Post-traumatic stress disorder in Australia and New Zealand: a clinical review of the consequences of inescapable horror.

Over the last 20 years, much has been written on the morbidity that results from disasters. However, it is only since 1980 with the introduction of the "new" diagnostic category of "post-traumatic stress disorder" in the third edition of the Diagnostic and statistical manual of mental disorders of the American Psychiatric Association (DSM-III) that a specific diagnosis has become available for many of the victims of such disasters. While, as a condition, it has been recognized from antiquity, it has lacked official recognition in the nomenclature and has tended to be viewed, particularly between the end of World War II and the introduction of DSM-III, as a transient disorder. A description of the disorder is followed by a discussion of its relevance with particular reference to papers by Australian and New Zealand authors.

A tormented mind: clinical and theoretical implications of overwhelming life events.

A case study illustrates the aim of this paper, which is to discuss the clinical and theoretical implications of adult patients who have experienced extreme or catastrophic stress in their distant past which may not be immediately "recognisable". A close relationship between Post-Traumatic Stress Disorder and Borderline Personality Disorder (as defined in DSM-III-R) is suggested.

Evaluation of a self-management plan for chronic obstructive pulmonary disease.

We hypothesized that the use of an Action Plan might assist self-management for patients with chronic obstructive pulmonary disease (COPD). A pilot process and randomized, controlled study were undertaken to evaluate an Action Plan that provided advice on management of usual care and exacerbations, together with a booklet on self-management. Fifty six subjects with COPD recruited through general practitioners (GPs) completed the 6 month study, 27 in the control group and 29 in the intervention group. The control group received usual care from their GP, and the intervention group received a booklet and Action Plan from their practice nurse plus a supply of prednisone and antibiotic from their GP. The two groups were demographically similar with a mean age of 68 yrs. The resources were well received by GPs, practice nurses and intervention group subjects. After 6 months, there were no differences in quality of life scores or pulmonary function. There were significant changes in self-management behaviour in the intervention group compared to controls. In response to deteriorating symptoms, 34 versus 7% (p=0.014) initiated prednisone treatment and 44 versus 7% (p=0.002) initiated antibiotics. Subjects in the intervention group readily adopted self-management skills but did not show any difference in quality of life or lung function parameters. A larger, prospective, controlled, clinical trial of this approach is warranted.