ABSTRACT
Joe was a forty-two-year-old man with advanced metastatic cancer who was referred to the author for opinion on managing panic and anxiety. He was an inpatient within the local hospice and his anxiety had been managed by benzodiazepines. He had been reviewed by a consultant psychiatrist who had recommended the addition of amitryptiline at night. The duration of assessment was limited due to his physical health status but concentrated on a review of his nursing notes, discussion with several members of nursing staff and discussion with him about a recent problem episode. He was encouraged to talk about his thoughts and feelings when experiencing panic and asked about the presence of any images. Information was collected on his family and personal history and his sisters were interviewed. He talked about a distressing image when he had been at home on the day of his father’s death some years previously. Staff were encouraged to assess the personal significance of this in further detail.
