There are many critical opinions among the members of Japanese Psychosomatic Society against the definition of psychosomatic disease that was published from the medical therapeutic committee of the society in 1970,because it contains the following vague illogical neaning which makes people so confused with diagnostic procedure. In the first place, if we would obey it, every human disease has to be called psychosomatic disorder; and secondly physical syptoms of psychiatric disease would be considered as psychosomatics. In order to surface such hidden opinions and to prepare for making a new official diagnostic standard of the disease, an enquete survey was performed for all councilors of the society. A hundred twenty doctors gave us the answer who were 64 percent of the all councilors. More than half of them replied that the word psychosomatic disease does not mean an independent unit of single disease ; it is one of pathophysiological somatic states which are caused by psychosocial stress ; thus diagnostic criteria should contain organic or functional pathological bodily changes. lt seems that the members of committee at the time of defining the disorders in 1970 had confused conceptions of psychosomatic approach to the human disease and ethiological components of psychogenic disorders from the standpoint of medical science. Author presented a new definition and diagnostic criteria of psychosomatic disease according to his own opinion. Much discussion is expected to take place among active members of the society very soon.

View full abstract

At the symposium of epidemiology of psychosomatic disease (hereafter : PSD), the author will report on the following themes with his considerations bud upon his own clinical experiences ; the definition of PSD, the standard of diagnosis, the investigation of actual condition and the guidance therapy. First, with regard to the definition of PSD, the author took into consideration of the definition made by Japanese Society of Psychosomatic Medicine, Dr. Nakagawa, Dr. Katayama, Dr. Shimpuku, ICD-9 and DSM-III, and concluded thet the PSD in a narrow sense is limited to case where correlation of body and mind can be recognized in the bodily disorder with tissue damage. In addition, in connection with the definition of PSD, the description of PSD will be mentioned. Secondly, in diagnosing PSD, the confirmation of the correlation of body and mind is required, that is to say, the diagnosis of pathological state ranges over both body and mind. The method of its confirmation will also be mentioned. Thirdly, concerning the investigation of actual condition, since July in 1970 the author has been advocating "the department of psychosomatic medicine". For the past 13 years and six months, the number ot patients whom the author treated directly was 1,937,of which male patients were 863 and female 1,074. According to the data at Tokyu Hospital, gathered tor six years from January in 1978 through December in 1983,there have been 662 cases of the patienth303 males, And Sly femaIeS. Concerning the Above numbers of the patients, the Structure of ages, the clwiGcation of diseases, the Ailing period of the patients, the period the the patients receivid therapy, actual days of therapy, patients treated once for all, effectiveness of psychological tests, the grade of improvement of the patients, and other factors will be investigated and reported. Lastly, the guidance of therapy will be mentioned. The author thinks that among others the therapists are riquired to know how to control their own personality of such intricacy as diversity and immense inconsistency, which is considerd to determine the success or failure of therapy.

View full abstract

A fact-finding about kinds and grades of psychological factors participating in some diseases is very inportant for development of PSM study. This plan was carried out in bronchial asthma. Subjects are 319 cases (m. 166,f. 153,15-84 years, mean 52.2 years) of envirdonmental pollution, from Oct. 17,'84 to Jun, 24,'85. Psychological factors are examined by CAI at the time of physical examination. Results : 1. Cases without psychological factors are 3.4% 2. PSD cases are 25.5% 3. Neurotic cases are 68.9% 4. Depressive cases are 13.4% 5. On PSD cases : conditioning, suggestion, expected anxiety are remarkable. On neuroses including depressive cases : negative attitudes towards prognosis, decreased motivation towards therapy are remarkable. When psychological factors are diagnosed on bronchial asthma, they often contain neuroses or depressive state, but PSD showed usually no psychological factors on the surface.

View full abstract

The disease occurs under the various influences, such as physiological factors, psychological problems and sociocultural factors. To elucidate these factors, an epidemiological method is one of the most sultable to apply. From this point of view, we investigated and compared the structures of diseases between A City, which is the center of industry and commerce in our prefecture, and B Town, which is the the farm village in the same prefecture located in the northern part of the mainland of Japan. The subjects were 702 persons in A City and 665 persons in B Town The examination was carried out by questionnaires which were composed of the life style items, self rating depression scale (SDS). hypochondric score (MMPI), childhood stability acale, life stability acale, job stability scale and the past history of diseases. In the case of male subjects, the frequency of the paat history of peptic ulcer of A City (30%) is significantly higher than that of B Town (9.6%). Furthermore, among the workmen in production and transpotation of the city, peptic ulcer had occured 36.6% out of these 138 persons. We understood these workmen had some characuteristic life styles. That is 1) they had irregular mealtimes and irregular work times, 2) they had not sufficient sleeping time, 3) they had many alcohol drinking chances and smoking habits, and 4) they had many visitors. On the psychological tests, the workmen who had past history of peptic ulcer Showed significantly higher hypochondric score average than the workmen who had not the past history of peptic ulcer. In the case of women, the city house wives had the highest frequency of peptic ulcer. On the psychological tests, these wqmen who had the past history of pcptic ulcer had higher hypochondric score average than those who had not the past history of peptic ulcer. These results showed the usefulness of epidemiological approach to investigate the factors influencing psychosomatic diseases.

View full abstract

ln order to evaluate the role of psychosoial somatic factors in the pathogenesis of acute myocardial infarction (AMI), the correlation between emotional stress, mental condition, life Stress, coronary risk factor or behavior pattern and the attack of AMI were investigated on the moment of attack or for 1 week prior to the attack in 174 patients admitted into coronary care unit. 1) As to life stress or physical condition for 1 week prior to the attack, 42 among 96 cases were exhausted due to continuous life stress such as busy job in patients under 59 yrs, family troubles in old patients, whereas acute emotional stress provocated the attack in only 4 cases. 2) Type III and IV of CMI test were found more frequently and Type D of YG test was found less frequently in patients with AMI, as compaed to the control. 3) In JMI (Japan Productivity Center Mental Health Inventory) test, score points were different significantly between patients and normal controls, that is, in 12 of mental abnormality scale, 5 of personality scale, and 5 of occupational scale in AMI. 4) Coronary risk factors such as hypercholoesteremia, hyperglycemia, hypertension, alcohol or smoking, were recognized in half of patients.

View full abstract

I) Statistical studies on anorexia nervosa in Japan were carried out by our research group. Questionnaires were sent to physicians at 1,030 representative institutions throughout Japan and data were collected from 315 institutions. The total number of patients with anorexia nervosa in 1981 was 940 outpatients and 372 inpatients. The number of patients in 1981 was twice as high as in 1976. Detailed data on 1,011 patients were investigated. of the 1,011 patients, 4% (41) were males. The average onset age was 18 years. The incidence of signs, symptoms, abnormalitics of laboratory data and endocrinological data were investigated. The outcome of 418 of the 1,011 cases was judged by their doctors as 'good' in 186 cuses (44%), 'intermediate' in 162 cases (39%) and 'poor' in 58 cases (14%). 12 cases (3%) of the patients had died. Unsatisfactory outcome appear to be associated with clinical data such as late onset of the disease. presence of synptoms such as bulimia, vomiting, abuse of laxatives and weak selfcontrol. A number of the patients expressed a desire to remain single. Mensses returned in 74% of the patients. In 24% of them, the menstral rhythm remained irregular. I) As anorexia nervosa patients often deny the existence ol disease, and as they tend not to seek hospital treatment, further investigation on the prevalence of anorexia nervosa among school girls were carried out. It is suspected that there are several school girls with anorexia nervosa ro borderline-anorexia nervosa And there are also many cases of those who show eiting disorders or desire to reduce body weight. In these cases rates are found to be higher in senior high school students and students in the city. III) h the etiology of anorexia nervosa, which is more important, hereditary or environment? This question was examined by studying seven cases of anorexia nervosa in monozygotic twins in the authors' own practice. In 5 of 7cases, only one of a set of twins was found to be suffering from anorexia nervosa. On the other hand, in 2 of 7 cases, both the twins were diagnosed as having anorexia nervosa. Even in the concordant cases studied by the authors, however, the quality or degree of anorexia nervosa between each case was different. Therefore, even given the existence of concordant cases, without inquiring precisely into the quality or degree of anorexia nervosa, it is not possible to conclude that hereditary factors phy a determining role in the etiology of anorexia nervosa.

View full abstract

School stress was focused as a main source of the emotional disorders and psychosomatic illnesses in the Japanese adolescents. For this study 768 healthy school boys and girls (12-15 years old) were used. As the markers of stress tension, fatigability, sleep disturbance, eating disorder and neurotic habits were surveyed, including Cornell Medical Index (CMI). The similar questions were also asked of their parents, which led to the more precise observations on the children's symptons. These symptoms had significant correlation with one another, that is, the symptoms revealing themselves as the complex In addition, they did not show the expected physiological curve, i.e. inverted V shape. The obesity rate and Rohrer's index in this population were found very much deviated from the mean values in Japan. Furtherly, body image in the group with distress much differed from the measured body composition. These evidence suggested the proneness of females to the eating disorders in the stressssful situation. Decreased sleep time by the packed daily life had close correlation with difficult waking in the morning, which was also followed by the high frequency of the tatigability (p<0.0001). Moreover, fatigable group showed the higher incidence of the mood disturbance. Fatigability also related with the time spent for Jyuku, pricvate extra lessons outside schooling. The above symptoms as the reflection of the accumulated atress respectively increased both in frequency and intensity in parallel with age, adjacent to the entrance exanination. The persistence of these school boys and girls to their marks and records, which was possibly stimulated by their parents had significant correlation with the synptoms in subclinical level. In conclusion, the author speculates that the school stress mainly produced by the educational system and the competition. if combined with that due to intrinsic and extrinsic factors, consequently may lead to the incidence of the emotional disorders or psychosomatic illnesses.

View full abstract

In order to investigate the character of patients with bronchial asthma, we studied their chartacteristic traits through Seikenshiki Personality Inventory (INV) which has been well known to reflect the premorbid character. The results were 48 follows. A large number of patient with bronchial asthma were nervous and cyclothymic in the characteristic pattern. The characteristic traits of high frequency were "simple-minded", "insensible", "sympathetic". "hypochondriacal", "sticky" and "restrained". Comparing males with females a to characteristic traits "simple-minded" was more freequently observed in males than in females statistically; "fun'' was often observed in males and "restrained" was often observed iA females. "Precise" was more frequently observed in the oider group than in the younger. Atopic asthmtics were significantly more insensible, restrained and careless than nonatopic asthmatics. Asthmatics with paroxyamal type showed more schizophrenic and hysteric tendencies than those with chronic type in characteristic pattern. "Simple-minded" showed significantly higher frequency in the latter than in former. Comparing mild cases with moderately severe or severe cases as to characteristic pattern, epileptic pattern was highly apparent in mild cases. These reslts suggest that the asthmatic by nature tend to devote themselves to their excessive adaptation. Moreover, their characteristic traits might influence their chinical courses.

View full abstract