The Sleepy Woman With Anxiety Case Study Essay

CASE STUDY: #3
Case 3: Volume 1, Case #5: The sleepy woman with anxiety.

In the weekly discussions and the assignments, I look forward to reading what you have learned from the course resources and your personal experiences. In your weekly discussions and assignments, please be detailed in your description of the medications, including uses, potential adverse effects, monitoring and potential drug interactions. I ask that your assignments be clearly written, with proper sentence and paragraph structure. Please review your work prior to submission to assure that there are no spelling or grammar deficiencies. The discussions and assignments should include all of the elements listed in the assignment. Different Anxiety Experiences Nursing Case Study Essay
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Case 1: Volume 2, Case #16: The woman who liked late-night TV
Case 2: Volume 2, Case #11: The figment of a man who looked upon the lady
Case 3: Volume 1, Case #5: The sleepy woman with anxiety
• Review this week’s Learning Resources and reflect on the insights they provide.
• Go to the Stahl Online website and examine the case study you were assigned.
• Take the pretest for the case study.
• Review the patient intake documentation, psychiatric history, patient file, medication history, etc. As you progress through each section, formulate a list of questions that you might ask the patient if he or she were in your office.
• Based on the patient’s case history, consider other people in his or her life that you would need to speak to or get feedback from (i.e., family members, teachers, nursing home aides, etc.).
• Consider whether any additional physical exams or diagnostic testing may be necessary for the patient.
• Develop a differential diagnoses for the patient. Refer to the DSM-5 in this week’s Learning Resources for guidance.
• Review the patient’s past and current medications. Refer to Stahl’s Prescriber’s Guide and consider medications you might select for this patient. Different Anxiety Experiences Nursing Case Study Essay
• Review the posttest for the case study.

Post a response to the following:
• Provide the case number in the subject line of the Discussion.
• List three questions you might ask the patient if he or she were in your office. Provide a rationale for why you might ask these questions.
• Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation. Include specific questions you might ask these people and why.
• Explain what physical exams and diagnostic tests would be appropriate for the patient and how the results would be used.
• List three differential diagnoses for the patient. Identify the one that you think is most likely and explain why.
• List two pharmacologic agents and their dosing that would be appropriate for the patient’s sleep/wake therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other.
• If your assigned case includes “check points” (i.e., follow-up data at week 4, 8, 12, etc.), indicate any therapeutic changes that you might make based on the data provided.
• Explain “lessons learned” from this case study, including how you might apply this case to your own practice when providing care to patients with similar clinical presentations. Different Anxiety Experiences Nursing Case Study Essay

Anxiety experiences different in everyone in different times, it’s a normal response to actual danger, promoting the body through stimulating of sympathetic and parasympathetic nervous system will be helpful action. (Springhouse, 2007). Anxiety affects our whole being. It affects how we feel, how e behave and has very real physical symptoms. It feels a bit like fear but whereas we know what we are frightened of, we often don’t know what we are anxious about. Mild anxiety is vague and unsetting-severe anxiety can be extremely debilitating (Medical News Today, 2010). Acute pain it is not good sign about tissue damage, (Gulanick et al., 2010).

1- How can you manage Evert’s pain?
As a nurse, the following can be done to manage Evert’s pain:

Anticipate need for pain relief: early analgesic intervention helps to decrease pain.

We have to respond to pain complain as soon as possible: early respond to patient’s complaining of pain its help to decrease anxiety and on other side its help to make a trust relationship.

Trying to eliminate the addition of stressor or comfort as we can: help patient to tolerate the pain either these elements from environment, intrapersonal, or intrapschic factors.

Make an good atmosphere of comfort, relaxation, and sleep: we have to help patient to be in good atmosphere to take a rest and sleep comfortably because some patient’s experiences of pain may will put them in fatigue condition, so we have to put him in darkroom and disconnected his phone (Gulanick et al., 2010). Different Anxiety Experiences Nursing Case Study Essay

2- What can you do to alleviate Evert’s anxiety?
The following interventions can be done to alleviate Evert’s anxiety:

Anticipate need for pain relief: early analgesic intervention helps to decrease pain.

We have to respond to pain complain as soon as possible: early respond to patient’s complaining of pain its help to decrease anxiety and on other side its help to make a trust relationship.

Some of cognitive behavioral strategies as follows:
Images: if patient use his mental images its help to distract stress and pain with using all his five senses.

Distraction techniques: heighten one’s concentration upon nonpainful stimuli to decrease one’s awareness and experiences of pain and reduce stress such as nerve stimulation and breathing modifications.

Use the relaxation exercises: it’s important for patient to decrease attention and pain. Different Anxiety Experiences Nursing Case Study Essay

Use breathing exercises.
Using Music Therapy in treatment: the music therapy works well on patients. Its apart of treatment team (Mount& Munro, 1978).

3- Why was Evert’s wife so worried the Evert did not eat? Should you treat with IV nourishment?
Evert’s wife was worried because Evert might suffer from dehydration and malnutrition, and this will cause electrolyte imbalances and his condition will be aggravated by this, his health will deteriorate more rapidly. As a nurse the treatment plans for Evert to restoring fluid and correcting any electrolyte imbalances. Early treatment intervention its help to prevent any potentially life threatening such as hypovolemic shock (Gulanick et al., 2010).

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4- Make a nursing care plan for Evert. Explain and motivate you suggested nursing intervention in according with the four key areas listed in the introduction? Different Anxiety Experiences Nursing Case Study Essay
A. Assessment: defining characterized: Evert verbalizes pain, especially in connection with moving, narrowed focus such as withdrawal from social and physical contact, relief or distraction behavior( seeking out staff to do activities), restless, anxiety manifested, expression of helplessness, and inability to procure fluid and food.

B. Nursing Diagnosis: actual diagnosis: acute pain related to severe anxiety.

Nursing outcome: Evert will be enable adequate relief of pain when moving or ability to deal with the pain are not fully satisfied. Evert is able to recognize signs of anxiety.

Risk diagnosis: risk for fluid volume deficit related to inability to procure fluid and food.

Nursing outcome: sufficient fluids volume and electrolyte balance as evidence by urine output grater than 30ml/hr, consistency of weight, and normal skin turgor (Gulanick et al., 2010).

C. Nursing Intervention:
1. Assess pain characteristics: Quality as example sharp, burning, and shooting. If we want to measure the level of severity from 1 to 10, with 10 level it is more sever to patient. Location according to anatomical description, onset if it’s gradual or sudden. Duration for how long is it intermittent or continuous (Gulanick et al., 2010). Different Anxiety Experiences Nursing Case Study Essay

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2. Administer parenteral fluids as ordered: the nurse must give patient IV fluids as needed and as ordered, challenge with intermediate infusion of fluids for Evert who is unable to procure fluid and food (Gulanick et al., 2010).

3. Assess patients and help them to recognize the sign and symptoms of anxiety: it is important for patients to be able to know and recognize the sign and symptoms of anxiety, which will help Evert to be able to solve his sign and symptoms when anxiety level is low (Gulanick et al., 2010).

4. Relieving factors. Monitor the patient signs and symptoms with pain: Like Heart Rate, Temperature, Blood Pressure, skin color, restlessness, and patient inability to focus. Some patient’s ignoring sign and symptoms of pain when occur. The patient’s must inform the nurse about these sign and symptoms because it well helps the nurses in evaluation (Gulanick et al., 2010). Different Anxiety Experiences Nursing Case Study Essay

5. Assessing the main causes of pain: it is important for doctors and nurses to look to the causes of pain because the different causes having different treatments (Gulanick et al., 2010).

6. Assess the patient knowledge regarding pain relief strategies: a lot of patient’s may not realize how effective non drug method on them either with or without pain killing medication. So, we have to explain to them this point carefully (Gulanick et al., 2010).

7. Evaluate patient’s regarding response to pain medications or therapeutics: it is important to give patient’s chance to tell nurse about his expression regarding pain medication, and also let him to talk about effect of medication on him (Gulanick et al., 2010).

8. Assess patients from cultural, intrapersonal, intrapsychic, and environmental degree factors which are share to relief pain: these factors will affect patient’s expression on experiences, for example some cultural you have complete freedom to express how you fell (Gulanick et al., 2010).

9. Evaluate what is the meaning of pain to individuals: it is important to all patients’ to know the meaning of pain because if he doesn’t know it will affect him to response (Gulanick et al., 2010). Different Anxiety Experiences Nursing Case Study Essay

10. Assess patient’s regarding expectation of pain relief: it is important for nurses to know patients expectations regarding pain relief either the pain decreased or pain disappeared. Because these patient expectation will help the nurse to know either the pain relief or need to participate in another treatment (Gulanick et al., 2010).

11. Assess patients if they would like to explore some other techniques to control pain: it is important to patient to know that there is many ways of pain relief (Gulanick et al., 2010).

D. Evaluation: Evert manifests adequate relief of pain, recognizes sings of anxiety, and demonstrates positive coping mechanism. Evert’s urine output greater than 30ml/hr, weight is consistent and with normal skin turgor (Gulanick et al., 2010). Different Anxiety Experiences Nursing Case Study Essay

FOUR MAJOR AREAS:
Symptoms Control: A palliative approach, involving attention to symptoms control and the psychological, social and spiritual wellbeing of the patient and their family is relevant at all stages of the disease, and it has been argued that attention to these aspects combined with understanding of the patient’s feelings and concerns all contribute to improving quality of life of the person with acute pain (Montazeri et al., 1998). The principles of symptom control, which are used as standard by clinicians include: assessment of the symptom, understanding the meaning ascribed to it by the patient, explanation of the likely cause, investigation should only be undertaken if they will change the course of action to be followed, institution of treatment based on known or likely etiology, available options for treatment, and wishes of the patient, monitoring of the response to treatment and modification as necessary ( Steinhauser et al., 2000). Different Anxiety Experiences Nursing Case Study Essay

Communication: make a good relationship between nurse and patient which well make patient comfortable in communication. Trying to orient the patient to the environment and help him to take experiences from people as needed, and also when the patient is aware and oriented very well it will help him to be comfort and may will decrease anxiety. Help the patient to express anxious felling if the patient has ability to describe them. (Gulanick, 2010).

Teamwork: during assessment pain in patient, contributions from the multidisciplinary team is very important to evaluate the following: a detailed history of each pain, full examination, and psychosocial assessment, a history of analgesics already used and the response to them, investigations to confirm the diagnosis, depending on the stage of disease and the treatment options (Ripamonte et al., 1997). Perception of pain will be influenced by the meaning of pain for the patient. Open discussion among team members, family and patient, allowing fears to be discussed, providing explanation of the symptoms and reassurance of continued support is important (Twycross, R. G, 1993). Different Anxiety Experiences Nursing Case Study Essay

Family: the nurse must teach patient and his/her family about intervention regarding inadequate intake, and explain to him the importance of intake such as drinking fluids and eating food. Explanation of the importance of the rationale and intended effect of treatment program to alleviate pain, diminish anxieties (Gulanick et al., 2010).

The word anxious is part of our everyday conversation. Most of us have felt
anxious about an upcoming test or doctor’s appointment, or experienced a feeling of
anxiety before going to a social event. You may even have noticed that sometimes you
feel “anxious” without a clear understanding of why.
Anxiety is a normal part of the human condition and can be useful when it helps
us anticipate and appropriately respond to possible danger. When we experience a
stressful event, whether real or imagined, the body reacts by activating the sympathetic
nervous system, which leads to a fight-or-flight response. Normal stress, or “eustress,” is
part of everyone’s daily life. Richard Lazarus (1966) first used the term eustress to
describe the healthy reaction to stress that leads to a positive behavioral response and
feelings of success. Lazarus (1966) believed that people had to perceive a situation as
anxiety provoking in order to trigger this stress response—the thoughts that an individual
associates with an event determine if it is perceived as threatening and if a positive
outcome is viewed as achievable (Lazarus, 1966). If a positive outcome is viewed as
possible, we face the stressor, do what we have to do, and feel good about it afterward. In
fact, there is a great deal of research that shows that some stress or anxiety (but not too
much) actually increases performance (Davies, Matthews, Stammers, & Westerman,
2013). Different Anxiety Experiences Nursing Case Study Essay
Unfortunately, for some, the normal level of anxiety can become extreme and
excessive, and the ways of responding to it can then become dysfunctional, negatively
impacting mental and physical well-being (Wagner, 1990) and leading to an anxiety
disorder. Our current understanding of anxiety disorders in the Diagnostic and Statistical
Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013) is
as a cluster of mental health disorders marked by feelings of excessive worry, physical
distress, irrational fears, and apprehension about the future. This severe anxiety occurs
during situations where most people would not experience a significant level of concern
or worry, and reactions are markedly different from normal reactions to stress (). Unlike
the comparatively mild and transitory anxiety caused by a stressful event, such as a minor
car accident or a presentation at work, anxiety disorders last much longer and get
progressively worse if not treated. Different Anxiety Experiences Nursing Case Study Essay
Anxiety disorders are among the most common mental health issues in the United
States (Kessler, Berglund, Demler, Jin, & Walters, 2005). Anxiety disorders impact
roughly 10% of the adult (over 18) population at any given time, translating into over 40
million individuals (Kessler, Berglund, et al., 2005; Kessler, Petukhova, Sampson,
Zaslavsky, & Wittchen, 2012). Numbers are similar if not larger for children and
adolescents (Beesdo, Knappe, & Pine, 2009; Burstein, Beesdo-Baum, He, & Merikangas,
2014). Anxiety disorders commonly occur along with other mental or physical illnesses,
including alcohol or substance abuse, which may start as a form of self-medication. In
some cases, these co-occurring disorders need to be treated before or simultaneously in
order for the client to respond to treatment for the anxiety disorder (Kessler, Chiu,
Demler, & Walters, 2005).
A variety of therapeutic interventions for anxiety disorders are available that can
help individuals lead satisfying and productive lives. Many individuals, however, do not
seek treatment because they are ashamed to seek help or feel that they are coping the best
Ideas and Research You Can Use: VISTAS 2016
they can under difficult circumstances
& Bensing, 2010). When not treated, an
impacting personal relationships, career,
activities as shopping, driving, or making a phone call extremely difficult. Anxiety
disorders have been shown to affect morbidity and mortality rates, work productivity, and
alcohol and other drug use (Hoffman, Duk
Weissman, 1995; Wittchen & Fehm, 2001).
In this article, we focus on one of the most commonly treated anxiety disorders in
counseling settings, generalized
case conceptualization model (the Temporal/Contextual Model) to
biopsychosocial factors that
them, with the goal of increasing understanding
model, counselors can more effectively help
Case Conceptualization for Clients
All counselors recognize the importance of case conceptualization; however, there
are few models of case conceptualization
process. The models that do exist are tied to a specific theoretical orientation, making
their broad application to the diverse clients with whom counselors work difficult.
Temporal/Contextual (T/C) Model is
the counselor’s understanding of the client
Figure 1. Different Anxiety Experiences Nursing Case Study Essay

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3
they can under difficult circumstances (van Beljouw, Verhaak, Prins, Cuijpers, Penninx,
. When not treated, anxiety disorders can become
impacting personal relationships, career, or school, and can even make such common
activities as shopping, driving, or making a phone call extremely difficult. Anxiety
disorders have been shown to affect morbidity and mortality rates, work productivity, and
alcohol and other drug use (Hoffman, Dukes, & Wittchen, 2008; Leon, Portera, &
Weissman, 1995; Wittchen & Fehm, 2001).
In this article, we focus on one of the most commonly treated anxiety disorders in
eneralized anxiety disorder (GAD). We utilize a newly developed
ceptualization model (the Temporal/Contextual Model) to explicate
that put individuals at risk for anxiety disorders or help maintain
them, with the goal of increasing understanding. By applying a case conceptualization
model, counselors can more effectively help clients deal with the challenges of GAD.
Case Conceptualization for Clients with Anxiety Disorders
All counselors recognize the importance of case conceptualization; however, there
are few models of case conceptualization that provide an articulated framework of t
do exist are tied to a specific theoretical orientation, making
their broad application to the diverse clients with whom counselors work difficult.
Model is a holistic, atheoretical model designed
the counselor’s understanding of the client, which can be used with clients d
, Verhaak, Prins, Cuijpers, Penninx,
xiety disorders can become debilitating,
or school, and can even make such common
activities as shopping, driving, or making a phone call extremely difficult. Anxiety
disorders have been shown to affect morbidity and mortality rates, work productivity, and
Wittchen, 2008; Leon, Portera, &
In this article, we focus on one of the most commonly treated anxiety disorders in
isorder (GAD). We utilize a newly developed
explicate the various
disorders or help maintain
. By applying a case conceptualization
clients deal with the challenges of GAD. Different Anxiety Experiences Nursing Case Study Essay
All counselors recognize the importance of case conceptualization; however, there
provide an articulated framework of the
do exist are tied to a specific theoretical orientation, making
their broad application to the diverse clients with whom counselors work difficult. The
designed to facilitate
, which can be used with clients dealing with a
Ideas and Research You Can Use: VISTAS 2016
4
wide range of presenting problems. The Model is both comprehensive and streamlined,
with a visual flowchart in addition to a full description, making it easy to utilize in
practice and teach to students. Highlighted within the model are the client’s internal
world, including attitudes, values, and belief systems; the client’s external world,
including environment, relationships, and culture; and the important processes of
interaction between the internal and external worlds (behaviors, symptoms, readiness for
change, coping skills, and life roles). The model also includes a timeline, which allows a
focus on past experiences and future goals, as well as a reminder of the importance of the
here and now of the present counseling experience.
The Model
A brief description of each domain of the T/C Model follows.
The Triangle
The triangle represents the three major elements of human experience and
expression: behavior, cognition, and affect (emotion; Greenberger & Padesky, 1995)—
the client’s experienced world, both psychological and physiological. Represented within
is the client’s personality, which embodies the internal personality constructs (IPCs) that
form the client’s values and beliefs, self-concept, and world view. These internal
personality constructs also include the client’s attachment style, sense of self-efficacy,
and self-esteem. IPCs impact the way that the client perceives their environment,
including perceptions of risk, and how well they cope, and influence the client’s
readiness for change.
The points of the triangle—behavior, cognition, and affect—also connect to the
outside world. Cognition includes the client’s perception and interpretation of
information, beliefs about self and others, attachment status, and relationship style,
developed over time through interaction with the environment. Behavior encompasses
what clients “do”—eating, sleeping, activity level, and withdrawal, as well as the
counselor’s observations of the client in session. Affect includes the client’s ability for
emotional regulation, which can be a challenge for clients with GAD, leading to anxiety
and panic. Affect also encompasses awareness and expression of emotions. The
relationships among the points of the triangle and the outside world are reciprocal. The
client’s beliefs (cognition) and emotions (affect) impact behavior, while emotions are tied
to thoughts and experience. The client’s perceptions of biological and environmental
experience influence thinking style (Bronfenbrenner, 2009; Bronfenbrenner, & Morris,
1998). In order to understand and empathize with clients, counselors can be most
effective by keeping in mind the interrelationships between constructs. Different Anxiety Experiences Nursing Case Study Essay
Physiology and biology take into account clients’ individual differences as well as
strengths and vulnerabilities in physical health and constitution. This construct also
includes an understanding of genetic predispositions and temperament, reaction to stress,
biochemical differences in neurotransmitter function, and other brain chemistry factors,
which are often implicated in GAD. Genetic and physiological factors influence the
client’s thoughts, emotions, and behavior, the points of the triangle. For example, the
client’s beliefs, developed from the interaction of personality, biology, and experience
(environment) create “hot thoughts,” which are directly connected to affect (Beck &
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5
Beck, 2011). A “hot thought” is a thought that causes an emotional reaction such as
anxiety, usually based on the present environmental stimulus and the individual’s
attitudes, values, and beliefs regarding the meaning of that stimulus.
The Inner Circle
The inner circle represents the boundary between the client’s internal and external
worlds, the space where the client interacts with the environment and the environment is
in turn impacted by the client (Bronfenbrenner, & Morris, 1998). Symptomology is the
first and perhaps most obvious construct on the inner circle. Both somatic symptoms and
psychological symptoms must be assessed and understood before moving forward to a
diagnosis. Also included in the inner circle are the client’s coping skills and strengths and
their readiness for change (Prochaska & DiClemente, 1986), which must be uncovered
before the client moves into the process of change (Prochaska & DiClemente, 1982).
These coping strategies, client strengths, and motivation for change are located on the
inner circle since they can impact the development of either symptoms or healthy
adjustment. Different Anxiety Experiences Nursing Case Study Essay
The final construct in the inner circle is an understanding of the client’s life roles.
We all play multiple roles in life—mother, daughter, sister, coworker, accountant,
friend—and each role influences both what we do and how we view ourselves (Clark,
2000). Life roles are depicted along the inner circle since these impact the way the client
responds to stressful environmental events and are in turn influenced by the norms,
values, attitudes, and beliefs that the client has learned. The client’s negotiation of
multiple and sometimes conflicting roles has an influence on identity development and
can impact the client’s self-esteem and level of stress and anxiety.
The Outer Circle
The outer circle represents the multiple environmental and relational influences
that impact the client (and are in turn impacted by the client). These include the client’s
interpersonal relationships (family, peer, romantic, and the client/counselor alliance),
culture, socioeconomic status, community, social structures, and societal norms that
influence identity and experience (Bronfenbrenner, 2009; Clark, 2000). These constructs
are interrelated. Environment, for example, plays a critical role in how the client’s IPCs
are constructed, and various environmental conditions have differential impacts
depending on the client’s developmental stage (Greenberger & Padesky 1995). Within
the environment reside the precipitating stressors that may have brought the client to
counseling. Symptoms occur when the person’s risk factors and vulnerabilities
overwhelm their strengths and coping strategies, and are depicted in the diagram as
located in the intersection between person and environment.
Timeline
The line at the bottom of the model represents time: past, present, and future. The
timeline implies both context and setting and reminds both counselor and client that
events that happened in the past can be interpreted differently in the light of the present. Different Anxiety Experiences Nursing Case Study Essay
Environmental factors from the client’s past may have shaped thinking style and selfconcept, creating a vulnerability to stressors. Thus, it may be important to explore the
client’s early family experiences in order to gain insight into whether certain cognitions
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6
are distorted or behaviors are maladaptive. All of us learn some irrational beliefs as part
of the socialization process of childhood (Corey, 2009). The incorporation of the timeline
allows counselors to be flexible in assessing a client’s current circumstances by
examining a client’s identity across time and focusing on the future.
Counselors take into account the client’s behaviors, thoughts, and feelings in the
present by using a here and now focus to clarify and challenge whatever is getting in the
client’s way. The incorporation of the Timeline reminds us, however, that knowledge of
the past can impact the client’s progress in the here and now. A clear image from the past
can also be used as a starting point to imagine a future self, with fewer problems and a
healthy, positive identity. This imagined future self can serve as an aspirational goal,
increasing motivation. The model, in this way, lends flexibility to the counselor, with the
ability to focus on past experiences, the here and now, and future decisions and actions.
Generalized Anxiety Disorder (GAD)
Because GAD is often a long-standing problem, the T/C Model is particularly
useful as an economical way of gathering data and making sense of the client’s history,
while at the same time facilitating a thorough assessment. Both biological and
psychological factors may be relevant; there may be a genetic predisposition to anxiety,
as well as a learned component. The T/C Model also explicitly reminds counselors to
gather information on strengths, resources, coping skills, and supports. Such information
allows the counselor to empower the client, who may be experiencing feelings of
hopelessness in the face of a prolonged and pervasive disorder.
People with generalized anxiety disorder (GAD) suffer from extreme amounts of
worry accompanied by physical distress and behavioral disturbances. This excessive
worry has no specific trigger and lasts for several hours to most of the day, and includes
thoughts of impending disaster that focus on family, finances, career, health or
relationships. As the name suggests, the anxiety is generalized to almost all aspects of the
client’s life, unlike other anxiety disorders like specific phobias or social phobia. For
some, the anxiety can be so severe that getting out of bed is a struggle (American
Psychiatric Association, 2013).
People diagnosed with GAD feel like they have no control over their thoughts,
even though they realize that much of their anxiety is irrational or unjustified. They have
trouble sleeping or staying asleep and often describe themselves as being in a heightened
state of arousal. This excessive worry is associated with specific physical symptoms such
as muscle tension, being easily fatigued, difficulty concentrating or mind going blank,
irritability, sleep disturbance, and feeling keyed up, restless, or on edge (Rowa & Antony,
2008). Different Anxiety Experiences Nursing Case Study Essay
GAD affects about 3% of the population, or 6.8 million American adults (Kessler,
Berglund, et al., 2005; Kessler, Chiu, et al., 2005). GAD can begin at any age, but usually
develops between childhood and middle age. Although a specific cause is not known,
there is evidence that heredity and environment may play a role (Hettema, Neale, &
Kendler, 2001). Many people with GAD report having feelings of anxiety and fear for as
long as they can remember. Though there are periods of lesser symptoms at times of
relative calm, the anxiety always returns, and rates of full remission are unfortunately low
(American Psychiatric Association, 2013). The Sleepy Woman With Anxiety Case Study Essay