Adjustment disorder: a multisite study of its utilization and interventions in the consultation-liaison psychiatry setting.
The consultation-liaison (C-L) psychiatry services of seven university teaching hospitals in the United States, Canada, and Australia (the MICRO-CARES Consortium) used a common clinical database to examine 1039 consecutive referrals. A diagnosis of adjustment disorder (AD) was made in 125 patients (12.0%); as the sole diagnosis, in 81 (7.8%); and comorbidly with other Axis I and II diagnoses in 44 (4.2%). It had been considered as a rule-out diagnosis in a further 110 (10.6%). AD with depressed mood, anxious mood, or mixed emotions were the commonest subcategories used. AD was diagnosed comorbidly most frequently with personality disorder and organic mental disorder. Sixty-seven patients (6.4%) were assigned a V code diagnosis only. Patients with AD were referred significantly more often for problems of anxiety, coping, and depression; had less past psychiatric illness; and were rated as functioning better--all consistent with the construct of AD as a maladaptation to a psychosocial stressor. Interventions were similar to those for other Axis I and II diagnoses, in particular, the prescription of antidepressants. Patients with AD required a similar amount of clinical time and resident supervision. It is concluded that AD is an important and time-consuming diagnostic category in C-L psychiatry practice.
Strain
J J
JJ
Department of Psychiatry, Mount Sinai Medical Center, New York, NY 10029, USA.
Smith
G C
GC
Hammer
J S
JS
McKenzie
D P
DP
Blumenfield
M
M
Muskin
P
P
Newstadt
G
G
Wallack
J
J
Wilner
A
A
Schleifer
S S
SS
D000275:Adjustment Disorders / Q000145:classification / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D000328:Adult; D017677:Age Distribution; D000368:Aged; D001315:Australia / Q000453:epidemiology; D002170:Canada / Q000453:epidemiology; D016009:Chi-Square Distribution; D015331:Cohort Studies; D015897:Comorbidity; D003710:Demography; D003937:Diagnosis, Differential; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019965:Neurocognitive Disorders / Q000175:diagnosis* / Q000453:epidemiology; D010554:Personality Disorders / Q000175:diagnosis* / Q000453:epidemiology; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D017678:Sex Distribution; D013315:Stress, Psychological / Q000175:diagnosis / Q000453:epidemiology; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology; D014481:United States / Q000453:epidemiology