PTSD (PostTraumatic Stress Disorder) Services for Veterans With SMI (Severe Mental Illness) (PTSD/SMI)

• 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.
  
  
• Positive and Negative Syndrome Scale (PANSS) [ Time Frame: 1 Year ] [ Designated as safety issue: No ]
  Positive and Negative Syndrome Scale (PANSS) is the most widely used measure of symptom severity in schizophrenia. The 30-item scale, which yields three domain scores (positive psychosis, negative symptoms, and general psychopathology).
  
  
• 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.
  
  
• Structured Clinical Interview for DSM Disorders-DSM IV (SCID-IV) [ Time Frame: Baseline ] [ Designated as safety issue: No ]
  SCID-IV is a structured interview that assesses the criteria for DSM-IV Axis I diagnoses. The SCID is often considered the "gold standard" for assessing axis I disorders including major depression, bipolar disorder, and schizophrenia. The SCID will be used to confirm a diagnosis of SMI and to screen for substance abuse/dependence.
  
  
• 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.
  
  

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.