Adjustment Disorder

[JackD]

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I have been reading up on adjustment disorder lately, mostly because i realized that i have never had a professor who felt it was necessary to cover it. I have been wondering something. Do people with adjustment disorder have a greater risk of developing brief psychotic disorder?

 

[erg923]

Adjustment disorder is primarily used to describe a disturbance that has directly risen from a psychosocial stresser. It has specific specifiers, and is coded as "adjustment disorder with depressed mood", or "with disturbance in conduct", or "mixed anxiety and depression," etc. If they meet criteria for another Axis I disorder that accounts for the disturbance, it trumps the Adjustment DO diagnosis (eg., meeting the criteria for Conduct disorder trumps Adjustment disorder with disturbance in conduct, even if their was a recent stresser) There is not a psychotic specifier for Adjustment disorder. Brief Psychotic disorder itself has a specifier of "with or without marked stressers." Florid psychosis is NOT something you generally see in reaction to a stresser. However, if you do see it, the person likely had/has a preexisting underlying psychotic disorder. So, even in the case of an identifiable stresser and a month of psychotic symptomatology following that, the diagnosis of "Brief Psychotic disorder, With Marked Stressors" is most appropriate, not "Adjustment disorder."

I realize that was kind of rambling. To answer your question, no, I do not think their is a meaningful correlation (risk) between Adjustment disorder and Brief Psychotic disorder.

 

[JackD]

Adjustment disorder is primarily used to describe a disturbance that has directly risen from a psychosocial stresser. It has specific specifiers, and is coded as "adjustment disorder with depressed mood", or "with disturbance in conduct", or "mixed anxiety and depression," etc. If they meet criteria for another I disorder that accounts for the disturbance, it trumps the Adjustment DO diagnosis. There is not a psychotic specifier. Brief Psychotic disorder itself has a specifier of "with or without marked stressers." Florid psychosis is not something you generally see in reaction to a stresser, if that was the case the person likely had/has a preexisting underlying psychotic disorder. So, even in the case of an identifiable stresser and a month of psychotic symptomatology following that, the diagnosis of "Brief Psychotic disorder, With Marked Stressors" is most appropriate, not "Adjustment disorder."

Perhaps i am arguing from shaky ground here, as i said, no psychology class i have ever taken as spent more than 30 seconds talking about adjustment disorder. However, it seems like the two disorders are related and that brief psychotic disorder is a more severe form. Both have to do, at least from my understanding of these disorders, with poor coping skills. In adjustment disorder, you have a person experiencing short term problems, like behavioral misconduct, depression, and/or anxiety when dealing with a stressful event. In brief psychotic disorder, a person experiences short term psychosis, which is usually preceded by an event which causes overwhelming stress.

It seems to me that someone who has adjustment disorder, which would involve a history of poor coping skills, would be more likely than someone without it to develop brief psychotic disorder, a disorder that also seems to be triggered by some kind of overwhelming event.

 

[PinkSoil]

Like Erg said... an episode of psychosis would most likely indicate that the individual has some preexisting condition that would cause the person to become psychotic-- psychosis does not happen as a result of poor/lack of coping skils.

I have also seen individuals who may have had brief psychotic disorder at one point... and then recovered... but you never know what can happen down the road. These are individuals who later met the criteria for a chronic psychotic disorder.

The only time I saw adjustment disorders diagnosed a lot was when I worked in vocational rehab and our staff psychiatrist would evaluate people so that our funder would approve them for services.

 

[erg923]

I understand what you are saying, but I think you are interpreting "Adjustment disorder" as a pathological disease state in and of itself. Its not. It just a descriptive label that indicates a depressed state, or anxious state, etc. was precipitated by a psychosocial stressor. You will not see Brief psychotic disorder diagnosed that often in actual clincial practice. When it is, it is generally a sign that there is an underlying pathological disturbance. Many times its likely to be a psychotic disorder of some type that has just not continued long enough in its duration to qualify for the official diagnosis (e.g., schizophrenia). Remember, Brief Psychotic disorder can occur with or without a precipitating stressor. In either case, the diagnosis is reflective of an underlying pathology, the etiology of which is much more than a psychosocial stressor.