The Primary Care PTSD Screen (PC-PTSD)

Jeffrey Wilson — Thu, 18 Oct 2018 16:54:45 +0000

Date Added:

October 18, 2018

Journal/Publication:

Journal of General Internal Medicine

Issue:

Volume:

Pages:

1206-1211

URL:

The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5)

Type:

Clinical Decision Aids, Practice Management Research Results

Format:

Article

DOI (1):

10.1007/s11606-016-3703-5

Keywords

PTSD

post-traumatic stress disorder

DSM

PMID (1):

27170304

MeSH

stress disorder, post-traumatic

self report

diagnostic and statistical manual of mental disorders

patient health questionnaire

The PC-PTSD is a 4-item screen that was designed for use in primary care and other

medical settings and is currently used to screen for PTSD in veterans at the VA.

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BACKGROUND

Posttraumatic Stress Disorder (PTSD) is associated with increased health care utilization, medical morbidity, and tobacco and alcohol use. Consequently, screening for PTSD has become increasingly common in primary care clinics, especially in Veteran healthcare settings where trauma exposure among patients is common.

OBJECTIVE

The objective of this study was to revise the Primary Care PTSD screen (PC-PTSD) to reflect the new Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for PTSD (PC-PTSD-5) and to examine both the diagnostic accuracy and the patient acceptability of the revised measure.

DESIGN

We compared the PC-PTSD-5 results with those from a brief psychiatric interview for PTSD. Participants also rated screening preferences and acceptability of the PC-PTSD-5.

PARTICIPANTS

A convenience sample of 398 Veterans participated in the study (response rate = 41 %). Most of the participants were male, in their 60s, and the majority identified as non-Hispanic White.

MEASURES

The PC-PTSD-5 was used as the screening measure, a modified version of the PTSD module of the MINI-International Neuropsychiatric Interview was used to diagnose DSM-5 PTSD, and five brief survey items were used to assess acceptability and preferences.

KEY RESULTS

The PC-PTSD-5 demonstrated excellent diagnostic accuracy (AUC = 0.941; 95 % C.I.: 0.912– 0.969). Whereas a cut score of 3 maximized sensitivity (κ[1]) = 0.93; SE = .041; 95 % C.I.: 0.849–1.00), a cut score of 4 maximized efficiency (κ[0.5] = 0.63; SE = 0.052; 95 % C.I.: 0.527–0.731), and a cut score of 5 maximized specificity (κ[0] = 0.70; SE = 0.077; 95 % C.I.: 0.550–0.853). Patients found the screen acceptable and indicated a preference for administration by their primary care providers as opposed to by other providers or via self-report.

CONCLUSIONS

The PC-PTSD-5 demonstrated strong preliminary results for diagnostic accuracy, and was broadly acceptable to patients.

Author/s:

Prins, Annabel, Bovin, Michelle J., Smolenski, Derek J., Marx, Brian P., Kimmerling, Rachel, Jenkins-Guarnieri, Michael A., Kaloupek, Danny G.

The World Health Organization Adult Attention-Deficit/Hyperactivity Disorder Self-Report Screening Scale for DSM-5

Jeffrey Wilson — Thu, 23 Aug 2018 18:01:22 +0000

Date Added:

August 23, 2018

Journal/Publication:

JAMA Psychiatry

Publisher:

American Medical Association

Publication Date:

May 1, 2017

Issue:

Volume:

Pages:

520-526

URL:

The World Health Organization Adult Attention-Deficit/Hyperactivity Disorder Self-Report Screening Scale for DSM-5

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1001/jamapsychiatry.2017.0298.

Keywords

ADHD

DSM

Self report

PMID (1):

28384801

MeSH

self report

diagnostic and statistical manual of mental disorders

attention deficit disorder with hyperactivity

The article reports the high sensitivity, specificity, and positive predictive value of a new 6-item self-administered screening test for adult ADHD.

The actual test and scoring rules can be found here. If you use an unweighted scoring method, it’s free. If you want to use the weighted scoring method, you have to get permission and probably pay something.

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IMPORTANCE:

Recognition that adult attention-deficit/hyperactivity disorder (ADHD) is common, seriously impairing, and usually undiagnosed has led to the development of adult ADHD screening scales for use in community, workplace, and primary care settings. However, these scales are all calibrated to DSM-IV criteria, which are narrower than the recently developed DSM-5 criteria.

OBJECTIVES:

To update for DSM-5 criteria and improve the operating characteristics of the widely used World Health Organization AdultADHD Self-Report Scale (ASRS) for screening.

DESIGN, SETTING, AND PARTICIPANTS:

Probability subsamples of participants in 2 general population surveys (2001-2003 household survey [n = 119] and 2004-2005 managed care subscriber survey [n = 218]) who completed the full 29-question self-report ASRS, with both subsamples over-sampling ASRS-screened positives, were blindly administered a semistructured research diagnostic interview for DSM-5 adult ADHD. In 2016, the Risk-Calibrated Supersparse Linear Integer Model, a novel machine-learning algorithm designed to create screening scales with optimal integer weights and limited numbers of screening questions, was applied to the pooled data to create a DSM-5 version of the ASRS screening scale. The accuracy of the new scale was then confirmed in an independent 2011-2012 clinical sample of patients seeking evaluation at the New York University Langone Medical Center Adult ADHD Program (NYU Langone) and 2015-2016 primary care controls (n = 300). Data analysis was conducted from April 4, 2016, to September 22, 2016.

MAIN OUTCOMES AND MEASURES:

The sensitivity, specificity, area under the curve (AUC), and positive predictive value (PPV) of the revised ASRS.

RESULTS:

Of the total 637 participants, 44 (37.0%) household survey respondents, 51 (23.4%) managed care respondents, and 173 (57.7%) NYU Langone respondents met DSM-5 criteria for adult ADHD in the semistructured diagnostic interview. Of the respondents who met DSM-5 criteria for adult ADHD, 123 were male (45.9%); mean (SD) age was 33.1 (11.4) years. A 6-question screening scale was found to be optimal in distinguishing cases from noncases in the first 2 samples. Operating characteristics were excellent at the diagnostic threshold in the weighted (to the 8.2% DSM-5/Adult ADHD Clinical Diagnostic Scale population prevalence) data (sensitivity, 91.4%; specificity, 96.0%; AUC, 0.94; PPV, 67.3%). Operating characteristics were similar despite a much higher prevalence (57.7%) when the scale was applied to the NYU Langone clinical sample (sensitivity, 91.9%; specificity, 74.0%; AUC, 0.83; PPV, 82.8%).

CONCLUSIONS AND RELEVANCE:

The new ADHD screening scale is short, easily scored, detects the vast majority of general population cases at a threshold that also has high specificity and PPV, and could be used as a screening tool in specialty treatment settings.

Author/s:

Ustun, Berk, Adler, Lenard A., Rudin, Cynthia, Faraone, Stephen V., Spencer, Thomas J., Berglund, Patricia, Gruber, Michael J., Kessler, Ronald C.