CAPS-5 Score of 51 Indicates Severe PTSD
A CAPS-5 score of 51 places this pregnant patient in the severe PTSD category, requiring immediate trauma-focused psychotherapy and close monitoring for pregnancy complications, particularly preeclampsia. 1, 2
Understanding the CAPS-5 Score
The CAPS-5 is the gold standard diagnostic interview for PTSD, using structured questions and behaviorally anchored rating scales to assess frequency and intensity of symptoms. 3
Severity Classification
- A score of 51 falls well above the diagnostic threshold and indicates severe symptom burden. 4, 2
- Research demonstrates that CAPS-5 scores ≥15 predict later PTSD development with good accuracy (AUROC 0.767-0.854), and your patient's score of 51 is more than three times this threshold. 4
- The CAPS-5 total severity score has high internal consistency (α = .88) and excellent interrater reliability (ICC = .91), making this score a reliable indicator of severe disease. 2
Critical Pregnancy-Specific Considerations
This patient faces compounded risk due to the intersection of severe PTSD and pregnancy:
- Pregnant women with PTSD have increased risk for preeclampsia, creating a bidirectional relationship between PTSD and pregnancy complications. 1
- PTSD disrupts neuroendocrine health and increases cardiovascular disease risk, particularly relevant during pregnancy. 1
- Pregnancy itself can trigger PTSD symptoms or retraumatization, especially in women with previous traumatic experiences. 1
Immediate Management Algorithm
First-Line Treatment
Initiate trauma-focused cognitive behavioral therapy immediately, with image rehearsal therapy specifically for any nightmare symptoms. 3
- The American Academy of Sleep Medicine recommends image rehearsal therapy for PTSD-associated nightmares, and trauma-focused CBT has demonstrated efficacy in systematic reviews and meta-analyses. 3
- Evidence-based psychotherapy such as CBT or interpersonal therapy should begin immediately for all severity levels during pregnancy. 5
Monitoring Strategy
Use the Edinburgh Postnatal Depression Scale (EPDS) at every prenatal visit to track symptom trajectory. 5
- The EPDS is freely available, takes 10 questions covering the past 7 days, and can assess both depression and anxiety symptoms with a cutoff of ≥10. 5
- Mental health surveillance should occur at every follow-up visit using validated measures. 6
Obstetric Surveillance
Implement enhanced monitoring for preeclampsia and preterm birth throughout pregnancy. 1, 5
- Untreated severe anxiety and depression in pregnancy are associated with increased risk of preterm birth and low birth-weight infants. 5
- Pregnancy-specific anxiety is more strongly associated with adverse outcomes than general anxiety and should be addressed promptly. 5
Common Pitfalls to Avoid
Do not delay treatment waiting for "the right time" in pregnancy—severe PTSD requires immediate intervention. 5, 6
- Avoidant coping strategies are consistently associated with poor psychological well-being, prenatal distress, postpartum depression, and adverse birth outcomes including preterm delivery. 5
- The risks of untreated severe PTSD (preterm birth complications account for 14% of child deaths under 5 years globally) far outweigh concerns about initiating psychotherapy during pregnancy. 5
Do not overlook the patient's asthma and migraines as potential comorbidities requiring integrated management. 6
- Comorbidities such as depression and anxiety disorders are extremely common in PTSD and require concurrent treatment. 6
- Sleep disturbances are common in PTSD and may require specific treatment, including screening for obstructive sleep apnea. 6
Pharmacotherapy Considerations
If symptoms persist after psychotherapy or if the patient cannot access psychotherapy, consider SSRIs (fluoxetine, paroxetine, or sertraline). 6
- However, given pregnancy status, psychotherapy remains the preferred first-line approach, with medication decisions requiring careful risk-benefit analysis in consultation with obstetrics. 5