Questions and Answers
Adjustment disorders can be triggered by significant life changes such as a major change of work and residence.
True
Symptoms of an adjustment disorder do not include physical manifestations like palpitations and tremor.
False
Irritability is one of the emotional symptoms associated with adjustment disorders.
True
Adjustment disorders exclusively arise from experiences related to bereavement and sexual abuse.
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Deliberate self-harm is a possible behavior associated with adjustment disorders.
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Adjustment disorder typically lasts for several years without treatment.
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Substance abuse is not a potential complication of adjustment disorder.
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Adjustment disorders are exclusively triggered by traumatic events.
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Psychotherapy is a common treatment method for adjustment disorder.
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Antidepressants are sometimes prescribed for adjustment disorder.
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Adjustment disorder can coexist with other psychiatric disorders.
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Risk factors for adjustment disorder include a history of trauma and family mental health issues.
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The diagnosis of adjustment disorder can be made without considering symptom duration.
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Adjustment to illness is solely determined by the objective consequences of the disease.
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Illness behavior can occur even when no disease is present.
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The sick role includes the obligation to seek and cooperate with treatment.
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Denial can be beneficial in all stages of dealing with illness.
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Emotional reactions to physical illness such as anxiety and anger are typically permanent.
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Illness behavior is characterized by seeking help from doctors and giving up inappropriate activities.
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A patient continuing the sick role after recovery may hinder their progress towards independence.
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Adjustment to physical illness always results in a strong desire for long-term recovery.
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Physical illness can directly generate psychiatric symptoms such as depression or anxiety.
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Coping strategies must remain focused on emotion reduction throughout the entire duration of illness.
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Relatives of patients do not require information about what has been said to the patient.
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Specialist nurses are trained in both psychological and physical care of dying patients.
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Referral to a psychiatrist is unnecessary if the psychiatric symptoms are mild.
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Depressed patients' symptoms can sometimes be caused by physical illness.
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Grief, mourning, and bereavement have identical meanings in all contexts.
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Counseling and improved medical management can always effectively alleviate low mood in patients.
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It is advisable for patients to sensitively inform their children of their illness.
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In hospices, patients receive more generalized care similar to that in hospitals.
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Self-blame is a reliable indicator for diagnosing depressive disorders.
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Patients with advanced cancer cannot experience depressive disorders.
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Most people adjust poorly to a physical illness and often require psychological treatment.
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The psychiatrist is primarily responsible for managing mild mood disorders in physically ill patients.
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Screening questionnaires are completely sufficient for diagnosing mood disorders without any follow-up.
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Counseling is appropriate for all patients suffering from physical illnesses.
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Cognitive behavior therapy may be a useful structured treatment for patients adapting to illness.
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Young patients are more likely to experience emotional reactions compared to older patients in palliative care.
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Patients may feel guilty about their illness because they think they place excessive demands on their families.
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Anxiety in patients can sometimes increase due to families trying to conceal the truth about their condition.
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Patients undergoing treatment for depression are not eligible for collaborative interventions by healthcare professionals.
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Loss of independence and dignity are minor concerns among patients in palliative care.
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In the UK, less than 10% of deaths occur in hospitals and care homes.
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Psychiatrists are often involved in the ongoing care of all dying patients.
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Managing symptoms is not considered important by patients aiming for a 'good death'.
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The Kubler-Ross model includes a phase known as 'complete denial'.
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Advance directives are intended to communicate a patient's future wishes regarding their treatment.
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Dying patients generally become aware of their prognosis only if they are explicitly informed.
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Reducing confusion due to delirium is not a priority in symptom management for dying patients.
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Patients should always be provided with as much information as possible, regardless of their reactions.
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It is recommended for all staff to be aware of information shared with the patient to avoid conflicting advice.
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Anger is one of the phases listed in the Kubler-Ross model of psychological adjustment to death.
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Grief is considered abnormal if it lasts for more than 3 months.
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Complicated grief occurs in about 10% of those bereaved.
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Around 20% of depressive disorders during grief resolve within 6 months.
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Sleep disturbance is a common feature associated with complicated grief.
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Persistent avoidance of reminders of death is uncommon in abnormal grief.
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The threshold for diagnosing depressive disorder in bereaved individuals is generally considered high.
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The greatest increase in mortality among bereaved individuals occurs after the first year of bereavement.
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Grief is a universally understood response with no individual variations.
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The DSM-5 category of persistent complex bereavement requires a duration of grief of 12 months.
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Abnormal grief is more likely to occur when the death was anticipated.
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In the first stage of grief, a common reaction is anger towards medical professionals for perceived failures in care.
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The second stage of grief may last from a few weeks to about 6 months but can extend much longer.
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Communication with the dying person should avoid any discussions of their needs and preferences.
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Experiences of guilt are not a common reaction during the grieving process.
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During the third stage of grief, individuals typically experience an increase in grief symptoms.
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An individual care plan for a dying person should exclude psychological and spiritual support.
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Hallucinations of the deceased person's voice may occur as a part of the normal grief reaction.
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Social withdrawal is uncommon in the second stage of grief.
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Counselling for bereaved individuals should ideally avoid discussing feelings of guilt or anger.
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Viewing the deceased's body is encouraged to help the bereaved accept the loss as real.
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Support groups are only for those who have experienced the death of a spouse.
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Cognitive Grief Therapy (CGT) has been formally evaluated for its effectiveness in treating abnormal grief.
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Antidepressants are always recommended for individuals experiencing normal grief.
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Complicated grief treatment involves developing a narrative about the loss.
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Support groups provide a platform for grieving individuals to share experiences and coping strategies.
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Psychoeducation about grief is absent in dynamic psychotherapy.
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Sleep aids may be prescribed during the first stage of grief to help with disturbances.
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Sexual abuse in childhood does not affect adult psychiatric disorders.
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Partial amnesia is not a symptom associated with PTSD.
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Complete amnesia for repeated stressful events is considered highly probable by psychiatrists.
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About 25% of subjects can have non-abusive memories implanted by suggestion.
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Recovered memories of sexual abuse can arise for the first time in therapy and should be carefully considered.
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Around 20-60% of individuals reporting childhood sexual abuse have periods in which they do not remember the abuse.
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Adolescents who develop good quality relationships are less likely to experience negative psychiatric outcomes from childhood abuse.
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Victims of childhood sexual abuse have a lower rate of contact with mental health services than non-victims.
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Sexual abuse does not coalesce with other family factors that may also contribute to psychiatric disorders.
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Higher severity of childhood sexual abuse does not correlate with increased risk for psychiatric disorders in adulthood.
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Abuse is linked with feelings of guilt and worthlessness.
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Study Notes
Adjustment Disorders
- Psychological reactions triggered by stressors like divorce, job changes, migration, or the birth of a handicapped child.
- Common issues include bereavement, terminal illness, and sexual abuse impacting adjustment.
Clinical Features
- Symptoms: anxiety, worry, poor concentration, depression, irritability, physical symptoms from autonomic arousal (e.g., palpitations, tremors).
- May involve dramatic/aggressive behaviors, deliberate self-harm, or substance misuse.
Definition
- A mental health condition occurring due to difficulty coping with stressful events.
Symptoms
- Depression, anxiety, difficulty concentrating, sleep disturbances, lack of interest in activities, irritability, appetite changes, substance abuse.
Diagnosis
- Conducted by a mental health professional based on symptom severity, duration, and impact on daily life.
Treatment
- Psychotherapy focuses on coping skills and symptom management.
- Medication may include antidepressants for depression and antianxiety medications for anxiety.
Prognosis
- Typically good with treatment, recovery often within months; can persist for years if the stressor is ongoing or if untreated.
Risk Factors
- History of mental health issues, trauma, family mental health history, substance abuse, and certain personality traits (e.g., perfectionism).
Complications if Untreated
- Can lead to chronic mental health issues, substance abuse, and increased risk of suicidal thoughts or behaviors.
Special Kinds of Adjustment
Adjustment to Physical Illness and Handicap
- Adjustment influenced by beliefs about the disease and the impact on life.
Illness Behavior
- Describes behaviors associated with adapting to illness, can be adaptive or maladaptive.
The Sick Role
- Privileges: exemption from certain duties and the right to care.
- Duties: seek treatment and the desire to recover; prolonged sick role may delay recovery.
Adjustment to Terminal Illness
- Common emotional reactions include anxiety and depression, especially among younger patients.
- Concerns include loss of independence, dignity, and pain management.
Anxiety and Depression in Terminal Illness
- Anxiety can stem from fear of pain, death, and concern for family.
- Depression may be triggered by separation from loved ones or changes in physical appearance.
Guilt and Anger
- Patients may feel guilt for impacting family and struggle with anger related to their condition.
Treatment and Psychological Symptoms in Dying Patients
- A significant majority of deaths occur in hospitals; psychiatrists typically intervene for specific psychiatric issues.
- Important treatment goals: managing symptoms, avoiding prolonged dying, fostering a sense of control, and minimizing burden on families.
Kubler-Ross Model
- Outlines five stages of psychological adjustment to death: denial, anger, bargaining, depression, acceptance; criticized for being overly simplistic.
Helping Patients Adjust
- Establishing trust and providing clear, honest communication is crucial.
- Pacing information disclosure based on patient readiness is essential.
Support for Relatives
- Relatives need support and communication of relevant information to assist both themselves and the patient.
Referral to a Psychiatrist
- Necessary for severe symptoms, uncooperative behavior, longstanding issues worsened by illness.
Grief and Adjustment to Bereavement
- Definitions:
- Bereavement: loss through death.
- Grief: involuntary response to bereavement.
- Mourning: voluntary expressions and rituals responding to bereavement.
Priorities for Care of the Dying Person
- Recognizing imminent death, sensitive communication, involving family in decisions, and respecting family needs are critical components.### Individual Plan of Care
- Comprehensive care includes food, drink, symptom control, and psychological, social, and spiritual support.
- Care is coordinated and delivered with compassion.
Normal Grief Reaction
Stage 1: Hours to Days
- Manifestations include denial, disbelief, and emotional numbness.
Stage 2: Weeks to 6 Months
- Key symptoms consist of sadness, weeping, anxiety, restlessness, poor sleep, and diminished appetite.
- Individuals may experience guilt, blame others, and have vivid memories or hallucinations involving the deceased.
- Social withdrawal and preoccupation with memories are common.
- Extreme sadness and overwhelming yearning for the deceased often characterize this stage.
Stage 3: Weeks to Months
- Symptoms gradually diminish, allowing resumption of social activities.
- The bereaved may begin to recall happy memories and come to terms with the loss.
Abnormal Grief
- Defined as delayed, inhibited, or excessively intense grief, categorized as complicated or pathological.
- Delay indicated by absence of initial grief response within 2 weeks post-death.
- Abnormal duration noted if symptoms last longer than 6 months, with individual judgment necessary for slower recoveries.
Depression in Grief
- Around 30% of bereaved individuals may meet criteria for a depressive disorder during grief.
- Most depressive symptoms resolve within 6 months, with approximately 20% persisting longer.
- Depressive disorders correlate with poor social adjustment and increased medical consultations.
Complicated Grief
- Affects about 7% of bereaved individuals, marked by intense longing and feelings of purposelessness after loss.
- Characteristics include disbelief about the death, avoidance of reminders, sleep disturbances, and increased substance use.
- Related to severe impairment in social and work functioning.
Causes of Abnormal Grief
- More likely to occur in cases of sudden, unexpected deaths, or when relationships with the deceased were very close or dependent.
- Survivors with insecure attachment or past psychiatric issues at greater risk of abnormal grief.
Morbidity After Bereavement
- Increased mortality rates observed among bereaved individuals, particularly notable within the first 6 months after loss.
- Common causes of death include heart disease, cancer, liver cirrhosis, suicide, and accidents.
Management of Grief
- Grief is a natural response; support from family, friends, and rituals aids adaptation.
- In less connected communities, family doctors may play a crucial role in providing support.
Counselling Approaches
- Encourages bereaved individuals to express feelings and understand the grieving process.
- Practical guidance includes arrangements for funerals and managing everyday life after loss.
- Important to normalize experiences of hallucinations and feelings of the deceased's presence during grief.
Support Groups
- Organizations like Cruse support recently bereaved individuals by fostering shared experiences and coping strategies.
Psychotherapy
- Structured psychotherapy typically not recommended for the generally bereaved but may be useful for those with complicated grief.
- Complicated grief treatment (CGT) combines cognitive behavioral therapy and interpersonal therapy with a focus on narrative development regarding the loss.
Medication
- Prescriptions may alleviate severe anxiety or sleep disturbances; antidepressants are beneficial only if depressive disorder is diagnosed.
- Combination of medication and structured psychotherapy recommended for complicated grief.
Long-term Effects of Childhood Sexual Abuse
- Survivors may face lasting anxiety, depression, and PTSD, with increased vulnerability to adult psychiatric disorders.
- Persistent low self-esteem and the mental health impact of sexual abuse often extends into adulthood, affecting overall functioning.
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Description
Explore the psychological reactions associated with adjustment disorders in this quiz. It covers various circumstances like divorce, job changes, and coping with bereavement. Understand the clinical features and symptoms that characterize these disorders.
