How should I approach the management of a patient with adjustment disorder who is experiencing significant functional impairment?

Approach to managing a patient with adjustment disorder experiencing significant functional impairment:

• Assessment and diagnosis: Conduct a comprehensive assessment focusing on the degree of distress and functional impairment caused by the adjustment disorder, considering the impact on personal and social functioning.
• Psychological interventions: Offer appropriate psychological therapies, such as cognitive behavioural therapy (CBT), tailored to the patient's needs and severity of impairment.
• Stepped care approach: Use a stepped-care model starting with the least intrusive interventions, such as psychoeducation and active monitoring, progressing to higher intensity psychological treatments if functional impairment is marked or persists.
• Medication: Consider pharmacological treatment only if psychological interventions are insufficient or if there are comorbid conditions like depression or anxiety that complicate management.
• Address barriers and comorbidities: Identify and manage any coexisting mental health problems or social factors that may worsen functional impairment or hinder engagement with treatment.
• Safety planning and support: Develop a safety plan if there is risk of self-harm or suicide, and ensure ongoing support and monitoring, including referral to specialist services if needed.

This approach aligns with NICE guidance on managing mental health conditions with functional impairment, emphasising assessment, stepped care, psychological therapies, and consideration of medication when appropriate NICE CG113,NICE NG222,NICE CKS.