During the period between 1983 and 1989,thirty-four patients with anorexia nervosa were admitted to our hospital. Five of these cases were suffering from severe liver injury. Case I was a 16-year-old girl (height : 156cm, weight : 27kg). She showed GOT : 321U, GPT : 220U, LDH : 1082U, CPK : 581U, UN : 89mg/dl. PT : 40%. HPT : 37%. She recovered with fluid therapy administered via central venous catheter, but she also received a blood transfusion to correct anemia that developed during the clinical course. (cf. GOT : aspartate aminotransferase (ASAT), GPT : alanine aminotransferase (ALAT), CPK : creatine phosphokinase, UN : urea nitrogen, PT : prothrombin time. HPT : hepaplastin test.) Case 2 was a 17-year-old girl (153cm, 27kg) with severe liver injury. GOT : 2070U, GPT : 679U, PT29%, HPT : 21%. She died of heart failure in spite of a positive response to fluid therapy. Case 3 was a 20-year-old man (165cm, 29kg) with the following profile : GOT : 4710U, GPT : 856U, T. Bil : 5.3mg/dl. PT : 71%. HPT : 58%. He recovered with fluid therapy. Case 4 was a 17-year-old girl (151cm, 26kg). She, showing GOT : 266U, GPT : 638U, recovered with fluid therapy. Case 5 was a 15-year-old girl (162cm, 30kg). She, showing GOT : 2230U. GPT : 1940U, recovered with fluid therapy. The five cases reported shared a relatively similar clinical course. Their body weight losses were over 40% of standard body weight, and they were losing their body weight progressively. Elevated GOT and GPT scores coincided with complaint of muscle weakness and fatigue. Four of them showed a bleeding tendency. Their liver condition responded well to adequate fluid therapy. Fluid therapy with volumes of 500ml/day was not effective. We found fluid therapy in amounts exceeding 1500ml/day, 500kcal/day to be effective in treating this kind of case. HBs-Antigen was negative in all cases. During the course of treatment, normocytic anemia developed in all cases, two of which required blood transfusions. In cases 1 and 2,symptoms of heart failure increased. In cases 3 and 5,Iiver injury with body weight loss was recurrent. These cases suggest that severe liver injury is not rare in patients with anorexia nervosa. Patients with rapid, progressive body weight loss and complaints of muscle weakness should be payed careful attention during the clinical course.

View full abstract

It is said that the mother's rearing attitudes toward her children have important effects on their development. We investigated many various parameters which affect the mother's rearing attitudes, and selected the ones which have a high level validity and reliability. First, we rated 138 mothers with children between 4 & 5 years old (normal & mentally retarded) using the questionnaire "MS-form Rearing Attitude Questionnaires" which is composed of 23 items. From this questionnaire we selected four factors by factor analysis. The 1st factor-"Rejection" is composed of anger scolding and punishment toward her child. The 2nd factor"Anxrety" means fondness anxrety about separation, anxiety about losing her child and her child suffering a serious injury. The 3rd factor-"Maternal Immaturity" means disagreement with family members, overintervension and giving in to child's obstinate requests. The 4 th factor"Control" means she always wants to keep her child under her direction. From the factor correlations, we found that the 3 rd factor is the key. That is, the 3rd factor has high value correlations with the other three factors, and the findings that the 3rd factor is connected with the other 3 factors have very important meanings in the pathological viewpoint. We know clinically that compounding these factors results in mental or psychosomatic diseases. These diseases should be preventable if the pathological factors are found in the early stage. Second, the validity of the 4 scales (4 factors) was supported by the results of factor analysis with the 15 items : PAT, 4 scales of MS and Age. We have compcsed a diagnostic test, of high level validity, with which we can rate the mother's rearing attitudes.

View full abstract

The actual condition of technostress syndrome is little known. In order to reveal the actual condition of technostress syndrome, a certain scale is required. As the first step to establish the scale, the present study devised a questionnaire to evaluate a technostress tendency. Twenty-three computer operators were interviewed about their mental conditions when working with computers. Based on the information obtained by the interview, a draft questionnaire was made. After revision through the pretest, a questionnaire consisting of 37 questions was completed. Of 37 questions, 28 were associated with the techno-centered tendency and 9 were associated with the techno-anxious tendency. Each question has 3 categories-Yes No, or Unknown-for answers. The questionnaires were sent out to 273 (male : 241,female : 32) computer operators to collect data. Analysis was conducted by separating the questions associated with the techno-centered tendency from questions associated with the techno-anxious tendency. Each question was given a point according to the answer-1) Yes-1 point, 2) Unknown-O. 5 point, and 3) No-O point. The total points were used as the score to judge the technostress tendency of the subject. The mean value and standard deviation of the score were calculated. Subjects whose scores were≧mean+SD were put in the high tendency group and subjects whose scores were≦mean-SD were put in the low tendency group. Chi-square test was used to evaluate the difference in the answer to each question between high and low tendency groups. The questions in which the answers were significantly different between two groups were proved to be associated with a technostress tendency and selected. The questions selected by chi-square test were further analyzed by factor analysis in order to be classified. As the result of chi-square test, 22 out of 28 questions associated with the techno-centered tendency and all of the 9 questions associated with the techno-anxious tendency were selected. Factor analysis revealed that 22 questions to judge the techno-centered tendency were classified into 8 factors and that 9 questions to judge the techno-anxious tendency were classified into 3 factors. The author would like to conduct a further study to refine the questionnaire and hopes to establish a standardized scale.

View full abstract

The present study discussed the relationship between a technostress tendency and psychological characteristics. The interviews with 23 computer operators were conducted to devise a draft questionnaire to investigate a technostress tendency. After analyzed by chi-square test, a questionnaire which consisted of 31 questions was completed. The completed questionnaire was sent out to 273 computer operators (male : 241,female : 82). Each question had 8 answers-Yes, No, and Unknown-. At the same time, MAS test, SDS test, Y-G test were conducted on the subjects. Questions about a technostress tendency were given a point according to the answer-1 point for Yes O.5 point for Unknown, O point for No-. Total points of the questions were used as the score to judge the technostress tendency of the subject. Subjects whose scores were≧mean+ SD were in the high tendency group and subjects whose scores were≦mean-SD were in the low tendency group. With MAS test, subjects were divided into 2 groups-1) the subjects with anxiety, 2) those without anxiety. With SDS test, subjects were divided into 3 groups-1) the subjects with depression, 2) those with slight depression, 3) those without depression. The data from Y-G test were used to observe 3 profile patterns-Y-G 12 profiles, Y-G6 profile groups. Y-G 5 personality types. With the data on Y-G 12 profiles, subjects were divided into 5 classes. With the data on Y-G 6 profile groups, subjects were divided into 3 groups-1) subjects who have a strong profile, 2) those who have a slight profile, 3) those between 1) and 2) . Chi.square test was used to examine if these psychological characteristics were significantly different between the high and low technostress tendency groups. The results showed that subjects who had strong psychological characteristics as follows were contained significantly more in the high technostress tendency group than in the low one. 1) Techno-centered tendency : anxiety (MAS), depression, nervousness, Iack of cooperativeness, thinking introversion, obedience (Y-G 12 profiles), emotional instability, social maladjustment (Y-G 6 profile groups). 2) Techno-anxious tendency : anxiety (MAS), depression (SDS), nervousness, depression, Iack of cooperativeness, aggressiveness, Iack of objectivity, inferiority feeling, rhathymia, cyclic tendency (Y-G 12 profiles), emotional instability, social maladjustment, activity (Y-G 6 profile groups). It was also observed that the high tendency group of techno-centered stress contained significantly more A and B type people and less D type people than the low one and that the high tendency group of techno-anxious stress contained significantly more A, B and E type people and less C, D type people than the low one (Y-G 5 personality types). The author would like to conduct further studies based on this study, especially a case study and a case-control study, and hopes to obtain a standard conclusion.

View full abstract

Of the patients with anorexia nervosa (A. N.), those with body weight less than 20 percent of the standard body weight and particularly those whose body weight decreased below 40 kg may see their weight loss rapidly accelerate to 35 kg, 30 kg or less and fall into a dangerous mental and physical condition, which might lead to death. The treatment of A.N. is very difficult and not much about it has been grasped although various characteristics have been mentioned. According to studies, these A. N. patients with a marked body weight loss were found to have a strong feeling of rejecting hospitalization as follows : ・They have an image of the hospital where patients are made put on weight like a broiler. ・Why should I be hospitalized when 1'm getting along very well ? ・I don't want to be alone, ・I don't want to part with my family members, ・My daily life will be restrained. ・I doubt if the attending physician will understand me when I'm hospitalized. ・I am worried that the weight gain might not stop. ・Worrying about the hospital life. We therefore fixed an out-patient body weight limit (body weight requiring hospitalization) by which to take the hospitalization measure in accordance with patient's mental/physical conditions in case of their body weight decreasing below that limit. We also had them make efforts not to break below the level of the body weight in hospital by the period promised and had them gradually increase their body weight on their own. By this method, eighty percent of 18 cases of A. N. who met the diagnostic criteria of DSM-III-R were able to escape from the critical body weight zone and to receive treatment at the out-patient clinic. The merit of this therapy lies in that even intractable A. N. can receive treatment only at the out-patient clinic and escape from the critical loss and that extreme thinness can be prevented by setting up the body weight requiring hospitalization, if A. N. is discovered early. From the standpoint of medical economy which has recently been taken up actively for debate, this therapy can be said to have the cost merit since the whole cost of hospitalization is saved. It is therefore concluded that this is an excellent therapy for A. N.

View full abstract

The authors reported a case of 51-year-old woman with perfect blindness due to Wegener's granulomatosis who had varieties of visual hallucinations over one year. It was considered that some psychological factors caused her visual hallucination on the basis of ophthalmological factors. These psychological factors included suffering from Wegener's granulomatosis over ten years, anxiety about perfect blindness, unhappy incidents in her childhood and unfortunate marital life, and her character, i. e. "Typus Melancholicus" proposed by Tellenbach. Above all, she was not able to see her first grandchild at all because of her perfect blindness which occurred prior to the birth of the infant. This experience of the loss of sight seemed to be the most significant precipitating factor for causing her visual hallucinations. Her hallucinations had intimate tones to her, which could be understood from the view points of psychological aspects. In 1759,Charles Bonnet reported a patient who exhibited visual hallucinations with the disturbance of sight. However, the patient had the insight that the hallucinations were not real and showed no other psychiatric signs. Such cases were known as Charles Bonnet's syndrome. Authors regarded the presented case as one of Charles Bonnet's syndrome, and concluded that some psychological factors played significant roles in the cause of the disease.

View full abstract

This report concerns a 26-year-old woman with anorexia nervosa complicated by anemia due to repeated hematemesis. She began to suffer from vomiting after meals and anorexia 4 years ago .and since then she had been repeating binge eating and vomiting. Her weight had decreased from 47 kg to 38 kg and she beame amenorrhea. Two years ago her weight decreased to 30 kg, and from that time on, she began noticing blood mixed in her vomited material. She with as admitted to the hospital on an emergency basis for hematemesis. During hospitalization, the patient's hematemesis and vomiting were alleviated, but whenever she was discharged from the hospital, the hematemesis recurred, so she became anemic, and a blood transfusion was carried out over again. Upper gastrointestinal endoscopy was conducted repeatedly, the finding of .hemorrhagic gastritis was observed, but local hemorrhagic source like as a gastric ulcer or laceration was unclear. In the cases of eating disorders, it is predicted that irritation due to chronic malnutrition, binge eating, and vomiting affects the gastrointestinal tract. Accordingly, it is thought that patients with eating disorders should be placed at great risk for digestive tract disorders. However, there have been few reports to date of gastrointestinal bleeding related to vomiting in patients with eating disorders. As one of the reasons for the rareness of the reports, it can be hypothesized that habitual vomiting as a background factor for hematemesis is difficult to be detected because of their denial, .so that the patients are not diagnosed as eating disorders and treated only as cases of digestive tract disorders. On the other hand, some investigators claimed that these peculiar behaviors only rarely result in gastrointestinal disease. Concerning frequency of incidence of gastrointestinal complications, Hall and Cuellar et al. reported that the frequency of those is relatively high, but Kiss et al. report that digestive tract mucosal injury due to long-term vomiting and binge eating is limited and not so frequent. Up to date, a uniform conclusion cannot be reached. Conclusively, according to our case of anorexia nervosa with repeated hematemesis, we recognized the needs that we should notice the existence of "masked" eating disorders in patients with digestive tract bleeding for understanding the mechanism and frequency of gastrointestinal tract complication of eating disorders.

View full abstract

The psychosomatic approaches in India have been of a very ancient origin. The evolution of these approaches started with Hindu medicine 1500 B.C. ago and was expanded and spread to other parts of Asia like China. Korea, IndoChina, Thailand and eventually Japan by Buddhist medicine in 510 B.C. The Buddhist medicine as originated from the teaching of Lord Buddha and completed by Jivaka spread to the whole of Asia by Buddhist monks and with the spread of Buddhist religion. Philosophy, science, religion, spiritualism and culture merged through the time and greatness of people to make Hindu Buddhist medicine a holistic one, yet based on biopsychosocial and ecological concept. In this paper nonpharmacological approaches of Hindu Buddhist medicine is described which can be of significant therapeutic benefit in the management of psychosomatic diseases. Hindu Buddhist approaches imparts information and knowledge concerning the measurable structure and powers of psyche. Hindu approaches clarify the processes by which experiences are apprehended, assimilated, interpreted, and comprehended while Buddhist approaches eradicate the cause of sickly spells, dream of ignorance, and thus to make possible the attainment of serene awakened perfection. The combind approaches of two ancient religions help us to assimilate the foundation of our being without which everything remains stressful and empty. The combined and cohesive approaches produce the state of utter consciousness super-rationally and open the door of self which is composed of spiritual, physical and emotional joy. Psychosomatic diseases are pathological expressions of biologieal, psychic and social parameters of health and illness whereas Hindu Buddhist approaches show the way to bind closely the normal interrelationship of the above. The increasing uses of Yoga, Morita, Zen, Monko, Mo-he-zhi-guan, Nai Kan and Kenpo therapies in psychosomatic disorders are consistent and successful examples. Vyasa, Patanjali, Bodhidhara, Chih-i. Morita with their teachings have harmonized the physical, spiritual and emotional parameters of human life. This paper will discuss in detail the importance of Hindu Buddhist approaches in psychosomatic disorders.

View full abstract