The majority of patients with diurnal enuresis are accompanied by nocturnal enuresis. The diurnal enuresis can be classified into two types.(1) The diurnal enuresis with micturitional urgency.The patients have an invreased micturutional sensation. They have difficulty holding micturition because of the strong contraction of the bladder.(2) The diurnal enuresis with no micturitional urgency.The patients have a decreased micturitional sensation. The inhibitory control of central nervous system to vesicourethral tract might be insufficient. The urine drops one by one. The urine volume at each micturition remains lower, so micturitional stimulus might not be increased. Some patients go to toilet by feeling wet. Others do not go to toilet even when their clothes got wet. They do not have the feeling at all. Habituation by repetitive wetting for a long period might elicit a further decrease in micturitional sensation. The following result may suggest existance of the habituation. Twenty patients with diuretic enuresis and no micturitional urgency (age 4〜10 years old) wore no underpants and had only loose skirt-shaped towels around the loins in the daytime for 2-3 weeks. Results were as follows : 1) Daytime wetting disappeared in 8 of 20 patients.2) Daytime wetting diminished in 6 of 20 patients.3) Daytime wetting stayed same in 6 of 20 patients.As soon as they clothed in the loins, diurnal enuresis reccured in all patients.

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The psychiatric and psychosomatic aspects of muscle contraction headache (MCH) were reported in this study. 48 cases of MCH were selected. Based on a consideration of clinical course, 48 cases were divided into 4 groups : the first group consisted of MCH patients with psychosomatic trend : the second group included those with neurotic trend; the third group, those with depressive trend; the fourth group, those with transient trend.The General Health Questionnaire (GHQ) completed at first visit of our department was used for comparison of each MCH subgroup. The results of this evaluation revealed that MCH patients with neurotic trend demonstrated high total score, while those with depressive trend demostrated both high total score and depressive score, and those with psychosomatic trend demonstrated both low total score and depressive score. These results indicate the usefulness of GHQ.On the other hand, although no significant statistical difference was observed, antidepressants showed relative effect for MCH, compared with antianxietics and muscle relaxants. This effect of antidepressants was obtained either with or without the presence of depressive symptoms. This may suggest that antidepressants are also effective against pain as well as depressive symptoms. Therefore from the above results, the more frequent use of antidepressants for the treatment of MCH could be recommended.

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Many recent studies in psychosomatic medicine have indicated that is difficult to understand psychosomatic disorders by means of simple causality. Those studies suggested that psychosomatic disorders result from genetic factors and breaking of the network around the individual such as environmental stress and problems in their sociocultural backgrounds. The breakage of such network also brings about social maladjustments including alcohol abuse, bulimia, suicidal behaivior and conduct disorders. These disorders are all on the increase recently as psychosomatic disorders are. This indicates that there might be some relationship between psychosomatic disorders and social maladjustments.From this view point, we conducted a research on psychosomatic disorders in delinquents. We studied the health status of two hundred and seventy-five delinquents and three hundred and forty high-school students with a newly devised medical questionnaire. The mean ages of delinquents and high-school students were 17.1 years and 16.9 years respectively. The results were as follows.(1) Delinquents showed significantly higher morbidities than high-school students, not only in infectious diseases and trauma, but also in psychosomatic disorders. Those who were suffering from bronchial asthma were 5.4 percent in delinquents, 2.1 percent in high-school students. There were 4.3 percent of delinquents and 1.2 percent of high-school students who had affected by peptic ulcer. Enuresis in childhood was much more common among delinquents as compared with high-school students (15.8 percent versus 8.8 pecent).(2) Delinquents were significantly more likely to complain of physical symptoms, such as palpitation, shortness of breath and languid.These results suggested that delinquent behaviors would have connections with the development of psychosomatic disorders.

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In relation to its diagnosis and treatment, obesity needs to be regarded as one of psychosomatic disorders. Two types of obesity, in the light of its mechanism, could be considered : one in which obesity results from eating behaviors as the way of dissolving psychological anxiety and tension in one's background, and the other in which psychological anxiety and tension is rather slight, but one's eating habitude itself is the cause of obesity.In order to investigate the characteristics of psychological aspects and eating habitudes relating to obesity, we studied 821 subjects (653 males and 168 females) by the means of STAI (State-Trait Anxiety Inventory), TEG (Todai Egogram) and the eating habitude questionnaire.In the males, we compared the results of STAI and TEG as psychological scales by obesity index, and found no difference in the scales by obesity index. However, the examination of eating habitudes showed some distinctions by obesity index. In the group with obesity index below 30%, eating habits of the subjects themselves lead to obesity. On the other hand, the subjects with obesity index over 30% seemed to have eating behaviors as the ways of dissolving their anxiety and frustrations besides the eating habits leading to obesity.As for the females, we hardly came to any conclusion due to the small size of the group. Yet, the ration of subjects of anxiety and over-adaptation increased in the group with obesity index over 10%. Accordingly, this suggested making further inquiries into psychological problems of female obesity. Conerning eating habitudes, the group with obesity index over 30% possibly used behaviors to diminish anxiety and to change psychological moods in the same manner as the males.

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I studied on the scaling of life events in Japanese children. Three hundreds and forty-nine subjects were asked to estimate life events in terms of how much influence thess events had on children's ordinary life. Subjects were composed of 314 teachers and 35 pediatricians. I used the method as Coddington with some modifications of the items because some of the items described by Coddington did not fit Japanese children's ordinary life. I made four questionnaires according to children's ages (for infants under 1.5 years of age, for children between 1.5 and 5 years of age-i.e., under school age, for elementary school children, and for junior high school children). It has been reported that the rank ordering of events was highly similar between different sociodemographic groups. Therefore, I tried to convert the rank orders into scores. For this purpose, in order to calculate life change unit (LCU) I used a percent value of each item score and a modified value of reciprocal score of each item rank (N items : N/N×100…1/N×100) in addition to a geometric mean. As a result, for each life event I got three LCUs (LCU-G : derived from the geometric mean, LCU-P : derived from the percent value, LCU-R : derived from the item rank).The rank order correlations were over 0.9 for all three LCUs between most pairs of different sociodemographic groups. They were at the level of 0.8 only between groups with and without their own children in LCU-G of the infant under 1.5 years of age questionnaire, and between job different groups in LCU-P of the elementary school age questionnaire. The rank order correlations for LCU-P and LCU-R were significantly higher than those for LCU-G in some pairs of groups. There were significant differences in the absolute scores given to particular life events of three LCUs in some pairs of groups. The number of such events was large between age different groups, especially between young group (20's and 30's) and senior group (over 50's). The numbers of events with significantly different scores between groups were smaller in LCU-P and LCU-R than those in LCU-G. These suggest that LCU-P and LCU-R may have more universality than LCU-G. It is concluded that it may be better to calculate LCU by using percent values of item scores or modified values of item ranks.

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[in Japanese]

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A male company employee, unmarried 46-year-old, had been engaged in computer related business for the past 26 years. Since March, 1986,when the merger of the company became an issue, he had not got enough time to sleep on account of the preparation for it. He was suffering from insomnia. At that time he was diagnosed as vegetative dystonia because anorexia and emotional irritability. He was given a tranquilizer.Toward the end of September in the same year, he was brought to the hospital of a medical college due to an attack of dyspnea and received emergency treatment. After that, he was referred to the department of psychiatry where he was treated for the diagnosis of depressive state.He was afflicted as ever, however, with such multiple symptoms as dyspnea, insomnia, night sweat, nausea, anorexia, anxiety, emotional irritability, loose idea, feeling of fatigue and so on. In April of 1987,he was treated at home for a whole month. At the beginning of May, he was allowed to work at a department which was unrelated to the computer, on favorable conditions that he was permitted to go to work late, go home early and do an easy work. In about a month, as his state promptly improved, he was returned to the ordinary work. At present, 10 months since then, he is working without any abnormality.In this case, his memorandum which is like a computer flow chart, his own personality and his clinical course were definitely characteristic. So he was considered as technostress syndrome (Techno-centered).

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A 12-year-old girl was admitted to our hospital because of a recurrent cough and headache. They had both begun 34 months prior to the admission, when she had had an upper respiratory infection. The cough was non-productive and occurred frequently when she was speaking, but never during sleep.Physical and neurological examination revealed no abnormality. Complete blood counts and biochemical and serological studies were unremarkable. Radiography of the chest and electroencephalography were normal. Pulmonary function tests, including a spirogram and a maximum expiratory flow volume curve, were performed, but the patient couldn't participate well enough to obtain reliable data. A methacholine inhalation challenge test revealed no obvious hyperresponsiveness. On psychological evaluation, an intropunitive tendency on frustration and a desire for dependency were suspected. Also, it seemed that she thought her mother didn't have very intimate affection toward her.Her persistent cough was diagnosed as a psychogenic cough, so she was treated by means of psychotherapeutic approaches including family counseling. We tried the "bedsheet technique" on her, and the cough stopped within two days after its application. Pulmonary function tests showed no obstructive dysfunction later.We think that a psychogenic cough is not rate in children. A psychosomatic approach is important when dealing with a chronic recurrent cough.

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