Transcript Detecting PTSD - Portland State University

Tools for Working with PTSD
and Associated Conditions
Resources and Challenges
Shannon McCaslin-Rodrigo, Ph.D.
Health Science Specialist
National Center for PTSD, VA Palo Alto Health Care System
Assistant Professor (Vol)
University of California, San Francisco
[email protected]
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In the Group
Detecting/Assessing for PTSD
Treatments for PTSD
Tools and Resources for Providers
http://www.ptsd.va.gov/public/about_face/veterans/timmlovitt/how-i-knew-i-had-ptsd.html
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Experiences treating Veterans and needs?
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VA experiences?
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Knowledge of VA and online resources?
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PTSD is the most under-recognized and untreated
anxiety disorder in primary care (Schonfeld et al., 1997)
Why?
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No one asks
PTSD is a disorder of avoidance
Stigma and lack of problem recognition
Individuals with PTSD present to care for other reasons:
 Major Depressive Disorder
 Other Anxiety Disorders
 Alcohol and Substance Use Disorders
 Relationship Problems
 Chronic pain
 Medical Conditions
Primary Care PTSD Screen (PC-PTSD; Prins et al., 2004)
In your life, have you ever had any experience that was so
frightening, horrible, or upsetting that, in the past month, you…
1. Have had nightmares about it or thought about it when you did
not want to?
2. Tried hard not to think about it or went out of your way to avoid
situations that reminded you of it?
3. Were constantly on guard, watchful, or easily startled?
4. Felt numb or detached from others, activities, or your
surroundings?
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Positive screen if 3 or more answered “yes”
Posttraumatic Checklist (PCL; Weather et al., 1993)
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Description
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Scoring
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Sample Item
◦ 17-item self-report measure
◦ Rate how much they were “bothered by that problem in the past month”
on a 5-point scale ranging from 1 (“not at all”) to 5 (“extremely”).
◦ Total score (range 17-85)
 Cutoff scores for a probable PTSD diagnosis (44 civilians, 50 military)
 Use DSM-IV criteria
 Combined scoring
“In the past month, how much have you been bothered by: Repeated,
disturbing memories, thoughts or images of a stressful experience from
the past?”
1 = Not at all
2 = A little bit
3 = Moderately
4 = Quite a bit
5 = Extremely
Unstructured Clinical Interview
 Follow DSM-IV-TR criteria
Structured Clinical Interview
 Clinician Administered PTSD Scale (CAPS for
DSM-IV)
Additional Information
 Self-report measures (e.g., PTSD Checklist)
 Collateral report
 Chart review
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Expert Consensus Guidelines (Journal of
Clinical Psychiatry)
◦ Foa, E.B., Davidson, J.R.T., & Frances, A.J. (1999).
Treatment of posttraumatic stress disorder
(Expert consensus guideline series). Journal of
Clinical Psychiatry, 60, Supplement 10.
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ISTSS
◦ Foa, E.B., Keane, T.M., & Friedman, M.J. (2000).
Effective Treatments for PTSD. New York: Guilford
Press.
American Psychiatric Association Practice
Guidelines
VA/DOD Joint PTSD Practice Guidelines
 www.healthquality.va.gov
Significant benefit (good evidence): A
strong recommendation that the intervention is always indicated and acceptable
◦ Cognitive Therapy
◦ Exposure Therapy
◦ Stress Inoculation Training
◦ Eye Movement Desensitization Reprocessing (EMDR)
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Released October 2007
Sponsored by VA
Identified a total of 2771 studies
Included only randomized controlled trials
(RCTs)
◦ 37 pharmaceutical (14 RCTs of SSRIs)
◦ 53 psychotherapy
http://www.iom.edu/Reports/2007/Treatment-of-PTSD-AnAssessment-of-The-Evidence.aspx
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Exposure-based therapy is the only therapy
found evidence sufficient to conclude it is
efficacious in PTSD
Overall evidence inadequate to confidently
determine efficacy of SSRIs
◦ Minority opinion stated evidence suggestive although
not sufficient for efficacy in the general population
(not male, chronic, VA)
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88% of U.S. households currently have at
least one mobile phone.
44% own a smartphone, as compared
with 18 percent two years ago.
By 2013, mobile phones will overtake PCs
as the most common Web access device
worldwide.
62% of smartphone users downloaded an
app within the last 30 days.
◦ Discover apps through searching the public
marketplaces (63%) or relying on
recommendations of trusted others (61%).
◦ Those who download apps have avg 33 apps on
their mobile phones.
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This marks the beginning of a wireless
era in which smartphones will be the
primary mechanism through which
consumers will connect with friends,
media, and the internet.
Acknowledgement to Julia Hoffman and Eric Kuhn
54K downloads in 62 countries
•High ratings: IOS 5/5 stars; Android 4.5/5 stars
•Awards: 2011 FAA Chairman’s Award for Advancement in Accessibility & 2012
ATA President’s Innovation Award
•Named: Best Federal App (Nextgov.net) and Top 10 Health Apps (Yahoo)
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PE Coach and CPT Coach (in development)
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Linkage to electronic health record and selfentered database
Ability to share directly with clinicians to
optimize care. Bidirectional communication
including personalization of apps by
clinicians
System-wide surveillance to enhance
program evaluation and mitigate crisis
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Education
Assessments
Training
Provider Pro Section
◦ Assessments (29 measures)
 Symptoms (e.g., alcohol, anger, PTSD) & wellness
 PCL –under the military sexual trauma section
◦ Educational Handouts
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Symptoms (e.g., depression, PTSD, mTBI)
Work adjustment
Sleep
Resilience
◦ Have a chat feature for Service Members
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Veteran Videos
◦ Can filter by operation, gender
◦ Can filter by signs, symptoms, conditions
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Educational Client Handouts
◦ Signs and symptoms
◦ Conditions
◦ Life events and experiences
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Resources and Support
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Public and Provider Sections
Video Trainings
◦ PTSD 101 (CEUs)
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Military Culture – handouts & training
Educational Handouts
Assessment and Treatment Information
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Trainings in CPT and PE
Handouts on Conditions
Resources
Offer Workshops
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24 hour crisis line
Can download materials
Chat online
http://www.veteranscrisisline.net/24 hour crisis line
http://cpt.musc.edu/index
9-hour course
Contact hours maybe available for continuing
education credit
Includes video demonstrations of
expert CPT clinicians
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VA
◦ www.va.gov
◦ http://www.oefoif.va.gov
◦ www.PTSD.va.gov
 PTSD 101 (free CEUs)
 Clinician’s Trauma Update
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VA/DoD Clinical Practice Guidelines
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International Society for Traumatic Stress Studies
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Cognitive Processing Therapy
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Seeking Safety
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Department of Defense
◦ www.oqp.med.va.gov/cpg/cpg.htm
◦ www.ISTSS.org
◦ http://cpt.musc.edu/index (free 9-hour web training)
◦ www.seekingsafety.org
◦ www.Battlemind.army.mil
◦ www.Afterdeployment.org
Enrollment
 Online: Visit the enrollment and benefits webpage
https://www.1010ez.med.va.gov/sec/vha/1010ez/
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Telephone: 1-877-222-VETS (8387), Monday through Friday, between
the hours of 8:00 AM and 8:00 PM (Eastern Time). A VA representative
will have your completed form sent to you for verification and signature.
Mail: Print the 10-10EZ form or 10-10EZR form or call to have the form
mailed to you. Complete and sign the application, then mail it to your
local VA Medical Center or clinic.
In Person: Your client can visit the VA Medical Center or clinic nearest
you to apply for enrollment or to update information
Program locator:
http://www2.va.gov/directory/guide/home.asp?isflash=1
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Family resources
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http://www.caregiver.va.gov/
◦ Caregiver toolkit
◦ Services
◦ Caregiver support line
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National Center for PTSD
DOD
militaryhomefront.dod.mil
VA
www.seamlesstransition.va.gov
National Guard
www.guardfamily.org
operationmilitarykids.org
OR National Guard
www.orng-vet.org
www.mil.state.or.us/ORFP/fam_supp.html
Military Wives: www.militarywives.com
Military Husbands: www.militaryhusbands.com
Military Children: www.militarychild.org
NG & R Military Kids: www.ourmilitarykids.org
Mothers of Service members:
www.bluestarmothers.org
Family Support: www.operationhomefront.net
www.militaryhomefront.dod.mil
www.militaryfamily.org
THANK YOU & Questions
[email protected]
Acknowledgements:
NC-PTSD staff
Julia Hoffman PsyD; Eric Kuhn, PhD
Suzanne Best, PhD