— 心理社會完整性 · MEDIUM · MCQ —
護理師照護一位 3 個月前經歷創傷事件的個案，現有閃回、逃避及過度警覺表現。護理師應使用哪種篩檢工具？
A nurse is caring for a client who experienced a traumatic event 3 months ago and now reports flashbacks, avoidance, and hypervigilance. Which screening tool is most appropriate for the nurse to utilize?
- AMini-Mental State Examination (MMSE)迷你心智狀態檢查 (MMSE)
- BPTSD Checklist for DSM-5 (PCL-5)✓ 正解DSM-5 創傷後壓力症候群清單 (PCL-5)
- CGeneralized Anxiety Disorder-7 (GAD-7)廣泛性焦慮症量表-7 (GAD-7)
- DPatient Health Questionnaire-9 (PHQ-9)患者健康問卷-9 (PHQ-9)
— Explanation · 中文詳解 —
個案表現出創傷後壓力症候群（PTSD）的典型核心症狀：重新體驗、逃避與過度警覺。PCL-5 是目前臨床針對診斷 PTSD 最標準的篩檢工具。PHQ-9 用於憂鬱篩檢，GAD-7 用於廣泛性焦慮，MMSE 則是認知功能的整體評估，皆無法針對性地評估創傷反應。
The client's flashbacks, avoidance, and hypervigilance are the hallmark PTSD symptom cluster. The PCL-5 (PTSD Checklist for DSM-5) is the validated, targeted self-report measure for PTSD symptom severity. PHQ-9 screens depression, GAD-7 screens generalized anxiety, and MMSE evaluates cognition—none specifically address trauma symptoms.
✦ 台美臨床差異
美國心理健康照護中，護理師常被訓練執行並判讀 PCL-5；台灣則通常轉介臨床心理師進行專業心理測驗與評估。