Monday, October 24, 2016

Some Patients May Develop Adjustment Disorder Up to Year After Trauma

Although adjustment disorders—characterized by the development of emotional or behavioral symptoms within three months of a stressor—are considered to be relatively common, much remains unknown about the course of the disorder, its phenomenology, or its relationship to other disorders. A study published today in AJP in Advance suggests that some people may continue to develop adjustment disorder up to one year after a traumatic event.

The findings came from an analysis of over 800 injury survivors (aged 16 to 70) who had been hospitalized in trauma centers in Australia. Baseline data were collected prior to discharge from the hospital, which was on average seven days after injury, and follow-up data were collected at three months and 12 months after injury.

The authors found that the overall prevalence of adjustment disorder was 19% at three months and 16% at 12 months. While one-third of the patients with adjustment disorder at three months continued to experience symptoms at 12 months, the majority of patients with the disorder at 12 months were not diagnosed as having adjustment disorder at three months. Injury survivors that were diagnosed with adjustment disorder at three months were significantly more likely to meet criteria for another psychiatric condition at 12 months compared with those with no psychiatric disorder.

The most common symptoms reported among those with adjustment disorder were PTSD-associated symptoms including poor concentration, disturbed sleep, and irritability. 

“This study adds to the limited research evidence on adjustment disorder by demonstrating that the diagnosis identifies people who following a stressor experience distress/functioning impairment and who are at risk for developing more severe disorders,” Meaghan O’Donnell, Ph.D., and colleagues at the Phoenix Australia Centre for Posttraumatic Mental Health in Australia, wrote. “However, it challenges the current diagnosis by finding that (1) many people develop the disorder beyond the initial three months after the stressor and (2) it does not present with distinct anxiety or depressive symptoms but rather mixed features, with PTSD symptoms playing an important role. Considering the frequency with which this diagnosis is used by clinicians, it is imperative that more structured research is conducted so that robust diagnostic criteria can be established.”

To read more about this topic, see the Psychiatric News article “When Somebody Has an Adjustment Disorder” by Patricia Casey, M.D., and James Strain, M.D.

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