Estudios realizados y conclusiones de los mismos

Although panic and trauma have particular salience in the emergency depart-ment context, other types of anxiety-related conditions impact the likelihood and nature of patient presentations to the emergency room. All of the anxiety disorders can contribute to heightened fear or worry in the face of physical symptoms and can increase the odds that a patient will appear for emergent care instead of pursuing help through less urgent avenues. Patients with ob-sessive-compulsive disorder may demonstrate a near-delusional level of con-cern about germs or infection. Patients with a blood-injection-injury phobia

may faint when in the emergency department for another reason. Patients with generalized anxiety disorder may have a somatic focus for their worry, causing them to present to the emergency room for an evaluation that could wait for a primary care appointment. Similarly, somatoform disorders such as hypochondriasis and somatization also involve intense anxiety about physical symptoms, and even though they are not classified as anxiety disorders, they will bring highly anxious patients into the emergency department. A full dis-cussion of these conditions is beyond the scope of this chapter.

Key Clinical Points

• Anxiety is a common complaint in the emergency department, and anxiety disorders pose a significant burden to the medical system if they are not adequately recognized and treated.

• Panic attacks can be managed without medications, using cognitive and behavioral techniques.

• SSRIs provide relief from most anxiety disorders, although a slow titra-tion to the goal dose may be needed given the propensity of SSRIs to cause anxiety-provoking physical symptoms as these medications are initiated.

• Trauma patients with severe distress or dissociation in the aftermath of trauma exposure, a pretrauma history of mental illness, difficulty re-turning to normal functioning after the trauma, and signs of autonomic arousal are at highest risk of developing PTSD.

• PTSD risk may be reduced with rapid introduction to cognitive-behavioral techniques and normalization of life rhythms (e.g., sleep) after the trau-matic event. There is insufficient evidence at this point to support ef-forts to prevent PTSD pharmacologically.

• High anxiety does not reduce the likelihood of major medical problems requiring urgent attention and should not divert attention from neces-sary medical evaluation. High risk may remain even if life-threatening medical illness is ruled out, because anxiety may reflect an underlying psychiatric disturbance that carries high risk for self-harm or harm to others.

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Suggested Readings

Craske MG, Barlow DH: Master of Your Anxiety and Panic: Therapists Guide, 4th Edition. New York, Oxford University Press, 2006

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