We examined 64 cases of essential hypotension from the standpoint of state anxiety and trait anxiety by using the Mirror Drawing Test (MDT) in addition to Taylor's Manifest Anxiety Scale (MAS).We also examined changes of blood pressure during MDT.According to the classification of MDT patterns, Types A & C were seen in more than 30% of the cases.Normal MDT patterns including Types A & B were found in 51.6%, while abnormal MDT patterns including Types C, D & E were seen in 48.4%.A comparison of sex differences showed that the majority of males were Type A whereas Type C was fiound in the majority of females.An increase in systolic blood pressure was observed in Types C & D when the first instruction was given in hte course of MDT.As classified by MDT and MAS, the psychosomatic type (with low scores in MAS and abnormal MDT patterns) was seen in 12.5% of the cases with essential hypotension.

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Pre-and post-operative testosterone levels were measured to study the effect of surgical stress on testicular funcion.The results are summarized as follows.(1) Plasma testosterone levels tended to fall for a few days after surgery and return to the pre-operative levels in a week or so.(2) Plasma testosterone levels showed a marked decrease and the return to the pre-operative levels delayed more as the sugical stress increased.(3) Plasma testosterone levels did not decrease under a considerable surgical stress if it was given temporarily.A decrease in plasma testosterone levels was necessitated when the surgicasl stress continued for a definite period of time.It was concluded, from these results, that surgical stress lowered testosterone secretion.

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The relationship between the personality types and serum dopamine-β-hydrozylase (DBH) activity was examined in 78 healthy subjects. The personality types were determined by Yatabe-Gilford personality test (YG) and Maudsley Personality Inventory (MPI).The relationship between serum DBH activity and the personality types was as follows ; Serum DBH activity of Type C classified by YG (emotionally stable-inactive) was significantly lower than that of other types. On the contrary, serum DBH activity of Types B and D (active) was relatively high.There was no correlation between serum DBH activity and the personality types classified by MPI.These results support the assumption that serum DBH activity is likely to play a significant role as the index of biological aspect of personality.

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The body image boundary is the term which refers to the feeling of the surface of the body. The body image boundary penetration score is a Rorschach scoring system which has been devised to describe the body image boundary according to the degree of its weakness and penetrability.The purpose of this study is to clarify the meaning of the boundary penetrability by conducting case studies of normal adolescent individuals who showed high penetration scores.The following tendencies were found to be characteristic to them.1. They were poor at self-control and were in conflictive situations.2. They showed marked oral dependency and had been sensitivity and frustration over it.3. They seemed to vacillate between infant-like pursuit of pleasure and fear of physical injury.4. They reacted to stimuli with uncontroled body sensations.On the bases of these findings, it can be said that a certain correlation exists between the penetration score and oral dependency, and that these individuals with high penetration scores have conflicts over their early mother-child relationship. They are suffering from a dilemma between their with to maintain the symbiotic relationship with mother figures and the life's reality which forces them to separate themselves from mother figures.It can also be said that an illusion of sharing one boundary and one body representation with mother figures makes these individuals depend more on mother figures in controling their body sensations, and that they may refuse to develop their body representations.The above findings suggest that the highly penetrable persons may deny the boundary which is to develop to demarcate them from the objects of their oral dependency. The penetration scores may be a reflnexion of their tendency to deny their body boundaries.

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The perception of pain in phantom limb after amputation has long been considered important in terms of relief of pain and presented a challenge for those who attempt to treat pain problems. We used new techniques to measure pain experiences in the patients with phantom limb pain.The signal detection theory divides pain experiences into two determinants, i.e.d' and c. The first d' indicates discriminability and provides an index of physiological functioning which still remains unaltered when variables such as attitude and expectation are modified.The other factor, c is an indicator of the observer's criterion for emitting a particular response and function of psychological variables.Seven phantom limb pain patients were treated with alpha-biofeedback training, relaxation therapy, nerve block, analgesics and psychotherapy.All patients were requasted to answer some kinds of personality tests.Relaxation therapy and alpha-biofeedback training appeared to be effective for self regulation in the patients who had shown low d' in the pretreatment period. Nerve block combined with relaxation therapy produced an increase of d' value and a decrease of c value. It was effective for phantom limb pain by recurrent tumor. Psychotherapy and relaxation therapy brought an apparent decrease of c in the patients with psychogenic troubles.Phantom limb patients who had shown d' value of one or more low c value in the pretreatment period improved onlly with analgesics.These results suggest that the evalution of pain by the signal detection theory is important in determining the treatment of phantom limb pain.

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Sixteen neurotic patients with so-called neurocirculatory asthenia were examined in this study. Polygraphical observation was made of these subjects under resting state and the mental stress loading. Mental stress loading was given by letting the patients imagine the scene of first ranked hierarchy item that appeared in their self ratings of anxiety. During the mental stress loading, changes in GSR, digital plethysmotram, heart rate, respiration, EMG, peripheral skin temperature and systolic blood pressure were determined simultaneously.Following results were obtained from the present study ;1) The patients were divided into the responded and unresponded groups according to the polygraphical response to the mental stress loading. The patients in both groups, however, told that they could imagine the scene vividly.2) The responded group showed remarkable polygraphical changes being accompanied with acute anxiety, while no polygraphical changes or anxiety was triggered in the unresponded group.3) The unresponded group was occupied by the patients with profound conflicts or frustrations whose clinical diagnosis was hysterical or hypochondriacal neurosis. On the other hand, the patients with phobic neurosis occupied the responded group.4) Systemic desensitization therapy was significantly more effective in the responded group than the unresponded group.

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Sixty-one patients suffering from chronic pancreatitis were studied in order to clarify the psychosomatic aspects of this dosease. They were classified into 5 types, out of which 3 types were examined in detail according to their personality traits and life habits. It was found that the mind-body relationship took the primary form in the psychosomatic and neurotic types, while in the organic type it took the secondary form such as distorted life habits. This finding indicated that the distortion in the personality structure and that of life habits were closely interelated.The authors also discussed the clinical features of chronic pancreatitis from the standpoint of alexithymia. The patients with the organic type were most alexithymic, which were followed by the psychosomatic type. It was learned that alexithymic problems were reflected in the patients' life habits.

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[in Japanese]

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A 46-year-old woman complained sever oligulia and edema of the whole body for the past four years. These complaints occurred when she put on a plutinum necklace and a ring, and also after sleep disturbance, overwork, bathing and taking medicine. Physical examination revealed no abnormal findings, except for allergic reactions to the cosmetics which she usually used. She was treated with an automatic hypnotic instrument which automatically induced her into middle and deep hypnotic states, consequently leading to the disapperance of her symptoms. This instrument automatically induced the patient into various stages of hypnotic trance by alternating strain relaxation along with the suggestions to which the patient listened on a taperecorder in a reclinning chair.

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A 23-year-old woman was admitted to our psychiatric department with chief complaints of convulsive attacks accompanied by unconsciousness and self-mutilation, complete motoric paralysis and complete anesthesia in both lower limbs. At the age of 18,she was treated under the diagnosis of hyperthyroidism, at 20,she was hospitalized under the diagnosis of thyrotoxic crisis but recovered from it after about 1 month. However, since then, she had been suffering from lack of appetite and general fatigue, which compelled her to stay in bed. One year and three months after recovering from the crisis, convulsive attack began to appear. Nine more months later, complate motoric paralysis and complete anesthesia of both lower limbs appeared, and after 3 months she was admitted to our hospital.Physical and neurological examinations, thyroidal functions and hematological tests were all normal. The convulsive attack was very amorphous from the clinical viewpoint including its type and duration. In addition, the zones of anesthesia and motoric paralysis did not coincide with the nerve-controling zones, and the symptoms were not considered as of any neural origin. Consequently, she was diagnosed as conversion hysteria as the disease was non-organic and the symptoms appeared in the zones contoled by the motoric and sensory nerve system.In treatment, hypnosis was ineffetive. As the low-frequency device was applied, however, har paralyzed lower limbs as well as the convulsive attack and anesthesia were improved without particular madical endevour. She has no symptoms since then. The present paper includes some comments and discussion in regard to her illness.

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A 38 years-old male with hypertensive episodes was admitted to our hospital for the therapeutic purpose.His complaints included head heaviness, dizziness, fatigue and discomfort of the gastric region. His blood pressure was elevated by both somatic and psychic stresses concerning hypertension. Clinical examination revealed nothing abnormal except for high renin activity shown by uprihgt loading and positive isoproterenol test. Autonomic dysfunction was observed such as revealed in positive dermography, positive cold pressure test and abnormal pattern in microvibration.In this case, a behavioral approach including cessation of self-measurement of blood pressure was effective to maintain the normal blood pressure and also to be free from his subjective symptoms. The β-blocker was found to be ineffective.

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The patient was a 52-year-old male who has been suffering from periodic, alternate symptoms of elevated blood pressure during a confused state and of diarrhea during a depressive state.He had a general tendency of hypertension. When confronted with psychologically stressful situations, he tended to be confused and at the same time show extraordinarily elevated blood pressure. Then, a few days later when the blood pressure would suddenly go down, he would suffer from diarrhea for a day or two and fall into a depressive state for one or two weeks.These symptoms were repeated periodically, and often accelerated by psychological stress.Characteristic signs were revealed by psychological tests. The EEG record showed abnormal findings, and autonomic function tests (adrenaline and pilocarpine tests) showd both sympathetic and parasympathetic hyperreactions. Organic disorders, however, differentially excluded.Included among the symptoms in this case were labile type of essential hypertension, irritable colon syndrome and atypic psychosis.Judging from the association with atypic psychosis, periodicity of symptoms and EEG abnormality, it was possible to assume that endogenous disturbance of the center of autonomic nervous system might exist, even though it could not be denied that psychological stress played a certain role in making these psychosomatic and psychotic symptoms manifest. Therefore, some endoreactive mechanisum could be assumed in this case, and his somatic symptoms, i.e. extraordinarily elevated blood pressure and diarrhea, could be considered equivalent to atypic psychosis which was related to depression or epilepsy.In summary, what is suggested in this case is as follows : 1) There can be a psychosomatic syndrome which includes in itself both labile type of essential hypertension and irritable colon syndrome.2) Being equivalent to atypic psychosis, the somatic symptoms in this case (extraordinarily elevated blood pressure and diarrhea) are considered as a masked type of depression or epilepsy.

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