i posted reply to this in forum named panic attack. have look there.
start with sharing that you havebeen told/informed that she/he has been diagnosed with Panic attck.
and express that .... empathy
then rest is explained in my post about panic attack
Peanut allergy counslling. Stean said - 6 yo had swollen lips and short of breath. We are going to discharge the boy, talk to father about peanut allergy
The body's immune system normally reacts to the presence of toxins, bacteria or viruses by producing a chemical reaction to fight these invaders. However, sometimes the immune system reacts to ordinarily benign substances such as food or pollen, to which it has become sensitive. This overreaction can cause symptoms from the mild (hives) to the severe (anaphylactic shock) upon subsequent exposure to the substance. An actual food allergy, as opposed to simple intolerance due to the lack of digesting enzymes, is indicated by the production of antibodies to the food allergen, and by the release of histamines and other chemicals into the blood.
The Peanut Problem
Peanuts, a cheap source of dietary protein predominantly ingested as peanut butter, have indeed become one of the world's most allergenic foods. They are, unfortunately, progressively finding their way into more and more food products either directly, or by indirect contamination of food products during the manufacturing process. Peanut may be designated on a food label in a less easily recognized term such as "hydrolysed vegetable protein" or "groundnuts". It is important to realize that for the sensitive person, this is a lifelong allergy, and that even trace amounts can kill. Sensitization may possible occur during a pregnancy when the mother overindulges in or perhaps even just eats peanut products, and peanut proteins have even been found in breast milk.
The Allergic (Anaphylactic) Shock Reaction
This reaction can begin and proceed rapidly, occasionally proving fatal within minutes. It must be treated with epinephrine immediately at the first signs of reaction, and the reaction may recur after initial therapy so that ongoing observation and care are required. Possible symptoms of reaction to peanuts may include (not necessarily in this order):
* sense of foreboding, fear, or apprehension
* flushed face, hives, swollen or itchy lips, mouth, eyes, or tongue
* tightness in mouth, chest or throat
* difficulty breathing or swallowing, drooling, wheezing, choking, coughing
* running nose, voice change
* vomiting, nausea, diarrhea, stomach pains
* dizziness, unsteadiness, sudden fatigue, rapid heartbeat, chills
* pallor, loss of consciousness, coma, death
Factors Which May Contribute To Fatal Peanut Reactions
A. Failure Of Institutions
* Incomplete or inadequate labelling of foods or packages thereof
* Ignorance of food allergy problems by restaurants, school personnel, etc.
* Non-availability of medications or resuscitation equipment or inappropriate use thereof
* Having peanut products in the home or school lunchroom of a peanut sensitive individual
* Peanuts may be altered and sold as walnuts, almonds or pecans
B. Failure To Prevent Problem
* Failure to always read food labels carefully
* Not always inquiring about contents of foods regardless of where prepared
* Trying to taste a tiny bit of an unknown but suspected food to see if it contains peanut
* Sharing foods or utensils
* Obtaining foods from others when the contents may be unknown
* Relying on the service personnel in restaurants instead of the chef
* Kissing someone or being kissed by someone who has eaten peanut products
C. Failure To Identify Problem
* Failure to appreciate that minimal amounts of peanut material can kill
* Minimization of, or denial of, symptoms of previous non-fatal reactions
* Failure to speak out when one even suspects that a reaction may be occurring
* Not wearing a bracelet showing "Allergy To Peanut"
D. Failure Of Treatment
* Failure to carry and know how to use in-date epinephrine (Epi-Pen®, Ana-Kit ®) at all times. (In some cases, failure of a caregiver to understand fully or to administer this.) It is often wise to have a child's picture on the epinephrine container.
* Failure to use epinephrine immediately for a peanut reaction
* Failure to have a second epinephrine dose available if necessary
* Attempting to use an oral antihistamine alone to control symptoms
* Failure to be taken to a nearby hospital quickly after epinephrine use
* Impaired awareness of potential peanut product due to alcohol or other drug influence
* Taking Beta-Blocking Medications (check with a physician or pharmacist)
Lifestyle Adjustments
* The sensitive individuals must recognize that they are different, bear a large responsibility, and know they can die of a reaction
* Residue of peanut material on a wiped counter top, cutlery or plates may induce a reaction. Aerosolized peanut material (e.g. opening a sealed jar of peanut butter, or fumes from cooking) may cause asthma in a susceptible individual. Some may experience nausea if people nearby are eating suspected foods.
* Peanut butter may be used to thicken chili, or to seal egg rolls. Bakery products and ice creams may easily be contaminated.
* It is unsafe to pick out a "safe" nut from a mixture containing peanuts. Avoid all nuts.
* Parents of the susceptive person must be vigilant, and yet worry about a possible fatal mistake. Most exposures are accidental.
* Peer pressure may be large -- One child received anonymous E-Mail saying "I'm Peanut, You're Dead"; another was chased about the schoolyard by a [bleep] brandishing a peanut, while a third had the pouch containing life saving epinephrine taken as a prank.
* The parents of non-sensitive children may selfishly (or for financial reasons) argue that, "Why should my child be deprived of peanut when the problem is that of another child?" Perhaps the answer lies in the counter-argument that if their child had the life threatening reaction, would they not be the first to demand that all peanuts be removed from the child's environment. Fortunately, many schools and summer camps have come to realize the magnitude of the problem and controlled the problem.
* Some individuals also must avoid other foods in the legume family e.g. soya bean, pea, and garbanzo (chickpea) if allergy to these has been previously demonstrated.
* Education of friends, relatives and acquaintances is essential. Divorce situations may pose a special threat where one of the parents chooses to deny the problem.
* Pure peanut oil is generally non-allergenic, but cold pressed peanut oil or oil contaminated with peanut protein through cooking may be dangerous.
Future Hope
Immunotherapy has been worked upon with encouraging results, but it is too early to tell if this will be an effective form of therapy for all peanut sensitive individuals.
Read this link it has more than enough material to talk about.
Step after hello hi and rapo etc
ask for why /whats the concern.
Then you can answer alomst any concern by readig this link.
here is more material canadian version expressing same things in different lingo.
The development of vaccines has led to the reduction and, in some cases, the elimination of many life-threatening diseases. However, in recent years pediatricians have been faced with increasing public concern about the necessity and safety of vaccines.
SLACK Incorporated, with the support of an unrestricted educational grant from Merck & Co., assembled a panel of experts in the area of pediatrics to discuss vaccine safety issues and the common concerns that parents have about immunizing their children. Panel members were involved in an interactive symposium, the results of which are published in this monograph. The purposes of the symposium and monograph are to facilitate awareness about vaccine misperceptions and to emphasize the importance of communication between pediatricians and parents regarding the benefits and risks of vaccines.
An Ounce of Prevention: Communicating the Benefits and Risks of Vaccines to Parents
Truths About Vaccines
Gary S. Marshall, MD
Not long ago, the public embraced vaccination as nothing short of a medical miracle. Children lined up outside clinics with smiles and sleeves rolled up, eager to receive a lollipop, a Polio Pioneer button and a shot. None of them knew if the shot contained the vaccine or placebo, but they considered themselves lucky for the chance to participate in history. The polio vaccine, along with other vaccines before and after it, constitutes one of the most important public health initiatives ever invented.
Diseases disappeared before vaccines were introduced
Most people who get sick have been vaccinated
Many vaccines cause serious adverse events
Vaccines cause many illnesses and deaths
Vaccine-preventable diseases are rare
Multiple vaccinations overload the immune system
Today, physicians find themselves challenged by parents to explain why vaccines are necessary, and they are called to defend the safety record of vaccines in the face of proliferating misinformation and anti-vaccine rhetoric. On September 18, 2002, an interactive symposium was held in Chicago entitled “An Ounce of Prevention: Communicating the Benefits and Risks of Vaccines to Parents.” Sixty-five pediatricians from a variety of practice settings were convened with a distinguished faculty to develop a framework for communication with parents that informs, answers questions, empowers parents with scientific facts and preserves the successes of immunization programs.
One could ask the simple question: “What has changed since the days of Albert Sabin, MD, and Jonas Salk, MD?” The answer is that diseases have disappeared and fear of disease has been replaced by fear of vaccines. It is necessary to continue to reevaluate the risk/benefit formula regarding vaccines. For example, the risk of vaccine-associated paralytic polio (VAPP) caused by oral polio vaccine (OPV), estimated to occur once for every 2.4 million doses distributed, was acceptable at a time when 20,000 devastating cases of natural polio occurred each year in the United States.
However, with no cases of natural polio in the country since 1979 and no cases in the Western Hemisphere since 1991, the risk of five or 10 cases of VAPP each year outweighed the benefits of OPV. This is what prompted the switch to the inactivated polio vaccine (IPV) in 2000.2
The history of the polio vaccine illustrates that, in policy-making, risks and benefits are carefully weighed. However, in recent years, some parents have become convinced that vaccine policies ignore the “facts” about vaccines, many of which are actually misconceptions perpetuated on the Internet and in the lay press.3 Some of these misconceptions are addressed by the Centers for Disease Control and Prevention in a paper entitled “Six common misconceptions about vaccination and how to respond to them” (Table 1).
Vaccine truths
The truths about vaccines are also worth reviewing. First, that vaccines have been an important public health achievement, has already been alluded to (Table 2). The second truth is that public concern about vaccines is pervasive. Articles in magazines, segments on television talk shows, sound bytes on the evening news, hearings on Capitol Hill and conversations at dinner parties all attest to this. The third truth, that fear of vaccines can lead directly to public harm, may not be so obvious. In the United Kingdom and other countries in the 1970s, fear that whole-cell pertussis vaccine caused encephalopathy led to dramatic declines in vaccine uptake and consequent epidemics of disease.4 Senseless deaths occurred because children were not vaccinated. While whole-cell pertussis vaccine was reactogenic, there remains no proof that it caused permanent neurological damage.
This leads to the fourth truth that vaccines are not 100% safe. However, the safety net in place to detect serious adverse effects from vaccines is extensive, beginning with controlled clinical trials and rigorous licensing procedures and continuing with post-marketing surveillance, the Vaccine Adverse Event Reporting System and ongoing review by bodies like the Institute of Medicine.
Vaccines are one of the most important public health achievements
Public concern about vaccines is pervasive
Fear of vaccines can lead to public harm
Vaccines are not 100% safe
Parents want what is best for their children
The public has little understanding of the vaccine development process
Risk perception is critical
There are anti-vaccine champions
Questions remain
The decision not to vaccinate is an active decision to accept the risks of disease
(Courtesy of Gary S. Marshall, MD.)
The experience with the rotavirus (Rotashield, Wyeth) vaccine illustrates the effectiveness of this safety net.5,6 Within one year of licensure, intussusception associated with the vaccine was detected and vaccine use was suspended. The attributable risk is now estimated to be less than one case per every 10,000 vaccinations, which is actually lower than the natural incidence of intussusception (around one in 2,000 infants); this level of risk was too low to have been detected in prelicensure trials, in which approximately 11,000 children received the vaccine. Ongoing clinical trials of new rotavirus vaccines will enroll tens of thousands of children to ensure that those vaccines do not cause intussusception.
The fifth truth is that parents want what is best for their children. The problem is not that they want harm to come to their children but rather that many have become convinced that responsible parenting means protecting their children from the vaccines rather than the diseases. Physicians must reframe the discussion about vaccines so parents understand the risks of the diseases and the risks of the vaccines in the proper context.
The sixth truth is that parents have little understanding of vaccinology. The effort involved in isolating the causative agent, understanding disease pathogenesis, determining correlates of protection, testing vaccine prototypes in animals, establishing safety, conducting field trials and collecting a database that allows for licensure is underappreciated. This process takes many years of research as well as millions of dollars of funding.
The seventh truth about vaccines is that risk perception is critical. Without minimizing the importance of preparedness for bioterrorism, it is ironic to point out that, most likely, no one will die of smallpox in the United States this year, but approximately 20,000 people will die of influenza. Yet, parents who are leery of influenza vaccination express interest in smallpox vaccine because of the perception of risk. Parents living in non-endemic areas expressed interest in the Lyme vaccine because the disease was perceived to be serious; at the same time, many parents took their children to chickenpox parties because they perceived acquiring the natural disease to be less risky than the varicella vaccine. In the early 1990s, there were approximately 50 pediatric deaths each year from varicella,7 which were more deaths than from any other disease preventable by a routinely administered childhood vaccine at the time.
The eighth truth is that just as there are vaccine champions, there are vaccine anti-champions. No one can argue that the attention brought to vaccine safety issues by activists has not benefited the public. Much of the expansion of the vaccine safety net can be attributed to this activity. However, much of the information that is easily accessible to parents (e.g. on the Internet8) is not accurate. The only available filter through which parents can interpret this information is the primary-care physician. Studies have repeatedly shown that, in addition to laying out the facts, the personal endorsement of the physician is the most important aspect of advocating for vaccines in practice.
Questions remaining
The ninth truth is that many questions about vaccines remain. For example, which vaccine safety claims are worth investigating? Clearly, not every claim can be studied, and perhaps only those with reasonably plausible hypotheses deserve scientific attention. How can the medical community and the vaccine industry address issues of conflict of interest while advocating for vaccination? What financial and logistical barriers do practitioners face in promoting vaccination? How do families differ in their orientation toward traditional medicine, and how should the physician’s approach to discussing vaccine safety with parents be adjusted based on that orientation?
Parents may think that in accepting vaccinations they are making active choices and that in refusing vaccinations they are passively deferring to the status quo. In fact, the (tenth) truth is that the decision to refuse vaccination is an active decision to accept the risks of the disease. This idea may help some parents place the true risks and benefits of vaccination in perspective and make informed decisions.
Myths Regarding Immunization
Jay M. Lieberman, MD
Vaccines are one of the most powerful tools to keep our children healthy and were recognized by the Centers for Disease Control and Prevention as one of the 10 greatest public health achievements of the 20th century.1 However, myths, misconceptions and misperceptions about vaccines and, in particular, about the safety of vaccines threaten immunization programs and consequently the health of our children.
Vaccine myths are dangerous because they can lead to the perception that vaccines are unsafe. Perceptions matter because they influence behavior, and concerns about safety can erode confidence in vaccines and cause some parents to refuse to have their children vaccinated. If too many parents refuse vaccination, this can lead to the reemergence of infectious diseases that have been virtually eliminated. For example, fears about the safety of whole-cell pertussis vaccine led to the temporary discontinuation of pertussis immunization programs in a number of countries.2 Predictably, as immunization levels fell, these countries experienced dramatic increases in the incidence of pertussis.
Similarly, concerns about a possible link between the measles-mumps-rubella (MMR, M-M-R II, Merck & Co.) vaccine and autism have resulted in decreased MMR immunization levels in the United Kingdom with resultant increases in measles and mumps cases.
Vaccine knowledge
According to a study that examined parents’ knowledge about vaccines, 87% of parents deemed immunizations extremely important to keep their children healthy. In addition, children’s health care providers were cited as their most important source of information about immunizations.3 Therefore, physicians and nurses can significantly influence the decisions that parents make about vaccines.
Despite the general recognition that vaccines are beneficial, some parents had important misperceptions about vaccines. According to the study, 23% of parents thought that children receive more immunizations than are good for them and 25% thought a child’s immune system could be weakened as a result of too many immunizations.3 Unfortunately, these myths are common not only among parents. According to a poll of the physician audience at the interactive symposium “An Ounce of Prevention: Communicating the Benefits and Risks of Vaccines to Parents,” 40% of attendees believed that children receive more immunizations than are good for them and 12% were unsure if too many immunizations could weaken the immune system.
Because vaccines are preventative and are usually given to healthy individuals, they must be as safe as possible, and it is important for parents and physicians to understand vaccine safety issues. This understanding, however, should be based upon proof not theory, upon science not anecdote.
Immune dysfunction
The idea that too many immunizations can overload or damage the immune system is not based on scientific evidence. Theoretically, infants have the capacity to respond to 10,000 vaccines at one time,4 and clinical studies have shown that infants and children are capable of generating protective humoral and cellular immune responses to multiple vaccines administered simultaneously.
Furthermore, although the immunization schedule has greatly expanded over recent decades and children receive more vaccines than ever, they are exposed to fewer antigens.4 In 1960, children received vaccines against five diseases: smallpox, diphtheria, tetanus, pertussis, and polio. The smallpox vaccine contained approximately 200 antigens and the whole-cell pertussis vaccine approximately 3,000 antigens.
With the global eradication of smallpox, the smallpox vaccine was removed from the immunization schedule. In addition, the whole-cell pertussis vaccine has been replaced by the acellular pertussis vaccines, which contain only two to five antigens. Therefore, although vaccines today protect children against many more diseases, the number of antigens contained in all of the recommended vaccines has decreased from more than 3,200 to fewer than 130 (Figure 1).
The Institute of Medicine (IOM), part of the National Academy of Sciences, formed an Immunization Safety Review Committee to evaluate the evidence on a series of immunization concerns. The committee consists of 15 health professionals who have expertise in areas including pediatrics, immunology, infectious diseases, neurology, epidemiology, public health, and risk perception and communication. A key feature of the committee is that members have no real or perceived conflicts of interest.
One issue that the committee considered was vaccines and potential immune dysfunction, including autoimmune and allergic diseases.5 Considering the evidence, the committee favored rejection of a causal relationship between multiple immunizations and an increased risk of heterologous infections, meaning that vaccination does not increase a child’s risk of serious infection, such as pneumonia or meningitis, in the post-vaccine period. In addition, the evidence suggests that vaccines do not cause Type 1 diabetes as some have alleged. The data were inadequate to accept or reject a causal relationship between multiple immunizations and an increased risk of allergic disease, particularly asthma.
Vaccine adverse events
Many myths center on serious adverse events purported to be caused by vaccines. As with all drugs, vaccines have adverse events, most of which are local reactions that are mild and self-limited. Rarely, vaccines are associated with serious adverse events, such as the oral rotavirus vaccine and intussusception or the oral polio vaccine and paralytic poliomyelitis.
However, there are common misperceptions about vaccine side effects. Vaccines have been blamed for supposed relationships with a number of chronic conditions for which the etiologies remain unknown. For example, it has been alleged that hepatitis B vaccines may cause demyelinating neurologic disorders, such as multiple sclerosis (MS). The genesis of these allegations was anecdotal reports of individuals who developed disease after vaccination.
In 2001, two studies published in the New England Journal of Medicine found no association between hepatitis B vaccination of adults and the development of MS or relapse of MS.6,7 Analyzing the evidence, the IOM favored rejection of a causal relationship between the hepatitis B vaccine administered to adults and the development of MS or MS relapse, although there was weak evidence for a biological mechanism by which the hepatitis B vaccine could possibly influence an individual’s risk of a demyelinating neurologic disease. Data were inadequate to evaluate the relationship between hepatitis B vaccination and other demyelinating diseases, such as Guillain-Barré syndrome, acute disseminated encephalomyelitis, optic neuritis or transverse myelitis.8
MMR and autism
One of the most prevalent myths recently promoted by anti-vaccine groups has been that the MMR vaccine causes autism. Autism is usually first identified in children during the second year of life. The vaccine that children receive closest to this time is MMR and thus some children develop or are recognized as having autism shortly after receiving MMR. However, this temporal association does not prove causation.
Andrew Wakefield, MD, and colleagues published a report in 1998 that proposed an association between MMR and autism. They described 12 children referred to their pediatric gastroenterology unit with diarrhea and abdominal pain, as well as a history of normal development followed by a loss of acquired skills. Eight of the children had autism. The onset of symptoms was associated with MMR in six of the eight children with autism. When gastrointestinal endoscopy was performed, seven out of the eight were found to have lymphoid nodular hyperplasia. Wakefield hypothesized that the MMR vaccine introduced a series of events, including colitis, intestinal inflammation, increased intestinal permeability and absorption of encephalopathic proteins into the bloodstream that enter the brain and cause autism.9
However, the behavioral symptoms preceded the gastrointestinal symptoms in all cases, and ileal and colonic lymphoid hyperplasia occurs in about 25% of children and is considered a normal variant. With a small case series and the absence of a control group, the authors correctly concluded that these cases “did not prove an association between measles, mumps, and rubella vaccine and the syndrome described.”9 Epidemiologic studies subsequently conducted in the United States and Europe have not found an association.
A population-based study from the United Kingdom investigated the incidence of autism before and after introduction of MMR vaccine in October 1998. Approximately 500 cases of autism were identified during the period studied, with a steady increase in cases by year of birth. However, there was no change in the trend after introduction of MMR vaccine, and no temporal association between MMR vaccination and the onset of autism. The authors concluded that their analyses did not support a causal relationship between MMR and autism.10
In the United States, retrospective analyses of cases of autism and MMR vaccine coverage rates among children in California born between 1980 and 1994 showed no apparent correlation between the vaccine and autism.11 Although diagnoses of autism rose sharply in children through the study period, there was no corresponding increase in MMR vaccine coverage during those years.
A recent study provides the strongest evidence to date that the MMR vaccine does not cause autism. This population based, retrospective cohort study looked at all 537,303 children born in Denmark from January 1991 through December 1998. MMR vaccine had been administered to 82% of children. Autism was diagnosed in 316 children and an autistic spectrum disorder in 422. The analysis showed no increased risk of autism or autistic spectrum disorders in vaccinated children compared with unvaccinated children. Furthermore, there was no association between the age at vaccination or the time since vaccination and the development of autism.12
In 2001, after reviewing the available research on the MMR-autism hypothesis, the IOM concluded that the evidence favored rejection of a causal relationship between MMR and autism. The committee found no proven biological mechanisms that would explain such a relationship.13
Thimerosal and autism
As the evidence has accumulated that MMR does not cause autism, anti-vaccine groups have switched the spotlight to thimerosal, a vaccine preservative used in some vaccines since the 1930s that contains small amounts of ethyl mercury. In 1999, the FDA concluded that some infants given thimerosal-containing vaccines at multiple visits would receive cumulative doses of ethyl mercury that exceed safety guidelines established by the Environmental Protection Agency for methyl mercury, another form of organic mercury. The American Academy of Pediatrics and the U.S. Public Health Service, therefore, recommended that thimerosal-containing vaccines be reduced or eliminated. This goal was established as a precautionary measure, as there was no evidence of any harm caused by the low levels of mercury in vaccines.
Mercury is a known neurotoxin, and anti-vaccine proponents have suggested a relationship between thimerosal and neurodevelopmental problems, including autism, attention-deficit/hyperactivity disorder and speech and language delay.
A review by the IOM concluded that the hypothesis that thimerosal exposure through childhood vaccines has caused neurodevelopmental disorders is not supported by clinical or experimental evidence, although there are inadequate data to accept or reject a causal relationship.14 The hypothesis has some biological plausibility and, therefore, research studies are ongoing to assess if thimerosal use was associated with mild levels of neurologic impairment. If thimerosal did cause autism, one would expect the incidence of autism in the United States to decrease over the next few years since thimerosal has been removed from all vaccines routinely given to infants.
Perception
Vaccines are preventative so, by their very nature, nothing happens when they are effective in preventing a child from dying or suffering significant morbidity. In addition, because vaccines have been so effective, the diseases they prevent are rare and are often no longer seen as threats. Parents are not afraid of polio, diphtheria or measles because they have never seen these diseases. As fear of the diseases declines, fears of adverse events, whether real or only perceived, can predominate. Widespread concerns about vaccine safety can lead to lower immunization levels and a resurgence of disease. The resurgence of disease may then serve as a "reminder" of the importance of immunizations (Figure 2).
Millions of children in the United States are vaccinated each year at 2, 4 and 6 months of age, so it should not be surprising that some children will develop a cold, fever, diarrhea or seizures within a day or two of being vaccinated. But sequence is not the same thing as consequence. An illness or chronic disease that occurs after vaccination was not necessarily caused by the vaccine.
Several years ago, a pediatrician told me a true story that illustrates this point. Parents had brought their 2-month old daughter in for her first set of immunizations. Because the parents had seen a Dateline NBC story that suggested a link between pertussis vaccines and brain damage, they did not want to have their daughter vaccinated against pertussis. However, after the pediatrician spoke to the parents about what was known and not known about pertussis, the pertussis vaccine and brain damage, the parents agreed to have their daughter vaccinated.
As the vaccine was being drawn up into the syringe to be administered, the child had a seizure. Had the vaccine been given 30 minutes, three hours or a day earlier, the parents would have been convinced that the vaccine caused the seizure. They would have been wrong.
If a child experiences an adverse reaction after receiving a vaccine, physicians are encouraged to report it (through the Vaccine Adverse Event Reporting System at
but should not assume that the vaccine caused the problem. Physicians need to remain educated about vaccines and vaccine safety issues so that they can discuss concerns that parents have. Vaccine myths and misperceptions should not interfere with our vaccination programs – no child should needlessly suffer or die from a vaccine-preventable disease. Parents want the truth, so we should give it to them — immunizations are one of the most important things they can do to keep their children healthy.
next question please.
keep me busy.
i am concentrating on content part i hope u can solve the acting part of it.
Bring me more questions keep me busy please
I am interseted in joining your group but dont see you discussing anything for a long time. Let me know if you have moved else where.
For the above scenerio.
I suppose you assume panic disorder and are beyond the stage of differential diagnosis-
First ask the patient to calm down and sit down.
Tell him panic attacks usually settle down in a few minutes and that they are not life threatening or sinister in any way
You could distract him with topics such as family and work or even advise him to think of scenerios that he finds pleasant.
You could ask him to breath in and out as he is counting 101, 102, 103 to slow down and deepen his breathing so that he is not hyperventilating which can cause dizzyness and pins and needles in his finger tips etc. Alternatively youcould ask them to breath into a paper bag.
And then get history if possible about the duration of problem, frequency, triggers and treatment so far!
Your answer is very sensible and would probably get a good score.
I would also add asking her why she feels he should not told of the diagnosis and address her fears or deal with any difficulties that she points out to.
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