Therapeutic Focus

Adjustment Disorders

Presenting complaints

Patients feel overwhelmed or unable to cope.
There may be stress-related physical symptoms such as insomnia, headache, abdominal pain, chest pain, palpitations.

Diagnostic features

• Acute reaction to recent stressful or traumatic event.
• Extreme distress resulting from a recent event, or preoccupation with the event.
• Symptoms may be primarily somatic.
• Other symptoms may include: low or sad mood, anxiety, worry, feeling unable to cope. Acute reaction usually lasts from a few days to several weeks.

Differential diagnosis

If dissociative symptoms (sudden onset of unusual or dramatic somatic symptoms) are present, see Dissociative (conversion) disorder - F45.
Acute symptoms may persist or evolve over time. If significant symptoms persist longer than one month, consider an alternative diagnosis:

• if significant symptoms of depression persist, see Depression - F32
• if significant symptoms of anxiety persist, see Genralized anxiety - F41.1
• if stress-related somatic symptoms persist, see Unexplained somatic complaints -F45.
• if symptoms are due to loss of a loved one, see Bereavement disorders - Z63.

Adjustment disorder - management guidelines

Essential information for patient and family

• Stressful events often have mental and physical effects.
• Stress-related symptoms usually last only a few days or weeks.

Counselling of patient and family

• Encourage the patient to acknowledge the personal significance of the stressful event.

Review and reinforce positive steps the patient has taken to deal with the stress.

• Identify steps the patient can take to modify the situation that produced the
  stress. If the situation cannot be changed, discuss problem-solving strategies.
• Identify relatives, friends and community resources able to offer support.
• Short-term rest and relief from stress may help the patient.
• Encourage a return to usual activities within a few weeks.

Medication

Most acute stress reactions will resolve without use of medication. However, if severe anxiety symptoms occur, use antianxiety drugs for up to three days (e.g., benzodiazepines such as lorazepam 0.5-1.0mg up to three times a day).
If the patient has severe insomnia, use hypnotic drugs for up to three days (e.g., temaxepam 15mg each night).

Specialist consultation

If symptoms last longer than one month, consider a more specific diagnosis (see Differential diagnosis). Follow advice regarding consultation for that diagnosis.