History

Henry, a 40-year-old schoolteacher attends his general practitioner surgery with his wife with
complaints of feeling constantly fearful and stressed. These feelings have been present on most
days over the past 3 years and are not limited to specific situations or discrete periods. Henry
also experiences poor concentration, irritability, tremors, palpitations, dizziness and dry mouth.

He has continued to work, but his symptoms are causing stress at work and at home. He denies
any problems with his mood and reports that his energy levels are fine. He admits that he is
experiencing problems with his sleep. He finds it difficult to fall asleep and states that he does
not feel refreshed on waking up. He has been married for 15 years and lives with his wife and
two sons aged 8 and 10. His parents live locally and he has no siblings. His father has been
diagnosed with Alzheimer’s dementia. He remembers his mother being anxious for much of his
childhood. He has no previous medical or psychiatric history and is not taking
any medication. He smokes 20 cigarettes per day and drinks alcohol socially. He has never used
any illicit drugs. He tends to hide his symptoms and said that he was seeing his general
practitioner because his wife wanted him to seek help.
Mental state examination
He makes fleeting eye contact. He is a neatly dressed man with no evidence of self-neglect. He
appears to be restless and tense but settles down as the interview progresses. He answers all
the questions appropriately and there is no abnormality in his speech. His mood is euthymic
and he does not have any thoughts of self-harm. There is no evidence of delusions or
hallucinations. He is able to recognize the impact of his symptoms on his social and occupational
functioning and is keen to seek help.

Physical examination
His blood pressure is 140/90 mm Hg and his pulse is regular and 110 beats per minute. The
rest of the physical examination does not reveal any abnormality.