Evidence-based assessment/Traumatic brain injury (assessment portfolio)/extended version

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Medical disclaimer: This page is for educational and informational purposes only and may not be construed as medical advice. The information is not intended to replace medical advice offered by physicians. Please refer to the full text of the Wikiversity medical disclaimer.

What is an assessment "portfolio"?

For background information on what assessment portfolios are, click the link in the heading above.

Preparation Phase

Demographic information

This section describes the demographic settings of the populations sampled, base rates of PTSD diagnoses, country/region sampled, and the diagnostic methods that were used. Using this information, clinicians will be able to anchor the most appropriate rate of PTSD that they are likely to see in their clinical practice.

Base rates of PTSD in different clinical settings and populations

Setting	Reference	Base Rate	Demography	Diagnostic Method	Best Recommended For
Non-clinical: Population based	Kessler et al., 2005	6.8%	United States, nationally representative, age 18 and older	National Comorbidity Survey - Replication
Non-clinical: Population based	de Vries & Olff, 2009	7.4%	Netherlands, nationally representative, age 18-80	Composite International Diagnostic Interview (CIDI)
Non-clinical: Population based	Pietrzak et al., 2011	6.4%	United States, nationally representative, age 18 and older	Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions
Non-clinical: Population based	Bunting et al., 2013	8.8%	Northern Ireland, representative sample, age 18 and older	Northern Ireland Study of Health and Stress
Non-clinical: Population based	23819543 Atwoli et al., 2013	2.3%	South Africa, nationally representative sample, age 18 and older	South African Stress and Health Study, using the Composite International Diagnostic Interview (CIDI)
U.S. Service Members	Hoge et al., 2004	11.5% - 19.5% ♦	U.S. Army and Marine Soldiers Deployed to Iraq and Afghanistan	PTSD Checklist
Non-clinical: Population based	Merikangas et al., 2010	5.0%	United States, nationally representative, ages 13-18	National Comorbidity Survey Replication—Adolescent Supplement (NCS-A)

♦ Note: These rates were using broad PTSD Checklist scoring criteria of being scored positive if subjects reported at least one intrusion symptom, three avoidance symptoms, and two hyperarousal symptom that were categorized as at the moderate level. The 11.5% is for soldiers returning from deployment in Iraq, 19.5% is for soldiers returning from Afghanistan. Another common practice is to use a strict cutoff of 50 on the PCL, above which someone screens positive for PTSD. With this cutoff, rates are 6.2% and 12.9% for Service Members returned from Afghanistan and Iraqi, respectively.

Prediction Phase

Diagnosis

DSM-5 criteria

The DSM-5 criteria are copyrighted by the American Psychiatric Association, which restricts access. We are working on getting permission to reproduce or link to them here.

Diagnostic changes

The DSM-5 criteria for posttraumatic stress disorder differ significantly from those in DSM-IV and also are different from the current definition in the International Classification of Diseases (ICD). Changes between DSM-IV and -5 and are as follows:

• Stressor criterion (Criterion A) is more specific regarding the individual experience of "traumatic events";
• Criterion A2 (subjective reaction) no longer exists;
• The three major symptoms clusters in DSM-IV (re-experiencing, avoidance/numbing, and arousal) are now four symptom clusters in DSM-5.
  • The avoidance/numbing cluster is now divided into two distinct clusters: avoidance and persistent negative alterations in cognitions and mood;
  • The persistent negative alterations in cognitions and mood cluster contains most of the DSM-IV arousal symptoms and includes irritable or aggressive behavior and reckless or self-destructive behavior;
• Diagnostic thresholds have been lowered for children and adolescents to be more sensitive to development;
• There are additional separate criteria for children 6 years of age or younger.

Developmental sensitivities

• Diagnostic thresholds have been lowered for children and adolescents to account for development.
• Separate and additional criteria have been added for children age 6 or younger.

Posttraumatic stress disorder is now more sensitive to development in that diagnostic thresholds have been lowered for children and adolescents. Furthermore, separate and additional criteria have been added for children age 6 years of age or younger.

Screening and diagnostic instruments for PTSD

Measure	Format (Reporter)	Age Range	Administration/ Completion Time	Inter-rater reliability	Test-retest reliability	Construct validity	Content validity	Highly recommended
Glasgow Coma Scale	Clinician Administered	adult and pediatric versions available	5 minutes	N/A	G	E	G	X
CAPS (Clinician Administered PTSD Scale)	Clinician Administered Self-Report	adult and child versions available	40-60 minutes	E	E	E	E	X
SCID-IV (Structured Clinical Interview for DSM-IV)	Interview (Patient)	adult	1-2 hours	A	A	G	G	X
PSS-I (PTSD Symptom Scale Interview)	Interview (Patient)	adult	20 minutes	E	G	G	G
SI-PTSD (Structured Interview for PTSD)	Interview (Patient)	adult	20-30 minutes	E	A	G	G
ADIS (Anxiety Disorder Interview Schedule)	Interview (Patient)	adult	2-4 hours	G	A	G	G
UCLA PTSD Reaction Index for DSM-5	Self-Report, Caregiver Report	child
CPSS (Children's PTSD Symptom Scale)	Self-Report	child	10-20 minutes
IES-R (Impact of Event Scale-Revised)	Self-Report	adult	10-15 minutes	N/A	A	G	G
M-PTSD (Mississippi Scale for Combat Related PTSD)	Self-Report	adult, specific versions for veterans and civilians	10-15 minutes	N/A	G	E	E
PK Scale (Keane PTSD Scale of the MMPI-2)	Self-report	adult	60-90 minutes (entire MMPI-2)	N/A	G	E	G
PDS (Post-traumatic Diagnosis Scale)	Self-Report	adult	10-20 minutes	N/A	G	E	G	X
LASC (Los Angeles Symptoms Checklist)	Self-Report	adult	5-10 minutes	N/A	G	G	G

Note: L = Less than adequate; A = Adequate; G = Good; E = Excellent; U = Unavailable; NA = Not applicable

Process Phase

Treatment

Behavioral interventions

• Recommended:
  • Brief Cognitive Behavioral Therapy (CBT; 4-5 sessions) has significant benefit.
    • This includes stress inoculation training, trauma-focused therapy including components of cognitive restructuring, Cognitive Processing Therapy (CPT), imaginal, virtual, and in-vivo exposure as in Prolonged Exposure psychotherapy (PE)²
    • Patient education is recommended as part of psychotherapy for patients and family members
  • EMDR may help both acute and chronic PTSD, especially individuals who have trouble with prolonged exposure or have trouble verbalizing their trauma. Long term gains require further study.

• Treatments with weaker evidence:
  • Patient education, imagery rehearsal therapy, psychodynamic therapy, hypnosis, relaxation techniques, and group

therapy may have some benefit. Web-based CBT, Acceptance and commitment therapy, and Dialectical Behavioral Therapy have unknown benefit.

Medication

• SSRIs are more effective than placebo in treating PTSD.
• There is no evidence to support a medication to prevent the development of PTSD.
  • Imipramine, propranolol, prazosin, other antidepressants, anticonvulsants, and atypical antipsychotics have unknown benefit.
  • Strongly recommend against the use of benzodiazepines² and typical antipsychotics since they have no benefit and potential harm.

Process and outcome measures

Severity and outcome

Clinically significant change benchmarks with common instruments for PTSD

Measure	Cut-off scores			Critical Change (unstandardized scores)
Benchmarks Based on Published Norms
	A	B	C	95%	90%	SEdifference
Primary Care PTSD Screen	1.0	3.1	2.0	1.0	.8	.5
PTSD Checklist Scores	28.8	40.8	34.9	4.6	3.8	2.3
Clinician Administered PTSD Scale	28.8	40.8	34.9	8.3	7.0	4.2

External links

For professionals

• Post Traumatic Stress Disorder Information Resource from The University of Queensland School of Medicine
• APA practice parameters for assessment and treatment for PTSD (Updated 2017)
• Resources for professionals from VA National PTSD Center

For caregivers

• Tips for parents on shooting media coverage
• Parent guidelines to helping youths after a shooting
• Caregiver tips for helping teens with traumatic grief
• Caregiver tips for helping school-age children with traumatic grief

For educators

• Teacher tips for providing psychological first aid
• Educator tips for helping youths after a community trauma

For public

• Psychological impacts of recent shootings
• Tips to talking to youths about a shooting
• Tips to talking to children about a shooting
• Helping young children heal after a crisis
• Psychological first aid for schools
• Resources and manuals on psychological first aid
• Resources for the public from VA National PTSD Center
• Posttraumatic stress disorder at Curlie (based on DMOZ)

References

Click here for references