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Adjustment Disorder :Treatment You Can Count On 

Adjustment disorders treatments must come in a timely fashion so that there will be no unnecessary impairment of an individuals functioning in their work, study and interpersonal pursuits.  There are basically two approaches to adjustment disorder treatment.  First is based upon the understanding that this disorder is a psychological reaction to a stressor.  In this case, the stressor needs to be identified, described and shared with the individual, and plans must be made to ameliorate it as soon as possible.   If it is caught early, an abnormal response may be either attenuated or eliminated.  Some studies have found that among the medically ill, the most common stressors are the medical illness itself, and the adjustment disorder may remit when the medical illness improves or a new level of adaptation is achieved.  The other approach to adjustment disorder treatment is to provide intervention to the symptomatic presentation, despite the fact that it does not deal with the origin of the problem.  This approach to adjustment disorder treatment is based on the premise that it is associated with the impairment and that it reduces the opportunity for a pronounced presentation of the pathology to develop.  These two approaches to adjustment disorder treatment may include medication treatment, psychotherapy or a combination of both. 


Adjustment disorders treatment with medication: 

Psychiatric medication has been used among the medically ill, terminally ill and among individuals who have not been helped by the verbal therapies.  Some researchers have found that among the medically ill with depressive disorders (the type of depression was unspecified), 16 of the 29 individuals involved (55%) improved within two days of treatment with a maximal dose of amphetamine drugs.  If delirium was present the response was much more limited.  It was not examined whether methylphenidate is useful among individuals with adjustment disorders with depressed mood.  Randomized controlled trials concluded that bereavement-related depression also appears to respond to antidepressant medication. It is usually recommended that the medication chosen should reflect the nature of the prominent mood that accompanies the adjustment disorder (e.g.  benzodiazepines for adjustment disorder with anxious mood: antidepressants for adjustment disorder with depressed mood).  Also, it is recommended that the therapist consider both psychotherapy and pharmacology in cases when adjustment disorder is accompanied by an anxious mood, and it is recommended that the psychiatrist also prescribed anxiolytics as part of the adjustment disorder treatment.

 Adjustment disorders treatment: Homeopathic treatments 

Some authors have begun to examine the effect of homeopathic treatments for adjustment disorders. In a 25 week multi-center randomized placebo-controlled double-blind trial, a special extract of kava kava was reported to be effective in the treatment of adjustment disorders with anxiety, without the adverse side effect profile associated with tricyclic antidepressants and benzodiazepines. Tianeptine, alprazolam and mianserin were found to be equally effective in improving the symptoms of individuals with adjustment disorder and anxious mood.  In another random trial, trazodone was more effective than clorazepate in individuals with cancer for the relief of anxious and depressive symptoms.  Also, similar findings were observed among individuals who were HIV positive. 

Adjustment disorder treatment nonresponders: 

Individuals who do not respond to counseling or medication treatment with antidepressants or anxiolytic medication should be regarded as treatment non-responders.  It is essential to reevaluate the individuals to make sure that the diagnosis has not changed or that they have not developed a major mental disorder, which may require a more aggressive form of treatment.  The clinician should also consider whether a personality disorder (Axis II) might be interfering with an individualís resolution of the adjustment disorder.  Also, when the stressor that underlies the adjustment disorder remains and cannot be removed, additional support and management strategies may need to be employed to ensure that the individual is able to optimally benefit from the adjustment disorder treatment.

Some information from the DSM-IV-TR Mental Disorders: Diagnosis, Etiology and Treatment by Michael B. First and Alan Tasman


 Webpage by Paul Susic  Ph.D. Licensed Psychologist  (Health and Geriatric Psychologist)



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