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a source of ongoing disability Similar spells of anxiety are also a prominent feature of the postconcussive syndrome (page 864) The onset of anxiety neurosis is often insidious feelings of tenseness, vague apprehension, fatigue, weakness, and giddiness having been present for weeks or months before the rst panic attack From the history alone, two patterns of chronic anxiety neurosis are discernible In one, there is a nearly lifelong history of poor exercise tolerance, little stamina, inability to do heavy physical work or participate in vigorous sports, tenseness, nervousness, and intolerance of crowds, ie, what had been called neurasthenia These symptoms often arise during military service and had been designated, since the American Civil War, as neurocirculatory asthenia, irritable heart, or soldier s heart In the other pattern of onset, the patient is vigorous and symptom-free before the anxiety state begins The latter type usually has its origin in a late-life anxious depression that nonetheless may arise on a background of lifelong mild anxiety or obsessiveness Most patients with chronic symptoms rst consult a physician not with a complaint of anxiety but with symptoms referable to the cardiorespiratory system or gastrointestinal system (dyspepsia, loss of appetite, or irritable colon ) The physical examination between acute attacks yields relatively little of diagnostic value The common ndings, disclosed by the study of Cohen and associates, were slight tachycardia, sighing respirations, yawning, ushed face and neck, tremor of the outstretched hands, and brisk tendon jerks The patient tends to be restless and abrupt in movement, expressive of an inner uneasiness During a panic attack, there may be manifest agitation and a tendency to leave the current venue, and blood pressure is invariably elevated The onset of both acute and chronic anxiety neurosis is rare before 18 or after 35 to 40 years of age (average age of onset, 25 years) The condition in some series is twice as frequent in women as in men, and there is a high familial incidence In one study (Wheeler et al) there was a prevalence of 49 percent among the grown children of patients with anxiety neurosis, compared with a prevalence of about 5 percent in the general population Slater and Shields found that there was a concordance rate of 40 percent in identical twins, compared with 4 percent in dizygotic twins Among the relatives of index cases, the mothers suffered from anxiety neurosis more often than did the fathers; in the latter, alcoholism was more frequent than in the population at large (Modlin) The pattern of inheritance has not been established, but it most closely approximates that of autosomal dominance with incomplete penetrance The course of anxiety neurosis is variable The symptoms uctuate in severity without apparent relation to environmental stress A 20-year follow-up study by Wheeler and associates showed that symptoms of anxiety neurosis were still present in 88 percent but persisted in being moderately or severely disabling in only 15 percent Most affected patients were able to work and to enjoy a reasonably normal family and social life Their only liability to further psychiatric illness was to recurrent anxiety neurosis or to later anxious depression whereas so-called psychosomatic illnesses and other psychiatric illnesses did not occur more frequently than in the general population The life span of patients with anxiety neurosis is not shortened Those with pure, uncomplicated anxiety neurosis rarely commit suicide.

Anxiety neurosis has been attributed to a genetic abnormality, to constitutional weakness of the nervous system, to social and psy-

FIGURE 7-6

Many things can cause the computer not to turn on, including a bad power supply or system board It can also be a result of the system not being plugged in or an improperly connected hard drive Check the hard drive ribbon cable to ensure that the red stripe is aligned with pin 1 Sometimes your friends may play practical jokes on you Many power supplies are now configured to support 120 or 220 volts (European standard) Verify that someone did not change the setting to the wrong voltage setting to see if your troubleshooting skills are up to snuff

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