title: Treatment of anxiety and depression in a patient with brugada syndrome.
abstract: Background. Brugada syndrome is rare and has been a clinically diagnosable entity since 1992. Its clinical manifestations are highly variable, and while some patients remain asymptomatic, others endure sudden cardiac death. Initial presenting symptoms may include palpitations, seizures, syncope, and nocturnal agonal respiration. The diagnosis of Brugada syndrome relies on both clinical findings and characteristic ECG patterns that occur spontaneously or are induced by usage of sodium-channel blocking agents. Aims of Case Report. Many psychiatrists may be unaware of the possibility of medical cocontributing etiologies to physical symptoms of anxiety and depression. We present a case of a patient who was treated psychiatrically for anxiety and panic attacks and who was subsequently diagnosed with Brugada syndrome and treated medically with an implantable cardioverter defibrillator (ICD), the only treatment option demonstrated to be effective. Her psychiatric symptoms predated her diagnosis of Brugada syndrome by at least fifteen years. Conclusion. The patient's eventual diagnosis of Brugada syndrome altered the course of her psychopharmacologic medication management and illustrates the utility of a psychosomatic approach to psychiatric symptom management.
authors.affiliation: Behavioral Health Services, Cheyenne Regional Medical Center, Cheyenne, WY 82001, USA ; Department of Psychiatry, Geisel School of Medicine at Dartmouth College and Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA.
authors.forename: Jasper J
authors.identifier: 0000-0002-5032-5714
authors.initials: JJ
authors.lastname: Chen
authors.affiliation: Department of Cardiology and Electrophysiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA.
authors.forename: Rajbir S
authors.identifier: 0000-0002-1512-9048
authors.initials: RS
authors.lastname: Sangha
references.citation: Rev Esp Cardiol. 2010 Aug;63(8):963-83
references.pmid: 20738941
references.citation: Hong Kong Med J. 2013 Apr;19(2):159-67
references.pmid: 23535677
references.citation: Circulation. 2002 Jan 1;105(1):73-8
references.pmid: 11772879
references.citation: J Am Coll Cardiol. 1996 Apr;27(5):1061-70
references.pmid: 8609322
references.citation: World J Biol Psychiatry. 2008;9(2):150-3
references.pmid: 17853265
references.citation: Circulation. 2005 Feb 8;111(5):659-70
references.pmid: 15655131
references.citation: Am J Cardiol. 2000 Jul 1;86(1):91-4
references.pmid: 10867101
references.citation: J Cardiovasc Electrophysiol. 2001 Jun;12(6):680-5
references.pmid: 11405402
references.citation: Circulation. 2000 Feb 8;101(5):510-5
references.pmid: 10662748
references.citation: Rev Esp Cardiol. 2009 Nov;62(11):1297-315
references.pmid: 19889341
references.citation: Arch Intern Med. 2004 Jun 28;164(12):1293-7
references.pmid: 15226162
references.citation: J Am Coll Cardiol. 1992 Nov 15;20(6):1391-6
references.pmid: 1309182
references.citation: Circulation. 2005 Sep 13;112(11):1527-31
references.pmid: 16144991
references.citation: Am J Psychiatry. 2007 Sep;164(9):1440-1
references.pmid: 17728436
references.citation: Heart. 2003 Feb;89(2):169-74
references.pmid: 12527670