1. © 2011 QTC Management, Inc. Confidential & Proprietary “Examinations for America’s Heroes”

2. 2 PTSD Perspective August 31, 2011 © 2011 QTC Management, Inc. Confidential & Proprietary

3. I - HISTORY © 2011 QTC Management, Inc. Confidential & Proprietary  Psychiatric conceptualization and focus  Diagnostic nomenclature  Military psychiatry and the DSMs generally  Definition and evolution of DSMs

4. II – WHAT IS PTSD? © 2011 QTC Management, Inc. Confidential & Proprietary  DSM-IV-TR definition  DSM-IV-TR criteria

5. Definition of PTSD © 2011 QTC Management, Inc. Confidential & Proprietary  The development of characteristic symptoms following exposure to an extreme traumatic stressor involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one’s physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person, or learning about unexpected or violent deaths, serious harm, or threat of death or injury experienced by a family member or other close associate. The person’s response to the event must involve intense fear, helplessness, or horror. The characteristic symptoms resulting from the exposure to the extreme trauma include persistent reexperiencing of the traumatic event, persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness and persistent symptoms of increased arousal.

6. Diagnostic Criteria for PTSD © 2011 QTC Management, Inc. Confidential & Proprietary A.The person has been exposed to a traumatic event in which both of the following were present: 1.The person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others. 2.The person's response involved intense fear, helplessness, or horror.

7. Diagnostic Criteria for PTSD © 2011 QTC Management, Inc. Confidential & Proprietary B.The traumatic event is persistently reexperienced in one (or more) of the following ways 1.Recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. 2.Recurrent distressing dreams of the event. 3.Acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening of when intoxicated). 4.Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event. 5.Physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.

8. Diagnostic Criteria for PTSD © 2011 QTC Management, Inc. Confidential & Proprietary C.Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following: 1.Efforts to avoid thoughts, feelings, or conversations associated with the trauma. 2.Efforts to avoid activities, places, or people that arouse recollections of the trauma. 3.Inability to recall an important aspect of the trauma. 4.Markedly diminished interest or participation in significant activities. 5.Feeling of detachment or estrangement from others. 6.Restricted range of affect (e.g., unable to have loving feelings). 7.Sense of foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span).

9. Diagnostic Criteria for PTSD © 2011 QTC Management, Inc. Confidential & Proprietary D.Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following: 1.Difficulty falling or staying asleep 2.Irritability or outbursts of anger 3.Difficulty concentrating 4.Hypervigilance 5.Exaggerated startle response E.Duration of the disturbance (symptoms in Criteria B, C, and D) is more than 1 month. F.The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

10. III – WHAT CAUSES PTSD? © 2011 QTC Management, Inc. Confidential & Proprietary  Usual civilian causes  Usual military causality (combat vs. non-combat)  New VA evidence requirements  Meaning of “service connection”

11. IV – HOW IS PTSD TREATED? © 2011 QTC Management, Inc. Confidential & Proprietary  Evolution of military and VA treatment  Group therapy  Individual therapy  Pharmacological therapy

12. V – WHAT ARE COMMON COMORBIDITIES? © 2011 QTC Management, Inc. Confidential & Proprietary  Depressive disorders  Substance abuse disorders; “self medication issue”  Panic disorder  Cognitive disorder/TBI  Overlapping criteria/interacting symptoms

13. VI – WHAT ARE USUAL DISABILITY PATTERNS? © 2011 QTC Management, Inc. Confidential & Proprietary  PTSD alone (GAF; SSA impair)  Common combinations (GAF; SSA impair)

14. Questions & Answers © 2011 QTC Management, Inc. Confidential & Proprietary

15. © 2011 QTC Management, Inc. Confidential & Proprietary “Examinations for America’s Heroes” THANK YOU