Bourke J P, Turkington D, Thomas G, McComb J M, Tynan M
Department of Cardiology, Freeman Hospital NHS Trust, Newcastle upon Tyne, UK.
Heart. 1997 Dec;78(6):581-3. doi: 10.1136/hrt.78.6.581.
To increase awareness of the potential for disabling anxiety and depression in patients receiving shocks from implanted cardioverter-defibrillators (ICDs).
ICDs are implanted in patients at this hospital for control of serious ventricular tachyarrhythmias 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 if they experience shocks. Symptoms of anxiety or depression were not actively sought, nor was a patient support group operating at the time of this data collection. When overt psychopathology was identified, patients were referred to a designated psychiatrist for management.
Over a six year period, six (17%) of 35 patients with ICDs developed florid psychiatric problems after experiencing shocks. None had premorbid psychiatric predisposition. Of the six patients suffering severe psychiatric problems, four were men, their age range was 30-63 years, and left ventricular ejection fraction was 18-40%. All shocks were appropriate for clinical arrhythmias and ranged in frequency from two in six months to 111 in 24 hours. All six patients manifested severe anxiety, focused on fear of future shocks. Depression was also evident in three patients and two had become housebound. All responded within weeks to anxiolytic or antidepressant drugs, combined with relaxation and cognitive therapies. Ongoing psychiatric therapy was refused by one patient, and was required for between three and 18 months in the remainder. One patient died and one received a cardiac transplant during the follow up period (median 27.5 months, range 8-43).
Because ICD implantation occurs against a complex medical background with inevitable psychological stress, all such patients should be considered at high risk for developing psychopathology.
提高对植入式心脏复律除颤器（ICD）电击患者发生致残性焦虑和抑郁可能性的认识。
本院为控制药物治疗效果不佳、不适合进行标测引导下抗心律失常手术的严重室性快速心律失常患者植入ICD。所有患者均在专门的ICD门诊定期复查，并被建议在电击发作时就诊期间进行联系。未主动询问焦虑或抑郁症状，在本次数据收集时也未设立患者支持小组。当发现明显的精神病理学症状时，患者会被转介给指定的精神科医生进行管理。
在六年期间，35例植入ICD的患者中有6例（17%）在经历电击后出现明显的精神问题。无一例有病前精神易感性。在这6例患有严重精神问题的患者中，4例为男性，年龄范围为30 - 63岁，左心室射血分数为18% - 40%。所有电击均针对临床心律失常，频率范围从六个月内2次到24小时内111次。所有6例患者均表现出严重焦虑，主要是对未来电击的恐惧。3例患者也有明显抑郁，2例足不出户。所有患者在数周内对抗焦虑或抗抑郁药物治疗有反应，同时结合放松和认知疗法。1例患者拒绝继续接受精神治疗，其余患者需要接受3至18个月的治疗。随访期间1例患者死亡，1例接受了心脏移植（中位随访时间27.5个月，范围8 - 43个月）。
由于ICD植入是在复杂的医学背景下进行的，不可避免地会带来心理压力，所有此类患者都应被视为发生精神病理学问题的高危人群。
