Adjustment Disorder and Suicidal Behaviours Presenting in the General Medical Setting: A Systematic Review

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.

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Homoeopathy for Adjustment Disorder: A Case Series

Homœopathic Links ◽

10.1055/s-0040-1721057 ◽

2021 ◽

Vol 34 (01) ◽

pp. 041-051

Author(s):

S. Karunakara Moorthi ◽

Susu Pertin ◽

S.V. Vishnupriya ◽

K.C. Muraleedharan ◽

P. Radhika

Keyword(s):

Causal Attribution ◽

Case Series ◽

Adjustment Disorder ◽

Liaison Psychiatry ◽

Positive Role ◽

Statistical Manual ◽

Diagnostic And Statistical Manual ◽

High Prevalence ◽

Self Harm

AbstractDespite its high prevalence in clinical and consultant liaison psychiatry populations, adjustment disorder (AD) research has traditionally been hindered by its lack of clear diagnostic criteria. Here, we are presenting five cases of AD diagnosed with Diagnostic and Statistical Manual of Mental Disorders.Five patients who consulted at the Out Patient Department of National Homoeopathy Research Institute of Mental Health, Kerala, India, with symptoms of AD were treated with individualised homoeopathic medicine. Assessment of the symptoms was done using Depression, Anxiety and Stress Scale—21 Items. Details of consultations, treatment and assessment are summarised. Possible causal attribution of changes was explicitly depicted by Naranjo Criteria. It shows the positive role of homoeopathic treatment in AD.All five patients showed marked improvement.We were able to prevent the considerable self-harm and suicidality associated with AD. However, more extensive research is needed in the topic to prove the effectiveness of individualised homoeopathic medicine in AD.

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The Adjustment Disorder Diagnosis, Its Importance to Liaison Psychiatry, and its Psychobiology

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16234645 ◽

2019 ◽

Vol 16 (23) ◽

pp. 4645 ◽

Cited By ~ 1

Author(s):

James J. Strain

Keyword(s):

Psychiatric Diagnosis ◽

Adjustment Disorder ◽

Screening Tools ◽

Medical Setting ◽

Psychiatric Diagnoses ◽

Liaison Psychiatry ◽

Common Features ◽

Biological Studies ◽

Depression Scales ◽

The Military

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.

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Suicidal ideation and non-fatal deliberate self-harm presentations in the Kimberley from an enhanced police–mental health service notification database

Australasian Psychiatry ◽

10.1177/1039856216671682 ◽

2016 ◽

Vol 25 (1) ◽

pp. 35-39 ◽

Cited By ~ 2

Author(s):

Cate McHugh ◽

Sivasankaran Balaratnasingam ◽

Anita Campbell ◽

Murray Chapman

Keyword(s):

Mental Health ◽

Suicidal Ideation ◽

Health Service ◽

Community Mental Health Services ◽

Population Level ◽

Indigenous Populations ◽

Deliberate Self Harm ◽

Police Services ◽

High Prevalence ◽

Self Harm

Objectives: To determine the rate of presentations for suicidal ideation and deliberate self-harm in the Kimberley region of Western Australia, characterized in terms of age, gender, rates of repetition and engagement with community mental health services. Methods: An observational study of health service presentations over 12 months. Setting: 10 sites across the region with police services were included, capturing the overwhelming majority of self-harm presentations in the region. Participants: all Indigenous presentations were analyzed. Of the 433 individuals who presented, 361 were Indigenous. Main outcome measures: suicidal phenomena, including suicidal ideation and any type of deliberate self-harm regardless of intent. Results: Analysis suggests a broadly similar age and sex stratification of self-harm in this population compared with international reports. The rates, however, are 5–20 times higher than those reported in non-Indigenous populations in Australia and abroad, depending on whether the comparison rate is calculated from population surveys or hospital presentations. Conclusions: Prevalence of suicidal phenomena is very high and is likely to be much higher than estimated by this hospital based study. Such high prevalence suggests that a population level intervention is required in addition to interventions involving clinical services.

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Adjustment disorder considered

Advances in Psychiatric Treatment ◽

10.1192/apt.bp.111.010058 ◽

2013 ◽

Vol 19 (2) ◽

pp. 99-107 ◽

Cited By ~ 3

Author(s):

Patricia Casey ◽

Faraz Jabbar

Keyword(s):

Adjustment Disorder ◽

Structured Interview ◽

Research Community ◽

Evidence Based ◽

Liaison Psychiatry ◽

Many Instruments ◽

Evidence Based Treatments ◽

Consultation Liaison Psychiatry ◽

Self Harm ◽

Over 40 Years

SummaryAdjustment disorder has been included in psychiatric classifications for over 40 years but has received little attention from the research community. It is particularly common in consultation liaison psychiatry. Evaluation is problematic since it may be mistaken for major depression, generalised anxiety or non-pathological reactions to stress. Its measurement by structured interview is difficult since it is not included in many instruments and, in others, cannot be diagnosed once the threshold for another disorder is reached. There are few evidence-based treatments and it is possible that these transient reactions may not require any formal intervention. Adjustment disorder generally carries an excellent prognosis but in some individuals is associated with self-harm and suicide.

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Adjustment Disorder: Current Developments and Future Directions

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16142537 ◽

2019 ◽

Vol 16 (14) ◽

pp. 2537 ◽

Cited By ~ 8

Author(s):

Meaghan L. O’Donnell ◽

James A. Agathos ◽

Olivia Metcalf ◽

Kari Gibson ◽

Winnie Lau

Keyword(s):

Adjustment Disorder ◽

Liaison Psychiatry ◽

Future Directions ◽

Dsm 5 ◽

Symptom Profile ◽

Current State ◽

High Prevalence ◽

Assessment And Treatment ◽

Classification Of Diseases ◽

International Statistical Classification

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.

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Attachment Organization in Suicide Prevention Research

Crisis ◽

10.1027/0227-5910/a000231 ◽

2014 ◽

Vol 35 (1) ◽

pp. 60-66 ◽

Cited By ~ 10

Author(s):

Amanda Venta ◽

Carla Sharp

Keyword(s):

Risk Factors ◽

Suicidal Ideation ◽

Suicide Attempt ◽

Interpersonal Relationships ◽

Suicide Ideation ◽

Suicide Attempts ◽

Critical Role ◽

Self Report ◽

Future Research ◽

Self Harm

Background: Identifying risk factors for suicide-related thoughts and behaviors (SRTB) is essential among adolescents in whom SRTB remain a leading cause of death. Although many risk factors have already been identified, influential theories now suggest that the domain of interpersonal relationships may play a critical role in the emergence of SRTB. Because attachment has long been seen as the foundation of interpersonal functioning, we suggest that attachment insecurity warrants attention as a risk factor for SRTB. Aims: This study sought to explore relations between attachment organization and suicidal ideation, suicide attempts, and self-harm in an inpatient adolescent sample, controlling for demographic and psychopathological covariates. Method: We recruited 194 adolescents from an inpatient unit and assigned them to one of four attachment groups (secure, preoccupied, dismissing, or disorganized attachment). Interview and self-report measures were used to create four variables reflecting the presence or absence of suicidal ideation in the last year, single lifetime suicide attempt, multiple lifetime suicide attempts, and lifetime self-harm. Results: Chi-square and regression analyses did not reveal significant relations between attachment organization and SRTB, although findings did confirm previously established relations between psychopathology and SRTB, such that internalizing disorder was associated with increased self-harm, suicide ideation, and suicide attempt and externalizing disorder was associated with increased self-harm. Conclusion: The severity of this sample and methodological differences from previous studies may explain the nonsignificant findings. Nonsignificant findings may indicate that the relation between attachment organization and SRTB is moderated by other factors that should be explored in future research.

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The Role of Perfectionism and Autobiographical Memory in a Sample of Parasuicide Patients

Crisis ◽

10.1027/0227-5910.29.2.64 ◽

2008 ◽

Vol 29 (2) ◽

pp. 64-72 ◽

Cited By ~ 22

Author(s):

Susan A. Rasmussen ◽

Rory C. O’Connor ◽

Dallas Brodie

Keyword(s):

Suicidal Ideation ◽

Autobiographical Memory ◽

Memory Task ◽

Self Report ◽

Hierarchical Regression ◽

Overgeneral Autobiographical Memory ◽

Socially Prescribed Perfectionism ◽

Hopelessness Depression ◽

Self Harm ◽

First Time

The main objective of this study was to investigate the relationship between social perfectionism, overgeneral autobiographical memory recall, and psychological distress (hopelessness, depression/anxiety, and suicidal ideation) in a sample of parasuicide patients. Forty patients who had been admitted to a Scottish hospital following an episode of deliberate self-harm participated in the study. The participants completed the autobiographical memory task and a battery of self-report measures (multidimensional perfectionism, hopelessness, depression/anxiety, and suicidal ideation). The results showed that repetitive self-harmers were more overgeneral in their recall of positive autobiographical memories than were first-time self-harmers. Hierarchical regression analyses showed that socially prescribed perfectionism interacted with overgeneral recall of both positive and negative memories to predict suicidal ideation/depression. The findings are discussed in relation to previous research.

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G619(P) The experience of young people admitted to the general paediatric ward due to self-harm or suicidal ideation

10.1136/archdischild-2019-rcpch.599 ◽

2019 ◽

Author(s):

C Strauss ◽

G Hann

Keyword(s):

Suicidal Ideation ◽

Young People ◽

Paediatric Ward ◽

Self Harm

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Efficacy of dialectical behavior therapy for adolescent self-harm and suicidal ideation: a systematic review and meta-analysis

Psychological Medicine ◽

10.1017/s0033291721001355 ◽

2021 ◽

pp. 1-11

Author(s):

Oswald D. Kothgassner ◽

Andreas Goreis ◽

Kealagh Robinson ◽

Mercedes M. Huscsava ◽

Christian Schmahl ◽

...

Keyword(s):

Systematic Review ◽

Clinical Trials ◽

Suicidal Ideation ◽

Dialectical Behavior Therapy ◽

Meta Analysis ◽

Adolescent Psychopathology ◽

Cochrane Library ◽

Behaviour Therapy ◽

Clinical Consequences ◽

Self Harm

Abstract Background Given the widespread nature and clinical consequences of self-harm and suicidal ideation among adolescents, establishing the efficacy of developmentally appropriate treatments that reduce both self-harm and suicidal ideation in the context of broader adolescent psychopathology is critical. Methods We conducted a systematic review and meta-analysis of the Dialectical Behaviour Therapy for Adolescents (DBT-A) literature on treating self-injury in adolescents (12–19 years). We searched for eligible trials and treatment evaluations published prior to July 2020 in MEDLINE/PubMed, Scopus, Google Scholar, EMBASE, and the Cochrane Library databases for clinical trials. Twenty-one studies were identified [five randomized-controlled trials (RCTs), three controlled clinical trials (CCTs), and 13 pre-post evaluations]. We extracted data for predefined primary (self-harm, suicidal ideation) and secondary outcomes (borderline personality symptoms; BPD) and calculated treatment effects for RCTs/CCTs and pre-post evaluations. This meta-analysis was pre-registered with OSF: osf.io/v83e7. Results Overall, the studies comprised 1673 adolescents. Compared to control groups, DBT-A showed small to moderate effects for reducing self-harm (g = −0.44; 95% CI −0.81 to −0.07) and suicidal ideation (g = −0.31, 95% CI −0.52 to −0.09). Pre-post evaluations suggested large effects for all outcomes (self-harm: g = −0.98, 95% CI −1.15 to −0.81; suicidal ideation: g = −1.16, 95% CI −1.51 to −0.80; BPD symptoms: g = −0.97, 95% CI −1.31 to −0.63). Conclusions DBT-A appears to be a valuable treatment in reducing both adolescent self-harm and suicidal ideation. However, evidence that DBT-A reduces BPD symptoms was only found in pre-post evaluations.

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