It is a very important problem for the preoperative anesthetic management to relieve anxiety and fear of surgical patients. We observed the preoperative emotional states in relation to pain threshold, pain tolerance and reaction to experimental pain by appling the signal detection theory. The following results were obtained in the preoperative states which were compared with the resting states in the control group, the diazepam group and the relaxation group.(1) The control group showed no changes of pain threshold, tolerance and sensitivity(d') but demostrated a significantly increased bias response (c).(2) The diazepam group showed unaltered pain threshold, sensitivity (d') and response bias (c), but decreased pain tolerance.(3) The relaxation group showed a decrease in pain threshold and tolerance but an increase in sensitivity (d') to stimulation and a decrease in bias response (c).The results indicate that observation of the sedative effect is useful in order to understand the preoperative anxiety in reaction to experimental pain when it is done not only by the measurement of the traditional threshold and tolerance bu by the evaluation of (d') and (c) in the signal detection theory analysis.

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Trichotillomania in chilren has been considered as a neurosis or behavior disorder in most cases.In this paper, the author presented a case study of a 5-year old girl, who had been treated by operant conditioning therapy. In the course of his therapy, however, her symptom get worse sometimes, and these changes were found in exact concordance with various affairs occurring around her mother. Although the mother denied the existence of the troubles with apparently calm attitudes, actually she was so irritated that she couldn't follow the indications of the author. Thus the author considered it necessary to study her life history in detail.Through this study, the author saw the typical example of mother's emotional state affecting the course of therapy, and learned that a focus must put upon the examination of mother's life history.

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Thirty two patients with endogenous depressino were treated with cloxazolam, one of the benzodiazepine derivatives recently synthesized in Japan, in an open clinical trial. Twenty eight patients continued to receive previously prescribed antidepressants concomitantly with cloxazolam, and four patients cloxazolam alone.Fifty percent of all the patients showed clinical improvement. Therapeutic efficacy of the drug was significantly lower in bipolar type than in unipolar type (p<0.01).In most patients, cloxazolam was particularly effective for the improvement of anxiety. In some patients, the improvement of depressive mood or psychomotor retardation was accompanied with that of anxiety.In 12 patients cloxazolam was compared with other minor tranquilizers as diazepam, oxazolam etc., in cross over method.In 7 patients cloxazolam had better therapeutic efficacy, and in 5 patients depressive symptoms remained unchanged.Main side effect was drowsiness, which was observed in 8 patients.

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We psychosomatists are sometimes confronted with extremly difficult cases that are often given up by the attending physicians because of the patients' pertinacious somatic complaints and their lack in co-operative attitude. In this paper the author reported on the treatment of two such patients, the result of which, contrary to the initial anticipation, turned to be very satisfactory. This treatment consisted of simultaneous psychotherapeutic approach to the doctor and the patient. Case 1. was a 46-year old single laboror. His complaints were palpitation and fatiguability. Case 2. a 34-year old male clerk. His complaints were diarrhea and fatiguability.Throughout consultation on the treatment of these cases, the author took sympathetic and supportive attitude toward the attending physicians in order to restor their subjectivity which was a vital necessity in a therapist. Only after this, some concrete advice on the treatment was presented to the physicians in concise and concrete terms. At the same time, the author promised the doctors to take over their cases in the out-patient clinic after their discharge.After the discussion, doctors fully encourged, went on to carry out the concrete treatment. Other staffs became spontaneously co-operative. After this, the confused therapeutic atmospher gradually disappeared and the patient's attitude as well as pertinacious complaints were slowly improved.In the author's opinion, consideration over the doctor-patient relationship is sometimes necessary in troublesome patients, and in fact, psychotherapeutic approaches to the attending psysician as well as to the patient were very effective.

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It this paper, the author investigated the relationship between the ovarian function and non-specific complaints following vitamin E administration in 7 female patients whose ages ranged from 19 to 46. Their non-specific complaints had developed in relatino to adolescence, post delivery, post artificial abortion or climacteric period. At the beginning of treatment, the patients showed different patterns of basal body temperature courve such as seen in non-ovulation, impairment of luteal phase (severe, slight), impairment of follicular phase (variant type or high temperature phase of follicular phase), and imbalance of the period of follicular and luteal phase (follicular phase>luteal phase, follicular phase<luteal phase).For the purpose of improving ovarian dysfunction observed in those patients, a single administration of vitamin E (α-tocopherol acetate, 300mg per day orally) or a combined administration of vitamin E and chlordiazepoxide (20mg per day orally) was carried out in all patients. After 3 to 4 months of this treatment, initial non-specific complaints more or less disappeared concomitantly with the improvement of basal body temperature curve in all patients. Four out of 7 patients showed various periodical complaints such as nausea, stomach distress, stomachache, sore neck, stiff shoulder or headache in the follicular or ovulation phase in which the abnormal pattern of basal body temperature curve appeared. However, these complaints also disappeared in all patients after the normalization of basal body temperature curve.The above-mentioned facts seem to suggest that the control of ovarian function plays an important role in the treatment of non-specific complaints which were developed due to the changes in endocrinological environment of female gonadal glands.

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The purpose of this study is to clarify the pathological mechanism of autonomic seizures of the chest. Clinical and electroencephalographical studies were performed in 197 patients with the chief complaints of palpitation, pressure or strangling sensation in the chest, feeling of difficulty in breating, pain of the chest or tachypnea, and with no findings of organic respiratory and cardiac diseases. Their EEGs were abnormal in 131 patients (A-group) and normal in 66 (N-group). The patients were found to be predominantly in their 10's and 30's in the A-group and in their 30's in the N-group. The ratio of male and female was about 1 : 2 in both groups.The predominant abnormal EEG findings included 14 and 6 per second positive spikes in 74 patients (56.5%) and diffuse slow or sharp and slow wave bursts in 85 (64.9%). Inducements of the seizures were known in 29 of 131 patients in the A-group and 24 of 66 patients in the N-group. Physical inducements such as intensitive bodily exercise, overwork or alcohol ingestion were more frequently found in the N-group, and psychic inducements such as emotional stress from problems in the family, place of work or school were higher in the A-group. The Cornell Medical Index and Yatabe-Guiford's personality test were given to 44 patients in the A-group and 28 in the N-group. More than 70 per cent of both groups were neurotic according to the CMI. The Y-G test indicated more cases of emotional instability and/or maladjustment in the N-group than in the A-group.

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It is generally known that the improvement of home environment plays an important role in the prognosis of asthmatic children. The unbalanced psychological attitude of mothers often become a negative factor in the treatment of these children.In many cases, the distorted attiude of mothers toward their children serves as the main cause of enuresis, while, on the other hand, the mental stability of mothers is effective for the progress of childrens psychosomatic diseases.In the present case, the frequency of asthmatic attacks and enuresis has been decreased as the child care improved.It was difficult, however, to improve the mother's attitudes toward child care when they were highly educated, or when there existed conflicts betwen mothers and their mothers-in-law in their families.

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The patients with kidny insufficiency have been helped to prolong their life by aid of hemodialysis. Some problems have been added, however, not only physical side, but also to psychological side as well.In this paper, wer discussed a case who underwent the treatment of hemodialysis. The patient was a 45-year old homewife. Her medical history and family history showed no particular findings. Since she could not eat she received nasal feeding for about three months.Her anorexia and fatigue began in the middle of June 1973. She was admitted to the internal department of our hospital on 25th of July 1973. At once she received hemodialysis and fortunately became well by the therapy. She left the hospital on 3rd of December 1973.She came back to our hospital due to aggravation on 8th of December 1973. As she complained of nausea, anorexia and gastric pain, she was obliged to receive nasal feeding on 13th of December 1973. Many physical examinations showed no abnormal signs in digestive organs and CNS. Since we found that she was found of nasal feeding, we sent her to the department of neuropsychiatry on 25th of February 1974.After she was treated by drug therapy (Diazepam and Oxazolam) and psychotherapy (supportive therapy), she began to eat total meal and recovered from the disease within one month. She left our hospital on 30th of May 1974. It is one year since she was discharged, but she is presently woking hard.We found a slightly abnormal pattern in her EEG. Her IQ was 70 in Wechsler-Bellevue test and she showed M=1,CF>FC, low of form level, three of pathological blood reactions in Rorschach test. From the fact mentioned above, her condition was related to her emotional unstability and severe anxiety about her body.

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