Recently a great number of Japanese go not only to western countries but also to developing conutries, and vatious psychosomatic symptoms are seen in them while they stay overseas. But there are little published clinical data and no systematic investigations have been made as to their psychosomatic disturbances. So we tried to make a study of epidemiology of these disturbances using a personality inventory and a questionnaire on life overseas. Subjects and Method : we investigated the relationship of the TPI (the MMPI revised to assess Japanese, a 500 item parsonality inventory) and a questionnaire in regard to life and health overseas, which were administered to 162 male subjects of the Japan Overseas Cooperation Volunteers (JOCV). The TPI was given 2 months before their departure from Japan, while the questionnaire was administered on their return in 1989. JOCV members are Japanese who are sent to developing countries for a 2-year period of duty to contribute to the social development of these countries. The mean age of our subjects at the time of departing from Japan was 26.8±3.6 (M± SD) yrs. Results : 1) During their period of duty, 67(42.4%) of subjects experienced psychosomatic disturbances. The mean onset period was 6.3±5.2 months after assignment and the mean duration of symptoms was 5.4±5.0 months. 2) Items directly relatd to human relationships were rated as the main courses of strees and were higher than such items as changes in climate, weather, life style and anxiety about illness. 3) Comparing the TPI csores, it was found that the group (n=56) who strongly experienced psychosomatic disturbances, in comparison to the group (n=60) without such disturbances, had significantly (p<0.01,p<0.05) higher mean scores on the In (Introversion) scale and the Ep (Epilepsy) scale as well as significantly (p<0.05) lower mean scores on the Ma (Manie) scale. It was suggested that such disturbances were likely to be experienced by those who are introverted and sesitive, tending to suffer alone, by those who suppress feelings and are rather inflexibility in thinking, or by those who have less activities. 4) The duration of psychosomatic disturbances correlated significantly (r=0.48 : p<0.001) with the scores of the In scale. It was suggested the possibility that character tendencies before leaving Japan have some influence not only on the onset but also on the prosess of psychosomatic disturbances while overseas. 5) 12.7% of subjects strongly had feelings like persecution mania in the new surroudings while overseas; this group was significantly (p<0.01) less likely to engage in hobbies than the group without these feelings. It was suggested that enjoying a hobby is one of the effective methods in maintaining psychological health while overseas.

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The cultural pressure for thinness and dieting is an important cause for an increased incidence of eating disorders. Thus, we studied the influences of the cultural pressure on body image, self image, and their relationship in 712 students (357 male and 355 female) of junior-high school age, when the prevalence of eating disorders has been known to increase. The body image was assessed by following three questions : 1) Choose adjectives suit for your own body shape (fat, average, or lean; and bad, normal, or fine), 2)How much are your actual and desirable body weights? How much do you think the standard body weight for the same and oppsoite sex students having the same height are, and 3) From among a set of eight figures drawing fron very thin to very heavy shapes of women, choose figures like actual and desirable body shapes (applied only for female students), and choose figures like atandard and attractive body shapes for women. The self image was assessed by the self-esteem inventory consisted by 23 items developed by Kajita. Female students were more interested in diet than male students (p<0.001) and the ratio of the intersted female students increased with advancing school grade (p<0.05). Although the female students had a lower obesity index than the male students, the ratio of those who thought their own body shape fot or bad was greater in female students than in male students (p<0.001) and the ratio increased with school grade (p<0.05). Independently of actual body weight, the female students desired to have lower body weight and thinner body shape than those they thought standard for themselves (p<0.001). The body shapes selected as standard or attractive by the female students were thinner tha those selected by the male students for women (p<0.001). The self-esteen score in female students was lower than that in male students (p<0.001) and was lower in the second- and third-grade female students than in the first grade students(p<0.001). The female students thinking their body shape fat showed lower self-esteem score than those thinking it averave or lean (p<0.001). Our results indicate that female students desire to be thinner than the other students and their higher self-esteem is associated with their thinner body image, while the male students show no such tendencies. We conclude that cody image, self image, and their relationship are considerably affected by recent cultural pressure concerning body shape and diet in female but not male junior-high school students.

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Recently, many studieds have been reported in which a sleep-wake rhythm was regarded as an index of circadian rhythm. Also from the clinical view-pont, judgement of a style of sleep-wake rhythm is becoming more necessary. It is said that there are two styles of human behavior : the morning type and the evening type. Using Oquist's Morningness-Eveningness Questionnaire (M-E Questionnaire), we have reported that there was no problem concerning its validity and reliability when we used it in Japan, and that was a close relationship between the style of human behavior and aging. In the present study, we investigated the relationship between the style of human behavior and the human character. Seventy-nine remitted patients (38 males and 41 females) were judged as to their behavior types Oquist's M-E Questionnaire in Japanese. Though the original questionnaire has 19 questions, we used 16 questions as the remaining 3 questions had significantly lower validity as we reported before. According to the total score of the 16 questions, behavior types were divided into 3 types : Evening type (total score of less than 36), Neither type (37-53), and Morning type (more than 54). At the same time we investigated the character type of the cases using Cornell Medical Index (CMI) in Japanese, and compared the results of CMI as to each behavior type. The results were as follows : (1) The cases of evening type complained more somatic disturbances and disturbances of moods and feelings than the cases of morning type. (2) Significant correlations were found between the scores of 4 items of CMI, namely, "fatigability", "frequency of illness", "inadequacy", and "anger", and the scores of M-E Questionnaire. Some authors have reported that there are a marked tendency of irregular style of sleep-wake rhythm in cases of evening types compared to the cases of morning types, and this fact is supposed to have a close relationship to our results that the cases of evening types complain more than the cases of morning types somatic disturbances and disturbances of moods and feelings. But as it is not clear whether the behavior type decides the character or the character decides the behavior type, further investigation is neccessary concerning to this issue.

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Labor is not a simple physiological phenomenon, but a process influenced by personality, social factors, and psychosomatic environmento. In this study, to investigate the changes of the autonomic nervous activity as labor progresses, 150 samples of plasma catecholamines were estimated and 150 recordings of Microvibration pattern (MV) were analyzed in 41 patients. In addition, the changes in their autonomic nervous system as affected by postpartum hemorrhage were examined. Differences between primigravidas and multigravidas, effect of labor with or wihtout hasband's presence, and the nature of their egograms were also observed in these patients. The results were as follows. 1. As labor progresses, both plasuma noradrenaline and adrenaline significantly increased until crowning (p<0.01,p<0.05). By one hour after delivery, the levels had significantly decreased (p<0.01,p<0.05). 2. At full dilatation, the slow and alpha wave components of MV were decreased (p<0.01), and the fast wave component of MV were increased (p<0.01). By one hour after delivery, patterns of MV returned to their former states (p<0.01). 3. Postpartum hemorrhage caused plasma catecholamines to increase (p<0.05), the alpha wave component of MV to decrease (p<0.01) and the slow wave component of MV to increase (p<0.05). 4. Primigravidas had higher adrenaline values at early first stage (cervical dilatation was under 3cm) than multigravidas (p<0.05). At crowning, primigravidas had larger fast wave element of MV than multigravidas (p<0.05). 5. The plasma adrenaline levels in the group of the labor with husband was significantly lower than those without husband when the cervix dilation was 4-9cm (p<0.01) and 10cm (p<0.05). 6. Compared to A and M type egogram patients, N type patients had no significant differences about the changes of plasma catecholamines and MV.

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The purpose of this study is to examine relations between life events and health states in Japanese infants. The subjects were 719 infants who had all three routine infant health checkups at the age of 3,10 and 18 months. A life event questionnaire, which was Coddington's one with some modifications, and a questionnaire about infant's health states and histories of consulting doctors were administered to their mothers at each health checkup. There was no significant relation between the number of life events/the score of life change unit (LCU) and the number of days of consulting doctors after the events occurred. The Spearman's rank correlation coefficients were very low (range : -0.003〜0.06). Only one event as to the death of a family member was found to have a signifidant relation to the number of days of consulting doctors. Infants, who had experienced an event of family member's death by the age of 3 months, consulted doctors until 10 months significantly more frequently than infants who had not had such an event (p<0.05). Although there was no significant difference, a similar tendency was found on infants who had an event of removal. It seems that these life events such as the death of a family member and removal have some influences on health states of infants. There was also a significant relation between the score of LCU and the results of health checkup at the age of 18 months. Infants who had high scores of LCU had more problems to be followed than those who had low LCU scores. Interestingly, such a relation was not found between the number of life events and the results of checkup. Therefore, it is necessary to consider both the number and the LCU score in the study of life events. It is concluded that not the quantity but the quality of the life event may have important influences on the life of infant because an infant is influenced by life events indirectly.

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A 46-yr-old female farmer was admitted to the department of psychosomatic medicine of Kyushu University Hospital for treatment of right upper quadrant abdominal pain and abnormal dependence on the analgesic injection. Four years ealier, she received cholecystectomy for recurrent biliary type pain, and was treated with endoscopic sphincterotomy (EST) for suspected sphincter of Oddi spasm in the manometric study prior to admission. The patient, however, has remained troubled by the same kind of pain. Examinations on admission revealed no organic lesion in the biliary system and gut. The mechanism of abdominal pain after EST was considered due to motility abnormality of the gut in this case. Her frequent requirement of injections for abdominal pain embarrased the medical staff every day. Several psychological problems of the patient were pointed out : feeling of solitude and emptiness after hard working or nursing children all her life, its unconscious suppression, and compensatory satisfaction in medical service. Main purpose of our therapy was withdrawal from abnormal dependence on analgetic injections, but its process was very hard. Our medical staff tried to maintain the consistent attitude, "confrontation" to her dependence and "sympathy" to her solitude. An art therapy, "Chigirie" accelerated the therapeutic development of her suppressed inner world in chilhood. Five months later, at the time of discharge she was able to control herself in part even when colicky pain was about to threaten her with a panic.

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A case of Akatsuki disease was reported. Akatsuki disease which was named and reported first by Dr. Sakamoto in 1964 is defined as the skin lesions that are induced by neglect of skin hygiene and based upon certain psychological mechanisms. A 58 year-old female diagnosed as Akatsuki disease was referred to our department by a bermatologist. She had not been able to bathe for more than seven years because she felt burning sesations on her face when she took a bath. When she was admitted to our hospital, her cheeks looked red. When she put her hands into hot water, her face became more red and that state lasted over ten hours. However, endocrinological studies could not explain her complaints. As she was in a hypochondriacal state and also suspected to be in a hypersensitive state of the vasomotion of her face, Autogenic Training as well as the image therapy called "Nanso no Hou" were introduced in addition to supportive psychotherapy and congnitive, behavioral modification. As the result, the redness of her cheeks disappeared and she became able to take a hot shower in two months, and was discharged from the hospital.

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Pheochromocytoma is often accompanied by anxiety symptoms, so we need to differentiate anxiety neurosis from pheochromocytoma. We experienced two cases of pheochromocytoma, one patient complained of anxiety and the other did not. The patient with anxiety was a 40 year old man who consulted our hospital because of palpitations and headache with anticipatory anxiety. Our diagnosis was anxiety neurosis, so we administered lorazepam. It was not effective, but sulpiride improved his condition. As the diagnosis was pheochromocytoma, he was operated on for a tumor. A Y-G Personal Invetory before the operation showed aggressiveness, and after the operation was provisional normal. A Rorschach test revealed passiveness and dependence. The other patient was a 17 year old man who did not complain of anxiety. He entered our hospital (urological department) for a pheochromocytoma operation. We carried out a psychological test with his agreement. A Y-G Personal Inventory showed almost a normal profile. A CMI profile before the operation was provisional neurosis but after the operation was provisional normal. MAS was within a normal limit. The catecholamine concentration of Case 2 was higher than that of Case 1,but anxiety symptoms were not accompanied with Case 2. Peripheral catecholamine is said to be relevent to anxiety. Our cases suggest that high peripheral catecholamine alone cannot evoke anxiety but with other factors, e.g. congnitive factor, can evoke anxiety.

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A 60-year-old man was admitted to our hospital because of refractory chronic urticaria in September, 1998. The age of onset was 11 years old. He had been administered prednisolone, most of antihistaminic drugs and antiallergic drugs for a long time. He had also received non-specific therapy. There were causative factors related to his symptom on neither physical nor laboratory examination. Psychological tests indicated he had a neurotic and depressive personality. In addition to psychological tests, he was diagnosed clinically as hypochondriacal neurosis and neurotic depression. According to our clinical observation, his symptom of urticaria exacerbated with stress and subsided with relaxation. With regard to his psychological background, the onset of the illness followed bereavement of his loving father. Moreover, he missed affection of his dominant mother. He suppressed or repressed his aggression against his mother for long. Futhermore, he grew to be in a state of depression because of his work and senility. It seemed that his symptom was related to these psychological factors. Two months later, he was improved by psychosomatic therapy. He no longer needed prednisolone. He had a good clinical course afterward. In conclusion, it is important to practice a psychosomatic approach for urticarial patients from an early stage of treatment.

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