ABSTRACT
OBJECTIVE: The implantable cardioverter-defibrillator (ICD) has dramatically improved survival rates following sudden cardiac death episodes. However, researchers have devoted little attention to the psychosocial consequences of living with the device. The current study used a longitudinal design to evaluate the impact of adaptation to the ICD on incidence and severity of anxiety and depression. METHOD: ICD recipients were administered standardized anxiety and depression questionnaires as well as questions evaluating quality of life related to the ICD in two consecutive yearly assessments. A preliminary evaluation of potentially important theoretical variables, such as the perceived predictability and controllability of shock onset was also conducted. RESULTS: One-third of the study population (N = 38) had clinically significant levels of anxiety, depressed mood, and fear of symptoms of autonomic arousal. These negative affective states persisted over time, with 40 to 63 percent of subjects continuing to have ongoing difficulties over a one-year time period. Anxiety about the ICD firing was closely associated with the occurrence of depression, while avoidance of activities was associated with anxiety. "Worry" about the ICD and a belief that ICD firing can be predicted were associated with anxiety sensitivity. CONCLUSIONS: Depressive and anxiety states in ICD recipients may be frequent, clinically significant, and resistant to spontaneous resolution. Early signs of anxiety and depression in ICD recipients should be evaluated. Implications for future research are discussed.
Subject(s)
Anxiety/psychology , Defibrillators, Implantable/psychology , Depression/psychology , Sick Role , Adaptation, Psychological , Adult , Aged , Anxiety/diagnosis , Arousal , Death, Sudden, Cardiac/prevention & control , Depression/diagnosis , Female , Follow-Up Studies , Humans , Male , Middle Aged , Personality Inventory , Quality of LifeABSTRACT
The existence of panic disorder in children and adolescents is currently a highly controversial topic. It has been postulated that children are unable to experience panic owing to cognitive developmental limitations. In a similar manner it was previously believed that children were unable to experience the clinical syndrome of depression. Hence, panic disorder in children and adolescents has been largely ignored and treatment is currently in an experimental phase of development with regard to both psychologic and psychopharmacologic interventions. Behavioral treatment has been successful in treating childhood anxiety disorders, and new treatments are being developed specifically for panic disorder. This paper reviews the controversy surrounding this area and the available treatment literature. A cognitive behavioral treatment program is reviewed and case presentations are included.
