Abstract
Adjustment disorder is a temporary change in behaviour or emotion as a reaction to a stress factor. Therapy consists of psychotherapy, and pharmacotherapy can be advised. However, data on the real-life pharmacological treatment are sparse. Prescription data for 4.235 psychiatric inpatients diagnosed with adjustment disorder in the time period 2000–2016 were analysed. The data were obtained from the Drug Safety Programme in Psychiatry (AMSP). Data were collected on two reference days per year; prescription patterns and changes over time were analysed. Of all patients, 81.2% received some type of psychotropic drug. Mostly antidepressants (59.8%), antipsychotics (35.5%), and tranquilisers (22.6%) were prescribed. Prescription rates for antidepressants decreased slightly over the years, while rates for antipsychotics increased, especially for atypical antipsychotics. It is important to note that the diagnosis “adjustment disorder” is most likely a working diagnosis that is used for patients in immediate need of psychiatric aid. Overall, pharmacotherapy for inpatients with this diagnosis is mostly symptom-oriented and focuses on depressive moods, agitation and anxiety. Therapy regimes changed over time and show an increased use of atypical antipsychotics with sedative properties. However, for most of the medication, there are neither evidence-based studies nor guidelines, and drugs might be contraindicated in some cases.
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References
Anastasia A, Colletti C, Cuoco V, Quartini A, Urso S, Rinaldi R et al (2016) Demographic variables, clinical aspects, and medicolegal implications in a population of patients with adjustment disorder. Neuropsychiatr Dis Treat 12:737–743. https://doi.org/10.2147/NDT.S92637
Annseau M, Bataille M, Briole G, De Nayer A, Fauchère PA, Ferrero F et al (1996) Controlled comparison of tianeptine, alprazolam and mianserin in the treatment of adjustment disorder with anxiety and depression. Hum Psychopharmacol Clin Exp 11(4):293–298
Ayd FJ (1979) Benzodiazepines: dependence and Withdrawal. JAMA 242(13):1401–1402
Ayuso-Mateos JL, Vázquez-Barquero JL, Dowrick C, Lehtinen V, Dalgard OS, Casey P et al (2001) Depressive disorders in Europe: prevalence figures from the ODIN study. Br J Psychiatry 179:308–316
Bachem R, Casey P (2017) Adjustment disorder: a diagnosis whose time has come. J Affect Disord 227:243–253
Bengel J, Hubert S (2010) Anpassungsstörung und Akute Belastungsreaktion. Hogrefe, Göttingen
Bourin M, Bougerol T, Guitton B, Broutin E (1997) A combination of plant extracts in the treatment of outpatients with adjustment disorder with anxious mood: controlled study versus placebo. Fundam Clin Pharmacol 11(2):127–132
Bridler R, Häberle A, Müller ST, Cattapan K, Grohmann R, Toto S et al (2015) Psychopharmacological treatment of 2195 in-patients with borderline personality disorder: a comparison with other psychiatric disorders. Eur Neuropsychopharmacol 25(6):763–772. https://doi.org/10.1016/j.euroneuro.2015.03.017
Casey P, Dowrick C, Wilkinson G (2001) Adjustment disorder—fault line in the psychiatric glossary. Br J Psychiatry 179:479–481
Casey P (2009) Adjustment disorder: epidemiology. Diagnosis and Treatment CNS Drugs 23(11):927–938. https://doi.org/10.2165/11311000-000000000-00000
De Leo D (1989) Treatment of adjustment disorders: a comparative evaluation. Psychol Rep 64:51–54. https://doi.org/10.2466/2Fpr0.1989.64.1.51
De Wit S, Cremers L, Hirsch D, Zulian C, Clumeck N, Kormoss N (1999) Efficacy and safety of trazodone versus clorazepate in the treatment of HIV-positive subjects with adjustment disorders: a pilot study. J Int Med Res 27(5):223–232. https://doi.org/10.1177/2F030006059902700502
Dilling H, Mombour W, Schmidt MH (2010) Internationale Klassifikation psychischer Störungen ICD-10 Kapitel V (F). Hans Huber, Bern
Domhard M, Baumeister H (2018) Psychotherapy of adjustment disorders: current state and future directions. World J Biol Psychiatry 19(Sup1):S21–S35. https://doi.org/10.1080/15622975.2018.1467041
Engel RR, Grohmann R, Rüther E, Hippius H (2004) Research methods in drug surveillance. Pharmacopsychiatry 37(Suppl 1):12–15. https://doi.org/10.1055/s-2004-815506
Flatten G, Gast U, Hofmann A, Knaevelsrud C, Lampe A, Liebermann P et al (2011) S3–LEITLINIE: Posttraumatische Belastungsstörung ICD-10: F43.1. Trauma Gewalt 5(3):202–210
Greenberg WM, Rosenfeld DN, Ortega EA (1995) Adjustment disorder as an admission diagnosis. Am J Psychiatry 152:459–461. https://doi.org/10.1176/ajp.152.3.459
Greil W, Häberle A, Haueis P, Grohmann R, Russmann S (2012) Pharmacotherapeutic trends in 2231 psychiatric inpatients with bipolar depression from the International AMSP Project between 1994 and 2009. J Affect Disord 136(3):534–542. https://doi.org/10.1016/j.jad.2011.10.033
Grohmann R, Engel RR, Rüther E, Hippius H (2004) The AMSP drug safety program: methods and global results. Pharmacopsychiatry 37(Suppl 1):S4–S11. https://doi.org/10.1055/s-2004-815505
Holl AK, Grohmann R, Letmaier M, Painold A, Mörkl S, Toto S et al (2015) Pharmacotherapy of anxiety disorders in German-speaking countries: current status and changes between 1994 and 2011. Eur Arch Psychiatry Clin Neurosci 265:199–208. https://doi.org/10.1007/s00406-014-0523-7
Jones R, Yates WR, Zhou MH (2002) Readmission rates for adjustment disorders: comparison with other mood disorders. J Affect Disord 71:199–203
Koran LM, Sheline Y, Imai K, Kelsey TG, Freedland KE, Mathews J et al (2003) Medical disorders among patients admitted to a public sector psychiatric inpatient unit. Psychiatr Serv 53(12):1623–1625. https://doi.org/10.1176/appi.ps.53.12.1623
Kumano H, Ida I, Oshima A, Takahashi K, Yuuki N, Amanuma M et al (2007) Brain metabolic changes associated with predispotion to onset of major depressive disorder and adjustment disorder in cancer patients–a preliminary PET study. J Psychiatr Res 41(7):591–599. https://doi.org/10.1016/j.jpsychires.2006.03.006
Maercker A, Lorenz L (2018) Adjustment disorder diagnosis: improving clinical utility. World J Biol Psychiatry 19(S1):S3–S13. https://doi.org/10.1080/15622975.2018.1449967
Moore N, Verdoux H, Bruno F (2005) Prospective, multicentre, randomised, double-blind study of the efficacy of escitalopram versus citalopram in outpatient treatment of major depressive disorder. Int Clin Psychopharmacol 20(3):131–137
Pelkonen M, Marttunen M, Henriksson M, Lönnqvist J (2005) Suicidality in adjustment disorder, clinical characteristics of adolescent outpatients. Eur Child Adolesc Psychiatry 14:174–180. https://doi.org/10.1007/s00787-005-0457-8
Poppe C, Müller ST, Greil W, Walder A, Grohmann R, Stübner S (2016) Pharmacotherapy for obsessive compulsive disorder in clinical practice—data of 842 inpatients from the International AMSP Project between 1994 and 2012. J Affect Disord 200:89–96. https://doi.org/10.1016/j.jad.2016.04.035
Semaan W, Hergueta T, Bloch J, Charpak Y, Duburcq A, Le Guern ME et al (2001) Cross-sectional study of the prevalence of adjustment disorder with anxiety in general practice. Encephale 27(3):238–244
Servant D, Graziani PL, Moyse D, Parquet PJ (1998) Treatment of adjustment disorder with anxiety: efficacy and tolerance of etifoxine in a double-blind controlled study. Encephale 24:569–574
Shear MK, Greeno C, Kang J, Ludewig D, Frank E, Swartz HA et al (2000) Diagnosis of nonpsychotic patients in community clinics. Am J Psychiatry 157:581–587. https://doi.org/10.1176/appi.ajp.157.4.581
Spalletta G, Troisi A, Saracco M, Ciani N, Pasini A (1996) Symptomprofile, axis II comorbidity and suicidal behavior in young males with DSM-III-R depressive illness. J Affect Disord 39:141–148
Spina E, Santoro V, D’Arrigo C (2008) Clinically relevant pharmacokinetic drug interactions with second-generation antidepressants: an update. Clin Ther 30(7):1206–1227
Stein DJ (2015) Etifoxine versus alprazolam for the treatment of adjustment disorder with anxiety: a randomized controlled trial. Adv Ther 32:57–68. https://doi.org/10.1007/s12325-015-0176-6
Stein DJ (2018) Pharmacotherapy of adjustment disorder: a review. World J Biol Psychiatry 19(S1):46–52. https://doi.org/10.1080/15622975.2018.1492736
Strain JJ (2018) The psychobiology of stress, depression, adjustment disorders and resilience. World J Biol Psychiatry 19(1):S214–S220. https://doi.org/10.1080/15622975.2018.1459049
Tripodianakis J, Markianos M, Sarantidis D, Leotsakou C (2000) Neurochemical variables in subjects with adjustment disorder after suicide attempts. Eur Psychiatry 15(3):190–195
Young SL, Taylor M, Lawrie SM (2014) “First do no harm.” A systematic review of the prevalence and management of antipsychotic adverse effects. J Psychopharmacol 29(4):353–362. https://doi.org/10.1177/2F0269881114562090
Acknowledgements
This study was supported by the AMSP Drug Safety Programme, Hannover, Germany. The analysis of the data and this publication were made possible by a grant from Immanuel Clinic Rüdersdorf. We thank Frederike Bredy for proof reading and language editing.
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T Greiner, B. Haack, F. Faltraco, M. Schneider and M. Heinze declare no conflict of interests. The AMSP Drug Safety Programme is based on non-profit associations in the German-speaking countries Germany, Austria and Switzerland. In recent years, financial support has been contributed by almost all the pharmaceutical companies involved in CNS research. Since 1993 educational and research grants have been awarded by the following pharmaceutical companies to the three national non-profit associations of the AMSP: Austrian companies: AstraZeneca Österreich GmbH, Boehringer Ingelheim Austria, Bristol–Myers Squibb GmbH, CSC Pharmaceuticals GmbH, Eli Lilly GmbH, Germania Pharma GmbH, GlaxoSmithKline Pharma GmbH, Janssen-Cilag Pharma GmbH, Lundbeck GmbH, Novartis Pharma GmbH, Pfizer Med Inform, Servier Pharma Austria, Wyeth Lederle Pharma GmbH. German companies: Abbott GmbH & Co. KG, AstraZeneca GmbH, Aventis Pharma Deutschland GmbH GE–O/R/N, Bayer Vital GmbH & Co. KG, Boehringer Mannheim GmbH, Bristol-Myers-Squibb, Ciba Geigy GmbH, Desitin Arzneimittel GmbH, Duphar Pharma GmbH & Co. KG, Eisai GmbH, esparma GmbH Arzneimittel, GlaxoSmithKline Pharma GmbH & Co. KG, Hoffmann-La Roche AG Medical Affairs, Janssen-Cilag GmbH, Janssen Research Foundation, Knoll Deutschland GmbH, Lilly Deutschland GmbH Niederlassung Bad Homburg, Lundbeck GmbH & Co. KG, Nordmark Arzneimittel GmbH, Novartis Pharma GmbH, Organon GmbH, Otsuka-Pharma Frankfurt, Pfizer GmbH, Pharmacia & Upjohn GmbH, Promonta Lundbeck Arzneimittel, Rhone-Poulenc Rohrer, Sanofi-Synthelabo GmbH, Sanofi-Aventis Deutschland, Schering AG, Servier Pharma, SmithKlineBeecham Pharma GmbH, Solvay Arzneimittel GmbH, Synthelabo Arzneimittel GmbH, Dr Wilmar Schwabe GmbH & Co., Thiemann Arzneimittel GmbH, Trommsdorff GmbH & Co. KG Arzneimittel, Troponwerke GmbH & Co. KG, Upjohn GmbH, Wander Pharma GmbH, Wyeth-Pharma GmbH. Swiss companies: AHP (Schweiz) AG, AstraZeneca AG, Bristol–Myers Squibb AG, Desitin Pharma GmbH, Eli Lilly (Suisse) S.A., Essex Chemie AG, GlaxoSmithKline AG, Janssen-Cilag AG, Lundbeck (Suisse) AG, Mepha Schweiz AG/Teva, MSD Merck Sharp & Dohme AG, Organon AG, Pfizer AG, Pharmacia, Sandoz Pharmaceuticals AG, Sanofi-Aventis (Suisse) S.A., Sanofi-Synthe´labo SA, Servier SA, SmithKlineBeecham AG, Solvay Pharma AG, Vifor SA, Wyeth AHP (Suisse) AG, Wyeth Pharmaceuticals AG. S. Bleich, R. Grohmann and S. Toto are project managers of the AMSP programme. S. Toto has been a member of the advisory board for Otsouka and has received speaker‘s honoria from Janssen-Cilag, Lundbeck, Otsouka and Servier.
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Greiner, T., Haack, B., Toto, S. et al. Pharmacotherapy of psychiatric inpatients with adjustment disorder: current status and changes between 2000 and 2016. Eur Arch Psychiatry Clin Neurosci 270, 107–117 (2020). https://doi.org/10.1007/s00406-019-01058-1
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DOI: https://doi.org/10.1007/s00406-019-01058-1