Doctor-Patient Relationship was studied in this report on bronchial asthma through an questionnaire and three psychological tests-Yatabe Guilford test (YG), Cornell Medical Index (CMI) and Manifest Anxiety Scale (MAS). The questionnaire about asthma and its treatment was presented to 14 doctors who worked at the Department of Clinical Immunology, Dokkyo Univ., School of Medicine, the Allergy Clinic of Physical Therapy and Clinical Medicine, Tokyo Univ., Scool of Medicine and an affiliate allergy clinic in Tokyo.The questionnaire recealed the following six points.1) Doctors gave a good explanation to the patients about the type and severity of asthma, as weel as possible prolongation of treatment before they began to treat the patients.2) In caes of severe asthma, steroid hormone was fully given at the early stage of treatment and then decreased gradually.3) Skin test was given and hyposensitization therapy was conducted when the test was positive.4) A half of the doctors recognized that hyposensitization therapy was effective.5) Doctors realized that bronchial athma was not a curable but manageable disease.6) Patients who responded mentally to doctor's approaches were apt to improve.According to the three psychological tests : 1) Almost all 14 doctors showed normal patterns and 135 out-patients showed slightly abnormal patterns in YG in comparison with the normal control.2) Doctor's YG profiles were compared with of patients. YG profiles of two of five doctors were found to be prominent in their patients' YG patterns.3) Psychological tests were conducted twice to 31 patients-at the first visit to our clinic and a year later. Three attending physicians who treated them had different YG profiles with no neurotic tendency and different anxiety levels. After one year of treatment, similar profiles of YG to doctors' increased among those patients. No definite change, however, was found in CMI and MAS.

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A total of 263 patients with functional enuresis were examined in this study. Their ages ranged from 4 to 22 years. Two hundred thirty-six cases (90%) belonged to the persistent type and the remaining 27 to the aquired type.Twenty-two out of 27 aquired type of patients (81%) had had the history of spontaneous awaking for micturition before enuresis began, while only 57 of 1,017 healthy children (6%) were proved to have such a habit.Twenty-four of 27 such patients (89%) were found to have experienced certain psychological or physical stresses just before the onset of their enuresis. Such stersses were likely to cause supression of their spontaneous awaking and subsequent appearance of their enuresis.Most of the patients with the persistent type of enuresis were shown to have had pollakisuria even in thier diaper period and also a tendency not to be woken up easily. A combination of these two factors, i.e. decreased urine keeping capacity and deep sleep, was thouth to cause enuresis in these patients. It was also suggested that psychological astresses increased urinary frequency and thus aggravated enuresis.

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Many clinicians have observed the influence of emotional stress on the prognosis of infectious disease, autoimmune disease and malignant neoplasia. Recently, the immune system is regarded to be similar to the central nervous system and endocrine system to maintain the homeostasis of the body. Furthermore, recent basic studies of immunology clarify its similarity to the central nervous system to maintain the integrity of the organism in relation to the external environment.This suggests that the immune system is very important as a pathway through which emotion influences the prognosis of the cancer patient.In order to clarify this pathway in detail, the authors utilized the animal experiment. C3H/He mice are used to be recipients for transplantation ofEL-4 leukemia cell. Sterssed groups were given sterss by buzzer and electricity for three days before and following the immunization. EL-4 cells (5×10) were injected in the subcutane of mice recipient). Eleven days after immunization, spleen cells (effector cell) of the recipient were prepared and cytotoxity tests were performet. 51-Cr traced target cells (EL-4 cell) and effector cells (spleen cells) were incubated for four hours and then released 51-Cr in supernatant was measeured. Results were that suppression of cytotoxity occurred in the stressed groups.In another experiment, using CRBC (chicken red blood cell) instead of EL-4 cells, stress also suuppressed the function of cytotoxity of killer cells.Our two experiments show that stress can influence the function of the killer cell and suppress its cytotoxicity.

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Recently, a group of out-patients are being observed in our urological department who complain strongly, repetively, or for a prolonged period of subjective symptoms which do not correspond to the results of urological examinations (such as pain, unpleasant feeling, or hot feeling in or around sexual organ). Therefore, thenecessity of psychosomatic treatment for these symptoms is being recognized.However, in our country, only a few papers have been reported on this problem. Under the cooperation of our psychiatric department and urological department, a new division was established in our urological department, where psychosomatic diagnosis and treatment are given to out-patients. Our present report is concerned with the results obtained in the course of diagnosis at this new division.The subjects consisted of 1) those who were found negative in bacteriological and incubation tests of urine after prostrate massage; 2) those who were found positive in bacteriological test but whose subjective complaints did not correspond to our objective findings; and 3) those who had stronger push-pain in prostrate at manual examination. All of these patients also had the above-mentioned subjective symptoms. These cases were diagnosed as "chronic prostatitis".We also examined for comparison a group of patients with "chronic prostatitis" for whom psychosomatic care was not necessary. The subjects were 24 males in total, whose ages varied from 20 to 76(average : 41 years-old). The number of subjects in each age group was as follows : age 20-29-8; age 30-39-7; 40-49-none; age 50-59-5; age 60-76-4.The time required from the subjects' first visit to the commencement of psychosomatic diagnosis and the number of patients involved are as follows : less than 1 year-7; more than 1 year and less than 2 years-9; more then 2 and less than 3 years-4; 4 to 8 years-4. the results of diagnosis and the number of subjects were as follows : 1) Group of Neurosis : 10 (41.6%)a) Subjects with neurotic symptoms characterized by conflict concerning masculine identity 6-(25%)b) Subjects whose neurotic conflicts were inherent, but not clinically observed and social adaptation was easy-2 (8%)c) Subjects with iatrogenic neurosis with anxiety, or hypochondriac symptoms-2 (8%)2) Subjects with psychosomatic symptoms in a narrow sense-8 (34%)3) Subjects whose psychological factors are typical to the old age-4 (17%)4) Subjects in whom no particular psychological problem was observed-2 (8%)

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Polygraphical examination was conducted during systematic desensitization therapy of five patients with acture anxiety attacks and anticipating anxiety. Determinations were simultaneously made of the following parameters : GSR, digital plethysmogram, electrocardiogram, cardiotachogram, respiration, EMG, peripheral skin temperature and abdominal peristalitic murmurs. Polygraphical responses induced by the imagination of fearful scenes in hierarchy of anxious situations were recorded before, during and after the systematic desensitization procedure. Anxiety attacks and anticipating anxiety improved completely in all the patients after the treatment.The results were summarized as follows;1) Changes in GSR, respiration and digital plethysmogram were triggered by the imagination of a fearful scene, while no response induced by the imagination of a meaningless scene.2) Degree of the polygraphical response corresponded to the degree of subjective unit of disturbance in the hierarchy.3) THe polygraphical response disappeared during the desensitizatin process along with a decrease in subjective unit of disturbance.4) The imagination of the fearful scene that had produced marked polygraphical responses initially did not produce any polygraphical response after the patients were successfully treated by the systematic desensitization therapy.5) Presentation of the polygraphical improvement to the patients played an important role in their understanding of the progress of the treatment. Advantages and limitations of the application of polygraphical examination to the systematic desensitization therapy were also discussed.

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In a case of house-wife of 49 years old, who had been suffering from attacks of chest pain resembling angina pectoris for 4 years, a diagnosis of anxiety neurosis was given by a psychosomatic analysis after her hospitalization. Her electrocardiogram was monitored and recorded frequently during attacks; however, no abnormal ST, T change was observed even during her attack. Also in her coronary angiography, no abnormal coronary occulusion was recognized. She had several kinds of familial throubles in her life history. In addition, repeated events of death in her family and relatives promoted fer attacks. Thus we found that there was a close relation between her attacks and her psychological factors. As she understood that she had no coronary heart disease, her complaints gradually improved and her attackes disappeared completely 2 months later.It was concluded that a combination of careful observation of continuous monitoring electrocardiogram and psychoanalysis was important for differentiating real angina pectoris from anxiety neurosis resemblimg angina pectoris.

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This is a case report of a 24-year-old woman with irritable colon syndrome and depressive state who was improved by Autogenic Training (A.T.) and a small group of Transactional Analysis (T.A.).She visitted our clinic with complaints of bad smell, flatulence and constipation. On examination, no organic change was found except for gas accumulation in the adbomen by X-ray. She was found to have neurotic and anxious character traits by psychological tests.A.T. and group T.A. were applied together with some medication. She was relaxed by A.T. and was soon freed anxiety and tension. In the group therapy of T.A, , she came to learn thet she was functioning mainly as an adapted child and a critical parent.By 6 months training, she was able to express herself as a free child and to achieve the goal of treatment She has no longer been bothered by flatulence and had smell since.

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