SUMMARYThirty-one elderly people were examined in Lockerbie and compared with 24 younger survivors of the disaster which took place in December 1988. Examination took place within one year of the disaster, but was timed to avoid the anniversary period. All subjects were in Lockerbie at the time the aeroplane exploded in mid-air. Examinations werc conducted for purposes of medico-legal assessment. The elderly had similar responses to the younger disaster victims, the majority of whom met DSM-111-R criteria for PTSD. The elderly, however, had a very high incidence of coexisting major depression, unlike the younger population. Loss or injury to friends and the witnessing of human remains was positively correlated with a diagnosis of post-traumatic stress disorder in the elderly but not in the younger subjects. Neither material nor personal loss, nor the witnessing of human remains, was associated with a diagnosis of depression in the elderly, although significant material loss was associated with depression in the younger patients.KEY woms-Elderly, disaster, outcome, PTSD, depression, loss.Lockerbie is a small village located in a pleasant pocket of the south west of Scotland. When PanAm Flight 103 exploded in mid-air on December 21, 1988, at about 7.00 pm, many of the village's inhabitants were watching a popular television programme. A huge fireball of burning aviation fuel destroyed part of Sherwood Crescent, in one of the village's new housing schemes. The explosion generated a large crater. Several people were lost without trace in the fire. Survivors were often trapped in their homes by the flames. Many witnessed mutilated human remains in their garden. Two typical cases are briefly described. Case 1. Mrs R (72) and her husband were watching television when the explosion brought down their living room ceiling. Windows were blown in

A sample of 173 female nurses was studied to assess the amount of stress they experienced whilst at work. Psychological symptoms were found to be commoner in younger, less experienced nurses spending more time with patients. Suggestions are made to reduce distress in vulnerable nurses.

SUMMARYThe long-term outcome of a civilian disaster is examined in an elderly population assessed originally for medicolegal purposes. Thirty-one elderly inhabitants of the village of Lockerbie, who had survived the Lockerbie air disaster, were assessed 1 year after the event. Nineteen of the sample were available for reexamination 2 years later. Although there was a significant reduction in the incidence of PTSD and significant improvement across a range of anxiety-based symptoms, 15.7% of the subjects continued to fulfil diagnostic criteria (DSM-111-R) for PTSD. In these subjects, there was a persistence of other anxiety-related symptoms and of major depression . This is the only longitudinal assessment of PTSD in elderly subjects and it shows that, as with younger subjects, PTSD tends to persist for at least 2 years after the traumatic event and, for a substantial minority, has still not remitted within 3 years of the traumatic event.KEY WORDS-PTSD, elderly, disaster, long-term outcome An initial study in 1989 (Livingston et at., 1992) examined 31 elderly survivors of the disaster in which Pan Am Flight 103 exploded in mid-air, scattering burning aircraft debris and human remains throughout the town of Lockerbie in Dumfriesshire. All of the subjects assessed in this study were in Lockerbie at the time the aeroplane exploded at the end of December 1988. This initial sample was derived as follows: general practitioners screened patients using the GHQ-28 and those who scored within the caseness range, and who wished to be assessed for compensation, were seen by the psychiatric team. Subsequently, 1 year after the disaster, 26 of 31 elderly subjects examined (84%) had post-traumatic stress disorder (DSM-111-R) and 18 (5 1%) had coexisting major depression (DSM-III-R). Loss or injury to friends and family was positively correlated with a diagnosis of post-traumatic stress disorder. The diagnosis of depression was not, however, directly associated with the subject's disaster experience, such as witnessing human remains.The group was reexamined 3 years after the disaster, 2 years following the initial assessment. As yet, there are no long-term outcome studies of PTSD in an elderly population. It was hoped to obtain useful information on the evolution of PTSD in elderly people as well as an impression of the response to treatment. Compensation claims had been settled by the time of this follow-up examination. There is a possibility that symptomatology could be exaggerated in anticipation of compensation (although clinicians often report the opposite finding, ie that litigants minimize symptoms (Curran et al., 1990)). This possibility was avoided by carrying out this second assessment after settlement of the financial claims.

After initial enthusiasm, the use of monoamine oxidase inhibitors (MAOIs) has been limited by the wide range of MAOI-drug and MAOI-food interactions that are possible, particularly with sympathomimetic medications or tyramine-containing foods, resulting in hypertensive reactions. Despite their clinical benefits, this has led to a reduction in use of such medications. Discovery of the 2 main subgroups of monoamine oxidase, types A and B, led to the synthesis of MAOIs selective for one or other of these isoenzymes. Consequently, selegiline (deprenyl), a selective MAO-B inhibitor, was developed for the treatment of idiopathic Parkinson's disease. This drug is useful in the treatment of the early stages of the disease and later on as an adjunct to other drug therapies. Although the selective MAO-A inhibitor, clorgiline (clorgyline), was found to be effective in the treatment of depression, it still retained the potential to cause hypertensive reactions. Recently, agents that are not only selective, but reversible in their inhibition of MAO-A (RIMAs) have been synthesised (e.g. moclobemide and toloxatone), and have proven antidepressant efficacy. Whilst they are less likely to induce hypertensive reactions with the concomitant administration of sympathomimetic drugs or with tyramine-rich foodstuffs, it still seems wise to advocate care in co-prescribing potentially interacting medications and to advise a degree of caution with regard to the dietary intake of foodstuffs likely to contain a high tyramine content. Although these newer drugs represent an advance in safety, their use has, as yet, only been established in the treatment of depression. RIMAs also retain a potential for adverse interaction with other drugs. Concomitant prescription of serotonin-enhancing drugs should only be undertaken with caution for patients on moclobemide, toloxatone or selegiline. Coprescription of sympathomimetic drugs should also be avoided with these newer MAOIs and patients should be advised against purchasing over-the-counter preparations that may contain sympathomimetic drugs.

A new rating instrument, the Glasgow Assessment Schedule (GAS), is described for the evaluation of head injury outcome. The instrument, which has been used in samples of head-injured men, provides for a comprehensive assessment, and can distinguish mildly and severely injured patients and rate change over time. Inter-rater reliability and concurrent validity with a global rating scale has been found to be satisfactory. It is expected that the GAS will mainly be of use in clinical and research settings in which longer-term management is envisaged.