Cognitive–Behavioral Treatment of Panic Disorder With Agoraphobia Triggered by AICD Implant Activity

Abstract

Received January 24, 1997; revised June 18, 1997; accepted July 8, 1997. From the Department of Psychiatry, State University of New York (SUNY) Health Science Center at Brooklyn. Address reprint requests to Dr. Smith, Box 1203, 450 Clarkson Avenue, SUNY Health Science Center at Brooklyn, Brooklyn, NY 11203. Copyright 1998 The Academy of Psychosomatic Medicine. The use of automatic implantable cardioverter defibrillators (AICDs) has been successful in reducing the incidence of sudden arrhythmic mortality in high-risk patients to less than 3% per year. However, in addition to the stress associated with chronic cardiac disease, AICD patients face unique problems, such as device dependency and fear of unpredictable shocks, which make them particularly vulnerable to anxiety, depression, and other psychological disturbances. As many as 50% of these patients have been shown to develop a psychiatric disorder: 30% adjustment disorder–mixed type, 15% major depression, and 5% panic disorder. Supportive treatment, often within a group setting,and the use of psychotropic medications (primarily benzodiazepines) are common treatment modalities. Cognitive–behavioral therapy (CBT) in particular can be helpful in managing anxiety and fatigue, maximizing physical and social activity, and reframing the meaning of the AICD from the center of one’s life to a neutral medical intervention designed to enhance and prolong life. Although CBT is mentioned in most articles addressing the psychiatric management of patients with AICDs, no detailed account of its specific application or effectiveness has been reported. We will describe the psychological reaction and comprehensive case management of a client with an AICD.