Getting Started Global Assessment

All clinical evaluations begin with identifying the presenting problem of a given patient or patients. Individuals with PTSD rarely come in and state, "Hey, I have PTSD and here are my symptoms." Instead, much like most people presenting for mental health services, they complain of less core symptoms and of more peripheral problems. Here is a quick guide to common PTSD presenting problems:

■ Memory, attention, and concentration problems

■ Irritability, agitation, and anger

■ Feeling stressed out or keyed up

■ Feeling fearful, as if something bad is going to happen

■ Feeling numb, wanting to avoid people, and relationship problems

■ Nightmares

■ Depression

Individuals with PTSD will often present with memory, attention, and concentration problems. They will report, or their family members will report, that they forget conversations, where they placed objects, and common daily events. They act spaced out. Agitation or irritability is also a common complaint. They report feeling keyed up or stressed out all the time. They might complain of feeling emotionally numb and disconnected from people. They might be having nightmares. No matter what the presenting problems are, once enough information has been ascertained by the clinician to suspect that the patient might be suffering from PTSD, a PTSD-relevant background and history taking needs to be performed.

All clinicians have training and favored methods to use in their general approach to the generic patient. To one extent or another, clinicians employ a structured or semistructured interview method in beginning to grasp and develop an understanding of a particular patient's issues. With respect to PTSD presentations, there exist a number of structured and semistructured clinical interview methods or instruments.

The Structured Clinical Interview for DSM-IV Axis I Disorders, Clinical Version (SCID-I) is a very widely used and trustworthy structured interview for all psychiatric disorders. It is considered a sensitive instrument in accurately identifying persons with PTSD versus those who do not have PTSD. A weakness of this instrument is considered to be its reliance on the interviewee's memory and recollection of symptom severity over a long period of time. This may result in distorted or inaccurate measurement.

Other structured or semistructured interview techniques of note are the PTSD Interview (Watson, Juba, Manifold, Kucala, et al., 1991) and the Clinician-Administered PTSD Scale (CAPS; Blake et al., 1990, 1995). The PTSD Interview has shown strong reliability features and good sensitivity. It is brief and does not require a professional to administer. Its weaknesses are its face validity and potential for bias due to reporter distortion. The CAPS was developed for use with veterans and is considered a solid instrument because of its psychometric properties and its rating of both the intensity and frequency of symptoms. It is considered an accurate and efficient instrument. Its weaknesses are its administration length and its limited use with nonveterans.

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