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¿Tiene este paciente ansiedad generalizada o trastorno de pánico? : La revisión sistemática del examen clínico
Nathaniel R Herr1, John W Williams2, Sophiya Benjamin3
1Department of Psychology, American University, Washington, DC.
JAMA
|July 25, 2014
Resumen
Esta revisión encontró que la Escala de Trastorno de Ansiedad Generalizada 7 (GAD-7) y el Cuestionario de Salud del Paciente son efectivos para la detección del trastorno de ansiedad generalizada y el trastorno de pánico en entornos de atención primaria.
Área de la Ciencia:
- La psiquiatría es la psiquiatría.
- Medicina de la Atención Primaria Medicina de la Atención Primaria.
- Precisión en el diagnóstico.
Sus antecedentes:
- El trastorno de ansiedad generalizada (TAG) y el trastorno de pánico son condiciones prevalentes pero a menudo pasadas por alto en la atención primaria.
- Las herramientas efectivas de detección son cruciales para mejorar la detección y el manejo de estos trastornos de ansiedad.
Objetivo del estudio:
- Evaluar sistemáticamente la precisión diagnóstica de los instrumentos de detección de autoinforme para el TAG y el trastorno de pánico en adultos.
- Identificar herramientas fiables y prácticas para los entornos de atención primaria.
Principales métodos:
- Se realizó una búsqueda exhaustiva de la literatura en las principales bases de datos (MEDLINE, PsycINFO, Cochrane Library) desde 1980 hasta abril de 2014.
- Se incluyeron estudios prospectivos de precisión de diagnóstico que comparaban los instrumentos de autoinforme con los diagnósticos clínicos estándar de oro (criterios DSM / ICD).
Principales resultados:
- El Ítem 7 de la Escala de Trastorno de Ansiedad Generalizada (GAD-7) demostró un fuerte rendimiento para la detección de GAD (LR + 5.1, LR- 0.13).
- El Cuestionario de Salud del Paciente mostró una alta precisión para la detección del trastorno de pánico (LR + 78, LR- 0.20).
- Se identificaron nueve instrumentos en 10 estudios que involucraron a 2785 pacientes con trastorno de ansiedad generalizada y 2637 con trastorno de pánico.
Conclusiones:
- El GAD-7 y el Cuestionario de Salud del Paciente son herramientas de detección prometedoras y factibles para el trastorno de ansiedad generalizada y el trastorno de pánico en la atención primaria.
- Se recomienda una validación adicional en diversas poblaciones de atención primaria debido a la limitada replicación de los resultados.
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