Management of anxiety and patient distress

Transcription

1 Braunschweig F et al. Europace Dec;12(12): Management of anxiety and patient distress Christoph Herrmann-Lingen Dept. of Psychosomatic Medicine and Psychotherapy Zentrum Psychosoziale Medizin

2 Conflicts of interest Received lecture honoraria from Medtronic, Berlin-Chemie, Pfizer, Servier Received royalties from Hans Huber Publishers for German version of the Hospital Anxiety and Depression Scale

3 Distress by number of ICD shocks (Herrmann C et al., PACE 20, 1997:95-103) 60 % psych. distress p<0, shocks 5-9 shocks >= 10 shocks

4 The continuum of ICD shocks, coping, and patient distress Braunschweig F et al. Europace Dec;12(12):

5 Shock-distress interactions Braunschweig F et al. Europace Dec;12(12):

6 Effects of anxiety and depression on QoL before ICD implantation (GAIMS; Herrmann-Lingen C et al., Psychother Psych Med 2004 ) no distress distress Global QoL Vitality Social support Cardiac symptoms Neg. body image -0,8-0,6-0,4-0,2 0 0,2 0,4 0,6 0,8 Z values

7 GAIMS: Quality of life 1 y. post-implant by pre-implant distress & shock frequency no distress, <3 shocks distress, <3 shocks no distress., >=3 shocks distress, >=3 shocks Independent effects: Baseline QoL: p<.0005; shock frequency: p=.002 Baseline distress: p=.012: distress*shock: p=.036

8 RMSSD by anxiety and depression in ICD patients Francis JL et al. Psychosom Med 2009;71:

9 Incidence of adequate ICD shocks by depression Whang W et al. JACC 2005; 45:1090-5

10 Mortality by Type D personality in ICD patients Pedersen SS et al., Europace 2010; doi: /europace/euq296

11 Mortality by severity of posttraumatic symptoms in ICD patients Ladwig KH et al., Arch Gen Psychiatry 2008; 65:

12 Measures for preventing and detecting anxiety and depression Reduce shock rates. Support patients coping resources. Identify psychological symptoms and maladaptive personality traits or coping strategies as early as possible, preferably before ICD implantation. Systematically ask for symptoms of distress and / or use validated self-report measures. Braunschweig F et al. Europace Dec;12(12):

13 Recommended self-rating scales for assessing psychological risk in ICD patients Braunschweig F et al. Europace Dec;12(12):

14 Assessing psychological reactions in the acute setting Ask patients for shock perception and interpretation. Ask for feelings of anxiety, helplessness, or panic. Ask for sources of support in family, friendship, and medical system. In case of relevant distress, offer basic interventions to stabilize the patient Patients who feel traumatized by the shock urgently need physical and emotional security to prevent severe posttraumatic stress disorders. Braunschweig F et al. Europace Dec;12(12):

15 Basic interventions to relieve acute distress Provide reassurance by empathetic listening, correction of misbeliefs about the shock and/or arrhythmia, or help with calling friends or relatives for emotional support. Benzodiazepines may be used for reducing acute anxiety in the acute phase. If needed, consult with a mental health expert (Psychosomatic Medicine, Psychology, or Psychiatry). Braunschweig F et al. Europace Dec;12(12):

16 Ten practice tips for preventing and reducing shock-induced distress I General measures 1. Establish trustful relationship with patients and partners 2. Establish trustful relationship with mental health expert inside or outside the team 3. Listen to patients and leave room for questions and emotions Braunschweig F et al. Europace Dec;12(12):

17 Ten practice tips for preventing and reducing shock-induced distress II Preventive measures 4. Provide information and answer patients questions about the ICD and related topics before and after implantation. Explain that the ICD may save the patient s life but emphasize that it does not cure heart disease 5. Discuss participation in comprehensive rehabilitation and encourage regular exercise adapted to individual preference and physical capacity Braunschweig F et al. Europace Dec;12(12):

18 Ten practice tips for preventing and reducing shock-induced distress III Assessment and basic treatments 6. Regularly explore beliefs, health resources, and distress in person or via telephone calls 7. Offer quick help if shocks and/or distress occur 8. Ask for subjective effects of shock and encourage resumption of activities as soon as possible 9. Explore patient needs for more information and support 10. Provide reassurance and referral to a mental health expert, structured psychosocial intervention, and/or support group as appropriate Braunschweig F et al. Europace Dec;12(12):

19 Specialised interventions Structured telephone follow-up Educational (eg, Dougherty et al. 2005, Dunbar et al. 2010) cognitive-behavioural (eg, Crössmann et al. 2010; Irvine et al. 2011) Face-to-face cognitive-behavioural therapy and other forms of face-to-face education / psychotherapy (eg, Kohn et al. 2000, Chevalier et al. 2006, Sears et al. 2007, Vazquez et al. 2010, Donahue et al. 2010) Guided self-help programmes (eg, Lewin et al. 2009) Web-based psychosocial interventions (eg, Pedersen et al. 2009)

20 Effects of psychotherapy on ICD recipients well-being Kohn CS et al., PACE 2000;23(Pt. I): p<0.05 p< Psychotherapy Control group no shock >=1 shock no shock >=1 shock Anxiety Distress

21 Additional sources of support Self-help groups Exercise Antidepressant medication Multimodal rehabilitation programmes In-patient psycho-cardiology treatment (Herrmann-Lingen 2011)

22 Psychokardiologische Station 2024 im Herzzentrum Göttingen

23 Psychokardiologische Station 2024 im Herzzentrum Göttingen

24 Summary Anxiety and distress = frequent concomitants of heart disease, arrhythmias and ICD shocks Adverse effects on QoL and prognosis Systematic assessment and basic support needed Specialised treatments effective for prevention and amelioration of ICD-related distress