NEED  FOR  THE  STUDY:

We live in a century where people more suffer from mentally disturbed state rather than physical conditions. Mental health includes our emotional, psychological, and social wellbeing. It affect how we think, feel, and act. It also helps determine how we handle stress, relate to others and make healthy choices.

The battle for existence and survival is a never ending series of events throughout life. If the results are not according to our expectations, we change our goal. After the initial failure living organisms likes shifting to more defensive position in order to face the challenges of circumstances. This feature of the living organism is called adjustment.

On the basis of relationship of living organisms with the environment and their relationship with self, they can be considered as maladjustment or adjusted. Maladjusted person cannot be able to adjust with his environment easily. If the living organisms face problem in adjustment with the environment or with the self then it will leads to stress.

Adjustment disorder is an unexpected strong emotional or behavioral reaction that occurs in response to an identifiable stressful life change that occurred within the previous three month.

The percentage of individuals in outpatient mental health treatment with a principal diagnosis of an adjustment disorder ranges from approximately 5% to 20%. In a hospital psychiatric consultation setting, it is often the most common diagnosis, frequently reaching 50%. ⁽¹⁾

Stressful events have significant negative impact on the individual, or a group of people taking in to consideration of external context and cultural factor.

Development of such emotional symptoms to particular stressful incidence might not that much intent for other but for that particular person this incidence may have mark psychological meaning which leads to adjustment disorder.

Homoeopathy could play greater role for an effective management of the symptoms of adjustment disorder is evident considering fact that it is a holistic treatment approach and had durable impact. Homoeopathy treats the patients on all levels, the spiritual, mental/emotional and physical plane; the planes on which the symptoms of adjustment disorder are manifest and express. The study aims to provide valuable insights in to clinical presentation of adjustments disorder and studying the management of it with homoeopathy.

REVIEW OF LITERATURE:

 INTRODUCTION:

Those who has not mastered earlier development tasks take  

         Longer and harder to adjust. ⁽²⁾

The adjustment disorders are a diagnostic category characterized by an emotional response to a stressful event. There are currently no such criteria for the stressor of an adjustment disorder. There is little specificity to qualify these symptoms other than an excess of what would be expected from the particular stressor or a significant social or occupational impairment. By definition, the symptoms must begin within 3 months of the stressor, and must remit within 6 months of removal of the stressor. ⁽³⁾

 EPIDEMIOLOGY:

The prevalence of the disorder is estimated to be from 2 to 8 percent of the general population.

Women are diagnosed with the disorder twice as often as men, and single women are generally overly represented as most at risk.

The disorders can occur at any age but are most frequently diagnosed in adolescents.

Among adolescents of either sex, common precipitating stresses are school problems, parental rejection and divorce, and substance abuse.

Among adults, common precipitating stresses are marital problems, divorce, moving to a new environment, and financial problems.

Adjustment disorders are one of the most common psychiatric diagnoses for disorders of patients hospitalized for medical and surgical problems. ⁽⁴⁾

Stressors and symptoms may vary depending on cultural influences ⁽⁵⁾

ETIOLOGY

By definition, an adjustment disorder is precipitated by one or more stressors. The severity of the stressor or stressors does not always predict the severity of the disorder; the stressor severity is a complex function of degree, quantity, duration, reversibility, environment, and personal context. ⁽³⁾

Psychodynamic Factors Pivotal to understanding adjustment disorders is an understanding of three factors: the nature of the stressor, the conscious and unconscious meanings of the stressor, and the patient’s preexisting vulnerability. A concurrent personality disorder or organic impairment may make a person vulnerable to adjustment disorder ⁽⁴⁾

 DIAGNOSIS AND CLINICAL FEATURE

Disorders follow a stressor, the symptoms do not necessarily begin immediately. Up to 3 months may elapse between a stressor and the development of symptoms. Symptoms do not always subside as soon as the stressor ceases; if the stressor continues, the disorder may be chronic. ⁽³⁾

DISGNOSTIC CRITERIA FROM DSM-5

A.    The development of emotional or behavioral symptoms in response to an identifiable stressor occurring within 3 months of the onset of the stressor.

B.    These symptoms or behaviors are clinically evident, as evidenced by one or both of the following:

a.    Marked distress that is out of proportion to the severity or intensity of the stressor, taking into account the external context and the cultural factors that might influence symptom severity and presentation.

b.    Significant impairment in social, occupational, or other important areas of functioning.

C.   The stress-related disturbance does not meet the criteria for another Disorder

D.   Mental disorder and is not merely an exacerbation of a preexisting Mental Disorder.

E.     Do not persist for more than an additional 6 months. ⁽¹⁾

 SUB TYPES OF ADJUSTMENT DISORDER

1.    with depressed mood:

2.    with anxiety:

3.    with mixed anxiety and depressed mood:

4.    with disturbance of conduct:

5.    with mixed disturbance of emotions and conduct:

6.    Unspecified: ⁽¹⁾

 DIFFERENTIAL DIAGNOSIS:

Major depressive disorder.

Posttraumatic stress disorder and acute stress disorder.

Personality disorder.

Psychological factors affecting other medical conditions.

Normative stress reactions ⁽³⁾

 COMORBIDITY

Adjustment disorders can accompany most mental disorders and any medical disorder. Adjustment disorders can be diagnosed in addition to another mental disorder only if the latter does not explain the particular symptoms that occur in reaction to the stressor. ⁽¹⁾

 COURCE AND PROGNOSIS:

With appropriate treatment, the overall prognosis of an adjustment disorder is generally favorable. Most patients return to their previous level of functioning within 3 months. Some persons (particularly adolescents) who receive a diagnosis of an adjustment disorder later have mood disorders or substance related disorders. Adolescents usually require a longer time to recover than adults. ⁽³⁾

 GENERAL MANAGEMENT:

Supportive Psychotherapy is the most appropriate choice in the management of adjustment disorders.

Crisis intervention helps patients to efficiently solve their life situation that has led to the clinical condition of adjustment problems.

Stress management techniques and coping methods help the patients cope with their problems in a better way. ⁽⁶⁾

HOMOEOPATHIC APPROACH

Homoeopathy recognizes the individuality of each patient or case. The entire examination of a patient is conducted with a view to discovering not only the general or common features of the case by which it may be classified diagnostically and pathologically, but the special and particular symptoms which differentiate the case from others of the same general class. It recognizes the fact that no two cases or patients, even with the same the disease, are exactly alike, and maintains that a true science of therapeutics must enable the practitioner to recognize these differences and find the needed remedy for each individual. In actual practice the “differences” are very often the deciding factor in the choice of remedy. To use frequently quoted epigram: “Homoeopathy does not treat disease. It treats the patients. ⁽⁶⁾

According to aphorism 215-216 Hahnemann considers mental disease as one sided disease of the chronic type affecting the whole psychosomatic entity. ⁽⁷⁾

SOME HOMOEOPATHIC MEDICINE SUITABLE FOR AD. ⁽⁸⁾

1.    GELSEMIUM SEMPERVIRENS

2.    IGNATIA

3.    STAPHYSAGRIA

4.    ARUM METALLICUM

5.    SILICEA

6.    NATRUM MUR

7.    OPIUM

8.    PH-AC

 OBJECTIVES OF THE STUDY

TO ASSESS THE EFFECTIVENESS OF HOMOEOPATHIC MANAGEMENT IN CASES OF ADJUSTMENT DISORDER IN EARLY ADULTHOOD.

TO STUDY THE CLINICAL PRESENTATION OF ADJUSTMENT DISORDER IN EARLY ADULTHOOD.