Hostname: page-component-cd9895bd7-dk4vv Total loading time: 0 Render date: 2024-12-25T14:07:58.978Z Has data issue: false hasContentIssue false

A descriptive study of adjustment disorder diagnoses in general hospital patients

Published online by Cambridge University Press:  13 June 2014

Paul Foster
Affiliation:
Parkside Clinic, 63-65 Lancaster Road, London, Wl 1 IQG, England
Thomas Oxman
Affiliation:
Dartmouth Medical School, 1 Medical Centre Drive, Lebanon, NH 03756-001, USA

Abstract

Objective: A descriptive survey of the characteristics of medical and surgical patients given the diagnosis of adjustment disorder.

Method: 124 case notes of patients with adjustment disorder diagnoses seen over a one year period in a tertiary care hospital were reviewed to describe their characteristics. Patient demographic data, medical illness, hospitalisation details and psychiatric consultation notes were examined.

Results: This diagnosis represented 18.5% of consultation-liaison referrals. The length of hospitalisation for the adjustment disorder patients was more than twice that of general medical admissions. At least one psychosocial stressor was noted in 93% of all patients; in 59% of patients the medical illness was one of the stressors noted. About a third of patients had a past psychiatric history. Only 9% of patients had new courses of antidepressants recommended and in only 2% was inpatient psychiatric admission required. The diagnosis was used especially in patients with serious medical conditions, self-harm, injury and poisoning, and in cases presenting with a mixture of somatic and psychic symptoms.

Conclusions: The results suggest that this is a commonly used diagnosis in the medical consultation setting; it is largely being used in a way consistent with DSM criteria, whilst there were indications that it was also used for a range of problem behaviours that are difficult to classify.

Type
Original Papers
Copyright
Copyright © Cambridge University Press 1994

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.World Health Organisation. International classification of diseases, 10th rev ed. Geneva: WHO, 1990Google Scholar
2.American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 3rd rev ed. Washington DC: American Psychiatric Association, 1988.Google Scholar
3.Fabrega, H, Mezzich, J. Adjustment disorder and psychiatric practice: cultural and historical aspects. Psychiatry 1987; 50:3149.CrossRefGoogle ScholarPubMed
4.Andreasen, NC, Wasek, P. Adjustment disorders in adolescents and adults. Arch Gen Psychiatry 1980; 37:166–70.CrossRefGoogle ScholarPubMed
5.Popkin, M, Callies, A, Colon, E, Stiebel, V. Adjustment disorders in medically ill inpatients referred for consultation in a university hospital. Psychosomatics 1990; 31(4):410–4.CrossRefGoogle ScholarPubMed
6.McKegney, FP, McMahon, T, King, J. The use of DSM-111 in a general hospital consultation-liaison service. Gen Hosp Psychiatry 1983; 5:115–21.CrossRefGoogle Scholar
7.Derogatis, LR, Morrow, GR, Fetting, J, et al.The prevalence of psychiatric disorders among cancer patients. JAMA 1983; 249(6):751–7.CrossRefGoogle ScholarPubMed
8.Razavi, D, Delvaux, N, Farvacques, C, Robaye, E. Screening for adjustment disorders and major depression in cancer inpatients. Br J Psychiatry 1990; 156:7983.CrossRefGoogle Scholar
9Fabrega, H, Mezzich, J, Mezzich, A. Adjustment disorder as a marginal or transitional illness category in DSM-111. Arch Gen Psychiatry 1987; 44:567572.CrossRefGoogle ScholarPubMed
10.Derogatis, LR, Wise, TN. Anxiety and depressive disorders in the medical patient. Washington DC: APA, 1989; 4:123–30.Google Scholar
11.National Centre for Health Statistics. The international classification of diseases, 9th Revision: clinical modifications. Ann Arbor, Michigan: CPHA, 1970.Google Scholar
12.Rosen, D, Gregory, R, Pollock, D, Schiffman, A. Depression in patients referred for psychiatric consultation. Gen Hosp Psychiatry 1987; 9:391–7.CrossRefGoogle ScholarPubMed
13.Lipowski, ZJ, Wolston, EJ. Liaison psychiatry: referral patterns and their stability over time. Am J Psychiatry 1981; 138:1608–11.Google ScholarPubMed
14.Kaplan, HI, Sadock, BJ, (eds). Comprehensive textbook of psychiatry. Baltimore: Williams & Wilkins, 1989:476–9.Google Scholar
15.McGlynn, TJ, Metcalf, HL (eds). Diagnosis and treatment of anxiety disorders: aphysician's handbook. Washington DC: American Psychiatric Press; 1989: 43–8.Google Scholar
16.Schatzberg, AF. Anxiety and adjustment disorder: a treatment approach. J Clin Psychiatry 1990 (Nov supp.); 51: 20–4Google ScholarPubMed
17.Snyder, S, Strain, JJ, Wolf, D. Differentiating major depression from adjustment disorder with depressed mood in the medical setting. Gen Hosp Psychiatry 1990; 12:159–65.CrossRefGoogle ScholarPubMed
18.Dean, CD. Psychiatric morbidity following mastectomy: preoperative predictors and types of illness. J Psychosom Res 1987;31:385–92CrossRefGoogle ScholarPubMed
19.Andreasen, NC, Hoenk, PR. The predictive value of adjustment disorders: a follow-up study. Am J Psychiatry 1982;139(5):584–90Google ScholarPubMed
20.Seligman, ME. Helplessness. San Francisco: Freeman, 1975Google ScholarPubMed
21Faulstich, ME, Williamson, DA. An overview of atopic dermatitis: towards a bio-behavioural integration. J Psychosom Res 1985; 29:647–54.CrossRefGoogle Scholar
22.Paykel, ES, Prusoff, BA, Myers, JK. Suicide attempts and recent life events: a controlled comparison Arch Gen Psychiatry 1975; 32:327–33.Google Scholar
23.Fard, F, Hudgens, RW, Weiner, A. Undiagnosed psychiatric Illness in adolescents: a prospective and seven year follow up. Arch Gen Psychiatry 1979; 35:279–81CrossRefGoogle Scholar
24.Pollock, D. Structured ambiguity and the definition of psychiatric illness: adjustment disorder among medical inpatients. Soc Sci Med 1992; 35:1:2535.CrossRefGoogle ScholarPubMed
25.Pomerantz, AS, de Nesnera, A, West, AN. Resolution of depressive symptoms in medical inpatients after discharge. Int J Psych in Med 1992; 22(3):281–9.CrossRefGoogle ScholarPubMed
26.Kathol, RG, Wenzel, RP. Natural history of symptoms of depression and anxiety during inpatient treatment on general medicine wards. J Gen Intern Med. 1992; 7;3; 287–93.CrossRefGoogle ScholarPubMed
27.Spier, SA, Frontera, MA. Unexpected deaths in depressed medical inpatients treated with fluoxetine. J Clin Psychiatry 1991; 52;377–82Google ScholarPubMed