Phoenix Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia.
J Trauma Stress. 2018 Jun;31(3):321-331. doi: 10.1002/jts.22295.
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.
适应障碍是一种常见的精神障碍，但对于适应障碍的有效治疗方法知之甚少。在本次系统评价中，我们旨在研究针对成人适应障碍的心理和药物干预措施，以确定哪些干预措施对改善适应障碍症状具有最佳证据。我们对 1980 年 1 月至 2016 年 9 月期间发表的文献进行了数据库检索，并确定了包含大多数被诊断为适应障碍的个体样本和适应障碍症状结果的研究。有 29 项研究符合定性综合的纳入标准；大多数研究（59%）调查了心理治疗，而非药物治疗（35%）。所测试的心理治疗方法多种多样，其中大多数包含认知行为疗法（CBT）成分（53%），其次是三项与心理动力学相关的研究、三项基于行为疗法的研究和两项涉及放松技术的研究。我们使用改良的国家卫生和医学研究理事会（National Health and Medical Research Council）质量和偏倚检查表对个别研究进行评分，然后使用推荐评估、制定与评估（Grading of Recommendations Assessment, Development and Evaluation；GRADE）系统（Grade Working Group，2004）对所有心理和药物治疗对适应障碍症状的影响的总体证据质量进行评分。尽管有几项随机对照试验，但所有心理和药物治疗对适应障碍症状的积极影响的证据质量均被评为低至极低。未来针对适应障碍治疗的高质量研究有可能对那些在经历压力事件后难以康复的个体产生重大影响。
