Evaluación de patrones de personalidad, estrés y síntomas psicopatológicos en pacientes portadores de un Desfibrilador Automático Implantable (DAI)

Abstract

The aims of this Thesis have been to review and study the presence of the psychological variables related to psychological adjustment in patients with Implantable Cardioverter Defibrillator (ICD), based on the reason of its implantation, whether primary or secondary, and according to gender. The specific purposes are: - Adaptation and validation of Type D Personality Scale (SD-14) to Spanish population. - Analyzing the differences in psychological adjustment, fear of discharges and subjective degree of discomfort associated with the illness based on the reason of implantation. - Assessing the presence and impact of Negative Affectivity (NA), Type A Personality Pattern (TACP), stressful life events, as well as to establish relationships between personality patterns, stress and anger. - Designing a Psychological Intervention Program to increase and improve patients' psychological well-being. Once the project had been presented to the Arrixaca Hospital's Ethics Committee, in collaboration with its Arrhythmia Unit, it was evaluated between February 2015 and May 2017 by means of individual semi-structured interviews to patients with a ICD that, on a voluntary basis, wanted to take part in the survey. The instruments used in the psychological evaluation were: Type D Personality Scale (DS-14), Framingham Type A Scale (FTAS), Assessment Stress Scale, General Stress Scale (GSA-G), State-Trait Anger Expression Inventory (STAXI) and sociodemographic and health questionnaire. It has been found that the prevalence of Type D Personality in community population was 29.7%, it therefore could be concluded that 3 out of 10 participants were classified with Type D Personality. With respect to psychopathological symptoms, it has been discovered that 43.9% of patients with ICD, regardless of the reason for its implementation, suffered sleep disturbance and 28% reached very high scores on the Somatization Scale. In terms of psychological adjustment based on the cause of prevention, patients with a primary implementation showed higher scores scales on the Somatization, Psychoreactivity, Obssession-Convulsion, Anxiety and Psychoathological Risk Index. The rate of 25% of these patients demonstrated a moderated or intense subjective level of disease discomfort compared to 14.7% amongst all secondary implementation patients. In relation to the fear of suffering shocks, a larger proportion within the secondary prevention group was found, almost 30% of the participants, being the ones who have experienced or suffered more shocks (63.2%). 40% of the patients in this study obtained high ratings in NA, being a typical feature of Type D Personality and this ratings becoming higher in women than in men. Concerning TABP, the ratings were similar in both men and women. With respect to stress intensity evaluation, women shown significantly higher scores than men. A differential pattern was found between men and women regarding the relationships between variables. In women, External Anger Control is significantly related to the rest of the variables considered. In men, it is the Internal Expression of Anger that presented a greater association with the rest of the variables, which means that male patients with ICD are experiencing feelings of anger. In the light of the above, the focus of the proposed Cardiac Rehabilitation Program is on the necessity of a comprehensive care for these patients after the implantation, with the ultimate aim of reducing the emotional impact of the disease, enabling the emotional expression and management.