Citation

Lott A, Borgeat F, Carron R. Schweiz Arch. Neurol. Psychiatr. 2003; 154(3): 96-105.

Copyright

(Copyright © 2003, Zeitschriften)

DOI

10.4414/sanp.2003.01353

PMID

unavailable

Abstract

Adjustment disorder is a very frequent disorder but surprisingly it has not been studied much and it remains a controversial diagnosis. In different studies, it has been considered either as a minor form of a specific disorder, a psychological vulnerability revealed by a stress factor or a precursor of a major psychiatric disorder. Those three different points of view raise the basic question of the aetiology of this disorder. The objective of this study is to show if adjustment disorder is a clearly differentiated diagnosis whose existence is justifiable. In order to answer this question, we attempted to compare this diagnosis with another frequent and important psychiatric diagnosis, major depressive disorder. In this retrospective study we selected all the patients with a diagnosis of adjustment disorder (77) or major depressive disorder (125) among the patients hospitalised in the psychiatric hospital of Malévoz in Valais during the year 1993 (580). It is based on clinical diagnosis. Their social and demographic characteristics (age, sex, nationality, marital status, professional activity), their past psychiatric history (earlier psychiatric hospitalisations, ambulatory treatment and attempted suicide), their hospitalisations during the next 5 years, their index hospitalisation (length, attempted suicide, comorbidity) and their drug treatment (number and class of prescribed drugs) were compared. This survey confirms certain differences between adjustment disorder and major depression disorder: patients suffering from adjustment disorder were more often men, not married, younger than those suffering from major depression; their hospitalisations were shorter with a better evolution between hospitalisations and they received less medication. However, the study does not allow to clearly distinguish between the two diagnoses or to conclude that adjustment disorder is not only a minor form of a specific psychiatric disorder. Yet it confirms that adjustment disorder is not a light diagnosis (importance of the psychiatric past, high number of past attempted suicides, rehospitalisations, number of comorbid disorders and weight of the prescribed psychotropic treatments among which neuroleptics were frequent). The three aetiological hypotheses that have been proposed (minor form of a specific disorder, specific psychological vulnerability revealed by a stress factor or precursor manifestation of a major psychiatric disorder) can still be considered as plausible. The diagnosis of adjustment disorder points to methodological limitations of the atheoretical approach of the DSM-III-R. The fact that, in its DSM-III-R definition, it is stated that the diagnosis of adjustment disorder has often to be based only on clinical judgment shows very well that such a diagnosis inevitably refers to a psychopathological theory. Indeed, the authors consider an approach without such a reference as difficult, a reference which remains the only way to appreciate accurately the symbolic weight of a given event for an individual person.

Language: de

Keywords

Major depression; Adjustment disorder; Comparison