A seven-dimensional model of personality permits the efficient differential diagnosis of all personality disorders and accounts for comorbidity with other psychopathology including psychosomatic illness. The presence or absence of any personality disorder is indicated by underdevelopment of the character traits of self-directedness, cooperativeness, and self-transcendence. Specific subtypes of personality disorder are indicated by the profile of temperament traits including novelty seeking, harrn avoidance, reward depen-dence, and persistence. All seven traits can be rated by either interview or self-report using a test called the Temperament and Character Inventory (TCD . Using the TCI, temperament types can be specified so that they are mutually exclusive so as to avoid multiple overlapping diagnoses. The temperament traits have been shown to be genetically homogeneous and independent with heritabilities of about 50% each. The configuration of character traits determines susceptibility to psychopathology including schizophrenia, mood and psychosomatic disorders. For example, the "type A" coronary-prone person is hostile (low cooperativeness) , conventional (low self-transcendence) , and assertive (high self-directedness) . The melancholic character is low in all three character dimensions, whereas creative characters are high in all three. Cyclothymics are high in self-transcendence and cooperativeness but low in self-directedness. Schizotypals are high in self-transcendence but low in the other two character dimensions. The TCI is based on a conceptual paradigm that integrates neurobiological, psychodynamic, sociocultural, and cognitive -behavioral approaches to normal and abnormal personality. It provides a clinical method of differential diagnosis of Axis I and Axis 2 psychopathology that is practical, reliable, and valid.

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Psyco-oncology has established in 1980 as a new study of enhancing quality of life for cancerous patients. It includes many studious field related to broad field such as somatic medicine, psychiatry, nursing sience, psychology, and sociology. The first research of psycho-oncology is to investigate thoroughly mental and psychic influence of a desease called cancer upon patients, family, and medical care paticipants, and how to cope with these. Also, it is how society grasp these, and how society should cope with these for cancerous patients and their family. The second research is to elucidate scientifically how mental and psychogenesis influence symptoms of cancer, progress of treatment, and disease. Nowadays, as a result of psycho-neuro-immunology's development, treatment of cancer is paid attention to mental and psychogenic influence.Psycho-oncology is a study of researching clinical field of cancerous patients and fatal diseased patients who are in all stages from their first medical examination until their death, and it includes medical science, the psyche, mentality, society, environment, and culture which surrond patients and their family. Also, it is to research psychic and social problems for all the people (patients, children, a spouse, friends, colleages, physicians, nurses, religionists, and volunteers) who are related to the patients and their family. Consequently, it is a all-round study of enhancing QOL for cancerous patients who are in all stages from their first medical examination until their death.

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The QOL of cancer patients in current cancer treatment in Japan is discussed from a psychosomatic point of view. In Japan, collected cancer therapy, which is mostly biological, is practiced for cancer patients. But the needs of cancer patients contain not only biological but also psychological, social, economical, existential and religeous needs. The medical treatment and care for cancer patients must meet all these needs and demands. Therefore, psychotherapy and psychosomatic treatment are indispensable for the QOL of cancer patients. In our paper, some of the discrepancies found in literature and practice are also discussed. A hollistic approach which we are practicing for cancer patients is introduced.

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Liaison Psychiatry in Cancer Care, that is Psychooncology is concerned with the psychological, social, and behavioral aspects of cancer. This academic area addresses the two major dimensions : (1) psychosocial impacts of cancer on the quality of life of the patient : (2) the role that psychological and behavioral variables may have in cancer risk and survival. The latter area is also considered as psychoneuroimmunology, addressing the impact of mood states on the immune and endocrine systems that may contribute to cancer risk. Psychiatric epidemiological studies revealed that 20-30% of the hospitalized patients with cancer was moderately or severely depressed. However, only approximately 2% are referred for psychiatric consultation. Depression is frequently underestimated and undertreated because the diagnosis of depression is frequently clouded by neurovegetative symptoms (e.g. fatigue, insomnia, Ioss of appetite, psychomotor retardation and diminished ability to concentrate) that may be secondary to either cancer or depression. It is important to diagnse depression in cancer patients appropriately, since depression is responsive to brief supportive psychotherapy and psychotropic medications. The need for a large variety of psychosocial interventions is enhanced as increasing numbers of patients with cancer have longer survival. The primary goals of the psychosocial interventions for cancer patients are designed to have beneficial effects on quality of life. The second goal is to have beneficial effects on cancer risk and survival presumably by enhancing effective coping toward cancer and reducing affective distress as well as improving life style and compliance with medical regimens. Group psychosocial intervention for persons with high risk (e.g. genetic high risk group, heavy smokers) as well as early and advanced cancer have been carried out.

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Supportive therapy is a therapeutic method designed to improve patients' QOL by properly bringing out their ability to solve problems and thus helping them to solve problems by themselves. In this paper, we present our actual method of supportive therapy in group therapy and private therapy for patients with cancer. This therapy involves (1) construction of a trusting relationship, (2) support in clarifying the problem issues and (3)support m solving problems. The support mentioned in item (3) includes "support by providing information" concerning alternative therapies for cancer etc "support through posrtrve out look", which allows patients to accept their problems by changing their psychological frame : and "support from existential viewpoint", which shows how to deal with the fear of death and recurrence. Finally, we also examine the degree of feeling that life is worth living among patients with cancer through PIL (Purpose in Life) test.

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There are still many unknowns yet to be elucidated concerning the relationship between stress, cancer and immunity. Never the less, there is mounting evidence that psycho-social factors can influence the numerous steps involved in oncogenesis. Though the nascent discipline of psycho-oncology originated with the aim of relieving patients, its present turn towards psycho-neuro-immunology promises that it will play an important role in the future of cancer prevention and cancer therapy.

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Objective and Method : Despite absence of some heart disease based on examination and normal coronary angiogram, these patients, we believe, have a panic disorder (PD) , claim symptoms, social and occupational disabilities. To clarify physiological characteristics of PD, we compared findings of 24 hour Holter Electrocardiograms, personality traits and 24 hour urinary catecholamine levels in PD (n=2D with those in non-PD depressive patients (n=20) . Incremental exercise test for anaerobic threshold (AT) and six minute constant work rate tests for time constant of VO2 kinetics were performed in 10 PD patients and 10 controls. We investigated whether endogeous lactate elevation would induce panic attack. In addition, we studied the effects on the exercise capacity and catecholamine metabolism in PD patients during exercise. Results : Twenty-four hour spectral analysis of heart rate in PD showed no significant suppression of chorinergic function. However, urinary excretions of both noradrenaline and dopamine were markdly elevated in PD indicating increased noradrenergic tone in PD. All the patients completed exercise testing up to AT with-out any panic attacks. Percent of maximum oxgen uptake and % AT were reduced and time constant of V02 kinetics was prolonged in PD, demonstrating excercise characteristics of poor effort and deconditioning. Marked elevation of plasma catecholamine was observed after exercise in PD, suggesting that excess catecholamine secretion may play a role in the pathogenesis of panic disorder and possibly may be relieved by β-adrenergic blockade. Conclusion : Exercise tesing on PD patients could serve to remove patients' fears for attacks by reassuring them of excellent prognosis and promoting activity of daily life. Exercise challenge for PD could concern as one of cognitive and behavioral therapeutic strategies.

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The case of a 26-year-old woman who had been suffering from lumbago since the age of 14 earlier is herein reported. She also demonstrated claudication because of lumbago. Numerous examinations revealed no abnormal findings except for a slight lumbar disc herniation, and conventional orthopedic therapy such as traction only worsened her symptoms, thus she was eventually' admitted to our department of psychosomatic medicine. The psychological interview revealed that she had felt stress from her over-interfering mother since her childhood and that she could only avoid the unpleasant feelings by means of her symptoms. It was thus suggested that some psychological mechanism existed as a conversion disorder for her symptoms. She also indicated that her mother, coworkers and the previous medical staff did not show sufficient understanding for her symptoms, and such feelings were also considered to be contributive factors for the continuation of her symptoms. We therefore showed acceptance and sympathy for her pain while taking a neutral attitude to her pain behavior. We also performed family therapy in order to help reduce the stress in the family environment. As a result of this psychological treatment, her pain behavior began to gradually decrease.

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