Five patients with chronic pains in the various parts of the body such as muscular pain of the extermities and trunk, aticular pain, backache, etc. were reported. in addition to these pains, they had other somatic symptoms and emotional disturbances. Physical and neurological examinations showed no organic changes. Laboratory data were normal except for EEGs, in which minimal EEG abnormalities such as 14-6 Hz positive spikes and 6 Hz phantom spike and wave complexes were found in all the patients. Form the EEG findings, chronic pains in the present paper are regarded as one of central autonomic nerve and emotional disturbances of an epileptic nature in the broadest sense of the term. However, we would like to stress that these patients should be treated from a viewpoint of psychosomatic medicine, because they showed a neurotic tendency which was apparently caused by unsuitable diagnosis and treatment.

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The effects of music and diazepam on state anxiety and psychological functionings in 49 surgical patients admitted to the National Cancer Center Hospital were investigated.Subjects who had medium anxiety were selected. Fourteen patients were assigned to nontreatment group, 19 to a music group and 16 to a diazepam group.1) State anxiety measured by STAI significantly decreased from 3 days before operation to just preperative state in the diazepam group, while in the non-treatment group, a slight increase in state anxiety was observed.2) With respect to the stroop color word test, increased performance of confictual color word tasks under music therapy, seems to indicate increase ability to focus attention on the task, whereas significantly decreased performance on simple color naming tasks after injection of diazepam, may be a result of distubed functioning of attention.3) The critical flicker fusion test, which is an overall index of cortical activity, was markedly lowerd by an injection of diazepam, while under music therapy, such a change was not evident.4) From this evidence it may be concluded taht music has asedative effect on preperative patients and that utilization of the sedative effects of music shows promise as a therapeutic aid.

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The present study dealt with the relationship between the psychophysiological findings by means of Visual Evoked Response (VER) and psychic condition of patients with hyperventilation syndrome (HVS). There were 12 subjects al of whom were above 12 years of age (6 males and 6 females). Visual Evoked Potentials (VEPs) and Vertex-potentials (V-pot's) out of VERs were recorded simultaneously at rest and at 2 to 4 minute intervals during hyperventilation by means of a Digital Computer (ATAC-201). The amplitudes of VEP and V-pot were measured between the negative peaks (at about 100 msec) and the positive peaks (at about 200 msec). Thus the changes in amplitudes of VEPs and V-pot's under hyperventilation were examined for correlation with manifest anxiety in the patient with HVS.The results were as follows : 1. In the five patients with HVSs caused by anxiety neurosis, the amplitudes of VEPs on two (40%) and those of V-pot's on four (80%) increased during hyperventilation. An average amplitude of V-pot's during hyperventilation indicated a sgnificant increase (P<0.02) as did those of anxiety neurotic patients.2. In the five patients with HVSs caused by hysterical neurosis and two caused by nonneurosis, neither the amplides of VEPs nor those of V-pot's increase during hyperventilation as did those of hysteric and obsessive-compulsive neurotic patients or normal adults.3. These results suggest that V-pot's, which is dependent on a non-specific pathway, is affected by a psychic condition. The amplitudes of V-pot's in HVSs by anxiety neurosis may increase because manifest anxiety depending on anxiety neurosis becomes much stronger during hyperventilation. On the other hand, the amplitudes of HVSs by hysterical neurosis may not increase because manifest anxiety hardly becomes stronger during hyperventilation as the anxiety in hysterical neurosis is already converted into a physical symptom. These results also suggest that V-pot might afect VEP which is dependent on a specific visual pathway, and thus V-pot might cause correlated change in amplitude of the secondary component of VEP.4. We ponited out that the varied psychic conditions of HVS might be distinguished by means of VER, that is the recording of VEP and V-pot. We also indicated the psychophysiological methods dscribed above might be useful to clinical treatment for HVS.

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Studies were made to evalute biofeedback therapy for migraine and muscle contraction headache. The results were as follows.1) Fifteen individuals suffering from migraine headache were trained by skin temperature biofeedback in the usual finger warming procedure with the omission of autogenic phrases. In ten (76.9 per cent) of these patients excluding two drop-outs, significant relief from migraine headache was obtained.2) EMG biofeedback treatment was performed in 27 patients with muscle contraction headache. A favorable response was elicited in fifteen (71.4 per cent) of those excluding six drop-outs.3) Cornell Medical Index (CMI), Yatabe-Guilford test (Y-G test), Manifest Anxiety Scale (MAS) and Self-Rating Questionnaire for Depression (SRQ-D) were administered to 42 patients who received the biofeedback therapy at their visit. There was a tendency that patients with muscle contraction headache showed area IV in CMI and type E in Y-G test more frequently than those with migraine. They showed higher scores in MAS and/or SRQ-D than those with migraine.4) Comparisons by psychological tests between respondents and nonrespondents were made. There was a tendency that respondents for EMG biofeedback among those with muscle contarction headache showed lower scores in MAS and /or SRQ-D than total of those.5) The effect of biofeedback on the automic nervous system by plasma Dopamine-β-Hydroxylase (DβH) activity was studies in three migraine headache patients. Plasma DβH activity was measured before and after each training session first, 4 weeks and 8 weeks later. Plasma DβH activity was reduced at the training session 8 weeks later.Additionally was reported two cases : one was a migraine patient whose headache activity decreased by EMG biofeedback therapy, and the other was a patient with muscle contraction headache who was first treated with EMG biofeedback training without positive response and treated later with skin temperature biofeedback with positive response.

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The authors investigated the effects of EMG biofeedback training on heart rate and subjective pain ratings during the cold pressor test.The subjects were 22 preoperative surgical patients who had been admitted to the National Cancer Cencer Hospital. All of them recieved the first cold pressor test (30 sec immersion of the ice water) one week before their surgical operation and the second cold pressor test after the following conditions were fulfilled. In two of teh thre conditions, patients were given EMG biofeedback training either for decreasing (Dec-BF) or for increasing (Inc-BF) EMG activities. Remaining condition was a no-training control. In Dec-BF, patients were asked to decrease their EMG activities before the second cold pressor test, while those in Inc-BF were asked to increase their EMG activities.Significant differences in heart rate and subjective pain ratinds were obtained among the three groups during the second cold pressor test. The largest difference on heart rate during the second cold pressor test was observed between Dec-BF and either Inc-BF or Control. Patients in Dec-BF showed a significant slowdown of heart rate during the second cold pressor test. The mean ratings of pain in the second cold pressor test for Dec-BF, Inc-BF and Control were 6.29,6.88 and 7.71 respectively. Difference between Dec-BF and Control reached significance.The above results suggest a possibility of clinical application of EMG biofeedback training to the control of pain reactions.

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It is well known that some patients with bronchial asthma show superficial adaptive patterns in interpersonal relationship, but also show peculiar cognitive distortion. The research has been conducted by devising a psychological test, whose aim is to grasp cognitive distortion in a concrete from and to quantify it. The aim of our test is to examine the discrepancy in the patient's inmost mind, personal and external attitudes which could not be grasped by the conventional test, and also to examine his mental tension by adding the blank of projective speculation response to PF-Study.The subjects of our study included 11 female asthmatics and 14 healthy females who filled up to blank of projective speculation response as well as PF-Study. The projective speculation responses were classified into three categories, that is, 1) confusion response, 2) disagreement response and 3) reject response. The total number of these problem responses was also summed up. As the result, the finding was very significant in that the patient-group showed the problem responses in 12 scenes. Particularly, the disagreement response, which seems to be related to emotional tension, can be identified in 33.7% of scense of PF-Study by the patient-group, whereas it is 0% by the control-group.By analyzing 12 scenes where the patient group showed cognitive distortion, it has been found that they are related to private and interpersonal rather than social situations.

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[in Japanese]

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A number of researchers had reported that depression revealed a lot of neuroendocrine disturbance. Our previous studies (TSH response of TRH test in depression) suggested also neuroendocrine abnormality in pituitary hormones. But the studies of LH and FSH response in LH-RH test were very few in previous literatures.We experimented two cases of postmenopausal depressed women by comparing LH and FSH responses in LH-RH test before and after treatment.Case 1 was a 63 year-old menopaused female diagnosed as involutional melancholia. She complained of anorexia, restlessness and insomnia, and given trimipramine 25 mg and sulpiride 100mg per day by oral administration. Her clinical course was favorable remittent for 2-3 months, and her complaints such as appetite loss, anxiety and insomnia disappeared. Psychological test of depression score (SRQ-D) showed improved responses both in depressive and remittent states. As demonstrated by Altman et al., LH concentration of Case 1 was lower than the control.Case 2 was a 51 year-old female diagnosed as monopolar depression. She complained of dizziness and diminished drives, and given nortriptyline 25 mg, sulpiride 100 mg and lorazepam 1 mg. Her clinical course was relatively favorable, and psychological test revealed improvement. Her main complaints such as dizziness and diminished drives also subsided. LH-RH test revealed hyper-well response in a deprssive state and lower response in a remittent state.It was considered in Case 2 that changes of LH response would be corresponded to depressive phase. According to the above two cases, endocrinological change might be associated with the clinical classification.

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The patient was a 36-years old female. She had been treated at 17 under the diagnosis of deprssion. She visited our hospital with the complaints of fever, sore throat, general fatigue, loss of appetite, insomnia, irritability and depressive mood. In examination, struma was touched with tenderness and a diagnosis of subacute thyroiditis was made subsequently. She seemed to have developed depression during her clinical course.No report has not yet been found as to subacute thyroiditis which induced symptomatic depression. In this present case drug induced depression could also be denied. As the result, this case was most likely to be suffering from endogenous deprssion on the basis of her past depressive episode.

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We reported two cases with psychogenic pains. They complained of persistent pains and visited various hospitals. Each had local anesthesias and acupunctures as well. Personality deviations common in these two cases were lack of reality-testing and cooperation, rigidity and persecution complex. MMPI showed high scores in hypochondriacal. depressive and hysterical scales.Case 1 was a 30-year-old male with psychogenic facial pains which had persisted over 6 years. Communications in his family were very poor and limited, and he strongly supressed aggression towards his parents and his younger brother, which seemed to be closely related to the symptom formation.Case 2 was a 39-year-old female with conversion hysteria who had had abdominal operations four times. She began to complain of abdominal pains seven years ago when she had an operation of myoma uterii. Total removal of uterus may symbolically suggest the loss femininity Besides abdominal pains, she showed hyperventilation, opisthotonus and astasia.As for the drg treatment, benzodiazepine derivatives, carbamazepine an tricyclic antidepressant were not effective to Case 1 and Case 2,but relatively high doses of levomepromazine were effective to those cases. Levomepromazine might be a useful drug when the patient resists various drug and other treatment.

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