Recently, we developed a biofeedback system, composed of a polygraph recorder, an A/D converter, a microcomputer and a display. The microcomputer deals with bio-information and shapes the target data of the next step according to achievement ratio. Feedback signals are presented on a display in digital and analogue form. In this study, ten experimental subjects were trained with this biofeedback system of systolic blood pressure for increasing and decreasing, bidirectionally. All subjects were healthy young women, aged from twenty to twenty-four. The experimental design included two control sessions and five training sessions respectively. Subjects were rewarded with money in proportion to gained scores during the training sessions. All subjects have learned to control their systolic blood pressure bidirectionally. There were statistically significant systolic blood pressure changes compared with control data [Increasing+7.5mmHg, p<0.001] [Decreasing -5.8mmHg, p<0.05]. During this biofeedback training sessions, there were no remarkable changes of heart rate and respiration rate. Auto-shaping method by microcomputer has effectively increased and decreased systolic blood pressure of all subjects. In our previous study, this biofeedback system was also effective in changing of heart rate of all subjects. Therefore, it is proved that auto-shaping method of this biofeedback system is effective to reform autonomic response. Blood pressure biofeedback has a possibility as one of the most effective method of nonpharmacological treatment of essential hypertension. If small computerized biofeedback system will be developed in the future, hypertensives will be able to learn to decrease their own blood pressure at home according to programed schedules.

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Egogram has been known as a valid proven psychological test based on the theory of trasactional analysis and used extensively in the field of psychosomatic medicine. Most of egograms available today are originally designed for adults, and we made an egogram questionnaire for schoolchildren since we know that the ego can develop at any age. Children were divided into three groups, the first to third grade and the fourth to six grade primary schoolchildren, and junior high school students and standardized as high abnormal, high borderline, normal, low borderline and low abnormal based on the T score.(Shinshin-Igaku 25; 36-44,1985) In this study 562 junior high school students(281 boys, 281 girls)and 723 senior high school students (355 boys, 368 girls) were selected for the standardizetion of the egogram we developed. In order to compare two standardized egogram profiles, 12 junior high school students with chronic asthma who have been hospitalized for a long time, and 18 high school atudents with several kinds of psychosomatic diseases such as recurrent headache, asthma, hyperventilation syndrome and schoolphobia were analyzed by the egogram. There was a significant correlation between two standardized profiles, however some discrepancies were found at high points. We concluded that the egogram questionnaire for children standardized with age and sex should be reliable and valuable also for adolescence with/without psychosomatic diseases.

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Egogram is a sort of psychological scale theoretically based on Transactional Analysis. As having reported, we developed a new egogram questionnaire by means of multivariated analysis and standardized it. The previous studies were done on sociocultural factors essential for clinical application of this inventory and also on characteristics in the egograms obtained from neurotic patients. Presently, as a part of cotinuous studies on clinical application of the egogram questionnaire, we have investigated psychological features of psychosomatic-disorder patients. In comparison with the normal group, the results were summarized as follows : 1.Patioents of"writer's cramp" showed low FC (Free Child), high NP (Nurturing Parent) and AC (Adapted Child), and a shallow N-shaped egogram on the whole. 2.Patients suffering from irritable bowel syndrom recorded high CP (Critical Parent) and AC, and a center-bent egogram. 3.Patients complaning psychogenic pain revealed high NP and A (Adult), low AC and showed a bell-shaped (right-handed slant) egogram. 4.Patients of anorexia nervosa showed high CP, A, AC, low NP, FC (Free child), and a typical W-shaped egogram. 5. Spasmodic torticollis patients showed no significant difference from the normal group in any scales, and rather a flat type egogram. 6.Patients suffering from peptic ulcer recorded high NP and A, and a hill-curved egogram. Evidently, functional psychosomatic disorders such as writer's cramp and irritable bowel syndrome, as well as psychogenic pain and anorexia nervosa with such particular psychopathologies, have their own egograms reflecting their psychological states. On the contrary the egograms obtained from peptic ulcer subjects showed a hill-shaped pattern, which didn't implicate any problems and were often found in the normal goup. This resut implies the difficulty in detecting personality traits of typical psychosomatic disorders involving organic transformation by means of this egogram qustionnaire.

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This is a report on a 12-year-old girl with a diagnosis of conversion hysteria. She was brought up by the parents who had marital problems since her early childhood. At age 8,she began to live only with her mother, though she liked her father as well as her mother. Thereafter her father kept in contact with her in the absence of her mother, which put her in a conflicting situation. She wanted to live with her father and to tell her mother of her father's visit, but she could not do so. At school she was unable to make friends with her father's visit, but she could not do so. At school she was unable to make frieands with her shoolmates. She also had poor academic achievement. These difficulties led her to have a desire for escape from school. Under such conditionas, she developed abasia, aphonia and abnormal bodily movement at age 9. Worthy of note was her bizarre athetosis-like movement. Through psychiatrie interviews it became clear that the development of her physical symptoms was etiologically related to her psychological conflicts at home as well as at school. Her athetosis-like movement could be regarded as an expression of 'organ language'. Treatment of conversion symptoms in this patient included psychotherapeutic approach (mainly supportive), antianxietic medication (diazepam, 6mg/day) and behavior therapy.

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This report is concerned with EMG-biofeedback treatment with frequency modulation. A42-year-old male patient, whose occupation is a chief of the clerk's office, has been suffering from stiff type writer's cramp. His symptoms have been gradually exacervated since 38-year-old. We had tried to administer anxiolytics, muscle relaxtant and to recommend him autogenic traininng during his outpatient for half a year. But these trials were not effective. So we started EMG-biofeedback therapy without medicine. We had designed and made the biofeedback instrument, which was connected to the output of the electromyography. The electrodes of surface EMG were distributed on the thenar, 1st dorsal interosseous, brachioradial and deltoid muscles. The amplitude of the surface EMG on thenar muscle was modulated, converterd to the change of the frequency and used as feedback signal. We used the instruction "You must change lower the tone of the feedback signal." One session consisted of five trainings. We applied 17 sessions to him in two months. The results were stored with data recorder and analyzed with signal processor. Mean amplitude was caliculated. The clinical course was observed with the parameters, mean amplitude, writing speed, and ratio (writing speed/mean amplitude), where writing speed was defined as a number of kana words which were written in a minute. The muscle tension of his arm was higher and writing speed was lower than control. The writing speed increased in late session after the reduction of the mean amplitude in early session. We supposed that not only mean amplitude of the surface EMG but also writing speed, ratio (writing speed/mean amplitude) reflected of the degree of improvement of the symptoms. In the final portion of this report we considered the change of the symptom in the progress of EMG biofeedback training.

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The patient was a 26-year-old female. She had weighed 51kg when she began to diet at the age of 19,resulting in a weight decrease of about 10kg after a year, when she became amenorrheic. By the age of 24,her weight had fallen to 35kg. Upon consulting one hospital, she showed no sign of improvement, she was admitted to our hospital on January 20,1984. On admission, her height was 162cm, and her weight, 35.9kg (-33% of ideal body weight). On physical examination she appeared very emaciated. Her temperature was 35.6℃; blood pressure, 105/75mmHg ; and pulse, 48/min. She had various abnormal attitudes toward food such as furtive eating, food desposal, etc. Results of laboratory studies including urinalysis, CBC, serum electrolytes, blood urea nitrogen, serum creatinine and liver function tests were within normal limits. Stool for occult blood was positive only on the first of several studies. The ECG, EEG, chest X-ray, stull X-rays, brain CT, and G-I tract examinations were all normal. Thyroid fanction testa showed the "low T3 syndrome". Other endocrinological studies revealed the hypothalamic pituitary dysfunction. She was diagnosed as anorexia nervosa and then her treatment was started. Her weight had not improved three months after admission. However, through a combination of tube-feeding and restriction of her behaviour, her weight gradually recovered to 45kg over the following 4 months. She subsequently began drinking a large amount of water and developed mild water intoxication due to dilutional hyponatremia. In anorexia nervosa as well as schizophrenia, self-induced water intoxication may be a cause of death, preventable by early recognition and treatment.

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