惊恐障碍和场所恐惧症：植入式心脏复律除颤器治疗的副作用
Panic disorders and agoraphobia: side effects of treatment with an implantable cardioverter/defibrillator.
作者信息
Godemann Frank, Butter Christian, Lampe Felix, Linden Michael, Schlegl Michael, Schultheiss Hans-Peter, Behrens Steffen
机构信息
Department of Psychiatry of the Charité, Free University of Berlin, Germany.
出版信息
Clin Cardiol. 2004 Jun;27(6):321-6. doi: 10.1002/clc.4960270604.
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.
背景
植入式心脏复律除颤器（ICD）治疗降低了心脏性猝死高危患者的死亡率。然而，ICD放电可能会引发对新放电的焦虑，并导致预防性的，例如恐惧行为。本研究评估了ICD患者惊恐障碍和广场恐惧症的发生率，并评估了其发生的危险因素。
假设
ICD治疗是焦虑症发生的一个危险因素。
方法
使用标准化的精神综合征终生诊断访谈（DIPS）对90例ICD患者进行检查。该访谈能够估计惊恐障碍和广场恐惧症的发生率。评估了基础心脏病的严重程度、ICD放电次数以及电击体验的主观评价对惊恐障碍和广场恐惧症发生的影响。
结果
15例患者（16.7%）在植入ICD后出现焦虑症。有ICD放电的患者发生率为21%，无ICD放电的患者发生率为6.9%。每年有两次或更多次ICD放电的患者，惊恐障碍和广场恐惧症的发生率高于每年有单次ICD放电的患者（62%对10%，p<0.01）。对自身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
惊恐障碍和广场恐惧症是ICD治疗常见的副作用。这些障碍发生的危险因素是每年两次或更多次ICD放电以及对ICD放电的负面认知评价。治疗应旨在减少ICD放电次数并提供早期心理治疗。
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