TY - JOUR
T1 - Adjustment disorder
T2 - A multisite study of its utilization and interventions in the consultation-liaison psychiatry setting
AU - Strain, James J.
AU - Smith, Graeme C.
AU - Hammer, Jeffrey S.
AU - McKenzie, Dean P.
AU - Blumenfield, Michael
AU - Muskin, Philip
AU - Newstadt, Geoffrey
AU - Wallack, Joel
AU - Wilner, Ascher
AU - Schleifer, Steven S.
N1 - Funding Information:
The authors wish to acknowledge the assistance of Mrs. Jenny D’Souza in the preparation of this manuscript, and the data management by Mr. Paul Low. The Green Foundation (New York City), Lita Annenberg Hazen Charitable Trust, Joseph Hazen Foundation, Enid Annenberg Houpt, the Stephen and Nan SWID Foundation, the Neil S. Hirsch Foundation, and the Norman and Vivian Weiden Foundation, Pharmacia & Upjohn Company, USA and Australia, and the Buckland Foundation gave financial support.
Funding Information:
Such confounds intensify the demand to learn the factors influencing the C-L psychiatrists’ selection of the AD category and the intervention strategies they choose. This paper reports such a study, using a methodology akin to “Practice Sampling,” employed by the American Psychiatric Association Division of Research funded by a McArthur Foundation Network grant [10] . C-L psychiatrists at seven academic teaching units in the USA, Canada, and Australia used a standardized database protocol prospectively to collect salient clinical variables on their referred patients, including diagnostic and treatment practices. Although a consortium approach is a strategy commonly utilized by other disciplines in medicine to minimize biases endemic to individual sites, to date it has not been used for research efforts in the C-L setting. The opportunity to perform multisite studies has been enhanced by the development of a C-L psychiatry software database system, MICRO-CARES, tested and refined over a 20-year period and constituting the record-keeping system for over 30,000 patients [11] . This schema incorporates a microcomputer software program with a standardized database, a network communication system, and cooperating university data collection sites. The existence of a glossary, ongoing training exercises, and supervision regarding the recording of each case, especially the diagnosis, enhances the quality of the data.
PY - 1998/5
Y1 - 1998/5
N2 - The consultation-liaison (C-L) psychiatry services of seven university teaching hospitals in the United States, Canada, and Australia (the MICRO- CARES Consortium) used a common clinical database to examine 1039 consecutive referrals. A diagnosis of adjustment disorder (AD) was made in 125 patients (12.0%); as the sole diagnosis, in 81 (7.8%); and comorbidly with other Axis I and II diagnoses in 44 (4.2%). It had been considered as a rule-out diagnosis in a further 110 (10.6%). AD with depressed mood, anxious mood, or mixed emotions were the commonest subcategories used. AD was diagnosed comorbidly most frequently with personality disorder and organic mental disorder. Sixty-seven patients (6.4%) were assigned a V code diagnosis only. Patients with AD were referred significantly more often for problems of anxiety, coping, and depression; had less past psychiatric illness; and were rated as functioning better-all consistent with the construct of AD as a maladaptation to a psychosocial stressor. Interventions were similar to those for other Axis I and II diagnoses, in particular, the prescription of antidepressants. Patients with AD required a similar amount of clinical time and resident supervision. It is concluded that AD is an important and time- consuming diagnostic category in C-L psychiatry practice.
AB - The consultation-liaison (C-L) psychiatry services of seven university teaching hospitals in the United States, Canada, and Australia (the MICRO- CARES Consortium) used a common clinical database to examine 1039 consecutive referrals. A diagnosis of adjustment disorder (AD) was made in 125 patients (12.0%); as the sole diagnosis, in 81 (7.8%); and comorbidly with other Axis I and II diagnoses in 44 (4.2%). It had been considered as a rule-out diagnosis in a further 110 (10.6%). AD with depressed mood, anxious mood, or mixed emotions were the commonest subcategories used. AD was diagnosed comorbidly most frequently with personality disorder and organic mental disorder. Sixty-seven patients (6.4%) were assigned a V code diagnosis only. Patients with AD were referred significantly more often for problems of anxiety, coping, and depression; had less past psychiatric illness; and were rated as functioning better-all consistent with the construct of AD as a maladaptation to a psychosocial stressor. Interventions were similar to those for other Axis I and II diagnoses, in particular, the prescription of antidepressants. Patients with AD required a similar amount of clinical time and resident supervision. It is concluded that AD is an important and time- consuming diagnostic category in C-L psychiatry practice.
UR - http://www.scopus.com/inward/record.url?scp=0031811609&partnerID=8YFLogxK
U2 - 10.1016/S0163-8343(98)00020-6
DO - 10.1016/S0163-8343(98)00020-6
M3 - Article
C2 - 9650031
AN - SCOPUS:0031811609
VL - 20
SP - 139
EP - 149
JO - General Hospital Psychiatry
JF - General Hospital Psychiatry
SN - 0163-8343
IS - 3
ER -