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From the Institute of Medical Psychology and Behavioral Neurobiology (P.P., G.B.-B.), University Hospital of Psychiatry and Psychotherapy (G.W., W.D.), Medical Clinic and Policlinic (V.K.), University of Tübingen, Tübingen, Germany.
Address reprint requests to: Paul Pauli, PhD, Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Gartenstr. 29, 72074 Tübingen, Germany. E:mail: Paul.Pauli{at}uni-tuebingen.de
OBJECTIVE: Anxiety seems to be a frequent problem in patients with an automatic implantable cardioverter defibrillator (AICD). Distressing experiences before or after AICD implantation such as resuscitation, or AICD shocks are suspected as causes for enhanced anxiety levels. A closer examination of the level and structure of anxiety in AICD patients and a comparison with panic patients might help to examine additionally both conditioning and cognitive models of anxiety.
METHODS: There were 61 AICD patients examined with a specifically designed AICD questionnaire and standardized anxiety and depression questionnaires. Subgroups of AICD patients without, with some, and with definite anxiety related to AICD shocks were compared with panic patients and healthy control subjects.
RESULTS: Although fear of dying was greatly reduced by AICD implantation, approximately one third of the AICD patients, especially patients with definite anxiety related to AICD shocks, were characterized both by enhanced anxiety levels and avoidance behavior. These patients were comparable with panic patients in most questionnaire scores. Anxiety levels were not associated with objective AICD shock experiences or medical variables.
CONCLUSIONS: Anxiety in AICD patients seems to be unrelated to traumatic experiences, a finding that casts doubt on pure conditioning models of anxiety. Presumably, a life-threatening cardiac disorder increases the likelihood for catastrophic interpretations of bodily signs, especially in anxiety prone AICD patients. In accordance with cognitive models of panic disorder, this cognitive dysfunction could lead to anxiety and depression levels comparable with those of panic patients.
Key Words: automatic implantable cardioverter defibrillator, • AICD, • anxiety, • panic disorder.
Abbreviations: AICD = automatic implantable cardioverter defibrillator;; US = unconditioned stimulus;; UR = unconditioned response;; CS = conditioned stimulus;; CR = conditioned response;; ACQ = Agoraphobia Cognition Questionnaire;; BSQ = Body Sensation Questionnaire;; FSS = Fear Survey Schedule;; TAI = Trait Anxiety Inventory;; BAI = Beck Anxiety Inventory;; BDI = Beck Depression Inventory;; MI = Mobility Inventory.
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