ADJUSTMENT DISORDER WITH
DEPRESSION OR ANXIETY
BEHAVIORAL DEFINITIONS
1. Depressive symptoms (e.g., sad mood, tearfulness, feelings of hope-
lessness) that develop in response to an identifiable stressor (e.g.,
medical illness, marital problems, loss of a job, financial problems,
conflicts about religion).
2. Anxiety symptoms (e.g., nervousness, worry, jitteriness) that develop
in response to an identifiable stressor.
3. Symptoms cause distress beyond what would normally be expected.
4. Significant impairment in social and/or occupational functioning be-
cause of the symptoms.
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LONG-TERM GOALS
1. Alleviate symptoms of stress-related depression through medication
and/or psychotherapy.
2. Alleviate symptoms of stress-related anxiety through medication
and/or psychotherapy.
3. Stabilize anxiety and/or depression levels while increasing ability to
function on a daily basis.
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12 THE PSYCHOPHARMACOLOGY TREATMENT PLANNER
4. Learn and demonstrate strategies to deal with dysphoric and/or anx-
ious moods.
5. Effectively cope with the full variety of life’s stressors.
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SHORT-TERM
THERAPEUTIC
OBJECTIVES
INTERVENTIONS
1. Describe the signs and symp-
1. Explore the adjustment disorder
toms of an adjustment disorder
symptoms that are experienced
that are experienced and note
by the patient (e.g., excessive
their impact on daily life.
worry about a current stressor,
(1, 2, 3)
sad mood, decreased sleep, re-
duced appetite).
2. Determine what stressors are
present and the time course of
symptoms in relation to the
stressors.
3. Gather information from the
patient about the impact of the
symptoms on daily life (e.g.,
impaired social or occupational
functioning, neglect of routine
chores).
2. Describe other symptoms or
4. Assess the patient for comorbid
disorders that may also be
disorders (e.g., see the Person-
present. (4, 5)
ality Disorder, Psychosis, and
Panic Disorder chapters in this
Planner).
5. Gather detailed personal and
family history information re-
garding the patient’s substance
abuse and its potential contribu-
tion to the adjustment disorder;

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ADJUSTMENT DISORDER WITH DEPRESSION OR ANXIETY 13
refer the patient for in-depth
substance abuse treatment, if
indicated (see the Chemical
Dependence chapters in this
Planner).
3. Verbalize any current suicidal
6. Explore the patient’s current and
thoughts and any history of
past suicidal thoughts and suici-
suicidal behavior. (6, 7, 8)
dal behavior; check for family
history of suicide (see interven-
tions designed for Suicidal Idea-
tion in this Planner).
7. Administer to the patient an ob-
jective assessment instrument
for assessing suicidality (e.g.,
the Beck Scale for Suicidal Idea-
tion); evaluate the results and
give feedback to the patient.
8. Arrange for hospitalization
when the patient is judged to
be harmful to himself/herself
or others or unable to care
for his/her basic needs.
4. Outline a complete and accur-
9. Explore the patient’s history of
ate medical and psychiatric
previous treatment for any psy-
history, including treatment
chiatric disorder and the success
received and its effectiveness.
of, as well as tolerance for, that
(9, 10)
treatment.
10. Assess the patient for the pres-
ence of other medical problems
and the medications used to treat
them.
5. Cooperate with a physical
11. Perform a complete physical and
examination and laboratory
neurological examination on the
tests. (11, 12)
patient and send his/her blood
and/or urine for analysis to as-
sess any medical problem that
may contribute to the adjustment
disorder (e.g., cancer, diabetes,
hypertension, cardiovascular
disease).
12. Provide feedback to the patient
regarding the results and

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14 THE PSYCHOPHARMACOLOGY TREATMENT PLANNER
implications of the physical
examination and laboratory
test results.
6. Pursue treatment for con-
13. Treat or refer the patient for
current medical problems that
treatment for any medical prob-
may contribute to depressive
lem that may be causing or con-
and anxiety symptoms.
tributing to the adjustment
(13, 14)
disorder.
14. Monitor the patient’s progress in
recovery from concomitant dis-
orders and the impact on his/her
mood.
7. Complete psychological
15. Administer objective instruments
testing and other questionnaires
to assess the patient’s depressive
for measuring depressive and
and anxiety symptoms (e.g., Beck
anxiety symptoms. (15)
Depression Inventory [BDI],
Hamilton Depression Rating Scale
[HDRS], Montgomery Asberg
Depression Rating Scale
[MADRS], Hamilton Anxiety
Rating Scale [HARS]); evaluate
the results and give him/her
feedback.
8. Express an understanding of
16. Emphasize the negative and
possible causes for adjust-
dangerous impact of substance
ment disorder and the relation-
abuse on adjustment disorder
ship between substance abuse
symptoms.
and adjustment disorder.
17. Educate the patient on the possi-
(16, 17)
ble contributing factors (e.g.,
stressful life events, maladaptive
coping skills) and signs of ad-
justment disorder.
9. Verbalize an understanding
18. Discuss appropriate treatment
of treatment options, expected
options with the patient
results from medication, and
including medication and
potential side effects.
psychotherapy.
(18, 19)
19. Educate the patient on psycho-
tropic medication treatment in-
cluding the expected results,
potential side effects, and dosing
strategies.

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ADJUSTMENT DISORDER WITH DEPRESSION OR ANXIETY 15
10. Participate in psychotherapy
20. Assess the patient for potential
sessions as planned with the
benefit from psychotherapy and
therapist. (20, 21)
refer him/her to a psychothera-
pist, if necessary.
21. Monitor the patient’s response to
psychotherapy; assess his/her
ability to verbalize a basis for
progress in recovery from the
adjustment disorder (e.g., im-
proved mood, reduced anxiety,
increased ability to cope with
adversity, improved social and
occupational functioning).
11. Verbalize any symptoms of
22. Explore the adjustment disorder
anxiety that are experienced.
symptoms that are experienced
(22, 23)
by the patient (e.g., excessive
worry about a current stressor,
sad mood, decreased sleep, re-
duced appetite).
23. Determine if the patient has de-
bilitating symptoms of anxiety
(e.g., worry, nervousness, re-
duced sleep) that interfere with
his/her functioning.
12. Take prescribed antianxiety
24. Prescribe to the patient an anxio-
or hypnotic medications
lytic or hypnotic agent (e.g., zol-
responsibly at times ordered
pidem [Ambien®], zaleplon [So-
by the physician.
nata®], lorazepam [Ativan®],
(24, 25, 26, 27)
flurazepam [Dalmane®],
triazolam [Halcion®], diazepam
[Valium®], chloral hydrate
[Noctec®], estazolam [Pro-
Som®], temazepam [Restoril®])
to help the patient with sleep
(see the Sleep Disturbance chap-
ter in this Planner).
25. Consider the use of a long-
acting benzodiazepine (e.g.,
clonazepam [Klonopin®],
diazepam [Valium®]) to help
alleviate excessive daytime
anxiety.

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16 THE PSYCHOPHARMACOLOGY TREATMENT PLANNER
26. Avoid the use of benzodiazepi-
nes and other hypnotics if the
patient has a history of sub-
stance abuse; use an alternative
medication (e.g., hydroxyzine
[Atarax®, Vistaril®], diphen-
hydramine [Benadryl®], tra-
zodone [Desyrel®]) for the
patient.
27. Instruct the patient to minimize
his/her use of medication and
take it only when symptoms
become intolerable.
13. Report as to the effectiveness
28. Titrate the medication every two
of the antianxiety medication
to three days, as tolerated, until
and any side effects that
the patient’s symptoms are con-
develop. (28, 29)
trolled or the maximum dose is
reached.
29. Monitor the patient frequently
for the development of side ef-
fects, response to medication,
adherence to treatment, and
abuse of the medication.
14. Verbalize any depressive
30. Explore the adjustment disorder
symptoms that are experienced.
symptoms that are experienced
(30, 31)
by the patient (e.g., excessive
worry about a current stressor,
sad mood, decreased sleep, re-
duced appetite).
31. Determine if the patient has de-
bilitating depressive symptoms
(e.g., sad mood, tearfulness, de-
creased appetite) in response to
a chronic stressor (e.g., chronic
medical illness, ongoing finan-
cial or legal problems).
15. Adhere to the SSRI anti-
32. Consider prescribing a selective
depressant medication as
serotonin reuptake inhibitor
prescribed by the physician.
(SSRI) (e.g., fluoxetine
(32, 33)
[Prozac®], sertraline [Zoloft®],
paroxetine [Paxil®], citalopram
[Celexa™], escitalopram

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ADJUSTMENT DISORDER WITH DEPRESSION OR ANXIETY 17
[Lexapro™]) to help treat the pa-
tient’s depressive symptoms (see
the Depression chapter in this
Planner).
33. Titrate the patient’s SSRI anti-
depressant medication to the
minimum effective dose for
treating the patient’s symptoms.
16. Report as to the effectiveness
34. Monitor the patient frequently
of the SSRI antidepressant
for the development of side ef-
medication and any side effects
fects, response to the SSRI
that develop. (34, 35, 36)
medication, and adherence to
treatment.
35. Increase the dose of the SSRI
antidepressant every four to six
weeks, as tolerated, until the pa-
tient has a satisfactory response
or the maximum dose is reached.
36. Repeat administration of objec-
tive rating instruments for as-
sessment of the patient’s depres-
sion and anxiety; evaluate the
results and give him/her
feedback.
17. Retain a remission or signi-
37. Maintain the patient on current
ficant reduction in depressive
medication until the stressor(s)
and/or anxiety symptoms.
resolve and/or the patient devel-
(37, 38, 39)
ops better coping skills to reduce
his/her depression or anxiety
without medication.
38. Continue antidepressant treat-
ment indefinitely if he/she has
had previous episodes of adjust-
ment disorder and has shown
limited or no progress in devel-
oping adequate coping skills to
effectively deal with adversity.
39. Reduce medications gradually
over several days to weeks;
monitor closely for recurrence
of symptoms and/or withdrawal.

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18 THE PSYCHOPHARMACOLOGY TREATMENT PLANNER
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DIAGNOSTIC SUGGESTIONS:
Axis I:
309.0
Adjustment Disorder with Depressed Mood

309.24
Adjustment Disorder with Anxiety

309.28
Adjustment Disorder with Mixed Anxiety and
Depressed Mood

309.3
Adjustment Disorder with Disturbance of
Conduct

309.4
Adjustment Disorder with Mixed Disturbance
of Conduct and Emotions

309.9
Adjustment Disorder Unspecified
296.xx
Major
Depression

309.81
Posttraumatic Stress Disorder

308.3
Acute Stress Disorder
V62.82
Bereavement
305.00
Alcohol
Abuse
305.60
Cocaine
Abuse








Axis II:
301.83
Borderline Personality Disorder

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Document Outline

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