今日の臨床サポート

適応障害

著者: 白波瀬丈一郎 慶應義塾大学

監修: 上島国利 昭和大学

著者校正/監修レビュー済:2022/03/30
患者向け説明資料

概要・推奨   

  1. 適応障害は、明らかなストレス因子が先行し、正常の反応を超えた著しい苦痛や社会的障害をもたらしており、ストレス因がなくなれば症状も速やかに軽快するストレス因関連疾患である。
  1. 有病率が高く、日常臨床の場面で出会うことの多い疾患である。
  1. 適応障害の治療は心理—社会的治療が主である(推奨度2)
アカウントをお持ちの方はログイン
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります
薬剤監修について:
オーダー内の薬剤用量は日本医科大学付属病院 薬剤部 部長 伊勢雄也 以下、林太祐、渡邉裕次、井ノ口岳洋、梅田将光による疑義照会のプロセスを実施、疑義照会の対象については著者の方による再確認を実施しております。
※薬剤中分類、用法、同効薬、診療報酬は、エルゼビアが独自に作成した薬剤情報であり、 著者により作成された情報ではありません。
尚、用法は添付文書より、同効薬は、薬剤師監修のもとで作成しております。
※同効薬・小児・妊娠および授乳中の注意事項等は、海外の情報も掲載しており、日本の医療事情に適応しない場合があります。
※薬剤情報の(適外/適内/⽤量内/⽤量外/㊜)等の表記は、エルゼビアジャパン編集部によって記載日時にレセプトチェックソフトなどで確認し作成しております。ただし、これらの記載は、実際の保険適応の査定において保険適応及び保険適応外と判断されることを保証するものではありません。また、検査薬、輸液、血液製剤、全身麻酔薬、抗癌剤等の薬剤は保険適応の記載の一部を割愛させていただいています。
(詳細はこちらを参照)
著者のCOI(Conflicts of Interest)開示:
白波瀬丈一郎 : 特に申告事項無し[2022年]
監修:上島国利 : 原稿料(大日本住友製薬)[2022年]

改訂のポイント:
  1. 定期レビューを行い、各セクションにおいて加筆修正を行った。

病態・疫学・診察

疾患情報  
  1. 適応障害は、ストレス因子の始まりから3カ月以内に生じた情動面または行動面の症状であり、これらの症状は臨床的に著しく、それは以下のいずれかあるいは両方により裏づけられる[1]
  1. 著しい苦痛:それは、症状の重症度やその出現に影響を与え得る外的文脈および文化的要因を考慮しても、ストレス因子の過酷さや強度をはるかに超えたものである
  1. 社会的または職業的(学業上の)機能の著しい障害
  1. 適応障害の診断の際には、他の精神疾患の診断基準を満たしていないこと、すでに存在している精神疾患の単なる悪化ではないことを確認する必要がある。また、死別反応は除外する[1]
  1. ストレス因子がなくなれば、その後6カ月以内に症状は消失する[1]
 
  1. 適応障害は有病率が高く、日常臨床の場面で出会うことの多い疾患である。
  1. 精神科以外の臨床場面でも、適応障害の患者に出会うことは少なくない。一般人口における有病率は1〜2%[2]、プライマリケアでは3〜10% [3][4]、精神科外来や終末期ケアでは約15%[5]、精神科コンサルテーションではしばしば50%に達するという報告がある[6] [7]
問診・診察のポイント  
  1. 適応障害を引き起こしたと思われるストレス因子を同定する。

これより先の閲覧には個人契約のトライアルまたはお申込みが必要です。

最新のエビデンスに基づいた二次文献データベース「今日の臨床サポート」。
常時アップデートされており、最新のエビデンスを各分野のエキスパートが豊富な図表や処方・検査例を交えて分かりやすく解説。日常臨床で遭遇するほぼ全ての症状・疾患から薬剤・検査情報まで瞬時に検索可能です。

まずは15日間無料トライアル
本サイトの知的財産権は全てエルゼビアまたはコンテンツのライセンサーに帰属します。私的利用及び別途規定されている場合を除き、本サイトの利用はいかなる許諾を与えるものでもありません。 本サイト、そのコンテンツ、製品およびサービスのご利用は、お客様ご自身の責任において行ってください。本サイトの利用に基づくいかなる損害についても、エルゼビアは一切の責任及び賠償義務を負いません。 また、本サイトの利用を以て、本サイト利用者は、本サイトの利用に基づき第三者に生じるいかなる損害についても、エルゼビアを免責することに合意したことになります。  本サイトを利用される医学・医療提供者は、独自の臨床的判断を行使するべきです。本サイト利用者の判断においてリスクを正当なものとして受け入れる用意がない限り、コンテンツにおいて提案されている検査または処置がなされるべきではありません。 医学の急速な進歩に鑑み、エルゼビアは、本サイト利用者が診断方法および投与量について、独自に検証を行うことを推奨いたします。

文献 

Paulina Zelviene, Evaldas Kazlauskas
Adjustment disorder: current perspectives.
Neuropsychiatr Dis Treat. 2018;14:375-381. doi: 10.2147/NDT.S121072. Epub 2018 Jan 25.
Abstract/Text Adjustment disorder (AjD) is among the most often diagnosed mental disorders in clinical practice. This paper reviews current status of AjD research and discusses scientific and clinical issues associated with AjD. AjD has been included in diagnostic classifications for over 50 years. Still, the diagnostic criteria for AjD remain vague and cause difficulties to mental health professionals. Controversies in definition resulted in the lack of reliable and valid measures of AjD. Epidemiological data on prevalence of AjD is scarce and not reliable because prevalence data are biased by the diagnostic algorithm, which is usually developed for each study, as no established diagnostic standards for AjD are available. Considerable changes in the field of AjD could follow after the release of the 11th edition of International Classification of Diseases (ICD-11). A new AjD symptom profile was introduced in ICD-11 with 2 main symptoms as follows: 1) preoccupation and 2) failure to adapt. However, differences between the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition and ICD-11 AjD diagnostic criteria could result in diverse research findings in the future. The best treatment approach for AjD remains unclear, and further treatment studies are needed to provide AjD treatment guidelines to clinicians.

PMID 29416339
Anna Fernández, Juan M Mendive, Luis Salvador-Carulla, María Rubio-Valera, Juan Vicente Luciano, Alejandra Pinto-Meza, Josep Maria Haro, Diego J Palao, Juan A Bellón, Antoni Serrano-Blanco, DASMAP investigators
Adjustment disorders in primary care: prevalence, recognition and use of services.
Br J Psychiatry. 2012 Aug;201:137-42. doi: 10.1192/bjp.bp.111.096305. Epub 2012 May 10.
Abstract/Text BACKGROUND: Within the ICD and DSM review processes there is growing debate on the future classification and status of adjustment disorders, even though evidence on this clinical entity is scant, particularly outside specialised care.
AIMS: To estimate the prevalence of adjustment disorders in primary care; to explore whether there are differences between primary care patients with adjustment disorders and those with other mental disorders; and to describe the recognition and treatment of adjustment disorders by general practitioners (GPs).
METHOD: Participants were drawn from a cross-sectional survey of a representative sample of 3815 patients from 77 primary healthcare centres in Catalonia. The prevalence of current adjustment disorders and subtypes were assessed face to face using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). Multilevel logistic regressions were conducted to assess differences between adjustment disorders and other mental disorders. Recognition and treatment of adjustment disorders by GPs were assessed through a review of patients' computerised clinical histories.
RESULTS: The prevalence of adjustment disorders was 2.94%. Patients with adjustment disorders had higher mental quality-of-life scores than patients with major depressive disorder but lower than patients without mental disorder. Self-perceived stress was also higher in adjustment disorders compared with those with anxiety disorders and those without mental disorder. Recognition of adjustment disorders by GPs was low: only 2 of the 110 cases identified using the SCID-I were detected by the GP. Among those with adjustment disorders, 37% had at least one psychotropic prescription.
CONCLUSIONS: Adjustment disorder shows a distinct profile as an intermediate category between no mental disorder and affective disorders (depression and anxiety disorders).

PMID 22576725
Jan Sundquist, Henrik Ohlsson, Kristina Sundquist, Kenneth S Kendler
Common adult psychiatric disorders in Swedish primary care where most mental health patients are treated.
BMC Psychiatry. 2017 Jun 30;17(1):235. doi: 10.1186/s12888-017-1381-4. Epub 2017 Jun 30.
Abstract/Text BACKGROUND: The overall aim of this study is to present descriptive data regarding the treated prevalence of nine common psychiatric and substance use disorders in the first Primary Care Registry (PCR) in Sweden: Major Depression (MD), Anxiety Disorders (AD), Obsessive-Compulsive Disorder (OCD), Adjustment Disorder (AdjD), Eating Disorders (ED), Personality Disorder (PD), Attention Deficit Hyperactivity Disorder (ADHD), Alcohol Use Disorder (AUD) and Drug Abuse (DA).
METHOD: We selected 5,397,675 individuals aged ≥18. We examined patterns of comorbidity among these disorders and explored the association between diagnoses in the PCR and diagnoses obtained from Hospital and Specialist care. We explored the proportion of patients with these nine disorders that are only treated in primary health care.
RESULTS: For four of our disorders, 80% or more of the cases were present only in the PCR: AdjD, DA, AD and MD. For two disorders (OCD and ED), 65-70% of cases were only found in the PCR. For three disorders (PD, AUD, and ADHD), 45-55% of the patients were only present in the PCR.
CONCLUSION: The PCR will, in the future, likely prove to be an important tool for studies in psychiatric epidemiology.

PMID 28666429
Yousif Ali Yaseen
Adjustment disorder: Prevalence, sociodemographic risk factors, and its subtypes in outpatient psychiatric clinic.
Asian J Psychiatr. 2017 Aug;28:82-85. doi: 10.1016/j.ajp.2017.03.012. Epub 2017 Mar 16.
Abstract/Text BACKGROUND AND OBJECTIVE: This study aims at assessing the prevalence and risk factors of Adjustment disorder (AD), the AD subtypes, and the common causing stressors.
PATIENTS AND METHODS: A cross sectional study was conducted at outpatient psychiatric clinic in Duhok City from July 2008 to July 2009. 637 patients equal and above 18 of both genders were selected randomly. SCID-I/P (Version 2.0) was adopted to diagnose patients with AD. SPSS (version 21), was used for data analysis.
RESULTS: The study showed that the prevalence of AD was 11.5%. It was more common among youngest age group (15-25 years) with a rate 69.9% (p=0.001) while lowest educational level (illiterate and primary) 53.5% (p=0.040), single 54.8% (p<0.001), students 39.7 (p<0.001) and from urban areas 71.2% (p=0.012) with statistically significant association. Although AD was more common among females (61.6%), no significant association was found between AD and gender (p=0.380). The most common subtype of AD was AD with mixed anxiety and depressed mood (34.2%) and was the commonest among females (19.2%) followed by AD with Anxiety subtype 30.1% which was the commonest among males (13.7%). The commonest psychosocial stressor was the illnesses (28.8%) followed by love affairs (26%) and domestic problems (16.4%).
CONCLUSIONS: The prevalence of AD was found to be high. The risk factors included young, low educational level, single, students, and those from urban areas. The most common subtype was AD with mixed anxiety and depressed mood and the commonest psychosocial stressor was the illnesses followed by love affairs and domestic problems.

Copyright © 2017 Elsevier B.V. All rights reserved.
PMID 28784404
M K Popkin, A L Callies, E A Colón, V Stiebel
Adjustment disorders in medically ill inpatients referred for consultation in a university hospital.
Psychosomatics. 1990 Fall;31(4):410-4. doi: 10.1016/S0033-3182(90)72136-6.
Abstract/Text The study examined medical records of 121 medical-surgical inpatients diagnosed with adjustment disorder by psychiatric consultants in a university hospital. Medical illness was the primary stressor, evoking the maladaptive reaction in 83 (68.6%) cases. These patients were largely free of preceding psychiatric problems, suffering protracted hospitalizations for advanced illnesses, particularly malignancy and diabetes; in contrast, the 38 (31.4%) patients whose adjustment disorder was precipitated by a stressor other than medical illness had established psychiatric histories and recurrent problems with relationships or finances. The data suggest that in the medically ill, identifying the primary stressor producing an adjustment disorder is more instructive than focusing upon "predominant" symptomatology and "subtypes."

PMID 2247569
Matthias Domhardt, Harald Baumeister
Psychotherapy of adjustment disorders: Current state and future directions.
World J Biol Psychiatry. 2018;19(sup1):S21-S35. doi: 10.1080/15622975.2018.1467041.
Abstract/Text OBJECTIVES: This narrative review article provides an overview of current psychotherapeutic approaches specific for adjustment disorders (ADs) and outlines future directions for theoretically-based treatments for this common mental disorder within a framework of stepped care.
METHODS: Studies on psychological interventions for ADs were retrieved by using an electronic database search within PubMed and PsycINFO, as well as by scanning the reference lists of relevant articles and previous reviews.
RESULTS: The evidence base for psychotherapies specifically targeting the symptoms of AD is currently rather weak, but is evolving given several ongoing trials. Psychological interventions range from self-help approaches, relaxation techniques, e-mental-health interventions, behavioural activation to talking therapies such as psychodynamic and cognitive behavioural therapy.
CONCLUSIONS: The innovations in DSM-5 and upcoming ICD-11, conceptualising AD as a stress-response syndrome, will hopefully stimulate more research in regard to specific psychotherapeutic interventions for AD. Low intensive psychological interventions such as e-mental-health interventions for ADs may be a promising approach to address the high mental health care needs associated with AD and the limited mental health care resources in most countries around the world.

PMID 30204563
Meaghan L O'Donnell, Olivia Metcalf, Loretta Watson, Andrea Phelps, Tracey Varker
A Systematic Review of Psychological and Pharmacological Treatments for Adjustment Disorder in Adults.
J Trauma Stress. 2018 Jun;31(3):321-331. doi: 10.1002/jts.22295.
Abstract/Text Adjustment disorder is a common psychiatric disorder, yet knowledge of the efficacious treatments for adjustment disorder is limited. In this systematic review, we aimed to examine psychological and pharmacological interventions that target adjustment disorder in adults to determine which interventions have the best evidence for improving adjustment disorder symptoms. We performed database searches for literature published between January 1980 and September 2016 and identified studies that included both a sample majority of individuals diagnosed with adjustment disorder and findings on adjustment disorder symptom outcomes. There were 29 studies that met the inclusion criteria for qualitative synthesis; the majority of studies (59%) investigated psychological therapies rather than pharmacological treatments (35%). The range of psychological therapies tested was diverse, with the majority containing cognitive behavioral therapy (CBT) components (53%), followed by three studies that were psychodynamic-related, three studies that were behavioral therapy-based, and two studies that involved relaxation techniques. We rated individual studies using a modified National Health and Medical Research Council quality and bias checklist and then used the Grading of Recommendations Assessment, Development and Evaluation (GRADE; Grade Working Group, 2004) system to rate the overall quality of the evidence. Despite several randomized controlled trials, the quality of the evidence for positive effects of all psychological and pharmacological treatments on symptoms of adjustment disorder was ranked as low to very low. Future high-quality research in the treatment of adjustment disorder has the potential to make a significant difference to individuals who struggle to recover after stressful events.

Copyright © 2018 International Society for Traumatic Stress Studies.
PMID 29958336

ページ上部に戻る

戻る

さらなるご利用にはご登録が必要です。

こちらよりご契約または優待日間無料トライアルお申込みをお願いします。

(※トライアルご登録は1名様につき、一度となります)


ご契約の場合はご招待された方だけのご優待特典があります。

以下の優待コードを入力いただくと、

契約期間が通常12ヵ月のところ、14ヵ月ご利用いただけます。

優待コード: (利用期限:まで)

ご契約はこちらから