The brain peptide neuropeptide Y (NPY) and galanin (GAL) have both been found to have stimulatory effects on eating behavior in rats. Both peptides act in part through a structure of the hypothalamus which is the paraventricular nucleus (PVN). This nucleus controls both the endocrine and behavioral processes related to nutrient homeostasis. However, they produce very different and specific effects on the behavioral process of eating. The actions of NPY focus on processes related to carbohydrate intake and carbohydrate metabolism. This peptide, with corticosterone, operates through a specific hypothalamic circuit involving the arcuate nucleus where the NPY synthesizing cell bodies exist, and the PVN to which these cell bodies project. This neurocircuit is most strongly activated at the start of the active feeding cycle. In contrast to NPY, GAL appears to act preferentially on the ingestion of fat and may enhance fat deposition. It seems that these processes occur through neurons in the PVN and medial preoptic area. GAL gene expression and synthesis are activated under conditions associated with increased fat intake ; these include the mid-to late hours of the active feeding cycle and the developmental period around puberty. Implications for understanding the symptoms of eating disorder were analyzed and discussed. First, PVN NPY Ievels decrease in rats fed with high-carbohydrate diet, which indicates a negative feedback mechanism. In contrast to NPY, PVN GAL Ievels increase in rats fed with high-fat diet, and this indicates a positive feedback mechanism. The possibility of GAL relating to binge eating and NPY to anorexia was argued. Second, hypothalamic GAL levels rise just after puberty in female when GAL synthesizing neurons are positively activated by estrogen. Moreover, fat intake in female rats increases predominantly after puberty. These evidences provide information on underlying physiological conditions at the onset of eating disorder. Although we must be well aware of the limits of animal experiments, this research field will contribute to further understanding of the biological basis of eating disorder.

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There have been some reports on the assessment of mortality rate in eating disorders. The reports in Western countries and Japan have shown the mortality rate of 1-lO%, and studies on many cases revealed the rate was approximately 4%. Of the outpatients who visited our department for the past 23-years, 724 had eating disorders. In this paper, the prognosis, the number of patients who died, and the situation of their death were investigated in these 724 patients. Data were collected from outpatient charts, registers, data bases and questionnaires given to attending physicians in our department. Data were collected from 434 of the 724 patients, and their list was made. We directly asked the attending physician for a summary of each individual patient and the items described later. Death was confirmed in 9 of the 434 patients. All of them were women, and the age at death ranged from 17 to 48 years (mean, 28 years) . The age at the onset ranged from 14 to 21 years (mean, 17 years) . Four patients had anorexia nervosa (AN) alone, and 5 had AN and bulimia nervosa (BN). The body weight at the time of death was 17-66 kg (mean, 35kg) . Hepatopathy has been confirmed in 6,edema in 4,hypokalemia in 5,and hypoglycemic attack in 4. The cause of death was weakness (debility) in 3,suicide by leaping from a high place in 2,heart failure following attempted suicide by taking medicine in 1,sudden death in 2,and cancer in one patient. As psychosocial factors, a desire for emaciation (fear of obesity) was observed in all the patients, and an attempted suicide, personality disorder, child-mother binding (symbiosis) , obsessive character and hysteric tendency were observed in 4,4,6,5 and 3 patients, respectively. The following points were reconsidered from the standpoint of the attending physician : l . Three patients (Cases 1,3 and 9) with AN, who died from weakness. No therapeutic relationship was established or motivation for the treatment was lacking. These points were reflected upon commonly in these three patients. In Case 9,her mother's load was increased because her father worked away from their home. Her mother showed a strong negative transference to the attending physician. This has been considered a therapeutic problem. 2 . Two patients (Case 5 and 8) with AN + BN commited suicide by leaping from a high place. Management of their unstable mental condition was not adequate. No evaluation was made nor countermeasure taken for chronic depression. Prediction of and response to attempted suicide were not adequate. 3 . A patient (Case 6) with AN+BN and a patient (Case 7) with AN died suddenly. No precise evaluation was made regarding her physical condition.

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Twenty-six postmarital onset patients had a significantly higher age at onset and non-significantly shorter duration of illness compared with 14 premarital onset patients and 22 never-married eating disorders patients older than 28 years old. However, the various clinical features such as binging and purging behavior of the three groups did not differ. Four premarital onset patients showed exaggerated clinical features after marriage, but the other patients showed no change in clinical features. In the postmarital onset group, eating disorders were triggered, in more than half of the patients, by marital disharmony or crisis, whereas eating disorders were triggered by dieting to be slim in more than half of the patients of the premarital onset group and the never married group. These results were discussed.

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Patients with anorexia nervosa (AN) had statistically more frequent strong feelings against hospitalization compared to patients with bulimia nervosa or control subjects. We attempted to utilize this aversion in outpatient treatment of AN by setting a body weight that required hospitalization. The therapy was conducted as follows : 1) The patient's family should refrain from mentioning the body weight and food intake of the patients. 2) A body weight limit permitting outpatient treatment was set according to the patient's mental and physical conditions. Hospitalization would occur if the patient's weight fell below this limit within a given period of time. 3) The body weight requiring hospitalization was gradually raised in consultation with the patient. 4) If the body weight permitting continued outpatient treatment was not reached within the predetermined time, hospitalizaion occurred. 5) Even if a patient did not achieve the target weight, hositalization might be postponed under certain circumstances. As anorexia nervosa patients have a strong hospital aversion, this method was well accepted by the patients and had a success rate of approximately 80%. A therapy utilizing this characteristic by setting a body weight requiring hospitalization was extremely efiicacious as an outpatient treatment method, and should be considered as a basic outpatient therapy for AN. In this study, we compare the frequency of hospital aversion among patients with AN received a therapy which had set a body weight requiring hospitalization before and after treatment. The proportions of subjects responding hospital aversion were many before as well as after treatment. On the basis of this results we consider that hospital aversion of AN is very important and is a kind of the patient's sense which is diffcult to change.

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In this article, the author discusses the psychopathology and treatment of eating disorders from the aspect of psychoanalysis. Firstly, he points out the vulnerability of eating disorder patients to separation, based on his experience with eight cases of psychoanalytic psychotherapy during the past nine years. Keeping one eye on the particular characteristic, he surveys the recent psychoanalytic understandings : (1) the importance attached to the disturbances of the relationship between mother and child in early infancy as the origin of the psychopathology, (2) the failure of patients to internalize good object-relations, due to the disturbances, and resulting inability to build up the weakened ego and self, (3) the patient's struggle to make up for the disturbances with a pathological dependence on objects, or their confrontation of the anxiety of object-loss and/or fragmentation or depletion of self when threatened by separation from a dependence object, (4) we may understand the clinical features of eating disorders as the expression of pathological defenses against the above mentioned anxieties. In the latter half of this article, he considers the treatment issues of the disorder, introducing the concept and usefulness of a "container/contained model" by Bion. Specifically, presenting the clinical materials, he discusses the problems around the introduction to treatment and the acting out or somatization which eating disorder patients frequently present in the process of treatment.

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Behavioral therapy (BT) for anorexia nervosa (AN) conducted in our department is very effective for behavioral modification, but we have not evaluated its effects on cognitive improvement. The purpose of the present study was to determine whether or not cognitive modification occurred after BT. We have evaluated the cognitive aspects of BT comparing the results of Eating attitudes test (EAT) , Maudsley personality inventory (MPI) and Yatabe-Guilford personality inventory (Y-G) of 8 inpatients with AN ; these tests were conducted before and after the completion of BT for AN. The mean EAT scores after therapy were significantly higher than those before therapy. The MPI scores also showed a significant improvement in extroversion and reduction of neuroticism. The Y-G test showed that the personality of the patients shifted from the average type (type A) to an assertive-stable one (type D) . These findings suggest that behavior therapy not only improves eating behavior but also induces cognitive improvement among AN patients.

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Many workers and health professionals consider that mental health at the workplace is very important in order to maintain workers' health. To improve their mental health, evaluating stress at the workplace and planning adequate stress management are necessary. This report deals with these two areas. 1. A survey on occupational stress in local government employees In order to evaluate occupational stress, we made a set of questionnaires including the NIOSH Generic Job Stress Questionnaire (the Japanese version) and the 12-item General Health Questionnaire (GHQ) , and requested employees of two local governments in Fukuoka Prefecture to answer the questions. We received replies from 300 employees, 204 males and 95 females ( 1 unknown) , whose average age was 42 . 2 years old. The multiple regression analysis was used to clarify how well the GHQ score would be explained by the scale scores of the NIOSH Questionnaire. The result indicated that respondents who had higher scores of "Interpersonal Confiict within Groups" and "Variance in Workload, " and lower scores of "Self-Esteem" and "Job Satisfaction" had higher scores of the GHQ. The regression explained twenty-eight percent of the GHQ score variance. The scales of "Self-Esteem" and "Variance in Workload" had a larger explanatory power on the GHQ score than the others. The cluster analysis of respondents also revealed that stressors might have strong influence on mental health in a group of respondents and personality factors might play a significant role in another group. 2. Training of active listening in a company We provided one-day training of active listening (AL) for 44 employees of managerial positions in a certain company. The training included lectures and practices of AL. According to their answers to the questionnaire filled in just after the training, almost all participants were interested in mental health, and 94% of them recognized that they were under stress. All of them thought that the training was useful, and 77% replied that AL would be helpful. The questionnaire survey conducted 6 months later revealed that many of them were trying to make good use of AL.

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Municipal govemment employees were asked to respond to a questionnaire regarding subjective aspects of fatigue states. The relationships between fatigue score and stress, life style, psychobehavioral responses were examined. We found that stress, life style (sleep status, daily life behavior, eating behavior and work situation) and psychobehavioral responses (depressive mood and type A behavior pattern) were primary causal factors of fatigue. There were significant differences between liquor consumption, smoking rate (cigarettes per day) and blood pressure, body mass index, in the levels of triglycerides, uremic acid, hemoglobin, liver enzymes. Furthermore, the relationship between fatigue and exercise, goals to live for were studied. Respondents who exercised more than twice a week had lower mental and physical fatigue scores compared with those who exercised less than once a week. Respondents who had many goals to live for had lower mental and physical fatigue scores as compared to those who had no goals to live for. There was a significant negative correlation between mental fatigue score and NK cell activity but physical fatigue score was not related to NK cell activity. There was a significant negative correlation between the total fatigue score and NK cell activity. These results suggest that NK cell activity may be a potential objective measure of the degree of fatigue.

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Clinical investigation was performed to observe the health promotive effect induced by systematic stress coping program. More than 3700 employees of 11 enterprises attended to the stress coping programs which consisted of several lectures concerning health management and stress coping skills. Brief autogenic training (referred to as AT) was applied as a coping technique. The effect of health promotion was estimated before and after 3 months of program with Japanese Mental Health Inventory namely JMI Health Questionnaire and physiological laboratory test. In this studies, 155 cases of the AT group and 43 cases of non-AT control group were compared. Both groups showed an improvement in physical health, mental health, and environmental adaptability. The scores for psychological indicators such as spontaneity, social responsibility, anxiety, hypochondriacal tendency, suggestibility, explosive temper and hyperthymia improved. Scores for accuracy of work, motivation to work, belongingness, personal relationship with fellow workers improved in the AT group after three months of program. Laboratory data were also compared before and after the program. Serum cortisol level was significantly decreased and immunological (NK activity. CD 4/CD 8 and albumin/globulin ratio) , hematological (white blood cell), and endocrinological (LDL/HDL cholesterol ratio) alteration were observed toward more healthy direction after coping program in the AT group. The AT group showed more improvement in psychological health by decreased hebephrenical tendency and elevated controlability of emotion. Laboratory data showed more significant increase of serum uric acid and creatinine in the AT group. Serum level of albumin decreased and α1- and α2-globulin elevated, which may explain the decreased A/G ratio and elevated ZTT and TTT. These data suggested that AT may have some potential for alteration of the physiological condition through endocrinological, immunological and metabolical mechanisms. This investigation revealed that stress coping program in the industries might be usable as effective tools for psychosomatic relaxation and health promotion.

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The purpose of this paper is to study how to prevent stress-related diseases of employees, and treat them early. For this purpose, 119 employees were analyzed by mental health examinations, (so called Stress Dock) at Osaka Prefectural Mental Health Center for 4 months. Our findings and conclusions are as follows. 1) Conferences were held for determining stress conditions of the above mentioned 119 employees. They were classified into 4 groups, i.e. "severe, " "borderline, " "moderate" and "a little." 2) Most employees felt themselves stressful and 55% of them were classified into "severe." 3) 40% of the employees were diagnosed as having stress-related diseases for the first time. Twenty-four of 36 employees who had psychosomatic diseases could be found earlier. The Stress Dock was therefore very useful for finding stress-related diseases of employees early. 4) Making employees realized their stress conditions as a stress management was very effective. 5) Most employees who were suffering from stressful conditions were recommended to attend relaxation seminars and workshops for employees' stress management. In conclusion, it is very important for employees' stress management to organize a comprehensive system which can prevent stress-related diseases by finding and treating them.

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To Japanese overseas workers and their families, mental health care is a very important concern. However, as there are so many psychosocial factors involved when living abroad, it is very diffcult to determine what factor is important for mental health maintenance. So, in this study, we tried to assess the relationship between the psychosocial background and the mental health state of the Japanese living overseas. Three hundred and one people who consulted JOHAC (Japan Overseas Health Administration Center) , were examined. The author had an individual interview with each person and investigated their psychosocial background and demographic data. Results of this data was compared to the score of the GHQ (General Health Questionnaire), which we used as the index of mental health state of the subjects. In this process, we adopted multivariate statistical analysis ; the Quantification Type I method. This analysis revealed that the combination of four of the items ((1) Stress coping pattern, (2) Optimism/ Pessimism, (3) The motive for going abroad, (4) Alcohol), could most accurately estimate GHQ score (Rsquared = O.308,p < O.001) . In particular, the stress coping pattern seemed to be the most useful measurement. The author concluded that the above four psychosocial factors were very important for anticipating one's adaptability to living abroad.

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