A randomized controlled trial of cognitive behavior therapy tailored to psychological adaptation to an implantable cardioverter defibrillator.

OBJECTIVES: To evaluate a eight-session cognitive behavior therapy (CBT) intervention tailored to adaptation in implantable cardioverter defibrillator (ICD) patients; and to test for treatment group by gender interaction effects. METHODS: Patients receiving their first ICD implant were randomized to CBT or usual cardiac care. Primary outcomes measured at baseline, 6-month, and 12-month follow-ups were symptoms of anxiety and depression (Hospital Anxiety and Depression Scale), posttraumatic stress disorder symptoms (Impact of Events Scale-Revised), and phobic anxiety (Crown-Crisp Experiential Index). Secondary outcomes were quality of life (Short Form-36 Physical Component Summary and Short Form-36 Mental Component Summary) and ICD shocks or antitachycardia pacing therapies. RESULTS: Of 292 eligible patients, 193 consented and were randomized to CBT (n = 96) or usual cardiac care (n = 97). Eighty percent were male; mean age was 64.4 years (standard deviation = 14.3); and 70% received an ICD for secondary prevention. No baseline differences were observed between the treatment conditions; however, women scored worse than men on all psychological and quality of life variables (p < .05). Eighty-three percent completed follow-up. Repeated-measures analyses of covariance revealed significantly greater improvement with CBT on posttraumatic stress disorder total and avoidance symptoms for men and women combined (p < .05) and significantly greater improvement in depressive symptoms and Short Form-36 Mental Component Summary only in women (p < .01). No differences were observed between treatment conditions on ICD therapies over follow-up. CONCLUSION: A CBT intervention to assist adaptation to an ICD enhanced psychological functioning over the first year post implant.

Predicting response of ADHD symptoms to methylphenidate treatment based on comorbid anxiety.

OBJECTIVE: In this small pilot study, the association of comorbid anxiety with the treatment of ADHD is studied. METHODS: Eighteen volunteers from a pediatric clinic are tested for ADHD and anxiety and assessed for behavioral and cognitive ADHD symptomology. Response to methylphenidate as treatment for ADHD symptoms is measured 2 to 3 weeks, and again 4 to 6 weeks following the diagnosis of ADHD. RESULTS: Methylphenidate proves effective for treating ADHD symptoms (both behavioral and cognitive). Participants are categorized into two groups, those with ADHD and comorbid anxiety and those with ADHD alone. Behaviorally, no statistically significant differences are seen in response between the two groups; however; cognitively, the non-anxious group improves significantly more than the anxious group. CONCLUSION: Although anxiety may not affect behavioral response to stimulant medication in ADHD, it does appear to affect the medication response of more subtle symptoms of cognitive performance in ADHD patients.