G. Reassess PTSD Symptoms; Diagnostic Status, Functional Status; Quality Of Life; Additional Treatment Needs; Patient Preferences

OBJECTIVE

Assess patient status following therapeutic intervention to determine future direction

RECOMMENDATIONS

1. Follow-up status of patients with PTSD should be monitored at least every three months. Use interview and questionnaire methods to assess PTSD symptoms and function.
   • Diagnostic status and symptom severity
   • Functional status / Health-related quality of life
   • Psychosocial treatment needs
   • Patient preferences
   • Therapy adherence
   • Adverse treatment effects

DISCUSSION

Patients should be assessed every three months after initiating treatment for PTSD, in order to monitor changes in clinical status and revise the intervention plan accordingly. The interval of three months is suggested because many controlled trials of first line therapies for PTSD recommended in this guideline demonstrate clinically significant changes during this time frame. Assessment of the following domains is advised: (a) diagnostic status and symptom severity of PTSD and comorbid mental disorders and medical conditions; (b) functional status and quality of life in major areas of adjustment (e.g., occupation, social and family relations, activities of daily living and capacity for self-care, physical health needs, and spiritual fulfillment); (c) psychosocial treatment needs (e.g., financial and housing deficits); (d) patient satisfaction with treatment received and preferences for type and amount of continued treatment, (e) compliance or adherence with treatments provided; and (e) adverse side effects of pharmacological or psychosocial treatments administered.

A number of interview and questionnaire methods are recommended for assessing the diagnostic status and clinical severity of patients (see PTSD - Primary Care Module, Annotation E). These measures may be used to identify the presence/absence of major mental disorders, including PTSD, as well as the degree of symptom severity. This information is also a useful form of feedback to be shared with patients in assessing progress of treatment and making collaborative decisions about future directions of care. The DSM-IV criteria for PTSD domains (b - e) can be routinely measured using standard clinical interview methods. Alternatively, a patient-administered clinical outcome questionnaire that assesses all domains is available for clinical assessment and program monitoring. This instrument is available through the VA Northeast Program Evaluation Center.