Classic conditioning and dysfunctional cognitions in patients with panic disorder and agoraphobia treated with an implantable cardioverter/defibrillator.
OBJECTIVE
A model for the development of anxiety disorders (panic disorder with or without agoraphobia) is needed. Patients with an implantable cardioverter/defibrillator (ICD) are exposed to repeated electric shocks. If the theory of anxiety development by aversive classic conditioning processes is valid, these repeated shocks should lead to an increased risk of anxiety disorders. To study this hypothesis, we retrospectively studied 72 patients after implantation of an automatic ICD.


METHODS
Patients were assessed with the semistructured Diagnostic Interview of Psychiatric Disease 1 to 6 years after implantation of an automatic ICD. Panic disorder and/or agoraphobia was diagnosed in patients who fulfilled all DSM-III-R criteria for those conditions.


RESULTS
Anxiety disorder developed in 15.9% of patients after ICD implantation. This was significantly related to the frequency of repeated defibrillation (shocks) to stop malignant ventricular arrhythmias. Dysfunctional cognitions are an additional vulnerability factor.


CONCLUSIONS
The data support both the conditioning hypothesis and the cognitive model of anxiety development. These findings suggest that ICD patients are an appropriate risk population for a prospective study of the development of anxiety disorders.
Godemann
F
F
Department of Psychiatry, Free University of Berlin, Germany. godemann@zedat.fu-berlin.de
Ahrens
B
B
Behrens
S
S
Berthold
R
R
Gandor
C
C
Lampe
F
F
Linden
M
M
D000368:Aged; D000379:Agoraphobia / Q000209:etiology* / Q000523:psychology; D003072:Cognition Disorders / Q000209:etiology* / Q000523:psychology; D019336:Cognitive Science; D003214:Conditioning, Classical; D017147:Defibrillators, Implantable / Q000009:adverse effects* / Q000523:psychology*; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016584:Panic Disorder / Q000209:etiology* / Q000523:psychology; D015995:Prevalence; D012189:Retrospective Studies; D012306:Risk; D012307:Risk Factors; D012720:Severity of Illness Index; D017180:Tachycardia, Ventricular / Q000523:psychology