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Archivos de Medicina de Urgencia de México

2026, Number 1

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Arch Med Urg Mex 2026; 18 (1)

Anxiety in the emergency room: a narrative review of diagnostic and therapeutic strategies

Bravo-Sombrerero M, López-Loyola T

Language: Spanish
References: 44
Page: 87-96
PDF size: 327.05 Kb.


ABSTRACT

Anxiety disorders are common in emergency departments and usually manifest with somatic symptoms that make their differential diagnosis difficult with acute organic pathologies. The objective of this narrative review was to synthesize current evidence on etiology, neurobiology, diagnosis, and therapeutic management of anxiety in the acute setting. A review of the scientific literature published between 2008 and 2025 in PubMed, Scopus and SciELO was conducted. The findings highlight the importance of a comprehensive clinical evaluation, the rule out of organic etiology, and the identification of risk factors, particularly in settings with limited availability of immediate psychiatric care. Management includes brief emotional containment interventions, cognitive-behavioral strategies, and individualized pharmacological treatment. Training of medical personnel continues to be critical to optimizing care and reducing complications.


REFERENCES

  1. American Psychiatric Association. Anxiety disorders. In: Diagnosticand Statistical Manual of Mental Disorders. 5th ed, text rev.Washington, DC: American Psychiatric Association; 2022:215-231.

  2. Secretaría de Salud, Centro Nacional de Excelencia Tecnológicaen Salud. Diagnóstico y tratamiento de los trastornos de ansiedaden el adulto [Internet]. México: CENETEC; 2010 [consultado Julio11, 2025]. Disponible en: https://www.cenetec-difusion.com/CMGPC/IMSS-392-10/ER.pdf

  3. Nieto R, Iribarne C, Droguett M, Brucher R, Fuentes C, Oliva P.Urgencias psiquiátricas en el hospital general. Rev Med Clin LasCondes. 2017;28(6):914-922. doi:10.1016/j.rmclc.2017.09.004.

  4. Observatorio Mexicano de Salud Mental y Adicciones. Una miradaa la atención en salud mental en México: principales condicionesatendidas en el sistema de salud [Internet]. México: Comisión Nacionalde Salud Mental y Adicciones; 2024 [consultado Julio 11,2025]. Disponible en: https://www.gob.mx/conasama/documentos/dia-mundial-de-la-salud-mental-380122

  5. DeGeorge KC, Grover M, Streeter GS. Generalized anxietydisorder and panic disorder in adults. Am Fam Physician.2022;106(2):157-164.

  6. Vannucci A, Flannery KM, Ohannessian CM. Social media useand anxiety in emerging adults. J Affect Disord. 2017;207:163-166. doi:10.1016/j.jad.2016.08.040.

  7. Alvaro PK, Roberts RM, Harris JK. A systematic review assessingbidirectionality between sleep disturbances, anxiety, and depression.Sleep. 2013;36(7):1059-1068. doi:10.5665/sleep.2810.

  8. Bawden D, Robinson L. The dark side of information: overload,anxiety and other paradoxes and pathologies. J Inf Sci.2009;35(2):180-191. doi:10.1177/0165551508095781.

  9. Baik HW. Mental health and micronutrients: a narrative review.Ann Clin Nutr Metab. 2024;16(3):112-119. doi:10.15747/ACNM.2024.16.3.112.

  10. Koskinen MK, Hovatta I. Genetic insights into the neurobiologyof anxiety. Trends Neurosci. 2023;46(4):318-331. doi:10.1016/j.tins.2023.01.007.

  11. Almeida FB, Pinna G, Barros HMT. The role of HPA axis andallopregnanolone in the neurobiology of major depressive disordersand PTSD. Int J Mol Sci. 2021;22(11):5495. doi:10.3390/ijms22115495.

  12. Janak PH, Tye KM. From circuits to behaviour in the amygdala.Nature. 2015;517(7534):284-292. doi:10.1038/nature14188.

  13. Torrico TJ, Abdijadid S. Neuroanatomy, limbic system. In: StatPearls[Internet]. Treasure Island, FL: StatPearls Publishing; 2025[consultado Julio 11, 2025]. Disponible en: https://www.ncbi.nlm.nih.gov/books/NBK538137/

  14. Rolls ET. The Brain, Emotion, and Depression. Oxford: OxfordUniversity Press; 2018.

  15. Marcuse LV, Langan M, Hof PR, et al. The thalamus: structure,function, and neurotherapeutics. Neurotherapeutics.2025;22(2):e00550. doi:10.1016/j.neurot.2025.e00550.

  16. Al-Kachak A, Di Salvo G, Fulton SL, et al. Histone serotonylationin dorsal raphe nucleus contributes to stress- and antidepressant-mediated gene expression and behavior. Nat Commun.2024;15:5042. doi:10.1038/s41467-024-49336-4.

  17. De Matteis M, Basurte Villamor I. Protocolo diagnóstico y terapéuticode la ansiedad aguda. Medicine (Barc). 2015;11(84):5036-5040. doi:10.1016/j.med.2015.07.014.

  18. González MG, Martín PF. Protocolo diagnóstico y terapéuticodel trastorno por crisis de ansiedad. Medicine (Barc).2019;12(84):4957-4961. doi:10.1016/j.med.2019.07.007.

  19. Sociedad Española para el Estudio de la Ansiedad y el Estrés.¿Cuáles son los síntomas de la ansiedad? [Internet]. Madrid:SEAS [consultado Marzo 13, 2025]. Disponible en: https://ansiedadyestres.org/cuales-son-los-sintomas-de-la-ansiedad/

  20. Raju NN, Kumar KSVR NP, Nihal G. Clinical practice guidelinesfor assessment and management of anxiety and panic disordersin emergency setting. Indian J Psychiatry. 2023;65(Suppl2):S181-S185. doi:10.4103/indianjpsychiatry.indianjpsychiatry_489_22.

  21. National Institute for Health and Care Excellence. Generalisedanxiety disorder and panic disorder in adults: management [Internet].London: NICE; 2019 Jul [consultado Julio 11, 2025]. (NICEClinical Guidelines, No. 113). Disponible en: https://www.ncbi.nlm.nih.gov/books/NBK552847/

  22. Richmond JS, Berlin JS, Fishkind AB, et al. Verbal de-escalationof the agitated patient: consensus statement of the American Associationfor Emergency Psychiatry Project BETA De-escalationWorkgroup. West J Emerg Med. 2012;13(1):17-25. doi:10.5811/westjem.2011.9.6864.

  23. Simonelli-Muñoz AJ, Gallego-Gómez JI, Fernández-García N, Rivera-Caravaca JM. Initial management of patients with psychiatricinvolvement in hospital emergency departments: a systematic review. An Sist Sanit Navar. 2021;44(1):71-81. doi:10.23938/ASSN.0939.

  24. Moyon Ureta JS, Tumbaco Constante LF. Atención en crisis psiquiátricas:evaluación y manejo en el área de emergencias delHospital General “Dr. Verdi Cevallos Balda”. Código Cient RevInvestig. 2025;6(E1):1134-1154. doi:10.55813/gaea/ccri/v6/nE1/741.

  25. McGuire S, Safi MH, Daniels J. Acceptability and effectivenessof cognitive behavioral therapy and psychologically based interventionsfor emergency department attenders with medical complaints:a systematic review. Cogn Behav Ther. 2022;15:e51.doi:10.1017/S1754470X22000472.

  26. Torous J, Bucci S, Bell IH, et al. The growing field of digital psychiatry:current evidence and the future of apps, social media,chatbots, and virtual reality. World Psychiatry. 2021;20(3):318-335. doi:10.1002/wps.20883.

  27. Chin P, Gorman F, Beck F, et al. A systematic review of brief respiratory,embodiment, cognitive, and mindfulness interventions to reducestate anxiety. Front Psychol. 2024;15:1412928. doi:10.3389/fpsyg.2024.1412928.

  28. Fincham GW, Strauss C, Montero-Marin J, Cavanagh K. Effect ofbreathwork on stress and mental health: a meta-analysis of randomizedcontrolled trials. Sci Rep. 2023;13(1):432. doi:10.1038/s41598-022-27247-y.

  29. Banushi B, Brendle M, Ragnhildstveit A, et al. Breathwork interventionsfor adults with clinically diagnosed anxiety disorders: ascoping review. Brain Sci. 2023;13(2):256. doi:10.3390/brainsci13020256.

  30. Locke AB, Kirst N, Shultz CG. Diagnosis and management of generalizedanxiety disorder and panic disorder in adults. Am FamPhysician. 2015;91(9):617-624.

  31. Zeller SL, Rhoades RW. Systematic reviews of assessment measuresand pharmacologic treatments for agitation. Clin Ther.2010;32(3):403-425. doi:10.1016/j.clinthera.2010.03.006.

  32. Grupo de Trabajo de la Guía de Práctica Clínica para el Manejo dePacientes con Trastornos de Ansiedad en Atención Primaria. Guíade práctica clínica para el manejo de pacientes con trastornos deansiedad en atención primaria. Madrid: Plan Nacional para el SNSdel Instituto de Salud Carlos III; 2008.

  33. Hofmann SG, Gómez AF. Mindfulness-based interventions foranxiety and depression. Psychiatr Clin North Am. 2017;40(4):739-749. doi:10.1016/j.psc.2017.08.008.

  34. Williams M, Honan C, Skromanis S, et al. Psychological outcomesand mechanisms of mindfulness-based training for generalizedanxiety disorder: a systematic review and meta-analysis. CurrPsychol. 2024;43:5318-5334. doi:10.1007/s12144-023-04695-x.

  35. Hoge EA, Bui E, Mete M, et al. Mindfulness-based stress reductionvs escitalopram for the treatment of adults with anxiety disorders:a randomized clinical trial. JAMA Psychiatry. 2023;80(1):13-21. doi:10.1001/jamapsychiatry.2022.3679.

  36. Salahuddin SM, Waheed S. Mindfulness in the emergency department:an asynchronous learning course to practise mindfulnessand resilience in a low-resource emergency setting. J CollPhysicians Surg Pak. 2021;31(10):1242-1243. doi:10.29271/jcpsp.2021.10.1242.

  37. Chesney M. Implementation of a wellness program for emergencydepartment medical professionals [tesis doctoral en Internet].Louisville, KY: University of Louisville; 2020 [consultado Julio 9,2025]. Disponible en: https://ir.library.louisville.edu/dnp/70

  38. World Health Organization. mhGAP intervention guide for mental,neurological and substance use disorders in non-specializedhealth settings. 3rd ed. Geneva: World Health Organization; 2023.

  39. Brunner E, Chen CA, Klein T, et al. Joint clinical practice guidelineon benzodiazepine tapering: considerations when risks outweighbenefits. J Gen Intern Med. 2025;40(12):2814-2859. doi:10.1007/s11606-025-09499-2.

  40. Boettler MA, Shahwan KT, Cusick A, et al. Safety and efficacyof oral benzodiazepines for periprocedural anxiolysis: a systematicreview. Dermatol Surg. 2022;48(5):508-515. doi:10.1097/DSS.0000000000003407.

  41. Strawn JR, Stimpfl J. Optimizing benzodiazepine treatmentof anxiety disorders. Curr Psychiatry. 2023;22(6):22-33,39.doi:10.12788/cp.0365.

  42. Sakurai H, Inada K, Aoki Y, et al. Management of unspecifiedanxiety disorder: expert consensus. Neuropsychopharmacol Rep.2023;43(2):188-194. doi:10.1002/npr2.12323.

  43. Brandt J, Bressi J, Lê ML, et al. Prescribing and deprescribingguidance for benzodiazepine and benzodiazepine receptor agonistuse in adults with depression, anxiety, and insomnia: an internationalscoping review. EClinicalMedicine. 2024;70:102507.doi:10.1016/j.eclinm.2024.102507.

  44. Bandelow B, Michaelis S, Wedekind D. Treatment of anxiety disorders.Dialogues Clin Neurosci. 2017;19(2):93-107. doi:10.31887/DCNS.2017.19.2/bbandelow.




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