Evaluation of post-traumatic stress disorder (PTSD) and related comorbidities in clinical studies

Abstract

Patients with traumatic brain injury (TBI) of varying severities are experiencing adverse outcomes during and after rehabilitation. Besides depression and anxiety, post-traumatic stress disorder (PTSD) is highly encountered in civilian and military populations. As more prospective and retrospective studies - focused on evaluating new or old psychological therapies in inpatient, outpatient, or controlled environments, targeting patients with PTSD with or without a history of TBI - are carried out, researchers are employing various scales to measure PTSD as well as other psychiatric diagnoses or cognitive impairments that might appear following TBI. We aimed to explore the literature published between January 2010 and October 2021 by querying three databases. Our preliminary results showed that several scales - such as the Clinician-Administered PTSD Scale (CAPS), the Posttraumatic Stress Disorder Checklist Military Version (PCL-M) as well as Specific Version (PCL-S), and Civilian Version (PCL-C) - have been frequently used for PTSD diagnosis and symptom severity. However, heterogeneity in the scales used when assessing and evaluating additional psychiatric comorbidities and cognitive impairments are due to the study aim and therapeutic approaches. Therefore, conducting an intervention focusing on post-TBI PTSD patients requires increased attention to patients' medical history in capturing multiple cognitive impairments and affected neuropsychological processes when designing the study and including validated instruments for measuring primary and secondary neuropsychological outcomes.

Keywords: ACT – Acceptance and Commitment Therapy; ASD – Acute Stress Disorder; BDI-II – Beck Depression Inventory 2nd ed; CALM – cognitive applications for life management; CAPS; CAPS – Clinician-Administered PTSD Scale; CPT – Cognitive Processing Therapy; CPT-C – Cognitive Processing Therapy-Cognitive Only; D-KEFS – Delis-Kaplan Executive Function System; DASS – Depression Anxiety Stress Scale; HADS – Hospital Anxiety and Depression Scale; HIBS – Head Injury Behavior Scale; MBSR – Mindfulness-Based Stress Reduction; MD – Major Depression; NSI – Neurobehavioral Symptom Inventory; OEF – Operation Enduring Freedom; OIF – Operation Iraqi Freedom; OND – Operation New Dawn; PCL-C – Posttraumatic Stress Disorder Checklist Civilian Version; PCL-M – Posttraumatic Stress Disorder Checklist Military Version; PCL-S – Posttraumatic Stress Disorder Checklist Specific Version; PE – prolonged exposure; PTA – post-traumatic amnesia; PTSD – post-traumatic stress disorder; SSRIs – Selective Serotonin re-uptake inhibitors; TAU – trauma-focused group treatment; TBI; TBI – Traumatic Brain Injury; THR – Therapeutic horseback riding; WMH – World Mental Health; clinical studies; post-TBI PTSD; post-traumatic stress disorders.