Eighteen children (3 males, 15 females) with functional visual disorder were clinically investigated. The subjects were aged from 7 to 14,10.1 being the average. Ophthalmological examination including electro-retinography and visual evoked potential, revealed no particular findings. All of the children showed positive response from the visual acuity trick test, though their visual acuity ranged from 0.1 to 0.8 at the first examination. It was found that 9 children had spiral visual field, that 11 had narrowed visual field and that 8 of them had both spiral and narrowed visual field. Of these, 10 were accompanied with psychosomatic symptoms such as headache, abdominal pain, asthma and nocturnal enuresis. The subjects were divided into 4 groups including 1) psychogenic traumas type (6 cases), 2) conflictual situations type (3 cases), 3) introverted character type (6 cases), and 4) overadaptive type (3 cases). The author analysed the subjects nosologically and the following results were obtained : 1) The visual symptoms appeared after psychological traumas in 6 patients (psychogenic traumas type). It is suggested that psychological traumas caused in them acute psychogenic reactions. 2) Three patients revealed some conflictual situations in their families (conflictual situations type). It is suggested that the conflictual situations caused in them chronic psychosomatic reactions. Their prognoses were poor. Nine patients revealed neither psychogenic traumas nor conflictual situations in their families. Six of them have introverted characters (introverted character type). It is suggested that they suppress psychogenic conflicts in their daily life, which caused in them psychosomatic symptoms. They can be considered hysteria. 3) Three patients were in over adaptive state, which is one of the factors of psychosomatic disease in adult (over adaptive type). As a result of this investigation, the author stressed that functional visual disorder should be approached psychosomatically, considering the children's psychosomatic development and background.

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Many patients with acute myocardial infarction (AMI) demonstrate various psychic reactions in the early stage of illness. Author attempted to investigate the relationship between psychic reactions of inpatients with AMI at the early stage of illness and their previous behavior patterns. One hundred and seventy inpatients with AMI were observed, who were all treated in a coronary care unit or cardiovascular wards. Psychic reactions were classified into the following 4 grades. Grade I and II diagnosed as normal psychological and borderline reactions to AMI. Grade III and IV diagnosed abnormal psychological reactions. Behavior pattern was assessed by Jenkins Activity Survey (JAS) which was translated into Japanese by the Department of Psychosomatic Medicine of Tohoku University. The results were as follows. 1) In all patients, 67.1% were found to have type A behavior pattern. According to a classification of psychic reactions, in type A behavior pattern group, grade I was found in 29.8%, II in 42.2%, III in 25.4% and IV in 2.6%. In the type A group, patients with grade I were statistically significantly less and patients with grade III were significantly more than in the type non-A group. 2) According to Killip's diagnostic criteria in all patients, grade 1 was found in 50.0%, 2 in 31.8%, 3 in 15.3% and 4 in 2.9%. On these distribution of severity no significant difference was found between type A and type non-A groups. However in the type A group, patients with Killip 3+4 showed higher incidence of psychic reaction grade III+IV than patients with Killip 1+2 (61.9% vs 20.4%), and in the type non-A group, non difference was found in incidence of abnormal psychic reaction between patients with Killip 1+2 and 3+4. 3) Many types of arrhythmias who required medical treatments were found in 32.9% of all patients. No difference in incidence of arrhythmias was found between type A and type non-A groups. But in the type A group, patients with arrhythmia showed higher incidence of psychic reaction grade III+IV than patients without arrhythmia (40.5% vs 22.1%). On the other hand, in the type non-A group, no difference was found in incidence of abnormal psychic reaction between patients with and without arrhythmia. Concerning these results, reasonable explanation may be that compared with type non-A patients, type A patients have psychic and physical hypersensitivity and so they are more easily stimulated by and provoked to various psychic reactions while they suffer themselves from stressfull experiences caused by an AMI onset and admission to hospital.

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Much attention has currently been focused upon the impact of life stress on an individual's mental and physical health. A number of investigators have attempted to assess this impact. The measurements of the distressing effects of stressful events can be roughly divided into two types. One measures the degree of the potential power of life events which induce the stress. This type of measurement can not gauge individual differences in stress responses induced by a particular stressful event. The other type of measurement assesses the stress responses of an individual who actually experienced stressful events regardless of the nature of life events. Although a great variety of measures have been used to quantify stress responses, no multifarious measures are available that can assess an individual's psychological stress responses. The purpose of this research is to develop the Psychological Stress Response Scale (PSRS) in order to measure the above mentioned multifarious aspects of psychological stress responses and to examine reliability and validity of this scale. The PSRS, which has developed in Study 1,consists of thirteen subscales : four subscales designed to measure emotional responses (depressive affect, anxiety, irritation, and anger) and nine subscales designed to measure cognitive-behavioral responses (loss of self-confidence, distrust, hopelessness, worry, slowness of thinking, unrealistic wishes, helplessness, withdrawal, and restlessness). Empirical evidence to support the high reliability and sufficient validity of PSRS is reported in Studies 2 and 3. Finally, the significance of the PSRS for psychological research on stress and clinically applied research is discussed.

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Takano Hospital is a coloproctological surgical center in Kumamoto, Japan. The department of psychosomatic medicine was started in April 1986 to approach to psychosomatic problems in the field. Psychosomatic aspects of adolescents with irritable bowel syndrome were studied in twenty-two patients aged 13-19 yrs, who visited the department of psychosomatic medicine during a two year period of April, 1986-March, 1988. During the same period, the numbers of the whole patients who visited our department were 167. The results are summarized as follows : 1) Twenty-two adolescent patients, 3 males and 19 females with irritable bowel syndrome took up 77.3% of the whole adolescent patients in the department of psychosomatic medicine. 2) In the clinical patterns of adolescent patients with irritable bowel syndrome the "gas" pattern was dominant (59.1%). Patients with the gas pattern have mainly severe symptoms of flatus, fullness, rumbling sound and abdominal pain as well as bowel dysfunction, diarrhea and constipation. A decline in the incidence of the gas pattern of irritable bowel syndrome was evident for other generations as there were none in childhood, 15.0% in 20-39yrs, 11.1% in 40-59yrs, 33.3% in 60yrs-. 3) School-maladjustment (53.8%) and anthropophobia (53.8%) were found in the adolescent patients with the gas pattern. The results indicate the presence of an adolescent crisis caused by gas symptoms. 4) Gas symptoms in irritable bowel syndrome could easily be distinguished from a phobia associated with self-odor by the absence of paranoid conditions. 5) It is concluded that the irritable bowel syndrome in adolescence is mainly characterized by "gas". We need a new recognition of gas in the irritable bowel syndrome in adolescence.

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To evaluate the cognitive function in anorexia nervosa (AN), P300 component of event-related potential (ERP) was measured, using odd-ball paradigm, in 10 females with AN and 10 healthy young female controls. The P300 component was not detected in two of the patients with AN, but the remaining eight patients had a longer latency and bigger amplitude of P300 than the controls. The findings were not equivalent to those in psychiatric disorders such as manic depressive psychosis or borderline personality disorder. Together with the present and previous studies on pathophysiological implications of P300 component, P300 abnormality seems to be due to distorted cognition of patients with AN. However, it still remains unclear whether P300 component plays a critical role in the evaluation of cognitive function in AN. In comparison with other results, further studies on the implications of P300 abnormality will be necessary for a step toward its certification.

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Acute gastric dilatation (AGD) is one of the life-threatening complications which needs accurate diagnosis and appropriate treatment as soon as possible, although it occurs rarely in anorexia nervosa. We have unexpectedly experienced a case of AGD in anorexia nervosa caused by superior mesenteric artery (SMA) syndrome during the early stage of the treatment. An 18-year-old senior highschool girl was admitted to our hospital because of anorexia nervosa without any episodes of bulimia or vomiting. About one year before admission, considering herself overweight she had started dieting and had reduced her weight from 60kg to 33.8kg. After admission, she started taking, 1,000kcal of food by herself in addition to 200kcal of elementary diet by the tube feeding. On the 2nd hospital day, a plain chest X-ray picture showed the left-sided pleural fluid because of the pulmonary tuberculosis. The chest drainage tube was inserted on the 6th hospital day, and she was forced to lie on the bed. On the 8th hospital day, she suddenly felt nauseous and vomited. A plain abdominal X-ray picture showed the sign of AGD. A barium X-ray study on the 11th hospital day proved that the AGD was caused by SMA syndrome, showing vertical cut off sign at the 3rd portion of the duodenum obstructed by the SMA and oral side duodenal loop and the stomach were dilated. She was treated conservatively, and barium meal examination, on the 46th hospital day, proved that the signs of SMA syndrome had disappeared. After the completion of our step-by-step treatment program on the basis of cognitive behavior therapy with anti-tuberculosis drugs, she was discharged at the weight of 46.7kg, and she has been in good condition since then.

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In general, patients with eating disorders are apt to disobey the therapist and their parents. They may be induced to defy by perpetual and entrapping incitation of their ill mind. In the process of the behavior restriction therapy, constant stimuli were provided to patients in the therapeutic milieu. The way of therapeutic constancy not only in psychological stimuli but also in bodily sensation made it possible for the patients to resuscitate their own bodily perception. Once the patients learn to realize how they can release bodily functions from their ill mind, they are consequently potentiated to call up vivid emotion and behave freely without defying. The present paper presents the process of improvement in defying throughout the clinical course of a 17-year-old high school girl with chief complaints of abstemious diet and vomiting.

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This is a case report regarding the plasma β-endorphin level in a patient with premenstrual syndrome. She was a 25-year-old student suffering from severe headache, general fatigue, and irritable state in her premenstrual period. Blood samples were collected every 4 days for one menstrual cycle, starting from the second day of menstrual flow. This patient showed a decrease of plasma β-endorphin during one week before her menses and during the ten days of menstrual flow. Between the 14th day and 18th day of the menstrual cycle, the circulating levels of β-endorphin regained almost normal levels. These data indicate the involvement of β-endorphin in the nurture of mood and pain disorders in the premenstrual syndrome. We suggest that changes in circulating levels of β-endorphin are associated with symptoms of premenstrual syndrome.

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This is a case report of a 27-year-old woman with spasmodic torticollis. At age 2,she was taken ill with cerebral palsy and afterwards epileptic seizure appeared. Since then, she had been treated with antiepileptics. In April 1978,she was admitted to the Rehabilitation Center for disabled persons. After a while she suffered from spasmodic torticollis and was attended at an out-patient clinic of our hospital. Although organic diseases were not observed. Some psychological conflicts at the Rehabilitation Center i.e. difficulty in keeping discipline and in following rules as well as in maintaining discipline with others seem to be related to her spasmodic torticollis. From the findings mentioned above, we diagnosed this case as psychogenic spasmodic torticollis and then we applied the shaping procedure based upon the operant principle and autogenic training at the outpatient clinic. In this manner, the symptom continued to gradually improve and was almost healed after 6 months by these therapies. In this paper, we reported a case of psychogenic spasmodic torticollis that was healed by behavior therapies.

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