虚血性心疾患患者の行動パターン : JAS (Jenkins Activity Survey)による検討(第3報), 心筋梗塞急性期における心理反応と行動パターン

Many patients with acute myocardial infarction (AMI) demonstrate various psychic reactions in the early stage of illness. Author attempted to investigate the relationship between psychic reactions of inpatients with AMI at the early stage of illness and their previous behavior patterns. One hundred and seventy inpatients with AMI were observed, who were all treated in a coronary care unit or cardiovascular wards. Psychic reactions were classified into the following 4 grades. Grade I and II diagnosed as normal psychological and borderline reactions to AMI. Grade III and IV diagnosed abnormal psychological reactions. Behavior pattern was assessed by Jenkins Activity Survey (JAS) which was translated into Japanese by the Department of Psychosomatic Medicine of Tohoku University. The results were as follows. 1) In all patients, 67.1% were found to have type A behavior pattern. According to a classification of psychic reactions, in type A behavior pattern group, grade I was found in 29.8%, II in 42.2%, III in 25.4% and IV in 2.6%. In the type A group, patients with grade I were statistically significantly less and patients with grade III were significantly more than in the type non-A group. 2) According to Killip's diagnostic criteria in all patients, grade 1 was found in 50.0%, 2 in 31.8%, 3 in 15.3% and 4 in 2.9%. On these distribution of severity no significant difference was found between type A and type non-A groups. However in the type A group, patients with Killip 3+4 showed higher incidence of psychic reaction grade III+IV than patients with Killip 1+2 (61.9% vs 20.4%), and in the type non-A group, non difference was found in incidence of abnormal psychic reaction between patients with Killip 1+2 and 3+4. 3) Many types of arrhythmias who required medical treatments were found in 32.9% of all patients. No difference in incidence of arrhythmias was found between type A and type non-A groups. But in the type A group, patients with arrhythmia showed higher incidence of psychic reaction grade III+IV than patients without arrhythmia (40.5% vs 22.1%). On the other hand, in the type non-A group, no difference was found in incidence of abnormal psychic reaction between patients with and without arrhythmia. Concerning these results, reasonable explanation may be that compared with type non-A patients, type A patients have psychic and physical hypersensitivity and so they are more easily stimulated by and provoked to various psychic reactions while they suffer themselves from stressfull experiences caused by an AMI onset and admission to hospital.