This study seeks to examine the variation of somatic symptoms in depressed patients by their sex, age and clinical subtypes, and also investigate the course of these symptoms under medical teatment. The subjects were 134 inpatients with depression who were hospitalized in the Department of Neuropsychiatry of Fukushima Medical College Hospital from 1976 to 1985. They consisted of 74 males and 60 females, aged from 16 to 73 years (mean 42.5 years). They were classified into four subgroups based on their generations; 1) adolescent group (16-29 years) : 35 cases, 2) manhood group (30-44 years) : 38 cases, 3)presenile group (45-64 years) : 46 cases, 4) senile group (over 65 years) : 15 cases. According to Pichot's subtype classification of depression, monopolar type was 55 cases, bipolar type 29 cases, reactive type 22 cases, neurotic type 19 cases and organic type 7 cases. These data were analyzed statistically by means of x^2 or tmethods. Results were as follows; 1) The main somatic symptoms at admission were initial insomnia, middle insomnia, delayed insomnia, loss of appetite, head discomfort and general fatigue. 2) There were no significant sex differences in somatic symptoms, but the incidences of initial and middle insomnia were high in those with monopolar depression. Moreover, the complaint of initial insomnia tended to decrease with age. 3) The course of somatic symptoms such as initial insomnia, loss of appertite, delayed insomnia and head discomfort tended to extend with age. 4) Some of the somatic symptoms persisted after the patients recovered from psychotic symptoms. In generel, as the patients become older, the somatic symptoms continued longer. Among them, head discomfort tended to remain longer in all generations. Above-mentioned results suggest that symptoms in depression were not only necessary for diagnosis of depression but also necessary for evaluation of therapeutic effects.

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Many questions were unawared concerning the mechanism of type A behavior pattern in relation to development of coronary heart diseases. The author attempted to investigate cardiovascular responses of type A patients with acute myocardial infarction by an emotional stress test. Sixty-two inpatients with acute myocardial infarction (under 59 years of age) were observed. All patients were in I or II grade of Killip's severity criteria at the early stage of illness and showed good recovery process. Using mirror drawing test as a mental stress load, changes of blood pressure, pulse rate and plasma catecholamines were examined. Behavior patterns were assessed by JAS (Jenkins Activity Survey) which was translated into Japanese by the Department of Psychosomatic Medicine of Tohoku University. The subjects included some acute myocardial infarction patients with treated hypertension (in I or II grade of WHO classification). As a result, by combining behavior pattern and blood pressure level, 62 subjects were classified into the following 4 groups. Group A : type A hypertensives (19 cases) Group B : type A normotensives (22 cases) Group C : type B hypertensives (9 cases) Group D : type B normotensives (12 cases) The results were as follows. 1) Mirror drawing test stress evoked more elevation of blood pressure and plasma catecholamine level in type A patients than in type B patients. 2) Marked effects to increase systolic blood pressure and plasma noradrenaline level by Mirror drawing test were seen in group A, moderate effects were in groups B and C, contrary slight effects were in group D. Statestcally significant differences in mirror drawing test stress were seen in systolic blood pressure changes between group A and group B(p<0.05), group A and group D(p<0.01), and in plasma noradrenaline changes between group A and group D(p<0.05). 3) These results suggested that acute myocardial infarction patients with type A bahavior pattern had cardiovascular hyperreacivity based on hypersusceptibility of sympathetic adrenal medullary system.

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Previously we have examined the patients with menopausal symptoms, that is so called climacteric syndrome. We divided them into four types on the basis of personal interviews ; somatic type, psychosomatic type, neurotic type and depressive type. However, many of the patients with climacteric syndrome complain of lumbago, headache, general faigue, hot flush, insomnia and so on with no relationship to any of the four types. This time, we carried out a Microvibration study (lying position and standing position) with them to examine the state of the autonomic nervous system of women with menopausal symptoms. The fine and invisible tremors on the body surface were recognized by Rohracher in 1946 and they were named Microvibration. It has been found that Microvibration distinctly reflects the autonomic function. The results of Microvibration were analyzed and classified into four types, that is, normal pattern, slow wave pattern, fast wave pattern, and irregular wave pattern. Generally, a slow wave pattern indicates the predominance of sympathetic nerves and fast wave pattern the superiority of parasympathectic nerves. We also examined the plasma hormone value (Estradiol, LH, FSH, Testostorone) of the patients, and gave them Schellong's test and a personality test (the Cornell Medical Index). The results are as follows. 1) An abnormal Microvibration pattern was found 59.1% in lying position. 2) The neurotic type that was divided on the basis of personal interviews showed a significantly higher percentage of abnormal Microvibration patterns than others. 3) There was no significant relationship between Microvibration and the Cornell Medical Index. 4) In normal Microvibration pattern cases, the plasma Estradiol value is significant higher than others. 5) There is no relationship between Microvibration and LH, nor FSH nor Testosterone. 6) FSH/LH is 0.777 on the average (standard deviation is 0.338). 7) InSchellong's test, 4 cases was found to be abnormal and 3 of them was also found abnormal in Microvibration.

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THe safety of the aerobic exercise designed for pregnant women and its effects on their anxiety during pregnancy and labor were discussed. A consecutive series of primiparas (n=66) was assessed over the course of their pregnancy and after delivery. Twenty eight pregnant women over 20 weeks of gestation who attended to the aerobic training more than twice a week were recruited to this study. Thirty eight women of control group were gathered at random from the primiparas who were delivered in the obstetrical unit of the St. Marianna University Hospital. As obstetrical parameters, age, days of gestation, birth weight, apgar scores, length of labor, the percentage of Caesarean operation and obstetrical complications were recorded. Their anxiety was assessed by STAI at the admission and on the first day post-partum. The self-rating questionnaires about the course of the pregnancy and the delivery were also given to them. Results were as follows. (1) It was de, monstrated that maternal aerobic exercise exerts no effects on their pregnancy course. (2) Without length of labor, no statistically significant differences were obtained from abstetrical data in both groups. However, their self-estimates were different. These results may be explainede by the difference of their attitudes. The aerobic group consisted of women who might have been more active and positive for their pregnancy and delivery than the control group. (3) The aerobic exercise did not reduce discomfort significantly. (4) Gool effects of the aerobic exercise on improving the emotional stability of pregnant women and inspiring them to accept their labor experience should be emphasized.

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This is a report on a patient with eating disorder who developed mediastinal emphysema associated with frequent self-induced vomiting. The patient was a 20-year-old male who was admitted to our hospital with complaints of anorexia, self-induced vomiting and psychomotor restlessness. Medical and psychological evaluations were consistent with the diagnosis of eating disorder not otherwise specified according to the DSM-III-R. Chest radiography on the third day after admission showed both mediastinal emphysema and subcutaneous emphysema of the neck and shoulders. There was no history of trauma and lung diseases. Esophagoscopy was not remarkable. Bronchoscopy, however, showed a scar of the ulcer in the left piriform recess. Recurrent self-induced vomitings could be thought to be a contributing factor to the emphysema in this patient. After 10 days of treatment, during which time the patient was free from self-induced vomiting, chest X-ray films became normal. It is suggested that patients with eating disorder, especially those with frequent vomiting episodes, should be examined with careful attention to the complication of mediastinal emphysema.

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This paper reported a female case of spasmodic torticollis that is remitted by EMG biofeedback therapy. The EMG-BF session for 30 min was repeated twice a week and the effect was evaluated by the lowest value of action potential of the surface EMG and its total area. Anatomically, M. deltoideus does not directly correlate with M. sternocleidomastoideus but its relaxation brings not only relaxation of upper arm and shoulder but also secondarily relaxation of cervical and upper part of the body. In this case, instead of M. sternocleidomastoideus, we selected M. deltoideus as the initial target of EMG-BF therapy, to which relaxation was easily introduced. Relaxation of M. deltoideus was reduced to 35% of that before treatment. M. trapezius, the secondary relaxing muscle, was relaxed after 7 sessions. Full relaxation of M. sternocleidomastoideus, which was the ultimate goal, was achieved only after 14 sessions, although its action potential reduced to 12.5% as a result of relaxation of M. deltoideus and trapezius. To start the EMG-BF therapy from muscles which are easily relaxed has advatages that it is not only easy for patients but also ready to introduce to physicians who are not experienced in this therapy. Detailed further study will be required.

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