Psychological aspects of the aged hemodialysis patients, who had been on long-term hemodialysis (S1 group) and started on hemodialysis at over 65 years old (S2 group), were examined using various psychological tests such as MMPI Alexithymia Scale, Beth Israel Questionnaire and General Health Questionnaire. Firstly, alexithymic trait was observed most frequently in S1 group patients, compared with S2 group patients. Secondly, this trait has a positive correlation with various physical complications in not S1 group patients but S2 group patients. Thirdly, according to the personality classification of Yatabe-Guilford Personality Inventory, patients who displayed C type showed stronger alexithymic than those who displayed other types. From these results, two different secondary alexithymic patterns are speculated, in addition to primary alexithymia which is often observed in various psychosomatic diseases such as hypertension : 1) Secondary alexithymia due to long-term hemodialysis. 2) Secondary alexithymia due to aged hemodialysis start. These secondary alexithymia pattterns are different from secondary alexithymia induced by limited condition on the basis of hemodialysis.

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Psychological aspects of hemodialysis patients with diabetic nephropathy were examined using various psychological tests such as the MMPI Alexithymia Scale, Beth Israel Questionnaire and General Health Questionnaire. Alexithymia was observed in 83% of dialysis patients with diabetic nephropathy. Positive correlations beween alexithymia and self-control markers of renal failure and diabetes were found, suggesting that alexithymia, the lack of awareness of their own bodies results in sluggish self-control, affects prognosis of dialysis patients seriously. Moreover, visual disturbance such as severe retinopathy are likely to further accelerate this condition. For hemodialysis patients with alexithymia, therefore, it is required to make them aware of their own bodies.

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For phenomenological elucidation of panic attacks, patients with panic attacks were asked the sequence of panic symptoms they suffered during attacks. Enrolled in this study were 20 patients (6 men and 14 women) with a mean±SD age of 30.9±8.4 years. A diagnosis of panic disorder based on the DSM-III-R criteria was made in all patinents, half with agoraphobia and the other half without. The mean±SD age of the onset of the illness was 27.7±8.3 years and the mean±SD duration of it was 3.6±2.3 years. All patients had been receiving drug therapy before participating in the study, and 55% of them used to have at least one panic attack per week. These patients were requested to name the panic symptoms in order of their occurrence and specify the patterns of their abatement. The median number of symptoms experienced by patients was six. Symprom rankings were presented in a boxplot using medians, quartiles, minimumas, and maximumas. Panic symptoms were found to be claasifiable into three categories : early symptoms consisting of dizziness or faintness, palpitations, and sweating; intermediate symptoms comprising dyspnea, shaking, choking, nausea or abdominal distress, flush or chills, and chest pain or disomfort; late symptoms represented by paresyhesias, fear of dying, and fear of going crazy. Panic symptoms disappeared in 63% of the patients irrespective of the sequence of their occurence. The hypothesis that hyperventilation induces panic attacks seems to be untenable, because dyspnea is one of the intermediate symptoms. In our study fear was one of the late symptoms. This finding suggests that fear is caused by a sudden physical abnormality triggered by some biological factors, rather than supporting concept that anxiety and fear induce other symptoms of panic attakcs.

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Shift workers connot have regular sleep hours and rest time. Strees caused by a work shift has different effects on male and female workers, depending on their life styles and roles in the family. Therefore we investigated effects of work shift on psychosomatic health conditions of psychiatric and geriatric nursing staff. Two hundred nurses working in psychiatric and geriatric wards were studied. We divided them into four groups. The first group consisted of 20 male daytime workers with the mean age of 37.4±15.0 (mean±SD); the second group of 45 female daytime workers with the mean age of 38.6±12.8; the third group of 63 male shift workers with the mean age of 33.7±11.3,and the fourth group of 72 female shift workers with the mean age of 34.4±13.6. All shift workers were engaged in a 3 shift work system. The level of psychosomatic health of the subjects were assesed using CMI (Cornell Medical Index) and GHQ (General Health Questionnaire) tests. The shift workers had more psychosomatic complaints than the daytime workers, and such a tendency was especially marked in the females. The area III and IV of CMI and the upper 17 points of GHQ were significantly greater in the female shift workers than female daytime workers. The present results suggest that female shift workers experience more stress than male shift workersby working on the shifts, that female shift wokders have more difficulties in handling both work and household duties than male shift workers, that female shift workers tend to show a greater neurotic tendency than female daytime workers, and that female workers may be more vulnerable to a biological rhythm change than male workers.

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Married women working on shifts are likely to have greater stress in handling both work and household duties than unmarried women, and their psychosomatic health are adversely affected by the stress. However, Caplan and others assert that the family can provide a support to shift workers in dissipating stress. It is also known that each individual experinces different levels of stress from the same pressure placed on her, depending on how effectively she copes with it. The purpose of this study is to compare the leveis of psychosomatic health of married and unmarried nurse working on shifts and to assess whether the family is actually serving to dissipate stress. The relationship between the types of personality and the level of psychosomatic health is also investigated. Seventy-two nurses working on shifts in five mental hospitals were studied. In order to match the age of the subjects, nurses younger than 40 years were selected from the 72 nurses, and divided into a group consisted of 22 married nurses and group of 24 unmarried nurses. The mean age of the married group was 28.7±7.7 (mean±SD) and that of the unmarried group was 26.4±9.5. The level of psychosomatic health was assessed by GHQ and CMI tests. Personality traits were assessed with YG and MAS tests. GHQ showed no significant differences between the two groups. However CMI revealed, in all cases, that the scores of the married grouop were lower than those of the unmarried group on seven scales in dicating that the married nurses had higher health levels. The subjects with high psychosomatic health ratings were compared with those whose ratings were distinctly low, using YG and MAS tests. The nurses with high health ratisng showed low scores on eight scales in YG and MAS, except for the scale of intellectual extroversion, indicating that they are generally active and optimistic, and experience a low level of anxiety. The results of this study suggest that the family of married nurses functions as a social support in coping with the stress, and that nurses of active, optimistic and calm character remain mentally and physically health.

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We examined coefficient of variation of R-R intervals (CR_<R-R>) in order to know autonomic nervous function in patients with pulmonary diseases. We also examined the effects of Tofisopam on autonomic nervous function. (1) %CV_<R-R> at rest was decreased in patient groups of autonomic dystonia type and psyhosomatic disease type which were classfied by Toho Medical Index (TMI), a questionnaire which examines the tendency of autonomic dystonia. (2) %CV_<R-R> was increased at standing position in patients without autonomic dystonia, but %CV_<R-R> at standing position was not shown the difference with that at rest in patients with autonomic dystonia. (3) %CV_<R-R> was increased in patients whowere administered Tofisopam, but decreaased in patients who were not administered Tofisopam, but decreased in patients who were not administered to fisopam. (4) %CV_<R-R> was increased in non-asthmatic patients who were administered Tofisopam, but decreased in asthmatic patients who were administered Tofisopam. The opposite response to Tofisopam in asthmatic patients may indicate the different autonomic dysregulation in bronchial asthms.

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Hypertension is demonstrated to be the most commonly associated medical diagnosis in panic disorder, though the nature of the observed association is not clear. The case reported here is the clinical course of a patient with panic disorder and hypertension whose diastolic blood pressure was ultimately normalized as his QOL (quality of life) improved.Miled hypertension was observed during a six year course of psychiatric therapy for panic disorder with agoraphobia in this 32 year old unoccupied male with a family history of essential hypertension. When he first visited our hospital complaining of tachycardia and chest disomfort, his blood pressure was 170/100mmHg. He had been evaluated as hypertensive for three years. though he hadn't taken the prescribed antihypertensive drugs. Laboratory findings excluded possible secondary forms of hypertension. Retinal change was Scheie H_<1>S_<2> stage, and no left ventricular hepertrophy was demonstrated in the echo cardiogram. Laboratory findings showed mild liver dysfunction and elevation of uric acid, both of which came in normal range within 6 months. Obesity (+23%) and increased alcohol intake for selftreatment was observed. General antihypertensive education such as reduction of sodium intake, exercise and control of obesity, as well as pharmacological therapy withβ-blocking agents, a diuretic, benzodiazepiness and a tricyclic antidepressant were administered. The patient was also given in vivo desensitization for agoraphobia. After the agoraphobia was controled and anxiety was reduced, however, diastolic blood pressure did not decrease sufficiently to reduce the dose of antihypertensive drugs. In this situation, the patient was not impaired in evryday life, but he was dissatisfied with his inability to perform social roles, and especially inability to find an appropriate job. His problem was having unrealistically high achievement motives which had led him to constant dissatisfaction and low self esteem. After brief psychotherapy, he becaom more realistic, and interparsonal relationships also improved. He applied for an appropriate job and was employed. As he proved to be capable on the job, his self esteem heightened, satisfaction with life increased, and his QOL improved remarkably. This led to his high psychological well-being, and eventually diastolic blood pressure settled in the normal range and no more antihypertensive medication was needed. This case suggests that it is better not to view a patient as having either a medical or a psychiatric illness but to see him as a whole including physical, phychological and social characteristics. Aiming at improving his characterictic QOL will in itself have a therapeutic effect which leads to favorable outcome. QOL improvement is recommended for inclusion in the therapeutic plan to heighten the efficacy of treatment.

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The author experienced two cases of patients who showed psychiatric symptoms a few years after spinal cord-injury and considered psychological aspects of spinal cord-injured patients. A 40-year house wife met a traffic accident caused by her husband and got injured in her spinal cord 4 years ago. At the same time the accident bought her daughter paralysis. Before the accident she had been diligent and persevering. After that, she had been thought to adapt herself to the spinal cord-injury. However she develped a sudden possessive state. She accused her husband who caused the accident. On the other hand, she expressed guilty feeling toward her family whom she had depended on. She showed aggressive feelings toward medical treatment. She showed resistance to psychiatric treatment. A 20-year male injured his spinal cord when he jumped into a swimming pool 3 years ago. He had been denying his paralysis, especially disability to walk after the trauma. When an orthopedist said to him that he could not walk, he showed a transient acute confusional state. After that, he showed depressive symptoms. But he accepted his impairment, as he identified himself with the other spinal cord-injured patient. Generally speaking, spinal cord-injured patients often deny his paralysis. The patient's place in the life cycle can provide clues to their psychological vulnerability. Especially adolescent patients must be faced with identitiy crisis. Patients whose offender is one of their family members develop ambivalence toward them. Some of them have aggressive feeling toward medical treatment. Most of them resist psychiatric involvement because the mind is the last intact place for the spinal cord-injured patient.

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