Psychopathology in postinfarction patients implanted with cardioverter-defibrillators for secondary prevention. A cross-sectional, case-controlled study |
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Authors: | Redhead Anthony P Turkington Douglas Rao Sanjay Tynan Margaret M Bourke John P |
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Affiliation: | aDepartment of Cardiology, Freeman Hospital, Newcastle upon Tyne, UK;bDepartment of Psychiatry (Newcastle University), Royal Victoria Infirmary, Newcastle upon Tyne, UK;cThe Logos Centre, Tees, Esk and Wear Valley NHS Trust, Durham, UK |
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Abstract: | ObjectiveTo determine (1) the incidence of anxiety and depression in patients implanted with defibrillators for secondary arrhythmia protection after myocardial infarction; (2) the effect of comorbidity and receipt of shock therapy on psychosocial maladjustment.MethodsCross-sectional, one-off, questionnaire-based (HADS; MOS SF-36), case-controlled study of defibrillator recipients (n=100) from a 3-year implant period and three groups of matched controls [pacemaker (n=50), coronary intervention (n=50), atrial fibrillation (n=50)], sharing specific preselected previous health experiences. Spouses of each subgroup (n=106) were also studied. Although a cardiac rehabilitation program was available routinely for postinfarction patients, no specific rehabilitation was provided after defibrillator or pacemaker implant.ResultsMean scores for each assessment were similar for each group. Individual patient scores, however, revealed similarly high incidences of anxiety (24–34%) and depression (14–22%) in all groups. Experience of implantable cardioverter-defibrillator (ICD) ‘shock(s)’ and ‘shock storm(s)’ (≥3 shocks in 24 h) increased anxiety significantly. HADS criteria for anxiety ‘caseness’ or borderline ‘caseness’ were met in 63.6% of shock-storm recipients. Abnormal anxiety scores did not differ with interval from index event. Individual HADS scores also identified high incidences of anxiety in all spouse groups (25–48%).ConclusionsExperience of shock storm precipitates pathological levels of anxiety in ICD recipients, and need for an ICD contributes to spouse anxiety. Individual CBT is indicated for patients who experience multiple shocks along with psycho-education for spouses. Anxiolytic and antidepressant medications may be indicated as part of their psychological rehabilitation. |
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Keywords: | Abbreviations: AF, atrial fibrillation CBT, cognitive behavior therapy DSM-IV, Diagnostic and Statistical Manual of Mental Disorders, 4th Edition HADS, Hospital Anxiety and Depression Scale ICD, implantable cardioverter-defibrillator MOS-36, medical outcomes study short form 36 PCI, percutaneous coronary intervention SPSS, Statistical Package for Social Sciences |
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