Seventy-two inpatients with anorexia who received behavior modification treatment for the body weight gain were followed up for 6 months after discharge. Forty-three patients of the restrictor type and 29 of the bulimic type were mainly compaired regarding weight change and the social adjustment level. There were no significant difference between the two groups with regard to age at onset, age at admission, duration of illness, body weight at admission, the social adjustment level at admission, target body weight for discharge, body weight change in hospital, and the achievement level of treatment program. When the two groups were compared at 6 months after discharge, for body weight, body weight change and for the level of social adjustment, the restrictor type was significantly better than the bulimic type. The multiple regression analysis with the weight change in 6 months after discharge as a dependent variable showed that the type of disease (restrictor type or bulimic type) was contributed most to the body weight change. These results suggested that the behavior modification treatment aiming at weight gain was more suitable for the restrictor type. Furthermore, in addition to the conventional body weight gain program, the behavior modification treatment for the bulimic type might need some other devices, such as a target program for eating behavior.

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We examinated the function of the autonomic nervous system in patients who show physical symptoms for psychosomatic disorders or neurosis. We used skin potential response (SPR) for the test of the sympathetic nervous system, and coefficient of variation of R-R intervals (CVRR) for the test of the parasympathetic nervous system. Results were expressed on a graph, where the X-axis is CVRR, and the Y-axis is SPR. Results show that patients with numerous and severe symptoms are in the upper right quadrant (where both SPR and CVRR are high) . Patients with abdominal pain, diarrhea and abdominal distension are in the lower right quadrant (where SPR is low and CVRR is high) . This method reveals a clear relationship between physical symptoms and the autonomic nervous system, explaining the number of patients with psychosomatic disorders or neurosis who complain of physical problems. The test facilitates treatment, making it possible to focus on physical symptoms with patients. Pediatricians even at out-patient clinics can effectively use this method when treating patients with psychosomatic disorders or neurosis.

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Factitious diarrhea is most frequently found in patients with a factitious disorder who strongly complain of somatic symptoms. In general, both the diagnosis and treatment of such symptoms are very difficult. To date there have been few reports on the successful treatment of such disorders. We herein report five cases of patients with factitious diarrhea. We were able to indentify their problems as being in psychological crisis of some kind. We then tried to treat them by psychotherapy as well as by physical care and obtained favorable treatment results. Most of these patients were eventually able to return to their normal lives or jobs. The most important factor in this successful treatment was the view point of 'social role.'

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A psychophysiological change during the menstrual cycles was investigated using the menstrual distress questionnaire, power spectral analysis of electroencephalography, dichotic listening test and tapping test. The complaints were the least frequent in the intermenstrual phase and the most frequent in the menstrual phase. On power spectral analyses of electroencephalography the relative alpha 3 power was significantly higher in F 3,P 3,P 4,O 1 and O 2 at the premenstrual phase compared with that at the menstrual stage. The relative theta 2 wave in T 3 was significantly higher at the menstrual phase compared with that at the intermenstrual phase. The relative theta 2 wave in O 2 was significantly higher at the premenstrual phase compared with that at the intermenstrual phase. However, there was no change during the menstrual cycle in dichotic listening test and tapping test.

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[in Japanese]

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In order to support a smooth reinstatement in the workplace, the factors influencing reinstatement wereinvestigated in 51 cases with "return to work" diffculties in 12 hospitals which have a psychosomatic careunit.The disorders considered as main triggers of absenteeism in these cases were depression or depressivestate(22), anxiety neurosis(6), vegetative syndrome(5), bronchial asthma(4), hyperventilation syndrome(3), eating disorder(3), spasmodic torticollis(3)and other psychosomatic diseases(5).Out of 51 cases, 39 cases had problems at the workplace, and 21 cases of them showed interpersonalconflict in the group, and 32 of the 51 cases had difficulty in adjusting to the change of situation or role ofwork during 6 months before their absenteeism.The main problems related to the difficulty of reinstatement were 1)their own problems, such as illnessor personality aberration which were observed in 21 cases, 2)problems at the workplace such as, lack ofcooperation, over demand of work, or interpersonal conflict in the group, which were observed in 11 cases, 3)their own problems, problems at the workplace, and family problems such as lack of support in 5 cases, 4)their own problems, and family problems in 2 cases, 5)and others in 2 cases.Twenty-six cases succeeded in returning to work and showed good adaptation after reinstatement.Thereasons why they could return to work were 1)effective treatment, including pharmacotherapy and psychotherapy, and the cooperation of staff members at the workplace, which were observed in 10 cases, 2)effectivetreatment in 5 cases, 3)effective treatment, their determination to return to work, and the cooperation ofstaff members at the workplace and family members in 5 cases, 4)effective treatment, their determinationto return to work and the cooperation of staff members at the workplace in 4 cases, 5)others in 2 cases.These results suggested that effective treatment, determination to return to work, and cooperation of thestaff members and health care staffs at the workplace would be important factors to succeed in good reinstatement.

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A case of posttraumatic stress disorder (PTSD) , the onset of which was the complication of childbirth, was reported in this paper. The patient was a 31 year old housewife. She was suffering from the threatened abortion and threatened premature delivery when she was pregnant of her 2nd child. She was admitted to the obstetric department of another hospital for bed rest and IV infusion of ritodrine. She suffered from the complications of pulmonary edema during her late pregnancy and laryngospasm during Cesarian section. The episode of laryngospasm was a grave shock to her, making her feel death is imminent. After this incident, she began to suffer from reexperience symptoms, that is recurrent and intrusive distressing recollections of the event (flashback). She brought up the memory of the event very much vividly, as if she were experiencing the event just at that very moment. She also was much afraid of contracting disease, which would necessitate her to have surgery, and became hypochondriac. This hypochondriac tendency was actually prompted by the words of her obstetric doctor, who bluntly said to her "We cannot operate on you anymore. It'll be too risky." In addition to this, her doctors did not explain to her about the pulmonary edema. She was informed about it by a nurse later on. These events gave rise to her feeling of distrust toward medical profession. In addition to the physical complications, she also suffered the psychological trauma caused by her docotor's inappropriate remarks. It can be said that the iatrogenic PTSD was further inflicted on her in addition to the original PTSD. Three months after the childbirth, she was still suffering from the PTSD symptoms, including reexperience symptoms, generalized anxiety and agitation, burst of rage, hypochondriasis, anhedonia, distrust of medical profession, nightmare and insomnia. She presented herself to the psychiatric department of our hospital. The treatment of this case was done by the psychotherapy and pharmacotherapy (amoxapine and clonazepam) . The psychotherapy was a supportive-expressive one. The therapist tried to listen to her anxiety and traumatic experience empathically, explained to her about PTSD educationally, and gave reassurance to her physical intactness. Two weeks after beginning of the treatment, her anxiety was cosiderably alleviated and she could resume her usual housework. After one and half years, she resumed her normal life without taking any medications, and we agreed to end the treatment. This was the case of PTSD which had its onset on the very spot of practice of medicine, and its prominent feature was her hypochonriasis and distrust in medical profession. It is sometimes inevitable for patients to face their own death on the spot of practice of medicine. But, the response of the medical staff toward these patients may further infiict the unnecessary psychological trauma. Unfortunately, this was the case here, and it can be said that the iatrogenic PTSD was further inflicted. It is a matter of course, but none the less, the author strongly recommends here that in case of patients who have faced their own death, we the profession of medicine should listen to their anxiety and traumatic experiences empathically, and give the appropriate explanation fully understandable to them.

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