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[Psychological status of patients with implantable cardioverter-defibrillators].

BACKGROUND
We assessed the psychological status of 20 patients (19 male, 1 female; mean age 61 +/- 9.3) with implantable cardioverter-defibrillator (ICD). Each patient underwent the Cognitive Behavioral Assessment adapted for Hospital use (CBA-H), and completed an ad hoc 20 item questionnaire designed to measure patients' perceptions of their health.


METHODS
Psychological variables were treated as dependent variables and cardiac variables were considered independent variables in the one-way analysis of variance; when psychological and cardiac variables were discrete variables, Chi-square was used; correlations were performed by rank Spearman test.


RESULTS
Indicated maladaptive behaviours in on 35% of the sample. Patients with pre-ICD Ventricular Fibrillation (VF) or Sustained Ventricular Tachycardia (SVT) and VF were the most psycho-physically distressed (p < .02). These were also the patients who reported feeling most stressed in the last three months (p < .03). I-E causal attribution is a psychological dimension related to the way of codify an event; I = internal means that subject attributes to itself the cause of what happens; E = external means that subject attributes to others, fate and environment what happens. The treatment received and the I-E causal attribution were found to correlate: Internal in patients who underwent both pacing and shock treatment (who were also those with the highest number of recurrent VT/VF episodes), External in patients who underwent one treatment or none (F3, 16 = 3.28; p < .04; I-E mean = 1 +/- .63 in pacing/shock treatment group; I-E mean = 2.5 +/- .57 in shock treatment group; I-E mean = 1.8 +/- .5 in pacing treatment group; I-E mean = 2 +/- .1 in no treatment group. The time since implantation (5-9, 10-18, 19-32 months) seemed to have an important effect, even if it reached statistical significance in only two areas, namely: family relationships which were better in patients who had the ICD for > 9 months, and adjustment to the physical condition, which was better in patients who had the ICD for 10-18 months.


CONCLUSION
In the present study most of the patients with ICD proved to be fairly well-adjusted to their physical condition. The preimplantation cardiac condition, the treatment received, the number of recurrent VT/VF episodes, and the length of follow-up turned out to be the variables which most influenced the psychological status of patients with ICD.