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ADJUSTMENT DISORDER

Terms in this set (16)

Adjustment disorder
*a maladaptive reaction to a psychosocial stressor that can be readily identified
*maladaptive reaction occurs within 3 months after the onset of stressor and can't have lasted longer than 6 months
*chronic if longer than 6 months -such as debilitating physical illness-
Maladaptive reaction
*social or occupational -also school- functioning is impaired
*symptoms are exaggerated beyond the usual expected response to the severity of the stressor
*response doesn't meet criteria for any other mental disorder and is neither an isolated incident nor uncomplicated bereavement
6 types of adjustment disorder
*adjustment disorder with anxiety
*adjustment disorder with depressed mood
*adjustment disorder with disturbance in conduct
*adjustment disorder with mixed disturbance of emotions and conduct
*adjustment disorder unspecified
Adjustment disorder
*behavioral reactions to stress are expected to remit soon after the stressor ceases or, in cases of continued stress, when a new level of adaptation is reached
*genetic factors may dispose an individual to maladaptive response to stress
*chronic disorder, such as mental retardation, may increase likelihood of maladaptive stress response
Theoretical perspectives
*biological theory
*psychodynamic theory
*interpersonal theory
*behavioral theory
Biological theory
*problems result from biochemical imbalances in the brain
*midbrain releases norepinephrine, which causes severe anxiety
Psychodynamic theory
*hidden psychological conflicts cause anxiety
*this stimulates a maladaptive response to stress in a person who:
-can't complete appropriate developmental tasks
-has unmet dependency needs
- is fixated in an earlier developmental level
- has retarded ego development
Interpersonal theory
*problems result when a person's expectations or needs aren't met in interpersonal relationships with significant others
*unsatisfactory early interpersonal relationship -ex, early separation from one's mother- can lead to problems with adjustment later in life
Behavioral theory
*maladaptive behavior is learned
*negative learning patterns experienced by the person have impeded the development of self-esteem and effective coping skills
General nursing assessments
*assess time, duration, and nature of stressor
-patient usually reports a psychosocial stressor occurring in the 3 months before onset of symptoms
-if symptoms last longer than 6 months, another mental disorder should be considered
-single stressor or multiple stressors
-some easily identified -divorce or death-, others less evident -going away to school-
-stressor recurrent --seasonal business crisis-- or continuous --poverty, chronic illness
*assess any impairment in social and occupational functioning for symptoms beyond normal and expected reactions
-patient tearful jittery
-expresses anger inappropriately through fighting, vandalism, reckless driving
-use or abuse of psychoactive substances increases
-school or work performance declines
*assess for feeling of inadequacy, low self-esteem, and difficulty adapting to change
*asses patient's pre-illness ability to cope with day to day problems
Goals and treatment of adjustment disorder
*outpatient dependent on symptoms
*safety needs, lessening anxiety, identifying problem solving and coping mechanisms
*restore level of functioning to pre-illness level and promote behavioral changes to strengthen that part of personality still vulnerable to stress
*individual psychotherapy
Types of psychotherapy
*psychodynamic therapy
*behavioral therapy
*family therapy
Psychodynamic therapy
*problem results from negative self-image, early psychological trauma, or inadequate personality development
*therapist uses supportive and expressive psychodynamic technique to help patient resolve problem
Behavioral therapy
*problem results from patterns of maladaptive responses to situations
*coaching, modeling, and reinforcement schedules are some of the psychotherapeutic techniques used to help patient correct ineffective responses to stress
Family therapy
*directs treatment away from the patient and toward patient's family unit
*its goal is to change the social network function
General nursing interventions
*monitor danger toward self and others
*help patient identify thoughts and feelings associated with change in life or current situational crisis
-encourage patient to express feelings, including sadness and anger
-explore how to handle frustration or pent-up anger in socially acceptable ways, -walking, hitting punching bag
*teach patient relaxation techniques and have him practice
*determine which stage of grief patient experiencing and teach stages and behaviors
*help patient determine aspects of personal life still under patient's control
-help patient perform self-care, to set goals, make independent decisions
-help patient identify methods of coping or problem solving that proved successful in past
-assist patient in using problem solving process to explore alternatives and select more adaptive strategies of coping with stress
*refer to appropriate support group, AA or bereavement group
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