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ex100 {2009}\par\pard\li1373\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1373\ri0\sl
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w Zealand College of Psychiatrists (RANZCP),}\par\pard\li1373\ri0\sl-200\slmult0
\fs12\cf0\f0\charscalex100 {this information and advice is based on current med
ical knowledge and practice as at}\par\pard\li1373\ri0\sl-200\slmult0 \fs14\cf0\
f0\charscalex100 {the date of publication. It is intended as a general guide onl
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scalex100 {for individual medical advice. The RANZCP and its employees accept no
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for any consequences arising from relying upon the information contained in this
}\par\pard\li1373\ri0\sl-200\slmult0 \fs14\cf0\f0\charscalex100 {publication.}\p
ar\column\pard\li0\ri0\sl-600\slmult0 \fs36\cf3\f0\charscalex100 {Contents}\par\
pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\
par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\
cf0\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {Key points about
panic disorder and agoraphobia }\par\pard\li0\ri0\sl-413\slmult0 \fs18\cf0\f0\c
harscalex100 {Introduction }\par\pard\li0\ri0\sl-400\slmult0 \fs18\cf0\f0\charsc
alex100 {Managing anxiety symptoms }\par\pard\li0\ri0\sl-400\slmult0 \fs18\cf0\f
0\charscalex100 {Effective treatments for panic disorder }\par\pard\li0\ri0\sl-4
13\slmult0 \fs18\cf0\f0\charscalex100 {Finding professional help }\par\pard\li0\
ri0\sl-400\slmult0 \fs18\cf0\f0\charscalex100 {Appendix 1: Questions to ask }\pa
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\slmult0 \fs18\cf0\f0\charscalex100 {The Royal Australian and New Zealand Colleg
e of Psychiatrists}\par\pard\li1373\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex10
0 {309 La Trobe Street}\par\column\pard\li0\ri0\sl-400\slmult0 \*\tx5320\fs18\cf
0\f0\charscalex100 {Appendix 2: What should I do if my child or spouse is anxiou
s? }\tab \fs18\cf2\f0\charscalex100\b {30}\b0 \par\pard\sect\sectd\sbknone\pgwsx
n16773\pghsxn11893\marglsxn666\margrsxn133\cols3\colno1\colw9813\colsr-0\colno2\
colw5320\colsr-0\colno3\colw840\pard\li1373\ri0\sl-240\slmult0 \fs18\cf0\f0\char
scalex100 {Melbourne Victoria 3000}\par\pard\li1373\ri0\sl-240\slmult0 \fs18\cf0
\f0\charscalex100 {Australia}\par\pard\li1373\ri0\sl-240\slmult0 \fs18\cf0\f0\ch
arscalex100 {Telephone: (03) 9640 0646}\par\pard\li1373\ri0\sl-240\slmult0 \fs18
\cf0\f0\charscalex100 {Facsimile: (03) 9642 5652}\par\pard\li1373\ri0\sl-240\slm
ult0 \fs18\cf0\f0\charscalex100 {Email: ranzcp@ranzcp.org}\par\pard\li1373\ri0\s
l-413\slmult0 \fs18\cf0\f0\charscalex100 {Website: www.ranzcp.org}\par\column\pa
rd\li0\ri0\sl-266\slmult0 \fs18\cf0\f0\charscalex100 {Appendix 3: Sources of inf
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arscalex100 {Appendix 5: Development of the guideline }\par\pard\li0\ri0\sl-400\
slmult0 \fs18\cf0\f0\charscalex100 {Acknowledgements }\par\column\pard\li0\ri0\s
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or professionals, which was developed by}\par\pard\li0\ri0\sl-320\slmult0 \fs18\
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mn\pard\li0\ri0\sl-520\slmult0 \fs28\cf5\f0\charscalex100 {What is the differenc
e between anxiety}\par\pard\li0\ri0\sl-400\slmult0 \fs28\cf5\f0\charscalex100 {a

nd panic disorder?}\par\pard\li0\ri0\sl-373\slmult0 \fs18\cf0\f0\charscalex100 {

Everyone experiences anxiety at different times. It is normal and}\par\pard\li0\
ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {sensible to become anxious in som
e situations. For instance, if a}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\c
harscalex100 {stranger grabs you as you walk alone down a deserted street at nig
ht}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {it would be usua
l to show symptoms of anxiety (also called the \uc1\u8216Xfight}\par\pard\li0\ri
0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {or flight\uc1\u8217X response). You
r body has an in-built system that is activated}\par\pard\li0\ri0\sl-320\slmult0
\fs18\cf0\f0\charscalex100 {in times of potential danger to make you more able
to fight or flee.}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {T
his type of anxiety is both useful and normal and is not a cause for}\par\pard\l
i0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {concern. In fact, anxiety help
s in many day-to-day activities such as job}\par\pard\li0\ri0\sl-320\slmult0 \fs
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t a bit anxious}\par\pard\li0\ri0\sl-320\slmult0 \fs16\cf0\f0\charscalex100 {is
normal and often helpful. Panic disorder is diagnosed when the level}\par\pard\l
i0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {of anxiety is out of proportio
n to the situation. A person with panic}\par\pard\li0\ri0\sl-320\slmult0 \fs18\c
f0\f0\charscalex100 {disorder is anxious when not in danger.}\par\pard\li0\ri0\s
l-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\r
i0\sl-346\slmult0 \fs28\cf5\f0\charscalex100 {What is panic disorder?}\par\pard\
li0\ri0\sl-373\slmult0 \fs18\cf0\f0\charscalex100 {Panic disorder is very differ
ent to everyday anxiety. Panic disorder is}\par\pard\li0\ri0\sl-320\slmult0 \fs1
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every year. It}\par\pard\li0\ri0\sl-320\slmult0 \fs16\cf0\f0\charscalex100 {usua
lly begins during the teens or early twenties and women are twice}\par\pard\li0\
ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {as likely as men to experience it
. The exact causes of panic disorder}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\
f0\charscalex100 {are still unclear but there is some evidence of a family tende
ncy to}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {nervousness
and a link with major life events and stressors. What this}\par\pard\li0\ri0\sl320\slmult0 \fs18\cf0\f0\charscalex100 {means is that if a member of the family
has suffered from panic, there}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\cha
rscalex100 {is an increased risk of you suffering from it, especially when you a
re}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {stressed. Often
people with panic disorder have always thought of}\par\pard\li0\ri0\sl-320\slmul
t0 \fs18\cf0\f0\charscalex100 {themselves as sensitive, but this may not always
be the case.}\par\column\pard\li0\ri0\sl-413\slmult0 \fs18\cf0\f0\charscalex100
{Panic attacks are sudden attacks of fear or anxiety in situations that}\par\par
d\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {most people do not find fri
ghtening. They come on suddenly and}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f
0\charscalex100 {are usually over in less than half an hour. Many people have ha
d one}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {to two panic
attacks in their lifetime but people with panic disorder}\par\pard\li0\ri0\sl-32
0\slmult0 \fs18\cf0\f0\charscalex100 {have repeated attacks. The attacks come ou
t of the blue and in some}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscal
ex100 {situations, where help is not available or escape not possible, people}\p
ar\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {become disabled by th
eir panic attack. There is a fear of having}\par\pard\li0\ri0\sl-320\slmult0 \fs
18\cf0\f0\charscalex100 {future panic attacks. It is the interpretation of the e
xperience that}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {will
be important in both the development and continuation of panic}\par\pard\li0\ri
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causes the panic; it\uc1\u8217Xs what you think}\par\pard\li0\ri0\sl-320\slmult0
\fs18\cf0\f0\charscalex100 {the symptoms mean that causes the panic.}\par\pard\
li0\ri0\sl-413\slmult0 \fs18\cf0\f0\charscalex100 {A panic attack is defined as
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h }\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {a peak within t

en minutes:}\par\pard\li0\ri0\sl-400\slmult0 \fs18\cf0\f0\charscalex100 {\uc1\u8

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\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {\uc1\u8226X sweating}\par\pard\li0
\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {\uc1\u8226X trembling or shaki
ng}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {\uc1\u8226X se
nsations of shortness of breath or being smothered}\par\pard\li0\ri0\sl-320\slmu
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\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {\uc1\u8226X derealisation
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}\par\pa
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\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {\uc1\u8226X fear
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rscalex100\b {8}\b0 \par\column\pard\li0\ri0\sl-413\slmult0 \fs18\cf0\f0\charsca
lex100 {At least one of these attacks is followed by one or more of the}\par\par
d\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {following, lasting for at l
east one month:}\par\pard\li0\ri0\sl-400\slmult0 \fs18\cf0\f0\charscalex100 {\uc
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}\par\pard\li346\ri0\sl-320\slmult0 \fs18
\cf0\f0\charscalex100 {heart attack, or \uc1\u8216Xgoing crazy\uc1\u8217X)}\par\
pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {\uc1\u8226X a signific
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ult0 \fs28\cf5\f0\charscalex100 {What is agoraphobia?}\par\pard\li0\ri0\sl-373\s
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f \uc1\u8216Xopen spaces\uc1\u8217X.}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\
f0\charscalex100 {This is partly true. Many people with panic disorder avoid a n
umber}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {of situations
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ult0 \fs18\cf0\f0\charscalex100 {agoraphobia, which is anxiety about being in pl
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tuations with}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {a tru
sted friend or relative. Some people with agoraphobia even}\par\pard\li0\ri0\sl320\slmult0 \fs18\cf0\f0\charscalex100 {avoid places where help would be availab
le should a panic attack}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscale
x100 {occur. Obviously this can be extremely disabling and often limits}\par\par
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es.}\b0 \par\column\pard\li0\ri0\sl-600\slmult0 \fs36\cf3\f0\charscalex100 {Mana
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dizzy, a sense of unreality and feeling breathless. If you experience}\par\pard\
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13\slmult0 \fs18\cf0\f0\charscalex100 {would be helpful to monitor your breathin
g rate at different times}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscal
ex100 {throughout the day and to practise the technique.}\par\pard\li0\ri0\sl-38
6\slmult0 \fs18\cf0\f0\charscalex100 {Remember that it is much easier to prevent
a panic attack than to stop}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\chars
calex100 {one that has already begun. The best approach is to start slowing your
}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {breathing at the f
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f3\f0\charscalex100\b {it initially for six seconds (count or use a watch).}\b0
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he in and out in a six-second cycle (in for three,}\b0 \par\pard\li0\ri0\sl-320\
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e anxiety}\b0 \par\pard\li0\ri0\sl-306\slmult0 \fs22\cf3\f0\charscalex100\b {sym
ptoms of over-breathing have gone.}\b0 \par\pard\li0\ri0\sl-413\slmult0 \fs22\cf
3\f0\charscalex100\b {There are a number of tapes and CDs available}\b0 \par\par
d\li0\ri0\sl-320\slmult0 \fs22\cf3\f0\charscalex100\b {to assist you in this tec
hnique. It is not important}\b0 \par\pard\li0\ri0\sl-320\slmult0 \fs22\cf3\f0\ch
arscalex100\b {which one you choose \uc1\u8211X the important thing is}\b0 \par\
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fs18\cf0\par\pard\li0\ri0\sl-373\slmult0 \fs18\cf0\f0\charscalex100\b {Relaxatio
n training}\b0 \par\pard\li0\ri0\sl-400\slmult0 \fs18\cf0\f0\charscalex100 {Rela
xation is the voluntary letting go of tension. This tension can be}\par\pard\li0
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or it can be mental (or psychological)}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf
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of calm, both}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {physi
cally and mentally. Muscle relaxation has psychological benefits}\par\column\par
d\li0\ri0\sl-413\slmult0 \fs18\cf0\f0\charscalex100 {as well as physical. Throug
h relaxation training, you can learn how to}\par\pard\li0\ri0\sl-320\slmult0 \fs
18\cf0\f0\charscalex100 {recognise tension and achieve deep relaxation.}\par\par
d\li0\ri0\sl-413\slmult0 \fs18\cf0\f0\charscalex100 {When someone is in a contin
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ready highly activated.}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex
100 {A minor event, such as getting stuck in traffic, can trigger further}\par\p
ard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {tension, which in turn ca
n lead to hyperventilation (over-breathing)}\par\pard\li0\ri0\sl-320\slmult0 \fs
18\cf0\f0\charscalex100 {and panic.}\par\pard\li0\ri0\sl-400\slmult0 \fs18\cf0\f
0\charscalex100 {Constant tension makes people over-sensitive and they respond}\
par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {to smaller and small
er events as though they were threatening. By}\par\pard\li0\ri0\sl-320\slmult0 \
fs18\cf0\f0\charscalex100 {learning to relax, you can reduce general levels of a
rousal and tension,}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100
{and gain control over your feelings of anxiety.}\par\pard\li0\ri0\sl-400\slmult
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seful is}\fs18\cf0\f0\charscalex100\i { Living With It}\i0 \fs18\cf0\f0\charscal

ex100 {, by Bev Aisbett,}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscale
x100 {which is available in most bookshops.}\par\pard\li0\ri0\sl-413\slmult0 \fs
18\cf0\f0\charscalex100 {Educate yourself: read, speak to your health care profe
ssional, and}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {look o
n the internet. Some useful websites are included in Appendix 3.}\par\pard\li0\r
i0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-280\slmult0 \fs16\cf0\f0\charsca
lex100\b {Slow-breathing technique}\b0 \par\pard\li0\ri0\sl-400\slmult0 \fs18\cf
0\f0\charscalex100 {This has been discussed on page 10 of this guide and is desc
ribed in}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {the books
listed above.}\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213
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scalex100 {Facing fears can be hard work. Start slowly, go slowly, do it gradual
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(it}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {may be wise to
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ult0 \fs18\cf0\f0\charscalex100 {undertaking these activities). It is important
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you find}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {that you a
re still experiencing panic attacks and/or avoiding certain}\par\pard\li0\ri0\sl
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t professional help in treating}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\ch
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00\slmult0 \fs36\cf3\f0\charscalex100 {Effective treatments for }\par\pard\li0\
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ri0\sl-306\slmult0 \fs18\cf0\f0\charscalex100 {Panic disorder is a condition tha
t we know a lot about. There has }\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0
\charscalex100 {been a great deal of research to find out which treatments are}\
par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {effective and will s
ignificantly help someone with panic disorder.}\par\pard\li0\ri0\sl-400\slmult0
\fs18\cf0\f0\charscalex100 {The aims of treatment for panic disorder are:}\par\p
ard\li0\ri0\sl-413\slmult0 \fs18\cf0\f0\charscalex100 {\uc1\u8226X to help you
cope with and stop panic attacks}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\c
harscalex100 {\uc1\u8226X to become aware of and stop fear-driven avoidance}\pa
r\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {\uc1\u8226X to reduce
your vulnerability to future panic attacks.}\par\pard\li0\ri0\sl-400\slmult0 \f
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been helpful,}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {you

will probably still experience some symptoms of anxiety during}\par\pard\li0\ri0
\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {your recovery.}\par\pard\li0\ri0\sl400\slmult0 \fs18\cf0\f0\charscalex100 {The major treatments for panic disorder
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ognitive Behavioural Therapy (CBT)}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0
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0\slmult0 \fs18\cf0\f0\charscalex100 {Each of these treatments will be briefly d
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x100 {potential advantages and disadvantages. Your choice of treatment}\par\pard
\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {may depend on the skill of t
he therapist, cost or other considerations.}\par\pard\li0\ri0\sl-213\slmult0 \fs
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\b0 \par\pard\li0\ri0\sl-320\slmult0 \fs22\cf3\f0\charscalex100\b {attacks. You
can learn skills to deal with them.}\b0 \par\column\pard\li0\ri0\sl-520\slmult0
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13\slmult0 \fs16\cf0\f0\charscalex100\b {Education about the disorder}\b0 \par\p
ard\li0\ri0\sl-400\slmult0 \fs18\cf0\f0\charscalex100 {Following assessment, a t
herapist can teach you about anxiety in}\par\pard\li0\ri0\sl-320\slmult0 \fs18\c
f0\f0\charscalex100 {general, and panic disorder specifically. This may involve
talking about}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {the \
uc1\u8216Xfight or flight\uc1\u8217X response and details of how this affects th
e body.}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {Education m
ay also involve dispelling fears that people commonly have}\par\pard\li0\ri0\sl320\slmult0 \fs18\cf0\f0\charscalex100 {about this disorder such as that they ar
e \uc1\u8216Xgoing crazy\uc1\u8217X or will die as a}\par\pard\li0\ri0\sl-320\sl
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b {Interoceptive and in vivo exposure}\b0 \par\pard\li0\ri0\sl-400\slmult0 \fs18
\cf0\f0\charscalex100 {Interoceptive exposure involves becoming less frightened
of the}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {symptoms of
panic in a controlled manner. For instance, it might}\par\pard\li0\ri0\sl-320\sl
mult0 \fs18\cf0\f0\charscalex100 {involve jogging on the spot in a therapist\uc1
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rscalex100 {familiar with the meaning of certain symptoms such as rapid heartbea
t}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {and shortness of
breath. Alternatively, it may involve drinking cups of}\par\pard\li0\ri0\sl-320\
slmult0 \fs18\cf0\f0\charscalex100 {coffee or sitting in a hot room.}\par\pard\l
i0\ri0\sl-413\slmult0 \fs18\cf0\f0\charscalex100 {For those who avoid situations
for fear of having a panic attack, it is}\par\pard\li0\ri0\sl-320\slmult0 \fs18
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s breaking}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {a fearfu
l situation down into achievable steps and doing them one}\par\pard\li0\ri0\sl-3
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s achieved. For example, if a}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\char
scalex100 {person is fearful of train journeys, the treatment may include going
to}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {a station, then
going on a train, then going on trains with increasing}\par\pard\li0\ri0\sl-320\
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r crowds and so on.}\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\
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e to help deal with a panic attack}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0
\charscalex100 {and also to prevent a full-blown attack from occurring (see page
10).}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {Relaxation is
probably more useful as a general strategy for dealing}\par\pard\li0\ri0\sl-320\
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l for some people with}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex1
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f0\charscalex100 {Medications for panic disorder}\par\pard\li0\ri0\sl-413\slmult
0 \fs18\cf0\f0\charscalex100\b {Anti-depressants}\b0 \par\pard\li0\ri0\sl-400\sl
mult0 \fs18\cf0\f0\charscalex100 {There are many different types of anti-depress
ant medications that }\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex1
00 {have been found to be effective in treating panic disorder. Each type}\par\p
ard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {works slightly differentl
y, and with your doctor you will be able to}\par\pard\li0\ri0\sl-320\slmult0 \fs
18\cf0\f0\charscalex100 {decide which works best for you, and has minimal side e
ffects.}\par\pard\li0\ri0\sl-400\slmult0 \fs18\cf0\f0\charscalex100 {Most medica
tions will be started at a low dose and increased to }\par\pard\li0\ri0\sl-320\
slmult0 \fs18\cf0\f0\charscalex100 {an effective level. It is important that you
take the medication as }\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscal
ex100 {suggested by your doctor and do not make changes without checking}\par\pa
rd\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {with the doctor first. If
you experience unpleasant side effects, let your}\par\pard\li0\ri0\sl-320\slmult
0 \fs18\cf0\f0\charscalex100 {doctor know immediately so that you can be advised
whether they are}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {n
ormal or not. Some side effects are quite common and your doctor}\par\pard\li0\r
i0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {can help you to understand what to
expect. See Appendix 1 for a list}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0
\charscalex100 {of possible questions for your prescribing doctor. Currently the
re is no}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {evidence t
hat the benefits of medications continue once the }\par\pard\li0\ri0\sl-320\slm
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mult0 \fs18\cf0\f0\charscalex100 {In recent years, there has been a lot of talk
about drugs in this class}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscal
ex100 {of anti-depressants as they are as effective as the older types of anti-}
\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {depressants but hav
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s18\cf0\f0\charscalex100 {probably Prozac (fluoxetine), which was the first avai
lable, but there are}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100
{now a range of other SSRIs, many of which have been shown to help}\par\pard\li
0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {people with panic disorder (e.g
. Cipramil/citalopram, Zoloft/sertraline).}\par\pard\li0\ri0\sl-413\slmult0 \fs1
8\cf0\f0\charscalex100 {Side effects, while less frequent, can still occur and i
nclude headaches,}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {n
ausea, insomnia and difficulties with sexual intercourse. Symptoms }\par\pard\l
i0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {can also occur as you stop the
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th}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {professionals ab
out the treatments available to you. Choose an option}\par\pard\li0\ri0\sl-320\s
lmult0 \fs18\cf0\f0\charscalex100 {that seems to best fit your needs. You may ch
oose CBT provided by a}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex1
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\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {or medication prescribe
d by your doctor. You will only benefit from}\par\pard\li0\ri0\sl-320\slmult0 \f
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feel that the}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {treat
ment is right for you.}\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\r
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ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {to four weeks for results to be s
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}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {treatments.}\par\p
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d to be an active participant in the}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\
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arscalex100\b {20}\b0 \par\column\pard\li0\ri0\sl-600\slmult0 \fs36\cf3\f0\chars
calex100 {Finding professional help }\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\
par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\
cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-306\slmult0 \f
s18\cf0\f0\charscalex100 {Panic disorder is a disabling condition, but it can be
successfully treated}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex10
0 {with the right help. If you think you suffer from panic disorder, there }\pa
r\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {are many ways to get t
he help you need including:}\par\pard\li0\ri0\sl-400\slmult0 \fs18\cf0\f0\charsc
alex100 {\uc1\u8226X contacting your general practitioner}\par\pard\li0\ri0\sl
-320\slmult0 \fs18\cf0\f0\charscalex100 {\uc1\u8226X contacting your local men
tal health service}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {
\uc1\u8226X looking in the phone book for \uc1\u8216Xclinical psychologists\uc
1\u8217X, }\par\pard\li346\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {\uc1\
u8216Xpsychologists\uc1\u8217X or \uc1\u8216Xpsychiatrists\uc1\u8217X}\par\pard\
li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {\uc1\u8226X contacting one
of the anxiety disorders support groups for help in }\par\pard\li346\ri0\sl-320
\slmult0 \fs18\cf0\f0\charscalex100 {finding a therapist (see Appendix 3)}\par\p
ard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {\uc1\u8226X contacting
a local university to see whether their psychology }\par\pard\li346\ri0\sl-320\
slmult0 \fs18\cf0\f0\charscalex100 {department offers treatment for the general
public (alternatively, }\par\pard\li346\ri0\sl-320\slmult0 \fs18\cf0\f0\charsca
lex100 {they may be conducting treatment research that you could
}\par\pard\l
i346\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {participate in)}\par\pard\li
0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {\uc1\u8226X looking on the in
ternet; e.g.}\par\pard\li346\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {www.
swinburne.edu.au/lss/swinpsyche/etherapy/}\par\pard\li346\ri0\sl-320\slmult0 \fs
18\cf0\f0\charscalex100 {www.virtualclinic.org.au}\par\pard\li0\ri0\sl-320\slmul
t0 \fs18\cf0\f0\charscalex100 {\uc1\u8226X looking in your local bookshop to s
ee what information is available.}\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par
\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-333\slmult0 \fs28\cf5
\f0\charscalex100 {What level of treatment do I need?}\par\pard\li0\ri0\sl-386\s
lmult0 \fs18\cf0\f0\charscalex100 {Some people with panic disorder can be succes
sfully treated by their}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex
100 {general practitioner or psychologist. However, many people will need}\par\p
ard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {specialised treatment by
a clinical psychologist or psychiatrist. This is}\par\pard\li0\ri0\sl-320\slmult
0 \fs18\cf0\f0\charscalex100 {often because the first treatment does not work, o
r because they need}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100
{a combination of treatments, or because their panic disorder is severe}\par\par
d\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {and chronic. A clinical psy
chologist or psychiatrist with experience in}\par\pard\li0\ri0\sl-320\slmult0 \f
s18\cf0\f0\charscalex100 {panic disorder is the most suitable person to understa
nd and treat your}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {p
anic disorder.}\par\column\pard\li0\ri0\sl-520\slmult0 \fs28\cf5\f0\charscalex10
0 {Why should I get help?}\par\pard\li0\ri0\sl-373\slmult0 \fs18\cf0\f0\charscal
ex100 {Panic attacks and avoidance can seriously get in the way of everyday}\par
\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {life. Without seeking t
he right treatment, it is possible that many areas}\par\pard\li0\ri0\sl-320\slmu
lt0 \fs18\cf0\f0\charscalex100 {of your life will be affected, such as relations
hips, productivity at work,}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charsc
alex100 {social activities and your general mood.}\par\pard\li0\ri0\sl-213\slmul
t0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\f0\charscalex100 {People
with panic disorder often get demoralised and experience}\par\pard\li0\ri0\sl-32
0\slmult0 \fs18\cf0\f0\charscalex100 {depression. They are also often told to \u
c1\u8216Xget it together\uc1\u8217X, \uc1\u8216Xsnap out}\par\pard\li0\ri0\sl-30
6\slmult0 \fs18\cf0\f0\charscalex100 {of it\uc1\u8217X and other unhelpful thing
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charscalex100 {intended to be cruel, but reflect the fact that those who do not
have}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {panic disorder
often do not understand how awful it can be. You are}\par\pard\li0\ri0\sl-320\s
lmult0 \fs18\cf0\f0\charscalex100 {probably a better judge of whether you need h
elp than your relatives}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex
100 {and friends, who may not be aware of the extent to which the}\par\pard\li0\
ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {problem interferes with your life
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18\cf0\par\pard\li0\ri0\sl-333\slmult0 \fs28\cf5\f0\charscalex100 {What the rese
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d\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {that they know what the pro
blem is. They will want to understand}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0
\f0\charscalex100 {your panic attacks in detail. For example, by asking question
s such as}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {What? Whe
n? How often? Where do they occur?}\par\pard\li0\ri0\sl-413\slmult0 \fs18\cf0\f0
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e have}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {been other d
ifficulties before the panic attacks began, whether you}\par\pard\li0\ri0\sl-320
\slmult0 \fs18\cf0\f0\charscalex100 {have had treatment before and so on.}\par\p
ard\li0\ri0\sl-400\slmult0 \fs18\cf0\f0\charscalex100 {They may ask you to fill
in some forms to further assist the diagnosis.}\par\pard\li0\ri0\sl-320\slmult0
\fs18\cf0\f0\charscalex100 {Such forms may ask about your panic attacks and avoi
dance directly,}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {you
r mood, or about how the panic attacks have affected your life. At}\par\pard\li0
\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {the end of your treatment, you c
an look back at these documents to}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0
\charscalex100 {check your progress and see if the treatment has been helpful.}\
par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\
cf0\par\pard\li0\ri0\sl-333\slmult0 \fs28\cf5\f0\charscalex100 {How do I choose
a therapist?}\par\pard\li0\ri0\sl-413\slmult0 \fs18\cf0\f0\charscalex100 {Many m
ental health professionals say they can treat panic disorder}\par\pard\li0\ri0\s
l-320\slmult0 \fs18\cf0\f0\charscalex100 {but some may not use effective treatme
nts to do so. It is essential to}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\c
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ent }\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {strategies des
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0\sl-226\slmult0 \fs18\cf0\f0\charscalex100 {It is also very important that you
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par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {experience. It might
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alex100 {Questions to ask your therapist}\par\pard\li0\ri0\sl-386\slmult0 \fs18\
cf0\f0\charscalex100 {\uc1\u8226X What is the diagnosis?}\par\pard\li0\ri0\sl-3
20\slmult0 \fs18\cf0\f0\charscalex100 {\uc1\u8226X What can I expect if I do n
ot get treatment? What happens if }\par\pard\li346\ri0\sl-320\slmult0 \fs18\cf0
\f0\charscalex100 {I do nothing?}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\c
harscalex100 {\uc1\u8226X What are the treatment options?}\par\pard\li0\ri0\sl320\slmult0 \fs18\cf0\f0\charscalex100 {\uc1\u8226X What are the benefits and
harms (costs) of the treatment options?}\par\pard\li0\ri0\sl-320\slmult0 \fs18\c
f0\f0\charscalex100 {\uc1\u8226X How long will it take?}\par\pard\li0\ri0\sl-3
20\slmult0 \fs18\cf0\f0\charscalex100 {\uc1\u8226X What results can I expect?}
\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {\uc1\u8226X How m
uch time and/or effort will it take me?}\par\pard\li0\ri0\sl-320\slmult0 \fs18\c
f0\f0\charscalex100 {\uc1\u8226X What will it cost me?}\par\pard\li0\ri0\sl-32
0\slmult0 \fs18\cf0\f0\charscalex100 {\uc1\u8226X Is there anything that would
complicate treatment (other}\par\pard\li346\ri0\sl-320\slmult0 \fs18\cf0\f0\cha
rscalex100 {problems such as depression or substance abuse that may make}\par\pa
rd\li346\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {treatment more difficult
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ex100 {\uc1\u8226X Can we make a time to review progress and if necessary revi
se the}\par\pard\li346\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {treatment
plan?}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {\uc1\u8226X
Are these the latest treatment guidelines for my condition?}\par\pard\li0\ri0\s
l-320\slmult0 \fs18\cf0\f0\charscalex100 {\uc1\u8226X Can you recommend any re
ading material including self- }\par\pard\li346\ri0\sl-320\slmult0 \fs18\cf0\f0\
charscalex100 {help books?}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charsca
lex100 {\uc1\u8226X How do the benefits and harms weigh up for me?}\par\pard\l
i0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {\uc1\u8226X Can I speak to s
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harscalex100 {\uc1\u8226X Can I speak to someone who has been through this pro
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therapists?}\par\column\pard\li0\ri0\sl-506\slmult0 \fs28\cf5\f0\charscalex100
{Questions to ask about medication}\par\pard\li0\ri0\sl-386\slmult0 \fs18\cf0\f0
\charscalex100 {\uc1\u8226X What is the name of the medicine?}\par\pard\li0\ri0
\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {\uc1\u8226X When and how often do
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{\uc1\u8226X Are there any special instructions for its use?}\par\pard\li0\ri
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alex100 {Appendix 2}\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\
sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\
ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-426\slmult0 \fs28\cf5\f0\charsc
alex100 {What should I do if my child or spouse }\par\pard\li0\ri0\sl-400\slmul
t0 \fs28\cf5\f0\charscalex100 {is anxious?}\par\pard\li0\ri0\sl-386\slmult0 \fs1
8\cf0\f0\charscalex100 {Living with someone who is anxious can be difficult at t
imes. It may}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {restri
ct the activities of other members of the family in important}\par\pard\li0\ri0\
sl-320\slmult0 \fs18\cf0\f0\charscalex100 {ways. For instance, a child who is an
xious about going to unfamiliar}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\ch
arscalex100 {places may convince the family that they should not take a holiday
to}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {a new destinatio
n. Similarly, the partner of someone with agoraphobia}\par\pard\li0\ri0\sl-320\s
lmult0 \fs18\cf0\f0\charscalex100 {may have extra chores they are responsible fo
r, such as driving the}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex1
00 {children to sport and doing the weekly shopping.}\par\pard\li0\ri0\sl-413\sl
mult0 \fs18\cf0\f0\charscalex100 {The decision to get help for panic disorder ca
n be a difficult one}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100
{to make. There will often be a lot of fear associated with seeking}\par\pard\l
i0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {treatment, and for those with
agoraphobia even getting to treatment}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0
\f0\charscalex100 {will often involve facing one\uc1\u8217Xs fears. For some, pa
st treatment may}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {ha
ve been disappointing and they may be sceptical about the benefits}\par\pard\li0
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i0\sl-400\slmult0 \fs18\cf0\f0\charscalex100 {The key to supporting a relative o
r friend who is anxious is to be}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\c
harscalex100 {encouraging and understanding.}\par\pard\li0\ri0\sl-413\slmult0 \f
s18\cf0\f0\charscalex100 {The organisations and further reading suggested in App
endix 3 will}\par\pard\li0\ri0\sl-306\slmult0 \fs18\cf0\f0\charscalex100 {also b
e helpful for family and friends of people experiencing panic}\par\pard\li0\ri0\
sl-320\slmult0 \fs18\cf0\f0\charscalex100 {disorder and agoraphobia.}\par\column
\pard\li0\ri0\sl-600\slmult0 \fs36\cf3\f0\charscalex100 {Appendix 3 }\par\pard\l
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rd\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\pa
r\pard\li0\ri0\sl-400\slmult0 \fs28\cf5\f0\charscalex100 {Sources of information
and support}\par\pard\li0\ri0\sl-386\slmult0 \fs18\cf0\f0\charscalex100 {There
are a range of options for support while you are experiencing}\par\pard\li0\ri0\
sl-320\slmult0 \fs18\cf0\f0\charscalex100 {panic disorder or agoraphobia. It is
important to accept support when}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\c
harscalex100 {it is offered, as facing fears on your own can be hard work. Famil
y}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {and friends are a
n important source of support as well as your local}\par\pard\li0\ri0\sl-320\slm
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s and mutual support}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100
{organisations.}\par\pard\li0\ri0\sl-400\slmult0 \fs18\cf0\f0\charscalex100 {Th

e list of organisations and information sources provided in this}\par\pard\li0\r

i0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {Appendix, whilst not exhaustive, m
ay be of assistance in learning}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\ch
arscalex100 {about and managing panic disorder. Inclusion of these organisations
}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {and information so
urces does not imply RANZCP endorsement}\par\pard\li0\ri0\sl-320\slmult0 \fs18\c
f0\f0\charscalex100 {but rather aims to help people find information and to enco
urage}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {communication
about mental illness.}\par\pard\li0\ri0\sl-413\slmult0 \fs18\cf0\f0\charscalex1
00 {These organisations and resources are not intended as a replacement}\par\par
d\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {for formal treatment but as
an adjunct to it. If you are unsure about}\par\pard\li0\ri0\sl-320\slmult0 \fs1
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a treatment}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {you re
ad about may be appropriate for you, you should speak with}\par\pard\li0\ri0\sl320\slmult0 \fs18\cf0\f0\charscalex100 {your mental health care professional.}\p
ar\pard\li0\ri0\sl-400\slmult0 \fs18\cf0\f0\charscalex100 {If you have access to
the internet you may find it helpful to explore}\par\pard\li0\ri0\sl-320\slmult
0 \fs18\cf0\f0\charscalex100 {some of the websites listed on page 37}{ }\fs18\cf
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0 \fs18\cf0\f0\charscalex100 {the \uc1\u8216Xchat rooms\uc1\u8217X available on
many sites. The important thing is to}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0
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bia,}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {and those work
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ar\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {to ensure the informa
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\charscalex100 {Quality statement}\par\pard\li0\ri0\sl-373\slmult0 \fs18\cf0\f0\
charscalex100 {The original edition of this guide was consulted upon bi-national
ly}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {and drafts were
available for comment on www.ranzcp.org. It was}\par\pard\li0\ri0\sl-320\slmult0
\fs18\cf0\f0\charscalex100 {appraised using DISCERN by a national workshop of c
onsumer}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {consultants
and meets NHMRC criteria for presenting information}\par\pard\li0\ri0\sl-320\sl
mult0 \fs18\cf0\f0\charscalex100 {on treatments for consumers. The 2009 revision
sought to maintain}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100
{the integrity of this process by incorporating updated information}\par\pard\li
0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {supported by research findings
published in recent medical and other}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0
\f0\charscalex100 {scientific literature.}\par\pard\li0\ri0\sl-213\slmult0 \fs18

\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-346\slmult0 \
fs28\cf5\f0\charscalex100 {Acknowledgements}\par\pard\li0\ri0\sl-373\slmult0 \fs
18\cf0\f0\charscalex100 {The project to develop and print the original version o
f this booklet}\par\pard\li0\ri0\sl-320\slmult0 \fs16\cf0\f0\charscalex100 {was
commissioned by The Royal Australian and New Zealand College}\par\pard\li0\ri0\s
l-320\slmult0 \fs18\cf0\f0\charscalex100 {of Psychiatrists and was funded by Aus
tralia\uc1\u8217Xs National Mental Health}\par\pard\li0\ri0\sl-320\slmult0 \fs18
\cf0\f0\charscalex100 {Strategy, Commonwealth Department of Health and Ageing, a
nd the}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {New Zealand
Ministry of Health.}\par\pard\li0\ri0\sl-413\slmult0 \fs18\cf0\f0\charscalex100
{We appreciate the involvement of consumer organisations in Australia}\par\pard\
li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {and New Zealand which contrib
uted to the consultation process for}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\
f0\charscalex100 {the original edition of the booklet.}\par\pard\li0\ri0\sl-400\
slmult0 \fs18\cf0\f0\charscalex100 {The original edition was edited by Jonine Pe
nrose-Wall, Consultant}\par\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex1
00 {Editorial Manager RANZCP.}\par\pard\li0\ri0\sl-400\slmult0 \fs18\cf0\f0\char
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ar\pard\li0\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100 {by the Commonwealth D
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arscalex100 {The Private Mental Health Consumer Carer Network (Australia)}\par\p
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