The adverse effects of interferon (IFN) treatment have become matetrs of concern because of the widespread use of this agent. We evaluated the mental state of patients with chronic hepatitis C undergoing IFN-alpha (IFNα) therapy using psychological tests before and 2 weeks after the initiation of the therapy, and assessed whether the development of psychiatric morbidity following the initial 2-week introduction of IFNα is predictable. This study revealed that the patients evaluated≧40 by Self-rating Depression Scale (SDS) or mental factors≧10 by M-R of Cornell Medical Index (CMI) before IFN therapy were more likely to develop mental symptoms than those evaluated<40 by SDS or<10 by M-R of CMI in the treatment period. Especially, the patients marking higher scores after the initiation of IFN therapy were considered to be highly susceptible to psychiatric disturbances. The psychological tests (2 times) are considered to be helpful for the prediction and early detection of depressive and neurotic mental status.

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The purpose of this study was to investigate psychological and psychophysiological responses under an effortful coping condition and an distress coping condition. Efforful coping condition was defined as a condition in which a subject reported high commitment to the task and engaged in active coping. Distress coping condition was defined as a condition in which a subject reported uncontrollability and engaged in passive coping. Subjects were 22 male undergraduate students and were divided into 2 groups : control group and experimental group. All of them underwent both effortful coping condition and distress coping condition.In effortful coping condition, Ss were engaged in 2 mental arithmetic task sessions (low effort tast and high effort task). In the first session, Ss in both groups were requested to perform the low effort tasks under the same condition. In the second session, Ss in the experimental group were engaged in the high effort task session with rewards, and Ss in the control group were engaged in the low effort task session without rewards.In distress coping condition, Ss were engaged in 2 movie sessions(relaxation movie and aversive movie). In the first session, Ss in both groups were requested to watch the relaxation movie under the same condition. In the second session, Ss in the experimental group watched the aversive movie (eye surgery), and Ss in the control group watched the relaxation movie.Heart rate, systolic blood pressure, diastolic blood pressure, skin conductance level and skin temperature were recorded, and effort-distress scores, and psychological responses were measured.Heart rate, blood pressure, and skin temperature were significantly aroused in effortful coping condition and Depression-Anxiety score and skin conductance level were significantly aroused in distress coping condition. The results of ANOVAs revealed that a significant interaction among group, condition, and session was found in systolic blood pressure, diastolic blood pressure, and skin conductance level. These suggest that cardiovascular responses are associated with effort coping, and Depression-Anxiety and skin conductance level are associated with distress coping. Furthermore, the results of regression analyses revealed that the changes of diastolic blood pressure corresponded to the changes of effort score, and that the changes of skin conductance level corresponded to the changes of distress score.Finally, the specific relationship between effort-distress status in stress coping process and psychological-psychopsysiological responses were discussed.

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The 21-item Self Assessment Questionnaire for the post-traumatic stress disorder (PTSD) was given to 681 victims of Hanshin-Awaji earthquake, and the answers were analyzed statistically. The questionnaire was made to check ; trauma experience (2 questions), recall of trauma (4 questions), avoidance behavior (6 questions), excessive alertness (5 questions), and maladaptation (4 questions). The diagnosis of PTSD was made when the respondent answered positively for more than 1/4 for recall of trauma, 3/6 for avoidance behavior and 2/5 for excessive alertness.Among 681 victims, 49 (7.2%) were judged to have PTSD, and no sexual difference was observed. The ratio of occurrence of PTSD in both these over 60 year-old and in the period between 91-181 days after the earthquake increased significantly. High correlation was obtained between avoidance behavior and the occurrence of PTSD after single and multiple regression analysis. Because of a high coefficient of determination (r^2=0.589) after multiple regression analysis, this questionnaire seemed useful for PTSD screening. In addition, the odds ratio for PTSD was higher among victims who had experienced avoidance behavior. These results indicated that avoidance behavior may paly a central role in PTSD, and that focus on avoidance behavior is important for the treatment of PTSD. Comparison of the results of the present analysis with prior reports were done, and the reasons for inconsistent findings were considered.

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Many studies have surveyed perimenopausal women, but few have investigated sexuality and urogenital symptoms in Japanese postmenopausal women. To study the current situation and to select the proper treatment, we investigated vaginal symptoms by interview, questionnaire, and hormonal cytology, and analyzed factors influencing vaginal symptoms and the effects of hormone replacement therapy (HRT).Vaginal symptoms were studied in 237 women at our menopausal outpatient clinic who were menopausal or had undergone bilateral ovariectomy (age, 52.5±7.4 years (mean±SD) ; period after menopause or ovariectomy, 5.0±5.4 years). The symptoms were evaluated with the Keio modified Kupperman index. This index classifies vaginal symptoms as brownish discharge, vaginal dryness, vaginal itching, and dyspareunia. A total of 28 women receiving HRT and 86 receiving no treatment were compared on the basis of hormonal cytological findings, such as maturation index (MI) and the presence of white blood cells (WBC) and debris on vaginal smears.A total of 28.9% of the patients claimed having at least one vaginal symptom. The most frequent complaint was vaginal dryness, followed by dyspareunia, brownish discharge, and vaginal itching. From the standpoint of intensity, dyspareunia was the most serious complaint. There were no relationships between symptoms and age, period after menopause or ovariectomy. The findings of hormonal cytological studies were also unrelated to symptoms. These results suggest that factors other than hormonal condition affect vaginal symptoms.After 6 months of HRT, the incidence and intensity of vaginal symptoms decreased. The findings of hormonal cytological studies improved : MI shifted to the right, and the presence of WBC and debris had clearly decreased. The complaints of vaginal symptoms, however, worsened during the course of HRT.Changes in hormonal condition showed an apparent effect as expected, but other factors seemed to modify the effect of HRT.To identify other factors affecting vaginal symptoms, psychosomatic investigations, consisting of CMI, Y-G test, and SCT, were performed in 7 patients who did not respond to HRT. A neurotic tendency seemed to be an important factor, because 6 of 7 patients were III type on CMI. The results of SCT indicated the presence of psychic and social problems, such as anxiety, depression, and disorders of social adaptation.These results suggest that vaginal symptoms in postmenopausal women are influenced not only by aging and hormonal conditions, but also by other factors, such as psychic and social factors ; these factors also may modify the response to HRT. Psychic and social factors therefore warrant careful consideration when treating vaginal symptoms.

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We have experienced a case of trichotillomania which seems to have been greatly associated with pica caused by iron dificiency anemia. In the course of our diagnosis, the child patient had repeatedly pulled out his hair and put them in the mouth. Although the mother had the patient's hair cut short so that he might no longer pull out his hair, the child went so far as to cut the pet dog's hair and put in the mouth, which made us think on the possibility of iron deficiency anemia. As the existence of anemia had been recognized in the subsequent blood test, we began to administer iron to the patient. As a result, his trichotillomania and pica had remarkably improved.Generally, patients with a trichotillomania are said to feel sensuality in such a behavior of removing hair itself. However, in the present case, the paitnet seems to have felt sensuality in the act of putting the removed hair into the mouth rather than removing them. In this sense, the present case may be categorized as a rather rare case for the trichotillomania.

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In large hospitals, gastorintestinal psychosomatic patients are usually treated in general medical wards. We herein describe a case where a patient with psychogenic vomiting was treated in a general medical ward in accordance with the 5 following principles : 1) We meticulously examined the patient. 2) Psychosomatic psysicians pretended to be gastrointestinal physicians. 3) The chief physicians performed the main examinations (endoscopy, barium enema, etc.). 4) We informed the patient and his family about the functional disease in detail. 5) We did not initially treat the psychological problems. We explained to the patient and his family that symptoms of patients without organic disease are not necessarily psychogenic.The patient was an 18-year-old male who visited our hospital because of nausea, vomiting and general fatigue. His father seemed to suspect that the symptoms were psychogenic. However, we were careful to treat the patient as a regular medical case. Treating this case intentionally as non-psychogenic resulted in the patient's speedy recovery.

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