One purpose of this study is to subtype the patients who are diagnosed as "Eating Disorder Not Otherwise Specified " (NOS) according to DSM-III-R. We conducted this study from the point that investigation of atypical eating disorders is very important to consider the diagnosis of eating disorders. The second purpose of this study is to clarify the relationship between diagnosis, symptoms and outcome of eating disorders. The subjects were 62 patients with eating disorders who were admitted to our hospital. We diagnosed them using DSM-III-R. Patients who were diagnosed as NOS were subtyped into three groups, that is, restrictive type NOS (patients resembling anorexia nervosa), bulimic type NOS (patients resembling bulimia nervosa) , and others. Then, we examined the relationship between the subtypes and outcome. We compared 1) anorexia nervosa (AN), bulimia nervosa (BN), and NOS, 2) AN and restrictive type NOS, 3) BN and bulimic type NOS. We also examined the relationship between symptoms and outcome. The symptoms were such as distortion of body image, purging, binge eating, and overconcern with body weight and shape. Conclusion : Concerning subtypes and outcome, in the patients with bulimic type NOS, those who could continue to be under treatment or complete the treatment were tended to be at higher rate as compared with BN. With regard to symptom and outcome, patients who do not exhibit overconcern with body weight and shape significantly come to a better prognosis as compared with those exhibiting overconcern with body weight and shape.

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Palmar sweating is known to be affected by mental stress. This study was performed to inves. tigate the significance of palmar sweating in anorexia nervosa. In a case of anorexia nervosa (a 23-year-old female) who weighed 34. 85 kg on admission to our hospital, sweat rates on palm were recorded every two weeks using the apparatus for continuous recordings of local perspiration volume (Kenz-Perspiro OSS-100,Suzuken, Tokyo). Sweat volumes during relaxing with her eyes closed (CE) and sweat responses to mental arithmetic (R4F : reversing the order of 4 figures given with her eyes open) were measured and compared with the body weight and the mental state. Sweat rate during CE was found to refiect the long-term body weight changes. It was enhanced when her body weight was increasing and was reduced when her weight reached around 44 kg. Sweat responses to R4F reflected the short term changes in body weights. Spiky sweat response curves were observed while she gained weight and they diminished while her weight stopped increasing or reduced. Moreover, it was suggested that this variability of sweating responses were related to her mental state such as the willingness to get better (increased) and the fear of fatness (reduced). The relationship between the central control of sweating and that of food intake was discussed. These results suggest that the measurement of palmar sweating may serve as a new psychophysiological method of studying psychosomatic disorders.

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To investigate the characteristics of Japanese patients with coronary heart disease, we employed a psychosomatic approach by using Egogram, CMI and SDS on 83 patients with angina pectoris in relation to the number of risk factors and coronary artery lesions. Patients were classified into three groups of atherosclerotic heart disease (ASHD), vasospastic angina (VSA) and atypical chest pain syndrome (ACP) according to the findings of coronary arteriography. Extremely low levels of FC (Free Child) and high levels of NP (Nurturing Parent) observed in the ASHD group suggests over-adaptation could be a characteristic of the patients with ASHD. Over-adaptation Idex (NP/CP+AC/FC)-devised from the revised Egogram by lwaiIshikawa-demonstrated the greatest value in the group of ASHD. The number of coronary artery lesions correlated marvelously with Over-adaptation Index compared to risk factors. The higher values of hysterics and depression scored by CMI and SDS were recognized in the group of ACP. More than one third of patients in ACP scored over 50 by SDS. Our results indicate as follows : 1) The involvement of the characteristics of over-adaptation could be one of the coronary risk factors in Japan. 2) Masked depression might be found in the patients with atypical chest pain syndrome. 3) The application of Over-adaptation Index could provide productive information to the study of coronary heart disease.

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This experiment was conducted to clarify the influence of laughter on the immune system. Nineteen volunteer subjects were taken to a variety theater to experience laughter for three hours. Blood samples were taken from the subjects immediately before and after the performance. The NK activity and CD 4/8 ratio of these blood samples were examined. Without exception, in those subjects with NK activity levels which were below average before the performance, there was a significant increase in these activity levels, and in the CD 4/8 ratiosimmediately after the performance (p<0. 05,Wilcoxon's rank-sum test). In all the subjects who had CD 4/8 ratios that were above the standard level immediately before the performance, there was a significant decrease of these ratios immediately after the performance (p<0. 05,t-test). From these findings it is concluded that laughing increases the NK activity of people whose ac- tivity levels are below average and normalizes the CD 4/8 ratios of people whose ratios are above or below the standard levels.

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Many patients complain of various physical symptoms without any related organic pathology. We often diagnose these cases as unidentified clinical syndrome or so-called vegetative syndrome, However, it is extraordinarily difacult for physicians to understand these disturbances because of the various conceptions of them and few clinical reports evaluating them from a multiple point of view including the whole profile of aspects of this disease. Therefore, appropriate treatment of this syndrome is usually difiicult to accomplish. In the present study, we examined 62 patients complaining of more than three physical symptoms without any related organic pathology, who were admitted to the psychosomatic medical clinic of the First Department of Internal Medicine, Kagoshima University Hospital. Their clinical features as well as the response to therapy were assessed as follows : All the patients had mental disorders which were diagnosed by DSM-III-R Classification. Depressive Disorders were most common at 48%, followed by Somatoform Disorders at 31%, Anxiety Disorder at 10% and Psychological Factors Affecting Physical Condition (so-called psychosomatic disease) at 8%. The groups which response best to therapy included patients who had been socially well adjusted before getting ill and those who were over 50 years old. Younger patients tend to have more severe disease, whereas patients over 50 years old were pathologically light, such as in Depressive Disorders whose type is categorized as having socalled "good prognosis". The main etiological factors contributing to this syndrome were social immaturity in 90% of the patients under 29 years old, problems in the work place in 56% of male patients over 30 years old, and family problems in 48% of female patients over 30 years old. Based on these findings, it may be concluded that the unidentified clinical syndrome (so.called vegitative syndrome) is a variety of pathological conditions. Thus, since this ambiguous and comprehensive diagnosis is of insufiicient help for medical treatment, it is necessary to treat the cases according to their respective pathological conditions. Diagnosing the patients from the psychological point of view, evaluating their previous social adaptability, and defining age and sex may bring us the proper understanding of the clinical features and the response to therapy of the patients. This may further lead us to better treatment of patients with this syndrome.

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The photic feedback therapy is a kind of therapy used for inducing a relaxation state in a subject. In this therapy, the electrcencephalogram (EEG) records of the subject are converted into photic stimuli, which are applied to his visual sensory system to activate EEG. The principle is based on a combination of the photic driving of EEG and biofeedback theory. The characteristic of this therapy is in that the subject can control the amplitude and freqliency of his EEG with no intentional efforts. We applied this therapy to our outpatients with various psychosomatic diseases and neuroses according to the prescribed protocol and assessed the effectiveness using the psychological and physiological measures. Ten outpatients (8 males and 2 females) aged 21 to 77 (average of 32.2) in our department of psychosomatic medicine participated in this study. Five therapeutic sessions and 2 baseline sessions each before and after the therapeutic sessions were performed once weekly. The extent of improvement of symptoms and the changes of psychological and physiological measures between pre- and post-therapeutic baseline sessions were recorded. The improvement rating showed marked improvement in 3 patients, mild improvement in 4,and no change in 3. The psychological examinations in all subjects revealed a significant decrease (p<0.05) in Self-rating Depression Scale (SDS) score, a tendency of increase (p<0.1) in A score (eye symptom) of the Cornell Medical Index (CMI) and tendencies of decreases (p<0.O1) in T score (extroverted thinking) of the Yatabe-Guilford personality test (Y-G) and NP score (nurturing parent) of the Egogram (TEG). The evaluation in the improved subjects (n=7) revealed a significant decrease (p<0.02) in T score of Y-G and tendencies of increases (p<0.1) in A and M (maladaptation) scores of CMI. The physiological examination using coefiicient of component variance of low frequency (CCV・LF), that of high frequency (CCV・HF), and L/H ratio showed no significant difference. The fact that marked improvement in 3 patients and signifcant changes in some psychological measure were achieved after this short-term therapy suggested that this therapy is suitable as psychosomatic therapy. We guess that these psychological changes resulted from the relaxation state induced by this therapy, which made patients to pay attention to and become aware of their body sensation and their feelings.

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Medical and psychological investigations were performed on 37 members of 30 th Japanese Antarctic Research Expedition (JARE-30) wintering members throughout a year. Psychosomatic investigations consisted of CMl, Y-G and Egogram. Physiological investigations consisted of standard 12-induction electrocardiogram, Holter long-time electrocardiogram, blood 'pressure, hematological and biochemical studies, and serum cortisol level. Although no significant disease was observed throughout the wintering period, various mental and physical complaints were observed. A depressive tendency and the decrease in positiveness were seen in the midwinter period. With Holter long-time electrocardiogram recordings, the disappearance of the circadian rhythms of heart rate was observed. An elevation of serum cortisol level was observed which suggested the existence of stress-irritation. Serum total protein, serum albumin, hematocrit and hemoglobin lowered during the wintering period. Other examinations on electrocardiogram, blood pressure, hematological and biochemical studies revealed no significant changes.

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