The purpose of this study is to evaluate the effects of the Great Hanshin Earthquake in January 1995 on the onset of symptoms of the Posttraumatic Stress Disorder (PTSD) and psychological stress responses systematically. Three to four months after the quake, one hundred twenty eight earthquake victims (males : n-62,Age : Mean : =34.89±12.51,Min.=18,Max.=73; females : n=66,Age : Mean=29.56±11.42,Min.= 19,Max.= 62) were requested to complete a questionnaire, which consists of items from DSM-IV diagnostic criteria for PTSD and Psychological Stress Response Scale (PSRS-18). The rate of. prevalence of PTSD was 12.90% for males, 9.09% for females, and 10.94% for total subjects, suggesting that the prevalence rate of PTSD is almost same as one described in DSM-IV. Victims showed symptoms included DSM-IV criteria category B (persistent reexperience of traumatic events) most frequently (92.97%), followed by category D symptoms (persistent increased arousal : 54.69%), category F symptoms (distress or impairment of social and occupational functioning : 28-91%), and category C symptoms (persistent avoidance of trigger and numbing of responsiveness : 25.00%). Among category B symptoms, 82.03% of victims showed intense psychological distress at exposure to triggers, 69.53% of them showed recurrent and intrusive recollections of the traumatic event and acting or feeling as if the traumatic event were recurring, whereas only 15.63% of victims showed psychological reactivity on exposure to triggers. Among category C symptoms, efforts to avoid activities., places, or people that arouse recollections of the trauma was found in 69.53% of victims and sense of foreshortened future was found in 37.50% of victims. As there were no differences in the occurrence of category D symptoms, 35% to 50% of victims showed each symptom. Regarding to the results of PSRS-18,comparison of PSRS-18 scores between victims and the normative data revealed that victims showed significantly higher scores in all subscales : Depressive-anxious mood, Irritability and anger, and Helplessness. No significant gender difference was found. Further analysis of PSRS-18 scores revealed that victims with PTSD symptoms showed significantly more psychological stress responses than victims without PTSD symptoms in all subscales. These results were discussed with reference to past research data on PTSD caused by quake disaster. The importance of social support system to reduce psychological stress responses and some implications for the intervention of PTSD were discussed.

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This study systematically evaluated the psychosomatic reactions, especially physical symptoms of the victims living in the temporary shelters after the Great Hanshin Earthquake in January 1995. There are not so many studies which describe the somatic symptoms of victims in detail and reveal the results of blood pressure measurement after a natural disaster. As there has been no research which excludes the confounding factors in order to evaluate the effects of damages, it is a distinctive feature of this study that the multiple logistic regression analysis was performed in it. Physical and mental conditions of eighty victims (mean age=47.2±19.3; males : n=27,females : n= 53) were examined one month after the quake. Subjects were also requested to administer a checklist of psychosomatic symptoms which consisted of DSM-IV diagnostic criteria for ASD and PTSD. Blood pressure of about two hundred victims was measured both two and five weeks after the quake. Subjects of two weeks after the quake were 191 victims (mean age=58.4±13.1; males : n=68,females : n=123), and five weeks after the quake were 217 victims (mean age=60.1±12.1; males : n=77,females : n=140). Victims showed significantly more physical symptoms of insomnia, easy fatigue, anorexia, headache, palpitation, chest pain than non-victims as a control group. It was also found that three factors of victims, i.e. morbidity of chronic disease, death of close relatives, and complete destruction of houses had influence upon prevalence of psychosomatic symptoms. More symptoms of common cold, anorexia, easy fatigue, depressive feeling were found in victims with chronic diseases. Victims whose close relatives were killed by the quake showed significantly more symptoms of easy fatigue and less symptoms of common cold and anorexia. Victims whose houses were completely destroyed showed more symptoms of insomnia and depressive feeling. Forty-one to forty-six percent of victims who had not suffered from hypertension before the quake showed hypertensive status. Therefore, neurological, cardiovascular, and general symptoms were the most common reactions after exposure to the stressors due to disaster. Furthermore, these symptoms were affected by the severity of the damages in the disaster. These results suggest that somatic symptoms are important components of the reaction after a natural disaster. They also suggest the importance of proper care from both physical and mental perspectives, i.e. psychosomatic or holistic perspective.

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We have presented in our previous study the possibility of classifying technostress syndrome into 5 types based on clinical observation. In the present study, we investigated the possibility of classifying the syndrome based on Hayashi's quantification theory. In quantification III, objects could be devided into two types by factor I whether they exhibited somatic symptoms or mental symptoms. And objects also could be devided into two types by factor II according to clinical courses. Then we could see 4 types of internal structure by quantification III. In quantification II, we could divide 5 clinical subtypes (anxiety type, techno-centered type, somaticpersonality type, passive-adaptive type, immature type) into 5 different groups by evaluating 3 factors. As to classification, personality trait is the most attributable factor and cardiovascular symptoms and anxiety are also important. Consequently, the technostress syndrome is classified into the following types which are somewhat proper statistically. Each with its own characteristics as described below. 1. Anxiety type. This type is closely related to persons with typus melancholicus, anxiety disorder. Its response to drugs and prognosis are favorable. 2. Techno-centered type. This type is closely related to males with a long professional career. The personality trait is closely related to cluster A (DSM-III-R), suppressive symptoms mood disorders. 3. Somatic-personality type. Its personality trait is closely related to cluster C (DSM-III-R). This type is often diagnosed as somatoform disorder or psychosomatic disease. Its symptoms tend to be persistent. 4. Passive-adaptive type. Its personality trait is closely related to cluster C (DSM-III-R). This clinical course often becomes chronic but its social adjustment is good. In the present study, it is difficult to distinguish this type from other types. 5. Immature type. This type is closely related to females with a short professional career. From these findings, I came to the conclusion that it is important to evaluate technostress symdrome totally from the point of its longitudinal course, for example response to treatment, prognosis, as well as to pay attention to the onset situation.

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The patient was 53-year old woman who had been found to have valvular heart disease at the age of 20. She had suffered from schizoaffective disorder since the childbirth at the age of 28 and had been admitted to a mental hospital for eighteen years. After leaving the hospital, she had not consulted a doctor for two years. She was admitted to our mental hospital in July, X (age 48) because of psychomotor excitement and auditory hallucination with acute pulmonary edema due to severe heart failure. After admission she was making a transient recovery by treatment with medication. But she had recurrent attacks of pulmonary edema associated with psychomotor excitement in spite of taking cardiotonics and antipsychotics in high doses. In June, X+5,she was attacked with cardiogenic shock along with severe heart failure, which was followed by psychomotor excitement. After two days she recovered from the coma by treatment with cardiotonics and diuretics but the clouding of consciousness lasted for about three months. An EEG showed low voltage Θ waves in all leads and the MRI revealed ischemic change in cerebral cortex and white substance after about two weeks of the shock. However, she was slowly improving in intelligence and activities of daily living. For months after the shock, she was making a recovery from the severe heart failure and clouding of consciousness. She was taking no antipsychotics with no psychomotor excitement and auditory hallucination, and continued to be in good general condition.

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We reported the therapeutic process of sandplay therapy with a 12-year old boy who was just growing up from juvenile into adolescence. He had a nervous disposition and was always annoyed by the interference from his mother and sisters. Since he was eleven, trouble with his classmates led him to motor tic which appeared on his neck inclining his head to the left side quickly. After a few months, he visited us for treatment. Six months of sandplay therapy helped him to learn the ways of discharging and controlling his aggression and to collaborate with his friend. He then also learned to overcome the conflicts with his mother and sisters. In the meanwhile, his manners were improved to have proper relationships with his family members and to keep adequate distance from others in social life, and cosequently his motor tic disorder was removed.

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A 31-year-old female experienced a chronic pain because of stress after marriage; she also had various pathological conditions for 8 years such as eating disorder, low T_3 syndrome which was treated as hypothyroidism, drug dependence, renal dysfunction and electrolytic disorder. Her psychosocial problems were not properly dealt with during her previous hospitalizations such that her pathological state became complicated and she suffered from iatrogenic disease, too. We suspected that her condition was partially iatrogenic in origin. Her condition rapidly improved when we used a psychosomatic approach based on behavioral theory. The results suggest that the absence of psychosomatic approach during her previous hospitalizations may have led to severe complications which prolonged her condition.

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A 59-year-old man visited a clinic on May, 1995,because of a persistent chest discomfort at night and insomnia. He had experienced the Hanshin-Awaji Great Earthquake at Kobe alone and these symptoms had begun 1 month after the disaster. Preceding several physical examinations revealed no somatic etiology except for diabetes mellitus. The disease had also been worsened after the earthquake. On psychological evaluation, the patient felt not so much anxiety regarding earthquake and appeared to have an alexithymic personality. He also seemed to be in a state of masked depression. His symptom was confirmed only when he stayed in Kobe. From these viewpoints, the patient was diagnosed as Post-traumatic Stress Disorder. After psychosomatic therapy including antidepressant, he showed rapid improvement. In conclusion, it is important to practice psychosomatic approach for patients when their symptoms occurred after the experience of traumatic disaster.

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Anorexia nervosa is well known of its fatal complications with severe emaciation. We report a case of anorexia nervosa with multiple organ failure, disseminated intravascular coagulation syndrome and mediastinal emphysema. A 20-year-old woman, who had emaciated from 60kg to 36kg for 9 months, came to our Saitama Chuo Hospital. Further she lost her body weight of 5kg during two weeks and she was in coma on admission. Chest CT showed mediastinal emphysema and subcutaneous emphysema. We found severe liver dysfunction and disseminated intravascular coagulation syndrome on laboratory examinations. Tarry stool was found on 2nd day. We diagnosed her as duodenal ulcer by gastrointestinal endoscopy. On 16th day she had abdominal pain and her serum amylase was markedly elevated. Abdomen CT revealed that her pancreas was swelling with the diagnosis of acute pancreatitis. We started intravenous hyperalimentation, gabexate mesilate (FOY^[○!R]), platelet transfusions and H_2-blocker and her general condition was improved. She started eating and had weight gain. She was discharged on 141th day when she gained her body weight up to 37.2kg. We think that all complications of this case were induced by severe emaciation and especially weight loss which progressed rapidly.

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