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Psychosocial intervention for a geriatric patient to address fears related to implantable cardioverter defibrillator discharges.

Received July 14, 2003; accepted Aug. 14, 2003. From Stanford University School of Medicine, Palo Alto, Calif; and the Department of Clinical and Health Psychology and the Division of Cardiovascular Medicine, University of Florida, Gainesville. Address reprint requests to Dr. Urizar, Stanford Prevention Research Center, Stanford University School of Medicine, Hoover Pavilion, 211 Quarry Rd., Stanford, CA 94305-5705; urizar@stanford.edu (e-mail). Copyright 2004 The Academy of Psychosomatic Medicine. The efficacy of the implantable cardioverter defibrillator (ICD) in preventing sudden cardiac death is well described in the cardiovascular medicine literature. Nonetheless, ICD patients and their families must cope with the challenges of recovering from and adjusting to life after ICD implantation. ICD-specific fears and symptoms of both anxiety and depression are quite common and appear to be more prevalent in ICD patients who experience a high frequency of defibrillator discharges. These psychological sequelae may be due to patients’ misconceptions about the causes of dysrhythmia and ICD discharges, as well as perceived loss of control in daily functioning. For many patients, these misconceptions can lead to avoidance behaviors for fear of triggering an ICD discharge. As is found with young ICD recipients, 4 older ICD patients share common fears and concerns that include fear of unpredictable ICD discharge, device malfunction, and death. Given the psychological sequelae experienced by some ICD recipients, cognitive behavior stress management interventions have been suggested as one treatment modality to aid in the management of ICD-specific fears, concerns, and psychosocial challenges. However, few studies have examined the efficacy of such interventions for ICD recipients experiencing distress and poor adjustment, especially for older ICD recipients (age 65 years and older). The following case presentation highlights the efficacy of an ICD-tailored psychosocial intervention in facilitating adjustment and addressing specific fears and concerns related to the ICD in an older patient. Case Report