Panic disorders and agoraphobia: Side effects of treatment with an implantable cardioverter/defibrillator
Panic disorders and agoraphobia: Side effects of treatment with an implantable cardioverter/defibrillator
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DOI：
10.1002/clc.4960270604
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发表时间：
2004-06-01
影响因子：
2.7
通讯作者：
Behrens, S
中科院分区：
文献类型：
--
作者：
Godemann, F;Butter, C;Behrens, S
背景：植入性心律转复/除颤器(ICD)治疗降低了心源性猝死高危患者的死亡率。然而，ICD放电可能会引起对新放电的焦虑，并导致预防性行为，例如恐惧症。本研究评估了ICD患者中惊恐障碍和广场恐怖症的发生率，并对其发展中的危险因素进行了评估。假设：ICD治疗是焦虑障碍发生的危险因素。方法：采用标准化终生精神症状诊断性访谈(DIPS)对90名ICD患者进行测试。这次访谈使我们有可能估计恐慌症和广场恐惧症的发生率。分析基础心脏病的严重程度、ICD出院次数和对休克体验的主观评价对惊恐障碍和广场恐怖症发生的影响。结果：ICD植入术后有15例(16.7%)患者出现焦虑症。有ICD出院的患者发生率为21%，无ICD出院的患者为6.9%。在每年有两次或两次以上ICD出院的患者中，惊恐障碍和广场恐怖症的发生率高于每年一次ICD出院的患者(62vs.10%，p<；0.01)。对身体的自我观察强度与焦虑症的发生显著相关(P<；0.001)。结论：恐慌症和广场恐怖症是ICD治疗的常见副作用。这些疾病发展的危险因素是每年两次或两次以上ICD出院，以及对ICD出院的负面认知评估。治疗工作应以减少ICD出院次数为目标，并及早提供心理治疗。
Background: Implantable cardioverter/defibrillator (ICD) treatment has reduced the mortality of patients with a high risk of sudden cardiac death. However, ICD discharges may cause anxiety with respect to new discharges and lead to preventive, for example, phobic, behavior. This study evaluated the frequency of panic disorders and agoraphobia in patients with ICD and assessed the risk factors in their development.Hypothesis: Treatment with ICD represents a risk factor in the development of anxiety disorders.Methods: Ninety patients with ICD were examined using a standardized lifetime Diagnostic Interview of Psychiatric Syndromes (DIPS). This interview makes it possible to estimate the incidence of panic disorders and agoraphobia. The impact of the severity of the underlying cardiac disease, the number of ICD discharges, and the subjective appraisal of the shock experience on the development of panic disorders and agoraphobia was assessed.Results: Fifteen patients (16.7%) developed anxiety disorders after ICD implantation. The incidence was 21% in patients with and 6.9% in patients without ICD discharge. In patients with two or more ICD discharges annually, the incidence of panic disorders and agoraphobia was higher than that in patients with a single ICD discharge annually (62 vs. 10%, p < 0.01). The intensity of self-observation of their body was significantly related to the development of anxiety disorders (p < 0.001).Conclusion: Panic disorders and agoraphobia are frequent side effects of ICD treatment. Risk factors in the development of these disorders are two or more ICD discharges annually and a negative cognitive appraisal of ICD discharges. Therapeutic efforts should aim at reducing the number of ICD discharges and provide early psychological treatment.