1) Disease Description (Causes and Symptoms)
- Definition summary: This refers to a condition in which emotional and behavioral symptoms occur in response to a stressful event (psychological or social stress) at a level exceeding ordinary expectations and cause significant impairment in social, academic, or occupational functioning.
- Main diagnostic timing criteria: Symptoms usually begin within 3 months after exposure to the stressor and generally improve within 6 months after the stressor has disappeared.
- Causes and pathophysiology: The disorder develops through an interaction between external stressors (bereavement, illness or hospitalization, divorce or separation, unemployment, financial problems, etc.) and individual psychological vulnerabilities (sensitivity, intellectual ability, lack of social support, etc.). The exact biological mechanism is unclear, but an imbalance between the stress response system (such as the HPA axis) and psychological adaptation capacity is associated with it.
- Main symptoms: Depressed mood, feelings of hopelessness, excessive crying, anxiety or agitation, decreased motivation, changes in sleep or food intake, decreased energy, social withdrawal or behavioral problems, etc. Symptoms are closely related to the stressful situation.
- Differential diagnoses: It is necessary to distinguish it from major depressive disorder, chronic adjustment disorder, PTSD, anxiety disorders, and others.
2) Treatment Methods and Precautions
- First-line treatment (non-pharmacological): Psychotherapy is the standard treatment.
- Cognitive behavioral therapy (CBT), problem-solving therapy, brief psychodynamic therapy, and stress management and coping-skills training are effective.
- Family therapy and coordination with schools or workplaces (particularly for children and adolescents) are also important.
- Pharmacological treatment (adjunctive use):
- No medication has been established as a definitive treatment for adjustment disorder, but short-term antidepressants (SSRIs) or medications to relieve anxiety symptoms may be considered when anxiety or depressive symptoms are severe or functional impairment is substantial.
- Benzodiazepines may be used short term for insomnia or acute anxiety, but long-term use is not recommended because of the risk of dependence and side effects.
- Emergency response:
- If there is a risk of self-harm or suicide, or if maintaining daily functioning is impossible, emergency evaluation and inpatient treatment should be considered.
- Lifestyle management (self-care):
- Regular sleep and meals, appropriate physical activity (aerobic exercise), limiting alcohol and drug misuse, managing sources of stress, strengthening social support networks, and relaxation training (breathing and meditation), etc.
- Precautions and risk of complications:
- If symptoms persist or worsen, they may progress to other mental disorders such as major depressive disorder, so reassessment is necessary.
- Medications should be used short term and for an appropriate purpose according to a doctor's prescription; particular caution should be taken regarding the risk of dependence on benzodiazepines.
3) Checklist Before an Outpatient Visit (Including Recommended Items and Sample Questions)
- Recommended items to bring
- A list of currently used medications (including prescription drugs, OTC medications, and herbal medicines)
- Past diagnosis and treatment records (psychiatric records, psychological test results, etc.) and recent test results
- The timing and details of important life events (stressors) that occurred within the past 3 months (timeline)
- A symptom diary (daily records of changes in mood, sleep, meals, and energy; frequency of crying or agitation, etc.)
- Family history (mental disorders, suicide attempts, etc.) and alcohol or drug use history
- Items to tell the doctor first during the consultation
- Whether there are suicidal thoughts or suicide attempts, or severe functional impairment (being unable to go to work or school)
- The relationship between the time symptoms began and the time of exposure to the stressor
- The frequency, intensity, and duration of symptoms (for example, whether they have continued for 3 months or longer)
- Examples of basic questions to ask the doctor during an outpatient visit (briefly)
- "Do my symptoms meet the criteria for a diagnosis of adjustment disorder?"
- "What treatment do I need right now (such as psychotherapy or medication)?"
4) Examples of General Questions to Ask the Doctor
- What are the expected effects and side effects of this medication (or treatment)?
- How long is the treatment usually expected to last? (Psychotherapy/medication respectively)
- What specifically should I change in my lifestyle?
- If my symptoms do not improve, what is the next step (additional tests, changing medication, or specialized treatment)?
- What should I do if I see signs of suicide risk or severe worsening?
5) Examples of Condition-Specific Questions
- How can you distinguish whether my symptoms are simply a stress reaction, adjustment disorder, or progression to major depressive disorder?
- My current source of stress is still present. How do the goals and methods of treatment change when the stress continues? (For example, workplace problems or the divorce process)