Advanced Psychopharmacology

Anxiety and Insomnia Case Study Transcript

Chief Complaint: Katie Adams is a 19-year-old Caucasian female who states, “I worry about everything all the time.” “I can’t ever sleep, and I feel anxious and nervous at school and work.” “I cry often for no reason.”

History of Present Illness:

Onset: Following move to an out-of-town college, worsening over the past 3 months of being away from home and the stress of transitioning to college.

Location: Heart races, shortness of breath, sweating, headaches, dizzy.

Duration: Daily; lasts 2 to 4 hours then subsides; symptoms begin around 10 a.m. approximately 30 minutes before her first class starts at 10:30 a.m.

Characteristics: Worsens when attending large classes when peers and roommates pressure her to go out socially and drink; difficulty sleeping; avoids some classes; chest tightness often and shortness of breath.

Aggravating: With increased stress, crowds, when worrying about completing assignments or making good grades.

Relieving: Reading fiction, marijuana, sometimes a beer (1–2), staying in room alone when roommates go out.

Temporal: Worse in morning before classes and worse before bedtime.

Severity: “I hate how I feel; it’s horrible.”