The field of consultation-liaison psychiatry in Japan has been drawing gradual attention in the past decade. In this article the author made an attempt at statistical investigation concerning the present state and future prospects of consultation-liaison psychiatry in our country.For the purpose of this investigation a study was conducted by a questionnaire consisting of 11 items. The questionnaire was sent out to neuro-psychiatric departments of 80 medical colleges (MC) and to neuro-psychiatric clinics of 248 public general hospitals (GH). As the result, 60.4% of the 326 institutions responded. The findings were summarized as follows : 1) The response rates of the above mentioned two groups were somewhat different.2) 73.5% of the respondents of MC were concerned about liaison psychiatry and 52.2% of them have already put consultation liaison services into practice. Moreover, 72.5% of the MC evaluated liaison-psychiatry as a new methodology of psychiatric fields. On the other hand, only 43.6% of the respondents of GH have set to work gradually on liaison services.3) About the future prospects of consultation-liaison psychiatry in our country, 55.6% of the respondents of MC answered that they did not expect a remarkable development in the field of liaison-psychiatry in the near future.4) It is noteworthy that there were some respondents who refused to affirm the activities of psychiatric liaison. This may be due to that the definition and the method of consultation-liaison psychiatry have not yet well established.It may be concluded from these results that consultation-liaison psychiatry in Japan has only started and that one of the most urgent promotive factor of consultation-liaison services in our country is the patient-problem-management approach.

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Needs of psychiatry in general hospitals rose up under the influence of increase in aged people, change of structure of disease, and progress and development in medical treatment. Its role was also extended from dealing with psychiatric diseases proper to consultation and liaison service. As a result, its relation to the department of psychosomatic internal medicine, which has a very unique apoproach of our country, came into question. The author believes that psychiatry is characterized by being engaged in interpersonal problems, while psychosomatic internal medicine, though we admit it requires multidimensional understanding and approach, basically takes somatic illness as the object, and this difference inevitably clarifies each individual role, and therefore they would possibly work in partnership.

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The author has first established a clear definition of the consultation-liaison psychiatry. As the second point, the author has clarified various difficulties confronting Japanese psychiatrists when they practice consultation-liaison psychiaty at general hospitals in this country (Japan). For the third, the author discussed problems which arise when consultation-liaison psychiatrists cooperate with psychosomatists of other departments (e. g. internal or surgery department) at general hospitals in Japan.

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The present status of the psychosomatic approaches in research, education and practice in our department was introduced.References were also made as to the relationship between the psychosomatic approaches in our department and general hospital psychiatry with its main emphasis upon liaison-consultation service.Even though there might be some differences in their standpoints, both general hospital psychiatry and psychosomatic medicine share the common goal of realizing humanistic, comprehensive medicine.Therefore, it is expected that these two disciplines should make their efforts to communicate and cooperate one another to reach the same goal.

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With regard to consultation psychiatry, it has two major roles. One is the consultation given to treat psychiatric problems in general clinical departments such as internal medicine, pediatrics and pynecology. This role is usually played by psychiatrists both in the West and in Japan. This kind of consultation, i. e., consultation given by psychiatrists for psychiatric problems is widespread even in our country.The other is the consultation undertaken to deal with psychosomatic disorders in a general clinical setting. In the United States consultation psychiatry practiced by psychosomatists with psychiatric training is firmly established. The main role played by American psychosomatists with psychiatric trainign is, in fact, this kind of consultation. But in Japan psychosomatists with training in internal medicine, pediatrics or gynecology perform this work since Japanese psychiatrists have had little interest in consultation with psychosomatic patients. To put it in a defferent way : in Japan it is psychosomatists who were ofiginally medical doctors, who have systematized consultation for psychosomatic diseases, treatment which would normally have been undertaken by psychiatrists.The second subject I would like to take up is the role of liaison psychiatry practiced by a team of professionals, and area of liaison psychiatry which is led by psychiatrists in cooperation with physicians, pediatrists, gynecologists, nurses, social workers, counsellors and psychologists. This work is carried out by psychiatrists in the United States whereas such a system is still almost unheard of in Japan. Psychiatrists and psychosomatist, howevfer, are starting to assume that role in Japan.However a departure from psychodynatics had been attempted in Japan fairly early, for example by Ikemi, and others who created the framework of a system of therapy consisting of 3 pillars : autogenic training, transactional analysis and behavoir therapy.90% of patients receive autogenic training first. Patients with neuromuscular disturbances such as tics or writer's cramp receive biofeedback training. Patients with anxiety and compulsive neurotic complaints receive behavior therapy mainly systematic desensitization. Cases which have deep ionner conflict receive treatment by transactional analysis and Gestalt therapy.By entending this further, Ishikawa, et al attempted to integrate these three psychosomatic therapies based on cybernation therapy.In other works, early psychosomatic medicine or consultation-liaison psychiatry in Japan had been strongly oriented toward psychodynamics byt very soon divorced itself from its influence and crew into a more comprehensive, total approach, which provails at present in American consultation-liaison psychiatry which incorporates not only psycho-analysis but also psychotherapy and behavior therapy.

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Since 1970s the traditional psychosomatic medicine based on psychoanalytical psychogenicity has been developing to the core approach in the application of biopsychosocial medical model to all kinds of diseases by the integration of behavioral science, consultation-liaison psychiatry and others. Above all, consultation-liaison psychiatry has been found to be a great help to the practice of comprehensive medical management in various disciplines of clinical medicine through improvement of therapeutic human relations and problem-management-approaches to the patient's personal problems in the process of medical diagnosis and treatment. The psychoanalytical approach which has been found to be rather ineffective in the treatment of psychosomatic disorders is opening a new possibility in such a problem-management-approach.In the Unitted States the admirable progreess in the psychosomatic approach in clinical medicine has provided consultation-liaison psychiatry with the foundation for its development. The recent prevalence of psychosomatic approach in the Japanese medical circle urges us to initiate the negotiation on the reasonable collaborative system between psychosomaticists and liaison psychiatrists.Since the inauguration of the Japanese Psychosomatic Society in 1961 there has been some latent competitive and conflictual atmosphere between psychosomaticists in various clinical disciplines and psychiatrists who have been interested in psychosomatic approaches. This seems to be the lack of reasonable distinction in the role of the two members in psychosomatic medicine.Under these circumstances the new development of consultation-liaison psychiatry which indicates such a distinction will stimulate the peaceful co-operation between the two and greatly contribute to the progress of holistic medical care in our country.The fundamental role for psychosomatic medicine remains in the basic research of mind-body relationship in various diseases including malignant tumor. Such scientific data will continue to be the basis for sound development of holistic medical treatment under the co-operation of psychosomaticists in various clinical disciplines and consultation-liaison psychiatrists.

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The anothor presented two cases of patients with cancer; one was advanced gastric cancer and the other initial gastric cancer.It is difficult to ask questions to the physicians as to whether or not they frankly tell the diagnosis of cancer to the patients. It depends on psychological situations of the patients and their families. The right answer only comes from an assessment of each individual case from the psychologaical or social viewpoint. It would be easier to tell the truth to patients who consider that their lives have been rewarding or meaningful.Most of the medical students in Japan do not receive education on death and they are hardly exposed to the dying patients.On the side of dying patients, they too are not well prepared to accept their death as they miss the time for deep consideration on their death bacause their physicians usually concentrated themselves to prolong their lives by sophisticated procedures like resuscitation, which keep the patients from verbally communicating with health professionals and families.It is advisable that the most appropreate management be wisely adapted for the terminal care of the patients, and much emphasis should be placed upon how to fulfill the quality of life rather than prolonging thier life.As death appears drawing near, care-system rather than cure-system must be applied to the patient. It must be then considered who would be the most appropreate care-giver to the patient and his family.There must be verbal as well as non-verbal communicatoin by the care-giver with deep consideration and compassioin to the dying person, and holistic care must de extended to the patient and his family at the terminal stage of illness.

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The majority of incarcerated delinquents show sings and symptoms of psychosomatic disease.Such signs and symptoms might be explained as psychophysiological reactions under confinement.In addition to it, we think juvenile delinquents are psychopathologically susceptible to psychosomatic disease. Delinquency and psychosomatic disease have much in common. They often emerge at adolescencde. Delinquents and patients with psychosomatic disease have similar histories and family dynamics. So, it is possibel to regard delinquency as a behavioral manifestation of psychosocial stress, and psychosomatic disease as its somatic manifestation.We report a case that showed an interesting relationship between delinquency and psychosomatic disease during its course.The patient is a 17-year-old boy who was incarcerated in a reformatory school for the secong time because of his violent behavior and methamphetamine abuse. While in the reformatory school, he suffered from continual vomiting and remakable weight loss, and bothered himself about eating behavior disorder. On the contrary, being free, he did not vomit and kept his normal weight.

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