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).
1
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) .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.
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).
12
• https://wexnermedical.osu.edu/neurologic-institute/departments-and-centers/research-centers/ohio-valley-center-for-brain-injury-prevention-and-rehabilitation/osu-tbi-id |
|
| 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.
13
,14
• https://www.health.mil/Reference-Center/Forms/2015/04/30/Neurobehavioral-Symptom-Inventory-Form |
|
| Depression symptoms | PHQ-9: Consider total score as well as score on question 9.
15
• https://www.apa.org/depression-guideline/patient-health-questionnaire.pdf |
|
| PTSD symptoms | PCL-5 for DSM-5.
16
• https://www.ptsd.va.gov/professional/assessment/adult-sr/ptsd-checklist.asp |
|
| Alcohol use | Alcohol Use Disorders Identification Test.
17
• https://auditscreen.org/ |
|
| Anxiety symptoms | GAD-7.
18
• https://adaa.org/sites/default/files/GAD-7_Anxiety-updated_0.pdf |
|
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.
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References
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.
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.
- The DSM-5 approach to the evaluation of traumatic brain injury and its neuropsychiatric sequelae.NeuroRehabilitation. 2014; 34: 613-623
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.
- Post-traumatic stress disorder after civilian traumatic brain injury: a systematic review and meta-analysis of prevalence rates.J Neurotrauma. 2019; 36: 322-332
- A systematic review and meta-analysis on PTSD following TBI among military/veteran and civilian populations.J Head Trauma Rehabil. 2020; 35: E21-E35
- Traumatic brain injury and posttraumatic stress disorder.Psychiatr Clin North Am. 2014; 37: 55-75
- Exploring the convergence of posttraumatic stress disorder and mild traumatic brain injury.Am J Psychiatry. 2009; 166: 768-776
- PTSD as a mediator in the relationship between post-concussive symptoms and pain among OEF/OIF/OND veterans.Mil Med. 2019; 184: e118-e123
- 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
- A systematic review of recommended modifications of CBT for people with cognitive impairments following brain injury.Neuropsychol Rehabil. 2019; 29: 1-21
- Initial reliability and validity of the Ohio State University TBI Identification Method.J Head Trauma Rehabil. 2007; 22: 318-329
- Neurobehavioral Symptom Inventory.in: Kreutzer JS Deluca J Caplan B Encyclopedia of clinical neuropsychology. 2nd ed. Springer-Verlag, New York2018
- Persistent post-concussive syndrome: the structure of subjective complaints after mTBI.J Head Trauma Rehabil. 1995; 10: 1-17
- Validity of the Patient Health Questionnaire-9 in assessing depression following traumatic brain injury.J Head Trauma Rehabil. 2005; 20: 501-511
- The Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): development and initial psychometric evaluation.J Trauma Stress. 2015; 28: 489-498
- 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
- Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population.Med Care. 2008; 46: 266-274
Article Info
Publication History
Published online: December 15, 2021
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© 2021 The American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
