Florid psychopathology in patients receiving shocks from implanted cardioverter-defibrillators

Abstract

Objectives-To increase awareness of the potential for disabling anxiety and depression in patients receiving shocks from implanted cardioverter-defibrillators (ICDs). Patients and methods-ICDs are implanted in patients at this hospital for control of serious ventricular tachyarrhythmias inadequately controlled by drug treatment, who are unsuitable for map guided antiarrhythmic surgery. All are reviewed regularly at a dedicated ICD clinic and are advised to make contact between visits if they experience shocks. Symptoms of anxiety or depression were not actively sought, nor was a patient support group operating at the time of this data collection. When overt psychopathology was identified, patients were referred to a designated psychiatrist for management. Results-Over a six year period, six (17%) of 35 patients with ICDs developed florid psychiatric problems after experiencing shocks. None had premorbid psychiatric predisposition. Of the six patients suVering severe psychiatric problems, four were men, their age range was 30-63 years, and left ventricular ejection fraction was 18-40%. All shocks were appropriate for clinical arrhythmias and ranged in frequency from two in six months to 111 in 24 hours. All six patients manifested severe anxiety, focused on fear of future shocks. Depression was also evident in three patients and two had become housebound. All responded within weeks to anxiolytic or antidepressant drugs, combined with relaxation and cognitive therapies. Ongoing psychiatric therapy was refused by one patient, and was required for between three and 18 months in the remainder. One patient died and one received a cardiac transplant during the follow up period (median 27.5 months, range 8-43). Conclusions-Because ICD implantation occurs against a complex medical background with inevitable psychological stress, all such patients should be considered at high risk for developing psychopathology.

Technology-patient interactions: Internet use for gaining a healthy context for living with an implantable cardioverter defibrillator

“…Teplitz et al 16 and Badger and Morris 13 evaluated ICD support groups and reported that ICD patients and their families shared positive feedback with support group facilitators. The ICD recipients in another study, 9 who did not have a support group available, developed severe anxiety and depression.…”

“…4 A review of the literature on life after ICD implantation reported that patients and their families had difficulty adapting and experienced anger, anxiety, 5 fear, [6][7][8] and depression after experiencing ICD shock. 9 Craney et al 10 found by telephone interview that the majority (74%) of the ICD recipients studied experienced psychological distress as well as poor social and domestic adaptation. Furthermore, Lampert et al 11 found evidence that in patients with an ICD, mental stress may lead to increased incidences of sudden cardiac death through facilitating lethal ventricular arrhythmias, thus making it more compelling to manage this stress.…”

Quality of Life and Psychological Factors in Patients with Implantable Cardioverter Defibrillator

“…5) It has been reported that a significant number of ICD patients experience long-term difficulties. 6,7) Some ICD patients have psychological problems, such as anxiety disorders, depression, adjustment disorder and anger. 6,[8][9][10][11][12][13] The reported prevalence of psychological disorders ranged from 15 to 60%.…”

“…Anxiety disorders, depression and adjustment disorder were the most frequently cited. 6,[8][9][10][11][12] These psychological sequelae have caused impaired quality of life in some ICD patients. Studies on survivors of life-threatening arrhythmias found that the most frequent changes experienced were in lifestyle, increased psychological distress, feelings of dependence and fear of an uncertain future with heart rhythm disturbances.…”

Amiodarone Therapy in Patients Implanted With Cardioverter-Defibrillator for Life-Threatening Ventricular Arrhythmias

“…An important complication of appropriate or inappropriate shocks delivered by implantable defibrillators is that they may evoke serious psychological reactions in up to one third of the patients. 19,20 If the combined use of amiodarone with an ICD is tested prospectively, it is expected that the drug reduces the total mortality and improves the patient's QOL by inhibiting the electrical therapy from the ICDs.…”