The present study was undertaken to investigate various factors affecting the treatment of hospitalized anorexia nervosa patients. We compared the characteristics of patients who dropped out of therapy in hospital with those of patients who made good progress, and investigated representative 3 cases of anorexia nervosa who dropped out of therapy. Then, we investigated factors which resulted in discontinuance of therapy according to 3 points of patients, families and therapists. First, we investigated characteristics of anorexia nervosa patients who were admitted to Hiroshima University Hospital for the past 10 years. The total number of subjects in this study was 34,all females. They were diagnosed as anorexia nervosa based on the criteria of DSM-III or DSM-III-R. Subjects were divided into two groups ; the first group (group 1), 17 cases, who dropped out from therapy in hospital, and the second group (group 2), 17 cases, who made good progress. As a result, in the group 1,1) many cases had stubborn and competitive personality, and had no good personal relationship, 2) in many cases, families were less cooperative, 3) in many cases, contracts of therapy were uncertain. Next, we reported representative 3 cases who dropped out of therapy in hospital. In all 3 cases, patients were not emotive and had less ability to express their thoughts into words, and their families were not cooperative due to lack of understanding of the disease. Upon reflection, therapists took an excessively neutral stand, and their confusion in role-taking produced negative effects on patient-therapist relationships

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The effects of conducting Autogenic Training (AT) on autonomic nervous functions were studied by using non-invasive autonomic nervous function tests. We used the coefficient values of the R-R intervals of ECG (CVR-R) as a parameter of the parasympathetic nervous function, while the coefficient values of the wave heights of digital plethysmograph (CVwH100) were used as a parameter of α-adrenergic sympathetic nervous function. In addition, β waves of thenar microvibration (MV) were used as a parameter of parasympathetic and θ waves of MV were used as a parameter of sympathetic nervous function. Forty healthy volunteers underwent AT for 5 minutes in the supine position after a sufficient observation period. Blood pressure (BP), pulse rate (PR), CVR-R. CVWH1OO and MV were all checked before, during and after undergoing AT. Results : (1) The well trained group (n=10) showed a significant increase of α2 waves of MV both during and after the AT. CVR-R and CVWH100 did not show any significant change. The beginners group (n=30) showed a significant decrease of θ waves of MV but CVR-R and CVWH1OO did not show any significant change. BP and PR did not show any alteration in either group. (2) The group whose trait anxiety (STAI) increased (n=6) did not show any significant change in CVR-R, CVWH100,MV, BP and PR. On the other hand, the group whose trait anxiety (STAI) decreased (n=34) showed a tendency of increased CVR-R as well as CVWH1OO by practicing AT, a significant increase in α2 waves and a tendency of decrease in θ waves of MV after undergoing AT although no significant change was observed in either BP or PR. (3) A dominant waxing and waning phenomenon of the digital plethysmograph was also observed during the sessions in those whose skin temperature was increased by AT. These results indicate that sympathetic nervous function as well as parasympathetic nervous function are both activated and the vasomotion of peripheral vessels is also activated when AT can be successfully administered.

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We examined the psycho-social factors, behavioral responses and cellular immune function in adults who had no organic disorders, but complained of chronic fatigue saying they had no confidence in their health. The fatigue group suffered from more stress factors in their place of work and home as compared to the control group. There were no differences between the groups with regard to smoking and eating behavior of daily life. But the fatigue group slept less hours than the control group. The fatigue group clearly showed low Natural Killer cell (NK-celD activity in the immune function. Most of the low NK cell activity group improved after rest. On the other hand, we discovered that there was a group that continued showing low NK-cell activity. The group of persistently low NK-cell activity and the improved group showed characteristic psycho-behavioral response patterns to stress. Namely, the persistently low NK-cell activity group had many mental complaints and emotional instabilities. Further more this group was socially introvert and obedient in behavioral patterns. On the other hand, the improved group was socially extrovert and competent in leadership. We found that NK-cell activity was influenced by chronic fatigue and psycho-behavioral responses. As these results indicate, NK-cell activity may be one of the possible objective measures of the degree of fatigue.

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We conducted a psychosomatic study of 29 patients with ulcerative colitis (UC), focusing on the psychological and somatic features of the disease. In order to assess neurotic and alexithymic character, Cornell Medical Index (CMI), Yatabe Guilford Personality test (YG), and Minnesota Multiphasic Personality Inventory-alexithymia scale (MMPI-AS) were employed. Those who showed MMPI-AS score of more than 17 points were judged to be alexithymic. The severity of the disease was determined according to the criteria of Truelove and Matts. There was no significant correlation between psychological character and severity or clinical type of the disease. The average score of MMPI-AS was higher in the patients than in normal subjects. Significantly more alexithymic subjects were found among the patients suffering more than 6 years. In conclusion, the alexithymic trait was found to be more frequent in patients with UC, especially those suffering longer periods. We assume the contribution of secondary alexithymia to the clinical course of this disease.

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The concept of Quality of Life (QOL) has gradually been accepted as an important therapeutic goal for chronic diseases in recent two decades. However, we have never yet obtained "Golden Standard" for measuring QOL because of its broad bio-psycho-environmental concept. We originally developed a new self-completed questionnaire for QOL (QUlK) according to the holistic system theory, which is divided into four domains including physical functioning (20 questions), emotional adjustment (10 questions), interpersonal relationship (lO questions) and attitudes toward life (10 questions) in total of 50 questions, In this study we selected 212 patients with various chronic vascular disorders such as cerebral vascular disease (67 patients), ischemic heart disease (38 patients) and hypertension (107 patients) aged over 40 years (mean 68d±13 years) in order to evaluate reliability, validity and usefulness of QUIK. The internal consistency of QUlK was α=0. 88 (KR formula 20). There existed tight correlation among four domains each other. And each total score more and more increased as disorder got worse. In item analysis significant weakness of discriminating power was found in 3 questions, that is, incontinence, suspicion and troublesome in everyday life. On the other hand, very close correlation was seen among some questions, in particular, among present activities, sexual interest, difficulty of taking care of his-, or herself, which suggested mind-body-environmental correlation in chronic vascular disorders. It showed that total score of QUlK was influenced by various factors such as age factor or the severity of disorder according to analysis by quantification method of the first type. Finally, when we divided each total score of QUIK into following six classes ; 1) excellent, score O (ratio of incidence 2. 8%), 2) good, score I to 3 (15,l%), 3) fair, score 4 to 9 (32. 5%), 4) poor, score 10 to 18 (32. l%), 5) very poor, score 19 to 29 (15. 1%) and 6) grossly impaired, score over 30 (2. 4%), renewed distribution of QUlK showed nearly same proportion as that of normal distribution. Our results suggested that QUlK must be reliable, valid and useful for assessing therapeutic efficacy on psychosomatic disorders or rehabilitation in the elderly.

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Organ transplantation is now a widely accepted method for various oragan failures. The number of bone marrow transplantation ranked second among them. Along with the advent of medical high technology, comprehensive management including psychological care of children with physical diseases such as leukemia and aplastic anemia has been regarded more important. Of pediatric cases receiving bone marrow transplantation, we experienced two cases with psychogenic reaction due to isolation in laminar air flow room. Regressive state such as dependency was manifested in both cases. Furthermore, case 1 showed severe psychogenic reaction. Although the degree of regression in case 2 was moderate, his mother also indicated psychogenic reaction such as aggression toward her child and medical staff. Under severe stressful condition such as isolation in laminar air room for one month and side effects of radiation and chemotherapy, not only children but also their mother tend to become unstable, developing psychological problems. These cases suggest that comprehensive management is required in pediatric bone marrow transplantation.

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The present case report on two patients with spasmodic torticollis is concerned with EMG biofeedback (EMG-BF) using breathing exercise. The breathing exercise with prolonged respiratory exhalation is used as a strategy of muscle relaxation. It has already been reported that the breathing exercise is an effective method for reducing physiological and psychological arousal. The treatment to reduce the tension of sternocleidomastoid muscle contains 1) EMG-BF session, 2) EMG-BF with breathing exercise session, and 3) breathing exercise session without EMG-BF. Each of our two patients was treated in the order of these three sessions. Results show that their average EMG Ievels of the sternocleidomastoid muscles were almost significantly reduced during each session. After the first and second sessions, however, they could suppress the tension of muscle activities only by the breathing exercise. Furthermore, their various complaints were improved. The implications for the significance of the breathing exercise as a strategy of muscle relax. ation in the EMG-BF were discussed.

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The author have experienced 2 cases of occupational maladjustment disorders of young SelfDefense Officials in Fukuoka, Japan. The patients were treated by the author in the inpatient ward of Self-Defense Forces Fukuoka Hospital between June 1989 and May 1992. The author considered these cases had some characteristics of adjustment disorders (DSM-Il-R). We examined the relation between the occupational and individual factors from the psychosomatic point of view. The results were summarized as follows. 1. The patients were found within one year after they started working in Self-Defense Forces and most commonly found among high teenagers. 2. As the cause of adjustment disorders, immaturity, egotism, timidity and nervousness were found in individual personality. 3. Family therapy and cooperation with the superiors of the patients were important in order to improve the patients' environment. 4. The author emphasize that it is important to have some psychiatric or psychological screening before employing young people in Self-Defense Forces.

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