Advertisement

Mental Health Pocket Card for Management of Patients with Posttraumatic Stress Disorder and Mild Traumatic Brain Injury

    Published:December 15, 2021DOI:https://doi.org/10.1016/j.apmr.2021.10.013
        This pocket card aims to support mental health providers in understanding and using the Departments of Veterans Affairs and Defense Clinical Practice Guideline for assessing and treating posttraumatic stress disorder (PTSD) in those with comorbid mild traumatic brain injury (mTBI) (https://www.healthquality.va.gov/guidelines/mh/ptsd/index.asp).

        Department of Veterans Affairs/Department of Defense. VA/DoD clinical practice guidelines for the management of posttrumatic stress disorder and acute stress disorder. Available at: https://www.healthquality.va.gov/guidelines/mh/ptsd/index.asp. Accessed October 12, 2021.

        The pocket card (fig 1) is intended to be used as a supplement and guide to the Clinical Practice Guideline but not a replacement to it. Also included is a quick-reference table of public-domain, evidence-based measures to aid diagnosis and treatment (Table 1) .
        Fig 1
        Fig 1Mental health pocket card for management of patients with PTSD and a history of mTBI.
        Table 1Suggested measures available in public domain to use when working with patients with mTBI and mental health comorbidities
        Construct Measure Scores/Interpretation
        History of TBI

        OSU TBI-ID is the criterion standard in TBI assessment.
        Ohio State University TBI Identification Method (OSU TBI-ID).
        • Corrigan JD
        • Bognar J.
        Initial reliability and validity of the Ohio State University TBI Identification Method.


        https://wexnermedical.osu.edu/neurologic-institute/departments-and-centers/research-centers/ohio-valley-center-for-brain-injury-prevention-and-rehabilitation/osu-tbi-id
        • Worst TBI
        • First TBI
        • Multiple TBIs
        • Recent TBI
        • Other sources
        Postconcussive symptoms

        Symptoms can involve vestibular, somatic, cognitive, and affective domains. These symptoms are nonspecific among patients with TBI and MH conditions.
        Neurobehavioral Symptom Inventory.
        • Silva MA.
        Neurobehavioral Symptom Inventory.
        ,
        • Cicerone KD.
        Persistent post-concussive syndrome: the structure of subjective complaints after mTBI.


        https://www.health.mil/Reference-Center/Forms/2015/04/30/Neurobehavioral-Symptom-Inventory-Form
        • Survey current symptoms to guide symptom-focused treatment
        • Assess for symptom change over time
        • Total score is most reliable
        • Reported RCI is 8 points
        Depression symptoms PHQ-9: Consider total score as well as score on question 9.
        • Fann JR
        • Bombardier CH
        Validity of the Patient Health Questionnaire-9 in assessing depression following traumatic brain injury.


        https://www.apa.org/depression-guideline/patient-health-questionnaire.pdf
        • 0-4 None-minimal depression
        • 5-9 Mild
        • 10-14 Moderate
        • 15-19 Moderately severe
        • 20-27 Severe
        • Question 9: Suicidality
        PTSD symptoms PCL-5 for DSM-5.
        • Blevins CA
        • Weathers FW
        • Davis MT
        • Witte TK
        • Domino JL.
        The Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): development and initial psychometric evaluation.


        https://www.ptsd.va.gov/professional/assessment/adult-sr/ptsd-checklist.asp
        • Scores between 31-33 indicates a positive screen for PTSD
        Alcohol use Alcohol Use Disorders Identification Test.
        • Saunders JB
        • Aasland OG
        • Babor TF
        • de la Fuente JR
        • Grant M.
        Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption II.


        https://auditscreen.org/
        • 0-7 Provide alcohol education
        • 8-15 Give simple advice
        • 16-19 Give simple advice, brief counseling, and continue monitoring
        • 20-40 Give referral to specialist
        Anxiety symptoms GAD-7.
        • Löwe B
        • Decker O
        • Müller S
        • et al.
        Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population.


        https://adaa.org/sites/default/files/GAD-7_Anxiety-updated_0.pdf
        • 0-4 None-minimal anxiety
        • 5-9 Mild
        • 10-14 Moderate
        • 15-21 Severe
        Abbreviations: DSM-5, Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition); GAD-7, Generalized Anxiety Disorder Questionnaire 7; MH, mental health; PCL-5, PTSD Checklist; PHQ-9, Patient Health Questionnaire 9; RCI, Reliable Change Index.
        To read this article in full you will need to make a payment

        Purchase one-time access:

        Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
        One-time access price info
        • For academic or personal research use, select 'Academic and Personal'
        • For corporate R&D use, select 'Corporate R&D Professionals'

        Subscribe:

        Subscribe to Archives of Physical Medicine and Rehabilitation
        Already a print subscriber? Claim online access
        Already an online subscriber? Sign in
        Institutional Access: Sign in to ScienceDirect

        References

        1. Department of Veterans Affairs/Department of Defense. VA/DoD clinical practice guidelines for the management of posttrumatic stress disorder and acute stress disorder. Available at: https://www.healthquality.va.gov/guidelines/mh/ptsd/index.asp. Accessed October 12, 2021.

        2. Department of Veterans Affairs/Department of Defense. VA/DoD clinical practice guidelines for the mangement and rehaibiliation of post-acute mild traumatic brain injury. Available at: https://www.healthquality.va.gov/guidelines/rehab/mtbi/index.asp. Accessed October 12, 2021.

          • Wortzel HS
          • Arciniegas DB.
          The DSM-5 approach to the evaluation of traumatic brain injury and its neuropsychiatric sequelae.
          NeuroRehabilitation. 2014; 34: 613-623
        3. Centers for Disease Control Prevention. Surveillance report of traumatic brain injury-related emergency department visits, hospitalizations, and deaths—United States, 2014. Atlanta, GA: US Department of Health and Human Servies; 2019.

          • Van Praag DLG
          • Cnossen MC
          • Polinder S
          • Wilson L
          • Maas AIR.
          Post-traumatic stress disorder after civilian traumatic brain injury: a systematic review and meta-analysis of prevalence rates.
          J Neurotrauma. 2019; 36: 322-332
          • Loignon A
          • Ouellet MC
          • Belleville G.
          A systematic review and meta-analysis on PTSD following TBI among military/veteran and civilian populations.
          J Head Trauma Rehabil. 2020; 35: E21-E35
          • Bahraini NH
          • Breshears RE
          • Hernandez TD
          • Schneider AL
          • Forster JE
          • Brenner LA.
          Traumatic brain injury and posttraumatic stress disorder.
          Psychiatr Clin North Am. 2014; 37: 55-75
          • Stein MB
          • McAllister TW.
          Exploring the convergence of posttraumatic stress disorder and mild traumatic brain injury.
          Am J Psychiatry. 2009; 166: 768-776
          • Avallone KM
          • Smith ER
          • Ma S
          • et al.
          PTSD as a mediator in the relationship between post-concussive symptoms and pain among OEF/OIF/OND veterans.
          Mil Med. 2019; 184: e118-e123
          • Bolzenius JD
          • Roskos PT
          • Salminen LE
          • Paul RH
          • Bucholz RD.
          Cognitive and self-reported psychological outcomes of blast-induced mild traumatic brain injury in veterans: a preliminary study.
          Appl Neuropsychol Adult. 2015; 22: 79-87
          • Gallagher M
          • McLeod HJ
          • McMillan TM.
          A systematic review of recommended modifications of CBT for people with cognitive impairments following brain injury.
          Neuropsychol Rehabil. 2019; 29: 1-21
          • Corrigan JD
          • Bognar J.
          Initial reliability and validity of the Ohio State University TBI Identification Method.
          J Head Trauma Rehabil. 2007; 22: 318-329
          • Silva MA.
          Neurobehavioral Symptom Inventory.
          in: Kreutzer JS Deluca J Caplan B Encyclopedia of clinical neuropsychology. 2nd ed. Springer-Verlag, New York2018
          • Cicerone KD.
          Persistent post-concussive syndrome: the structure of subjective complaints after mTBI.
          J Head Trauma Rehabil. 1995; 10: 1-17
          • Fann JR
          • Bombardier CH
          Validity of the Patient Health Questionnaire-9 in assessing depression following traumatic brain injury.
          J Head Trauma Rehabil. 2005; 20: 501-511
          • Blevins CA
          • Weathers FW
          • Davis MT
          • Witte TK
          • Domino JL.
          The Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): development and initial psychometric evaluation.
          J Trauma Stress. 2015; 28: 489-498
          • Saunders JB
          • Aasland OG
          • Babor TF
          • de la Fuente JR
          • Grant M.
          Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption II.
          Addiction. 1993; 88: 791-804
          • Löwe B
          • Decker O
          • Müller S
          • et al.
          Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population.
          Med Care. 2008; 46: 266-274