A preliminary survey was carried out to know how patients thought about Psychosomatic Clinic, methods of therapy and their diseases, in order to get information or clues for how to give more adequate medical service to patients. Subjects are 150 new outpatients coming to Toho University Psychosomatic Clinic. A questionnaire was composed of 12 items and to each item patients could make free sentences as answer. Results are as follows. (1) Patients who were recommended to come to our clinic by other medical doctors or families were about half as many as those who came to our clinic voluntarily. (2) Patients who realized that their symptoms were related to Psychosomatic Clinic only after getting information through the mass media or from other people, occupied 88.9% among patients who came to our clinic voluntarily. (3) Patients who imagined that Psychosomatic Clinic took care of psychological aspects of diseases and treated them not only biologicaly but also psychologically, occupied 70.0%. (4) 45 Patients of all (33.0%) wondered whether they should come to our clinic in the course. (5) As to the question about therapy or treatment at Psychosomatic Clinic, 63.9% answered that it depended on doctors or they had no opinion. 30.7% asked for having psychological aspects taken care of, 2.7% for pharmacotherapy and 2.7% for information about causes of their diseases. (6) Patients who felt their manifestations had something to do with psychological stressors or physiological stressors or thier underlying personality, occupied 53.3% of all. At the next step, it is necessary to analyze individual interview or process of psychotherapy for clarification of these facts.

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The purpose of this study was to survey the psychological aspects and the autonomic nerve function in the out-patients of an obstetric and gynecologic department. The subjects were 730 female outpatients who first visited the Clinic of Obstetrics and Gynecology, University of Occupational and Environmental Health, Japan School of Medicine. The subjects were surveyed by the following psychological tests and a questionnaire for autonomic nerve function : Cornell Medical Index (CMI), Manifest Anxiety Scale (MAS) and Autonomic Nervous Symptoms-Score (ANS-S). The results of the tests and the questionnaire were as follows : 1) Pregnant women and sterile patients were the most stable in both psychological aspects and autonomic nerve function. The patients with vegetosis (autonomic nerve dysfunction, climacteric disorders, PSD) were, on the other hand, significantly unstable. And the Patients with inflammatory disease or dysmenorrhea (included premenstrual syndrome) showed compara tively high scores in CMI, MAS and ANS-S. 2) The patients in their twenties and thirties were stable in these two aspects. The patients in their teens and above 60 of age showed high scores in CMI, MAS and ANS-S. 3) There were significant correlations between the scores of CMI, MAS and ANS-S.

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1. Eating disorder is increasing in number remarkably. Thirteen years ago, the rate of the cases of eating disorder among all the newly visited patients of the year was only 0.2%, but last year, the rate increased up to 2.2%. Moreover, in addition to the increase of classical anorexia nervosa, the increase of bulimia was prominent. 2. In 1984 author experienced 51 cases of eating disorder. 20 cases were diagnosed as anorexia nervosa and 27 cases were bulimia. Four cases were atypical eating disorder. All cases were female except for one case of bulimia. Symptoms of anorexia nervosa and bulimia were compared and the results were as follows. The common symptoms of eating disorder were that the original weight in many cases was normal or rather less than the standard weight and cases of obesity were very rare. Mean age of onset was 18 years, and symptoms of bulimia started slightly later. In almost all the cases, such symptoms as fear of fatness, disturbance of body image were seen. Social adaptation was frequently disturbed. Dependence and/or aggression to mother was also frequent. Enlargement of salivary glands was specific. Some patients refused to take medication. In anorexia nervosa, only few cases had a previous record of psychiatric problems. Behavioral abnormalities during anorexia were also rare. So anorexia nervosa could be said as monosymptomatic. The patients were hyperactive. Amenorrhea was seen in all cases. Only few cases had sexual experiences. Diminution or loss of deep tendon reflexes were frequently observed. In bulimia, many cases had previous psychiatric problems and impulsive behavioral abnormalities during the episode of bulimia were also frequent. Marked irritability, symptoms of depression and ideas of self-blame were observed in almost all the cases. The patients were withdrawn and hypoactive. Amenorrhea was not always observed. Not so few cases had sexual experience. Deep tendon reflexes were diminished in bout half of the cases.

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Terminal cancer patients with severe pain have physical, Psychological, social as well as religious needs. When such needs are not met satisfactorily, the sensation of pain in the patient increases. In order to achieve an accurate knowledge of the psychological state of patients, we conducted two projective tests : the TAT and the SCT to 101 terminal cancer patients with severe pain, ages ranging from 20 to 70 years. The results obtained were considered from the points of sex, age and disease. The main findings obtained are as follows : 1) There were sex differences in cognition of the TAT cards. 2) The TAT cards cognition differed among diseases. 3) The SCT indicated differences in self image, view towards family and value among diseases. 4) There were age differences in response to the SCT but not to the TAT. As seen from the results above, this research has shed some lights on the psychological state of such patients. From these findings, we suggest the extreme importance of understanding the psychological state of terminal cancer patients with severe pain. Such knowledge would provide some guide as to the direction to follow in their approach.

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In the course of SLE, dermatological and physical symptoms such as erythema, loss of hair, hirsuteness, obesity, etc. appear which are related also to the steroids treatment in the young women. While we examined the psychiatric manifestations of SLE, we noticed the two cases whose anxiety or fears for their dermatological and/or physical symptoms seemed to influence their psychiatric manifestations, namely the disturbance of ego-consciousness or body-image. In case 1,the patient had actual hirsuteness as a dermatological symptoms of SLE. As she knew by delusional intuition that she expressed the feeling of anxiety and of strong hatred about obesity. In this case, as the disturbance of ego-consciousness increased, the anxiety about her physical symptoms and death became tangible. It was considered that her suicidal attempt and severe depersonalisation appeared as the means to overcome such anxiety. In case 2,the patient had excessive obesity by the steroids treatment. As a result she was worried about being slandered by her friends. Finally, she became delusional and refused to take any meals or drugs. In this case, we thought that her dissatisfaction with or inferiority complex about obesity caused by steroids was the source of her confusion of self-identity and delusional thought. Besides, an anorexia nervosa-like symptom in this case was thought to be closely related to the disturbance of body-image based on the severe obesity. We viewed such psychiatric symptoms in the course of physical diseases or steroids treatment on the basis of some papers. We also added our opinions as to the psychiatric manifestations of these patients with SLE which seemed to be related deeply to the physical symptoms. It seems very useful and important, in the psychotherapeutic support to the problematic patients of SLE, to understand their mental states such as discussed above.

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Recently our dental clinic has seen two patients who have demonstrated the characteristic clinical picture of polysurgery. The first case was a 34-year-old divorcee. The patient's chief complaint was long history of chronic pain in the area of the right nose wing. She was refferred to our clinic for the evaluation of pain which had no obvious organic etiology. She adamantly believed that an organic lesion existed which was the etiological factor responsible for this pain. The patient's psychological profile demonstrated flight into illness, being an immature and egocentric female. Our approach to her was primarily educational. We explained that from our examination no organic lesion was detected or suspected, therefore no surgical treatment was indicated. She strongly desired for extraction of the tooth and believed this would provide her with relief from the pain. The patient became angry at our explanation and refusal to conduct unnecessary surgery. She finally left our clinic. She subsequently continued to visit other dental clinics until surgical treatment was actually provided. Our second case was a 62-year-old single woman also with a history of divorce who visited our clinic complaining pain in the left buccal area. For the past two years, the patient had a dentist extract four teeth at her own request. She was referred to our clinic for the evaluation of pain which had no obvious organic etiology. Examination and evaluation at our clinic also failed to diagnose any organic disease which might have been responsible for her pain. A hypochondriacal condition was suspected. Again our department provided no surgical care, but did provide her with careful explanations and support. With this educational and supportive approach, the patient gained insight into her problem and realized that the previous extractions were not necessary. In addition, the presenting complaint of pain resolved spontaneously, and she no longer desired to have a tooth extracted.

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