შეჯამება
განსაზღვრება
History and exam
Key diagnostic factors
- presencia de factores de riesgo
- preocupación excesiva durante al menos 6 meses
- la ansiedad no se limita a otro trastorno de salud mental
- ansiedad que no se debe a medicamentos o sustancias
- tensión muscular
- alteración del sueño
- fatiga
- inquietud
- irritabilidad
- mala concentración
Other diagnostic factors
- cefalea
- sudoración
- mareos
- síntomas gastrointestinales
- dolores musculares
- aumento de la frecuencia cardíaca
- disnea
- temblor
- respuesta de susto exagerada
- dolor torácico
Risk factors
- antecedentes familiares de ansiedad
- estrés emocional o físico
- Antecedentes de traumatismo físico, sexual o emocional
- otro trastorno de ansiedad
- afección crónica de la salud física
- sexo femenino
Diagnostic investigations
1st investigations to order
- diagnóstico clínico
Investigations to consider
- pruebas de función tiroidea
- cribado de tóxicos en orina
- orina de 24 horas para catecolaminas, metanefrinas, normetanefrinas y creatinina
- pruebas funcionales respiratorias
- electrocardiograma (ECG)
Treatment algorithm
síntomas de ansiedad que cumplen los criterios del DSM-5-TR
síntomas de ansiedad que no cumplen los criterios del DSM-5-TR
Contributors
Authors
Philip John Cowen, MD, FRCPsych, FMedSci
Professor of Psychopharmacology
Department of Psychiatry
University of Oxford
Oxford
UK
Disclosures
PJC declares that he has no competing interests.
Acknowledgements
Professor Philip John Cowen would like to gratefully acknowledge Dr Christopher Gale, Dr Richard P. Swinson, Dr Elizabeth Hoge, and Dr Phebe Tucker, previous contributors to this topic.
Disclosures
CG is an author of the Royal Australian and New Zealand College of Psychiatrists clinical practice guideline on social phobia, panic disorder, and generalised anxiety disorder. Otago University has commercial and research relationships with multiple pharmaceutical companies. He is an author of a number of references cited in this topic. RPS has personally received royalties for articles published in UpToDate (Wolters Kluwer) and the Compendium of Therapeutic Choices, 2nd edition (Canadian Pharmacists Association). EH is an author of a number of references cited in this topic. PT has conducted research for GlaxoSmithKline, Bristol-Myers Squibb, Wyeth Pharmaceuticals, Astra-Zeneca, Cephalon, Inc., and Ortho-McNeil. She has also consulted for Forest Pharmaceuticals and received honoraria from Pfizer, Inc. and Forest Pharmaceuticals.
Peer reviewers
Lori Davis, MD
Research Director
University of Alabama
School of Medicine Tuscaloosa Campus
College of Community Health Sciences
Tuscaloosa
AL
Disclosures
LD declares that she has no competing interests.
Arianna Di Florio, MD, PhD
Senior Clinical Lecturer
Division of Psychological Medicine and Clinical Neurosciences
Cardiff University
United Kingdom
Disclosures
ADF declares that she has no competing interests.
Elaine Lockhart, MD, BCH, BAO
Consultant in Paediatric Liaison Psychiatry
Royal Hospital for Children
Glasgow
United Kingdom
Disclosures
EL declares that she has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed., text revision (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2022.
Bandelow B, Sher L, Bunevicius R, et al; WFSBP Task Force on Mental Disorders in Primary Care; WFSBP Task Force on Anxiety Disorders, OCD and PTSD. Guidelines for the pharmacological treatment of anxiety disorders, obsessive-compulsive disorder and posttraumatic stress disorder in primary care. Int J Psychiatry Clin Pract. 2012 Jun;16(2):77-84. Abstract
Bandelow B, Sagebiel A, Belz M, et al. Enduring effects of psychological treatments for anxiety disorders: meta-analysis of follow-up studies. Br J Psychiatry. 2018 Jun;212(6):333-8.Full text Abstract
Slee A, Nazareth I, Bondaronek P, et al. Pharmacological treatments for generalised anxiety disorder: a systematic review and network meta-analysis. Lancet. 2019 Feb 23;393(10173):768-77. Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Trastorno de pánico
- Trastorno de ansiedad social
- Trastorno obsesivo compulsivo
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