Hostname: page-component-cc8bf7c57-77pjf Total loading time: 0 Render date: 2024-12-10T02:02:14.787Z Has data issue: false hasContentIssue false

Trastorno adaptativo en adolescentes: factores estresantes y síntomas de ansiedad en 89 pacientes ambulatorios

Published online by Cambridge University Press:  12 May 2020

Mirjami Pelkonen
Affiliation:
Instituto Nacional de Salud Pública, Departamento de Salud Mental e Investigación del Alcoholismo, Helsinki, Finlandia Departamento de Psiquiatría Social, Universidad de Tampere, Facultad de Salud Pública, Tampere, Finlandia
Mauri Marttunen
Affiliation:
Departamento de Psiquiatría de Adolescentes, Hospital Peijas, Hospital de la Universidad de Helsinki, Vantaa, Finlandia Universidad de Oulu, Departamento de Psiquiatría, Oulu, Finlandia
Markus Henriksson
Affiliation:
Centro de Medicina Militar, Ministerio de Defensa de Finlandia, Lahti, Finlandia
Jouko Lönnqvist
Affiliation:
departamento de Salud Mental e Investigación del Alcoholismo, Instituto de Salud Pública Nacional, Helsinki, Finlandia
Get access

Resumen

Objetivo

El trastorno adaptativo (TA) en adolescentes se ha investigado poco. Clasificamos a los adolescentes con TA tratados de forma ambulatoria según su ambiente psicosocial y el tratamiento recibido y los comparamos con pacientes con otros trastornos no psicóticos (OTNP). Además, exploramos los factores estresantes, los síntomas de ansiedad y los problemas de conducta en chicos y chicas con TA.

Método

Se recogieron prospectiva y consecutivamente datos de 290 pacientes psiquiátricos ambulatorios, de 12 a 22 años, tratados en una clínica de atención secundaria de Finlandia. En función de la información disponible se asignaron diagnósticos del DSM-III-R al final del tratamiento.

Resultados

El TA fue el segundo diagnóstico más común en pacientes no psicóticos (el 31% de 290). Comparados con los pacientes con OTNP, los pacientes con TA eran principalmente chicas y tenían un deterioro psicosocial menos grave. En los análisis de comparaciones multivariantes, las características principales de los pacientes con TA fueron factores estresantes relacionados con la escuela, problemas con la ley y agitación en chicos, y enfermedades de los padres e interiorización de síntomas en chicas. La intensidad y la duración del tratamiento de los pacientes con TA fueron muy variables.

Conclusiones

El trastorno adaptativo es una entidad clinica común en adolescentes tratados de forma ambulatoria. La evaluación y el tratamiento psiquiátrico deberían individualizarse teniendo en cuenta los factores estresantes específicos de cada sexo y los síntomas de ansiedad en jóvenes con TA.

Type
Original
Copyright
Copyright © European Psychiatric Association 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bibliografía

Aalto-Setälä, T, Marttunen, M, Tuulio-Henriksson, A, Poikolainen, K, Lönnqvist, J. Depressive symptoms in adolescence as predictors of early adulthood depressive disorders and maladjustment. Am J Psychiatry 2002;159:1235–7.CrossRefGoogle ScholarPubMed
Al-Ansari, A, Matar, AM. Recent stressful life events among Bahraini adolescents with adjustment disorder. Adolescence 1993;28:339–46.Google ScholarPubMed
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 3rd ed. Washington, DC: APA; 1987. rev (DSM-III-R).Google Scholar
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: APA; 1994. DSM-IV.Google Scholar
Andreasen, NC, Wasek, P. Adjustment disorders in adolescents and adults. Arch Gen Psychiatry 1980;37:1166–70.CrossRefGoogle ScholarPubMed
Andreasen, NC, Hoenk, PR. The predictive value of adjustment disorders: a follow-up study. Am J Psychiatry 1982;139:584–90.Google ScholarPubMed
Casey, P, Dowrick, C, Wilkinson, G. Adjustment disorders. Fault line in the psychiatric glossary. Br J Psychiatry 2001;179:479–81.CrossRefGoogle ScholarPubMed
Central Statistical Office of Finland. Classification of occupations. Helsinki: Central Statistical Office of Finland; 1987.Google Scholar
Chorpita, BF, Barlow, DH. The development of anxiety: the role of control in the early environment. Psychol Bull 1998;124:321.CrossRefGoogle ScholarPubMed
Despland, JN, Monod, L, Ferrero, F. Clinical relevance of adjustment disorder in DSM-III-R and DSM-IV. Compr Psychiatry 1995;36:454–60.CrossRefGoogle ScholarPubMed
Endicott, J, Spitzer, RL, Fleiss, JL, Cohen, J. The global assessment scale. Arch Gen Psychiatry 1976;33:766–71.CrossRefGoogle ScholarPubMed
Fabrega, H, Mezzich, JE, Mezzich, AC. Adjustment disorder as a marginal or transitional illness category in DSM-III. Arch Gen Psychiatry 1987;44:567–72.CrossRefGoogle ScholarPubMed
Faulstich, ME, Moore, JR, Carey, MP, Ruggiero, L, Gresham, F. Prevalence of DSM-III conduct and adjustment disorders for adolescent psychiatric inpatients. Adolescence 1986;21:333–6.Google ScholarPubMed
Fergusson, DM, Horwood, LJ, Lynskey, MT. Parental separation, adolescent psychopathology, and problem behaviors. J Am Acad Child Adolesc Psychiatry 1994;33:1122–31.CrossRefGoogle ScholarPubMed
Forehand, R, Biggar, H, Kotchick, BA. Cumulative risk across family stressors: short-and long-term effect for adolescents. J Abnorm Child Psychol 1998;26:119–28.CrossRefGoogle Scholar
Ge, X, Conger, RD. Adjustment problems and emerging personality characteristics from early to late adolescence. Am J Community Psychol 1999;27:429–59.CrossRefGoogle ScholarPubMed
Giotakos, O. Parenting received in childhood and early separation anxiety in mole conscripts with adjustment disorder. Mil Med 2002;167:2833.CrossRefGoogle Scholar
Gonzalez-Jaimes, EI, Turnbull-Plaza, B. Selection of psychotherapeutic treatment for adjustment disorder with depressive mood due to acute myocardial infarction. Arch Med Res 2003;34:298304.CrossRefGoogle ScholarPubMed
Greenberg, WM, Rosenfeld, DN, Ortega, EA. Adjustment disorder as an admission diagnosis. Am J Psychiatry 1995;152:459–61.Google ScholarPubMed
Katzman, JW, Tomori, O. Adjustment dísorders. In: Sadock, BJ, Sadock, VA, editors. Comprehensive textbook of psychiatry. 8th ed. Philadelphia: Lippincott William &: Wilkins; 2005. p. 2055-62.Google Scholar
Kim, KJ, Conger, RD, Eider, GH Jr, Lorenz, FO. Reciprocal influences between stressful life events and adolescent intemalizing and extemalizing problems. Child Dev 2003;74:127–43.Google Scholar
Kovacs, M, Gatsonis, C, Pollock, M, Parrone, PL. A controlled prospective study of DSM-III adjustment disorder in childhood. Arch Gen Psychiatry 1994;51:535–41.CrossRefGoogle ScholarPubMed
Kovacs, M, Ho, V, Pollock, MH. Criterion and predictive validity of the diagnosis of adjustment disorder: a prospective study of youths with new-onset insulin-dependent diabetes mellitus. Am J Psychiatry 1995;152:523–8.Google Scholar
Lönnqvist, J. Evaluation of psychiatric treatment. Psychiatria Fennica 1984;15:2940.Google Scholar
Marttunen, MJ, Aro, HM, Henriksson, MM, Lönnqvist, J. Adolescent suicides with adjustment disorders or no psychiatric diagnosis. Eur Child Adolesc Psychiatry 1994;3:101–10.CrossRefGoogle ScholarPubMed
Newcorn, J, Strain, J. Adjustment disorder in children and adolescents. J Am Acad Child Adolesc Psychiatry 1992;31:318–27.CrossRefGoogle ScholarPubMed
Newcorn, JH, Strain, J. Adjustment disorder in children and adolescents. In: Widiger, TA, Frunces, AJ, Pincus, HA, Ross, R, First, MB, Davis, W, editors. DSM-IV sourcebook, val. 3. Washington, DC: APA; 1997. p. 291-301.Google Scholar
Pelkonen, M, Marttunen, M, Pulkkinen, E, Laippala, P, Aro, H. Characteristics of outpatient adolescents with suicidal tendencies. Acta Psychiatr Scand 1997;95:100–7.CrossRefGoogle ScholarPubMed
Pelkonen, M, Marttunen, M, Laippala, P, Lönnqvist, J, Aro, H. Psychosocial functioning in adolescent psychiatric pauents: a prospective study on the changes in psychosocial functioning among severely and moderately impaired adolescent outpatients. Acta Psychiatr Scand 1997;96:217–24.CrossRefGoogle Scholar
Pelkonen, M, Marttunen, M, Laippala, P, Lönnqvist, J. Factors associated with early dropout from adolescent psychiatric outpatient treatment. J Am Acad Child Adolesc Psychiatry 2000;39:329–36.CrossRefGoogle ScholarPubMed
Pelkonen, M, Marttunen, M, Aro, H. Risk for depression: a 6-year follow-up of Finnish adolescents. J Affect Disord 2003;77:4151.CrossRefGoogle Scholar
Pelkonen, M, Marttunen, M, Henriksson, M, Lönnqvist, J. Suicidality in adjustment disorder. Clinical characteristics of adolescent outpatients. Eur Child Adolesc Psychiatry 2005;14:174–80.CrossRefGoogle ScholarPubMed
Pichel, JI. A long-term follow-up study of 60 adolescent psychiatric out-patients. Am J Psychiatry 1974;131:140–4.CrossRefGoogle Scholar
Snyder, S, Strain, JJ, Wolf, D. Differentiating major depression from adjustment disorder with depressed mood in the medical setting. Gen Hosp Psychiatry 1990;12:159–65.CrossRefGoogle ScholarPubMed
Spalletta, G, Troisi, A, Saracco, M, Ciani, N, Pasini, A. Symptom profile, axis II comorbidity and suicidal behavior in young males with DSM-III-R depressive illnesses. J Affect Disord 1996;39:141–8.CrossRefGoogle ScholarPubMed
SPSS, Inc. SPSS base 12.0 for Windows: user's guide. Chicago: SPSS, Inc.; 2003.Google Scholar
Strain, JJ, Newcom, J, Wolf, D, Fulop, G, Davis, W. Considering changes in adjustment disorder. Hosp Community Psychiatry 1993;44:13–5.Google ScholarPubMed
Strain, JJ, Newcom, J, Mezzich, J, Kirisci, L. Adjustment disorder: the MacArthur reanalysis. In: Widiger, TA, Frunces, AJ, Pincus, HA, Ross, R, First, MB, Davis, W, editors. DSM-IV sourcebook, vol. 4. Washington, DC: APA; 1998. p. 403-24.Google Scholar
van der Klink, JJL, van Dijk, FJH. Dutch practice guidelines for managing adjustment disorders in occupational and primary health care. Scand J Work Environ Health 2003;29:478–87.CrossRefGoogle ScholarPubMed
Woolston, JL. Theoretical considerations of the adjustment disorders. J Am Acad Child Adolesc Psychiatry 1988;27:280–7.CrossRefGoogle ScholarPubMed