The purpose of this study was to develop and validate an instrument to measure the individual's mood state. After the selection of items which state the individual's temporary mood, and their factor analysis with 404 male and female subjects, scale development resulted in a 40-items Mood Inventory with five factors : tension and excitement, refreshing mood, fatigue, depressive mood, and anxious mood. Psychometric evaluation by test-retest method, odd-even method, and parallel test method suggested that the Mood Inventory is internally consistent and has well enough high reliability and validity. A comparative study among patients with psychosomatic diseases, patients with physical illness, and healthy subjects, revealed that patients with psychosomatic diseases showed signifcantly higher scores of tension and excitement, fatigue, depressive mood, and anxious mood than healthy subjects, and that the healthy subjects showed significantly higher refreshing mood score than other clinical subjects. It was suggested that the Mood Inventory has considerably high discriminant validity and enough potential for the clinical and research application.

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In order to explore the condition of child and adolescent patients with psychological problems at a general hospital, we investigated 1940 patients under 18 years of age who were referred to our department of clinical psychology during the period of April 1981 to March 1990,with the following results. Generally speaking, boys outnumbered girls, but recently the difference in number between them has diminished. The patients almost equally ranged from I to 18 years of age. The patients were referred by various departments, such as neuropsychiatry (32.2%), pediatrics (27.6%), urology (12.O%), ophthalmology (8.O%), and so on. The incidence of psychosomatic disorders was the highest and the number of cases with dominant difiiculties and problems was as follows : psychosomatic disorders 348,neurosis 146,retardation of speech development 144,and mental retardation 135. The number of enuresis and autism has decreased, while the number of eating disorders and low birth weight infants increased. An increase of number was not found in school refusal. The role of the department of clinical psychology at a general hospital was discussed. which is considered to maintain cooperation with other departments.

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Among the patients who visited our department during the period from January, 1986 to December, 1991,9 patients, who had psychosomatic symptoms in the process of being involved in the terminal care for the family members, have been investigated. The exacervation of original symptoms was found in the patients who had a past history of psychiatric illness and who had been under treatment in our department. Compared with depressive patients, neurotic patients tended to experience their symptoms at an earlier stage after they were notified that their family members would be incurable. The clinical picture during the terminal care was an anxiety-depression mixed state presenting autonomic nervous symptoms in both depressives and neurotics. While they were deteriorating among few patients immediately after that, the psychosomatic symptoms were exacervated among many patients transiently about 2 months after their family member's death.

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The purpose of this study was to examine the characteristics and disruptions in the quality of life (QOL) of psychosomatic patients and compare them with neurotic patients and normal samples. Method : A self-rated quality of life scale (QOLS) developed by the authors to measure subjective well-being was administered to psychosomatic (n=21) and neurotic (n=24) outpatients and normal controls (n=86). The 31 item QOLS is constructed with six subscales representing six factors extracted through factor analysis. (Factor I : Meaning of Life and Hopeful Expectations about the Future, Factor II : Enjoyable Life and Work Satisfaction, Factor III : Peace of Mind and Subjective Health, Factor IV : Satisfaction with Financial Status and Environment. Factor V : Satisfaction with Close Relationships. Factor VI : Self-Esteem and Social Support). Cronbach's alpha coeficient for the scale was O. 89. The mean QOLS total scores and six subscale scores of the three semple groups were tested by analysis of variance and then compared by Scheffe's method. The scores were further subjected to discriminant analysis to delineate the characteristics of the QOL of psychosomatic patients. Results : The mean QOLS total score and all but one (Factor IV ) subscale score were highest in the normal control group and lowest in the neurotic group, with those of psychosomatic group located in between. However none of the differences in scores between psychosomatic and normal groups reached statistical significance. Between the normal and neurotic groups, the total and three subscale scores were statistically significant (Total p<0. O1,Factor II p<0. OOl, III p< O. Ol, III p<0. O1). Between psychosomatic and neurotic groups, the scores were siguificantly different only in one subscale (Factor II p<0. 05). Diseriminant analysis of the scores showed that the item most powerfully discriminating psychosomatic and neurotic groups was the question related to energy (Factor II ). The results of our study indicate that in psychosomatic illnesses, in which psychosocial stressors affect physieal condition, patients' QOL is less disrupted than in neuroses, in which patients' psychological well-being is directly attacked, especially in the areas of morale. This might reflect the alexithymic tendencies which are often said to be associated with psychosomatic disorders. The issue of the interaction between alexithymia and QOL awaits further investigation.

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There have been many studies which suggest the psychosocial stressors impact on the progress of depression up to this point. We investigated the relationship between psychosocial stressors, coping, and three-month treatment outcome of DSM-III-R Major Depression. Subjects were 32 outpatients with Major Depression who were diagnosed by Structured Clinical Interview for DSM-III-R (SCID). They were followed up prospectively for four months and outcome was evaluated by the Hamilton Rating Scale for Depression based on the Frank's suggestion. For measurement of stressors and coping, the scale of Axis IV in DSM-III-R and the Time Ordered Stress and Health Interview were used, Our results indicated that patients who did not remit had experienced significantly more numbers of stressor during one-year before the entry than the remitted group (p<0. 05), but the degree of Axis-IV scale (DSM-III-R) was not related to outcome. Good three-month outcome group showed more cognitive coping (p<0. 05) and problem-solving (p<0. 10), whereas avoidant coping (p<0. 10) and wish for miracle (p<0. 05) were related to poor outcome. According to the discriminant analysis, the number of stressors (p<0. 05) and cognitive coping (p<0. Ol) had a strong influence on three-month outcome. We emphasize the importance of evaluating coping for stressful situations in case of investigating the relationship between a progress and psychosocial factors with depression, and hypothesizing the efficacy of therapeutic approach that might be able to change passive-avoidant coping into more positive-cognitive one.

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A questionnaire was conducted on the middle management to get information about their reactions to mental health problems in the workplace. In this study, 6,735 responded to the questionnaires and they were analyzed and divided into 2 groups ; the group of the head of a division or a section (3,969 men : Group A) and the group of foreman (2,766 men ; Group B). 1) During the past year, 4,679 men experienced severe job stress and its prevalence was 69.50%. The prevalence in Group A was 71.6%, which was significantly higher as compared to that in Group B. 2) Most frequent stress-producing problems which they experienced were "over or under work load in quality"(55. 9%), "over or under work load in quantity"(44.8%), and "conflicts in interpersonal relations"(42.8%). In Group A, the frequency of "over or under work load in quality"was as high as 61.6% ; however, no difference in frequency was found among the 3 types of stressors in Group B. 3) Concerning the ways of their stress coping, their most frequent practice was to endure it quietly. More than a half of them (54.6%) chose this way. It was also noteworthy that only 1% consulted the occupational physician, the health nurse or the counselor. 4) The number of the middle management who experienced that their subordinates showed mental health problems was 3,616 and its prevalence was 53.7%. The prevalence in Group A was 59.8%, which was significantly higher than that of Group B. 5) Most common problems of mental health shown by the subordinates were "conflicts in interpersonal relations"(49.4%) and "lack of energy" (49.1%). As to these two problems, a marked difference of frequency was observed between the two groups. 6) As the countermeasures, the middle management "gave advice to the subordinates to work out the problems" (53.5%) and "had the subordinates see a doctor"(31.2%), but 16.O% could not give any help. In Group B, the frequency of "could not grve any help" was as high as 21.3%. 7) The middle management expected "a superior" (72.1%), "an occnpational physician" (47.O %), and "a personnel manager" (33.4%) to act as an adviser in case where their subordinates showed mental health problems. In Group B, the frequency of "a personnel manager"was 17.4%, which was markedly lower as compared to 44.5% in Group A. 8) More than half (56.6%) of the middle management were convinced that some countermeasures against stress were necessary in their own workplaces.

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Setting an eye on the fact that bulimia nervosa (BN) patients are interested in animals, particularly dogs, authors had them keep an indoor pet dog as pet facilitated therapy (PFT). This paper is a report on two representative cases selected from among 9 cases for which PFT proved effective. Case 1 is a 21-year-old female. Because of severe BN, she has been followed up at the Kurokawa Internal Medicine Clinic since April, 1989. In January, 1992 she confined herself in her house at daytime with the sequence of day and night reversed and became desperate. In October, 1992 we proposed that she keep a pup. Accepting our proposal, she began raising a pup with a feeding bottle. After that, BN improved rapidly, and the outing time increased. She has obtained a license for motor-bike and started working part time at a coffee house. Case 2 is a 17-year-old female. She was 163 cm in height, weighed 36.5 kg and had anorexia nervosa (AN) when she was seen at the Kurokawa Internal Medicine Clinic in August, 1990. Since she showed a strong rejection to hospital admission, we administered the out-patient therapy (hospital body weight setting therapy) making use of the reiection to hospital admission, one of the regimens being employed at this clinic. She followed a satisfactory course, weighed up to 42. 5 kg in May, 1992 but began complaining of BN. In July of the same year, she weighed 45 kg but became worried about school examinations and BN so much as to show a suicidal attempt. Accepting our proposal, she started raising an indoor pet dog. With this as the turning point, she became stable mentally albeit with BN. She weighed 60 kg in January, 1993 but said, "As I keep a dog, my friend come to play with me. The dog serves as a sort of lubricant oil between me on the one hand and my family members and friends on the other". The PFT is effective when BN persists over a long period of time or when there is a shift from AN to BN. That is because patients with eating disorder have affinity to dogs in particular and pay more attention to dogs than bulimia and also because the indoor pet dogs particularly docile, easy to form skin contact and serves as a lubricant oil in the intrafamilial personal relations.

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Hypoglycemia is a common manifestation of anorexia nervosa. Despite the chronic malnutrition seen in anorexia nervosa, symptomatic hypoglycemia has been only rarely described. We report here a man with anorexia nervosa who was in coma with hypoglycemia, consequently suffered from respiratory arrest. He regained consciousness following intensive . therapy by artificial respirator. This 30-year-old man had a 15-year history of anorexia nervosa and had been hospitalized several times. After a fifth admission, he attended a religious training center for psychological reasons. However, he continued to restrict his food intake and was loosing weight, was complaining of high fever and general fatigue, and was, therefore, brought to the hospital. On admission, his chest X-rays showed a diffuse pneumonia, although arterial blood gas analysis was within the normal range. On the first night, he suddenly became comatose with apnea. Brain CT showed no abnormality and blood pressure was normal. Blood glucose level was 25mg/dl. Biochemical studies showed no other abnormal findngs related to the coma, with suppressed levels of insulin and elevation of growth hormone and cortisol levels, suggesting that the coma was due to hypoglycemia related to severe malnutrition. Immediately after onset of coma and apnea, he was intubated and total parenteral nutrition was begun after which he recovered consciousness on the third day. He finally recovered to the normal state and discharged on the 71th day of admission. A case of anorexia nervosa with hypoglycemic coma with apnea is documented. This suggests that prompt diagnosis and treatment are necessary for anorexia nervosa patients who present in a coma because of the high possibility of death due to hypoglycemic attack as described in this report.

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