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A 73-year-old woman presents with four months of worry, restlessness and difficulty sleeping. She has never been an anxious person and nothing in her circumstances has changed. She now wakes at 4 am, has lost 6 kg, has given up her weekly bridge game and says she has 'let everybody down'. She has no tremor and no goitre. Full blood count, electrolytes, calcium and thyroid function are normal, and cognitive testing including delayed recall is normal. Her only medicine is atorvastatin. Which one of the following best accounts for her anxiety symptoms?
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