Anger and anxiety in patients with primary aldosteronism treated with amiloride hydrochloride or spironolactone or adrenalectomy

Armstrong, Robin Sherill (2007) Anger and anxiety in patients with primary aldosteronism treated with amiloride hydrochloride or spironolactone or adrenalectomy. Masters by Research thesis, Queensland University of Technology.


In Primary Aldosteronism (PAL) excessive amounts of aldosterone cause sodium and water retention and, in many individuals, this leads to moderate to severely high blood pressure. Although the chemistry and physiology are increasingly well understood, including the outcomes of treatment on physical health, there has been no systematic study of the psychological dimension of PAL. Anecdotally, patients exhibit symptoms such as angry outbursts, irritability, anxiety and defensiveness, and partners of these patients sometimes mention poor anger control and brittle or unpredictable moods. This thesis reports a systematic study of anger and anxiety among patients undergoing treatment for PAL. Eighty-three patients were recruited over an 11-month period to a prospective, pre-post design study to determine if treatment was associated with change in psychological state. Participants completed the State-Trait Anger Expression Inventory (STAXI-2), State-Trait Anxiety Inventory (STAI) and Psychosocial Adjustment to Illness Scale (PAIS) questionnaires. Adrenal Vein Sampling confirmed overproduction of aldosterone in one or both adrenal glands. Patients with Aldosterone Producing Adenoma (APA) were offered adrenalectomy. As per usual treatment protocols, patients with Bilateral Adrenal Hyperplasia (BAH) were prescribed spironolactone or amiloride depending predominantly on severity of blood pressure and potassium levels. Post-test questionnaires were completed after 6-8 months. Analysis was by mixed design (between-within subjects) ANOVA. Participant numbers in the adrenalectomy group fell far short of expectations. Fourteen past patients who had undergone unilateral adrenalectomy completed a retrospective semi-structured questionnaire. This qualitative data was analysed to identify themes similar to quantitative data. At baseline, 'non-completers' (ie those who did not complete the post-test; n=19), were significantly more angry than 'completers' (n=50) in State Anger (p< .01), Trait Anger (p< .05) and Anger Expression Index (p< .001). Trait Anxiety was also higher (p< .05), as was Psychological Distress (p< .05). Among those who participated at both interviews, there was small but statistically significant adverse treatment effect with higher scores for State Anger (p< .05), and Feeling Angry (p< .05). However for Trait Anger (p< .01), and 2 of its 3 sub-scales Angry Temperament (p< .05) and Angry Reaction (p< .01) there was a slight to moderate decrease in negative affect with treatment. Psychological Distress scores also improved (p< .05). Across all ANOVAs, there were no significant interaction effects, suggesting that any treatment effect was equivalent for the two drugs. Qualitatively collected data elucidated participants' changes in approach to life and relationships since adrenalectomy. Themes that emerged in the data included improved ability to cope with external stress, better control of emotions, more relaxed relationships and attitude to work, and a greater vitality and quality of life. Generally the comments were consistent with the drug treatments; there was noticeable benefit, including perceived better anger control and less anxiety. Positive psychological effects of treatment observed in the two drug groups were triangulated with data from a qualitative study. The combined evidence suggests that when excess circulating aldosterone is reduced (adrenalectomy), or blocked (spironolactone), or aldosterone's salt and water retaining effects are minimised (amiloride), then nervous irritability and its subsequent psycho-behavioural manifestations are reduced. The effect however is slight and the conclusions are weakened by an apparent attrition bias, and the absence of a control group. Implications for further research are discussed.

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ID Code: 16375
Item Type: QUT Thesis (Masters by Research)
Supervisor: Dunne, Michael & Young, Ross
Keywords: primary aldosteronism, amiloride hydrochloride, spironolactone, adrenalectomy, STAXI-2, state-trait anger expression inventory
Divisions: Current > QUT Faculties and Divisions > Faculty of Health
Department: Faculty of Health
Institution: Queensland University of Technology
Copyright Owner: Copyright Robin Sherill Armstrong
Deposited On: 03 Dec 2008 04:02
Last Modified: 21 Jun 2017 14:41

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