Table 1.
Posttraumatic Stress Disorder (PTSD) Assessment Tool: 2 Patient Cases and 25 Interactive Questions Based on the Guideline of the Department of Veterans Affairs (VA) and Department of Defenseab
| Patient Case/Assessment Questions | Appropriate Response | Source |
| Patient Case Vignette 1: Ms A, 36 years old, visits your office for the first time for a routine annual examination. Her physical examination shows that she is in good health. During the visit, she mentions that she is in the National Guard and returned from active duty in Iraq 3 months ago | ||
| (1) What is the prevalence of PTSD diagnosis among those who were on active duty upon return to civilian life in the United States? | 12%–25% | Milliken et al (2007)3 |
| (2) Ms A does not complain of any emotional symptoms at this visit and tells you that she screened negative for mental health problems when she left active duty 3 months ago. Would you screen for PTSD at this visit? | Yes | Quinlan et al (2010)7 |
| Veterans Affairs/Department of Defense (2010)15 | ||
| (3) Which of the following short screens for PTSD have you used in your own clinical practice? | Beck Anxiety Inventory-Primary Care | Multiple responses allowed; Veterans Affairs/Department of Defense (2010)15 |
| SPAN | ||
| SPRINT | ||
| SPRINT-E | ||
| Primary Care PTSD Screen | ||
| Short-form PTSD Checklist | ||
| Short screening scale for PTSD | ||
| Trauma Screening Questionnaire | ||
| Davidson Trauma Scale | ||
| (4) Approximately how long does it take to administer the Primary Care PTSD Screen? | ≤2 min | Prins et al (2004)21 |
| (5) During the examination, when asked, Ms A says she tries not to think about her active duty experiences now that she is back home. She describes trouble sleeping, being bothered by even small noises, and waking up frequently at night for the past month. She lives alone. When asked, she reluctantly describes feeling tired and out of touch with her home life and friends, but denies being troubled by nightmares or flashbacks. Which of the following does this indicate to you? | A positive PTSD screen result | Veterans Affairs/Department of Defense (2010)15 |
| (6) In your practice setting, do you currently have a system in place to routinely identify mental health problems in your patients who are service members returning from active duty? | Yes | Self-report |
| Planned but not implemented | ||
| No | ||
| (7) If Ms A screens positive on a short screen for PTSD, which of the following would be your next step to reach a diagnosis? | Assess with a structured interview for PTSD and/or other mental disorders | Veterans Affairs/Department of Defense (2010)15 |
| (8) Do you currently have access to referral to specialist mental health services for your patients? | Yes | Self-report |
| No | ||
| My practice specializes in mental health | ||
| (9) What proportion of your patients do you estimate have ever served in the military on active duty? | 0%–5% | Self-report |
| 6%–10% | ||
| 11%–20% | ||
| 21%–50% | ||
| >50% | ||
| Patient Case Vignette 2: Mr B, 40 years old, visits your office for the first time with his sister, who describes his symptoms to you for him. She tells you that he complains of frequent headaches, which his sister believes to be migraines, and that he has stopped going to work. During the visit, she also tells you that her family relocated to your community from New Orleans, Louisiana, where her brother was a police officer for 10 years | ||
| (10) Would you screen Mr B for PTSD at this visit? | Yes | Centers for Disease Control and Prevention (2006)12 |
| Veterans Affairs/Department of Defense (2010)15 | ||
| Weisler et al (2006)13 | ||
| (11) Would you screen Mr B for depression at this visit? | Yes | Centers for Disease Control and Prevention (2006)12 |
| Weisler et al (2006)13 | ||
| (12) The degree of functional impairment that PTSD causes is related to other impairments in which of the following ways? | PTSD causes impairment similar to that of major depression | Veterans Affairs/Department of Defense (2010)15 |
| (13) Mr B’s sister had discussed his headaches. Which of the following would be your next step if Mr B is currently taking opioid medication to control migraine-related pain? | Mitigate potential for opioid misuse, abuse, or overdose | Bray et al (2010)22 |
| Stetka (2010)23 | ||
| (14) You question Mr B with the items from the Primary Care PTSD Screen, and his responses and input from his sister indicate a positive screen. What is your next step? | Speak with him privately, review screen results, and screen for suicidal ideation | Veterans Affairs/Department of Defense (2010)15 |
| (15) Which of the following tools would you use to screen for mental health status if you were not sure of PTSD symptoms after the initial screen? | Mini International Neuropsychiatric Interview | Self-report |
| Primary Care Evaluation of Mental Disorders | ||
| PTSD Checklist | ||
| Other assessment | ||
| (16) Which of the following is most likely when discussing health status with a patient who has PTSD? | Patient will present with somatic complaints | Veterans Affairs/Department of Defense (2010)15 |
| (17) Which of the following distinguish PTSD from acute stress disorder? | Presence of symptoms 1 month or longer after a traumatic event | Veterans Affairs/Department of Defense (2010)15 |
| (18) How confident are you in your ability to screen for PTSD in your own practice? | Not at all confident | Self-report |
| (19) How confident are you in your ability to diagnose PTSD in your own practice? | Somewhat confident | |
| Confident | ||
| Very confident | ||
| (20) If Mr B refuses a referral to a mental health professional after a positive Primary Care PTSD Screen, what is your next step? | Discuss referral for evaluation rather than treatment | Veterans Affairs/Department of Defense (2010)15 |
| (21) Which of the following barriers to identifying PTSD in your clinical practice do you most frequently encounter related to patient factors? | Reluctance or refusal of the patient to discuss symptoms | Self-report; multiple responses allowed |
| Reluctance of the patient to discuss positive PTSD screen results | ||
| Stigma associated with a mental health disorder | ||
| Lack of educational resources for patients | ||
| Need for educational resources in a language your patient understands | ||
| (22) Which of the following barriers to identifying PTSD in your clinical practice do you most frequently encounter related to systems? | Insufficient time with patients for effective screening | Self-report; multiple responses allowed |
| Lack of insurance coverage for treatment | ||
| Reimbursement issues | ||
| Lack of availability of referral to specialized mental health care | ||
| Lack of access to VA care for mental health | ||
| (23) What is your current practice setting? | Community mental health center | Self-report |
| VA hospital | ||
| Academic hospital/community hospital | ||
| Group practice | ||
| Private practice | ||
| Other | ||
| (24) Approximately how many patients do you currently screen for PTSD each week? | 0–5 | Self-report |
| (25) Approximately how many patients do you newly diagnose with PTSD each month? | 6–10 | |
| 11–20 | ||
| 21–50 | ||
| 51–100 | ||
| >100 |
a
Based on the guideline of Veterans Affairs/Department of Defense.15
b
The Internet assessment patient case–based questions and the appropriate answers used to score the assessment are shown. The full, interactive assessment is available online at http://www.medscape.com/viewarticle/727096. The most appropriate response is based on the current guideline and recommendations as cited in Brown and Weisler.17
Abbreviations: SPAN=Startle, Physically upset by reminders, Anger, Numbness; SPRINT=Short Posttraumatic Stress Disorder Rating Interview; SPRINT-E=SPRINT-Expanded.