Cognitive–Behavioral Treatment of Panic Disorder With Agoraphobia Triggered by AICD Implant Activity

Smith, Langan S.; Fogel, Dov; Friedman, Steven

doi:10.1016/s0033-3182(98)71311-8

Cited by 17 publications

(25 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Moderate to severe panic disorder, agoraphobia, and other anxiety disorders have been documented in patients with no pre-existing and only mild psychiatric illness. [31][32][33][34] Family members may also experience significant distress from watching their loved one being shocked so close to death. 16 It may be more personally acceptable to some providers to discontinue therapies that can cause physical or psychological distress, such as an AICD, or have an ongoing physical burden associated with them, such as a left ventricular assist device (LVAD).…”

Section: The Concept Of Burdenmentioning

confidence: 99%

Is Pacemaker Deactivation at the End of Life Unique?: A Case Study and Ethical Analysis

Whitlock

Goldberg²,

Singh

2011

Journal of Palliative Medicine

View full text Add to dashboard Cite

Although there has been considerable controversy regarding the deactivation of pacemakers near the end of life, clinicians can expect to face more requests for pacemaker withdrawal as the number of implants grows. Despite a clear ethical and legal precedent, these requests may elicit significant psychological and moral distress on the part of the clinical team. We illustrate some of the difficulties clinicians may face by describing the case of a patient with end-stage heart failure who asked to have her pacemaker turned off near the end of life. We discuss the challenges in determining pacemaker dependency, differing attitudes toward deactivating pacemakers versus other cardiac devices, and how the issues of perceived burden and timing of death may contribute to a clinician's sense of moral distress.

show abstract

Section: The Concept Of Burdenmentioning

confidence: 99%

Is Pacemaker Deactivation at the End of Life Unique?: A Case Study and Ethical Analysis

Whitlock

Goldberg²,

Singh

2011

Journal of Palliative Medicine

View full text Add to dashboard Cite

show abstract

“…Behavioral maladjustment (significant agoraphobia) was negatively reinforced by shock-focused anxiety and avoidance of perceived triggers. A cognitive-behavioral treatment plan (see Table 3) was primarily designed to follow cognitive-behavioral models of panic (Barlow et al, 2000;Clark, 1986;Smith et al, 1998) and nonischemic chest pain (Salkovskis, 1992), with additional elements to target depressive symptoms (Beck, Rush, Shaw, & Emery, 1979). Given that phobic responding was the most prominent and functionally impairing set of behaviors as considered by both the patient and therapist alike, treatment was initially focused on anxiety/agoraphobia as the primary or core clinical issue from which the others were secondary.…”

Section: Case Conceptualizationmentioning

confidence: 99%

“…Pharmacotherapeutic assistance would have reduced the patient's arousal sufficiently such that adherence to the behavioral assignments (i.e., approach) was within the patient's tolerances and behavioral repertoire and were a part of the successful report of Smith et al (1998). This is a situation in which symptom-focused use of a benzodiazapine could be an effective adjunct to cognitive-behavioral therapy.…”

Section: Complicating Factorsmentioning

confidence: 99%

Fearful Appraisals and Behavioral Responses of a Patient with an Implantable Cardioverter Defibrillator

Janeck

Deaner²

2004

Clinical Case Studies

View full text Add to dashboard Cite

The implantable cardioverter defibrillator (ICD) is an effective treatment device for potentially malignant arrhythmias, including those leading to sudden cardiac death. However, some patients develop a variety of adjustment problems to the ICD. Clinical behavioral scientists have conceptualized ICD adjustment problems using principles of classical conditioning (i.e., cardiophobia), the learned helplessness paradigm of depression, and cognitive-behavioral models of panic. This case study likens ICD adjustment problems to a cognitive-behavioral model of panic and chest pain illustrating the limits of these models in terms of how Type I/Type II threat appraisal by the patient serves as a significant barrier to full symptom resolution. This case study supports the need for modifications in such models and related interventions as they relate to the presence of real comorbid risk factors.

show abstract

“…Ost [Ost und Westling, 1995] konnten in ihrer Untersuchung in bezug auf beide Therapien eine deutliche Wirksamkeit zeigen. Smith [Smith et al, 1998] berichtete in einer Kasuistik von einer 36jährigen Patientin, bei der es bald nach Implantation eines Defibrillators zu mehreren lebensrettenden Defibrillationen gekommen war. 6 Monate nach Implantation des Defibrillators wurde bei der Patientin eine Panikstörung mit Agoraphobie diagnostiziert.…”

Section: Introductionunclassified

“…In der folgenden Falldarstellung geht es um die verhaltensmedizinische Behandlung einer Patientin mit einer Panikstörung mit Agoraphobie bei bestehender maligner Tachyarrhythmie mit Schrittmacher-und Defibrillatorimplantation. Im Gegensatz zu der Falldarstellung von Smith [Smith et al, 1998] …”

Section: Introductionunclassified

Maligne Tachyarrhythmie, Schrittmacher- und Defibrillatorimplantation und Panikstörung mit Agoraphobie

Bankier¹,

Bach²,

Guiterrez³

et al. 1999

Verhaltenstherapie

View full text Add to dashboard Cite

A 35-year-old female patient was admitted two times to the Behavior Medicine ward of the Department of Psychiatry, Division of Social Psychiatry, of the University of Vienna, Austria, for panic disorder with severe agoraphobia. Tachyarrhythmias have been diagnosed in the patient at the age of 3. Because of the cardiac disease, a pacemaker and a defibrillator were implanted. The first panic attack occurred at the age of 33 and could clearly be distinguished by the patient from occurring tachyarrhythmias. During the first inpatient treatment, the patient underwent a cognitive-behavioral therapy including single and group therapy sessions, exposure in sensu and in vivo as well as applied relaxation. After discharge, the patient re-experienced panic attacks and numerous life-saving defibrillations, leading to a second admission. Again, she was treated with cognitive therapy including single and group therapy sessions, exposure therapy, and applied relaxation in addition to an SSRI medication. A follow-up 5 month after discharge showed that the therapy was successful in eliminating the panic disorder with agoraphobia. During this time no defibrillations occurred.

show abstract

Cognitive–Behavioral Treatment of Panic Disorder With Agoraphobia Triggered by AICD Implant Activity

Cited by 17 publications

References 10 publications

Is Pacemaker Deactivation at the End of Life Unique?: A Case Study and Ethical Analysis

Is Pacemaker Deactivation at the End of Life Unique?: A Case Study and Ethical Analysis

Fearful Appraisals and Behavioral Responses of a Patient with an Implantable Cardioverter Defibrillator

Maligne Tachyarrhythmie, Schrittmacher- und Defibrillatorimplantation und Panikstörung mit Agoraphobie

Contact Info

Product

Resources

About