CARE MANAGER CONTACT LOG - DEPRESSION &.

PTSD
Patient Name: M F DOB: ID#:
Addres:;: _ _ _ _ _ _ _ _ _ _ _ _~"._;_..,----- Date ofIndexom=.c-ce"""'v:c:isl:-:·C-t;-_-"""'/,-_---:---
Practice: Clinician: -,----:=-_:-:-;-_~-----_=,____---.
Primary Phone# L-l _ _ - (Type_ _-.,-) A1lematePhone# L-l __ - (Type _
Call Interval (1,. fit..,
I/Ol« ..1.ItI): 1 Wk 4 Wks 8 Wks 12Wks 16 Wks (----lWks
Call Type: Initial PRN Routine Phase: Acld;e Continuation Maintenance
CompletedCuD-Date: _ _I_ _ / _ _ Starttime_ _:_ _ Endtime_ _:_ _ Total Time:_ _minutes

"Uii .·'iiUjj."i,.....)
Attempt Date Time Home Work Other (sueciM NoAns. LeftMCS882e1 HOW? Busy Not Avail.
#1
#2
#3
itt '" •.... , ... " ••• 1.,

W(l)Cimflm raib!d,4JtetnPtsR~chd -Aetit1"Tllkttll~" ) (CW#1Mt 11JJ1l}~

Primary care Cliaichm eonbleted by pholN 14ft,r Letict to patient Patient di$enrol1ed tdale: )
OIhcr

PrescriptiQllS filled, but not begun

PrescriptiollSstopp«l by:
(Cbed WIt) Patient FCC
Other ( )
AddiU(lIllll pre!iCtJptiontI rillc¢ but not begun
Pl'eIlClipti(lllS begun and/orcmtinued \I$.dirccted
D.wUf.RS·BNCOUMUlD BU·_)
tJncM.atntY abOUt medication et'feeuven6SS
Few or addietiQll Di~ withdiee,l1osis
Medication costs A!tIl:livalence abolltdiagJtosis
Stipe UnsupporliVe fl1tlilylfriends
Side cl'feots(CJiick all ditir 'fP.\IJ
or Sc49tiO/l J\gillIlitniAmiiety Ory.M(IIlt,h
Sleep pl:oblems Oecrease4.SQI: drive
L i hlbel'lded!Oi Olfll~r

ity
Pleasumble activities
Support from people
~ti(;~ r~8XBlion
Simple. gQa1sISBlalJ steps
Improved n.utrition
Other
slli,*'"'"0ijt1~0 0."

MIl Prof~ona1 Dillciplihe: PII)'tlhietrist PllychC40gist

SpciaiWorkcn: N~ a~ Olbet{ }
Next Apptdate:
J.·l1!que.ncy of Appts,
It AppWsessions com·-p--;lc-::ted"""'.:-:_-_-_--------
# ApptslllCssioJl$Missed:,c__.• Reason; _

Page 59 of62
 Disagrees withdiagnosis Ambivalence about diagnosis
Stigma Unsupportive family/mends
Counseling costs No accessible counselor
Missed/forgot appt Ins.lmanaged care problems
Notransportation Excessive waitfor appt.
Uncertainty about counseling effectiveness
Other·S if:

Symptoms Score
• gJl!!!pJ§!l!lwlWJi:A§!!!M!1lI!t!l•.il0tH!t?!L~i"8I;'n.1Ll~:~Q£2·
'-#lIIt", OOcpme: ~lhouibts 0I'Ilyim '~OI\ ~quirtd
~ thoJ.!&bls • CQlffmt'fltnM t1l:tionS Jaktn fJJCJudtnadinJ£IIllI COIlltW:

Symptoms
• Cqmplm Suicii,JmUttW/l,lfQutll/M "lP# IC9I'¢ II t Apr 3.
M .•_Imt CIutgqme: ~tftoll8hU CIiIYfno alltlOlt required
,1l,1i~ tbouglllr>. C_*'I11.IIId alrioru m'-iTlCllirJillg qi!mjun 1,'!?!!JIl#(

"" ... ·i ii,·8&..·.·." i'·',8&B';J.'·· ••• •••••• •.......&<

SclwcJUle Nnt n-t.; Tiam lIomt Work
~~liDeCaU
~.
CMCaIf / ! Ii
Date ofNnt DIlle: I!NQfJ/'pL,
Clinieilan AnDf. I I -whatisMl$mf?
CkJIlng Notes; (1w(MireIJJIleJ1tllfUl/w.t flHJ'~~ IJIeh.l1fltlJIMHtJ'IlI11 fQlllJawt "'" discllPlld.1

Page 60 of 62
References
PHQ-9
Spitzer R, Kroenke K, Williams J. Validation and utility of a self-report version of PRIME-MD: the
PHQ Primary Care Study. Journal of the American Medical Association 1999; 282: 1737-1744
Kroenke K, Spitzer R L, Williams J B. The PHQ-9: validity of a brief depression severity measure.
Journal of General Internal Medicine 2001; 16(9): 606-613
Rost K, Smith J. Retooling multiple levels to improve primary care depression treatment. Journal of
General Internal Medicine 16: 644-645,2001
Kroenke K, Spitzer RL. The PHQ-9: A new depression and diagnostic severity measure. Psychiatric
Annals 2002; 32: 509-521
Williams JW, Noel PH, Cordes J A, Ramirez G,Pignone M. Is this patient clinically depressed?
Journal of the American Medical Association 2002; 287: 1160-1170
Lowe B, Unutzer J, Callahan CM, Perkins AJ, Kroenke K. Monitoring depression treatment
outcomes with the patient health questionnaire-9. Medical Care, 2004. 42(12): 1194-201
Pinto-Meza A, Serrano-Blanco A, Penarrubia MT, Blanco E, Haro JM. Assessing depression in
primary care with the PHQ-9: can it be carried out over the telephone? Journal of General Internal
Medicine, 2005.20(8): 738-42
PTSD Guidelines
Ballenger JC, Davidson JRT, Lecrubier Y, Nutt DJ, Foa EB, Kessler RC, McFarlane AC, Shalev AY:
Consensus statement on posttraumatic stress disorder from the International Consensus Group on
Depression and Anxiety. J Clin Psychiat 2000 61 (suppl 5)60-66
Management of Post-Traumatic Stress Working Group. VA/DoD Clinical Practice Guideline for the
Management of Post-Traumatic Stress, Version 1.0. West Virginia Medical Institute and AXCS
Federal Health Care. 2004
Pizarro J, Silver RC, Prause 1. Physical and mental health costs of traumatic war experiences among
Civil War veterans. Archives of General Psychiatry. Feb 2006;63(2): 193-200
Schoenfeld, FB, Marmar CR, Neylan TC, Current concepts in pharmacotherapy for posttraumatic
stress disorder. Psychiatric Services, 2004.55(5): p. 519-31
PCL
Blanchard EH, Jones-Alexander JJ, Buckley TC, Forneris CA: Psychometric properties of the PTSD
Checklists (PCL). Behav Res Ther 1996;34:669-673
Walker, EA, Newman E, Dobie DJ, Ciechanowski P, Katon W, Validation of the PTSD checklist in
an HMO sample of women. General Hospital Psychiatry., 2002. 24: 375-80
RESPECT-Depression and the Three Component Model
Dietrich AJ, Oxman TE, Williams JW Jr, Schulberg HC, Bruce ML, Lee PW, Barry S, Raue PJ,
LeFever JJ, Moonseong H, Rost K, Kroenke K, Gerrity M, Nutting PA: Re-engineering systems for
the primary care treatment of depression: A cluster randomized controlled trial. British Medical
Journal 2004; 329:602-605
Oxman TE, Dietrich AJ, Williams JW Jr, Kroenke K: A three component model for re-engineering
systems for primary care treatment of depression. Psychosomatics 2002; 43 :441-450
PTSD Background
Hoge CW, Castro CA, Messer SC, McGurk D, Cotting DI, Koffman RL: Combat duty in Iraq and
Afghanistan, mental health problems, and barriers to care. New Engl J Med 2004; 351: 13-22

Page 61 of62
 Friedman MJ: Posttraumatic Stress Disorder Among Military Returnees From Afghanistan and Iraq
American Journal of Psychiatry 2006 163: 586-593
Lecrubier Y: Posttraumatic stress disorder in primary care: A hidden diagnosis. J Clin Psychiatry
2004;65 (suppl 1): 49-54
PTSD Four Question Screen
Prins A, Ouimette P, Kimerling R, Cameron RP, Hugelshofer DS, Shaw-Hegwer J, Thrailkill A,
Gusman FD, Sheikh Jl.The primary care PTSD screen (PC-PTSD): development and operating
characteristics. Primary Care Psychiatry 2004; 9:9-14
Zlotnick C, Rodriguez BF, Weisberg RB, Bruce SE, Spencer MA, Culpepper L, Keller MB:
Chronicity in posttraumatic stress disorder and predictors of the course ofposttraumatic stress
disorder among primary care patients. J Nerv

Page 62 of62
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PTSDITBI and Behavioral Health

PURPOSE: To provide basic information on PTSD, T81 and behavioral health
issues and programs in the Army.

...,,1

1, ' "Context and Current €on.tfict

, ~>, R~Sili~nce/Recovery/Relht~gr~t!on
:~;,' 3,/': ~eployment Relateq$tress 'R~actions
,i 0: ..I~_'_ ~.. ~_ -: ~~' ~ .: ~'_: ."

. ~iV. ID~~,nit~~h~ ~~ p:rs~:~ !~~, FBI ,'

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'5. . Behavioral Health and TBI : 'Where We
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". . .~ Were,:~iArf? and Where We are .G oing .'

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.' "6. Next Steps .

l(b)(6) I Slide 2 of 15
 . ~

'tii...-. '.tf~
/' .'
The Context:
A Brief History
• World War I--"shell shock", over evacuation led to chronic psychiatric
conditions
• World War II--ineffective pre-screening, "battle fatigue", lessons
relearned,3 hots and a cot
• The Korean War---first high rates of psychiatric casualties, then dramatic
decrease
Principles of "PIES" (proximity, immediacy, expectancy, simplicity)
• Vietnam
- Drug and alcohol use, misconduct
- Post Traumatic Stress Disorder
• Desert Storm/Shield
- "Persian Gulf illnesses", medically unexplained physical symptoms
- Questions about exposures to toxins
• Operations Other Than War
- Combat and Operational Stress Control, routine front line mental
health treatment
• 9/11
- "Therapy by walking around"

l(b)(6) I Slide 3 of 15
 ~

. it; ' .A~

'l;y ... ..
-, -,
~
Operation Enduring Freedoml
Operation Iraqi Freedom

• Numerous stressors
- Multiple and extended deployments
- Battlefield stressors
• lEOs, ambushes, severe sleep deprivation, direct combat, etc.
- Medical
• Severely wounded Soldiers, injured children, detainees
• Changing sense of mission
• Strong support of American people for Soldiers
• Numerous new programs developed to support Soldiers and
Families

l(b)(6 ) I Slide 4 of 15
 r~Jlit i gate II dentitv
ueat
St r-e ngtJ,e n d'J I I , J

-.k ' . r I' Lc c:

re f t; !' t<.J
l' I ! -. ":I' -
'::> \. Il l·~ 2d lu
~l
s ue ss ors 1
iI I-IJ: U , :1 . k ~i P I~I
I"' ..,., ' ..- .'

ens ure slee p medi cal

s up po rt : safe . cairn:
ens ure
build & re st: t e a ch re c ogni ze
tre at ment
toughne s s : s elf- c a re . inj uries and
co mpliance
f o st er unit t ea ch budd y drop in u nit
me ntor bac k
co hes ion ca re cohesi on
to duty
---- -- ·--1R
:E
_.. ~~.- -··- ' 1

Leadership
~~ ---.
"\11- di ~
~_~~st~t~~ I1 e 0

_____ -------sYIl1PtOIl1~
iii t-"

Traull1atlC
o".~<>ss
f post

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o ..
I e ical
stresS
Diagnosedd:
Estill1
ate
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IE I

1.5 M DeplOyed IR
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'-~;~f<,~;~<1 Y
_R~a c ti ng :;.q':Irl'ju red ' .', ·! ~:· ; ·: ;' '~m
;~;~)~'.
• irritable ~ loss of .. - ~~~;;

5~t'
• worrvrn q control
• cJi ffi cu Ity • can't sleep
sleepi ng and • panic it~;
relaxinq • apathy
• poo r focu s • can 't c ontrol
(tiso la ti on emotio ns
!lIE! !NIl

~. r .~1rII
 ~ ..
. ,. ~

";t; A~ Range of Deployment-Related Stress Reactions .

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.
l, " - ' " ;:J
-;
'

• Mild to moderate
- Combat Stress and Operational Stress Reactions (Acute)
- Post-traumatic stress (PTS) or disorder (PTSD)
- Symptoms such as irritability, bad dreams, sleeplessness
- Family / Relationship / Behavioral difficulties
- Alcohol abuse
- "Compassion fatigue" or provider fatigue
- Suicidal behaviors
• Moderate to severe
- Increased risk taking behavior leading to accidents
- Depression
- Alcohol dependence
- Completed suicides

Il b)(6 l I Slide 6 of 15