We studied the symptomatology fo bowel dysfunction, effect of antidepressants and clinical course in senile patients with depressive states. Twenty-seven depressed patients over age 60 visited the department of psychosomatic medicine of the coloproctological surgical center, Takano Hospital during the period of Apr. 1986 to Sept. 1989. Seventeen patients were selected in this study, whose predominant disturbance in bowel dysfunction was clearly improved by the administration of antidepressants, sulpiride 100〜200mg and/or amitriptyline 10〜40mg per day. As to their symptoms, constipation was seen in 82.4%, diarrhea in 5.9%, distension in 52.9%, rectal dissatisfaction in 52.9%, and abdominal pain in 52.9%. Characteristically, most of those constipated patients complainted of frequent stools and related urgency. The properties of their constipation were close to that of a spastic colon and not atonic. Peripheral digestive drugs and minor tranquilizers did not always improve their bowel dysfunction. This indicated that the site of the pharmacological action of antidepressants on bowel dysfuntion was central. Prior bowel conditions, anal lesions and physical illness or injury were very significant with regard to a cause of senile depressive states.

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An investigation was carried out of 25 male patients who attended the University Hospital or other hospitals in Niigata Prefecture from 1973 and 1988 with the chief complaint of eating disturbances. The 25 subjects were classfied into 4 groups according to clinical characteristics : 1) typical group of eating disorder (16 cases) 2) reactive group (5 cases) 3) obsessive-compulsive group(2 cases) 4) phobia group (2 cases) The typical group (16 cases) were further classified into 3 subgroups according to the age of onset. (1) preadolescence (2 cases) (2) adolescence (13 cases) (3) pre-adulthood (1 cases) A typical case of each group was reported, and clinical characteristics of and differences among the groups were explatined. Concerning the typical group, possible reasons of the onset were discussed in rather details from the developmental standpoint. Most of the patients of the typical group, i.e. 13 cases, had the onset during their adolescence. It was supposed that the main psychopathology of the typical group of eating disorder was ego-identity confusion and withdrawal from or evasion of undertaking the socail role of the masculine gender. The ego-identity confusion was supposed to have derived from a composite of immaturity of the patients' mental development and a family factor that they felt strong attachment to their mothers while feeling estrangement from their fathers. Premorbid obesity was supposed to be connected with symptom selection of eating disturbances.

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It is well documented that psychologic stimulation has been implicated in the occurrence and pathophysiology of bronchial asthma. Psychological factors are considered to be highly connected with social backgrounds, however those relation with symptoms seemed to be complicated in patients with asthma. We have therefore studied the relationship of asthmatic attacks and emotions in daily life using a revised Diary of Asthmatic Attack and Emotion (Asthma-Kokoro Diary). Since many patients complained of feelings of fatigue and workload as their main emotions in the asthma diary, we have also investigated each relationship of these complaints and asthmatic attacks. Also several psychological tests were conducted. 28 male and 22 female asthma patients with a mean age of 53 years ranging from 19-79,were selected, all of whom were known to have asthma as defined by the American Thoracic Society. A positive relationship between asthmatic symptoms adn emotions was observed in approximately 30% of patients, and more than 40% of patients complained of workload (feeling) or fatigue (feeling) suggesting that these emotional factors might induce asthmatic attacks. Drug dependency was found in the positive group according to the Comprehensive Asthma Inventory (CAI), and decreased motivation towards therapy was found in the negative rgoup. No significant correlation between other psychological tests and asthma sympromatic condition was found in all patients. We conclude taht the Diary of Asthmatic Attack and Emotion would be a useful psychomatic appruoach to evaluate emotional factors in patientas with esthma.

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Fifty five cases of the patients with rheumatoid arthritis (RA) were examined by the egogram (TEG) and the Rorschach test. The purpose of this study was to understand the ego states of the RA patients and then to find some methods for the care of their lives. The controls were thirteen cases of the patients with systemic lupus erythematosus (SLE) and forty normals. The results of the Rorschach test were corresponded to the ego states of the TEG. The RA patients showed high points in NP and low points in FC than controls. Their patterns belonged to a bit flat N type. The results of SLE patients were high in NP and AC, and those of the normals were relatively high in NP and FC. These results did not correlate to the duration of illness. The cases with severe joint deformity tended to show much higher scores in NP. We hope that the RA patients will be cared taking into consideration of their psychological aspects and their quality of life.

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One hundred and fifity five asthmatic children out of a total number of 188 hospitalized chidren who had been hospitalized for the first time between the ages of one and fifteen during the 7 year period between 1980-1987 and were treated by institutional therapy with the duration of more than 1 month, were studied. One year after their discharge, a questionnaire was sent out to them asking about asthmatic attacks, daily life and parental attitudes. Our findings and conclusions are as follows; 1) With regard to asthma itself, the frequency of asthmatic attacks (95%), the severity of attacks (96%), various self-control techniques to control asthma (88%), and the fear of asthma (94%), were markedly improved. In terms of the daily life of those chidren, absenteeism (96%), independence (66%), confidence (76%) and peace of mind (71%) were also improved. As to parental attitudes, fear of asthma (97%), and over-protection in daily life (73-76%) were improved as well. 2) With respect to the difference in age groups, improvement (in both asthma itself and daily life) was greater in the infant group as compared to older groups. Infants with asthma, however, must be treated on an indevidual basis and greater care must be administered when hospitalized. Although the degree of improvement was a little lower both in the early school-aged group and in the later school-aged group, School aged childeren as a whole are considered to be suitable for institutional therapy partially due to the psycho-socianl development of asthmatic children.While the results show a greater improvement in the puberty group as against the school aged group, it is speculated that oder chilren tend to show lass improvement in their disease, as there were few older patients who responded to the questionnaire. It is therefore advisable that asthmatic chidren who had severe or intractable asthma in their early years be hospitalized for institutional therapsy during early years in school. 3) The transition of morbid improvement in ashtmatic chidren was correlated to the level of medical care, and to the presence or absece of some form of mutual reliance beween the patient, his or her family, and the doctor. To ensure thesuccessful performance of appropriate institutional therapy, a mutually cooperative team led by a physician should be utilized. Additionally, team members should try not only to educate the patient and his or her jamily, but also accept them encouraging the development of their mutual reliance. 4) Those cases which produced unexpected results, those who did not respond to the survey, as well as readmission cases should be investigated further and in more detail.

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We investigated the precipitating factors of trasient global amnesia (TGA). TGA is an acute sel-imited organic amnestic syndrome of uncertain etiology. Some cases of TGA have been reported to accur in the context of a psychological stressor. We identified such psychological stress in 4 out of 6 TGA cases. The stress included insomnia, pain, death of family and quarrels. This feature is similar to that of psychogenic amnesia. Therefore, we think it necessary to pay particular attention to the clinical differentiation of these two disroders.

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In stress polycythemia, various types of stress are closely associated with the development of the disease; however, the exact etiological mechanism remains unknown, Recantly, we found a typical case of stress polycythemia which was apparently induced by emotional stress. The patient was a 61-year-old man. He had been the headmaster of an elementary school until March 1989. After retiring from the school upon reaching the age limit, he was employed as a director of a kindergarten in April 1989. The new job quite different from the previous one and very stressful for him. In November 1989,such symptoms as severe insomnia, lack of energy and ruddy face gradually appeared. He visited Asahikawa Medical College Hospital on January 4,1990 for a medical examination. The hematological findings at the time were : red blood cell count, 6,380,000/μl; hemoglobin, 19.78g/dl; hematocrit, 59.7%; white blood cell count, 5,310/μl;and platelet count, 309,000/μl. Arterial oxygen saturation (SaO_2) and serum erythropoietin level were within normal limits. Splenomegaly was absent and chromosomal analysis of the blood cells showed normal karyotype. Thus, the possibility of polycythemia vera or secondary polycythemia was excluded and a diagnosis of stress polycythemia was made. Since the patient felt unable to endure the work, he was absent from work after January 5,and resigned on January 16,1990. After that, his insomia and other symptoms gradually disappeared. Four weeks after his initial visit to our hospital, patient's red cell count returned to normal without any treatment. This case clearly indicates that emotional stress is a major causative factor of stress polycythemia, and that the latter is a psychosomatic disease. A case of stress polycythemia was documented and the etiology of stress polycythemia was discused by reviewing relevant literature.

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