Course: Mental Health Nursing�Topic: Mood Disorder- Adjustment Disorder

​

"The Nurses International Community"

​

Developed: 2022 Copyright Nurses International

Module Goals

Learners will be able to

1. Define adjustment disorder
2. Identify the symptoms that are reported by clients with adjustment disorder
3. Identify the clinical manifestations of adjustment disorder
4. Discuss the evidence based management of adjustment disorder
5. Identify the appropriate nursing interventions for client with adjustment disorder

​

​

​

​

• An adjustment disorder is an unhealthy behavioral response to a stressful event or circumstance

​

• Stressful events of a child or adolescent
• A family move
• Parental divorce or separation
• The loss of a pet
• Birth of a sibling

​

Adjustment Disorder

Image by, Pixabay

(Virginia Commision on Youth, 2017)

• Symptoms do not last more than six months, and the majority of individuals quickly return to normal functioning
• May be difficult to distinguish from major depressive disorder
• Males and females are equally affected
• Occurs at all ages
• Symptoms in adolescents are primarily behavioral
• Symptoms in adults are primarily depressive

​

Adjustment Disorder

Image by, Pixabay

(Virginia Commision on Youth, 2017)

• Emotional and behavioral disturbances
• Feeling of sadness
• Anxious
• Overwhelmed
• Social withdrawal
• Difficulties with activities of daily living such as washing, cleaning, and cooking

​

Characteristics of Adjustment Disorder

(Mental Health Foundation, 2021)

Image by, Pixabay

Critical Thinking Question

A diagnosis other than Adjustment Disorder, is more appropriate if a client has symptoms for less than 6 months.

1. True
2. False

​

​

​

• Common trigger:

Grief and bereavement (death of a family member or sibling)

• No evidence of biological factors
• Vulnerability of the individual (in children, depends on the characteristics of both the child and the child’s environment)
• High stressor rate
• Individuals in “disadvantaged life circumstances” as stated in the DSM-5 are at increased risk

​

Causes of Adjustment Disorder

Image by, Pixabay

(Virginia Commision on Youth, 2017)

• May be acute (lasting up to 6 months) or chronic (lasting beyond 6 months)
• Reduced desire to eat
• Increased feelings of hopelessness or sadness
• Reduced capacity to enjoy or have an interest in hobbies
• Increased episodes of crying
• Increased feelings of anxiety, nervousness, worry
• Spending less time around friends or family
• Reduced capacity to focus
• Problems sleeping

​

Symptoms of Adjustment Disorder

(Mental Health Foundation, 2021)

Image by, Wikimedia Commons

• Problems performing everyday functions
• Feeling overwhelmed
• Difficulty carrying out daily activities
• Delinquent in paying bills
• Missing work
• Suicidal ideation

​

Symptoms of Adjustment Disorder

(Mental Health Foundation, 2021)

​

Image by, Wikimedia Commons

Critical Thinking Question

Which of the following are the risk factors for adjustment disorder? (Select all that apply)

1. Vulnerability of a child
2. Biological factors of a child
3. Stressful event
4. Disadvantaged life circumstances

​

​

• Six subtypes of adjustment disorder, based on the major symptoms experienced in adults with:

​

1. A depressed mood

2. Anxiety

3. Depressed mood and anxiety

4. The disturbance of conduct

5. Mixed disturbance of emotions and conduct

6. Unspecified

​

Adjustment Disorder Classifications

Image by, Ph

(Virginia Commision on Youth, 2017)

​

Symptoms of minor depression

• Depressed mood
• Tearfulness
• Feelings of hopelessness
• ​

Symptoms with anxiety

• Symptoms of anxiety are dominant
• Nervousness, worry, jitteriness
• Fear of separation from major attachment figures

Subtypes of Adjustment Disorders

Image by, Ph

(Virginia Commision on Youth, 2017)

With depressed mood and anxiety

• A combination of depression and anxiety

Symptoms from both the depressed and anxiety subtypes

​

With the disturbance of conduct

• Behaviors that break societal norms or violate the rights of others
• Violation of the rights and societal norms and rules
• Truancy
• Destruction of property
• Reckless driving
• Fightings

​

Subtypes of Adjustment Disorders (Continued)

(Virginia Commision on Youth, 2017)

With mixed disturbance of emotions and conduct

• Combined affective and behavioral characteristics with mixed emotional features and a disruption of conduct
• Depressed mood and anxiety and with disturbances of conduct

Unspecified

• Maladaptive reaction is not classified under other adjustment disorders but occurs in response to stress
• Reactions to stress that do not fit into other subtypes

​

Subtypes of Adjustment Disorders (Continued)

(Virginia Commision on Youth, 2017)

• The DSM-5 specific diagnostic criteria to diagnose adjustment disorder
• Emotional or behavioral symptoms in response to an external stressor
• Stress that is unproportional to the stressor
• Stress-related symptoms do not meet the criteria for another disorder
• Symptoms do not last longer than six months after the stressor is removed

Diagnosis

(Virginia Commision on Youth, 2017)

Critical Thinking Question

Which of the following are the criteria to diagnose adjustment disorder? (Select all that apply)

​

1. Symptoms do not last more than six month
2. Symptoms last more than six months
3. Symptoms do not meet the criteria for another disorder
4. Symptoms are not part of a normal grieving process

• The most widely accepted treatment process involves
• Identifying the stressor and communicating that stressor effectively
• Psychotherapy (treatment of choice)
• To reduce or remove the stressor or improve coping ability
• Interpersonal psychotherapy (IPT) has the most support for treating depressed adolescents with this disorder

​

Treatment

Image by, Gan Khoon Lay

​

(Virginia Commision on Youth, 2017)

• During psychotherapy, the following should occur:

​

• Analyze stressors affecting the client
• Clarify and interpret the meaning of the stressor
• Attempt to reframe stressor
• Illuminate concerns of the client
• Configure a plan to reduce stressors
• Increase coping skills of client

​

Psychotherapy

​

​

Image by, Pixabay

(Virginia Commision on Youth, 2017)

• Interpersonal-psychotherapy (IPT)
• Helps children and adolescents address problems to relieve depressive symptoms
• Cognitive behavioral therapy (CBT)
• Improves:
• Age-appropriate problem-solving skills
• Communication skills
• Stress management skills
• Supports the individual’s emotional state and support systems to enhance adaptation and coping

​

​

​

Psychotherapy

​

​

Image by, Flickr

(Virginia Commision on Youth, 2017)

• Stress management
• Particularly beneficial in cases of high stress
• Helps youth learn how to manage stress in a healthy way
• Group therapy
• Among like minded/afflicted individuals can help group members cope with various features of adjustment disorders

​

Psychotherapy

​

​

Image by, Open Clipart

(Virginia Commision on Youth, 2017)

• Family therapy
• Helpful for identifying needed changes within the family system
• These changes may include
• Improving communication skills
• Improving family interactions
• Increasing support among family members

​

​

Psychotherapy

​

​

Image by, Flickr

(Virginia Commision on Youth, 2017)

• Medication is seldom used as a single treatment because the individual requires assistance in coping with the stressors
• A few accepted medication options:
• Benzodiazepines
• Selective serotonin reuptake inhibitors (SSRIs)
• Serotonin–norepinephrine reuptake inhibitors (SNRIs)
• Plant extracts (kava kava or valerian)
• Short-term use of anxiolytics and hypnotics may be beneficial

​

Pharmacotherapy

​

​

Image by, Wikimedia Commons

(Virginia Commision on Youth, 2017)

Critical Thinking Question

A psychiatrist prescribes an anti-obsessional agent for a client who is using ritualistic behavior. A common anti-anxiety medication used for this type of client would be:

​

A. fluvoxamine (Luvox)

B. benztropine (Cogentin)

C. amantadine (Symmetrel)

D. diphenhydramine (Benadryl)

​

​

• Assist clients in identifying aspects of the change that they like and dislike
• Instruct the client to make a list of the factors identified
• Explore with the client’s ways in which they might view the differences more constructively

“What are some things you always wanted to do if you had more time?”

• Give positive feedback for expressing negative feelings

​

Nurse’s Role in Treatment of Adjustment Disorders

​

​

Image by, Clipart Library

(Videbeck & Schultz, 2013)

• Help client identify strengths
• Help client identify past methods of successful coping and encourage them to apply them to present situations
• Teach problem-solving process:
• Identify the problem
• Examine alternatives
• Weigh the pros and cons of each alternative
• Select and implement an approach
• Evaluate it
• Encourage client to ask for the help of family or friends

​

Nurse’s Role in Treatment of Adjustment Disorders

​

​

Image by, Clipart Library

(Videbeck & Schultz, 2013)

References

​

Mental Health Foundation, (2021). Adjustment Disorder. https://mentalhealthfoundation.org/health-conditions/anxiety-disorders/adjustment-disorder/?gclid=CjwKCAiAhreNBhAYEiwAFGGKPCizA3NLLX_bvFT4i2qkcfmLHJpR_tJzZcfxVqIpLvLuNPBoZvKxkRoCTy8QAvD_BwE

​

Videbeck, SL, & Schultz, JM, (2013). Psychiatric Nursing Care Plans. 9th edi. Wolters Kluwer Health.

​

Virginia Commision on Youth, (2017). Adjustment Disorder.

​

​

​

​

​

​

​

​

Please go to My Learning Experience�to provide feedback on your experience

Thank you…come back soon