It is a very important problem for the preoperative management to relieve the anxiety of surgical patients. The relationships among preoperative anxiety and respiratory sensitivity were investigated with 34 patients admitted to the National Cancer Center Hospital. They were subdivided into three groups according to their scores of MAS. They included 10 high, 15 medium And 9 low anxiety patients respectively. We measured the ratio &lrtri;V_E/P_<ETCO_2> and the ratio &lrtri;P_<0.1>/P_<ETCO_2> that has been termed the ventilatory response to CO_2 by rebreathing method. The results demostrated a negative correlation between V_E/P_ETCO., AP"/<PETCO_2> and trait-anxiety scores. Relation between trait-anxiety and the ventilatory response to CO_2 were discussed from the viewpoint of faciltating and blocking effects in the respiratory center by surgical stress. The ventilatory response to CO_2 may be seen as a psychological marker on the preoperative anxiety of surgical patients.

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Numerous abnormalities of endocrine and hypothalamic function in anorexia nervosa are well known but the details of their cause still remain obscure. Since it has been known that thyrotropin-releasing hormone (TRH) causes prolaction (PRL) secretion, TRH test was performed frequently as a PAL provocative test in anorexia nervosa. We studied PAL responses to TRH in 44 anorexia nervosa (AN) patients whose weight was below 80% of the ideal body weight and compared them to 7 patients of eating disorders (ED) with normal weight, and to 8 normal women as controls. TRH test (500μg i. v. inj.) was performed and blood samples for PRL, TSH, and GH were obtained. All patients were tested before treatment and 22 AN patients were retested following weight recovery. The basal PRL values were 13.0±1.9ng/ml (Mean±SE) in AN, 12.8±2.1ng/ml in ED, and 10.8±1.2ng/ml in normal women. In AN and ED, the mean basal PAL Values Showed no significant difference as compared with the controls. There were abnormal responses of PRL to TRH in 16 cases of AN (hyper responses in 7,low responses in 6,and delayed responses in 3 cases) and 2 cases of ED (hyper and low in each). Twenty-two AN patients were tested before and after weight gain. Following weight recovery, PRL responses were normalized in 6 of 8 abnormal responders. The frequency of abnormal responses of PAL to TRH in AN did not differ trom ED and no signficant relation was found between &lrtri;PRL (peak value-basal value) to TRH and body weight. There was no relationship between PRL resportses and TSH responses, or GH responses to TRH in AN. These findings suggest that abnormal responses of PRL to TRH are not solely dependent on weight loss.

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In order to investigate the function of the hypothalamo-pituitary-thyroid axis in patients with bulimia of normal weight. basal levels of serum T_3,T_4,rT_3,Free T_3,Free T_4 and TSH, as well as the responses of TSH and T_3 to TRH were studied. The subjects were 14 normal weight women who satisfied criteria for the diagnosis of bulimia according to the DSM-III. None had a history of weight loss suffcient to qualify for the diagnosis of anorexia nervosa. The results were compared to those found in a group of 8 normal subjects. The mean basal T_3 and T_4 levels in patients (71.1±4.0 ng/dl, M±SE, 6.3±0.4 μg/dl) were significantly lower than those of control subjects. Serum Free T_3 and Free T_4 of the patients were also lower than in controls whereas the mean basal rT_3 concentration of the patients was not Signiacantly diHerent from those of controls. With the patient group, TSH responses to TRH were normal in 7 cases, delayed in 5 and low in 2,maximun increase in serum T_3 (Max &lrtri;T_3), Max &lrtri;T_3/MAX &lrtri;TSH and net secretory response appeared significantly lower as compared with normal subjects, while the increment % was lower but not significantly. These results suggest that patients with bulimia of normal weight have abnormalities in the hypothalamo-pituitary-thyroid axis.

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During the period from January 1975 to July 1983,5l patients with the clinical diagnosis of S. L. E. (Systemic Lupus Erythematosus) were admitted to the internal, pediatric and dermatologic departments of Kinki University Hospital. The medical records of this group were reviewed with special attention given to the clinico-psychiatric points of view of S. L. E.. Seventeen patients had significant psychiatric problems during the course of their illness. We noticed that teem-aged patients had more frequent and severe psychiatric manifestations than other older patients. The principal psychiatric manifestations were as follows. a) Evident impairment of consciousness grand-mal seizures and/or coma : 4 cases, delirium : 3 cases b) Psychoses with slight impairments of consciousness paranoid-hallucinatoric state : 1 case, emotional disturbances : 2 cases, personality-regression : 1 case c) Episodes of functional psychoses schizophrenia-like psychosis : 1 case, depression : 3 cases d) Neurasthenic states : 3 cases e) Disturbance of behavior : 1 case Two patients showed 2 different types of psychiatric episodes respectively. Steroids were thought to be responsible for psychoses in 3 patients. 4 patients attempted suicide in the height of their depression, agitation or disturbance of ego-consciousness. From the clinical point of view, we pointed out the importance of detecting slight impairments of consciousness in the psychiatric manifestations of S.L.E. and prevention of their suicide.

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As reported in the first report (Shinshin-Igaku 23; 281-289,1983) we have observed school children by using Kurt Schneider's test, YG test and the questionnaire about their visit to the sanitary office of the school. The results were as follows.. (1) About the frequency of the visit, the tendency was observed of frequency change by class years during school life. First year grade's school children were visiting mostly one time, second year grade's school children were derided into two groups : one group visiting many times, and the other visiting less. Third year grade's children, however, showed mostly two to three times visits. (2) Observed through the whole three schooling years, the made cases showed mostly the early decreasing and later increasing type (D-I Type) regarding the frequency of visit, while the female cases showed mostly the early increasing and later decreasing type (I-D Type). (3) By factor analysis on reasons of visit in the questionnaire, three factors were obtained : 1) visit intention factor (f_1), 2) visit obligation factor (f_2) and 3) ill feeling factor (f_3). By plotting group means of frequency of visit and frequent incidence of feeling ill and proneness of trauma as well as YG type on the three dimension space of f_1,f_2,and f_3,special spiral lines were observed. (4) By factor analysis on Kurt Schneider's test result of total cases, we obtained three factors : outer factor, dynamic factor and inner factor. By plotting group means of frequency of visit and frequent incidence of feelhg ill and proness of trauma as well its YG type on the three dimension space of those three factors, specific Spiral lines were observed. (5) Compaing both factor analyses, school children visiting sanitary offce of the school too much frequent seemed to be akin to those visiting too much less with the personality which promote their intention whilst prohibit it simultaneously.

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While Studying etiological factors of psychosomatic diseases or neuroses in housewives in their thirties to fifties, we have become aware of their characteristic, neural and psychological conditions as described below. The subjects consisted of 35 cases of housewives in their thirties to fifties. All of these 35 cases were denied to have organic diseases. Their cheif conmhints were palpitation, depression, senstion of pharynx ill, etc. The onset of these symptoms in all the cases was in good agreement with the period when their sons or daughters had grown up and the wives were released from taking care of them. All their husbands were unconcened about their families. This condition seemed to accord with the concept of empty nest syndrome which was caused by a feeling of mental emptiness of middle-aged women whose sons or daughters lived away from their homes by reason of marriage. We helped the patients become aware of the condition of their disease. The symptoms were ameliorated or disappeared by making the patients recognize the condition of their disease with repeated interviews.

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Two cases with anorexia athletica were reported that suggest an early stage of anorexia nervosa : one was a 15-year-old highschool girl who was a member of a Shintaiso-club and the other a 29-year-old male ballet-dancer. The former responded well to minor psychotherapy, and menstruation was resumed shortly, whereas the latter anorexic male needed much more intensive treatment including self-analysis. Although both cases did not fully satisfy the criteria of anorexia nervosa, they were considered to represent a variant or precursor of the disease spectrum. Furthermore, on the basis of a questionnaire-survey of adolescent girls in a highschooI, a higher incidence of meal skipping, fancy eating and food hoarding was seen among the members of a Shintaiso-club than among those of non-athletic clubs. These results were thought to indicate that baryophobic state which is rather commot in modern adolescents may not infrequently lead to anorexia athletica. Selected cases thereof may eventually merge into anorexia nervosa.

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