The study was designed to investigate the reaction to the emotional stress of pregnant women, by loading MDT (Mirror Drawing Test)-stress and exposing a warning sound to them. Subjects were 53 normal healthy pregnant women (26.8±5.1 years of age) with 26. 5±5.1 weeks of gestation. As the controls were chosen 149 normal healthy non-pregnant women (25.8±7.3 years). The effects of the stress were measured by psychophysiological means such as EEG (Electroencephalogram) and GSR (Galvanic Skin Reflex), as well as CMI (Cornell Medical Index), Complain Fatigue (Physical Level), STAI (State・Trait Anxiety Inventory), other questionnaires, medical records and interviews etc. The results obtained were as follows : (1) No significant difference was observed between pre and post-stimulus loadings in EEG percen tage. (2) However, in GSR counting between pre and post-stimulus loadings, higher count was shown in pregnant women than in non-pregnant women. Especially, the most remarkable was the group of 20-41 weeks of gestation. (3) The repetition of hearing the warning sound did never reduce the stress effect in pregnant group (especially 20-41 weeks). (4) Among the pregnant women, those who have higher STAI-ii value after the stress showed more frequent spontaneous fluctuations in GSR, than did the lower STAI-ii group. Thus, the pregnant women revealed to be highly reactive towards the stress than the nonpregnant women ; they become easily excited, continuing a high level of reaction.

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We investigated the relationship between Type A behavior pattern (Type A) and depression in patients with ischemic heart disease (IHD) to clarify the characteristics of Japanese Type A. The subjects were 212 patients with IHD (IHD group) and 94 healthy individuals (control group) . The behavior pattern was evaluated by Jenkins Activity Survey (JAS) Form C and depression by Depression Related Personality Trait Scale in both IHD and control groups. Depression Related Personality Trait Scale was developed by Yoshimatsu et al. to evaluate the depression related personality (DRP). Previous reports assumed that DRP was present when the total score was in excess of 55 points (out of 76). The Self-rating Depression Scale (SDS) was also administered to 61 patients with IHD to evaluate the severity of depressive symptoms. The results were statistically analyzed by the Student's t-test, the x^2-test and the Pearson correlation coefficient. The incidence of Type A was significantly higher in IHD group than in control group, as was the incidence of DRP. In IHD patients with Type A, the incidence of DRP (39.7%) was significantly higher than in those (20.8%) with non-Type A. Similar results were obtained in the control group. DRP score of IHD patients with Type A (52.2±8.8,mean±SD) was significantly higher than that of those with non-Type A (45.4±8.7). JAS score of IHD patients with DRP (4.O±9.4) was also significantly higher than that of those with non-DRP (-1.3±8.l). In both IHD and control groups, JAS scores were significantly positively correlated with DRP scores. In 61 patients with IHD, there was no significant difference in SDS scores between Type A and non-Type A, and between DRP and non-DRP. It is interesting to note that no significant correlation were observed between SDS and JAS scores, and between SDS and DRP scores in IHD patients. Moreover, no significant relationship was observed in other coronary risk factors (systolic blood pressure, total cholesterol, triglycerides. HDL, FBS and uric acid) between Type A and non-Type A, and no relationship except uric acid between DRP and non-DRP. These results indicate that Type A is closely related to depression related personality in patients with IHD, but that there were no significant relationship between Type A and depressive symptoms.

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We studied the duration of pain in 92 patients with abdominal pain in relation to neurotic tendency, diagnosis, complications, etc. As a result, it was clarified that the longer the duration of pain, the stronger the neurotic tendency in the patient, and the difference was particularly significant between the patients experiencing pain for three months or longer and those for less than three months, and between those having pain for six months or longer and those for less than six months. However, there was no statistically significant difference among the diagnoses relating to pain. With respect to the presence of complications involved in pain, the longer the duration of pain, the higher the incidence of complications, with significant differences between those groups noted above. With regard to the diseases complicating abdominal pain, the most frequent diagnosis was irritable bowel syndrome, followed by chronic pancreatitis, depression, biliary dyskinesia, in this order, but there were no significant differences among the incidences of these diseases relative to duration of pain. In contrast, the longer the duration of pain, the higher was the incidence of past surgery in the abdominal region, and statistically significant differences were noted between those groups noted above. From these findings, it was clarified that (1) it is reasonable to define chronic abdominal pain as pain that persists for three months or longer, (2) if pain persists for three months or longer, there is more frequent appearance of complications, and the pathology of the pain along with the psychological factors are more diversified, (3) the increased incidence of abdominal surgery results from dysfunctions of the digestive tract, and (4) the early signs of chronic abdominal pain are already notable when the duration of pain is less than three months.

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Patients who have visual disturbances in acuity and field without any organic pathology are diagnosed as functional visual disturbance, but their pathophysiology is not uniform. The aim of this study is to clarify their pathophysiology. The subjects are 56 patients aged between 6 and 17 years (mean age : 1O.3) , including 14 males and 42 females. First their psychological characteristics were studied by psychiatric interview and Yatabe-Guilford Personality Inventory (YG test) . Secondly their visual functions including the near point and the contrast sensitivity were examined. Thirdly their viewing ways of objects were studied by recording their eye movements with eye mark recorder under the presentation of a figure showing a daily situation, and by estimating their recalling accuracy of the figure content. Lastly their prognoses were judged by examining their visual acuity and field 1 year after. The results were as follows. (1) In the YG test many patients showed C type (emotionally stable, socially adaptable and introverted), B type (emotionally unstable, socially inadaptable and extraverted) and E type (emotionally unstable, socially inadaptable and introverted) , each type was 32%, 30% and 24% respectively. Few patients showed A type (average) and D type (emotionally stable, socially adaptable and extraverted) , each type was 8% and 5% respectively. (2) The patients, especially those with low visual acuity (under 1.O) showed more distant near point and lower contrast sensitivity than those with visual acuity over 1.O. (3) The recovery rates of the visual acuity and field I year after the first visit were 82% and 59% respectively. The patients who had complaints of symptoms showed higher recovery rate than those having no complaint. (4) As results of the examination of eye movement, the patients showed shorter total movement distance of the fixation points than controls (p<0.05). They missed either the right or the left margin of the figure more frequently (p<0.05). They recalled the figure less accurately (p<O.O1) and failed to recall the objects involving confliction more frequently than controls (p<0.O1). In conclusion many patients have introverted character and few patients show hysterical tendency to complain their symptoms spontaneously. Functional visual disturbance have good prognosis in general although some of those having no complaint of symptoms need longer time to recover. This disorder might include problems of various function 'besides visual acuity and field, such as accommodation, contrast sensitivity and viewing way of objects.

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With the evolution of hemodialysis, it has become possible for patients with end-stage renal failure to survive longer. However, such patients confront much psychosocial stress. To investigate psychological adaptation to maintenance hemodialysis, we administered the CMI, YG, MAS, SDS, stress coping scales and the QOL questionnaire to 77 patients with a dialysis duration of one month-20 years. The results of our investigation indicate that patients on dialysis for a short time were more extraverted and neurotic. Depressive symptoms which were present after a short period on dialysis were maintained even after a long period on dialysis. We also found sex differences in coping patterns. Male patients used problem oriented strategies in coping with stress, independent of the duration of dialysis. Female patients, on the other hand, used suppression the longer they were maintained on dialysis. Males in all durations of dialysis indicated a lower quality of life as expressed by such factors as satisfaction and happiness and females a quality of life that was the same or higher, in comparison to normal people. This is particularly true of the degree of satisfaction in relationships with others, specially with family members, which remained high in females despite the duration of dialysis. In males, relations with family members were disturbed and QOL scores remained low after a long period of dialysis. In females, supported by family members, the QOL scores increased following a long period on dialysis.

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Because cancer patients with psychiatric disorders receive fewer psychiatric consultations compared to non-cancer patients, we investigated the effects of a psychiatric liaison program on consultation rates in Kure National Hospital. Consultation rates for all cancer patients before and after introduction of the program were compared to rates from non-cancer patients during the same 4-year period. Rates for the cancer patients were higher after the program (2.2%) than before (1.2%). The program had no effect on course of psychiatric symptoms in cancer patients. The course seemed to be responsible for the duration from the time of psychiatric consultation until death, not for the performance status of cancer patients. We conclude that liaison improves access to psychiatric treatments that often enhance the quality of life for terminal cancer patients.

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Very low calorie diets (VLCD) have many advantages, as they are inexpensive, safe and easy to give rapid and encouraging weight loss. On the other hand, many patients complain of psychic and somatic discomforts. Six simple obese patients (1 male and 5 females) had median body mass indexes of 32. 9 kg/m^2 and had median ages of 31 years. Associated medical problems included fatty liver, hyperlipidemia, and vertebral spondylosis in each 2 patients. Eating habits revealed irregular diet, anorexia, overeating, and unbalanced diet. In psychological tests, one male had near normal mentality, but 5 females showed some deviations of anxiety, dependency and hypomania. Affirmative attitude to self and/or others in egogram agreed well with our empirical assessment of patients. Typical weight loss during 2 complete formula diets and 4 combination diets was around 22 kg in 92 days. All patients demonstrated the elevation of the ketone body for starvation. Associated mental problems included anorexia (3/6) , depression (3/6), and insomnia (1/6) . Anorexia was the most important and concerned symptom since it was severe enough to suspect anorexia nervosa. Fortunately these problems were temporary, so VLCD could be continued without interruption. Other physical complaints were faintness and Gl symptoms (nausea, epigastralgia) , which were improved by conservative therapies. VLCD resulted in reliable weight loss in all cases. Among mental and physical complaints during VLCD anorexia occurred frequently. It was often severe enough to be suspicious of beginning of anorexia nervosa, but did not last long and VLCD could be continued. Consequently, psycho- somatic approach is needed to obese patients who undergo VLCD therapy.

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At present, drug therapy plays a limited role in the treatment of anorexia nervosa. Some patients with severe anorexia refuse treatment altogether. Here, we report a cas-e of an anorexic patient who improved remarkably, following continuous sleep treatment induced with haloperidol. A 15-year-old girl was admitted to our hospital. She was 159 cm tall but weighed only 30 kg. The patient compulsively limited her caloric intake, was very active and she refused any treatments. Because the signs of cachexia worsened, intravenous hyperalimentation was done. In order to calm her psychotic symptoms, a daily dose of 10 mg of haloperidol was given by intravenous drip. Following this, the patient fell into a continuous sleep for 10 days. She awakened after haloperidol was tapered off and at the time, she did not show any signs of anorectic symptoms. After that, she was improved with supportive therapy, and anorexic symptoms did not recur. The Tnechanisms of the improvement were discussed.

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