Abstract
Introduction
Some patients with ICDs experience the sensation of a shock in the absence of true therapy (phantom shock). We hypothesize that phantom shocks may be a manifestation of anxiety, depression or PTSD.
Methods and results
All patients over 18 years old with an ICD were eligible to enroll in the study. The first 75 subjects who agreed to participate were enrolled and divided into three groups: ICD patients with phantom shocks (n = 19); ICD patients who had actual shocks (n = 28) and ICD patients who had no shocks (n = 28). During a clinic visit a demographic questionnaire and three psychological rating scales were administered: the Spielberger State–Trait Anxiety Inventory (STAI); the Center for Epidemiologic Studies Depression Scale (CES-D) and the Posttraumatic Stress Checklist (PCL-C). No significant differences between groups were found in gender, race, age, history of MI or cardiac surgery status. Data analysis of the psychological indices using one-way ANOVA showed that the group with phantom shocks had more depression (CES-D p = 0.011) and more anxiety (STAI p = 0.010) than the other groups. Multiple comparisons of group means showed a greater percentage of clinically depressed patients in the phantom shock group than in the other groups.
Conclusion
Patients with phantom shocks are more likely to be clinically depressed and have higher levels of anxiety than other ICD patients, regardless of history of actual shocks.
Similar content being viewed by others
References
Andrykowski, M. A., Cordova, M. J., Studts, J. L., & Miller, T. W. (1998). Posttraumatic stress disorder after treatment for breast cancer: Prevalence of diagnosis and use of the PTSD Checklist-Civilian Version (PCL-C) as a screening instrument. Journal of Consulting and Clinical Psychology, 66(3), 586–590.
Bardy, G. H., Lee, K. L., Mark, D. B., Poole, J. E., Packer, D. L., Boineau, R., et al. (2005). Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. New England Journal of Medicine, 352, 225–237.
Bourke, J. P., Turkington, D., Thomas, Gm. McComb, J. M., & Tynan, M. (1997). Florid psychopathology in patients receiving shocks from implanted cardio-verter defibrillators. Heart, 78, 581–583.
Buxton, A. E., Lee, K. L., Fisher, J. D., Josephson, M. E., Prystowsky, E. N., & Hafley, G., for The Multicenter Unsustained Tachycardia Trial Investigators. (1999). A randomized study of the prevention of sudden death in patients with coronary artery disease. New England Journal of Medicine, 341(25), 1882–1890.
Carroll, D. L., Hamilton, G. A., & McGovern, B. A. (1999). Changes in health status and quality of life and the impact of uncertainty in patients who survive life-threatening arrhythmias. Heart Lung, 28, 251–260.
Conolly, S. J., et al. (2000). Canadian Implantable Defibrillator Study (CIDS). A randomized trial of the implantable cardioverter defibrillator against amiodarone. Circulation, 101, 1297–1302.
Dougherty, C. M. (1995). Psychological reactions and family adjustments in shock versus no shock groups after implantation of internal cardioverter defibrillator. Heart Lung, 24(4), 281–291.
Dunbar, S., Jenkins, L., Hawthorne, M., & Porter L. (1996). Mood disturbance in patients with recurrent ventricular dysrhythmia before insertion of implantable cardioverter defibrillator. Heart Lung, 25, 253–261.
Duru, F., Buchi, S., Klaghofer, R., Mattmann, H., Sensky, T., Buddeberg, C., et al. (2001). How different from pacemaker patients are recipients of implantable cardioverter-defibrillators with respect to psychosocial adaptation, affective disorders and quality of life? Heart, 85(4), 375–379.
Goodman, M., & Hess, H. (1999). Could implantable cardioverter defibrillators provide a human model supporting the learned helplessness theory of depression? General Hospital Psychiatry, 21, 382–385.
Hegel, M. T., Griegel, L. E., Black, C., Goulden, L., & Ozahowski, T. (1997). Anxiety and depression in patients receiving implanted cardioverter defibrillator: A longitudinal investigation. International Journal of Psychiatry in Medicine, 27(1), 57–69.
Herbst, J. H., Goodman, Feldstein, S., & Reilly, J. M. (1999). Health-related quality-of-life assessment of patients with life-threatening ventricular arrhythmias. Pacing and Clinical Electrophysiology, 22(Pt 1), 915–926.
Herrmann, C., von zur Muhen, F., Schaumann, A., Ulbrich, B., Kemper, S., Wantzen, C., et al. (1997). Standardized assessment of psychological well-being and quality-of-life in patients with implanted defibrillators. PACE, 20, 95–103.
Hsu, J., Uratsu, C., Truman, A., Quesenberry, C., McDonald, Km., Hlatky, Ma., et al. (2002). Life after a ventricular arrhythmia. American Heart Journal, 144(3), 404–412
James, J. E. (1997). The Psychological and emotional impact of living with an Automatic Internal Cardioverter Defibrillator (AICD): How can nurses help? Intensive Critical Care Nursing, 13, 316–323.
Kowey, P. R., Marinchak, R., & Rials, S. (1993). More things that go bang in the night [letter]. New England Journal of Medicine, 328, 1570–1571.
Luderitz, B., Jung, W., Deister, A., & Manz, M. (1994). Patient acceptance of implantable cardioverter defibrillator devices: Changing attitudes. American Heart Journal, 127(4), 1179–1184.
Mason, S., & Rowlands, A. (1997). Post-traumatic stress disorder. Journal of Accident & Emergency Medicine, 14, 387–391.
McCready, J. M., & Exner, D. V. (2003). Quality of life and psychological impact of implantable cardioverter defibrillators: Focus on randomized controlled trail data. Card Electrophysiol Rev, 7, 63–70.
Moss, A. J., et al., (Multicenter Automatic Defibrillator Implantation Trial Investigators). (1996). Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. New England Journal of Medicine, 335, 1933–1940.
Moss, A. J., Zereva, W., Jackson, W., Klien, H., Wilber, D. J., Cannom, D. S., et al. (2002). MADIT II clinical trial. New England Journal of Medicine, 346, 877–883.
Neel, M. (2000). Posttraumatic stress symptomatology in patients with automatic implantable cardoverter defibrillators: Nature and intervention. Int J Emerg Ment Health, 2(4), 259–263
Okun, A., Stein, R. E., Buaman, L. J., & Silver, E. J. (1996). Content validity of the Psychiatric Symptom Index, CES-depression Scale, and State-Trait Anxiety Inventory from the perspective of DSM-IV.Psychological Reports, 79(3 Pt 1), 1059–1069
Parkes, J., Bryant, J., & Milne, R. (2000). Implantable cardioverter defibrillators: Arrhythmias. A rapid and systematic review. Health Technology Assess, 4, 1–5.
Pauli, P., Wiedmann, G., Dengler, W., Blaumann-Beninghoff, G., & Kuhlkamp, V. (1999). Anxiety in patients with an automatic implantable cardioverter defibrillator: What differentiates them from panic patients? Psychosomatic Medicine, 61, 69–76.
Phillips Bute, B., Mathew, J., Blumenthal, J. A., Welsh-Bohmer, K., White, W. D. Mark, D., et al. (2003). Female gender is associated with impaired quality of life 1 year after coronary artery bypass surgery. Psychosomatic Medicine, 65(6), 944–951.
Prudente, L. A. (2003). Phantom shock in a patient with an implantable cardioverter defibrillator: Case report. American Journal of Critical Care, 12(2), 144–146.
Radloff, L. S. (1977). The CES-D Scale: A self-report depression scale for research in the general population. Applied Psychology Measurement, 1(3), 385–401.
Ritvo, R., Robinson, G., Irvine, F., Brown, L., Murphy, K. J., Stewart, D. S., et al. (1999). A longitudinal study of psychological adjustment to familial genetic risk assessment for ovarian cancer. Gynecologic Oncology, 74(3), 331–337.
Roberts, S. L., & White, B. S. (1990). Powerlessness and personal control model applied to the myocardial infarction patient. Progress in Cardiovascular Nursing, 5(3), 84–94.
Schuster, P. M., Philips, S., Dillon, D. L., & Tomich, P. L. (1998). The psychosocial and physiological experiences of patients with an implantable cardioverter defibrillator. Rehabilitation Nursing, 23, 30–37.
Shron, E. B., Exner, D. V., Yao, Q., Jenkins, L. S., Steinberg, J. S., Cook, J. R., et al. (2002). Quality of life in the antiarrhythmics versus implantable defibrillators trial: Impact of therapy and influence of adverse symptoms and defibrillator shocks. Circulation, 105, 589–594.
Smith, M. Y., Redd, W., DuHamel, K., Vickberg, S. J., & Ricketts, P. (1999). Validation of the PTSD Checklist-Civilian Version in survivors of bone marrow transplantation. J Trauma Stress, 12(3), 485–499.
Somervell, P. D., Beals, J., Kinzie, J. D., Boehnlein, J., Leung, P., Manson, S. M. (1993). Criterion validity of the Center for Epidemiologic Studies Depression Scale in a population sample from an American Indian village. Psychiatry Research, 47(3), 255–266.
Speilberger, C. (1983). State Trait Inventory for Adults. Redwood City, California, Review Set. Mind Garden.
Swygman, C. A., Link, M. S., Cliff, D. L., Foote, C. B., Munther, K. H., Wang, P. J., et al. (1998, May 6–9). Incidence of phantom shocks in patients with implantable cardioverter defibrillators. San Diego, California: Abstract presented at North American Society of Pacing and Electrophysiology.
The Antiarrhythmics versus Implantable Defibrillators (AVID) Investigators. (1997). Comparison of antiarrhythmic-drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias. New England Journal of Medicine, 337(22), 1576–1583.
Thomas, S. A., Friedman, E., & Kelley, F. (2001). Living with an implantable cardioverter-defibrilator: A review of the current literature related to psychosocial factors. AACN Clinical Issues, 12(1), 156–163.
Weathers, F. W., Huska, J. A., & Keane, T. M. (1991). The PTSD Checklist—Civilian Version (PCL–C) (Available from F. W. Weathers, National Center for PTSD, Boston Veterans Affairs Medical Center, 150 S. Huntington Avenue, Boston, MA 02130).
Weathers, F. W., Litz, B. T., Herman, D. S., Huska, J. A., & Keane, T. M. (1993). The PTSD Checklist (PCL): Reliability, validity, and diagnostic utility. Paper presented at the meeting of the International Society for Traumatic Stress Studies, San Antonio, Texas.
Author information
Authors and Affiliations
Corresponding author
Additional information
This publication was partially supported by Grant number K30-AT-00060 from the National Center for Complementary and Alternative Medicine (NCCAM). Its contents are solely the responsibility of the authors and do not necessarily represent the officicial views of the NCCAM or the National Institutes of Health.
Rights and permissions
About this article
Cite this article
Prudente, L.A., Reigle, J., Bourguignon, C. et al. Psychological indices and phantom shocks in patients with ICD. J Interv Card Electrophysiol 15, 185–190 (2006). https://doi.org/10.1007/s10840-006-9010-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10840-006-9010-z