Case history
Case history
A 25-year-old woman presents to her primary care physician with complaints of muscle tension, especially in her shoulders and neck, contributing to tension headaches. She describes sleep disturbance, chronic fatigue, and constant restlessness. She has poor concentration at work, with repeated run-ins with her coworkers. She has been a worrier since childhood, with worsening bouts when under stress; currently she reports having a hard time controlling her worry, which extends into several areas. Physical exam reveals a healthy, tense woman with normal vital signs and generalized muscular tension. She does not misuse substances, and medical history is unremarkable.
Other presentations
Patients may try to reduce anxiety by drinking alcohol or taking central nervous system depressants, thereby increasing the risk of substance misuse and dependence.[3] Depression or panic attacks may co-occur, with symptoms including shortness of breath, palpitations, hot and cold flashes, or fear of dying or "going crazy."
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