FLORID PSYCHOPATHOLOGY IN PATIENTS RECEIVING SHOCKS FROM IMPLANTED CARDIOVERTER-DEFIBRILLATORS

Objectives-To increase awareness of the potential for disabling anxiet y and depression in patients receiving shocks from implanted cardiover ter-defibrillators (ICDs). Patients and methods-ICDs are implanted in patients at this hospital for control of serious ventricular tachyarrh ythmias 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 i f they experience shocks. Symptoms of anxiety or depression were not a ctively sought, nor was a patient support group operating at the time of this data collection. When overt psychopathology was identified, pa tients were referred to a designated psychiatrist for management. Resu lts-Over a six year period, six (17%) of 35 patients with ICDs develop ed florid psychiatric problems after experiencing shocks. None had pre morbid psychiatric predisposition. Of the six patients suffering sever e psychiatric problems, four were men, their age range was 30-63 years , and left ventricular ejection fraction was 18-40%. All shocks were a ppropriate for clinical arrhythmias and ranged in frequency from two i n six months to 111 in 24 hours. All six patients manifested severe an xiety, focused on fear of future shocks. Depression was also evident i n three patients and two had become housebound. All responded within w eeks to anxiolytic or antidepressant drugs, combined with relaxation a nd cognitive therapies. Ongoing psychiatric therapy was refused by one patient, and was required for between three and 18 months in the rema inder. One patient died and one received a cardiac transplant during t he follow up period (median 27.5 months, range 8-43). Conclusions-Beca use ICD implantation occurs against a complex medical background with inevitable psychological stress, all such patients should be considere d at high risk for developing psychopathology.