We had reported the results of reliability analysis of the Stress Tolerance Check List (STCL) in healthy people in the 1st report. In this study, the answers of 215 patients of our psychosomatic clinic (Anxiety disorder ; 24,Depressive disorder : 151,Autonomic imbalance : 28,other diseases : 12) were analysed in the same way. The average point of STCL was 53.6±9.2 which was lower than the healthy people (61.2±7.4) of the 1st report (p<0.01). The Cronbach's alpha of STCL was O.8446,which is considered to be in good internal consistency. By the factor analysis, there were 5 factors in STCL, including 'cheerfulness and positive thinking', 'liberality and consideration in social relationship', 'self-unreliability', 'self-centerdness' and 'strain'. By discriminant analysis of the STCL, the healthy group and the patient group were separated significantly. The discriminant ratio was 77. 8%. We considered stress tolerance is the ability of harmonious and proper recognition, evaluation and coping with the stressor and it's demand. STCL is considered to be useful to surmize the stress tolerance to a certine degree. To estimate stress tolerance more exactly we are going to investigate more suitable questions, reconsider the subjects and examine the relation between STCL and stressor or stress reaction.

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In the treatment of psychosomatic disorders, even when treatment is based on the same theory, it is a well-known fact that the relationship between patient and doctor has a great effect on recovery. Therefore, in the treatment of psychosomatic disorders, an investigation was made on eating disorder to better understand the effectiveness of the pediatrician, who is good at physical treatment, in responding to patients based on the relationship between patient and doctor. The subjects were 25 outpatients who were treated at our hospital between June 1994 and December 1996. Outpatients treatment focused on physical examination and physical phenomena. A psychological principle was maintained by which the presentation of the problem was awaited from child patients with reference to Kurokawa's "outpatient treatment in view of a strong feeling against hospitalization". As a result, there were many cases in which satisfactory recovery was seen without fully obtaining the psychological insight. Conversely, there were cases in which psychological problems appeared to be the main problems after physical stability was achieved, which complicated the response to patients. In those cases, by sympathetically examining the physical conditions, which the patients felt closest to themselves, a rapport was maintained so that child patients could discuss problems of the mind from their perspective. There were cases in which children used their self-recovering power to overcome problems of the mind without being noticed by the doctor. In cases where the onset of the disorder was caused by school or studies, the main reason for recovery was due to a strong psychogenic reaction factor. Through strong family support to the child patients, coupled with the full assurance for physical support, their self-recovering power must have been enhanced. Conversely, when the cause was family related, family support to child patients was generally weak, which prevented full recovery through physical support. For outpatients suffering from minor psychosomatic symptoms, the cause was mainly related to school. By properly explaining to parents the fundamental correlation between mind and body (as well as child development) using a sympathetic analysis of both body and mind, no special psychological treatment may be necessary to respond to wide range of patients, as was seen in this report. For the pediatrician who requested another doctor to conduct psychological treatment, this method seems useful. Therefore, the repletion of psychosomatic education in madical faculties is greatly anticipated.

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The aim of this paper is to report one case of dizziness caused by antiphospholipid syndrome (APS) misdiagnosed as conversion disorder. The patient was a 41-year-old woman. She began to complain of dizziness during her work at the age of 38,when she became busy with her task. She visited the out patient clinic of otolaryngology, but her otoneurological study and MRI of the brain were found to be normal. Her dizziness was not improving. She felt depressive reactively by the symptom. Visiting the out patient clinic of psychiatry, she was diagnosed as "conversion disorder" caused by psychological stress due to her business. Although she took some medicine prescribed by the clinic, her dizziness was not improving. Her neurological examination at our clinic showed left central facial nerve palsy and left central hypoglossal nerve palsy. T_2 weighted MRI of the brain showed bi-parietal multiple spotty high intensity lesion and small rounded high intensity lesion in the right posterior limb of internal capsula-globus pallidus. Left facial nerve palsy and hypoglossal nerve palsy were also considered to be originated from ischemia of right posterior limb of internal capsula. MR angiography showed irregular wall of left internal cervical artery. Blood test showed prolonged APTT and positive anti-Caldiolipine-β_2 GPI antibody. Psychological assessment by Zung's self-rating depression scale (SDS) showed her depression was mild, which meant that "conversion disorder" was denied. We diagnosed her as primary APS, and considered that her dizziness was caused by ischemia of ventral posterior lateral nucleus and ventral posterior inferior nucleus which was central vestibular tract in right thalamus. This ischemia was one of the APS's symptoms.

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Since many of the causes of atopic dermatitis can be found in daily life, self-care and patient education play a very important role in the management of the disease. Due to time limitations and other factors, holistic care requires the participation of medical staff with dermatologists. In our clinic, holistic medical care of patients with atopic dermatitis has been practiced by adopting a team care system and self-care education of patients. Regarding patient education, the following approaches have been employed in our clinic : 1. Outpatient in-clinic consultation with dermatologists and other medical staff. 2. Telephone consultations. 3. Posting medical information in the clinic (figures and tables presented at medical meetings, clippings from newspapers, journals, books, etc.). 4. Distribution of leaflets for patient education. 5. In-house newsletters carrying patients' experiences, medical information and answers to queries placed in the Question Box (in the Clinic). 6. Arranging patient get-togethers. 7. Arranging trips to the sea, or hot-spring bathing. 8. Installing a Question Box into which patients can place queries for doctors. 9. Counseling by nurses. Patient self-care education and team care are closely related, to help ensure successful holistic care for patients with atopic dermatitis.

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