The clinical and psychological characteristics of 174 patients with eating disorders were examined. The groups classified on the basis of bulimic symptoms (B) and vomiting/purging (V). The group B & V was based on the presence of both (B) and (V), the B group based on the presence of (B) and absence of (V) and the V group based on the presence of (V) and absence of (B). The R group was based on the absence of both (B) and (V). The number of patients in group B & V was 83,group B 18,group V 12 and group R 61. Group V was found to have unique characteristics. Subjects in group V had a significantly higher level of somatic symptoms were more reflective and had more socially introverted tendencies than the patients in the other three groups. The onset of illness of this group was at a high age and tended to be of short duration. The maximum weight of group V did not significantly differ from the B & V or B groups. But the minimum weight of group V patients was significantly less than that of group B & V or group B. Group B & V patients are more depressive and anxious than group R patients. Group B & V patients have a cyclic tendency of mood and inferiority feelings. Group B & V closely resembled group B on relevant characteristics.

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It is said that child development and emotional disorders result from complicated interaction among many factors. Recently, it has been pointed out that mother's rearing attitudes and interpersonal relations in a family might have some influence on intellectual development and emotional disorders. It is recognized at present that parents should take an important role in the therapeutic team for handicapped children. In order to find a better therapeutic environment for child development and support mother as a therapist, we investigated the relation between mother's rearing attitudes and child development. The follow-up group consisted of 49 mother-handicapped child pairs who were treated by a play therapy group at N city, Osaka. The control group was made up of 51 mother-normal child pairs who were in nursery schools at H city or kindergartens at Osaka city. Children of both groups were all 2-4 years old. MS-form Rearing Attitude Questionnaire was carried out with the subjects' mothers for rating their rearing attitudes. H-form Rating Scale for Handicapped Children (HRSH) was carried out at similar time on the subjects' nurses or kindergarten teachers for rating children's interpersonal relationship and social development skills. The correlation matrix of 30 scales (4 scales of MS-form Rearing Attitude Questionnaires and 7 scales of interpersonal relationship in HRSH, 19 scales of social development skills in HRSH) were factor-analyzed. Four factors were extracted both from the follow-up group and from the control group. When two groups were compared on factor structure, there was some difference between them on the interpersonal relationship scales in HRSH. As regards social development scales in HRSH, in the control group, the first factor which included sociality made the same cluster with gross motor movement, toileting, drawing, speech, etc. And self-help ability scales were extracted from development scales in the forth factor, including isolation(-) scale of HRSH in the control group. On the other hand, in the follow-up group 13 scales in 19 social development scales were clustered in the first factor which included isolation(-) and sociality(-) scales. Interpersonal relationship scales and social development scales stood isolated each other in the control group. So did social development scales and four scales of MS-form Rearing Attitude Questionnaires of the follow-up group. But tension and sociality(-) in interpersonal relationship scales were mildly related to four factors of MS-form Rearing Attitude Questionnaires of the follow-up group. Rearing attitude was not related directly to social development of handicapped child. But as mother's pathological tendency, for example, anxiety & rejection, became clearer, child's sociality developed more highly, and tension became lower. In was well supposed that handicapped infant's mother made contact with her child more frequently and more densely. Thus her contacts affected child's imitative action and interpersonal contacts, and suppressed tension. It was important that therapeutic team staff should accept and support emotion and feeling of handicapped child's mother, and allay her anxiety, guilty feeling and rejective tendency for her child, and give advice on her rearing attitude.

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Rorschach and Sentence Completion Test (SCT) data of 21 eating disordered patients aged 15 to 29 were examined to uncover the nature of conflicts within the family. Analysis of Rorschach responses and SCT descriptions of parents and self showed that these patients tend to feel as though they are in completely helpless situations, especially with mothers who cannot detect signs that they are in need of help, or with fathers who are potentially powerful but do not use their power to help them. The fantasy among eating disordered patients that they have lost communication with important caretakers and therefore find themselves in desperate situations is discussed through reference to the detailed sequence analysis of the Rorschach data of Miss A., a 28-year-old eating disordered female patient, for psychodynamic understanding. Miss A. showed resignation to the mother who is engaging in her own activity and indifferent to her, idealized her father and expect him to be her powerful rescuer but soon noticed that he would never use his power to help her. These confrontation led Miss A. to develop a sense that she cannot escape from the crises, became desperate and exaggerated self-mocking attitude.

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Eleven patients with essential hypertension including borderline cases were examined to evaluate the effects of self-monitoring on their blood pressure readings. We also examined in 7 subjects as to whether the ability to estimate their blood pressure was improved during self-monitoring in order to study that the increased awareness of their blood pressure resulted in reductions of them. The subjects who have never measured their own blood pressures before recorded blood pressures three or four times a day for 36 days. The term was divided into six periods, that is, "Prac." (5 days for practice in measuring blood pressure), "Pre'' (5 days), "I" (7 days), ''II" (7 days), "III" (7 days) and ''Post" (5days). 1) Significant changes were observed in neither systolic nor diastolic blood pressure when the average blood pressure readings in all subjects were calculated for each period. 2) When the average blood pressure of each subject for the "Post" period was compared with that for the "Pre" period, significant reduction in systolic blood pressure was observed in 4 subjects and that in diastolic blood pressure in one subject. All of the subjects whose blood pressures reduced were out-patients. 3) The ability to estimate blood pressures was examined as to whether the difference between the estimated blood pressure before measuring and the measured blood pressure significantly decreased during self-monitoring. Although one subject could come to estimate more accurately his blood pressure (both in systolic and diastolic pressure values), no correlation was found between the blood pressure reduction and the improved estimation of their blood pressures. In this study, usefulness of home blood pressure self-measurement was shown because the significant fall in blood pressure, especially in systolic pressure, was observed in some patients with essential hypertension. Changes of behavior such as diet and drug compliance induced by increased attention to their blood pressure were supposed to lower the blood pressure.

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We reported 3 cases of Irritable Bowel Syndrome (IBS, l adult and 2 adolescents), whom we treated with self-monitoring (SM) which is one of the behavior therapy techniques. We then discussed the merits of SM and the difficulty in its application. Its merits are as follows; 1) Patients with IBS can recognize the anxiety Objectively. 2) They can modify their own behaviors which are cognitively distorted. 3) SM can reduce their anxiety caused by cognitive distortion. The difficulties are as follows; 1) Patients with IBS might have no motivation for recording their own behaviors. 2) They might be lacking in capacity for observing their own conditions. Therefore we as therapists must carefully monitor the patients.

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Psychosocial factors and clinical symptoms as well as long-term outcome in patients with eating disorder complicated with borderline personality disorder (BPD Group) were investigated and compared with those in patients with obsessive-compulsive personality trait (Obsessive-Compulsive Personality Group). The subjects were four males and 32 females with the mean age of 18.2 years who had been referred to the Neuropsychiatric Clinic of Fukushima Medical College Hospital and affiliated hospitals. The diagonses of borderline personality disorder, obsessive-compulsive personality trait, and eating disorders ware made according to DSM-III-R diagnostic criteria. Fifteen patients were diagnosed as having borderline personality disorder and 21 as having obsessive-compulsive personality trait. Among the psychosocial factors evaluated (precipitating factors, psychosocial stressors, and serious family pathology), extended parental absence was more common in the BPD Group than in the Obsessive-Compulsive Personality Group. Concerning the clinical symptoms (mental symptoms, behavioral disorders, and somatic symptoms), depressive mood, suicide attempts, and self-mutilating behaviors were more common in the BPD Group. Long-term outcome (more than five years after the onset) was evaluated in 11 patients in the BPD Group (mean duration, 8.5 years) and in 10 patients in the Obsessive-Compulsive Personality Group (mean duration, 7.6 years). In the BPD Group, long-term outcome for both eating behavior and mental symptoms was unfavorable, and was distinctly poorer than that for the Obsessive-Compulsive Personality Group. These results suggest that patients with borderline peresonality disorder are therapyresistant, that outcome is more likely to be unfavorable in this group than in patients with obsessive-compulsive personality, and that it may be necessary for such patients to receive more intensive treatment, including family therapy.

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Psychiatric therapy of symptoms such as delirium, confusion and depression, which are often manifested in acute stage in burn-intensive care unit (BICU), have been considered necessary. However, psychological management in rehabilitation stage is required to perform the improvement of quality of life (QOL) in severely burnt patients although psychiatric symptoms are not always manifested clinically. We experienced two burnt patients with psychological problems during rehabilitation stage. One female case showed regression, anxiety and depression. Supportive psychotherapy and psychological approach to family were effective for the improvement of her symptoms. The other showed secondary alexithymia by strong defense mechanisms such as denial and suppression for facial scar and physical disturbances. Stimulations to express the feeling in an attempt to improve alexithymia and manifest anxiety were repeatedly delivered. After that, the patient indicated dependency on medical staff, and the degree of alexithymia tended to be weak. Superficial acceptance by strong defense mechanism is not real acceptance. The manifestation of anxiety is required to perform psychological acceptance, and the existence of cases with the manifestation of secondary alexithymia may disturb psychological adaptation to society. With such in mind, we have reported here two cases valuable for reference in future liaison psychiatry for severe burn.

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We reported a patient of subarachnoid hemorrhage who had been hospitalized to treat a psychosomatic disorder. The case was a 34-year-old woman who had suffered from chronic recurrent headaches since her infancy. Her illicit love affair with a married man, who had his own family, was discovered in June, 1988. Since that time, she had complained of insomnia and headaches. Her headaches worsened on August 7,when she visited hospital. She strongly desired to be admitted to the hospital and was brought to our hospital by ambulance. On admission, She showed neither any neurological deficits, nor intracranial lesions after a head CT. We tried to relieve her from anxiety by explaining the mechanisms of muscle contraction headaches, prescribing minor tranquilizers, and introducing autogenic training into her treatment. Although she reported to us an improvement in the symptoms by relaxation, she later suffered a subarachnoid hemorrhage on September 12 when she was confronted with the fact that the man's wife was still very angry at her. She died on September 15,and the bereaved family did not allow an autopsy. We have discussed the following points regarding this case : 1) This case was considered to have had headaches which appeared to be muscle contraction headaches which were closely related to her psychosocial background. 2) Her hypertension was considered to have derived from the emotional strain caused by inappropriate social behavior such as getting divorced of her own will, having an illicit affair with a married man and then trying to commit suicide. 3) Concerning the subarachnoid hemorrhage, we suspected that she had an aneurysm of the right anterior communicating artery, which ruptured due to an elevation of blood pressure brought on by the emotional turmoil.

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