Even under similar varieties of psychological stress, the specific stress-reactive organ differs from one individual to another ; this represents one of the biggest Problems in psychosomatic medicine. In order to delineate the cause of such variation in organ selection, a Stress interview was performed on 60 patients. The experiment provided the following results. (1) With regard to psychosomatic diseases, significantly increased biochemical variables were : free fatty acid in all diseases, gastrin in peptic ulcer and irritable colon, cortisol in irritable colon and urinary noradrenaline in peptic ulcer. (2) Using the psychological tests, the sixty subjects were divided into two groups, psychologically stable and unstable. In the over-all index of variables there were no significant differences between two groups; however, taken individually, the unstable group showed more significant differences than the stable group in terms of specific variables. (3) On the basis of frequency of GSR during the stress interview, subjects were divided into two groups, high GSR and low GSR. No significant differences between two groups were noted. However, on the basis of individual variables, the high GSR group revealed significant increases of gastrin, cortisol, FFA and noradrenaline, while the low GSR group only increases in FFA and adrenaline. (4) Labile hypertension showed the highest increases in blood pressure and heart rates. Normotension, with a family history of hypertension, was more responsive to cardiovascular reactions than normotension without a family history of hypertension. It may be concluded that individual-response-specificity has much to do with the organ-selection problem in psychosomatic disease, and that hereditary factor is important in this specificity.

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Bronchial asthma can be caused by allergy, infection or psychological factors. Therefore such factors as conflict, suggestion, anxiety, anger, repression, frustration can be a direct or indirect trigger of the desease. Also asthma to patients are said to have tendencies of emotional unstability, introversion, nervousness etc. We paid our special attention to the nervousness indicated in Yatabe Guilford test (YG) and conducted a statistical study in bronchial asthma and chronic urticaria patients on the correlation among the scores of nervousness, neurotic tendency of the Cornell Medical Index (CMI), anxiety points of the Manifest Anxiety Scale (MAS) and the degree of Severity of asthma determined by Dr. Ohshima's Classification. Subjects were 132 patients with bronchial asthma and 45 with chronic urticaria who visited the Dept. of Clinical Immunology, Dokkyo Univ. School of Medicine for the past three years. The results are as follows : 1) The prtients weve grouped into two groups, normal and abnormal, in all these 3 tests. In YG, the normal group consisted of D, C, A and the abnormal B. E types; in CMI, areas I, II were considered normal and areas III, IV abnormal; in MAS, 0-20 points normal and, over 21 points abnormal. x^2 test was conducted between these normal and abnormal groups. No significant difference was found between asthma and urticaria. although they showed a higher incidence of abnormal groups when compared to the normal control as reported previously. 2) In asthmatic patients, correlations were studied with x^2 test among the scores of nervousness on YG (0-10,11-20), of anxiety on MAS (0-1,11-20,over 21) and the degree of asthma (mild, moderate, severe). As a result, nervous patients showed that the aggravation of disease coincided with the increase in anxiety (p<0.05). 3) D and C types of YG decreased in severe asthma. 4) A positive correlation was found between aggravation of asthma and neurotic tendencies (p<0.01). 5) In asthma and urticaria, nervous patients were liable to have neurotic tendencies. 6) A posititive correlation was detected between nervousness and anxiety (p<0.001 on asthma, p<0.01 on urticaria).

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One hundred seventeen patients with functional enuresis were treated with modified Mowrers' conditioning therapy. Among them, 58 were judged as cured and 31 as ineffective. The treatment was not completed in 28 p8tients because of various reasons. Relapse occurred in 10 "cured" patients Eight of them were those who awoke spontaneously for micturition after the therapy.

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The subjects in this study were 18 patients (mean age 37.0) diagnosed as psychogenic dizziness, in whom the occurrences of the symptom were associated with psychological factors proper to the individuals and the symptom was chracterized as a feeling of faintness. No significant abnormalities in neurological and laboratory examinations, which might be related to the dizziness, were found in these patients. Characteristics of their personality derived from the interview were such as nervousness, perfectionism, tendency to tension, dependency and immaturity. Results of Rorschach test suggested that, because of their immature personality, they could hardly maintain the ego stability and then the rationality tended to be confused against emotional stresses. The psychogenic factors in these patients were such as indemnity problems relating to traffic accidents (6 caases), sexual conflicts (7 cases) and inbstability in one's social situation (5 cases). When the patients were introduced to the stressful words concerning their psychogenic factors, vertebral flows measured by Doppler ultrasound decreased down to approximately 10% of those in the resting state and they simultaneously felt the faintness, whereas they showed no responses to common words. From thee results, the principal psychophysiological process in psychogenic dizziness was thought to be transient vertebro-basilar insuffiency via sympathetic vasoconstriction induced by a reaction of the specific immature personality to critical emotionl stresses.

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In order to investigate psychological factors in chronic rheumatoid arthritis (RA), 49 RA patients And 58 controls were given the Cornell Medical Index (CMI) revised by Fukamachi. The results of the tests showed that 28 out of the 49 RA patients (57.1%) fell into the neurotic area, while 12 out of the 58 controls (20. 6%) fell into the neurotic area. The difference h these neurotic traits between the two groups was statistically significant. In RA cases with the onset in old age, 7 out of 10 patients (70%) fell into the neurotic area, whereas in Malignant Rheumatoid Arthritis (MRA), all 6 patients (100%) belonged to the neurotic group. In order to determine whether psychological factors in RA were primary or secondary in origin, the correhtion between the stages of RA and the neurotic area indicated by the CMI was investigated, but no correlation was found. The profiles of the CMI were reviewed and were grossly classified into 5 types. Types 1 and 2 were considered as psychologically normal, Types 3 and 4 as sub-neurotic, and Type 5 as neurotic. Furthermore, 17 RA patients were interviewed in order to determine precipitating factors. Seven out 17 (41%) showed Buck factors. Two revealed psychic stress, 2 infection, 1 physical trauma, 1 exposure, and 1 over work. Thus, 2 RA patients in whom psychic stress worked as a precipitating factor were interviewed intensively, and case reports were presented. These patients showed introvert characters along with anger and irritability. When one's so-called rheumatic disposition is connected with a personality which is specific for RA, the so-called psychosomatic unit is formed. Under these circumstances, it is asumed that if psychic Stress works as A precipitating factor, apossility of the said person getting RA arises.

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A 7-year-old boy had a symptom of alternating divergent squint, the degree of which showed variations according to days of examinations and state of his emotions. Application of psychotherapy (sand play technique) resulted in improvement of the squint. The author assumed that psychogenic factors might play a role in the occurrence of the squint in addition to the conventional neurophysiologic factors.

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Three cases of tongue thrust in speech were reported. The patients were a 33 year-old male public service worker, a 26 year-old office girl, and a 56 year-old widow who had no family history of neurological nor mental iliness. They all had been mentally and physically healthy people, and socially well-adjusted. Although they had to talk tb many people in their social life, they were well-adjusted and had no feeling of anxiety in the situation before the onset of the symptom. Two of them visited our clinic 6 months after the onset and one patient came to us 3 yaps after the onset. The common symptom amongst the 3 patients was as follows : the tongue was protruded out of the mouth while speaking but showed normal movement in swallowing, whereas it was in the normal position at rest. We found no neurological disorder on physical examinations. The patients showed slightly obsessive-compulsive tendencies, but no other neurotic sigrl nor symptom. They denied preceding traumatic events in relation to the onset. We maintained that the symptom was functional in nature, and treated two of them with autogenic training and the remaining one with negative training. The synmptom disappeared in response to these approaches in all cases. Thus the results have confirmed our initial diagnosis.

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