The effects of autogenic training(AT), which was performed 3 times a day, on blood pressure (BP) and heart rate (HR) were studied. Ambulatory BP and HR were monitored at 30-minute intervals for 24 hours in 2 hypertensives (with white coat phenomenon) and 3 white coat hypertensives with anxiety, their ages ranging from 48 to 64. The following patients were calculated averaged BP and HR values for the nighttime period (00 : 00-06 : 00), the daytime period (10 : 00-20 : 00) and the 24-hour period (00 : 00-24 : 00). Averaged systolic BP (SBP) for the daytime period decreased significantly from 147.7±4.4 mmHg to 132.7±5.7 mmHg after performing AT (p<0.05). And averaged SBP for 24-hour period decreased from 140.1±8.9 mmHg to 133.2±7.9 mmHg (p<0.05). On the other hand, SBP for the night time did not decrease significantly. Averaged diastolic BP (DBP) decreased for the daytime period (from 86.7±3.7 mmHg) and for the 24-hour period (from 81.1±2.8 to 77.9±3.4 mmHg) significantly. The same tendency was seen in averaged SBP (p<0.05). However, HR did not change for the nighttime, the daitime and the 24-hour period after performing AT. In a 48-year-old hypertensive women, BP and HR were monitored for 50 days. A cosine fitting technique using the least-square method was employed to determine the circadian rhythm of BP and HR in this patient. Both SBP and DBP decreased after performing AT for 4 weeks. The circadian midline estimating statistic of rhythm (MESOR) for the BP decreased after performing AT for three days in a longitudinally monitored patient. This patient showed a decrease of 10 mmHg in the MESOR for SBP after performing AT for 4 weeks. These results suggest that AT is a useful method for controlling and preventing hypertension.

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We have been using the stepwise psychosomatic treatment (SPST) on asthmatic patients according to the evaluation of their medical examination and psychosocial factors that influenced the onset and clinical course of their asthma. The SPST consists of pharmacotherapy and stepwise psychotherapy in the following stages : 1) introduction to psychosomatic treatment and establishment of rapport between doctor and patient. 2) reduction of inner tension induced by a stressful situation and release from asthmatic attack. 3) making a patient aware of the relationship between asthmatic attack and psychosomatic factors. 4) helping the patients to modify their maladaptive behaviors and to develop an adaptive coping behavior. 5)termination of psychosomatic treatment. In this study, we investigated the effectiveness and problems in the practice of this therapy in 3 different medical care systems. The results are summarized as follows. 1. The modified SPST was applied to 17 patients (1 severe, 6 moderate and 10 mild cases), at A medical office, which is a clinic and has a small medical staff Most of the patients were young office workers, 14 of them had atopic disposition and 14 had psychosocial problems mainly at work. Fifteen patients showed a marked or fair improvement by this treatment. 2. Thirty-six patients (8 severe, 23 moderate and 5 mild cases) were treated with the modified SPST at B hospital which is a general hospital with respiratory division and has a sufficient medical staff. Seventeen patients had an atopic disposition and 26 patients had psychosocial problems at work or at home. Twenty-six patients showed a marked or fair improvement after personal or group education programs for asthma management and brief psychotherapy with pharmacotherapy. 3. The SPST was applied to 65 patients (31 severe and 34 moderate cases) at hospitals with an established psychosomatic care unit. All of them had psychosocial problems and 43 patients had an atopic disposition. Fifty-two patients showed a marked improvement or complete remission. The significant increase of Berle Index (BI) , which is the indicator of the ability for stress coping and social adaptation, was observed after the treatment for 2.4±1.1 years. The effectiveness of this treatment was seen to be best in life stress related types, better in neurotic types, and worst in personality related types. These results suggest that SPST may be applicable to all patients according to their pathophysiology and psychosocial situations at any hospital. SPSt's main aim, that is, the self-control of asthma, is consistent with the aim of the International Consensus Report on Diagnosis and Management of Asthma, which is the control of asthma and the reduction of the side effect of medication and promotion of the Quality of Life.

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Aim ; In recent years with the progress of the drug therapy for peptic ulcer, we are able get ulcer healing within several months. But few cases remain hard to cure or relapse. A psychosomatic approach for these intractable case is important. The aim of this study is to establish a new psychosomatic approach for the patients with peptic ulcer. Subjects and Methods; One hundred and ninety-nine patients whose peptic ulcers were treated in our university hospital were investigated. In order to asses the patient personality trait, health care related behavior and stressful life events, MMPI Alexithymia Scale (MMPI-A), Health Locus of Control (HLC) and Life Events Inventory were employed. Results; The both scores of MMPI-A and HLC showed significant correlation with age. The average scores of MMPI-A showed no differences between the patients with ulcer symptoms and those without them, and also between the patients receiving medical treatment and those not receiving it. Fourteen percent of patients showed high MMPI-A scores. The average scores of HLC showed no differences between the patients receiving medical treatment and those not receiving it. The patients with ulcer symptoms showed more internal tendency than those without it. A negative correlation was shown between the numbers of life events and age. The number of life events in the patients with ulcer symptoms were higher than that of those without them. Conclusion ; From these data, we made some suggestions about a psychosomatic approach for the patients with peptic ulcer. These patients may easily get the high quality of life by a combined approach of supportive therapy, life style modification and social skill training in consideration of individual personality traits and life style.

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The study was done to investigate the effectiveness of the strategy of our psychosomatic approach to the treatment of diabetic patients who have difficulty in adhering to a self-care regimen. Our theraputic program has been applied over the past 7 years to 74 patients with diabetes mellitus who had physiopsychosocial problems. Sixty-six of the patients were NIDDM, and the other 8 were IDDM : mean age 51.2 years, duration of illness 11.1 years, and mean hemoglobin A_1c at admission 9.1%. Data of diabetic patients with physiopsychological problems were compared with that from diabetic patients without such problems admitted our hospital for diabetic education and/or examination for physical complications. The frequency of high depression scores in patients with physiopsychological problems was much higher than that in patients without these problems. When diabetic patients with severe physiopsychological problems were interviewed, common characteristics were : 1) difficulty in developing a good doctor-patient relationship, 2) persecutive disturbance, 3) low self-esteem, and 4) low level of motivation to be successful in self-care. On the basis of these patient characteristics, we designed a psychosomatic therapeutic regimen for diabetic patients with adherence difficulties consisting of 3-steps based upon psychosocial and psychoeducational intervention. Two thirds of the patients were followed at our outpatient clinic and others were followed by their family doctors. Of the patients followed at our clinic, 47% are still in good glycemic control with hemoglobin A_1c less than or equal to 7.0%, whereas only 14% of the patients followed by their family doctors were able to maintain this level. Five of the 74 patients dropped out of the program and, unfortunately, 3 patients followed by family doctors died. In conclusion, psychosomatic treatment of diabetic patients with adherence difficulties as was done in 3-step program at our hospital followed by careful outpatient treatment seems to be effective.

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There are following characteristics in PSD in childhood. 1. Because children are in the midst of growing and developing, they complain rather general symptoms such as general malaise in PSD, while adults complain somatic changes or functional disorders of some particular organs like as gastric ulcer or angina. Since these symptoms may shift each other, it may be difficult to make exact distinction between somatic factors and psychological factors. For instance, headache, abdominal pain or general malaise may be the first symptoms of the children who can not attend school but they may also be the symptoms of the children with diabetes mellitus or hepatitis. 2. One of the characteristics of children is a poor verbal communication. In other words, they may resemble alexithymic patients who have difficulties in expressing emotions in words, and for whom dynamic psychotherapy cannot be effective. Therefore, psychotherapy in childhood is necessarily different from that conducted with usual adults with PSD. However, they can express their feelings much better through the process of drawings. About 800 patients have visited us for various psychological problems until now. They have left behind several hundreds of pictures that have led the author to believe that drawing tests are the best possible way to understand these young patients. The parents can understand their loneliness or distress through the products, and patients can reveal their anger or concealed aggression and be released from them during the process of drawing. 3. People around children may be convinced of normal developmental phenomena as abnormal. For instance, some parents may overestimate the behavior of their child in the gang age and thus protect or meddle him excessively. In that case it is important to remove the parent's anxiety. 4. The children who are tender, good and over adapted are liable to suffer from PSD. However, we may misunderstand their behavior because their way of thinking or acting is different from those of adults. Sometimes they play the role of a scapegoat or a peace maker of the family system. For instance, where there is continuing marital strife, he may intervene on behalf of one or the other of warring partner or defuse the conflict by behaving badly or having some symptoms. In that case it is necessary to pay attention not only to the symptoms of the child but to the system of the family. There are many implications in symptoms in children with psychological problems. Knowing their feelings or emotions is most important for a therapeutical involvement, therefore we should make efforts to stand on the children's view point and to understand the meaning of their symptoms in an appropriate manner. The author has explained the above by presenting some cases.

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