Panic disorders and agoraphobia: side effects of treatment with an implantable cardioverter/defibrillator.
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.


OBJECTIVE
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).


CONCLUSIONS
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.
Godemann
Frank
F
Department of Psychiatry of the Charité, Free University of Berlin, Germany.
Butter
Christian
C
Lampe
Felix
F
Linden
Michael
M
Schlegl
Michael
M
Schultheiss
Hans-Peter
HP
Behrens
Steffen
S
D000223:Adaptation, Psychological; D000379:Agoraphobia / Q000453:epidemiology / Q000209:etiology*; D017147:Defibrillators, Implantable / Q000009:adverse effects* / Q000523:psychology*; D005239:Fear; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D016584:Panic Disorder / Q000453:epidemiology / Q000209:etiology*; D012307:Risk Factors; D012647:Self-Assessment; D017180:Tachycardia, Ventricular / Q000523:psychology / Q000628:therapy*