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psych_adjustment

psych_adjustment

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Published by: api-3704562 on Oct 16, 2008
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05/09/2014

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ADJUSTMENT D/O
short term maladaptive rxns to a \u201cpersonal calamity\u201d
\ue000 aka PSYCHOSOCIAL STRESSOR
\ue001everyday events > catastrophic
must appear w/in 3 mo
resolve w/in 6 mo
\ue001after the stressor ceases
\ue001longer if chronic stressor or w/ long lasting
consequences
2-8% of general population
\u2640 2x
boys = girls (children & aolescent)
freq in adolescents

\ue001school problems
\ue001parental rejection & divorce
\ue001subst abuse

in adults

\ue001marital problems, divorce
\ue001new environment
\ue001financial

the severity of the stressor does NOT always predict
the severity of the d/o
stressor severity is a complex fxn of

\ue001degree
\ue001quantity
\ue001duration
\ue001reversibility
\ue001environment
\ue001personal context

\ue000loss of parent is diff for a 10 y/o & 40 y/o
stressors may be\u2026

\ue001single / multiple
\ue001recurrent / continuous
\ue001intrafamilial
\ue001crime victim
\ue001physical illness

\ue001@ community\ue000 nat\u2019l disaster/ persecution
\ue001developmental stages\ue000 leaving home, getting
married, retiring
Psychodynamic factors
3 FACTORS

\ue001NATURE of stressor
\ue001MEANING (conscious & unconscious) of stressor
\ue001(preexisting) VULNERABILITY of patient

\ue000personality d/o
\ue000organic impairment
\ue000loss of parent during infancy
\ue000reared in dysfunctional family
\ue000support from key relationships

the same stress can produce a range of responses
A person\u2019s capacity to respond to stress is greatly
influenced by \u2026
\ue001Mother
\ue000Good enough mother
\ue001D. Winnicott
\ue001A person who adapts to the infants needs
and provides enuf support to tolerate the
frustrations in life\ue002
\ue001Rearing environment
Patient tend to blame a particular event, when a less
obvious event may have had more meaning
Current
events
may
awaken
past
traumas
or
disappointments
Some children have less mature defensive constellations
than other children
Resilience\ue000 determined by nature of children\u2019s early
relationships w/ their parents
Response to traumatic life events is partially under genetic
control
physical s/s most common in children and the elderly
Diagnosis and Clinical Features
ADJUSTMENT d/o \u2026
w/ DEPRESSED MOOD\ue000 in adolescents (\u2191 risk for MDD)

\ue001Depressed mood,
\ue001Tearfullness
\ue001Hopelessness

w/ ANXIETY
\ue001palpitations, jitteriness, agitation
w/ MIXED ANXIETY and DEPRESSED MOOD
w/ DISTURBANCE of CONDUCT
\ue001rights of others are violated
\ue001age appropriate societal norms and rules are
disregarded
\ue001truancy, vandalism, reckless driving, fighting
w/MIXED DISTURBANCE of EMOTIONS and CONDUCT
UNSPECIFIED
\ue001Maladaptive rxns to stress
\ue001Inappropriate responses to the dx of physical illness

\ue000Massive denial
\ue000Severe noncompliance w/ tx
\ue000Social withdrawal
\ue000W/O depressed or anxious mood

ICD 10
adjustment d/o is in same category as rxns to severe stress
\ue001acute stress rxn
\ue001post-traumatic stress d/o

onset: within one month of event duration: no more than 6 months maladjustment features:

\ue001regressive behaviors

\ue000bed wetting
\ue000baby-ish speech
\ue000thumb sucking

DDX: px w/ adjustment d/o are impaired in social or occupational functioning and show s/s beyong the normal and expectable reaction to the stressor

Acute & posttraumatic stress d/o
\ue001More severe & longer lasting when stressor is of human
origin (rape) than when it is not (floods)
\ue001Most patients return to their previous level of fxning
w/in 3 mos
\ue000Adolescents usually req longer time
Psychotherapy

\ue001Treatment of choice
\ue001Group therapy
\ue001Individual therapy
\ue001Family therapy
\ue001Crisis Intervention

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