Sears S F, Todaro J F, Lewis T S, Sotile W, Conti J B
University of Florida, Department of Clinical and Health Psychology, Gainesville 32610, USA.
Clin Cardiol. 1999 Jul;22(7):481-9. doi: 10.1002/clc.4960220709.
The implantable cardioverter defibrillator (ICD) has proven to be superior to medications in treating potentially life-threatening ventricular arrhythmias, resulting in reduced mortality rates. Despite the number of patients receiving this therapy, its psychosocial impact is not well understood.
The purposes of this paper are (1) to review the available literature documenting the psychosocial impact of the ICD on patients, (2) to hypothesize possible mechanisms for this psychosocial impact, and (3) to suggest clinical risk profiles and indications for psychological consultation.
Electronic and library searches (e.g., MEDLINE, PsychLit) were used to gather studies examining the psychosocial impact of the ICD. Only studies investigating psychosocial outcomes (e.g., psychological distress, quality of life, social and role functioning), either prospectively or cross-sectionally, were admitted into the review. No literature reviews or secondary sources were included.
Current research suggests that ICD-specific fears and symptoms of anxiety (e.g., excessive worry, physiological arousal) are the most common psychological symptoms experienced by ICD recipients, with approximately 13-38% of recipients experiencing diagnosable levels of anxiety. Depressive symptoms are reported at rates that are generally consistent with other cardiac populations. Although the incidence of psychological disorders appears to be similar to that found in general cardiac populations, specific ICD-related concerns such as fear of shock, fear of device malfunction, fear of death, and fear of embarrassment have been identified. Selected psychological theories such as classical conditioning, learned helplessness, and a cognitive appraisal model help to explain the occurrence of psychological symptoms post implantation. Psychosocial adjustment risk profiles indicate that young ICD recipients and those with high discharge rates may experience the most adjustment difficulties.
植入式心脏复律除颤器（ICD）在治疗潜在的危及生命的室性心律失常方面已被证明优于药物治疗，可降低死亡率。尽管接受这种治疗的患者数量众多，但其对心理社会的影响尚未得到充分了解。
本文的目的是（1）回顾现有文献，记录ICD对患者心理社会的影响；（2）推测这种心理社会影响的可能机制；（3）提出临床风险概况和心理咨询的指征。
通过电子检索和图书馆检索（如MEDLINE、PsychLit）收集研究ICD心理社会影响的研究。纳入综述的研究仅为前瞻性或横断面研究心理社会结局（如心理困扰、生活质量、社会和角色功能）的研究。不包括文献综述或二手资料。
目前的研究表明，特定于ICD的恐惧和焦虑症状（如过度担忧、生理觉醒）是ICD接受者最常见的心理症状，约13% - 38%的接受者有可诊断水平的焦虑。抑郁症状的报告率与其他心脏疾病人群总体一致。尽管心理障碍的发生率似乎与一般心脏疾病人群相似，但已确定了一些与ICD相关的特定担忧，如对电击的恐惧、对设备故障的恐惧、对死亡的恐惧和对尴尬的恐惧。一些心理理论，如经典条件作用、习得性无助和认知评估模型，有助于解释植入后心理症状的发生。心理社会适应风险概况表明，年轻的ICD接受者和高放电率的患者可能经历最大的适应困难。
