Taylor's Manifest Anxiety Scale (MAS) and Depressive Scale (DEPS) were conducted in 57 patients with Duchenne type muscular dystrophy (DMD) to study the relationship between their somatic factors and psychological factors. The following results were obtained.1) The scores of MAS and DEPS did not run so significantly parallel with the disability stage and duration of illness.2) The number of patients with high scores of MAS, DEPS were increased significantly in cases with far advanced disability and long duration of illness.From above standpoints, the patients with DMD did not seem to show anxiety state and depressive state, by psychological test in comparison with their disability. The discrepancy between somatic factors and psychological factors remained to be solved. It was suggested that more cases with DMD should be examined to clarify these points.

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Subjects were 39 patients with Behcet's disease (25 males, 14 females) and 36 ones treated with dialysis (24 males, 12 females). They were evaluated by Cornell Medical Index (CMI), Manifest Anxiety Scale (MAS), author's own questionnaire about some sociopsychological problems and inerviews.The results were summarized as follows;1) About one-half of the subjects were found the III and IV areas of CMI.2) The profiles of physiological complaints in CMI showed a pattern related to the special symptoms of each disease. However, with regard to psychiatric complaints, there were no differences between both diseases.3) Significant correlations between scores of CMI and MAS were obtained, particularly in the "inadequacy"-item.4) The mean of MAS scores were as follows;Behcet's patient, meles : 19.7±9.7,females : 22.5±10.0. Dialysis, males : 19.6±9.3,females : 19.6±6.1. In females with Behcet's disease, the scores of MAS were correlative to the duration of illness. However, in the dialysis' patients, the scores of MAS were the highest in less than one year after the beginning of the treatment.5) For the patient with Behcet's disease, in males with ages from 40 to 59 scores of MAS were the lowest, whereas the scores were higher in both sexes from 40 to 59 years with dialysis.6) In Behcet's patients, anxieties were markedly correlative to the complaints of CMI. However, in dialysis' patients there were some discrepancies between anxiety-manifestations of the two personality tests and the evaluation of interviews.

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The present study was performed, in order to find a better method of short-term psychological stress loading test from the standpoint of changes in plasma catecholamines during rest and postural changes. Subjects were 30 male students. The tests began at 9 : 00 a. m. and the the subjects were asked to lie in a supine position for 60 minutes, sit for 30 minutes and lie for another 30 minutes. Blood pressure, heart rate and plasma catecholamines were measured. As a method to detect catecholamines, high-speed liquid chromatography with THI metod was used.The results were as follows : (1) Systolic blood pressure decreased during rest and postural changes from supine to sitting. Diastolic blood pressure did not show significant changes. Heart rate showed a tendency to increase from supine to sitting and decreased from sitting to supine.(2) Plasma norepinephrine decreased markedly at the beginning of rest and came to the plateau after 30 minutes. With the postural change from supine to sitting, the levels increased about two times, came to the plateau after 10 minutes after slight decrease, and decreased promptly by postural change from sitting to supine. Plasma epinephrine decreased by rest and came to the plateau in 30 minutes. However, it did not show a significant change according to postural changes.(3) There were no correlations between blood pressure and catecholamine changes. Correlations were found between heart rate and catecholamines.(4) Changes of norepinephrine were dependent on the values obtained prior to postural changes.From these results, we postulate that the following two points need to be considered concerning short-term psychological stress loading test. (1) The rest is needed at least for 30 minutes. (2) It it better not to change postures during study. If needed, however, the test should be started after the stabilizatino of plasma norepinephrine (for 10 minutes in sitting positio after 60 minutes' recumbency).

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Fifty-two patients with chronic abdominal pain were studied psychosomatically as to psychosomatic diagnosis, and the results were summarized as follws : 1. While male patients consisted predominantly of those with their ages above 40,female patients predominantly of those under 39.2. Exclusive diagnosis, positive diagnosis and therapeutic diagnosis were made to our subjects at the same time and the results revealed that the incidence of decisive factors for therapeutic diagnosis was as high as 44%.3. High incidences of the final diagnoses included chronic pancreatitis, which was 40 percent, followed by irritable bowel syndrome, which was 19 percent.4. With regard to incidences of complications, irritable bowel syndrome ranked first, followed by biliary dyskinesia, followed by depression and neurosis in that order.5. Fatal diseases, such as cancer of the pancreas and colonic tuberculosis, were erroneously diagnosed as psychogenic abdominal pains.6. Psychogenic abdominal pains were classified into five types according to their geneses, which were Psychopathic, Neurotic, Functional, Organic and Others. The frequency of these geneses was examined and the results showed that the Others, which had overlapping geneses, predominated, and as high as 78 percent of the Others were overlapped with the Organic group.7. Psychological mechanisms of pains were classified into three types and our subjects were examined accordingly. As the result, result, psychological reactions readily causing pain, such as depressive state, were seen as high at 51 percent.8. In diagnosing chronic abdominal pain, it was useful to apply both the classification of psychogenic abdominal pain and that of psychological mechanisms.

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In the previous paper, we reported psychosomatic aspects on the exercise training for the patients with ischemic heart disease (IHD) with successful results; not only physical fitness but also self-confidence in health and activity in social life was safely and effectively improved by the exercise training.This paper is to present our continuous study of psychosomatic approaches in the exercise training for the patients with cardiac neurosis or anxiety neurosis complaining of cardiac symptoms. The purpose of this study is to observe the effect of exercise training for these patients and compare the results to those obtained from patients with IHD.Materials and Methods : Fifteen patients (3 males and 12 females with average age of 42.2±9.1 years) were selected for the study.The training program consisted of one medically supervised training session at the institute and at least two other sessions of unsupervised home self-training in a week for 12 weeks. Physical fitness was determined by multiphasic treadmill stress test, before, after 6th and 12th week training period.Personal interviewing and Yatabe-Guilford personality inventory test were used to detect psychological and social problems among these patients.Results : 12 of fifteen patients were being free from their complaints with exercise training within 3 to 6 months.3 of 15 patinets showed less effect to improve their complaints in spite of increased physical fitness by exercise training. These 3 patients were diagnosed as hysterical neurosis who had poor motivation and full of dependence.We recognized that it takes more time to increase their physical activity by exercise training for the patients who were sedentary, compaired with the patients who were active.We believe the exercise training can be applicated to take off the anxiety or cardiac complaints of patients with anxiety state or anxiety neurosis as one of behavioral approaches concomitant with other psychotherapies and drug application.

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In order to analyze the adverse effect of disturbed sleep in peptic ulcer patients, the following study was performed.I) The sleeping habit was investigated in peptic ulcer patients consisting of 91 subjects with gastric ulcer and 88 with duodenal ulcer and the results were compared with control group consisting of 328 healthy workers and clerks of various ages and both sexes. The average bed time hour of gastric and duodenal ulcer patients was significantly later than that of the control group. The patient group required longer time to fall asleep, awoke and dreamed more frequently than the control group, suggesting light sleep in peptic ulcer patients.II) The sleeping habit was examined in peptic ulcer patients who had been hospitalized in our institute and the results were compared between the recurrent group and the non-recurrent group. In both duodenal and gastric ulcer patients, the recurrent group went to bed later than the non-recurrent group.The present study showed that the disturbance of sleep was contributory to ulcer occurrence. There may be three mechanisms regarding this problem. 1. The effect of nocturnal gastric function caused by disturbed sleep directly contributes to production of peptic ulcers. 2. The emotional stress which disturbes sleep also is contributory to peptic ulcer occurrence. 3. The emotional stress which is derived from disturbed sleep produces peptic ulcers. It is difficult to differentiate clearly these three mechanisms which work simultaneously on the occurrence of peptic ulcers. Sound sleep brings about comfortable emotions and plays a most important role in the treatment and prevention of peptic ulcers.

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In ulcerative colitis, the occurrence of histological change in the colon is well known, but the change of the regional arteries is rerely described. Authors investigated 35 cases of ulcerative colitis histopathologically including the mesocolon, and found the following three kinds of typical change in the arteries of the region.1) Perinuclear vacuoles (PnV) named by Prof. Takeuchi were confirmed to be present in the exactly transected arteried, 100 to 600μ in diameter; there were many media-muscular cells with round vacuole compressing the nucleus to the periphery. The etastica interna was also tortuous intensively. Electron microscopic examination revealed that the cell plasm of a muscular cell encroached upon the neighboring cell plasm, resulting in maldistribution of the nucleus. This change has been proved experimentally to be an acute spasm of the artery, and to be reversible to the normal structure when the spasm disappeared.2) The arteriole less than 100μ in diameter showed simple thickening of its wall due to increasing number of media-muscular cells, and remarkable tortuous elastica interna. This seems to be a transitional stage shitfing to the following change of 3).3) Change of hyalinous or necrotic thickening was found also in arterioles less than 100μ; it was an evenly thickened and amorphous status.The conditions of 2) and 3) above are well known to be present in the artery of repeated spasm which is induced by means of electric stimulation and some drugs.Three kinds of arterial change mentioned above were observed frequently in all 35 cases of 3 months to 12 years duration. There is no doubt that spasm of the regional arteries occurs without interruption while ulcerative colitis is present. This fact seems to be related to the pathogenesis, progress and difficult curability of the lesion. This is also a good example that functional abnormality can be transferable to organic abnormality.It was very characteristic that changes mentioned above were limited only in the regional arteries of the large intestine but none is found in other arteries in autopsy cases. Many specialists point out a psychological factor or stress as one the causes ulcerative colitis. It is well known that vascular function is most susceptible to the patient's psychological conditons (for example, shyness appears selectively in facial vessels). We suppose, however, that patients of this lesion generate some specific emotional inclination frequently which may selectively induce spasms of colon arteries. We would like to have a chance to discuss in details the emotional inclination of this disease in the future.

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Forty psychosomatic patients were evaluated for STAI (State-Trait Anxiety Inventory) and ECL (Egogram Check List) before and after psychosomatic therapy, and the relation between their clinical courses and changes of the scores of STAI and Egogram were analyzed. The results were as follows : 1) The score of state anxiety (A-State) was significantly decreased in the patients who showed an improvement (the Improved), but did not change in the patients who showed no change or an aggravation (the Unchanged or Aggravated) after the therapy.2) The score of trait anxiety (A-Trait) was not changed in the Improved, but significantly increased in the Unchanged or Aggravated after the therapy.3) In patients with depression or depressive state, state and trait anxiety were higher than those of others with anxiety and tension or conversion reaction both before and after the therapy.4) The score of "Adult" in Egogram significantly increased in the Improved, while it decreased in the Unchanged or Aggravated after the therapy.5) There was negative correlation between changes in the scores of state anxiety and "Nurturing Parent" and "Adult".6) There was also negative correlation between changes in the scores of trait anxiety and "Nurturing Parent" and "Free Child".From these findings, we concluded : 1) A-State was proved to be a sensitive indicator of the level of transitory anxiety and was very useful to measure changes of an anxiety by the psychosomatic therapy.2) A-Trait was proved to be very useful to evaluate an individual predisposition to an anxiety.

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Spasmodic torticollis is considered as a type or "forme fruste" of generalized dystonia. But not a few cases have psychic factors which relate to an appearence, an alteration or a back ground of this disease. The authors investigated psychosomatic aspects of spasmodic torticollis.Detailed psychological examination was performed to 21 male and 22 female patients with spasmodic torticollis.Twenty-three patients had past history or some associated signs related to psychosomatic diseases such as postural finger tremor, facial spasm, writer's cramp, gastric ulcer.Some social problems were noticed in 34 cases. Such problems were devided into 3 patterns, i.e (1) familial inharmony, (2) occupational trouble, (3) trouble in human relationship. Besides, one patient had an economical problem. However those problems were various depending on each case, and they did not always constitute a psychic etiology of the disease.Certain patients mentioned precipitating conditions for the appearence of symptoms, such as dental treatment, personal dispute, etc. In most cases, however, they only noticed their symptoms in such conditions.As to aggravating factors found in patients' daily life, emotional components were most frequently. In addition, motor activities such as walking also increased the degree of symptoms.As psychological tests, Cornell Medical Index (CMI), Yatabe-Guilford personality test (YG test) and Minnesota Multiphasic Personality Inventory (MMPI) were performed. They were compared to the results of the same tests conducted with hysterical patients.Half of the patients with spasmodic torticollis were found in regions I and II of CMI, and another half were distributed to regions III and IV, while most hysterical cases were distributed to regions III and IV, especially to region IV.In YG test, patients with spasmodic torticollis showed various types. The most dominant was the "C" type especially when compared to hysterical patients.The mean profile of MMPI fell within normal limits among the patients with spasmodic torticollis, whereas the reslts of MMPI in hysterical patients showed strongly psychopathologic aspects. The mean score of Taylor's MAS was 19.8 in the patients with spasmodic torticollis, while that was 28.0 in hysterical cases.The results of those personality tests were not related to the disease's chronicity.The patients with spasmodic torticollis seemed to have their own psychological conflicts, but those conflicts were not constant, and each conflict was different from that of other patients.Those psychologic profiles above mentioned are playing important roles in modifying the symptom of spasmodic torticollis, even if they are not etiological in the development of the disease. It is important to understand and treat spasmodic torticollis from the psychosomatic standpoint.

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This study was presented in order to compare two mass outbreaks of hyperventilation syndrome among high school girls in Nagoya and its neighborhood.One outbreak, named acute type, was observed during the training in a volleyball club of a private girl's high school. Hyperventilation attacks spreed out to 5 girls on the first day and 2 girls on the following day. The common physical and psychological backgrounds, such as fatigue, tension against the tournament, physiological hyperventilation etc, did play an important role in this group.The other epidemic, named chronic type, happened in a coeducational junior high school near Nagoya. Eight pupils in all, who were either classmates or clubmates, were involved in the mass outbreaks of almost 10 months long. Although definite and common back grounds, were not found, like in the acute type, the results of the analysis of YG test, egogram and environment showed the inclination mass outbreaks of hyperventilation. Hyperventilation attacks of this type seemed to be a manifestatin of regressive mechanism to intend to mantain the position of the star or to desire to impress their existence. It seemed to be more difficult to control the latter type at school because of their complicated mechanism.

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We report two cases of young women with psychogenic gait disturbance. Case 1 was a 25-year-old female who was difficult to take the first step forward at start for 5 years.Case 2 was a 14-year-old female who attempted suicide by taking high doses of sleeping drugs and showed astasia-abasia after recovery from comatose state. These two cases showed a discrepancy between neurological findings and neuroanatomical examinations.Both psychological and social backgrounds were significantly positive in each case.Whenever discrepancies were found between neurological findings and neuroanatomical standpoints, we postulate that psychosomatic consideration is essential prior to a neuroradiological approach or laboratory examinations.

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