Character is a problem of great concern not only in the field of psychiatry but in general medicine. These are many difinitions about character and it has been used interchangeably with personality. Among the studies on biological roots of character, genetic studies have been done with special reference to twin studies. Kretschmer's contribution to the study on physique and character is well known. The author his co-workers have done several studies concerning the correlation between character and cerebral electrial activity in healthy young adults. Frequency analyses of the EEG revealed that EEG had some correlation with character. The distinct activity appears, of which frequency is approx 6-7 Hz and voltage is 20-50μV, at frontal midline area, during performing Kraepeline's test. This θ activity has been called midline fontal theta (Fm θ). From our study, it was found that those subjects who showed low score in the Manifest Anxiety Scale (MAS), high score in the extrovertive scale of Maudsley Personality Inventory (MPI), and low score in the neurotic scale of MPI were apt to show high percentage of Fm θ. On the contrary, those who showed high score in the anxiety scale of MAS, low score in the extrovertive scale of MPI, and high score in the neurotic scale of MPI were apt to show low percentage of Fm θ or no appearance of it. Next, in subjecting 14 healthy university students, to partial differential rapid eye movement (REM) sleep deprivation (PDRD), the compensatory rebound of REM sleep during the next night was determined and showed fairly substantial individual differences in the increased percentage of REM sleep time. This study revealed that individuals who were extrovertive, active, optimistic, showy, and who had many fields had signficantly higher increases in the percantage of REM time than the individuals who were introvertive, neurotic, inactive, nervous, modest, and who had few friends.

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We discussed some of the physical symptoms of depression observed in general medical patients.G eneral medical patients suffering fron depression have been on the increas, particularly among young people. New patients amounted to 32% of the observed group, and the remaining 68% were formerly treated for other diseases. The latter group consulted at least three doctors, because their symptoms had not been relieved. Sixty eight percent of the depressed patients complained chiefly of digestive organ problems. In order depressed patients organic diseases, such as cancer, were found. In this reported we presented actual cases of deprerssion and discussed their physical symptoms noted. We also suggested corrective measures which were used in the treatment of these patients.

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Recently, much attention has been paid to the physical problem of depression. The depressed patients whose psychiatric syndromes are covered with more prominent somatic complaints, are not uncommon in daily general practice. The term of so called "masked depression", proposed from such a point of view, is now getting a great popularity. The present investigation was undertaken to classify the possible relationships between physical symptoms and various factors such as type of depression, sex, age, duration of admission, diurnal swing, premorbid character, etc. The total of 284 inoatients with depression were treated at Kitasato University Hospital, consisting of 102 cases of endogenous depression, 101 presenile depression, 13 senilke depression, 22 depressive reaction, 39 neurotc depression, 7 organic and symptomatic depression. The Results obtained were as followes ; 1) One hundred thierty-eight patients (48.6%) showed marked physical complaints and this phenomenon was observed more frequently in older cases. About 30% of the patients had recieved some treatment previously by general practitioners due to their somatic conditions. 2) More than 70 different kinds of physical symptoms were found in 284 patients, and they could be devided into three major categories ; that is 1) sleep disturbance, 2) gastrointestinal disturbance and 3) pains in various parts of the body. 3) In the cases of engogenous depression, their physical symptoms were closely related to reduction of vital feelings. Gastro-interstinal symptoms were seen predominantly in female patients and sleep disturbanced as well as general fatigue in male patients. 4) The patients with presenile depression manifested more physical symptoms of various kinds, and more frequently. 5) More severe automic symptom were tended to be found in the patients with long hospitalization. 6) While late insomnia was found more frequently in the patients with diurnal swing, early insomnia occurred in those with the compulsive character of Shimoda's type. The authors Discussed the clinical significance of physical problems in depressed patients on the basis of the above-mentioned findings.

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1. The percentage of depressive patients among the outpatients at the Department of Psychosomatic Medicine, Kyushu University Faculty of Medicine was 8.5%, 15.9%, 16.7% and 18.6% in 1963,in 1971,in 1972 and in 1973 respectively. The tend has been on the increase every year. 2. Depressive patients who visit internists complain chiefly of various physical symptoms. Therefore, their psychological symptoms tend to be overlooked, and only 11% of our patients were diagnosed as having depression. 3. Depressed patients often complained of gastrointestinal symptoms such as loss of appetite, loss of body weight, constipation, distention, feeling of stagnetion, nausea and mouth. 4. Active and healing gastric and duodenal ulcers were found in 11 patients (13.1%). These patients complained of less stomachache than the non-depressed ulcer patients, and it was easier for them to relapse in depressive state. 5. Depressed patients showed a tendency of having decreased gastric acidity in the basal gastric juice as compared to the normal control. 6. Many of depressed patients complained of loss of appetite and loss of body weight ; however, these two phases were not in accordance with each other, and were some patients who showed an increase in body weight. 7. Depressed patient tended to show abnormality in passage. It approximated to spastic constipation rather than to atomic constipation. 8. X-ray examination revealed that the function of the stomach in depressed tended to be inhibited as compared with the healthy control. Depressed patients showed hypertonicity and motor dyfunction in the interstine and colon. 9. Depressed patients showed significantly high leveles of blood glucose, compared with the healthy controls, at 60 min, 90 min, and 120 min, in the 50gm glucose tolerance test. This tendency was most marked in endogenous depression, and involutional depression being the next highest level followed by the neurotic depression. 10. In depressed states, abnormality in the excretion of urine-amylase was seen in 66%, while that of serum-amylise was 19.3%. However, they were not related to the abnormal glucose tolerance.

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For the last 3 years, there were 105 patients who were diagnosed as having a depression or being in a depressive state at the psychosomatic clinic of our department. The frequency of these patints was 14.5% of all patients who consulted with the clinic. With regard to the age distribution of these patients, highest incidence was seen in 40-50 years of age, which was followed by those of 50-60 years of age. However, there were about 20 patients whose ages were between 15-25. The majority of these adolescent patients had been diagnosed as having school phobis, and had been absent from school or given up school, because of easy fatigability, or stool abnormality, loss of volition for study, difficult awaking, stc. Among the digestive symptoms in patients with depression or depressive state, anorexia was most frequent. This was followed by the symptoms such as nausea, vamiting, abdominal discomfort, constipation, abdominal pain and diarrhea. These patients were treated mainly with antidepressants and antianxiety drugs. The improvement rate of symdroms was studies by a questionaire. It was discovered that a higher improvement rate was obtained in abdominal pain, nausea, vomiting and diarrhea than in the other symptoms. Moreover, a patho-physiological study was conducted to examine why digestive symptoms were complained in patients with depression or depressive state. Hyper motility with hypersecretion of the gastrointestinal tract was demonstrated in more than 75% patients. This was proven with barium enema examination and EMG of the colon. However, hypokinetic biliary dyskinesia were seen commonly in these patients. The physiologic or biochemical mechanism for the findings remained to be further elucidated.

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As masked depression (MD) and the climacteric syndrome manifest closely interrelated symptoms, it is difficult to make a clinical differentiation between these disease, especially when climacteric, psychosomatic disorders are involved. This inverstigation was concerned with a clinical evaluation of the symptomatology of MD in comparison with a parallel study of the climacteric syndrome of PSD type. Our results revealed the following characteristics in the MD patients, which we think may be of value in making the differential diagnosis of these two problems. First, in the MD patients, complaints included depression, inability to function adequately and a high degree of nonspecific anxiety. These strictly psychological complaints were highly prominent. The somatic complaints inclused marked fatigue sensations in the morning and varying degree of insomnia at night. Furhermore, these patients manifested diurnal variations, in which their condition was most severe in the morning with progressive improvement toward the evening. Among the various evaluation tests, the MD score are significantly higher in patients with MD. Logginess and headache were prevalent in both MD and the climacteric syndrome of PSD type, with an incidence of 80% and 95% respectively. Thus the checking of these symptoms seemed questionable in making the differential diagnosis.

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During 1975-76,22 cases were diagnosed as depression in our clinic (ENT), and they were treated with the aid of psychiatrists. Their chief complaints were tinnitus, headache, lump in throat, dizziness, stuffy nose, dysphsgia and voice disturbance, although they had manu other physical complaints, that is, sleep disturbance, appetite loss, weight loss, weakness and fatigue, sexual disturbances, etc. The diagnostic criteria was abnormal mental state of depression considering these physical complaints. Detailed physical examinations were performed on these patients to investigate whether these complaints depended on organic disease or the depressive state. The results were summarized as follows. 1) Thirteen cases had organic diseases closely related to their complaints ; 9 cases with auditory disturbance, 2 cases with chronic sinusitis, a case with hypertrophic rhinitis, and a case with cicatricial esophageal stenosis. However, exept for a case of esophageal stenosis which was the result of acid-agent ingestion commit suicide, their symptoms have been improved without any organic change after antidepressive treatments. Observation on these patients have lead us to think that they did pay attention to the organic diseases to the organic diseases when they were in a normal mental state, but they complained of physical symptoms in an exaggerated manner when they were in a depressive state. 2) In 9 cases, no organic disorder related to their symptoms was found. Thus it should be considered that their symptoms were evoked by depressive illiness itself. It should be emphasized that detailed history taking and precise examination on mental state are of essential impoetance for detection of depressive patients even when they had organic diseases, becaouse symptoms of these patients depended on both mental and physical states.

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It has been believed that most patients of depression seen in the out-patient clinics of internal medicine respond well to the treatment by antidepressants and recover in a relatively short period of time. However, there are some cases whom it takes more than a year to recover, though antidepressants are effective. In this report, these patients are called prolonged cases of depression. Twenty-four prolomged cases (15 males, 9 females) of depression experienced in the Department of Imternal Medicine of Nagoya University Hospital from 1971 to 1975 were studied to make clear the condition and the mechanism of prolongation. Duration of therapy ranged from one to six years ; 1-2 years in 11 patients, 2-3 years in 8 patients, and more than 3 years in 5 patients. The prolonged cases of depression were divided into three types according to the course of depressive condition : (1) Partially recovered type ; most distinctiv signs and symptoms are obviously diminished but a state of slight depression is still present. (2) Hypochondriac type ; depressive signs and symptoms are obviously diminished but anxiousness and tension about indefinite symptoms are apparent. (3) Unstable type ; depressive signs and symptoms disappear completely but they reappear within three months after returning to jobs. Among the 24 cases, patients of partially recovered type were 8,hypochondriac type 10,and unstable type 6 respectively. As the background factors in these prolonged cases, moderate personality deviations such as emotional immaturity, suggestability, and self-display together with SHUCHAKU-SEIKAKU, hypochondriac attachment to the slight physical symptoms, non-adjustable familial and social troubles were detected. And above-mentioned personality deviations, situstions, and symptoms interacted one another to disturb recovery of the disease. With the lapse of time, irregular taking of antidepressant drugs came to be apparent in some cases, and this conditon seemed to be one of the factors of prolongation.

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Two cases of depression were presented from a psychoanalytic point of view. The first case, a 30-year old woman, was of immodithymic premorbid personality. Severe aggressive and distructive behaviors, reparation and restitution (M. Klein) and recovery of capacity for concern (D.W. Winnicott) were seen during psychotherapy. The symptomatic characteristics included sadness feeling, motor and thought retardation, and gastro-intestinal disturbances.In particular, the author discussed that constipation had a close relationship to internalized aggressive feelings. The second case, a 26-years old college student, was of reserved but dependent personality. Becoming independent from his yje tie with mother and finding a new object to be introjected was his main therapeutic goal. The symptoms distinguishing this case from the first case was hopelessness and powerlessness (of his own muscle), but not vegetative dysfunctions. From the above, the author concluded that there were two of depression, one with sadness related to vegetative dysfunction and other with hopelessness to powerlessness of the body.

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The author studied about depression accompanied by marked somatic symptoms from the autonomic and endocrinological stand points. Autonomic bervous functiin was recorded by means of microvibration. Endosrinological investigation was conducted by examining pituitary thyroid function using TRH test. Sixty-two percent of the patints showed autonomic dysfunction according to the microvibration test. when autonomic function and psychic symptoms were compared, beta-dominant waves which were considered as vagotonia in microvibration incresed more significantly in the patients with retardation than those without retardation. Pituitary thyroid function was examined and no abnormality in T3,T4 and T3-RSU was confirmed. Then low TSH response to TRH appeared in patient with protracted depression. The author used a small amount of T3 together with the anti-depressants these cases, comparing the value for TSH before and after treatment. It was found that the therapy was effective for improvement as well as the normalization of TSH response to TRH. The author presented a case of marked improvement due the combined use of clomipramine plus T3 and referred it to the result of the TRH test.

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Physiological and endocrinological study was performed on seventeen depressed woman in perimenopausal stage. Psychological evaluation of depressed patients was carried out by CMI, SDS, and MMPI as well as medical interview. Basal body temperature (BBT) was measured several months up to a year mainly for hormonal assay. These patients showed higher basal secretion of LH and FSH than the control, and higher response of LH and FSH to LH-RH test, which was sustained even at 120 min. after injection. On the other hand, hyperresponsiveness of LH and FSH to LH-RH test in these patients was remarkably decreased when improved by psychotherapy and drug treantoment. The author thought it very important to catch the physiological change with physical and emotional atress. For this puressor test (CPT) and mirror drawing performance test (MDT) were used. Abnormal reaction of blood pressure both to CPT and MDT was seen in 76% of all, and MDT also induced remarkable increase of heart rate. These results show the patients were very sensitive to emotional saress as well as physical stress. Microvibration (MV) in body surface was also measured at rest and during physical stress (CPT) because it has been found useful for seeing the function of automic nervous system. According to the band analysis of MV, beta wave (over 13Hz) was significantly (E%=32.0±5.9) and theta wave was the least (5.4±1.1). However, MV did not change significantly during CPT in these patients. Their MV was classified as follows ; fast wave dominant type (F) 40%, normo-reactor (N) 60%, and slow wave dominant type (S) 0%. The remarkable increase of F type in MV, which often appears in the vagotonic state, may have a diagnostic value in these climacteric depressed women. Microvibration and gonadotropics (LH and FSH) had significant relationship ; LH increased significantly in F type group of MV. This fact suggests close corelationship between endocrine and automic function in these patients.

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The present study dealt with circadian variation of serum 5HT levels and the change of those during sleep deprivation and after a loading dose of L-5HTP in manic-depressed illness. 1. Circadian variation of serum 5HT level was measured at 8,12,20 and 24 o'clock in 12 normal subjects, 4 manic and 6 depressed patients respectively. There was no significantcircadian variation in each group. 2. The changes of serum 5HT level during sleep deprivation were determined in 9 normal subjects and 8 depressed patients (4 patients who received no psychotropic drug and 4 patients who received tricyclic antidepressants) at 20 and 24 o'clock of the first day of sleep deprivation and at 4,8,12 and 20 o'clock of the following day. There was no significant change in normal subjects. On the contrary, the serum 5HT level during sleep deprivation in the depressed group, who received no drug-treatment, showed a tendency increase This was especially, the case in the serum 5HT levels at 8 and 12 o'clock of the first day. 3. serum 5HT level after single administration of L-5HTP was investigated in 6 normal, 4 manic and 6 depressed patients. As a loading dose, L-5HTP 3mg/kg was given orally to all subjects at 8 o'clock in the morning. Serum 5HT level was examined at 8,9,10,12,16,20 and 8 o'clock of the next day. The results were rether scatter, but serum 5HT level for depressed patients showed a tendency to decrease, one and two hours after administration of L-5HTP. On the contrary, those in manic patients showed a tendency to increase one and two hours after the loading. those in normal subjects showed a tendency to increase 12 hours after the loading. 4. It seems that the sleep deprivation influenced the 5HT metabolism in depressed patients. The response to L-5HTP loading was different between manic and depressed groups, indicating a different activity of decarboxylase between manic and depressed groups, indicating a different activity of decarboxylase between them.

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