| Objective The study was designed to understand the rate of psychological disturbances in patients with implantable cardioverter defibrillator(ICD) retrospectively,to explore the etiological factor and psychopathogenesis and to evaluate the therapeutic effect of standard educational interventions program and comprehensive therapy likewise called "combination therapy".Method The study enrolled 88 patients(78 male,10 female,mean age of 60.8 years),who accepted the implantation of ICD/CRT-D in The First Affiliated Hospital of Kunming Medical College during 1998～december 2007 and receive a medical or physical examination in our hospital after implanted in other hospitals.All patients were assessed by life event scale of china(LES),maladaptation self-rating scale,defense style questionnaire(DSQ),symptom checklist 90(SCL-90),social support rating scale(SSRS),avoidance behaviors of ICD,Hamilton depression rating scale for depression(HRSD)and Hamilton anxiety scale(HAMA),and then a part of post-graduates(81 persons)in the Kunming medical college selected as the control group(heath persons)were appraised in the such ways.Both of results were compared after data were collected.ICD recipients were randomly divided into two groups from august 2006 to October 2007.The one received a set of experimental educational interventions about health and the other received a series of comprehensive educational interventions related to ICD.Psychological assessment of all operation-patients were executed before 1 week and 1 week,1 month,3 months,6 months,9months after implantation.Among all patients except operation-patients without shock in the former study,patients who suffered with psychological disturbances accepted a comprehensive therapy likewise called "combination therapy" and psychological assessment of such patients were carried out 1 week,2weeks,4weeks,6weeks and 10weeks after treatment;Severity of illness(SI)and global improvement(GI)were thought as index suggesting severity of diseases and therapeutic effect at the same time.Out-patient clinical examination,in-patient observation,care by telephone and drop-in investigation were adopted in the Follow-up period.Observation,questionnaire and semi-structured interview were employed in the progress of psychological assessment.Result 86 patients were enrolled and 292 cases were eligible in the study due to two male death(death causes were unknown).The research indicated that the mental health was poor in ICD patients and 42%of patients suffered psychological disturbances,the most frequent problems of which included anxiety(containing panic attack and generalized anxiety),sleep disorder,adjustment disorder and depression, which is obviously statistical significance compared with the heath crowds(P＜0.01).The study found that somatization,anxiety and photic anxiety could reasonably predict the psychological status when SCL-90 was considered as a predictor stating whether the mental heath is well or not;that anxiety/somatization,hopelessness,sleep disturbances,retardation and congnitive disturbance was believed as predictors for depression when the depression standard was HARD;and that somatic anxiety and psychic anxiety were equally meaningful predictors when HAMA was adopted to demonstrate existence of anxiety.SCL-90,HAMA and HRSD were applied for appraisal indexes in the control research about operation-patients,the severity of mental disorder in patients receiving the experimental educational intervention was far more than that in patients receiving the comprehensive educational intervention and rehabilitation time of the former was apparently longer than that of the latter statistically(P＜0.05);the mental disorder attacked ahead of time and the severity of illness reduced in the standard intervention group,compared to the results of the simple intervention group;the psychological disturbances of ICD patients might gradually vanished with time in both groups.In the therapeutic effect concerning the comprehensive therapy pilot study,SCL-90,maladaptation self-rating scale,HAMA,HRSD,SI and GI were deemed indexes of therapeutic effect,which were measured before and 1 week,2 weeks,4 weeks,6 weeks,10 weeks after treatment. The study concluded that the treatment strategies could substantially improve the severity of psychological disturbances,which was statistical significance(P＜0.05), and discovered that the therapeutic effect emerged after the second week.The psychopathogenesis of psychological disturbances might be explained altogether by the classical conditioning theory,the learned helplessness theory and the cognitive appraisal theory,according to the research achievements we gained and the outcomes a handful studies found.Conclusion 1.The attack rate of psychological disturbances exceeds that of the heath crowds and the phenomenon is easily ignored in the long run.2.The symptoms of psychological disturbances may gradually vanish with time,the process of which is described as the mountain.3.The retrospective study finds that the high-risk predictors for psychological disturbances in ICD recipients are ICD shock and mental defense mechanism.4.The classical conditioning theory,the learned helplessness theory and the cognitive appraisal theory have been altogether invoked to conceptualize these psychological disturbances in ICD patients.5.The standard educational intervention may utmost reduce incidence of psychological disturbances, relieve the severity of psychological disturbances in ICD recipients and quickly regain the normal life after implantation.6.The comprehensive therapy also called "combination therapy" may significantly relieve the symptoms of psychological disturbances in patients with ICD,which achieves the optimal therapeutic effect and produces a marked effect in the second week.7.The study implies that it is vital that patients attend the routine psychological assessment and psychological consultation, in order to detect and treat psychological disturbances of ICD patients in the early stage,which contributes to the primary or secondary prevention.
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