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Andreas Maercker - One of the best experts on this subject based on the ideXlab platform.
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the 12 month course of icd 11 Adjustment Disorder in the context of involuntary job loss
Clinical Psychology in Europe, 2020Co-Authors: Louisa Lorenz, Andreas Maercker, Rahel BachemAbstract:Background: After its redefinition in ICD-11, Adjustment Disorder (AjD) comprises two core symptom clusters of preoccupations and failure to adapt to the stressor. Only a few studies investigate the course of AjD over time and the definition of six months until the remission of the Disorder is based on little to no empirical evidence. The aim of the present study was to investigate the course of AjD symptoms and symptom clusters over time and to longitudinally evaluate predictors of AjD symptom severity. Method: A selective sample of the Zurich Adjustment Disorder Study, N = 105 individuals who experienced involuntary job loss and reported either high or low symptom severity at first assessment (t1), were assessed M = 3.4 (SD = 2.1) months after the last day at work, and followed up six (t2) and twelve months (t3) later. They completed a fully structured diagnostic interview for AjD and self-report questionnaires. Results: The prevalence of AjD was 21.9% at t1, 6.7% at t2, and dropped to 2.9% at t3. All individual symptoms and symptom clusters showed declines in prevalence rates across the three assessments. A hierarchical regression analysis of symptoms at t3 revealed that more symptoms at the first assessment (β = 0.32, p = .002) and the number of new life events between the first assessment and t3 (β = 0.29, p = .004) significantly predicted the number of AjD symptoms at t3. Conclusion: Although prevalence rates of AjD declined over time, a significant proportion of individuals still experienced AjD symptoms after six months. Future research should focus on the specific mechanisms underlying the course of AjD.
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translation and psychometric evaluation of the chinese Adjustment Disorder new module 20
International Journal of Mental Health, 2020Co-Authors: Louisa Lorenz, Andreas Maercker, Athena C. Y. Chan, Daniel Bressington, Wai Tong Chien, Mark Shevlin, Philip Hyland, Thanos KaratziasAbstract:The Adjustment Disorder – New Module 20 (ADNM-20) was developed for the assessment of Adjustment Disorder symptoms. The aim of the present study was to translate and conduct psychometric testing of...
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Risk factors of ICD-11 Adjustment Disorder in the Lithuanian general population exposed to life stressors
European journal of psychotraumatology, 2020Co-Authors: Paulina Zelviene, Evaldas Kazlauskas, Andreas MaerckerAbstract:Background: A new definition of Adjustment Disorder symptoms has been included in the 11th edition of the International Classification of Diseases (ICD-11). However, little is known about risk factors of ICD-11 Adjustment Disorder. Objective: The study aimed to analyse risk factors of Adjustment Disorder in a sample of the Lithuanian general population exposed to life-stressors. Method: In total, the study included 649 adult participants from the general population with various recent significant life-stressor experiences. ICD-11 Adjustment Disorder symptoms were measured using the Adjustment Disorder New Module-8 (ADNM-8) scale. Results: The prevalence of the ICD-11 Adjustment Disorder diagnosis in the sample was 16.5%. Job-related stressors and health-related stressors were significantly associated with Adjustment Disorder. Other risk factors for Adjustment Disorder in this study were female gender, greater age, and university education. Conclusions: We conclude that stressor type and demographic characteristics are associated with the risk of developing an Adjustment Disorder.
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Measuring ICD-11 Adjustment Disorder: the development and initial validation of the International Adjustment Disorder Questionnaire.
Acta psychiatrica Scandinavica, 2019Co-Authors: Mark Shevlin, Rahel Bachem, Philip Hyland, Thanos Karatzias, Menachem Ben-ezra, Marylene Cloitre, Frédérique Vallières, Andreas MaerckerAbstract:BACKGROUND: Adjustment Disorder (AjD) is one of the most frequently used diagnoses in psychiatry but a diagnostic definition for AjD was only introduced in release of the ICD-11. This study sought to develop and validate a new measure operationalizing the ICD-11's narrative description of AjD, and to determine the current rate of people meeting the symptoms indicative of AjD in the general population of the Republic of Ireland. METHODS: The International Adjustment Disorder Questionnaire (IADQ) was constructed to measure the core diagnostic criteria of ICD-11 AjD: stressor exposure, preoccupations with, and failure to adapt to, the stressor, timing of symptom onset, and functional impairment. A nationally representative sample (N = 1,020) of adults from Ireland completed the IADQ. RESULTS: Confirmatory factor analysis supported construct validity and the reliability estimates were excellent. The IADQ correlated strongly with depression, anxiety, and posttraumatic stress. The criteria were met by 7.0% of the sample, adjusted for other exclusionary Disorders. DISCUSSION: The IADQ is a measure based on the ICD-11's description and produces reliable scores, however it should not be used for clinical assessment until validated with clinical interviews.
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Translation and psychometric evaluation of the Chinese Adjustment Disorder – New Module 20
International Journal of Mental Health, 2019Co-Authors: Louisa Lorenz, Andreas Maercker, Athena C. Y. Chan, Daniel Bressington, Wai Tong Chien, Mark Shevlin, Philip Hyland, Thanos KaratziasAbstract:The Adjustment Disorder – New Module 20 (ADNM-20) was developed for the assessment of Adjustment Disorder symptoms. The aim of the present study was to translate and conduct psychometric testing of...
Patricia Casey - One of the best experts on this subject based on the ideXlab platform.
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Sleep Disturbance in Adjustment Disorder and Depressive Episode
International Journal of Environmental Research and Public Health, 2019Co-Authors: Anne M. Doherty, Louisa Lorenz, Eamonn O'leary, Faraz Jabbar, Patricia CaseyAbstract:Background: In this paper, we aimed to examine the patterns of sleep disturbance in Adjustment Disorder (AD) and depressive episode (DE), to examine the variables associated with sleep disturbance in AD and DE and associated impairment in functioning. Methods: This is a multi-centre case-control study of 370 patients: 185 patients with AD and 185 patients with a diagnosis of DE, recruited from the liaison psychiatry services of three Dublin hospitals. We examined the participants’ sleep pathology using the sleep disturbance items on the Schedule for Clinical Assessment in Neuropsychiatry, and the Inventory of Depressive Symptoms—Clinician-rated-30. Results: Patients with a diagnosis of AD were less likely to report disturbed sleep than those with a diagnosis of DE (p = 0.002). On multivariate analysis, sleep disturbance was significantly associated with greater severity of certain depressive symptoms: decreased appetite (p < 0.001) and psychomotor agitation (p = 0.009). Decreased appetite, younger age and single marital status were significantly associated with sleep disturbance in male patients, and decreased appetite and psychomotor agitation were significantly associated with sleep disturbance in female participants. Conclusions: This is the largest study to date which has examined sleep disturbance in Adjustment Disorder. Disturbance of sleep is a significant symptom in AD and may represent a potential target for treatment. With further research, patterns of sleep disturbance may be useful in differentiating AD from DE.
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Adjustment Disorder: A diagnosis whose time has come
Journal of affective disorders, 2017Co-Authors: Rahel Bachem, Patricia CaseyAbstract:Abstract Background Adjustment Disorder is among the most frequently diagnosed mental Disorders in clinical practice although it has received little academic attention and been the subject of substantial criticism over the past decades. While those suffering with Adjustment Disorders are often treated by mental health professionals, research interest in the origin of the Disorder or the effectiveness of psychotherapeutic and medical interventions has only recently begun to emerge. This article summarizes the empirical literature published on Adjustment Disorder and points out current diagnostic developments in DSM-5 and ICD-11. Methods Literature for this review was identified through established online search tools, including publications in English, German, and Spanish. Results This paper reviews literature on the evolution of Adjustment Disorder, and highlights the current state of research with regard to genesis and treatment. Importantly, for the first time ICD-11 intends to define Adjustment Disorder by explicit symptom groups, unlike DSM-5. Limitations Publications without an English abstract were not included. Conclusions Key directions for future research include investigating the concordance of the ICD-11 and DSM-5 concepts and the effect that the diverging conceptualizations may have. Risk and protective factors specific to AD should be identified and the biological underpinnings of the Disorder should be explored. Finally, given the high prevalence of AD in certain clinical settings effective Disorder-specific interventions should be developed and evaluated.
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suicidal behaviours in Adjustment Disorder and depressive episode
Journal of Affective Disorders, 2015Co-Authors: Patricia Casey, Faraz Jabbar, Eamonn Oleary, Anne M. DohertyAbstract:BACKGROUND: Little is known about suicidal ideation and behaviours in Adjustment Disorder (AD). In this paper we sought to examine the variables independently associated with suicidal ideation and behaviour in patients diagnosed with AD or depressive (DE) episode among psychiatric outpatients and in liaison psychiatry. METHODS: 370 patients who were referred to the liaison psychiatry services (including those seen in the Emergency Department) at 3 Dublin hospitals, and were clinically diagnosed with either DE or AD, based on the ICD 10 diagnostic criteria, were recruited to the study. We examined their demographic and clinical characteristics, and the associations between these and suicidal ideation and behaviour on multivariate analysis. RESULTS: Younger age, single marital status, and greater severity of depressive symptoms were significantly associated with suicidality across both diagnoses. On multivariate analysis, greater severity of depressive symptoms was associated with suicidality in those with AD (p=0.012) and DE (p=0.009). Those with AD exhibited suicidality at lower symptom scores than did those with DE but in both groups it still occurred at the highest level of severity. There were differences in the objective circumstances measure of suicide intent. LIMITATIONS: We used clinical diagnosis rather as the main diagnostic classification. The generalisability of this paper may be limited to consultation-liaison psychiatry settings, where suicidal ideation and behaviours are common. CONCLUSIONS: Suicidality in AD and DE has broadly similar risk factors but differ in aspects of suicide intent. Different mechanisms may underpin suicidality in those with AD compared to DE. Language: en
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Distinguishing between Adjustment Disorder and depressive episode in clinical practice: The role of personality Disorder
Journal of affective disorders, 2014Co-Authors: Anne M. Doherty, Faraz Jabbar, Brendan D. Kelly, Patricia CaseyAbstract:Abstract Background There is significant symptomatic overlap between diagnostic criteria for Adjustment Disorder and depressive episode, commonly leading to diagnostic difficulty. Our aim was to clarify the role of personality in making this distinction. Methods We performed detailed assessments of features of personality Disorder, depressive symptoms, social function, social support, life-threatening experiences and diagnosis in individuals with clinical diagnoses of Adjustment Disorder ( n =173) or depressive episode ( n =175) presenting at consultation-liaison psychiatry services across 3 sites in Dublin, Ireland. Results Fifty six per cent of participants with Adjustment Disorder had likely personality Disorder compared with 65% of participants with depressive episode. Compared to participants with depressive episode, those with Adjustment Disorder had fewer depressive symptoms; fewer problems with social contacts or stress with spare time; and more life events. On multi-variable testing, a clinical diagnosis of Adjustment Disorder (as opposed to depressive episode) was associated with lower scores for personality Disorder and depressive symptoms, and higher scores for life-threatening experiences. Limitations We used clinical diagnosis as the main diagnostic classification and generalisability may be limited to consultation-liaison psychiatry settings. Conclusions Despite a substantial rate of likely personality Disorder in Adjustment Disorder, the rate was even higher in depressive episode. Moreover, features of likely personality Disorder are more strongly associated with depressive episode than Adjustment Disorder, even when other distinguishing features (severity of depressive symptoms, life-threatening experiences) are taken into account.
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Adjustment Disorder considered
Advances in Psychiatric Treatment, 2013Co-Authors: Patricia Casey, Faraz JabbarAbstract:Adjustment 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.
Yves De Roten - One of the best experts on this subject based on the ideXlab platform.
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one minute of grief emotional processing in short term dynamic psychotherapy for Adjustment Disorder
Journal of Consulting and Clinical Psychology, 2015Co-Authors: Ueli Kramer, Jeannicolas Despland, Antonio Pascualleone, Yves De RotenAbstract:Objective: Depth of emotional processing has shown to be related to outcome across approaches to psychotherapy. Moreover, a specific emotional sequence has been postulated and tested in several studies on experiential psychotherapy (Pascual-Leone & Greenberg, 2007). This process-outcome study aims at reproducing the sequential model of emotional processing in psychodynamic psychotherapy for Adjustment Disorder and linking these variables with ultimate therapeutic outcome. Method: In this study, 32 patients underwent short-term dynamic psychotherapy. On the basis of reliable clinical change statistics, a subgroup (n 16) presented with good outcome and another subgroup (n 16) had a poor outcome in the end of treatment. The strongest alliance session of each case was rated using the observer-rated system Classification of Affective Meaning States. Reliability coefficients for the measure were excellent ( .82). Results: Using 1 min as the fine-grained unit of analysis, results showed that the experience of fundamentally adaptive grief was more common in the in-session process of patients with good outcome, compared with those with poor outcomes ( 2 6.56, p .01, d 1.23). This variable alone predicted 19% of the change in depressive symptoms as measured by the Beck Depression Inventory at the end of treatment. Moreover, sequences of the original model were supported and related to outcome. Conclusions: These results are discussed within the framework of the sequential model of emotional processing and its possible relevance for psychodynamic psychotherapy. What is the public health significance of this article? This study found that the experience of adaptive grief by adults during short-term psychodynamic psychotherapy was related to better outcome. A short moment of such productive grief at the right moment of psychotherapy may be enough for symptom change. Patients who benefit from symptom relief present a typical sequence of emotional processes in a good therapy session, which is less the case in patients with less optimal results.
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change in defense mechanisms and coping over the course of short term dynamic psychotherapy for Adjustment Disorder
Journal of Clinical Psychology, 2010Co-Authors: Ueli Kramer, Jeannicolas Despland, Luc Michel, Martin Drapeau, Yves De RotenAbstract:Short-term dynamic psychotherapy (STDP) has rarely been investigated with regard to its underlying mechanisms of change, even if psychoanalytic theory informs us about several potential putative mechanisms of change in patients. Change in overall defensive functioning is one. In this study, we explored the role of overall defensive functioning, by comparing it on the process level with the neighbouring concept of overall coping functioning. A total of N=32 patients, mainly presenting Adjustment Disorder, were included in the study. The patients underwent STDP up to 40 sessions; three sessions per psychotherapy were transcribed and analyzed by using two observer-rating scales: Defense Mechanism Rating Scales (Perry, 1990) and Coping Action Patterns (Perry, Drapeau, Dunkley, & Blake, 2005). Hierarchical linear modeling was applied to model the change over the course of therapy and relate it to outcome. Results suggest that STDP has an effect on the target variable of overall defensive functioning, which was absent for overall coping functioning. Links with outcome confirm the importance of the effect. These results are discussed from methodological and clinical viewpoints.
Dan J Stein - One of the best experts on this subject based on the ideXlab platform.
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new perspectives on Adjustment Disorder
World Journal of Biological Psychiatry, 2018Co-Authors: Dan J Stein, Frederic Rouillon, Andreas MaerckerAbstract:Given its high prevalence and associated morbidity, Adjustment Disorder is arguably the most profoundly neglected of the common mental Disorders. Fortunately, there have been a number of important ...
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Pharmacotherapy of Adjustment Disorder: A review
The world journal of biological psychiatry : the official journal of the World Federation of Societies of Biological Psychiatry, 2018Co-Authors: Dan J SteinAbstract:Background: Adjustment Disorder has been reconceptualized as a trauma- and stressor-related condition, and there is a growing understanding of the psychobiology of stress responses. Against this co...
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measuring the icd 11 Adjustment Disorder concept validity and sensitivity to change of the Adjustment Disorder new module questionnaire in a clinical intervention study
International Journal of Methods in Psychiatric Research, 2017Co-Authors: Rahel Bachem, Dan J Stein, Axel Perkonigg, Andreas MaerckerAbstract:Adjustment Disorder (AjD) is a frequent but under-researched diagnosis due in part to a lack of specific symptom criteria and adequate tools of measurement. The ICD-11 for the first time proposes a positive symptom catalogue to define AjD. This study presents a validation of the Adjustment Disorder - New Module (ADNM), the first symptom severity measure for AjD according to the ICD-11 concept. Validity and sensitivity to change were investigated in a sample of 190 individuals with a DSM-IV diagnosis of AjD. The ADNM scales demonstrated convergent and discriminant validity for anxiety symptoms (Hamilton Anxiety Scale; psychic anxiety r = 0.18-0.31), functional impairment (Sheehan Disability Scale; r = 0.18-0.47), and depression (Montgomery-Asberg Depression Scale; r = 0.13-0.30). At baseline 78% of the individuals with a DSM-IV diagnosis of AjD were also classified so by the ADNM. Repeated-measures ANOVA indicated significant ADNM-symptom decrease during treatment, replicating the patterns of the Hamilton Anxiety Scale, Sheehan Disability Scale, and Clinical Global Impression Scale. This article presents the first use of the ADNM as a measure for ICD-11 AjD in a randomized-controlled intervention study of AjD. It provides support for the construct validity and sensitivity to symptom change of this scale during pharmacological treatment.
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Adjustment Disorder with anxiety: Care practice
European Psychiatry, 2015Co-Authors: Dan J SteinAbstract:Adjustment Disorder with anxiety (ADWA) is a highly prevalent condition, particularly in primary care practice. Adjustment Disorders significantly impair patients' quality of life, but there are relatively few systematic treatment trials in the area of ADWA, and there are few data on predictors of treatment response. Here we review the limited pharmacotherapy data available on the treatment of ADWA. In primary care settings benzodiazepines are frequently prescribed for psychiatric symptoms, despite their adverse event profile and their potential risk for dependence. The non-benzodiazepine drug etifoxine is a promising agent insofar as it is not associated with dependence. Its efficacy and safety have been evaluated in three double-blind randomized clinical trials in comparison with non-benzodiazepine (buspirone) [1] and benzodiazepines (lorazepam and alprazolam) [2,3]. The three trials point to the anxiolytic properties of etifoxine, demonstrating an overall clinical improvement of patients, and no risk for dependence or rebound effect. In conclusion, even if benzodiazepines are often used for the treatment of ADWA, other therapeutic options are possible, with a better safety profile.
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etifoxine versus alprazolam for the treatment of Adjustment Disorder with anxiety a randomized controlled trial
Advances in Therapy, 2015Co-Authors: Dan J SteinAbstract:Background Adjustment Disorder with anxiety (ADWA) is a highly prevalent condition, particularly in primary care practice. There are relatively few systematic treatment trials in the area of ADWA, and there are few data on predictors of treatment response. Etifoxine is a promising agent insofar as it is not associated with dependence, but in primary care settings benzodiazepines continue to be frequently prescribed for psychiatric symptoms. A randomized controlled trial of etifoxine versus alprazolam for ADWA was undertaken, focusing on efficacy and safety measures, and including an investigation of predictors of clinical response.
Ueli Kramer - One of the best experts on this subject based on the ideXlab platform.
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one minute of grief emotional processing in short term dynamic psychotherapy for Adjustment Disorder
Journal of Consulting and Clinical Psychology, 2015Co-Authors: Ueli Kramer, Jeannicolas Despland, Antonio Pascualleone, Yves De RotenAbstract:Objective: Depth of emotional processing has shown to be related to outcome across approaches to psychotherapy. Moreover, a specific emotional sequence has been postulated and tested in several studies on experiential psychotherapy (Pascual-Leone & Greenberg, 2007). This process-outcome study aims at reproducing the sequential model of emotional processing in psychodynamic psychotherapy for Adjustment Disorder and linking these variables with ultimate therapeutic outcome. Method: In this study, 32 patients underwent short-term dynamic psychotherapy. On the basis of reliable clinical change statistics, a subgroup (n 16) presented with good outcome and another subgroup (n 16) had a poor outcome in the end of treatment. The strongest alliance session of each case was rated using the observer-rated system Classification of Affective Meaning States. Reliability coefficients for the measure were excellent ( .82). Results: Using 1 min as the fine-grained unit of analysis, results showed that the experience of fundamentally adaptive grief was more common in the in-session process of patients with good outcome, compared with those with poor outcomes ( 2 6.56, p .01, d 1.23). This variable alone predicted 19% of the change in depressive symptoms as measured by the Beck Depression Inventory at the end of treatment. Moreover, sequences of the original model were supported and related to outcome. Conclusions: These results are discussed within the framework of the sequential model of emotional processing and its possible relevance for psychodynamic psychotherapy. What is the public health significance of this article? This study found that the experience of adaptive grief by adults during short-term psychodynamic psychotherapy was related to better outcome. A short moment of such productive grief at the right moment of psychotherapy may be enough for symptom change. Patients who benefit from symptom relief present a typical sequence of emotional processes in a good therapy session, which is less the case in patients with less optimal results.
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change in defense mechanisms and coping over the course of short term dynamic psychotherapy for Adjustment Disorder
Journal of Clinical Psychology, 2010Co-Authors: Ueli Kramer, Jeannicolas Despland, Luc Michel, Martin Drapeau, Yves De RotenAbstract:Short-term dynamic psychotherapy (STDP) has rarely been investigated with regard to its underlying mechanisms of change, even if psychoanalytic theory informs us about several potential putative mechanisms of change in patients. Change in overall defensive functioning is one. In this study, we explored the role of overall defensive functioning, by comparing it on the process level with the neighbouring concept of overall coping functioning. A total of N=32 patients, mainly presenting Adjustment Disorder, were included in the study. The patients underwent STDP up to 40 sessions; three sessions per psychotherapy were transcribed and analyzed by using two observer-rating scales: Defense Mechanism Rating Scales (Perry, 1990) and Coping Action Patterns (Perry, Drapeau, Dunkley, & Blake, 2005). Hierarchical linear modeling was applied to model the change over the course of therapy and relate it to outcome. Results suggest that STDP has an effect on the target variable of overall defensive functioning, which was absent for overall coping functioning. Links with outcome confirm the importance of the effect. These results are discussed from methodological and clinical viewpoints.