The feature of bronchial asthma is often modulated by emotional factors, and we utilize the Comprehensive Asthma Inventory (CAI) to assess such factors. The CAI, which was originally published by the Japanese Society of Psychosomatic Research on Respiratory Disease, is a questionnaire containing 22 questions designed to find out emotional factors concerned with occurrece of asthma attack. Using CAI, we tried to find out clinical traits of depressive and neurotic patients with bronchial asthma. In this report, we tried calculating the percentage scores of 9 psychological categories as "extent of coditioning", "suggestibility", "expected anxiety", "dependency", "frustration", "flight into illness", "distorted life habits", "negative attitudes towards prognosis", "decreased motivation towards therapy" and taking average of total percentages (we call it CAI score). In this study, we applied four kinds of psychological tests (Cornell Medical Index-Fukamachi's method, Self-rating Depression Scale, Manifest Anxiety Scale, Seikenshiki Inventory) to assess depressive state and a neurotic tendency, and CAI to 121 cases with bronchial asthma (50 males, 71 females, ages; from 15 to 72,mean 39.8 years old) at the clinic of the 1st Department of Internal Medicine, Nihon University School of Medicine. The results were summarized as follows; l. 21 cases out of 121,17.4%, revealed depressive state and 53,43.8%, revealed a neurotic tendency, 47 cases, 38.8%, did not show either of neurotic or depressive state. 2. Mean score of SDS of the depressive group was 57.3,which was statistically higher than that of the neurotic group (38.5) and the third group (31.6) (p<0.01,respectively). Mean score of MAS of the depressive group (male 31.l, female 31.1) was higher than that of the neurotic group (male 20.9,female 20.5) and the third group (male 8.2,female 11.7) (each p<0.01 respectively). 3. Mean score of CAI of the depressive group was 46. 7,which was statistically higher than that of the neurotic group (36.7) (p<0.05) and the third group (21.2) (p<0.01). 4. The depressive group had higher scores in the following items of the CAI, "extent of conditioning suggestibility", "dependency", "frustration", "distorted life habits" (each p&lt0.01,respectively), "expected anxiety", "flight into illness", "negative attitudes towards prognosis", "decreased motivation towards therapy (p<0.05,respectively) than that of the neurotic group. 5. More cases in the depressive group answered "yes" to the questions of CAI as "Do you ever think that you had better die when you have your asthma attack ?" "Do you have other symptoms when you have no asthma attack ?'' (each p<0.01,respectively) comparing to the neurotic group.

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We had studied "psychogenic" hearing loss in childhood from a point of psychosomatic medicine (Shinshin-Igaku 25 : 429-436,1985.). This study was performed to compare "psychogenic" auditory disorders with visual disorders psychosomatically because the number of patients with both disorder is on the increase. The purpose of this study was, first, to investigate the points of similarity and/or differences between "psychogenic" auditory disorders and visual disorders with regard to psychological tests, clinical psychiatric view points, and secondly, to examine whether the classification which we had attempted to apply to "psychogenic" auditory disorders could be applied to "psychogenic" visual disorder patients. The subjects were 30 cases, who were devided into 3 groups. That is, 10 cases (Group I) had been diagnosed only as "psychogenic" auditory disorder at the outpatient clinic of otology. Another 10 cases (group II) only as "psychogenic" visual disorder at the outpatient clinic of opththalmology. And 10 cases (group III) as "psychogenic" auditory and visual disorders. The age of subjects ranged from 6Y5M and l2Y5M, the mean being 9Y5M (Male 6,Female 24). We analyzed the subjects to learn the relationship between psychological tests (Rorschach test, WISC-R, P-F study, Taken-shiki parent-child relationship test, etc.) and clinical observation (results of auditory and visual tests, psychosomatic symptom, prognoses etc.). The following results were obtained : (l) No significant difference was observed between group I and group III with auditory tests, and between group II and group III with visual tests. (2) No significant difference was observed among 3 groups about age of onset, sex, subjective symptoms, but cases who complained of psychosomatic symptoms were twice as many in group III as in group I and group II. (3) With prognoses, 9 cases of group I improved within a year. In group II, 4 cases improved within a year and 4 cases dropped out. But in group III, 5 cases improved and 3 cases relapsed. (4) As to psychological tests, they showed somewhat similar characters ; high passivity, high level of aspiration and suppression of their aggression. (5) According to the last report, the sufjects of Group I were classified into 3 types, that is, : over-adaptation type; 4 cases, mal-adaptation type; 5 cases and pre-adaptation type; l case. Group II : over-adaptation type ; 3 cases, mal-adaptation type ; 6 cases and pre-adaptation type ; l case. Group III : mal-adaptation type ; 9 cases and pre-adaptation type ; l case. As a result of the present investigation, it was concluded that there were many similarities and few differences between "psychogenic" audititory disorders and visual disorders with regard to psychological viewpoint and to clinical observation. Then, we proposed that both groups should be regarded as "psychogenic" sensory disorders and it would be advisable to apply a therapeutic approach based on our psychological classification. It is suggested that cases of the complexed group should be approached psychotherapeutically.

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Reports on depressive disorders suggest that some physical illnesses are considerded to be an important risk factor for depressive disorders in the aged. However, it has hardly been known whether or not there is an epidemiological evidence confirming an existence of a correlation between deperessive disorders and physical illnesses in the aged population. We have made an epidemiological study on senile depression in Higashi-Kubiki county, Niigata prefecture since 1985. Based on the results of the epiderniological study, we will here describe some relationships between depressive disorders and physical illnesses in the aged. In a total member of 1,392 households of the aged (65 and older) in Oshima village and Matsunoyama Town, Higashikubiki-county, we have interviewed 822 (59.l%) in the summer of 1985. They were classified into either major depressive disorder (MDD) or minor depressive disorder (mDD), or non-depressive disorder (Non-D) by the Research Diagnostic Criteria (RDC), and were surveyed as to the past history of physical illnesses, present physical disorders and a severity of physical disorders respectively. The results obtained were summarised as follows. 1) Of the 822,40 (4.87%) were diagnosed as MDD and 26 (3.16%) as mDD, and 756 (91.97%) as Non-D. 2) Life prevalence rates of cataracta and cerebral apoplexy were siginificantly higher in the MDD group than in the Non-D group (p<0.01). 3) There were no significant differences in any point prevalence rates of the present physical disorder (disorder of eye, ear, shoulder, hand, lower limb, waist, and others) between the MDD group, the mDD group and the Non-D group respectively. 4) Comparing with the Non-D group, the MDD group had disorders in the lower limb more commonly, as well as the rnDD group those in waist (p<0.02). 5) Population rates judged as "mild" physical disorder or "none" were high in the order of the Non-D, the rnDD and the MDD whereas, in contrast, those judged as "severe" high in the order of the MDD, the mDD and the Non-D (p<0.01). It seems to be reasonable to infer that physical disorders with pain or those leading to a loss of the role in daily life are prone to precipitate a development of depression in the aged, and that chronic severe physical disorders can be risk factors for a development of senile depression.

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Two children with diabetes mellitus having emotional disability were treated by psychotherapy. Emotional problems of diabetic children and their personality characteristics were analyzed using the results of the Picture-Frustration (PF) study carried out in 34 other children with diabetes mellitus. As the major personality characteristics, PF studies disclosed the rebellious type showing aggressiveness, maladjustability and lack of efforts to overcome difficulties, and the obedient type lacking positiveness and trying to amend errors with utmost effort. Diabetic children were likely to have more emotional problems than normal children, especially in expressing aggressiveness, Case studies of the 2 children showed that emotions were influenced also by the premorbid personality and domestic environments. The disease was not the direct cause of emotional disability, but rather acted to be incentive to expose patient's latent personality and hidden domestic problems. When emotional disability is observed in diabetic children, physicians should count the pre-disability condition of blood sugar control, the adjustability to society and the level of psychopathological findings. A diabetic child needs establishing a reliable relation with a particular doctor or other medical staffs, lasting to a long term. Treatment of diabetes mellitus is therefore desirable to be carried out in a polyclinic hospital, where the specialists of the disease can communicate closely with mental specialists.

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There exists considerable literature on the Stress Polycythemia, but little work has been done to study its psychosomatic approach. Therefore, two cases of possible stress polycythemia were reported here from a psychosomatic point of view. The first case was a 55-year old male patient whose occupation was a professor of the department of technology. Patient's chief complaint was anguish feeling on heart. Short-run and VPC was found by Holter's ECG. Blood pressure was 130/60mmHg. Haematological counts were RBC : 620×10^4/mm^3,Ht : 54.0%, and Hb : 17.8g/dl. Microscopic findings of blood in bone-marrow were normal. Psychosomatic interview revealed that patient's character was tenacious, and he was under stress in that he had to conduct twice as many lectures and seminars than those scheduled one year before. In addition, his wife was suffering from anxiety neurosis, and his eldest daughter had been living an asocial life. The second case was a 34-year old male who was an office manager. Patient's chief complaints were insomnia, headache, biting sharp pain on both eyes. Blood pressure was 140/80mmHg. Haematological counts were RBC : 542×l0^4/mm3,Ht : 52.7%, and Hb : 17.4g/dl. Psychosomatic interview revealed that he was kept extremely busy working from early morning till midnight accompanied by poor eating behavior. Regarding his personality ; patient has been spirited and impatient since his childhood. Patient's tenacious personality with a Type A behavioral life pattern has been manifested in his workerholic life style. Furthermore patient has a tendency of being an alkoholic and heavy smoker. His stress situation involved continuous overwork, depression of his wife and death of his father. The common factors in these two cases of possible stress polycythemia can be summaized from the psychosomatic point of view as follows : 1) Patients were middle-aged men and top-managers of their business. 2) Patients have been tenacious in personality and under depressive state due to their workerholic life style. 3) Patients have been anxious because of neurotic diseases of their family members. 4) Antidepressants, anxiolytics and a psychosomatic approach were effective to them. On the basis of the course of haematological count as well as the clinical course, it was concluded that psychosomatic approach was essential for the treatment of stress polycythemia.

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