Upper gastrointestinal bleeding is a frequent and serious problem among patients with advanced lung cancer. Sixty-two cases with lung cancer (Section cases) died during a 7-year period from July 1977 to July 1984,at the 2nd Department of Internal Medicine. Of the 62 cases, 12 cases were complicated by the apperance or reactivation of peptic ulcer. A retrospective study was undertaken to evaluate the clinical course of these 12 cases. These patients with advanced lung cancer included 9 males and 3 females, and they included 6 cases of squamous cell carcinoma, 2 of adenocarcinoma, 2 of small cell carcinoma, 2 of large cell carcinoma. Clinical stage were IV in all cases. A number of causative factors were assumed to be associated with peptic ulcers. Physical factors included : (1) Symptoms Such as pain and dyspnea due to lung cancer and its metastasis; (2) nutritive condition : emaciation and low alubminemia; (3) associated drugs : non steroidal anti-inflamatory drugs (indomethacin, diclofenac sodium, tiaramide hydrocloride) and corticosteroid; (4) past history of peptic ulcer : gastric ulcer or duodenal ulcer; (5) serious complications : metastasis (pleura, bone, liver, kidney, adrenal, brain), pnumonia, cerebral bleeding. Mental factors included : (1) personality such as nervous temperament; (2) mental cause : fear of death, anxiety about family, anguish. It is important to treat the patients with advanced lung cancer with careful consideration of causative factors of peptic ulcer.

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When we pay attention to the relationship between doctor and patient, we can realize that hypochondriac complaints easily swing and change according to the doctor's attitudes. In our psychiatric practice at a general hospital, we found that hypochondriac complaints often got worse due to some kinds of doctor's attitudes. In this paper, we chose 9 patients hypochondriasis who showed negative feelings toward their doctors. We examined their doctor-patient relationship, referring to 5 typical hypochondriac cases in detail. In those cases, hypochondriac complaints were usually reinforced by some doctor's attitudes. These attitudes include 1) rigid scientific attitudes on the part of the somatic doctor, which resulted in, for example, sadistic examinations and excessive administration of drugs, and 2) psychological attitudes on the part of the psychiatrist that the origins of hypochondriac symptoms were of psychogenic nature. The patient's reaction against those doctors' attitudes tends to increase hypochondriac complaints. We call the phenomenon as "micro-hypochondriac reaction." The hypochondriasis as a clinical entity is formed through the recurrence and accumulation of these micro-hypochondriac reactions. Therefore, the first step for treatment of hypochondriac patients should be our attempt to resolve each micro-hypochondriac reaction. However, we don't think that only the doctors' attitudes are responsible for the formation of hypochondriasis. We consider that those doctors' attitudes are also the reaction against the patient hypochondriac complaints. The more a hypochondriac patient complains, the less empathetic the doctor becomes. Then the patient reinforces his hypochondriac complaints. Thus, a vicious circle of hypochondriasis is established. In hypochondriasis, the problem involves such a mutual reinforcement of negative feelings and attitudes between doctor and patient. The patients with hypochondriasis show the characteristic attitudes similar to that of a narcissistic personality disorder conceptualized by H. Kohut. Those attitudes are so called idealized transference and mirror transference, in which the patients try to assign the role as "self-object (Kohut)" to the doctor. The doctors' negative feelings may be his psychological resistance to the role assigned by patients, because the role is usually incompatible with the role as a professional doctor.

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In our clinical practice, we often see depressive patients with a past history of physical illness. But it is unknown whether or not there is a significant relationship between depression and physical illness. Problems on the relationship of these two factors are summed up as follows : 1) Is there a significant relationship between depression and physical illnesss? 2) If there is, why is it? I took notice of the temporal cluster between the onsets of depression and physical illness to solve these problems. Purpose of this report is to give an answer to our questions. The samples were 61 patients (56.4±11.9 years old) who were diagnosed as major depression by Research Diagnostic Criteria. I interviewed them and made a survey of the past history of physical illness, the period between the onsets of depression and physical illness, psychosocial stressors (psychological situations of "over load" or "loss") prior to the present depressive illness and premorbid character (Typus melancholicus, etc). I made a statistical analysis by the method of Yokoyama of whether or not a temporal cluster between the onsets of depression and physical illness was significant. Then I investigated a relation of psychological stressor and premorbid character to the onset of psysical illness. The results were summarized as follows : (1) There was a significant temporal cluster between the onsets of depression and physical illnesses, which were gastro-duodenal ulcer, gastritis, asthma, irritable bowel syndrome and cerebral apoplexy. (2) Most of these four diseases except cerebral apoplexy occurred under the psychological situation of "over load", and they are categorized into psychosomatic disorders. (3) Cerebral apoplexy was a possible psychological risk factor for depression. (4) Most of the patients had a premorbid character of "Typus melancholicus." From the results described above, two reasons can be considered for the significant temporal cluster between the onsets of depression and physical illness. One reason is that some of physical illnesses, e.g. cerebral apoplexy, are a possible psychological risk factor for depression. The other is that psychological stressor and premorbid character of "Typus melancholicus" facilitate the onsets of both some physical illnesses and depression.

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It is said that Tanshin-Funin (people who live and work alone away from their families) of more than a hundred thousand live in Japan. Recently there has been much discussion on Tanshin-Funin as social problems. But very few reports and investigations have been made about this subject. We reported psychosomatic health investigations on Tanshin-Funin in Kagawa by using General Health Questionnaire (GHQ) and the questions : What do you think of Tanshin-Funin? GHQ has been developed by Goldberg in England and translated by A. Nakagawa in Japan in 1985. It consists of 60 questions dealing with recent symptoms. It was known that GHQ discriminate effectively between psychiatric patients and normal controls. Especially, we can find the patients in the area of neurosis and psychosomatic disease by estimating total score of GHQ and 4 factors (somatic symptoms, anxiety sleep disturbance, social dysfunction, severe depression) by GHQ. <Subjects and Method> Subjects; 215 men in 20 companies, Tanshih-Funin in Kagawa Controls; 201 men in the same companies We made a comparison between subjects and controls by GHQ. (1) Total scores of GHQ (Mean score, Percentage of over 17 score) (2) Histogram of GHQ scores in subjects and controls (3) 4 factors (somatic symptoms, anxiety. sleep disturbance, social dysfunction, severe depression) (4) Siginificant items between Subjects and controls regarding 60 questions by x^2-test. We asked Tanshin-Funin the questions of concerning "What do you think of Tanshin-Funin?" <Result and Discussion> 1) Subjects showed a tendency of higher scores by GHQ than controls. Especially, Tanshin-Funin who think "Tanshin-Funin is bad" showed a neurotic tendency. This may be due to the existence of neurotic tendency prior to this job arrangement. 2) Subjects were characterized with their tendencies that they have anxiety about the future and they do not go out after, saying that they are too tired. 3) Subjects have been under unstable circumstances from the standpoint of mental health. Because Tanshin-Funin have been living irregular life alone and lacking in the communications with their families, and suffering from economic burden for the double life. Tanshin-Funin have psychosomatic problems, which are related to the idea that Tanshin-Funin is bad. 4) Psychosomatic health controls of Tanshin-Funin are necessary in each company.

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The patient was a 29-year old woman with chief complaint of frequent vomiting after meals. Her husband's grandmother died in November 1983. About that time, she ate irregularly day after day because of the nursing and preparation for the funeral of the grandmother. From that time, she began to have a subfever, orthostatic dizziness, and vomiting after meals. As weight loss was also observed, she was carefully examined at a nearby clinic, but no abnormality was noted. In November 1984,she was admitted to our hospital. Based on her clinical course observation, she was diagnosed as having nervous vomiting not due to any organic lesion but due to psychological and functional mechanism. Data on the frequency of vomiting showed a good psychosomatic correlation, suggesting the incompatibility due to a psychological conflict. However, a possibility of repression in personal history could not be denied, either. In view of the situation that she was the mother of two children, we thus decided that she should be allowed to adapt herself to her life by behavior therapy or supportive psychotherapy instead of reducing her own role as a mother by undergoing insightive psychotherapy.

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This report is concerned with 2 girls, 10 and 11 rears old, of a same family who were almost simultaneously performed amputation and chemothrerapy for osteosarcoma. The younger sister complained of severe phantom limb pain and nausea and vomiting which occur at any time prior to chemotherapy injection, whereas the older sister did not complained of her symptoms in the postoperative course. Their family life history revealed that both of their parents were psychologically inmature and showed instability and tension. Psychological tests indicated that the younger sister suffered severe anxiety and was frustrated by chemothrapy and leg amputation. The parents' psychological instability might have influenced her. Her severe pain and frequent nausea were relieved by ralaxation training. On the other hand, the older sister frankly expressed her psychological distress and easily received chemotherapy due to the short period of its course without nausea and vomiting. Differential clinical pictures of the two sisters were discussed from the paychosomatic view point.

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