The authors review the forces that encouraged the entry of psychiatry into the general hospital in the 1930s. Those forces, which included concern about increasing health care costs, pressure to reform medical and psychiatric education, and the growth of dynamic psychiatry and psychosomatic medicine, are described. The activities of Alan Gregg, Director of the Medical Sciences Division of the Rockefeller Foundation during that era are highlighted. Gregg encouraged research in neurobiologic correlates of psychiatric illness and funded psychiatric units in eight general hospitals in the United States. The authors suggest that the development of general hospital psychiatry was strongly influenced by Alan Gregg and his support for a medical model of psychiatric illness. In addition to other forces that spurred the growth of general hospital psychiatry, the authors suggest that Gregg's influence significantly aided psychiatry's entrance into the general hospital.

In a previous study of patients undergoing angiography at Duke University Medical Center, we reported that of all components of the Type A behavior pattern (TABP), only Potential for Hostility and Anger-In were significantly associated with extent of coronary artery disease (CAD). The present study was undertaken to replicate these findings using a different patient population. Tape-recorded structured interviews from 125 angiography patients at Massachusetts General Hospital were blind scored using the component scoring system employed in the Duke study. The results confirmed our previous findings. Global TABP was completely unrelated to extent of CAD, while Potential for Hostility and Anger-In were significant independent predictors of disease severity. These findings argue for a reconceptualization of the manner in which the TABP is defined and assessed.

To determine how denial of illness affects the relationship between self-reported psychological state and cardiac status, the authors studied 204 men with heart disease. Differing degrees of denial masked the relationship between multiple-vessel coronary disease and tension, depression, or fatigue. At 1-year follow-up, denial confused the relationship between fatigue and cardiac state. Denial may augment or diminish risk; patients with high denial who did not complain of depression or tension had a higher risk for coronary disease, and patients with low denial who complained of fatigue had more morbidity at follow-up. Because of its variable effects on illness and its role in confusing the relationship between psychological state and disease, denial must be evaluated carefully.

Just as delay is the principal problem of the pre-hospital period in myocardial infarction, depression is the major stress of the post-hospital period or convalescense [1, 2]. This depressive response is said to be universal. Among others, Paul Dudley White acknowledged its importance in his statement, “It is important to realize that the heart may recover more rapidly than the depressed mental state which is so often a complication” [3]. The intensity of the depression varies from patient to patient, as does its course in time. It is reactive in nature, meaning that it occurs in response to the changes of life-style the infarction brings about. Generally, depressive thoughts focus about predictable concerns such as survival, earning capacity, ability to function as a family member and parent, as a sexual partner, and to lead an active life.

The bearing of clinical history, epidemiological risk factors, psychosocial factors, angiographic findings, and treatment characteristics was studied in relationship to the work status of 182 men who underwent coronary angiography because of presumptive coronary artery disease. Follow-up at one year found 42% of the cohort persistently unemployed or working at a lower level,40% at the same job, and 19% at a more demanding job.

This study examines the ability of a broad sampling of traditional risk factors, physical findings, and psychosocial measures to predict the extent of coronary vessel disease, given such disease is documented angiographically. The sample of 171 men underwent cardiac catheterization at Massachusetts General Hospital.

Using angiographic evidence of coronary artery disease, we have examined whether certain populations were particularly susceptible for risk engendered by Type A personality. Two hundred three men were studied with the Jenkins Activity Surveys; 103 of them were also studied with the Rosenman semistructured interview. The extent of vessel disease was found unrelated to Type A in each of the three ethnic groups studied--Irish Catholic, Italian Catholic, and white Anglo-Saxon Protestant. Likewise, no relationship between Type A and vessel disease was discerned in high depressed, low depressed, high stressed, or low stressed individuals. Finally, we examined whether cardiac symptomatology could affect any relationship found between Type A personality and vessel disease. No significant relationship was discerned in patients who had experienced or had not experienced a myocardial infarction or in patients with mild, moderate, or severe exertional angina.

The two most widely used instruments for assessing Type A personality are the Jenkins Activity Survey and the Rosenman semi-structured interview. The agreement between these two scales was studied in a population of 103 men awaiting coronary angiography at Massachusetts General Hospital. Portions of the sample that were considered questionable because of scoring characteristics of the respective techniques were removed to determine whether these characteristics confounded the relationship between Type A behavior and angiographic findings.

This study compares the ability of various risk factor combinations to predict the extent of coronary artery disease found on coronary angiography.

The role of alcohol as a risk factor in patients with established heart disease needs further empirical clarification and the literature that addresses the problem is limited. In healthy young males studied prospectively alcohol has a negative role as a risk factor in the development of coronary heart disease. However, conclusions about this group do not necessarily hold for those with already established cardiac damage. Two studies report a significant difference between normal controls and patients with cardiac disease using even small amounts of alcohol. One prospective study of risk factors for coronary heart disease found a record of alcohol intemperance significantly increased the risk of acute myocardial infarction or sudden death. The epidemiological, metabolic, hemodynamic and autopsy studies that bear on the effects of alcohol and its major metabolites on the heart are reviewed.

This study examines the association between Type A personality and the extent of coronary artery disease found at angiography. Our initial work failed to demonstrate an association between Type A as measured by the Jenkins Activity Survey (JAS) and vessel disease.

The relation between type A personality and the extent of coronary artery disease was studied in 109 patients who underwent selective coronary angiography. Type A personality as measured with the Jenkins Activity Survey was not correlated with the extent of coronary artery disease as assessed from the number of vessels with 50 percent or greater narrowing of diameter.

Dimsdale, Joel E. MD; Hackett, Thomas P. MD; Block, Peter C. MD; Hutter, Adolph M. Jr. MD Author Information