We have applied a new refeeding method to our inpatients with Anorexia Nervosa (AN) , using only the liquid formula at the initial stage of treatment. Our purpose of the present study was to reveal favorable and aversive effects of the liquid formula on physical and psychological functions as compared with the regular meals. Ten anorexic inpatients, who were diagnosed according to the DSM-III-R, participated in our initial therapeutic programs : 5 of them taking liquid formula (LF group) at least 2 weeks after hospitalization, and the other 5 taking regular meals (RM group) . The results were as follows : ( 1 ) Nutritional intake of 1500 kcal/day was achieved at the 2 nd week for the LF group, and at the 8 th week for the RM group. ( 2 ) Body weight increased up to +6.6% at the 4 th week for the LF group as compared with the weight at the 1 st week, while the RM group showed - 2 . 1% at the same week. ( 3 ) The LF group showed 0.66 times of defecation per day on the average at the 3 rd week, but the RM group could not reach by the 12 th week. ( 4 ) The liquid formula did not develop the phobia of becoming fatter, while the 3 patients of the RM group showed the vicious cycle of gastrointestinal discomforts-food phobia-refusal to eat, after exacerbation of the gastrointestinal symptoms at the initial stage of treatment. Thus, the liquid formula could improve the gastrointestinal symptoms, resulting in disruption of the vicious cycle, and the LF group motivated themselves to obtain the steady increase in body weight.

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In order to examine the psychophysiological effect of first-time Autogenic training (AT) , thirty-seven healthy subjects (Males 32,Females 5) who had never experienced AT practiced it with a taperecorder. The effect of this training was evaluated from the standpoint of objective skin temperature by using a thermography, subjective anxiety (STAI) and several other parameters including relaxed, heavy, warm sensations. The results are summarized as follows. 1 . As a result of AT, skin temperature of the hands increased more than 1℃, which was significant, and both state and trait anxieties decreased significantly. There was no correlation between skin temperature and state/trait anxiety before AT. 2 . According to the self-rating questionnaire, although 22 subjects felt tense before AT, 20 subjects relaxed themselves after practicing it. A warm sensation (30 subjects) was likely to be felt more compared to a heavy sensation (27 subjects) . Passive concentration (20 subjects) was also likely to be noticed more compared to an active one (8 subjects) or unknown (9 subjects) . 3 . Those who felt a heavy sensation had a lower rate of increase of skin temperature than those without during AT. 4 . There was a correlation between the decrement of state anxiety and relaxation before AT. Those who perceived a heavy or warm sensation had a higher increment of skin temperature than non perceived subjects during AT.

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Operant conditioning therapy (OCT) is thought to be an effective therapeutic method for inpatients with eating disorder (ED) including Anorexia nervosa (AN) and Bulimia nervosa (BN). However, some cases responded unsuccessfully to this procedure, which is suspected to be caused by the age factor. The purpose of this study is to evaluate usability of OCT for cases with ED on the basis of the following items ; 1) Onset age, 2) Age at admission, 3) Duration of disorder, 4) Body mass index, 5) Type of eating behavior (AN or BN) . Thirty subjects were treated by OCT, including 15 cases with AN and the same number of patients with BN. At the sixth months after discharging from hospital, efficacy of OCT on their prognosis were examined from behavioral, physical and social adjustment viewpoints. The total subjects were classified into 3 groups (Effective, None & Aggravated) according to the effects of OCT in order to compare the above-mentioned 5 items each other. A significant high correlation was found between the onset age and the efficacy of OCT. This therapy is considered to be effective for cases with ED in adolescence, although poor response was observed in other age groups of patients.

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Tokyo University Egogram (TEG) published in 1984 was a questionnaire based on Transactional Analysis with reliability and validity. It was constituted by 5 scales : CP (Critical Parent) , NP (Nuturing Parent). A (Adult), FC (Free Child), and AC (Adapted Child) . The second edition of TEG was published in 1993. The criterion validity of TEG 2.0 was confirmed by means of examining correlations with other psychological tests. In the present study, we attempted to investigate the clinical application of it. As the first step of investigation, we studied the psychological characteristics of controls and patients shown in TEG 2.0. 1 . The comparison between controls and patients with profile patterns judged by the definite criterion : 1) The patterns which were shown frequently in each group. 2) Percentage of adaptive or maladaptive patterns in each group. 2 . Multivariate analysis to deal with 5 scales : Profiles outlined by 5 scores of TEG are thought as total ego state. Thus, we applied multivariate analysis to deal with 5 scales simultaneously. Stepwise discriminant analysis with controls or patients as the class was conducted on CP, NP, A, FC, and AC as the independent variables. Then canonical discriminant analysis with two groups as the class was performed on selected scales by stepwise discriminant analysis out of 5 as the independent variables. The results of the procedure were summarized as follows. 1 . 1) Frequent patterns in each group by sex in the order of percentage : A dominant, N, and reverse N patterns were found in males of controls. N, fiat, and reverse N patterns were found in females of controls. Reverse N, low FC, and AC dominant patterns were found in males of patients. Low FC, N, and AC dominant patterns were found in females of patients. There are significant differences of percentages of TEG patterns between controls and patients of each sex. 2) Controls had a higher percentage of adaptive patterns than patients. Patients had a higher percentage of maladaptive patterns than controls. 2 . In male, the results showed that FC and CP had a significant canonical coefficient. It is suggested that one with lower score on FC and higher score on CP was significantly discriminated as patients. In female, the results showed that FC, CP, AC, and A had a significant canonical coefficient. It is suggested that one with lower score on FC and higher score on CP, AC, and A was significantly discriminated as patients. Consequently, clinical availability of the second edition of TEG was confirmed by these results of this study.

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The patient was a 24-year old male office worker. He used to late hours. When he was 23 years old, he tended to have hypersomnia and his wake up time was delayed, so he was often late for and absent from work. In July 1992,he consulted our hospital and was admitted. He was diagnosed as having delayed sleep phase syndrome (DSPS) by sleep log, polysomnography test, multiple sleep latency test (MSLT) and measurement of rectal temperature. After admission, we made his schedule free for 10 days to observe his sleep-wake schedule. Then he adapted his schedule to the time table of our hospital in order to fix sleep-wake pattern, while we treated him with VB12 for a week. Furthermore, he received timed exposure of the bright light for a week. After these treatments, we carried out polysomnography test, MSLT and measurement of rectal temperature again, his wake up time and bedtime were fixed at 7 a. m. and 10 p. m. respectively and sleep phase was advanced. After discharge, he stayed at dormitory to stable his sleep-wake schedule. He successfully maintained his regular schedule, although during the weekends, his sleep-wake schedule tended to delay temporarily. We considered that a change of life style induced by overtime work, single life and so on made it difiicult to synchronize circadian rhythm and consequently he developed DSPS.

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A 14-year-old boy visited our clinic in August, 1994 because of a persistent severe tic which had begun 4 years earlier. He had been administered Haloperidol with no effect. No abnormality was found on preceding EEG and brain CT. On psychological evaluation, his strict father always preached him not to make a compromise with everything. Therefore he came to have an alexithymic, overadaptive personality and showed several superior academic achievements. However, he had an inferiority complex regarding physical exercise which he denied. It seemed that his symptom was related to these psychological factors. After psychosomatic therapy including family counseling, the patient showed rapid improvement. His parents understood patient's psychological stress, his mind-body relationship and accepted him with supportive attitudes. Then the patient began to assert himself to his parents and learned to achieve self-control. In conclusion, it is important to practice a psychosomatic approach for parents as well as patients when we treat children with psychosomatic diseases.

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A 24-year-old single female with Crohn's disease (CD) preceded by alopecia universalis due to psychological stress was presented. It is well known that CD may associate with various cutaneous symptoms, but CD associated with alopecia universalis has rarely been reported. And according to those prior reports, alopecia universalis was considered as a secondary symptom of malabsorption or wasting due to CD. In our case, however, the onset of hair loss preceded CD by 2 years and the patient had no evidence of malabsorption or anemia. Therefore it is difficult to explain this alopecia as a result of some nutritional deficiency like other reported cases. The pathogenesis of both CD and alopecia universalis still remains unclear. On the other hand, it is suggested that not only immuno-mechanisms but also psychological factors were involved in both diseases. In our case, psychological factors seem to play an important role at the onset of each disease, and supportive psychotherapy combined with general somatic approach was thought to be effective. So our case may be considered interesting and useful to discuss the pathogenesis of CD in view of psychoneuroimmunology.

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