Heart 1997;78:581-583 ( December )

Florid psychopathology in patients receiving shocks from implanted cardioverter-defibrillators

John P Bourke,^a Douglas Turkington,^b Gareth Thomas,^b Janet M McComb,^a Margaret Tynan^a

^a Department of Cardiology, Freeman Hospital NHS Trust, Newcastle upon Tyne, UK, ^b Department of Adult Psychiatry, Collingwood Clinic, City Health Trust, Newcastle upon Tyne, UK

Correspondence to: Dr Bourke, University Department of Cardiology, Freeman Hospital, Freeman Road, Newcastle upon Tyne NE7 7DN, UK; email: j.p.bourke{at}ncl.ac.uk

Accepted for publication 28 August 1997

ObjectivesTo increase awareness of the potential for disabling anxiety and depression in patients receiving shocks from implanted cardioverter-defibrillators (ICDs).
Patients and methodsICDs 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.
ResultsOver 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).
ConclusionsBecause ICD implantation occurs against a complex medical background with inevitable psychological stress, all such patients should be considered at high risk for developing psychopathology.

Keywords: implantable cardioverter-defibrillators;  psychopathology;  complications

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© 1997 by Heart
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