ABORDAGEM DA PERTURBAÇÃO DE ANSIEDADE GENERALIZADA NOS CUIDADOS DE SAÚDE PRIMÁRIOS
Resumo
Introdução: A Perturbação de Ansiedade Generalizada (PAG) encontra-se entre as Perturbações de Ansiedade mais comuns nos Cuidados de Saúde Primários (CSP) e associa-se a morbilidade significativa com pesados encargos individuais e sociais. Contudo, está ainda subdiagnosticada e subtratada. Uma intervenção precoce nos CSP e a articulação eficiente com os cuidados secundários é fundamental no sentido de promover a saúde mental, parecendo essencial a criação de linhas orientadoras para uma abordagem sistematizada. Pretende-se fornecer um guia prático para a abordagem diagnóstica e terapêutica da PAG, particularmente dirigido aos CSP.
Métodos: Foi realizada uma pesquisa na base de dados PubMed, usando os termos: Generalized Anxiety Disorder, Management, Treatment e Primary Care. Foram selecionados artigos em língua portuguesa ou inglesa, publicados entre 2005-2015.
Resultados/Conclusão: Ao nível dos CSP, o diagnóstico da PAG revela-se um desafio por ausência de um padrão comum de apresentação; somatização; presença de comorbilidades e limitação de tempo. O Médico de Família poderá realizar uma avaliação diagnóstica sistematizada, auxiliada por critérios diagnósticos universalmente aceites. Também deverá conhecer as intervenções educativas, psicológicas ou farmacológicas disponíveis. Assume uma posição privilegiada pela relação longitudinal que estabelece com o doente, devendo capacitá-lo face ao problema, orientá-lo com base na decisão partilhada e referenciá-lo oportunamente.
Introduction: The Generalized Anxiety Disorder (GAD) is amongst the most common Anxiety Disorders in Primary Care (PC) and it is associated with significant morbidity and heavy individual and social burden. However, it is still underdiagnosed and undertreated. An early intervention in PC and efficient articulation with secondary care is essential to promote mental health, being fundamental to establish guidelines for a systematic approach. For that, we intend to provide a GAD diagnostic and treatment practical guide directed to PC physicians.
Methods: It was performed a PubMed database search of English and Portuguese publications (2004-2015), using as search terms: “Generalized Anxiety Disorder”, “Treatment”, “Diagnosis”, “Primary Care”.
Results/Conclusion: At the level of PC, the diagnosis of GAD proves to be a challenge due the lack of a common standard of presentation; somatization; presence of comorbidities and limited time. The general practitioner can perform a systematic diagnostic assessment, aided by generally accepted diagnostic criteria and should also know the available educational, psychological and pharmacological interventions. He assumes privileged position through the longitudinal relationship established with the patient and should empower him to address the problem, guide him on the basis of shared decision and reference in due course.
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