A 61-Year Old Woman Comes to the Office Due to Insomnia

question 48

Multiple Choice

A 61-year old woman comes to the office due to insomnia.  She has had difficulty falling asleep since her divorce was finalized 2 months ago and she relocated to a new state to be closer to her daughter and grandchildren.  The patient's sleep is restless and she is frequently awakened by household noises.  During this time, she has also felt anxious and tense.  The patient is overwhelmed by financial worries and the responsibilities of living on her own.  Although previously outgoing, she now avoids opportunities to meet new people and socializes only with her daughter.  The patient has no psychiatric history but does have a history of hypothyroidism treated with levothyroxine.  Physical examination is unremarkable.  TSH is 1.6 µU/mL.  Which of the following is the most likely diagnosis?

• A)Acute stress disorder
• B)Adjustment disorder
• C)Anxiety disorder due to a medical condition
• D)Generalized anxiety disorder
• E)Medication-induced anxiety disorder
• F)Normal stress response

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Definitions:

Genetic Factors

Traits or conditions determined by genes inherited from one's parents, influencing various aspects of an individual's life.

Testosterone

A steroid hormone that plays a key role in the development of male reproductive tissues, as well as promoting secondary sexual characteristics.

Pigmented Hairs

Pigmented hairs are hairs that contain melanin, which gives hair its color, varying from person to person and changing with age.

Terminal Hairs

The thick, pigmented hairs that replace vellus hairs in certain body parts during puberty.