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Transtorno de ansiedade generalizada

最后审阅: 20 Aug 2025
最后更新: 29 May 2024

小结

定义

病史和体格检查

关键诊断因素

  • presença de fatores de risco
  • preocupação excessiva que dura há, pelo menos, 6 meses
  • ansiedade não limitada a outro transtorno mental
  • ansiedade não decorrente de medicamento ou substância
  • tensão muscular
  • perturbação do sono
  • fadiga
  • sono agitado
  • irritabilidade
  • baixa concentração
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其他诊断因素

  • cefaleia
  • sudorese
  • tontura
  • sintomas gastrointestinais
  • dores musculares
  • frequência cardíaca aumentada
  • dispneia
  • tremores
  • resposta de sobressalto exagerada
  • dor torácica
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危险因素

  • história familiar de ansiedade
  • estresse emocional ou físico
  • história de trauma emocional, físico ou sexual
  • outro transtorno de ansiedade
  • doença física crônica
  • sexo feminino
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诊断性检查

首要检查

  • diagnóstico clínico
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需考虑的检查

  • testes da função tireoidiana
  • exame de urina para detecção de drogas
  • urina de 24 horas para catecolaminas, metanefrinas, normetanefrinas e creatinina
  • testes de função pulmonar
  • eletrocardiograma (ECG)
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治疗流程

持续性治疗

sintomas de ansiedade que satisfazem os critérios do DSM-5-TR

sintomas de ansiedade que não preenchem os critérios do DSM-5-TR

撰稿人

作者

Philip John Cowen, MD, FRCPsych, FMedSci

Professor of Psychopharmacology

Department of Psychiatry

University of Oxford

Oxford

UK

利益声明

PJC declares that he has no competing interests.

鸣谢

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.

利益声明

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

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

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.

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