A Study on Behavior Pattern of Patients with Coronary Heart Diseases : Application of JAS(Report I)

Abstract

The author attempted to investigate the behavior pattern of patients with coronary heat disease (CHD) by Jenkins Activity Survey (JAS) which was translated into Japanese by the Department of Psychosomatic Medicine of Tohoku University.JAS is one of the most useful tests for specific behavior pattern determination in Western countries.To study the Japanese coronary-prone behavior pattern, JAS may be useful also to compare the Japanese behavior pattern with that of Westerners and to characterize the Japanese Type A behavior pattern.One hundred and eighty patients with the new onset of CHD(144 cases of acute myocardial infarction and 36 unstable angina pectoris) were analysed.The results were as follows.1) Type A scale and Factor H(Hard-driving and Competitive) scale showed significantly higher levels in CHD patients than in controls. In CHD patients, 63.3% were found to have Type A behavior pattern.In CHD patients, these were no significant differences of indicence of Type A behavior pattern between acute myocardial infarction and angina pectoris, under the age 59 and above the age 60.In regard to occupational positions, Type A behavior pattern appeared to be more closely related to the administrative class rather than to the non-administrative class.Incidences of hypertension, hypercholesterolemia and cigarette-smoking which were considered as traditional coronary risk factors in CHD patients did not seem to be related to behavior patterns.2) In comparison with the Western Collaborative Group Study (WCGS) report and the Belgian study, the mean Type A score and mean Factor H score in my study showed lower scores, particularly the latter showing markedly lower levels in the author's CHD patients.However, in the author's CHD patients, the mean Factor H score of administrative classes showed higher levels than that in WCGS report.So it was supposed that in Japan Type A scores and Factor H scores were closely related to the occupational positions.3) Cornell Medical Index (CMI) is widely used for determination of neurotic tendencies of patients in Japan. Many Type A patients belonged to the categories III or IV of CMI.According to the CMI criteria, the category III is diagnosed as probably neurotic and the category IV as neurotic.The reson why many Type A patients belong to CMI neurotic categories is that Type A patients get angry more easily and more sensitive than non-type A patients.Therefore, in case of CHD patients, it is necessary to analyse CMI results carefully from the standpoints of both neurotic tendency and behavior pattern.In conclusion, JAS can be considered useful for determining behavior patterns of CHD patients in Japan also.