Psychosomatic studies on cancer were carried out with a patient with Hodgkin's disease and with leukemic children. The patient, a 29 y. 0. female, with Hodgkin's disease began to show anxiety reactions against her therapies after 8 years' treatment. Her main symptoms were vomiting, anorexia, weightloss and shivering of her body and these were enhanced before medication was to be administered. So any cancer therapy Could not be done in the cancer center concerned. After moving to the ward for psychosomatic Patients in our department, she was given interview therapy and autogenic training. By the interview therapy alone, her irritation did not change in spite of expression of her sad feelings. By AT and supportive therapies, she became relaxed gradually and her symptoms decreased. The body weight increased from 28.5kg to 33.5kg. We discussed the effectiveness and evaluation of psychotherapies for the terminal cancer patient. In the study on the leukemic children, PF study, diagnostic test for parent-child relationship, Life Change Unit(LCU), mother's estimation of daily attitudes of leukemic children and interviews with both parent and the child were done. The results showed characteristic features of leukemic children as compared to healthy children and asthmatic children. These features included strong self-confidence, suppression of their emotions, lack of dependency on their mothers, and weak parent-child relationship. Some of these result were similar to the reports on western leukemic children. Furthermore, there found some similarities to the characteristics of the personality traits of adult cancer patients. This suggested that the cancer presonality was already formed in childhood. The problems belonging to families were also mentioned.

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Tow cases of malignancy preceded by depressive symptoms were reported. Case 1 : Carcinoma of the pancreas. A 57-year-old man developed depressive symptoms associated with epigastralgis, and was referred to us for psychiatric consultation. One month prior to hospitalization a series of extensive medical examinations were conducted. Fasting blood sugar examination, gastrointestinal X-ray series and hypotonic-duodenography were all unremarkable, but 50g GTT showed a diabetic pattern. Therefore, diabetes mellitus was controlled with diet. There was little abatement of his depressive symptoms as well as the abdominal and back pain despite various medication. He continued to lose weight. Scintigram of the pancreas was preformed 20 days before his death, revealing a defect of the tail. Celiac angiography revealed encasement and irregularity of the splenic arteries suggesting the presence of a carcinomatous lesion of the pancreas. Microscopic examination of biopsy specimens of the tumor of the skin confirmed metastatic adenocarcinoma. Eleven months after onset of depressive symptoms, the patient died of carcinomatous effusion of the thorax. Case 2 : Carcinoma of the bile duct. A 68-year-old developed depressive symptoms such as poor appetite, insomnia and loss of ambition, and he was diagnosed as depression. Four months after the onset of depressive symptoms, he developed jaundice, which was diagnosed as obstructive jaundice. Percutaneus transhepatic cholangiography revealed complete obstruction of the bile duct, indicating carcinoma of the bile duct. Cytological examination of the bile found adenocarcinoma. Since depressive symptoms continued even after improvement of jaundice, the patient was referred to psychiatric consultation and diagnosed as depressive associated with malignancy. Patient was discharged after fistel construction. Even though the relationship between depression and malignancy has been emphasized ub a number of studies, medical illness was so often overlooked in the psychiatric patient. We discussed in this paper the features of depressive symptoms of our cases, the relationship between depression and malignancy and importance of medical evaluation of patients with psychiatric symptoms. Some psychiatric conditions, depression and hypochondria in particular, require thorough medical evaluation, as psychiatric treatment of these conditions offers no solution to other physical illness.

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Yatabe-Guilford test (YG test) was performed to asthmatic children and their parents to ihvestigate the personality of children who had been improved or cured 5-10 years after they first visited the Pediatric Allergic Clinic of Osaka University Hospital. The distribution of the personality of children and their parents were almost the same as that of ordinary healthy groups. In children with asthma which had been improved or cured, the type C was found less frequently than in children with asthma. It was very difficult to determine wheather or not this difference was due to their psychological development by aging or due to the favourable course of their asthma. The personalities of father and mother were tend to be similar, but the personalities of children were different from those ot their parents. It was not clear tht this personality differences between children and their parents were related to the past history of their asthma. Different distribution of personality was also found between improved and cured children. The Type C was found less in the personality of cured children than that of improved children. Also the Type C was found less in the personality of older children than that ef younger children.

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Seventy-four patients with open gastric ulcer and 21 patients with the scarring stage of gastric ulcer diagnosed by gastroendoscopy, were interviewed and evaluated for an inventory of life events and life changes. This inventory was based on Social Readjustment Rating Questionnaire, Schedule of Recent Experience and Recent Life Changes Questionnaire, and was compised of 47 items of stressful life events and life changes. Patients were asked whether they had these experiences within 6 months of their diagnosis. The results were as follows : (1) The total number of life events and life changes which the open gastric ulcer patients had experienced was significantly greater than that of the patients with the scarring stage of gastric ulcer (p<0. 001). (2) The total number of life events and life changes in the open gastric ulcer patients under 40 years of age was significantly greater than that in patients of 40-59 years and in those over 60 years of age (p<0.01). (3) The total number of life events and life changes of patients with initial gastric ulcer was not significantly different from that of patients with recurrent gastric ulcer. (4) Many of male patients with open gastric ulcer had experienced "Being busy with works, ' "A change in eating habits, " "A change in sleeping habits" and other working or financial exents and changes. On the contrary, many of female patients with open gastric ulcer had experienced "A change in sleeping habits, " "Troubles with a child, " "A change in eating habits " and other familial events and changes. From these fidings, the author concluded : (1) Life events and life changes were very important risk factors to the onset or recurrence of gastric ulcer. and the more life events and life changes the patient experienced, the more risk of the onset or recurrence of gastric ulcer increased. (2) The life events and life changes inventory was very useful to understand the circumstances of the patient's life rather easily. and to prevent the recurrence of gastric ulcer.

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[in Japanese]

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[in Japanese]

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In mitral valve prolapse syndrome, chest pain, palpitation, breathlessness and fatigue are often accompanied. These symptoms are similar to those in neurocirculatory asthenia. We present two cases of mitral valve prolapse syndrome with hyperventilation attacks, which were hard tot differentiate from neurocirculatory asthenia. Case 1 was a 55-year old male patient with movable chest pain and periodic hyperventilation attacks, who visited the department of psychosomatic medicine in Nov. 1980,because no abnormal findings has been revealed in a few hospitalizations. Physical examination disclosed midsystolic clicks in supine position. Echocardiogram showed pansystolic bowing. Stenosis of coronary arteries were not found while mitral valve prolapse was cofirmed in cardiac catheterization. His complaints were released after reassurance was given on the basis of examination results together with minor tranquilizer. Case 2 was a 30-year old housewife with chest discomfort, breathlessness, palpitation and fatigue. She was referred to the department of psychosomatic medicine in Sep. 1981 because of hyperventilation attacks, anxiety and hypochondriasis while mitral valve prolapse had been found by the auscultation and echocardiogram. Several kinds of medication (minor tranquilizer and beta-blocker) and psychotherapy were effective. Their hyperventilation attacks and neurotic behavior were suspected to be related to mitral valve prolapse. It was very hard, however, to distinguish the symptoms between mitral valve prolapse and anxiety reaction, which were considered to be overlapping one another. Because of its high frequency alone, mitral valve prolapse appears to take a generally benign course and might be on the same level of physical weakness as funnel chest or straight back, although we need attitudes of deferred judgement. It is obviously important to recognizie psychological disturbance in mitral valve prolapse syndrome as well as its serious physical complications.

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A three-year-old boy showed constipation after his father and family were transferred to Singapore from Tokyo area. At one time, his parents forcibly tried to pick up his feces and this seemed to bare psychologically affacted him. After this episode, the boy began to show more and more constipaticn and fecal incontinence. About one year later, this family came back to Japan and his mother took the patient to our clinic. The acquired megacolon was confirmed by X-ray examinations. In the course of therapy. mild laxative was given ud operant conditioning approach was conducted by which the patient was admired whenever his bowel novement was successfully performed. Since the 27th day, the patient became able to defecate without failure and joyfully told his sense of achievement to his mether. Then the sigmoidcolon by X-ray revealed to be normal. We are still following up this case. It is concluded that the behavioral treatment of operant conditionig has been very useful in this case.

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