03-29-2003, 08:23 AM
I took the psych shelf yesterday and thought it was a good and interesting exam.
I was wondering how future psychiatrists would answer the following. In the exam a 25 year old woman had moved to a new city for a new job 5 months ago. She stated that she was excited about her future and had no complaints except that she would wake up every night with anxiety and not be able to fall back to sleep. She drank two beers with every dinner and had a couple of drinks right before bed.
I narrowed it down to
a) alcohol induced insomnia
b) Adjustment disorder - anxious type.
At first I filled in "a" but then I switched to "b" as I thought she was drinking every night to relieve anxiety. What is the correct answer for such a question.
03-29-2003, 09:59 AM
I would probably guess "A", because of the time frame. Five months seems like an adequate amount of time to adapt to a new environment. The anxiety that accompanies adjustment disorder is expected to remit after the stress is alleviated or an adaptation is made to the new environment. I am only a third year medical student, so I am definitely not an expert.
03-29-2003, 11:57 AM
The answer is "B." An adjustment disorder occurs when a person develops affective (emotional) or behavioral symptoms in response to an identifiable stressor. Stressors can be natural disasters (such as an earthquake), events or crisis (such as car accidents, or development of a medical disorder) or interpersonal problems (such as divorce, or abuse). The person displays either marked distress, or impairment in functioning (i.e. unable to work or study). Adjustment disorders, by definition, last less than 6 months (after the stressor or its consequences end). If the symptoms last more than 6 months, the person may have another disorder, such as an anxiety or mood disorder.
Note that the key phrase is "last less than 6 months," which is actually "acute," according to DSM diagnostic criteria for Adjustment Disorders:
The development of emotional or behavioral symptoms in response to identifiable stressor(s) occurring within 3 months of the onset of the stressor(s).
These symptoms or behaviors are clinically significant as evidenced by either of the following:
marked distress that is in excess of what would be expected from exposure to the stressor significant impairment in social or occupational (academic) functioning
The stress-related disturbance does not meet the criteria for another specific Axis I disorder and is not merely an exacerbation of a preexisting Axis I or Axis II disorder.
The symptoms do not represent Bereavement.
Once the stressor (or its consequences) has terminated, the symptoms do not persist for more than an additional 6 months.
Acute: if the disturbance lasts less than 6 months
Chronic: if the disturbance lasts for 6 months or longer
Adjustment disorders are coded based on the subtype, which is selected according to the predominant symptoms. The specific stressor(s) can be specified on Axis IV.
With Depressed Mood
With Mixed Anxiety and Depressed Mood
With Disturbance of Conduct
With Mixed Disturbance of Emotions and Conduct
03-29-2003, 11:59 AM
By the way, I'm an MPH student who works as an RA in a psychiatry department....what the hell do I know?
04-02-2003, 05:07 PM
I don't know...perhaps, you decided to copy it from the DSM manual
04-03-2003, 10:28 AM
Where else ya gonna find the answer, dingbat?