Statistical studies on the prognosis of anorexia nervosa were carried out by our research group. Subjects were 224 cases from thirty six university hospitals throughout Japan. Criteria for the diagnosis of anorexia nervosa were 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, 4. female, 5. amenorrhea, 6. eating disturbances, 7. desire to reduce body weight, 8. hyper-activity 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 as atypical case. Detailed data on the clinical picture of these patients was reported at the first presentation. This report is a follow-up on previously reported subjects. The questionnaire was mailed to each patient in cooperation with their doctors. The questionnaire included weight, self-image, attitude toward eating, gastrointestinal signs and symptoms, menstruation, marriage, psychosocial adaptation, occupation. and general health. The outcome of 143 out of 224 cases was judged by doctors. The outcome was good in 47(normal weight, no abnormal attitude toward eating, regular menstruation, satisfactory psychosocial adjustment) but it was intermediate in 69,and poor in 19 patients. 8 had died. Unsatisfactory outcome could be associated with clinical data such as late onset of disease, long duration of illness, presence of symptoms such as bulimia, vomiting and abuse of laxative, weak self-control, and poor parental relationships. The prognosis of typical cases was much poorer than that of atypical cases. This study was supported by a Research Grant for lntractable Disease from the Ministry of Health and Welfare of Japan. The authors took charge of the collection and analysis of the data.

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In order to examine an interaction between emotional response to detailed risk disclosure and effects of anti-anxiety drug, 30 surgical preoperative patients were classified into 2 groups, i. e. experimental and control, according to with or without detailed risk disclosure. Emotional responses were evaluated using the STAI, the Nowlis check list, and an assessment of sedation in the operative theatre. The results were summarized as follows : (1) In preoperative visit. no difference was observed with regard to state anxiety and trait anxiety. (2) The control group showed a significant decrease in state anxiety in the preoperative theatre, while the experimental group did not. Also, the control group displayed significantly higher sedation scores. (3) At present, we feel that the most reasonable approach is to tell the patient, with cautious attitudes, of serious, but remote, risks of anesthesia.

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The present study dealt with the relationship between the physical findings and the psychic conditions of young patients with anorexia nervosa or bulimia. Our 15 subjects were all over 13 years of age (4 males and 11 females). The anorexia nervosa patients were divided into two subtypes, i. e. the typical type and the atypical type according to the clinical diagnostic criteria which Suematsu et al. offered. The psychic conditions were assessed by clinical data and psychological tests such as the Sentence Completion Test(SCT) and the Manifest Anxiety Scale (MAS). Four female patients showed the typical type of anorexia nervosa and their psychic conditions were similar to alexithymia in all cases according to clinical examinations and the psychological tests. That is, they were not aware of their own disease displaying inconspicuous conflicts in the SCT and/or manifesting less anxiety on the MAS. Also, 6 patients (3 males and 3 females) showed the atypical type of anorexia nervosa and 5 (1 male and 4 females) Showed bulimia. Their psychic conditions differed from the former group showing a state of anxiety neurosis more frequently. That is, they were very anxious about their condition showing conspicuous conflicts and/or considerable manifest anxiety. Among the atypical cases of anorexia nervosa, one young female patient who had a transient delusional period while she was in a state of severe emaciation was diagnosed as a borderline case rather than a neurotic case. These results suggest that the SCT are useful for distinguishing a state of alexithymia in the patients with eating disorders. In general, it may be said that the typical type of anorexia nervosa patients belong to PSD as their condition is a state of alexithymia, whereas the atypical type can be considered neurosis or borderline as their condition is a state of anxiety rather than alexithymia. In addition, we suggested a three-scale classification of anorexia nervosa, i. e. 1) typical type, 2) atypical type and, 3) borderline type, modifying the diagnostic criteria which Suematsu et al. proposed.

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In this study, author attempted to observe religions of inpatients with acute myocardial infarction (AMI, 120 cases) and congestive heart failure (CHF, 60 cases) by means of interview and questionnaire for the purpose of better understanding of their psychosomatic problems. The results were summarized as follows : 1) Generally, many Japanese people have traditional family religions and few have their own personal faith in God or gods. In AMI patients, 19.2% had a personal religion (A), 55.0% only obeyed their traditional family religion (B), and 25.8% had no religion (C), In CHF patients, A) was observed in 38.3%, B) in 41.7% and C) in 20.0%. 2) There were higher incidences of patients who had their own religion in CHF than in AMI. This tendency Was seemed to be caused by patient's age, personality, and above all by severe longterm treatment and negative expectation about prognosis in CHF. 3) Religion of patients were correlated to their age distribution (the elder were patients, the higher was incidence of religion), and there were no marked relationships between the incidence of belief, grade of disease severity and psychological reactions during admission. 4) Almost of All the patients who had their own personal religion recognized that religion helped them to endure their diseases. On the other hand, in patients who only obeyed their traditional family religion, over half of them did not recognize the effect of religion on treatment. 5) There were many kinds of religion in patients. Traditional Buddhists were most common, and some patients belonged to newly risen religions (for example, Hokke-kei, Shinto-kei) and a few to Shrine-Shinto and Christianity. All patients who started believing in their religion when they had a heart disease, belonged to newly risen religious groups. It seems that this fact suggests a strong effect of newly risen religion on patients. For better medical treatment and care of patients with severe or long-term heart diseases, it will become necessary to understand the meaning of patients' religions.

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The essential blepharospasm is of unknown origin, and has been treated by many kinds of therapy. But a definitely efficient therapy has not been established yet. In this study, we discussed the indication of the electromyographic biofeedback therapy(EMG-BF) for this disease. The subjects were 6 patients seen in the Department of Neuro-Psychiatry, School of Medicine, Yamagata University. Two were females and four were males. The age of onset was between 37 and 50 years old. The duration of the disease before visiting us was between 3 months and 4 years. The results of the psychological tests were as follows : In CMI, one was in I area, four were in II area and one was in III area. In YG, two patients each showed a tendency of A type. C type and D type. In MMPI, 3 patients showed the profile of "conversion V". In Rorschach test, the patients whose therapy was not effective showed overcontrol of their emotions. The results of their therapy were as follows : In one patient, her symptom was relieved by medication and autogenic training. In two patients, their symptoms were relieved by EMG-BF. In one patient, his symptom was relieved by EMG-BF with diazepam injection. In one patient, her symtom was partially relieved by EMG-BF. In one patient, his symptom has not been influenced by medication, autogenic training and EMG-BF. With regard to the difference of efficiency of their therapy, we suppose that it is related to their psychological characteristics. That is, the patient who overcontrols his emotions in his daily life is hard to be treated efficiently only by EMG-BF.

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[in Japanese]

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A 16-year old high school, male student came to us complaining amnesia, restlessness, headache and sleep disturbance. Previously he had an episode of head contusion on his occipital at the age of 6 months, and scarlet fever at the age of 11. Restlessness has been recognized since the end of his kindergarten life. His school record got worse progressively after the episode of scarlet fever. When he was in junior high school, above mentioned problems were not outstanding. He spent 2 months almost normally after entering agricultural high school. Then, maladaption of interpersonal relationships, especially between his superiors at the school dormitory, changed his personality from cheerfulness and activeness to gloominess and slowness. Amnesia appeared in addition to headache, abdominal pain, sleep disturbance. Aggression against his teachers also began to appear. After the relatively stable condition during summer vacation, these singns and symptoms got worse in the new semester. He consulted with our clinic and was admitted to the psychiatric ward. Amnesia, loss ofattentiveness, difficulty in learning and slowness were recognized as the main signs and symptoms when he visited our clinic. After his admission to our ward, for the investigation of the organic diseases, EEG, brain CT Scanning, lumbar puncture, and several psychometric examinations were conducted. But no outstanding abnormalities were proved, except relatively lower level of intelligence (IQ 81 by WAIS). No particular findings were proved by neurological or ophthalmological investigations. Spending about 10 days in the psychiatric ward, he restored his original cheerfulness, and got along well with other patients. He went back to high school after 2 months' admission, but signs and symptoms immediately relapsed under the school environment. So he and his family made up their mind for him to leave the high School. AS the result, his signs and symptoms have disappeared. As mentioned above, not only his personality of vulnerability and immaturity, but also maladaptation under the special circumstances of the dormitory, were thought to be the main causes of his psychosomatic disease. Therefore, after being freed from burdensome high school life, he was easily able to recover from psychosomatic disturbances.

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Fractures of the first rib are generally uncommon. Particularly, stress fractures of the first rib are rare. The authors report a case of the stress fracture of the first rib due to heavy continuous cough, believed to be psychogenic in origin. The case is of a 36-year old single nurse who was referred to the department of psychosomatic medicine for having fractured her first left and right seventh ribs due to heavy continuous cough whose organic causes could not be found. During the first interview with a psychologist, she became aware of the fact that her cough had started on the third anniversary of her father's death, and that she had not mourned the loss of her father sufficiently, as he died of cancer of the pancreas at the hospital ward where she worked. At work, she could not express her grief due to her overadaptive Personality, neither could she share with the grief of her family, to whom she felt responsible that she, as a nurse, could not have detected her father's cancer at an earlier stage. The "nervous cough" began on the third anniversary of her father's death, Which may be an "anniversary reaction" in a wide sense of the term. The authors discuss the mechanisms of the stress fracture, the psychological process of "mourning work" and how she had not undergone this process, and finally, they point to the need for holistic medical attention in general city hospitals.

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The author investigated psychogenic visual disturbance in a 17-year old female who had been complaining of severe eyestrain, binocular central scotoma and constriction of the visual field. Results of general physical and neurologic examinations were normal. Moreover, by the objective visual field examination (Pupillographic Perimetry and Kani's fundus controlled Perimetry), no abnormal findings were observed. The results of psychological tests (P-F study, and GAT, etc.) revealed her characteristic personality tendencies including dependency, immaturity and phobic neurotic signs. We treated her with psychotherapy and tranquilizer. We discussed the difference in symptoms of psychogenic visual disorder between adolescents and infants and assumed the former was different from the latter. A 17-year old female complained of binocular central scotoma and constriction of visual field and she was diagnosed as a psychogenic disorder by the result of objective ophthalmological examinations (VECP, Pupillographic Perimetry and Kani's fundus controlled perimetry) and psychological tests. The author discussed the variation of symptoms in the psychogenic visual disorder from the view point of aging factors.

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