PTSD (PostTraumatic Stress Disorder) Services for Veterans With SMI (Severe Mental Illness) (PTSD/SMI)
As in the general population, there is no clear standard of care within Veterans Affairs Medical Centers for treating posttraumatic stress disorder (PTSD) among individuals with severe mental illness (SMI). This is a considerable issue because trauma, posttraumatic stress disorder (PTSD), and severe psychiatric comorbidity are particularly common among Veterans and this symptom presentation clearly exacerbates the overall course and severity of mental illness. This study is significant in that it proposes to establish the efficacy of a frontline exposure based intervention for posttraumatic stress disorder (PTSD), Prolonged Exposure, for improving critical clinical, quality of life, and cost outcomes among Veterans with severe mental illness (SMI) enrolled in VA healthcare. Collectively, it is anticipated that these data will establish a much needed clinical course of action for what is considered a vulnerable yet highly underserved patient population.
Post Traumatic Stress Disorder
Behavioral: PE + TAU
Behavioral: Treatment As Usual
|Study Design:||Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Single Blind (Outcomes Assessor)
Primary Purpose: Health Services Research
|Official Title:||Improving PTSD Service Delivery for Veterans With Severe Mental Illness|
- PTSD (Posttraumatic stress disorder) Checklist (PCL) [ Time Frame: 1 Year ] [ Designated as safety issue: No ]The PTSD (Posttraumatic stress disorder) Checklist (PCL) is a 17-item self-report measure of PTSD symptoms based on DSM-IV criteria. Total scores on the PCL range from 17 to 85 and higher scores reflect greater PTSD severity.
- Clinician Administered PTSD (Posttraumatic stress disorder) Scale (CAPS) [ Time Frame: Baseline ] [ Designated as safety issue: No ]The Clinician Administered PTSD (Posttraumatic stress disorder) Scale (CAPS) is a 30-item structured interview that corresponds to the DSM-IV criteria for PTSD. The CAPS can be used to make a current (past month) or lifetime diagnosis of PTSD or to assesses symptoms over the past week.
- Beck Depression Inventory-II (BDI-II) [ Time Frame: 1 Year ] [ Designated as safety issue: No ]Beck Depression Inventory-II is a 21 item measure of depressive severity with higher total scores indicative of more severe depression.
- Young Mania Rating Scale (YMRS) [ Time Frame: 1 Year ] [ Designated as safety issue: No ]Young Mania Rating Scale (YMRS) is an eleven-item, multiple-choice diagnostic questionnaire used to measure the severity of manic episodes in patients.
- Brief Psychiatric Rating Scale-Extended (BPRS-E) [ Time Frame: 1Year ] [ Designated as safety issue: No ]Brief Psychiatric Rating Scale-Extended (BPRS-E) measures psychopathology across several dimensions (i.e., delusions, motor hyperactivity, withdrawal and blunted affect, self-neglect, etc.) and is a commonly used measure for severely and persistently ill patient populations.
- Veterans SF 12 Health Survey (SF-12) [ Time Frame: 1 Year ] [ Designated as safety issue: No ]The Veterans SF 12 Health Survey (SF-12) is a valid and reliable instrument to measure quality of life and/or functional status in Veterans. The SF-12 will be used to track changes in general mental and physical health functioning (i.e., functional status or general health functioning
- Index of Functional Impairment (IFI) [ Time Frame: 1 Year ] [ Designated as safety issue: No ]The Index of Functional Impairment (IFI) is a self-report inventory of PTSD-related functional impairment. Patients rate their level of functioning across multiple psychosocial domains including romantic relationships, employment, and educational achievement.
- Treatment Expectancy [ Time Frame: 1 Year ] [ Designated as safety issue: No ]Treatment Expectancy measure assesses for differences in outcome expectancy and treatment credibility and will be administered during the third session of treatment and again at post-treatment.
- Charleston Psychiatric Outpatient Satisfaction Scale (CPOSS) [ Time Frame: post treatment (12 weeks) ] [ Designated as safety issue: No ]Charleston Psychiatric Outpatient Satisfaction Scale (CPOSS) is 16-item measure, with a Likert scale response format, based on a general measure of patient satisfaction
- Reactions Related to PTSD Research Participation [ Time Frame: Up to 12 weeks ] [ Designated as safety issue: No ]Reactions Related to PTSD Research Participation survey which asks participants to rate on a 10-point scale how distressing, difficult, and confusing they found the research procedures; how satisfied they were with their participation; how worthwhile they thought the experience was; and how willing they would be to participate in a similar study in the future
- Hamilton Rating Scale for Depression (HAM-D) [ Time Frame: 1 Year ] [ Designated as safety issue: No ]Commonly used observer-rated measure for depression. HAM-D is a 16-item measure that rates the severity of depression in patients who have been diagnosed with depression.
- Pittsburgh Sleep Quality Index (PSQI) [ Time Frame: 1 Year ] [ Designated as safety issue: No ]The PSQI is a 19-item commonly used and well validated self-report measure of sleep quality and disturbance. Scores on the PSQI range from 0 to 21, with rating of 5 or higher indicative of poor sleep quality.
- Clinical Global Impressions (CGI) [ Time Frame: 1 Year ] [ Designated as safety issue: No ]CGI scale is an index of overall clinical severity and improvement that is commonly used in clinical trials. The Severity and Global Improvement Subscales are each 7 point scales and are part of the ECDEU Assessment manual for Psychopharmacology.
- Combat Exposure Scale (CES) [ Time Frame: 1 Year ] [ Designated as safety issue: No ]CES is a 7-item self-report measure of combat exposure severity that ranges from 0 (no combat) to 41 (heavy combat) that has been found to have good psychometric qualities including high internal and test-retest reliability.
- Mini-International Neuropsychiatric Interview (MINI) [ Time Frame: 1 Year ] [ Designated as safety issue: No ]Is a brief structured interview that assesses the criteria for DSM-IV Axis I diagnoses. The MINI will be used to assess for a diagnosis of current depression and to screen for substance dependence.
- Reactions to Research Participation Questionnaire Revised (Newman et al., 2001) [ Time Frame: 1 Year ] [ Designated as safety issue: No ]It is a questionnaire that asks for participants opinion about what it was like participating in this study. It is a 23 question Likert scale design.
- psychotic Symptom Rating Scales (PSYRATS) [ Time Frame: 1 Year ] [ Designated as safety issue: No ]Two scales: one scale for auditory hallucinations and one scale for delusions. Each scale measures the presence and severity of a number of different dimensions of the psychotic symptoms in schizophrenia and psychosis.
- Hamilton Program for Schizophrenia Voices Questionnaire (HPS-VQ) [ Time Frame: 1 year ] [ Designated as safety issue: No ]13 item measure in which each of the first nine items are assigned scores on a five-point Likert scale from zero to four. The total score is intended to indicate the severity of auditory verbal hallucinations.
|Study Start Date:||May 2012|
|Estimated Study Completion Date:||March 2015|
|Estimated Primary Completion Date:||January 2015 (Final data collection date for primary outcome measure)|
Experimental: Arm 1
Prolonged Exposure Therapy +Treatment As Usual
Behavioral: PE + TAU
12 weekly sessions of Prolonged Exposure in addition to Treatment As Usual
Active Comparator: Arm 2
Treatment As Usual
Behavioral: Treatment As Usual
TAU will receive support services through the VA potentially inclusive of case management, psychotropic medication management, and/or supportive counseling
The overarching aim of this proposal is to compare the efficacy of Prolonged Exposure for posttraumatic stress disorder (PTSD) plus treatment as usual (PE+TAU) relative to treatment as usual (TAU) alone using a randomized, between groups, repeated measures design. One hundred fifty six (156) ethnically/racially diverse male and female Veterans with posttraumatic stress disorder (PTSD) and severe mental illness (SMI) will be recruited from the Charleston VA and affiliated Community Based Outpatient Clinics (CBOCs) during the study time frame. For our study purposes, severe mental illness (SMI) is defined as (1) the presence of a past year DSM-IV Axis I diagnosis of schizophrenia, schizoaffective disorder, bipolar disorder, or severe depression (2) resulting in persistent impairment in self-care, work, or social functioning. Veterans will be randomized 1:1 to one of two conditions: PE+TAU or TAU. The active intervention phase is 12 weeks. Veterans randomized to treatment as usual (TAU) will receive support services through the VA potentially inclusive of case management, psychotropic medication management, and/or supportive counseling and Veterans randomized to prolonged exposure (PE) plus treatment as usual (TAU) will receive 12 weekly sessions of prolonged exposure (PE) in addition to treatment as usual (TAU). All participants will be assessed at baseline, 6 weeks, post-treatment, and at 3 and 6 months. Additionally, they will complete two self report forms during sessions 3, 6, and 9.
|Contact: Anouk L Grubaugh, PhD MA BS||(843) 789-6664||Anouk.Grubaugh@va.gov|
|Contact: Stephanie M Youngerman, BS MPHfirstname.lastname@example.org|
|United States, South Carolina|
|Ralph H Johnson VA Medical Center||Recruiting|
|Charleston, South Carolina, United States, 29401-5799|
|Contact: Anouk L Grubaugh, PhD MA BS 843-789-6664 Anouk.Grubaugh@va.gov|
|Principal Investigator: Anouk L Grubaugh, PhD MA BS|
|Sub-Investigator: Clara E. Dismuke, PhD BS|
|Sub-Investigator: Ron Acierno, PhD MS BA|
|Principal Investigator:||Anouk L Grubaugh, PhD MA BS||Ralph H. Johnson VA Medical Center|