Case 2 - The Story of the Dizzy Electrician

A 27-year-old married electrician complains of dizziness, sweating palms, heart palpitations, and ringing in the ears of more than 18 months duration. He has also experienced dry mouth and throat, periods of extreme muscle tension, and a constant "edgy" and watchful feeling that has often interfered with his ability to concentrate. These feelings have been present most of the time over the previous 2 years; they have not been limited to discreet periods. Although these symptoms sometimes make him feel "discouraged," he denies feeling depressed and continues to enjoy activities with his family.

Because of these symptoms the patient has seen a family practitioner, a neurologist, a neurosurgeon, a chiropractor, and an ear-nose-throat specialist. He had been placed on a hypoglycemic diet, received physiotherapy for a pinched nerve, and told he might have "an inner ear problem."

He also has many worries. He constantly worries about the health of his parents. His father, in fact, had a myocardial infarction 2 years previously, but is now feeling well. He also worries about whether he is a "good father," and whether his wife will ever leave him (there is no indication that she is dissatisfied with the marriage), and whether he is liked by co-workers on the job. Although he recognizes that his worries are often unfounded, he can't stop worrying.

For the past 2 years the patient has had few social contacts because of his nervous symptoms. Although he has sometimes had to leave work when the symptoms become intolerable, he continues to work for the same company he joined for his apprenticeship following high school graduation. He tends to hide his symptoms from his wife and children, to whom he wants to appear "perfect," and reports few problems with them as a result of his nervousness.

(For those of you who prefer a directive approach)
Please give the Axis I diagnosis; defend your diagnosis with three to five characteristic
symptoms/situations; possible etiology, onset and prognosis; and suggest a treatment.