In connection with a series of studies on the comprehensive medical treatment of peptic ulcers, the authors have previously reported, (1) results of studies on the basic mechanisms of ulcer healing, and (2) the influence of psychoneurotic factors on the healing process of gastric ulcers. This third report deals with the influence of tranquilizers in the treatment of ulcers, with special reference to a Thienodiazepine derivate Clotiazepam, on the psychoneuroendocrine fucntion and the healing process of ucers in patients with a gastric ulcer.The multiclinical study was undertaken ona total of 29 in -paetients with gastric ulcers, each of whom was afflicted with an active ulcer of more than 10 mm in diameter. They were treated with 30 mgr. of Clotiazepam a day for 8 weeks.Results obtaiend were as follows : 1) The Clotiazepam treatment was found helpful in 93.1% of the cases studied. The therepeutic spectra of the drug covered various anxiety and hypochondrial symptoms, and observation of time required for healing of an ulcer disclosed an acceleration of healing due to the Clotiazepam.2) Patients were classified into two groups, group A with psychosocial stress and group B without psychosocial stress. Of the 11 cases belong to group A, 5 (45.5%) were found to be healed at the end of the 4th week, 7 (63.3%) at the end of the 6th week and 10 (90.9%) at the end of the 8th week. In comparison among the 18 cases of group B, the numbers were 5 (27.8%), 7 (38.9%) and 15 (38.3%) respectively. The differences in manifest anziety scores before and after the treatment were -3.44±1.92 in group A and -0.44±4.92 in group B. There was a significant reduction of anxiety levels in group A.The improvement of clinical symptoms and the ulcer healing achieved by the Clotiazepam treatment satisfactorily paralleled the reduction of MAS scores and the normalization of the circadian rhythms of blood corticosteroid in a case of a patient with psychosocial stress and recurrent multiple ulcers. The above results showed that treatment utilizing tranquilizers for patients with gastric ulcers can be effective in patients with psychosocial stress and suggested that the stabilization of psychoneuroendocrine funciton achieved by the tranquilizer influenced and promoted the early healing process of gastric ulcers.

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This paper deals with depression which developed in a 39-year-old woman and a 44-year-old woman who had been on an ovulational inhibition agent for 2 years and 10 months and 2 years and 8 months respectively. It also contains a review of the literature which deals with the relationship between ovulational inhibition agents and depression.A number of studies have been conducted recently in order to clarify the relaitonship between depression and the endocrine system. In the present study, the endocrine function was inverstigated in relation to depression which was indcted by ovulational inhibition agents and which had been described by few investigators. Changes in endocrine funciton during the period of abatement of depression were also observed.TSH was normal before a TRH load, but a slight reaciton was induced after a 500μg intravenous TRH load. In the stumulaiton test for proloactin secretion which was performed simultaneously with TRH test, the basal plasma prolactin level was sligthly elevated and also showed a positive reaciton to the load. Further the blood levels of LH and FSH in the LH-RH test were elevated before and after the load, and the peak/basal ratio was normally elevated.Glucose tolerance was slightly abnormal after a 100 g glucose load. The thyroid function test was diminished, yet it was within normal limits : the adrdenocortiacal function test was elecvated.The urine levels of catecholamine metabolites decreased, and the ovarian funcition test was normal. When the ovluational inhibition agent was withdrawn and depresison was mitigated by an antidepressive agent, TRH test, stimulation test for proloactin secretion and both LH and SFH in LH-RH test all showed normal reactions.

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Since to date there has been no definite diagnostic criteria set for anorexia nervosa, its range is so often obscure taht its origin and therapy have yet to be established.Discussed are differences between two groups of eating disorders, e.g. the typical group of anorexia nervosa ("A" group), and the atypical one of anorexia nevosa ("B" group), 5 and 14 cases respectively, a total of 19 cases. For classification purposes, diagnostic criteria are mentioned as follows-.1. Main symptoms are eating disturbance and loss of weight.2.An organic disease that can account for the reason symptoms and psychosis are neglected.3. Ptients are not aware of being ill.4. Patients show inadequate hyperactivity.5. Patients acutually dislike being fat. "A" group patients exhibit symptoms 1 thorugh 5,while "B" group patients exhibit symptoms 1,2 and other various ones.We cannot find much differences between "A" and "B" group as far as their life situations and physical findings. Some abnormalities in endocrine system seem to be related to malnutrition. There are some differences in eating patterns, patients' attitude toward examination and the results of Rorschach tests.1. "A" group patients refuse to eat and sometime overeat, while "B" group patients appear not to be able to eat because of digestive symptoms.2. "A" group choose not to co-operate with treatment, while "B" group patients have some insight into thir psychological problems.3. Following administration of Rorschach tests, the "A" group is sub-divided into two groups, and the "B" group is sub-divided into various groups according to the patient's clinical type. In general it may by said that "A" group patients have a worse prognosis than do "B" group patients.

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Although medical emergency care is an important role of primary care medicine for general practitioners, there are a very few papers in this field written by general practitioner themselves.For this reason, the author studied by actual observation, ambulance carried patients during last five years at his own clinic, where a psychosomatic approach was performed on all patients. The results were as follows : 1. In a total two hundred seventy seven cases, 186 (67.1%) of them did not need any emergency care and could go back home immediately after ordinary treatment ot he out-patients floor.2. Of the total number of patients, there were seventy eight (28.2%) cases whose illness was diagnosed as psychosomatic by the initial interview. The most frequent disorders were hypertension and peptisc ulcer in male patients, and hyperventilation syndrome due to conversion hysteria in female patients.3. These psychosomatic cses were treated with various psychosomatic therapies and significant effectiveness was obtaiend in all cases. The results suggest that a psychosomatic approach is essential in primary care of patients arriving by ambulance.

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Statistical studies on the clinical picture of anorexia nervosa were carried out. A preliminary investigation established that criteria for the diagnosis of anorexia nervosa can be defined as follows;1. loss of more than 20% of standard body weight, 2. a history of weight loss for more than three months, 3. age of onset less than 30 years of age, 4. female, 5. amenorrhea, 6. eating disturbances, 7. desire to reduce body weight, 8. hyperactivity, 9. denial of the existence of disease, 10. absence of evidence of organic disease or endogenous psychiatric disease.A typical case is a patient who fills all of these ten criteria. The patient who fills criteria numbers 1,2 and 10 is termed an atypical case.In the present investigation, detailed data on the 47 typical and the 186 atypical patients, a total of 233 cases, were collected from thirty five univertsity hospital throughout Japan. The incidence of signs, symptons, laboratory data, endocrinological data and data of hypothalamo-pituitary function tests was inverstigated. Among the signs, the incidence of bradycardia and hypertiricosis showed significant difference between the typical and the atypical cases. These signs are useful for the diagnosis of anorexia nervosa. Factor analysis of the symptoms of anorexia nervosa was carried out using a computer.Most patients had certain endocrinological abnormalities especially in hypotalamo-pituitary function. Statistical studies indicate that at least some of the abnormalities such as abnormal value of serum growth hormone might be secodnary changes due to the weight loss itself.However, other abnormalities such as an abnormal luteinizing hormone secretion might be due to hypothalamic dysfunciton.In the clinical course of the disease, 7 patients out of 233 studied, died including three (6.4%) of the 47 typical cases.These studies were supported in part by the Research Grant for Ministry of Health and Welfare of Japan.

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Reported is a case of a 23-year-old female who recovered from anorexia nervosa after Naikan therapy. A discussion of how her guilt feelings changed throughout the treatment is included.The patient had developed a serious physical conditions; namely, severe emaciation (body weight : 27 kg) associated with anemia, leucopenia and hypoproteinemia. Although her personality was rather introverted, she was not hysterical and she desired treatment. We treated her with Naikan therapy, when she recovered from her critical physical situation.The patient had guilt feelings before treatment as well as after Naikan therapy, but the contents of these feelings were very different. Before the treatment, she had an unconscious dissatisfaction with and hatred of her persional environment. She was ambivalent, suppressed her natural feelings strongly, and behaved inactively. After Naikan therapy, however, she became active and expresesd her feedlings and thoughts freely. Her conscience also began to work unrestrifctedly. This case suggests that Naikan therapy provides the patient with important psychological changes from the state of so-called 'conscience agony' to that of 'free conscience'.In other words, while the guilty state of the conscience agony is governed by the superego, forcing her ego to withdraw, the healthy guilt feelings of the free conscience are integratred within the ego. The authors consider this similar to the 'pure' guilt feelings which Yasunaga pointed out while working with the psychotherapeutic approach. Thus, it seems important to be aware of these possible psychological changes when treating nuetrotic or psychosomatic patients with Naikan therapy.

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This report deals with a girl who was diagnosed at the age of 12 years and 5 months as haivng anorexia nervosa. She eventually lapsed into a semicoma which lasted 3 weeks and died at the age of 14 years and 11 months after haivng been treated in hospitals by pediatricians, psychosomatic physicians and psychiatrists respectively.The principal autopsy findings were extreme emaciation (height 148 cm, body weight 20 kg, fatty liver, suspicion of pellagra), and acute hepatitis with marked jaundice and neagtive Auantigen. The hypothalamic region was microscopically normal. Cortical atrophy of the adrenal glands was found but the other endocrine glands normal.It should be noted that there were different opinions regarding the prognosis of anorexia nervosa and that there is a possible relationship between the different opinions and the characteristisc of the disease itself. Anorexia nervosa differs from other neutrotic disorders in respect to the secodnary somatic damages top the patient. It is therefore of the utmost importance that a veriety of procedures be used in an attempt to make such patients take food again.In the present case, from a retrospective viewpoint, doctors should have established more difinite goals for treatmebnt, giving priority to making the patient take the necessary foods. In order to successed in this treatment, more resolute attitudes should have been adopted toward shaping food taking behavior.At present, more effects need to be made to elaborate such procedures and to make the best use of these techiniques in treating anorexia nervosa.

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A 42-year-old man was admitted to our internal medicine department with complaints of nausea, epigastralgia, melena, headache, slight fever, polydipsia and polyuria. He has cerebral palsy due to high fever in infantile period. At the age of 28,he suffered a head injury from a traffic accident, lost consciousness for a week and lost the sight of his left eye. Two weeks after the accident he began to drink twenty litres of water a day, but this gradually subsided.At the age of 30 he complained of anorexia, nausea, epigastralgia, melena and anemia for the first time. A G-I tract survey could not ascertain the site of bleeding. At the age of 32,39 and 41 he complained of similar symptoms, the duration of which was from several months to several years. Physical examination revealed a similar abdominal tenderness and headache in each episode. Laboratory examinations done by several institutes revealed no organic disease which could account for his compants. An EEG showed a non-characteristic pattern (e.g. slow α wave, bursts of slow waves simnilar to a spike-and-wave complex).Summarizing his symptoms and signs, we found that they occured paroxysmally and repeatedly and were fixed and stereotyped. We also found that there were intermittent periods when no complaints existed. Consequently, we diagnosed him to have autonomic epilepsy caused by his head injury, evebn though the EEG was not characteristic of the usual autonomic epilepsy (i.e. 6 & 14 waves). We feel this case is peculiar due to its beginning after head injury, its long duration of attacks and the accompanying melena.

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It has recently been reported by several investigators that some patients of brain tumor in the hypothalamic region show a characteristic syndrome similar to anorexia nervosa.The present paper describes two cases of pinealoma wiht such an 'anorexia nervosa syndrome'.These patients, a 14-year-old boy and a 13-year-old girl, were hospitalized with persitent anorexia, marked weight loss, hyperkinetic behavior and emotional instability. At the beginning of admission, diagnosis of anorexia nervosa had been strongly suspected because of no aparent neurological signs slthough a mass lesion suggesting pinealoma was found in front of the 3rd ventricle of each patient by further examination. Subsequently, close relationchips were observed between diminishing of their psychiatric and decreasing of the tumor seize resulting from radiaiton therapy.Based on the above clinical observations, the possible causes of these clinical features were discussed in relation to the dysfunciton of the neuronal circuit via the hypothalamus and the feeding center in the lateral hypothalamus.

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