The aim of the present study was to clarify the mechanism of white coat phenomenon by comparing autonomic nervous functions and psycho-behavioral factors associated with the difference between clinic blood pressure (BP) and day-time mean ambulatory BP and those associated with the mental stress-induced BP elevation.We evaluated 86 untreated patients with mild to moderate essential hypertension who had clinic BP>140 mmHg systolic and/or>90 mmHg diastolic on at least 3 visits. Thirty-three males and 53 females were contained, and their ages ranged from 20 to 75 years. Clinic and 24-hour ambulatory BPs were monitored without medication, and the white coat effect was defined as the difference between clinic BP and day-time (6 : 00-21 : 00) mean ambulatory BP. After sufficient supine rest, BP and RR interval were recorded beat-to-beat at consecutive sessions of 10 minutes of supine rest, 6 minutes of mental stress by backward counting, and 7 minutes of orthostatic stress. Spectral analyses of the BP and RR interval variability were performed for assessing the sympathetic vasomotor tone (SVT) and the baroreflex sensitivity. In addition, various psycho-behavioral factors were assessed by self-administered questionnaires and a semi-structured interview. Then, stepwise multiple regression analyses were performed for systolic and diastolic white coat effects and systolic and diastolic mental stress-induced BP elevations, the independent variables of which were above-mentioned indices of autonomic nervous functions and psycho-behavioral factors.While SVT during mental stress was positively associated with stress-induced BP elevation, SVT during supine rest was negatively associated with white coat effect. While 'Neuroticism', 'Anger' and 'Distorted life style' were positively associated with, and 'Type A behavior pattern' was negatively associated with stress-induced BP evaluation, 'Depression' was positively associated with, and 'Maladaptation' and 'Anger' were negatively associated with white coat effect. Furthermore, there were no significant correlations between white coat effects and mental stress-induced BP elevations.In conclusion, white coat phenomenon was regarded as a quite different condition from mental stress-induced BP elevation based on teh relevant autonomi functions and psycho-behavioral factors.

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"Quality of life(QOL)" of terminal cancer patients are closely related with the way they recognize and cope with the situations where they are confronted with death. This study examined cognitive process of terminal cancer patients through analysis of verbal behaviors obtained by interview on a single case. Five interviews were carried out once a week for 1 month, until 8 days before the patient have passed away. Interview transcripts were segmented by themantic units (TU) and judges scored each units for 13 topic categories and Elaboration-Dyselaboration measures, which assessed emotional and defensive discourse. Duration of TU were timed by seconds. The results were obtained from these procedures. First, TU duration changed significantly (p<0.001) with physical condition of the patient. This indicates that the way of expression of the subject has changed from the one with rich modifiers to the direct one. It implies that physical situation has great affects on verbal behavior of the subject. Second, personal maning structure (person schemas) was estimated through Elaboration-Dyselaboration relationships of each category, that it consists of 2 selves ; the positive expected self which could control any situation, and actual self which had disability in bad physical condition.These results indicate that the change of physical condition have great effect upon relation between expected self from past experiences and perceived actual self that have less control over the situations. That is, congnition of physical condition plays an important role in cognitive process of terminal cancer patients. These discussion suggests, from the cognitive view, that symptom control is important. In addition to the symptom controls, psychological support such as structured intervention and enduring psychological supports in daily care is needed for patients' QOL.

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It is well known that the Okinawa people have the longest average life span in all of Japan. In this study, the authors attempt to elucidate characteristics of Okinawan normal adults and long-lived people in terms of the Type A behavior pattern in their prime of life. The survey was done for the subjects of healthy 94 Okinawan centenarians at home and 98 middle-aged and aged controls in the same areas of Okinawa, using a brief questionnaire developed by Maeda. Althogh, in comparison of freqeuency of Type A, statistically no significant difference was found between cotenarians and controls, distributions of means scores for each question-item demonstarted that profiles of the centenarians' Type A behavior pattern were different from those of control ; Those items of Time urgency and Tension which showed low means scores in centenaroans. whereas they showed high mean-scores in Self-confidece and Unyieldingness. Furthermore, by multi-factoral analysis 4 factors, i.e. Aggression, Hard driving, Tension, and Time urgency were extracted and their contribution rate was 61.3% as a whole. All of them had singnificant with each other except Aggression. Long-lived people may be judged as Type A outwardly, but when considering their detailed profils of behavior pattern they are different from the control group and in these profile differences, it might be possible to find psychological and/or psychosomatic factors for their longevity

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Fujino et al have developed a new therapeutic theory for obesity, the Brain Oriented Obesity Control System or "BOOCS". They have reported that the majority of obese persons using this method have succeeded in reducing body weight with few rebound cases. This theory considers obesity to be caused by "brain fatigue", progressive brain dysfunction under the stress of every day life, and emphasizes that management should be focused more on how to reduce "brain fatigue" rather than adherence to demanding diet/exercise regimens. To reduce "brain fatigue", "tow principles and three rules" as follows are given as instructions to obese persons. "Two principles" : (1) Make as few prohibition as possible and deny your wants as little as possible. (2) Do something pleasant for yourself. "Three rules" : (1) Do not prohibit what you like, even if it is bad for your health. (2) Do not practice what you dislike, even if it is good for your health. (3) Do only what you like among things and matters good for your health. Assuming that the binge eating of eating disordered patients might also be caused by "brain fatigue", we have applied BOOCS to the management of these patients.We developed a self-care manual for eating disorder (ED) patients with binge eating incorporating the BOOCS principles, which includes 4 instructions : (1) Learn to feed contentment from your main meals. (2) Do not attempt to force yourself to quit binge eating immediately. (3) You will not become obese if you feel content and comfortable with your main meals. (4) Try reducing the frequency of weighing yourself. We enrolled 6 new ED outpatients with binge eating (2 anorexia nervosa, and 4 bulimia nervosa, according to DSM-IV) who met the following criteria : (1) those not so physically critical that they needed to be hospitalized, (2) those who had not been treated medically before. We gave a manual to each patient on her first visit, and then using it gave her individual-therapeutic sessions weekly or bi-weekly. As a result, 5 out of 6 patients showed a reduction of binge frequency within 1 week of the first visit, and all 6 patients had remission of binging within 5 to 17 weeks without any medication or hospitalization. Although all the ptients had problems of interpersonal relationship besides their eating problems, 3 solved them by them-selves as they were released by BOOCS from the battle against binging. Moreover, the other 3 patients who required psychotherapy to treat interpersonal problems reported that the "two principles" from BOOCS had been applicable to solving such problems beyond their eating problems.In this report, we briefly present the histories and clinical courses of 4 patients, and discuss the possible mechanism(s) of the success of BOOCS. In conclusion, we suggest that BOOCS is applicable to be management of eating disordered patients with binge eating.

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The purpose of this study is to present the daily emotional states of patients suffering from subacute myelo-optico-neuropathy (SMON), and to investigate both the background factors and the coping styles for stresful situations in SMON patients with emotional problems.We therefore administered a survey to 107 SMONpatients living in Chugoku and Shikoku areas by means of 2 questionnaires, that is, Profile ofMood States (POMS) and Stress Coping Scale (SCS). POMS consists of 65 items and evaluates the states of mood or emotion by classifing 6 scales. SCS measures the stress coping behavior and contains 33 questions, which were divided into 5 scales.As a result of the survey, the number of available subjects was 102 (male 31,female 71). The mean±SD age of them was 68.7±9.1 (ranged from 51 to 88). And the mean±SD age at onset of SMON was 40.0±9.2.The results of POMS scores showed that the emotional states of SMON patients were more tense, anxious, depressive, vigorless, fatigued and confused. And then, they also hd markedly angry and hostile emotions. Those who were in emotional crisis were defined to score above the cut-off point at each scale of POMS. The ratio of SMON patients in emotional crisis extended to 40.2% of 102 patients. Especially, the number of elderly-aged(from 60 to 69)patients was comparatively large. However, there were no significant relations between the presence of emotional crisis and their sex, severity, complication, and status of family.The findings from SCS scores indicate that the stress coping behavior of SMON ptients had a less tendency to behave actively or passively for a diversion. Furthermore, the features of the coping styles in patients in emotional crisis were significantly recognized to rather suppress their emotional expressions and their actions derived from stress.These results suggest that SMON patients may be emotionally more unstable and stressful than we can expect. In order to support them mentally, it will be increasingly essential to help them disclose their individual emotional problems by psychological interview.

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An outbreak of Escherichia coli O157 : H7 infections associated with unpasteurized school lunch caused illness in more than 6,000 school children in July 1996 in Sakai, Japan. In addition, more than 100 children developed secondary hemolytic uremic syndrome (HUS). Seven patients with HUS were referred and admitted to our hospital for intensive care. In this paper we present the treatment for HUS in these patients and the management for preventing nosocomital infection in the pediatric ward. Moreover, we evaluated quality of life in 7 patients and their parents with an original questionnaire. The self-reported quality of life showed that (1) all parents had no right other than to agree with their children being transported to our hospital which is located far from their home, (2) all patients were treated together in the same isolated room of the pediatric ward, nevertheless this led to improvement of depressed mood in patients and their parents by encouraging each other. (3) Two out of 94 patients hospitalized by other illness complained of anxiety about nosocomital infection of Escherichia coli O157 : H7. We conclude that treatment of HUS caused by Escherichia coli O157 : H7 infection in the pediatric ward did not cause apparent psychological problems in the admitted patients and their guardians when the perfect prevention of secondary infection was provided.

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We investigated 6 cases with end-stage malignant tumor who had been undergone terminal care at their own home ("home terminal care"). Their diagnosis, clinical courses, family characteristics and feelings of the medical staff were reported. Family members who could not yet accept the diseases were very much involved and tired, and had difficulties to deal with patient's needs. A medical staff who had negative feelings toward the family could not provide appropriate care for the patients. It is concluded that "home terminal care" is a heavy burden for the care-taking family and the medical staff should support the whole members of the family.

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