We developed diazepam infusion sleeping therapy (DIST) that was completed by reforming diazepam sedation threshold test which had been developed to estimate the anxiety of patients objectively and quantitatively. We have applied this therapeutic method to clinical use. As the result, we have obtained some knowledge. The results obtained were as follows : (1) The diseases that DIST was very effective for were vegitative dystonia, generalized anxiety disorder, panic disorder etc. (n=30). The diseases that DIST was effective for were generalized anxiety disorder, panic disorder, depression, vegitative dystonia etc. (n=50). The diseases that was ineffective for were generalized anxiety disorder, depression, anorexia nervosa, mesencephalosis etc. (n=42). (2) On the clinical effect, more diazepam was required in the effective group and the very effective group compared with the ineffective group significantly (p<0.05,n=92). (3) The diazepam dosage of DIST was significantly higher in the IV area of CMI (Cornell Medical Index) compared with the I or II or III area of CMI (p<0.05,n=78). (4) Concerning the vital sign, the blood pressure decreased significantly at the sleeping point and after 30 minutes of DIST. The pulse and the respiratory rate increased significantly at the sleeping point of DIST (p<0.05,n= 44). (5) Concerning the autonomic nerve function, there was no significant difference in the value of coefficient of component variance (CCV) before and after DIST. But, the LF (low frequent) /HF (high frequent) component, which can be an index of the domination of the sympathetic nerve activity to the parasympathetic nerve activity, was decreased on the next day after DIST and six days after DIST compared with the LF/HF component before DIST significantly (p<0.05,n=14). (6) MAS (Manifest Anxiety Scale) score was decreased significantly in six days after DIST compared with the score before DIST(p<0.05,n=14). As mentioned above, DIST seemed to be a very effective therapy to diminish the clinical signs and symptoms (especially anxiety state) of psychosomatic diseases.

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We studied distinctive characteristics in case histories and family histories of probands in panic disorder and their families, and normal controls, in order to examine the effect of their genetic and environmental factors at the onset of panic disorder. Subjects were 48 probands of panic disorder according to DSM-III-R criteria. The mean (±SD) age at onset was 36.6±12.5 years and ranged from 14 to 55 years. Sex distinction was 20 males and 28 females. Normal controls were 32 hospital employees (12 males, 20 females; mean±SD age=32.4±4.55 years) who volunteered to participate in this study. Among probands of panic disorder, 20 patients (41.7%) had relatives that showed panic disorder, limited symptom attacks, or major depression and other associated disorders in the second degree family. Among them, 16 patients (33.3%) had a family history in the first degree family. Nine patients (18.8%) had a family history of panic disorder only. Patients of panic disorder had significantly more family histories and experienced significantly more numbers of death of relatives, and death of or separation from parents by the age of 15,compared to normal controls. Compared with patients of panic disorder without a family bistory, patients with a family history of panic disorder had more severe symptoms, and experienced significantly more number of life events and death of relatives. Also, patients with a family history showed significantly poor drug response, compared with patients without a family history. However, patients with a family history with horizontal transmission showed significantly good drug response, compared with patients with a family history with vertical transmission. Based on these findings, it was suspected that panic disorder could be labeled as a separate disease category having a high familial aggregation, and it was felt that genetic and environmental factors played a strong causal role in many cases.

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In the department of psychosomatic medicine, Kyushu University, a chronic pain patient is defined as "a patient whose pain complaint or social or occupational impairment is in excess of what would be expected from the underlying organic pathology." We have treated patients of this category by means of various kinds of somatic, psychologic and psychiatric methods. In this paper, 40 cases who had been treated for chronic pain on an inpatient basis in our institute were studied regarding applied treatment methods, their effect, treatment outcome and factors affecting prognosis. The results are as follows : 1) All the subjects were prescribed several kinds of antidepressants and minor tranquilizers as pharmacological treatment with the aim of alleviating the pain. 2) The somatic approach consisted of nerve block, laser and silver spike point electro therapy, all of which were applied to the patients with neurogenic pain. We feel that these methods also have some psychological effect. 3) Some behavioral methods were applied, such as autogenic training (AT), graded exercise quota and other operant techniques (time-out, prompting and token economy). AT helped the patients to effectively cope with pain caused by depressive disorders and psychophysiological mechanisms. Graded exercise quota was applied to teach patients to effectively manage avoidance pain behaviors to fearful situations. Other operant techniques were necessary for controlling more excessive pain behaviors. 4) In addition, some patients received either family therapy or counseling. The former was effective both for patients with depressive disorders whose family system acted as a psychological burden and for patients with conversion disorders who utilized their pain as a communication method. Counseling was necessitated for patients whose interpersonal cognitions were distorted or whose social skills were immature. 5) Treatment outcomes were evaluated from following four aspects; the strength of the subjective pain, the degree of the impairment of daily activity or role functioning and the dependence on medical treatments. Evaluation of the short-term outcome at 1-month after discharge showed 3 excellent, 14 good, 19 fair and 4 poor cases. Evaluation of the long-term outcome at 6-12 months revealed 5 excellent, 18 good, 10 fair and 7 poor cases. 6) Examination of factors affecting prognosis suggested that the most important was to analyse the patients' pain problems from a detailed multiphasic view and to institute the appropriate treatment on the basis of that analysis. On the basis of these results, the possibility was discussed as to how to apply various methods systemically, such as somatic approach, pharmacological treatment, behavioral therapy, family therapy and other psychotherapy, depending on the patients' pathogenesis.

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Type A behavior pattern has been established as a risk factor for coronary heart disease. It has been suggested that Type A individuals who are characterized as hard-driving, competitive, time-urgent, and impatient tended to increase stressors such as daily hassles and stressful life events. It has been also hypothesized that Type A individuals would suppress their subjective symptoms under stressful condition. The present study examined relationships between Type A behavior pattern and daily hassles, and stress responses of university students. To accomplish this, a questionnaire that consists of Type A behavior pattern scale (Jenkins Activity Survey) and psychological and physical stress response scale was administered to 835 students in Okinawa. The results were as follows. Subjects who are living outside their own homes reported significantly more daily hassles, depressive effect, anxiety, slowness of thinking, helplessness, withdrawal, restlessness than subjects who are living in their own homes. Consequently, it was considered that subjects who are living outside their own home would be a high stress group. Subjects with Type A behavior pattern reported significantly more daily hassles, irritation, unrealistic wishes than their counterpart. It was revealed that daily hassles correlated positively with stress responses among subjects with each behavior pattern and each stress group respectively. However, subjects with Type A behavior pattern of the high stress group did not show relationships between daily hassles and any stress responses. These results show that Type A individuals have more stressors than Type B individuals, and that Type A individuals under stressful conditions have no relationship with stressors and stress responses.

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We conducted a study to demonstrate the frequency and the kinds of psychiatric/psychological symptoms among rehabilitation patients. Subjects were conducted a Structured Interview according to the DSM-III-R, and they were asked to fill in four psychological tests such as Zung's Self-rating Anxiety Scale, Zung's Self-rating Depression Scale, Profile of Mood States, and Hamilton's Rating Scale for Depression. Total number of patients were 87 with a mean age of 57.7±17.1,and 54 males and 33 females. Concerning kinds of original physical diseases, 47 patients were suffering from cerebrovascular disease, 12 from spinal cord injury, 13 from orthopedic injury such as fracture, 5 from head trauma and 10 for others. Structured interview according to the DSM-III-R demonstrated that the 35 patients (40.2%) met the criteria for some forms of psychiatric disorders. Concretely, 28 patients met the criteria for major depression and 7 for adjustment disorder with anxious mood, which are almost consistent with previous studies in the foreign countries. The results of all psychological tests indicated highly significant differences between the normal group and both psychiatric disorders groups, which suggests that the psychological tests are useful in detecting some forms of psychiatric disorders.

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A 34-year-old single female nurse was refered to our psychosomatic unit due to severe anemia and loss of consciousness. Her mother and younger sister were also nurses, but her father had died from malignant lymphoma 4 years before. Laboratory data revealed iron deficiency anemia. On admission, she had a mild fever and was vomiting. She was administered a blood transfusion because her hematologic data showed pancytopenia as Hgb. 3.3g/dl, W.B.C. 1700/, μl, Pit. 6.7×10^4/μl. We found she had syringes and needles and observed her self-induced bloodletting. Furthermore she had complicated alopecia areata and trichotillomania. Her anemia was gradually treated by intravenous ferrous injection and she was discharged from hospital. During outpatient treatment, the vomiting disappeared and binge eating appeared. Nevertheless, she was readmitted because of the progression of anemia and dehydration due to vomiting and wrist cutting. Her vomiting continued and she had pyrexia due to factitious behavior like self-induced leakage of instillation instead of self-induced bloodletting. We assessed that her life history of self-sacrifice was related to her masochistic pathology. For example, she injured herself through self-induced bloodletting and she overdrove herself in spite of having a severe anemia. We regarded this case's self-induced bloodletting not only as compulsive behavior but also as an equivalent to drug addiction. We reviewed 11 factitious anemia cases including this case in Japan. They were aged from 21 to 42 (average of 28.1±5.8) ; of the 9 females, 7 were in medical professions, especially nurses. Minimum data of Hgb., W.B.C. and Pit. are 1.3g/dl, 8001/μl, 6.7x10^4/μl (this case) respectively. 4 cases were accompanied with eating disorders. Patients diagnosed as having factitious disorders often give up treatment, so that their prognoses are pessimistic. So, after making an early definite diagnosis, we emphasize that the first step of the therapy should be to make a continuous therapeutic collaboration

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We performed a psychological approach on an adult female with nocturia to facilitate her recognition of motherhood and found that her clinical symptoms improved. A 32-year-old female with nocturia has had problems, which are anxiety about separation from mother, discomfort of relationship between her husband and her and immaturity of motherhood. Treatment has included medication, counseling, transactional analysis, autogenic training and a psychological approach to facilitate her recognition of motherhood, and after 1 year her nocturia has gradually decreased. We have also noted that the improvement in her symptoms has been accompanied by a changed image of motherhood. We conclude that observating images of motherhood is a useful element for understanding the psychosomatic problems involved in these cases and evaluating the efficacy of treatment.

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