Patients with Graves' disease have many signs and symptoms which are not only somatic but also psychological. Althouth there are many reports in this regard, the data thereof have been collected by more than one doctor and not always under the same condition.Subjective complaints and objective signs of patients whose Graves' disease had not been treated were studied and the results were compared with other known reports. Our data, especially case histories, were collected by only one doctor. In addition, patients with Graves' disease and other thyroid diseases were examined by CMI.The results were as follows : 1) Main subjectve complaints consisted of sweating, fatigability, palpitation, tremor and goiter. The percentage of detecting patients' complaints was higher in our data than in those of other reports. This might be due to different subjects and methods as mentioned above.2)There were differences in number between the complaints presented by patients and those checked by a doctor, the latter being 2 or 3 times more than the former. This is probably related to the patient's ability for self-observation and self-expression. We considered it very important to take detailed and precise history of the patient.3) CMI revealed a high rate (66%) of neurotic tendency in patients with Graves' disease. However, the more circulatory complaints patient had, the higher was the scores in neurotic tendency. When tremor, which is a somatic complaint, ezists, it is regarded as tension in CMI, thus making high scores in the psychic items. Caution should be taken in evaluation CMI scores of patients with Graves' disease.

View full abstract

A study was conduceted to investigate the effect of a β-blocker upon 96 patients with various types of tremors after single administration of 15 mg of bufetolol hydrochloride or pindolol. Both drugs are known as β-blockers which have little inhibitory effect upon the central nervous system.Our 96 patients consisted of 26 with parkinsonian tremors and 70 with positional tremors. During examination, patient with parkinsonian tremors sat on a chair with his arms held down, while patient with positional tremors held his arms straight forward with his wrists and fingers extended.A tremor curve was lead from patient's hand before and 75 to 90 minutes after administrating the β-blocker, and the changes in the amplitude of tremors were examined. Furthermore, we examined an increase of the amplitude of tremors by the mirror-drawing test and by a subcutaneous injection of 0.15〜0.4mg of adrenaline, and then an inhibitory effect of the β-blocker upon the increase facilitated by these two methods.An inhibitory effect of the β-blocker upon tremors was observed in 67% of patients with parkinsonian tremors due to Parkinson's disease, and in most of the patients with other types of tremors. However, the inhibition was found in complete in most of these cases.The amplitude of tremors showed a marked increase in response to a subcutaneous injection of adrenaline.This increase was almost completely inhibited in all examined cases by administrating the β-blockers prior to the injection.When the mirror-drawing test was conducted, the amplitude of tremors on the site other than the drawing hand increased in most patients with parkinsonian tremors, while it did not increase in almost all patients with positional tremors. When patients with increased tremors by mirror drawing were re-xamined 75 to 90 minutes after administration of the β-blocker, the increase was inhibited in 60% of patients with parkinsonian tremors, though the inhibition was not always complete.No special relationship was found between MAS scores and the effect of the β-blocker upon tremors.On the basis of these results the author discussed pharmacological mechanisms of various tremors and inhibitory effects of β-blocker upon tremors.

View full abstract

Transactional Analysis is now being used quite extensively as one of the therapeutic methods in psychosomatic medicine. The egogram is of great usefulness in transactional analysis. A profile of an individual is shown on an egogram, where egostates are classified as Paternal Parent, Adult, Free Child and Adapted Child. This diagram is useful in showing which egostates dominate the individual's personality.We made a clinical application of egograms which had been drawn up from questionnaires filled in by the patients. We adopted the theories of Sugita, M., M.S.W. in most of the items of the questionnaires, although slight modifications were made in them.Egograms were drawn up for each of 121 normal subjects and 108 patients with psychosomatic diseases.The results were as follows : (1) There was no marked difference between male and female subjects.(2) No marked difference was found according to ages.(3) Compared with the egograms of normal subjects, those of the patients showed higher readings on the Adapted Child scale.(4) However, in some cases, the Adapted Child scales gradually fell as the result of psychosomatic treatment such as autogenic training and behavior thrapies.We think that the egogram can perform a useful function in linking intellectural awareness aquired through transactional analysis with the desired behavior modifications by means of behavior therapies.

View full abstract

In connection with a series of studies on the comprehensive medical treatment of peptic ulcers, the authors have previously reported a clinical study on the inpatient treatment with placebo and on the basic mechanisms of ulcer healing. This second report deals with the influence of psychoneurotic factors on the healing process of gastric ulcers.The study was undertaken on a total of 50 inpatients, each of whom was afflicted with an active single ulcer. Relations among seven factors influencing the rate of ulcer healing (age, sex, size of ulcer, gastric acid secretion, anxiety levels, types of mecholyl response on admission and emotional stress) and the time required for healing were analysed. The results obtained were as follows : 1) Of the 13 patients whose ulcers were less than 10mm in diameter, 11(84.3%) were healed at the end of 8th week, whereas out of the 37 patients whose ulcers were larger than 10mm in diameter, 15 cases (40.5%) were healed within 8 weeks. The differences between these two groups statistically significant (P<0.02).2) The patients with ulcers larger than 10mm in diameter were tentatively classified into two types, that is, i) the mental, physical stable type and ii) the psychosomatic type according to the presence or absence of emotional stress and the types of mecholyl response. Of the 15 cases belonging to the former type, 9 (60.0%) were healed at the end of the 8th week and 14 (93.3%) at the end of the 12th week. When the same period of examination was applied to the 22 cases of the latter type, the numbers were 6 (27.2%) and 15 (68.2%) respectively. The differences in the time required for the healing of the two types were statistically significant. Ages were the same for the two types.3) In the present study, it was not established whether or not psychoneurotic factors affected the rate of ulcer healing in the patients whose ulcers were less than 10mm in diameter.The above results suggested that emotional stress and an imbalance in the autonomic nervous functions influenced the healing process of relatively large gastric ulcers by delaying it.

View full abstract

Up until the present, very little is known about the pathophysiology of anorexia nervosa, one of the most typical psychosomatic diseases, which creates a disturbance in the food intake together with a variety of psychological symptoms. A biological change in the brain may be suggetsted from the fasts that it often appears in adolescent women, that it accompanies endocrinological disturbances, and that it usually has a certain character tendency and behavior pattern. It would be of great use in understanding the pathology of anorexia nervosa, to take synthetically the clinical data and the food intake regulation system, which has been substantiated recently in animal experiments.Animals have their delicate food intake regulation system in the hypothalamus which is regulated by humoral factors such as glucose and FFA, as main substances, together with growth hormone, insuline, glucagon, ACTH, corticosteroid, sex hormones and so on. These humoral factors in anorexia nervosa change very little in the direction of strengthening food intake. This fact is a result of long periods of starvation and cannnot explain the diturbance in food intake as the result of the change in humofal factors. The pathological state of the food intake system in the hypothalamus must now be considered. It would appear, from the facts, that a disturbance of food intake is influenced by psychological factors and it is reversible, that it is a functional change. First of all, an abnormal condition of a neurotransmitter in the brain is considered to account for the pathological state of anorexia nervosa. Until the present, no definitive evidence for the role of monoamine in the feeding behavior has been completed. It would appear, according to electrophoretic experiments, that noradrenaline and dopamine create an inhibitory effect to the feeding center. To explain the pathophysiology of anorexia nervosa, the hypothesis that dopamine may be increased in the hypothalamus may be accountable for an anorexia and psychological systems such as hyperactivety etc. But from the standpoint that psychological factors are closely related to onset and clinical course of this disease, it is necessary to consider changes in the higher central nervous system. Recent studies have demonstrated the existence of an inhibitory pathway in monkeys that goes directry from the orbitofrontal cortex, a part of the frontal cortex, to the feeding center. Thus, in anorexia nervosa patient, it would be of interest in understanding this disease to assume that a pathway exists from the cerebral cortex via the orbitofrontal cortex through which psychological factors inhibit the feeding center.

View full abstract

Mirror Drawing Test (MDT), one of the most convenient mental stress tests developed in our country, was carried out in 73 hypertensives and 6 normal controls. In this experiment, the response of blood pressure, heart rate and cardiac work were analysed.1) Blood pressure, heart rate and cardiac work were increased during MDT test in most of the patients. However, the response was different from patient to patient. Blood pressure responese was greater in hypertensives than in normal controls.2)Even in hypertensive individuals, there were various types of the cardiovascular responses to the test. The grade and pattern of the responses were influenced by the pathophysiological aspects such as the type or the stage of hypertension, or by the psychological aspects such as type in CMI test, YG test, TPI test or Rorschach test and troubles in life history, of the patient.3) It was important to learn that the attitude or eagerness of the patients toward the test seemed to modify the response to it.4)MDT seems to be a useful routine test to investigate the correlation between the emotional stress and the cardiovascular function in the clinical field. However, further investigation will be needed to clarify the role of psychosomatic factors regulating the cardiovascular responses to the emotinal stress.

View full abstract

From the behavioral point of view, anorexia nervosa is understood as a manifestation of abnormal eating behavior which began casually and has been continuously reinforced by rewards of attention-getting from close relatives and others and of anxiety-reduction due to the diseased state, etc.Our report is a case of anorexia nervosa who was successfully treated with behavior therapy technique. The patient was a 22-year-old male whose symptoms has persisted for about 4 years. The main therapeutic measures were as follows : I. Exclusion of reinforcing factors of abnormal eating behavior : (1) the patient's daily life was restricted within the hospital ward ; contacts with relatives by means of visits, telephone calls, writing, etc were strictly prohibited ; (2) all medical personnel behaved neutral and unresponsive to the abnormal eating behavior and subjective complaints of the patient.II. Positive procedures for reshaping the desirable eating behavior : (1) the amout of daily diet given to the patient started from 1,100 cal, hoping to motivate the patient's psychological need for food, and was gradually increased by 200-300cal within an interval of 5-7 days ; (2) each time the patient consumed all the food given, he was positively encouraged by verbal praise sand attention from the medical staff ; (3) a weight increase of 0.5kg or more per week was positively rewarded by allowing the patient to make one telephone call, to see a visitor or to leave the ward for a short time.By these procedures, the patient's weight increased from 33kg to 49kg in about 5 months. Follow-up studies after five and a half years showed that he had been happily married and well-adjusted to his job.

View full abstract