Blood coagulation disorders

1) Disease description (causes and symptoms)

• Summary of definition: Adjustment disorder refers to a condition in which emotional and behavioral responses to an identifiable psychological or social stressor greatly exceed what would ordinarily be expected and cause significant impairment in social or occupational (academic) functioning.
• Onset and course: It usually develops within 3 months after exposure to the stressor and generally improves within 6 months after the stressor has ended. If it persists for more than 6 months, the possibility of another mental disorder should be considered.
• Major causes (triggering stressors): Hospitalization, severe illness, surgery, pain, facing death (such as cancer or myocardial infarction), job loss, financial problems, divorce, separation, marriage, interpersonal problems, occupational stress, bullying at school, and so on. Individual psychological vulnerability (such as sensitivity and intellectual ability) affects the development of the disorder.
• Major symptoms: Depressed mood, hopelessness, easy tearfulness, decreased motivation, insomnia, changes in appetite, low energy, anxiety, agitation, and behavioral changes (withdrawal or problem behavior). Functional decline (impairment in work, academic activities, and interpersonal relationships) is characteristic.
• Possible accompanying conditions: It may occur together with major depressive disorder, anxiety disorders, behavioral or impulse-control disorders, social phobia, and others.

2) Treatment methods

• Psychotherapy (primary treatment)
  • Cognitive behavioral therapy (CBT): Stress-coping skills, cognitive restructuring, problem-solving training, and so on.
  • Supportive counseling and psychoeducation: Understanding the causes and responses to stress and learning coping methods.
  • Family therapy/couples therapy: Useful when family or relationship problems are also present.
  • Short-term, problem-oriented therapy: Intended to improve adaptation to acute stress.
• Pharmacotherapy (symptom-based use)
  • When depressive or anxiety symptoms are severe, antidepressants (such as SSRIs) may be considered for the short or intermediate term.
  • For anxiety, agitation, or insomnia, short-term use of sleeping pills or anxiolytics (mainly non-benzodiazepines or short-term benzodiazepines) may be possible, but dependence and side effects should be monitored.
  • Medications are basically used together with psychotherapy to control symptoms (they do not treat the underlying cause).
• Lifestyle management
  • Regular sleep, meals, and exercise; management of stressors (removing or reducing the stressor when possible); and strengthening social support.
  • Self-care: Keeping a stress diary, relaxation training (breathing and meditation), and establishing problem-solving plans.
• Precautions and complications
  • Assessment of the risk of self-harm or suicide is necessary (especially when depression or hopelessness is severe).
  • If left untreated for a long time, it may become chronic or progress to major depressive disorder or another condition.
  • When using medication, side effects (sedation, sexual dysfunction, gastrointestinal symptoms, and so on) and dependence (especially with benzodiazepines) should be considered.
• Prognostic factors
  • Outcomes vary depending on intellectual ability, sensitivity, whether the condition is acute or chronic, motivation for treatment, social support, physical health, and other factors.

3) Checklist before an outpatient visit (items, submitted documents, and records)

• Items to prepare/bring
  • A list of all medications currently being taken (including prescription drugs, OTC medications, and herbal medicines), along with the dosage and time of administration
  • Past medical history (mental and physical illnesses) and family history (mental illness and suicide)
  • Recent test results, if possible, hospitalization records, and other relevant medical records
  • The stressors and when they occurred (when and what happened), as well as when the symptoms began
  • A symptom diary (changes in mood, sleep, eating, activities, and so on) – records from the past several weeks, if possible
  • Information about whether there have been thoughts of self-harm or suicide and how specific they were
  • Alcohol or drug use
• Issues to tell the doctor about in advance during the outpatient visit
  • The degree of impairment in daily life, work, or academic functioning caused by the symptoms (specific examples)
  • Treatment preferences (medication, psychotherapy, or both) and times when treatment can be attended (ability to participate)
  • If the patient is a child or adolescent, bringing school-related materials (grades, attendance records, and teachers’ opinions) is recommended

4) Examples of general questions to ask the doctor

• "How can you distinguish whether my symptoms are adjustment disorder or another depressive or anxiety disorder?"
• "Among the treatments you recommend (psychotherapy and medication), which should come first? How long is the expected treatment period?"
• "What are the main side effects of the medication you plan to prescribe? What should I watch out for while taking it?"
• "I am worried about the risk of suicide. What support can I receive?"
• "What specific ways can my family or housemates help?"

5) Examples of condition-specific questions

• "Does the stress I experienced (for example, a recent divorce, job loss, or diagnosis of a serious illness) appear to be the main cause of these symptoms? If the stress continues, how should the goals of treatment be established?"
• "How is psychotherapy conducted, and how often and for how many sessions would it be helpful to receive it? (For children and adolescents, is school-linked support available?)"

Additional guidance: If symptoms are severe or you have thoughts of suicide, contact emergency services or a mental health specialist immediately. Evaluation and treatment are available in departments of psychiatry (adults) and child and adolescent psychiatry (children and adolescents).