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Poor Standards at A & E - Sun 6 Jul 2008

Many hospitals are failing to meet needs of panic sufferers

The experiences of Jack Archer, the young man who stabbed his father following discharge from hospital presenting with a panic attack, are not unique.

The National Phobics Society (NPS) – the UK’s leading anxiety disorders charity – has received a significant number of reports from their members who are dissatisfied with the standard of care and support received when visiting A&E during a panic attack. Many individuals commented that they had experienced poor standards of care, such as:

A& E staff trivialising panic with unhelpful comments such as ‘it’s just anxiety’ paper bags given out to control breathing (this could ultimately prolong the problem) discharging people without appropriate information or referral waiting times too long, and poor quality waiting areas lack of understanding and empathy from staff.

“The National Institute for Health and Clinical Excellence (NICE) guidelines for treating panic attacks are obviously not always being followed,” said Nicky Lidbetter, Chief Executive of the National Phobics Society (NPS). “A&E is often the first port of call for a panic attack sufferer, as they sometimes feel they can’t breathe or are having a heart attack. We know that A&E departments are very busy and under resourced, but it is essential that staff get it right because the standard of care and advice offered in accident and emergency can impact on the severity and duration of future attacks.”

Nicky Lidbetter continues, “The National Phobics Society has found that the focus in A&E departments is very much on physical health, and often there is a lack of professional skills in dealing with mental health issues. It is inappropriate for a panic attack sufferer to wait for long periods of time in a crowded waiting room, only to then be sent home without treatment or advice – and this is an all too common occurrence.”

The National Phobics Society is addressing this issue with a self-help booklet, available to panic attack sufferers and healthcare professionals as a resource*. The NPS is also holding a pilot training session with A&E workers at Trafford General Hospital in Manchester in the effective treatment of panic attack sufferers on 17 July 2008, drawing on the 2004 NICE guidelines. It is hoped that this training program will then be rolled out across the country, in response to the obvious gap in services.

The National Phobics Society hopes that this work will improve the level of panic awareness and treatment, ultimately having a real impact on the experiences of panic sufferers when presenting at accident and emergency.

* Available to download free from the National Phobics Society website at http://www.phobics-society.org.uk/docs/panic_booklet.pdf
Free booklet

See:- HERE

Obsessive-compulsive disorder - Wed 25 Apr 2007

Obsessive-compulsive disorder is characterized by anxious thoughts or rituals you feel you can't control. If you have OCD, as it's called, you may be plagued by persistent, unwelcome thoughts or images, or by the urgent need to engage in certain rituals.

You may be obsessed with germs or dirt, so you wash your hands over and over. You may be filled with doubt and feel the need to check things repeatedly. You might be preoccupied by thoughts of violence and fear that you will harm people close to you. You may spend long periods of time touching things or counting; you may be preoccupied by order or symmetry; you may have persistent thoughts of performing sexual acts that are repugnant to you; or you may be troubled by thoughts that are against your religious beliefs.

The disturbing thoughts or images are called obsessions, and the rituals that are performed to try to prevent or dispel them are called compulsions. There is no pleasure in carrying out the rituals you are drawn to, only temporary relief from the discomfort caused by the obsession.

A lot of healthy people can identify with having some of the symptoms of OCD, such as checking the stove several times before leaving the house. But the disorder is diagnosed only when such activities consume at least an hour a day, are very distressing, and interfere with daily life.

Most adults with this condition recognize that what they're doing is senseless, but they can't stop it. Some people, though, particularly children with OCD, may not realize that their behavior is out of the ordinary.

OCD strikes men and women in approximately equal numbers and afflicts roughly 1 in 50 people. It can appear in childhood, adolescence, or adulthood, but on the average it first shows up in the teens or early adulthood. A third of adults with OCD experienced their first symptoms as children. The course of the disease is variable--symptoms may come and go, they may ease over time, or they can grow progressively worse. Evidence suggests that OCD might run in families.

Depression or other anxiety disorders may accompany OCD. And some people with OCD have eating disorders. In addition, they may avoid situations in which they might have to confront their obsessions. Or they may try unsuccessfully to use alcohol or drugs to calm themselves. If OCD grows severe enough, it can keep someone from holding down a job or from carrying out normal responsibilities at home, but more often it doesn't develop to those extremes.

Research by NIMH-funded scientists and other investigators has led to the development of medications and behavioral treatments that can benefit people with OCD. A combination of the two treatments is often helpful for most patients. Some individuals respond best to one therapy, some to another. Two medications that have been found effective in treating OCD are clomipramine and fluoxetine. A number of others are showing promise, however, and may soon be available.

Behavioral therapy, specifically a type called exposure and response prevention, has also proven useful for treating OCD. It involves exposing the person to whatever triggers the problem and then helping him or her forego the usual ritual--for instance, having the patient touch something dirty and then not wash his hands. This therapy is often successful in patients who complete a behavioral therapy program, though results have been less favorable in some people who have both OCD and depression.

text taken from

ANXIETY DISORDERS: DECADE OF THE BRAIN (NIMH).

Seen in "The Anxiety Panic Internet Resource"
TAPIR

See:- HERE

Seeking help - Wed 21 Feb 2007

If we are put under a lot of pressure, we may feel anxious and fearful for much of the time. We usually cope with these feelings because we know what is causing them and we know when the situation will end. For instance, most of us will feel very anxious before taking a driving test, but we can cope because we know that the feelings will disappear once the test is over.

However, some of us have these feelings for much of the time without knowing what is causing them, and so not knowing when they might end. This is much harder to cope with and will usually need some help from somebody else. People will sometimes not want to ask for help because they think that people might think that they are 'mad'. In fact, people with anxiety and fears hardly ever have a serious mental illness. It's much better to get help as soon as you can rather than suffer in silence.

People with anxiety and phobias may not talk about these feelings, even with family or close friends. Even so, it is usually obvious that things are not right. The sufferer will tend to look pale and tense, and may be easily startled by normal sounds such as a door-bell ringing or a car's horn. They will tend to be irritable and this can cause arguments with those close to them, especially if they do not understand why the sufferer feels that they cannot do certain things. AIthough friends and family can understand the distress caused by anxiety, they can find it difficult to live with, especially if the fears seem unreasonable. Anxiety & phobias in children
Most children go through times when they feel very frightened about things. It's a normal part of growing up. For instance, toddlers get very attached to the people who look after them. If for any reason they are separated from them, they can become very anxious or upset. Many children are scared of the dark or of imaginary monsters. These fears usually disappear as a child grows older, and they do not usually spoil the child's life or interfere with their development. Most will feel anxious about important events like their first day at school, but they stop being frightened afterwards and are able to get on and enjoy their new situation.

Teenagers may often be moody. They tend to be worried about how they look, what other people think of them, how they get on with people in general, but especially about how they get on with the opposite sex. These worries can usually be dealt with by talking about them. However, if they are too strong other people may notice that they are doing badly at school, behaving differently, or feeling physically unwell.

If a child or teenager feels so anxious or fearful that it is spoiling their life, it's a good thing to ask the family doctor to look into it.

Helping people with anxiety and phobias
Talking about the problem This can help when the anxiety comes from recent knocks, like a spouse leaving, a child becoming ill or losing a job. Who should we talk to? Try friends or relatives who you trust, whose opinions you respect, and who are good listeners. They may have had the same problem themselves, or know someone else who has. As well as having the chance to talk, we may be able to find out how other people have coped with a similar problem.

SeIf-help groups
These are a good way of getting in touch with people with similar problems. They will both be able to understand what you are going through, but may be able to suggest helpful ways of coping. These groups may be focussed on anxieties and phobias, or may be made up of people who have been through similar experiences - women's groups, bereaved parent's groups, survivors of abuse groups.

Learning to relax
It can be a great help to learn a special way of relaxing, to help us control our anxiety and tension. We can learn these through groups, through professionals, but there are several books and videotapes we can use to teach ourselves (see below). It's a good idea to practice this regularly, not just when we are in a crisis.

Psychotherapy
This is a more intensive talking treatment which can help us to understand and to come to terms with reasons for our anxieties that we may not have recognised ourselves. The treatment can take place in groups or individually and is usually weekly for several weeks or months. Psychotherapists may or may not be medically qualified.

If this is not enough, there are several different kinds of professionals who may be able to help - the family doctor, psychiatrist, psychologist, social worker, nurse or counsellor.

Medication
Drugs can play a part in the treatment of some people with anxiety or phobias.

The most common tranquillisers are the valium-like drugs, the benzodiazepines (most sleeping tablets also belong to this class of drugs). They are very effective at relieving anxiety, but we now know that they can be addictive after only four weeks regular use. When people try to stop taking them they may experience unpleasant withdrawal symptoms which can go on for some time. These drugs should be only used for short periods, perhaps to help during a crisis. They should not be used for longer-term treatment of anxiety.

Antidepressants can help to relieve anxiety as well as the depression for which they are usually prescribed. Some even seem to have a particular effect on individual types of anxiety. One of the draw-backs is that they usually take 2 to 4 weeks to work and some can cause nausea, drowsiness, dizziness, dry mouth and constipation. Taking a certain kind of antidepressant, the MAOIs, may mean that you have to stick to a special diet. Please see our leaflet on antidepressants for more information.

Beta blockers are usually used to treat high blood pressure. In low doses, they control the physical shaking of anxiety and can be taken shortly before meeting people or before speaking in public.

Advice
Advice is obtainable from:

National Phobics Society: 339 Stretford Road, Hulme, Manchester M15 4ZY, Tel: 0870 7700456

Formed by a sufferer of agoraphobia for those affected by anxiety disorders. A volunteer-led organisation, run by sufferers and ex-sufferers of anxiety disorders.

Stress Management: 'Foxhills', 30 Victoria Avenue, Shanklin, Isle of Wight PO37 6LS. Tel: 01983 868 166.

The Thanet Phobic Group: 47 Orchard Rd, Westbrook, Margate, Kent CT9 5JS. Tel: 01843 833 720.

www.destigmatize.org.uk
A new organization working with the National Phobic's Society which aims to provide information and support for sufferers of anxiety disorders mainly, but not exclusively, in the Asian population.

Books
Anxiety and Depression by Robert Priest (McDonald and Co.)

Living with Fear by Isaac Marks (McGraw Hill)

Self-Help for your Nerves by Claire Weekes (Angus and Robertson)

Tapes

Control Your Tension, Lifeskills, Bowman House, 6 Billetfield, Taunton, Somerset TA1 3NN. Tel: 01823 451 771

The Mitchell Method of Relaxation Laura Mitchell, 8 Gainsborough Gardens, London NW3 1BJ.

This page was filched from The Royal College of Psychiatrists...thanks guys. CF.

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