PMC3878030_01
Time course of psychiatric symptom rating for case 1 during 1 year follow up. BDI, Beck depression Inventory; BAI, Beck Anxiety Inventory; PDSS, panic Disorder Severity Scale; PCL, PTSD Check list; SCS, Shock Catastrophizing Scale; FSAS, Florida Shock Anxiety Scale. Note the increase in reported PTSD symptoms (via PCL civilian) at 1-year anniversary of worst shock episode, accompained by a moderate score on the Florida Shock Anxiety Scale (typical mean for ICD patient = 15.2, standard deviation = 6.5; from Ford et al.,).
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F1
BCSD revealed an unchanged level of general anxiety (via BAI) and slightly decreased intensity of panic (via PDSS) (Figure 1). Based on these continued symptoms, he was referred for cognitive behavioral therapy (CBT) with a PhD psychologist specializing in treatment of PTSD. Quantitative review of his symptoms now demonstrated a nearly 50% drop in general anxiety down to a 'mild' level (via BAI), a continued decrease in panic severity (via PDSS), and a small but clinically insignificant decrease in depression (via BDI; Figure 1). ICD events were detected. In reviewing his progress, he spontaneously noted, "all in all, I have improved significantly from last fall and I can see a day when I will return to my prior self." Quantitative review of his symptoms now demonstrated a nearly 50% drop in general anxiety (via BAI) and a continued decrease in panic severity (via PDSS), with a small but clinically insignificant increase in depression (via BDI; Figure 1). 1 year after undergoing BCSD the patient's anxiety, panic and depression symptoms remained markedly attenuated, and in non-clinical ranges (Figure 1). So logic leads me to thinking that if the procedure lowers my heart rate then why would I increase it purposefully." Exactly 1 year after his worst shock episode, these preoccupations were reflected by moderately elevated scores on the SCS and FSAS, and clinically significant scoring on the PCL (Figure 1).
Time course of Beck Anxiety Inventory somatic, cognitive and interceptive symptoms in Case 1.
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F2
Subscale examination of the patient's anxiety revealed several notable patterns (Figure 2, Table 2).
Time Course of greatest reductions in Beck anxiety symptoms following BCSD in Case 1. Palpitations and dizziness were the largest reductions reported after BCSD. The largest magnitude reduction overall was feeling scared, which had fully decreased by 3 months, after the patient had begun Cognitive Behavioral Therapy. Scale: 0 = "Not at all." 1 = "Mildly, but it didn't bother me that much." 2 = "Moderately:it wasn't pleasant at times." 3 = "Severely:it bothered me a lot." Note: ratings for dizzy/lightheaded and faint/lightheaded were identical and overlapping.
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F3
Despite these increases, the patient reported decreases in feeling bothered by dizziness and lightheadedness, and a reduction in feeling bothered by the experience of his heart pounding and racing (Figure 3). In the case of heartbeat sensations, at 1 year the patient reported a complete cessation of symptoms (Figure 3).
PMC3878030_02
PMC3878030_03
Time Course of Psychiatric symptom ratings for Case 2 during 1 month follow up.
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F4
Evaluation of the patient's symptom scores at 1 month post-BCSD revealed clinically significant decreases in depression (via BDI), anxiety (via BAI) and shock catastrophizing (via SCS) (Figure 4).
Mean changes in systolic blood pressure from baseline during autonomic challenge before and after bilateral cardiac sympathetic decentralization (BCSD) in Case 2.
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F5
Figures 5-7 show changes in each measure from the resting baseline value pre- and post-BCSD.
Mean changes in diastolic blood pressure from baseline during autonomic challenge before and after bilateral cardiac sympathetic decentralization (BCSD) in Case 2.
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F6
Figures 5-7 show changes in each measure from the resting baseline value pre- and post-BCSD.
Mean changes in skin conductance level from baseline during autonomic challenge before and after bilateral cardiac sympathetic decentralization (BSCD) in case 2. muS, microsiemens.
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F7
Figures 5-7 show changes in each measure from the resting baseline value pre- and post-BCSD. Comparing pre- vs. post-BCSD, the patient demonstrated prominent declines in baseline adjusted SCL for all tasks (Figure 7).