Prior to the establishment of the Japanese Society of Psychosomatic Medicine a number of pioneers in this field in various parts of Japan greatly contributed to the development of psychosomatic medicine in our country. The Society was established in November, 1959 and its first congress was held in Tokyo under the presidency of Prof. T. Miura in May, 1960. The official journal of the Society has been published since February 1961. The number of members of the Society has amounted to 1974 and the Society has become the greatest psychosomatic society in the world. The society was officially approved as a sectional society of the Japaneses Medical Academy in September, 1979.At present five medical schools have psychosomatic centers (department, clinic or institute) and one has a psychosomatic unit. Several active conferences on psychosomatic research in various disciplines of clinical medicine have been organized. The fourth congress of the International College of Psychosomatic Medicine organized by the Society in Kyoto in 1977 has been appreciated as the greatest success in the history of International College of Psychosomatic Medicine. The Society has contributed to other international conferences such as European Conference on Psychosomatic Reserach, Federation International Balint etc.Since the fourth congress of the International College of Psychosomatic Medicine, psychosematic medicine in our country has been steadily progressing to the holistic medicine (biopsychosocioethical medical model) with can be a core approach to clinical medicine. Secondarily, the integration of Western and Eastern psychosomatic approaches has become an unique role of the Japanese psychosomatic medicine.Thirdly, the development of a collaborative system between psychosomatic medicine and liaison psychiatry, the application of holistic medical approach to the field of primary care, terminal care and the progress of specialized psychosomatic approaches to psychosomatic disorders in different stages of life cycle etc. have greatly broadened the horizon of psychosomatic medicine in our country. The essential problem of terminal care is how to cultivate the therapeutic self of the medical professional which helps him (her) approach to his (her) own life and death problem from scientific standpoint. "New Science", a new movement for integrating science and religion is recently throwing a light to this difficult problem.As to the mind-body problem, which has been one of controversy problems since the Kyoto Congress, the concept of mind-body non-dualism proposed by us which can be neither dualistic nor monistic seems to be an essential core for the sound development of international movement of psychosomatic medicine.

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The twelve children with psychogenic visual disorder from eight years to fourteen years of age, average 10.4 years were psychosomatically investigated. All of the subjects showed positive response to the trick test of visual acuity while their visual acuities examined by the routine method were below 1.0 ranging from 0.02 to 0.6 (mean 0.32). In nine of them spiral form of visual field was presented.Eight children were the youngest children of the family and others were the eldest including one only child. They attended "Juku" school 3.3 times a week on the average (the mean value in Osaka was 2.4). The rearing attitudes of their mother showed the tendency of meddiesomeness, anxiety and compulsiveness as a whole. The children with the disorder showed the characteristic personality trait including perfectionistic, compulsive, industrious and aggressive tendencies. The visual disorder accompanied with spiral visual field had been identified as hysterical nature since Charcot. However the children examined in this study did not complaind of anything like visual problems at all and did not exhibit the characteristic hysterical personality. So neither flight into diseases nor gains from illness were expected for these children as a defense mechanism of psychogenic disorders. After pointing out the symptom and the following psychiatric treatment a half of the children were got rid of the disorder within six months. Furthermore most of the children had several psychosomatic symptoms other than visual disorder, as for example, headache, abdominal pain, dizziness, enuresis nocturna, general fatigue and psychogenic deafness.As a result of the present investigation, the author posturated that the pathogenesis of a visual disorder without subjective complaint was more attributed to the process of psychosomatic disease than hysterical one. And it was more likely that the visual symptom in Japanese children was precipitated by so called educational stress which is prevailing among the psychosomatic symptoms in Japanese school children. To prove this notion, further extensive investigations for school children from the ophthalmologic as well as psychiatric view points are to be proposed.

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The authors examined the glucose metabolism and the endocrinological function of the pancreas in bulimic patients (bulimia) of normal weight. The patients received 50g oral glucose tolerance tests (O-GTT) and eight of 10 patients received insulin tolerance tests (ITT) before treatment. The plasma glucose, insulin and pancreatic glucagon levels were investigated in controls and bulimic patients.Basal levels of plasma insulin and glucagon in bulimia were lower than those in controls. Five of 10 patients (50%) showed the abnormalities of glucose tolerance. Insulin responce levels and insulinogenic index at 30 min during 50g O-GTT were significantly lower in bulimic patients than those in controls. After glucose loading, the plasma glucagon levels in patients tended to be slightly elevated without suppression and ΔIRG levels at 60,90,120 and 180 min were significantly higher among bulimic patients than among controls.The plasma glucose concentrations during ITT in bulimic patients were decreased at 30 min as well as in controls, but were significantly lower than in controls at 120min and the recovery from hypoglycemia was delayed. After insulin infusion, the plasma glucagon concentrations and Maximal ΔIRG (peak value-basal value) were significantly lower than in controls.According to our data, 1) It is suggested that impaired glucose tolerance occurs frequently in patients with bulimia and is caused by the abnormalities of insulin and glucagon secretion.2) These findings suggest that the similar abnormalities identified previously in anorexia nervosa cannot be explained solely as a secondary result of low weight and these abnormalities in eating disorders may be associated with the abnormal eating behaviors.

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In this study, clinical and electroencephalographical observations were performed on the 157 subjects who were thought to need psychosomatic comprehensive cares. The subjects consited of 53 males and 104 females, with ages ranging from 9 to 80.The results obtained were summarized as follows : 1) The abnormal EEG-paroxysms of centrencephalic nature (6-14 Hz positive spikes and others) were found in 48 cases (30.5%).2) The varieties of complaints presented by the patients with abnormal EEG's and normal ones were demonstrated. But among all complaints, no marked differences were found.3) In the incidence of mental states, any significant differences were not observed among both groups.4) The varieties and incidence of clinical classification were investigated in all subjects.And some characteristics were found. Masked depression showed a high incidence among the patients with normal EEG's. On the other hand, among abnormal EEG's, the incidences of autonomic seizures were most common.5) Their psychogenic factors, which were supposed to be preparatory ones such as character, environment, hereditary or experience, and immediate triggers such as changes in physical or mental circumstances, were investigated. As the result, psychodynamic relationships were found in 73.3% of normal EEG's and in 55.8% of abnormal ones.6) The clinical results showed no differences between normal EEG's and abnormal ones.But the rate of effective cases was 4.4% in normal EEG's and 19.2% in abnormal ones.The effective cases were divided into two groups which were treated by medicines such as antiepileptics, minor tranquilizers or antidepressants separately and in combined use with other treatments. But no differences were observed between normal EEG's and abnormal ones.Thus our experiences showed the importance of EEG-examination especially among psychosomatic diseases.

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The excellent result of the fasting therapy for psychosomatic disease was reported already in previous papers. However, the therapeutic mechanism is not yet clarified although eager research works are going on in our department. As one of the above studies, relationship of ketone bodies turnover and EEG power spectra was examined in 40 cases during fasting therapy.Total concentration of serum ketone bodies increased significantly from the 1st day to the 10th day of fasting period. On the other hand, urinary ketone bodies increased from the 1st day to the 8th day of fasting period. Both diminished during the refeeding period. Alpha energy percentage in EEG power spectra decreased on the 5th day of the fasting period, but turned to upward after the 6th day. Inversive correlation was obtained between the mean values of alpha energy percentage and serum beta-hydroxybutyrate on the 5th day of the fasting period. But on the 10th day, contrastingly, positive correlation was found on above two factors.From the results of this study, it is reasonable to presume that changes in alpha energy in EEG power spectra is much influenced by serum ketone bodies, it would be suggestable to clarify the effective mechanism of the fasting therapy.

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We encountered a 37-year-old woman with dysorexia nervosa (bulimia, vomiting, amenorrhea and obese-aversion) satisfied the criteria for Pseudo-Bartter syndrome, including hypokalemia, hyper-plasma renin activity, normal blood pressure, and poor response against exogenous angiotensin II/angiotensin II analogue as a result of self-administration of Colac^[○!R] (Bisacodyl) 50mg/day for more than 5 years. It was considered that the cause of hypokalemia was due to the excessive potassium excretino into the feces, 26.0mEq/day (potassium in diet, 70mEq/day). On the other hand, the urine potassium secretion was very low. Hormonal examination and thyroid aspiration biopsy revealed euthyroid chronic thyroiditis histologically, low T_3 syndrome and abnormal hGH response after TRH bolus injectin. The correlation between chronic thyroiditis and Pseudo-Bartter syndrome was unknown. Various drugs were administered to normalize serum potassium concentration. Exogenous potassium, Captopril, Indomethacin, Spironolactone were not effective. But only 2mg/day of Loperamide, antagonist prostaglandin-induced diarrhea, was effective. As long as the authors are aware, this is the first report that Loperamide is useful in hypokalemia of Pseudo-Bartter syndrome.Psychosomatic approach to the patient led to the insight for the mechanism of the disease. Eating attitude test (EAT) score was also improved.

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