Is Australia in the posttraumatic stress disorder petri dish?

O’Donnell, M.L., Alkemade, N., & Forbes, D. (2015). Is Australia in the posttraumatic stress disorder petri dish? Australian and New Zealand Journal of Psychiatry. Advance online publication. doi: 10.1177/0004867415572413

 

This editorial comments on the recent and proposed changes to diagnostic criteria for posttraumatic stress disorder (PTSD) in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD). These two key nosological entities are taking markedly different directions leading to a divergence of the PTSD construct across systems. The modifications to the diagnostic criteria for PTSD in DSM-5 were motivated by an intent to capture a more comprehensive clinical profile of traumatic stress responses. The changes proposed in ICD-11 aim to refocus the diagnosis of PTSD to its essential features. The implications for prevalence, research and compensation systems are discussed.

 

Cooper, J., Metcalf, O., & Phelps, A. (2014). PTSD – an update for general practitioners. Australian Family Physician, 43(11), 754-757.

 

This article informs general practitioners about changes to the diagnosis of PTSD by comparing DSM-5 with DSM-IV, and orients them to the revised Australian Guidelines for the Treatment of Acute Stress Disorder and Posttraumatic Stress Disorder. The role of GPs in managing PTSD is highlighted along with information about the current recommended pharmacotherapy and psychological treatments for PTSD.

 

Lloyd, D., Couineau, A. L., Hawkins, K., Kartal, D., Nixon, R., Perry, D., & Forbes, D. (In press). Preliminary outcomes of implementing Cognitive Processing Therapy for posttraumatic stress disorder across a national veterans’ treatment service. Journal of Clinical Psychiatry.

 

There is relatively little published research supporting the effectiveness of evidence-based PTSD treatments following national implementation efforts. This is the first study to systematically report Cognitive Processing Therapy (CPT) treatment outcomes from a national implementation effort, using service-based outcome monitoring data. Results indicate that when administered as part of routine clinical practice, CPT achieves large clinically significant improvements for self-reported PTSD (ES=1.01, p<.001) comparable with those found in randomised controlled trials. In addition, the study obtained high levels of treatment fidelity in the delivery of the CPT treatment.

 

Wade, D. & Dennison, M. (2015). Rapid-fire response: psychological action following a bushfire. Australian Doctor, 20-21.

 

This article appeared in the Grand Rounds section of Australian Doctor which presents interesting cases to educate doctors about medical issues. The article is based on the case of Sarah, a 25-year-old single teacher, who presents to a GP for the first time. She reports difficulty sleeping, feelings of being overwhelmed and panicky, outbursts of crying, and a racing heart after a recent narrow escape from a bushfire in which she lost her rental home and all her possessions. The article describes how the GP provides emotional and practical assistance to Sarah based on the recommended approach of Psychological First Aid (PFA). For those individuals exposed to a traumatic or very stressful event, PFA seeks to reduce initial distress, address basic needs, promote adaptive coping, encourage engagement with existing social supports, and monitor recovery over time.

 

Forbes, D., Alkemade, N., Waters, E., Gibbs, L., Gallagher, H., Pattison, P., … Bryant, R. (2015). Anger and major life stressors as predictors of psychological outcomes following the Victorian Black Saturday bushfires. Australian and New Zealand Journal of Psychiatry, 1-8. doi: 10.1177/0004867414565478

 

In a study of communities affected by the 2009 Black Saturday Bushfires, structural equation modelling established that anger and major life stressors were important mediators of the relationship between exposure to the fires and mental health outcomes. Multi-group analyses across gender suggested that mental health problems in males were driven predominantly by anger and subsequent stress, whereas in females the characteristics of the traumatic event remain important as well. The implication for postdisaster intervention strategies which target anger and minimise additional stressors is discussed.