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Protocol - PTSD Symptoms, Severity, and Diagnosis - DSM-IV

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Description:

The Clinician-Administered PTSD Scale (CAPS-IV) for The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) is a 30-item semistructured interview that is used to make a current (past month) or lifetime diagnosis of post-traumatic stress disorder (PTSD) and to provide a continuous index of PTSD severity. It also can be used to assess PTSD symptoms over the past week. In addition to assessing DSM-IV PTSD symptoms, questions target the onset and duration of symptoms, subjective distress, and impact of symptoms on social and occupational functioning, improvement in symptoms since a previous CAPS administration, overall response validity, overall PTSD severity, and features of dissociation (depersonalization and derealization).

Administration requires identification of an index traumatic event to serve as the basis for symptom inquiry. The Life Events Checklist (LEC-5, substituting for LEC-IV) for The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is recommended prior to the Criterion A inquiry included in the CAPS-IV. Standardized questions and probes are provided for each symptom.

Protocol:

Summary of the Clinician-Administered PTSD Scale for DSM-IV (CAPS-IV)

The CAPS-IV is a 30-item structured interview that can be used to:

  • Make current (past month) or lifetime diagnosis of PTSD
  • Provide a continuous index of PTSD severity
  • Assess PTSD symptoms over the past week

In addition to assessing DSM-IV PTSD symptoms, questions target the onset and duration of symptoms, subjective distress, and impact of symptoms on social and occupational functioning, improvement in symptoms since a previous CAPS administration, overall response validity, and features of dissociation (depersonalization and derealization). Most symptom severity ratings are anchored to a combination of symptom frequency and intensity; only amnesia and diminished interest are anchored to amount of disturbance and intensity.

Administration requires identification of three index traumatic events to serve as the basis for symptom inquiry. The Life Events Checklist for DSM-5 (LEC-5, see Trauma Adversity and Exposure) is recommended prior to the Criterion A inquiry included in the CAPS-IV. Standardized questions and probes are provided for each symptom.

The CAPS was designed to be administered by clinicians and clinical researchers who have a working knowledge of PTSD, but can also be administered by appropriately trained paraprofessionals. The full interview takes 45-60 minutes to administer.

Sample Item:

Frequency

Have you ever had unwanted memories of (EVENT)? What were they like? (What did you remember?) [IF NOT CLEAR:] (Did they ever occur while you were awake, or only in dreams?)

[EXCLUDE IF MEMORIES OCCURRED ONLY DURING DREAMS] How often have you had these memories in the past month (week)?

0 Never

1 Once or twice

2 Once or twice a week

3 Several times a week

4 Daily or almost every day

Intensity

How much distress or discomfort did these memories cause you? Were you able to put them out of your mind and think about something else? (How hard did you have to try?) How much did they interfere with your life?

0 None

1 Mild, minimal distress or disruption of activities

2 Moderate, distress clearly present but still manageable, some disruption of activities

3 Severe, considerable distress, difficulty dismissing memories, marked disruption of activities

4 Extreme, incapacitating distress, cannot dismiss memories, unable to continue activities

Scoring:

It is recommended that the "1, 2" rule be used to determine a diagnosis; that is, a frequency score of 1 (scale 0 = "none of the time" to 4 = "most or all of the time") and an intensity score of 2 (scale 0 = "none" to 4 = "extreme") is required for a particular symptom to meet criterion (Weathers et al., 1999). The diagnosis is then made according to the DSM-IV algorithm:

• At least one Criterion B symptom,

• At least three Criterion C symptoms,

• At least two Criterion D symptoms,

• Criterion A is met,

• Criterion E is met, and

• Criterion F is met.

A severity score for each symptom is calculated by summing the frequency and intensity scores, which can then be summed for all 17 symptom questions and/or for the three symptom clusters.

Availability:

The Clinician-Administered PTSD Scale (CAPS-IV) for The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) is available from the National Center for PTSD www.ptsd.va.gov.

Protocol Name from Source:

This section will be completed when reviewed by an Expert Review Panel.

Availability:

Publicly available

Personnel and Training Required

The Clinician-Administered PTSD Scale (CAPS) was designed to be administered by clinicians and clinical researchers who have a working knowledge of posttraumatic stress disorder (PTSD), but can also be administered by appropriately trained paraprofessionals. CAPS can only be distributed to qualified mental health professionals and researchers. Information and training materials for the CAPS are available from the National Center for PTSD at www.pstd.va.gov.

Equipment Needs

None

Requirements
Requirement CategoryRequired
Major equipment No
Specialized training Yes
Specialized requirements for biospecimen collection No
Average time of greater than 15 minutes in an unaffected individual Yes
Mode of Administration

Interviewer-administered questionnaire

Life Stage:

Adult

Participants:

Adults, ages 18 and older

Specific Instructions:

This measure includes both the DSM-IV and DSM-5 versions of the Clinician-Administered PTSD Scale. The PhenX PTSD Working Group anticipates that scientific demands will dictate that researchers typically collect data in accordance with the most recent PTSD criteria and will use the DSM-5 version of the protocol. However, under special circumstances (e.g., when adding to older, existing data sets), researchers may decide to use the DSM-IV version instead.

The potentially traumatic events reflected in the Life Events Checklist are routinely examined in preparation for the Criterion A inquiry outlined in the Clinician-Administered PTSD Scale (CAPS-IV) for The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). This inquiry can be supplemented by the potentially traumatic events for military populations covered by the Deployment Risk and Resilience Inventory (DRRI-2; see Trauma Adversity and Exposure).

Selection Rationale

The Clinician-Administered PTSD Scale (CAPS) is the gold standard in posttraumatic stress disorder (PTSD) assessment and diagnosis for both military Veteran and civilian trauma survivors. The Clinician-Administered PTSD Scale (CAPS-IV) for The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) provides investigators with a framework for collecting data that are consistent with prior, foundational work on PTSD.

Language

English

Standards
StandardNameIDSource
Common Data Elements (CDE) PTSD Symptoms Severity Diagnosis Questionnaire Score 4588683 CDE Browser
Process and Review

This section will be completed when reviewed by an Expert Review Panel.

Source

Blake, D. D., Weathers, F. W., Nagy, L. M., Kaloupek, D. G., Gusman, F. D., Charney, D. S., & Keane, T. M. (1995). The development of a clinician-administered PTSD scale. Journal of Traumatic Stress, 8, 75-90.

The Clinician-Administered PTSD Scale (CAPS-IV) for The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) is available from the National Center for PTSD at www.ptsd.va.gov.

General References

Gray, M., Litz, B., Hsu, J., & Lombardo, T. (2004). Psychometric properties of the Life Events Checklist. Assessment, 11, 330-341.

Orsillo, S. M. (2001). Measures for acute stress disorder and posttraumatic stress disorder. In M. M. Antony & S. M. Orsillo (Eds.). Practitioner’s guide to empirically based measures of anxiety (pp. 255-307). New York: KluwerAcademic/Plenum.

Weathers, F. W., Keane, T. M., & Davidson, J. R. (2001). Clinician-Administered PTSD Scale: A review of the first ten years of research. Depression and Anxiety, 13, 132-156.

Weathers, F. W., Ruscio, A. M., & Keane, T. M. (1999). Psychometric properties of nine scoring rules for the Clinician-Administered Posttraumatic Stress Disorder Scale. Psychological Assessment, 11, 124-133.

Protocol ID:

630401

Variables:
Export Variables
Variable NameVariable IDVariable DescriptionVersiondbGaP Mapping
PX630401000000 Protocol 630401 - proprietary. Check DCW for contact 4 N/A
Research Domain Information
Measure Name:

PTSD Symptoms, Severity, and Diagnosis

Release Date:

November 21, 2014

Definition

A clinician administered semistructured interview to assess symptoms of post-traumatic stress disorder (PTSD) and to establish a clinical diagnosis.

Purpose

This measure is used to make a current (past-month) or lifetime diagnosis of post-traumatic stress disorder (PTSD) and to provide a continuous index of PTSD severity. It also can be used to assess PTSD symptoms over the past week.

Keywords

Trauma, Potentially traumatic event, Stress, Stressor, Posttraumatic Stress Disorder, PTSD