psychiatrists Promote Dangerous, Harmful, and Ineffectual Neuroleptic Drugs

2013 ◽  
Vol 15 (2) ◽  
pp. 87-99
Author(s):  
Joseph Tarantolo
Keyword(s):  
Endocrine System ◽  
Biological Psychiatry ◽  
First Line ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Psychological Phenomena ◽  
Working Definition ◽  
Definition Of ◽  
Psychiatric Power

This article will briefly review the case that multigenerations of neuroleptic (NL) drugs are dangerous: causing brain damage, shortening life span, disrupting the endocrine system, interfering with cognitive function, and are half as likely to have a positive long-term outcome as are nonmedical approaches. Given this dismal record, the writer will address the question of why then are they the first line of treatment for seriously disturbed patients? This article will explore how a corrupt and corrupting system of pharmaceutical science and psychiatric power feeds the insecurities of psychotherapists who treat these patients. The author posits the theory that countertransferential phenomena, as elaborated by (Searles, 1979; Winnicott, 1949; and Miller, 1980) (hate, fear, guilt, powerlessness, inability to comfort, capitulation to manipulation, and rationalizations that delusions are biological rather than psychological phenomena), prevent the therapist from properly doing his job. This article will offer a working definition of acute psychosis as unexplored eccentric thinking that will support nonpharmacological psychotherapeutic intervention and distinguish between enlightened and unenlightened biological psychiatry.

scholarly journals Proposal of a New Definition of “Very Early” Intrahepatic Cholangiocarcinoma—A Retrospective Single-Center Analysis

2021 ◽  
Vol 10 (18) ◽  
pp. 4073
Author(s):  
Oliver Beetz ◽  
Angelica Timrott ◽  
Clara A. Weigle ◽  
Andreas Schroeter ◽  
Sebastian Cammann ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Intrahepatic Cholangiocarcinoma ◽  
Tumor Size ◽  
Tumor Biology ◽  
Extrahepatic Disease ◽  
Term Outcome ◽  
Term Survival ◽  
Long Term Outcome ◽  
Definition Of

Intrahepatic cholangiocarcinoma (ICC) is a rare disease with poor outcome, despite advances in surgical and non-surgical treatment. Recently, studies have reported a favorable long-term outcome of “very early” ICC (based on tumor size and absence of extrahepatic disease) after hepatic resection and liver transplantation, respectively. However, the prognostic value of tumor size and a reliable definition of early disease remain a matter of debate. Patients undergoing resection of histologically confirmed ICC between February 1996 and January 2021 at our institution were reviewed for postoperative morbidity, mortality, and long-term outcome after being retrospectively assigned to two groups: “very early” (single tumor ≤ 3 cm) and “advanced” ICC (size > 3 cm, multifocality or extrahepatic disease). A total of 297 patients were included, with a median follow-up of 22.8 (0.1–301.7) months. Twenty-one (7.1%) patients underwent resection of “very early” ICC. Despite the small tumor size, major hepatectomies (defined as resection of ≥3 segments) were performed in 14 (66.7%) cases. Histopathological analyses revealed lymph node metastases in 5 (23.8%) patients. Patients displayed excellent postoperative outcome compared to patients with “advanced” disease: intrahospital mortality was not observed, and patients displayed superior long-term survival, with a 5-year survival rate of 58.2% (versus 24.3%) and a median postoperative survival of 62.1 months (versus 25.3 months; p = 0.013). In conclusion, although the concept of a “very early” ICC based solely on tumor size is vague as it does not necessarily reflect an aggressive tumor biology, our proposed definition could serve as a basis for further studies evaluating the efficiency of either surgical resection or liver transplantation for this malignant disease.

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