We studied the shifts of diagnostic subtypes and psychiatric comorbidity, during the clinical course (average period : 34.9 M) in 25 anorexia nervosa patients who had inpatient treatment at the age of 18 and under. 17 patients met the DSM-IV criteria for anorexia nervosa restricting subtype and 8 met binge-eating/ purging subtytn on their first admission. In 3 of 8 patients with binge-eating subtype on admission had a history of restricting subtype. Patients with restricting subtype had significantly lower weight on admission and 4 of 17 restricting subtype patients changed their eating behaviors and shifted to another subtype such as binge-eating purging type, bulimia nervosa, eating disorder not otherwise specified during their follow-up periods. 9 patients were diagnosed to have psychiatric comorbidity at the end of follow-up period. The diagnoses included conduct disorder, borderline personality disorder, schizoid personality disorder and dependent personality disorder. They showed lower rate of returning to school life than the patients without psychiatric comorbidity. 7 of 9 patients with psychiatric comorbidity readmitted due to the symptoms and behaviors relating to the psychopathology of comorbidity. Their clinical courses were largely influenced by the type of personality disorder. The patients with psychiatric comorbidity showed some of the symptoms relating to the comorbidity before being diagnosed as having psychiatric comorbidity. Therefore careful assessment of psychiatric comorbidity and its psychopathology is indispensable for a long-term adequet treatment of anorexia nervosa.

View full abstract

The aim of this study is to identify adaptive or maladaptive family type based on perceptions of family functioning in bereavement. Also our cross-sectional study can demonstrate process that adaptive (or maladaptive) families influence psychological health of the widowed. The subjects were 45 widowed persons and 45 married persons. They answered a questionnaire concerning cohesion and expressiveness in family functioning (Family Environment Scales Japaneses Version) , and psychological health (General Health Questionnaire Japanese Version, 28 version ; GHQ 28). As a result of cluster analysis, three types of families emerged from cohesion and expressiveness (i.e.high-cohesive and high-expressive family, mid- and mid- family, low- and low- family). There were no age. sex, number of child and marital status differences among the family types. Second, three family types were compared by using one-way analysis of the variance (ANOVA) on psychological health, and further post hoc comparisons of significant results were undertaken. The Sores of anxiety & insomnia, social dysfunction, and severe depression on GHQ 28 of the high-cohesive and high-expressive family were significantly lower than that both of the mid- and mid- family and of the low- and low- family. Finally, the interaction of family types by marital status on psychological health was examined by using two-way analysis of the variance (ANOVA). There was the significant interaction on both anxiety & insomnia and severe depression. According to post hoc test, while there was a significant difference on them among family types in the widowed, but no difference in the married. That is, high-cohesive and high-expressive family has buffering effect on psychological health after conjugal loss. These findings suggested the following to clinical setting ; 1) The high-cohesive and high-expressive family may be "adaptive family" after bereavement. 2) The courses of intervention are to enhance the family cohesion and to develop open expression of thoughts and feelings. 3) The screening for high-risk (then maladaptive) family before patient's death is effective. Family intervention in advance may be regarded as the preventive bereavement care.

View full abstract

Psychogenic factors are involved in chronic urticaria. We applied a solution-focused brief therapy to the treatment of chronic urticaria as well as common psychotherapy such as reassurence, support and explanation. Nine out-patients (2 males, 7 females) suffering from urticaria for more than 6 weeks were treated. The median suffering period was 6 months including 4 patients suffering over 1 year. The doctor took the history of the disease from the patients, informed that psychological stress might have been concerned, and asked if they had experienced any stress. One of the patients talked about her stressful living, and another took a positive attitude toward her living after she noticed her Stress. The rest of the patients were asked a miracle question : "Suppose a miracle would happen and your every suffering would have disappeared while you are sleeping tonight, what change could you notice when you wake up tomorrow?" They talked about psychosocial events such as difficulties, efforts, successes, prides or images of solution in their lives. When the patients talked how difficult their lives were, the dcctor sympathized with them, and asked how they could manage to live through the difficulties. He also tried to find a positive aspect in their lives and helped them to notice their ability to solve the problem by themselves. Then, the doctor complimented them on every effort and small success they had made in their lives. The patients who had been filled with negative feelings such as anger, anxiety, irritability or fatigue in the beginning, gradually recovered positive feelings such as love, Self-respect, indomitable spirit or ease. At the same time their urticaria gradually weakened and disappeared. The anti-histamine drugs which had been nessesary so far in several patients, gradually decreased in amount or became unnecessary. The psychotherapy was judged effective in 7 out of 9 patients (78%) by 5 other medical doctors. (Solution-focused approach was effective in 6 out of 8 patients<75%>). In conclusion, chronic urticaria is a psychosomatic disease, and solutionfocused brief therapy is effective as its psychotherapy.

View full abstract

Panic disorder is often accompanied by chest pain, which is often felt as dull pain or palpitation as if in the case of mimics ischemic heart attacks. The patients show strong feelings of anxiety but they are not so severe as pathologically occured pain. Three cases of the panic disorder were reported here whose chief complaints were chest and middle back pains and had been suspected of some organic causes. Case 1 was a 19-year old boy who was frequently upset about his chest pain followed by hyperventilation attacks. He was quite dependent on his mother because of his neurotic hypochondriacal tendency. He had a round shoulder with remarkable stiffness in his middle back muscles, indicating myofascial pain syndrome. Case 2 was a 40-year old female with intolerable chest pain after her promotion. She was diagnosed as an intercostal neuralgia in a pain clinic, received several thoracic epidural blocks in vain. Psychological examinations revealed her strong tendency of self-defence and alexithymia. Physically she also showed the characteristic trigger points in her back with referred pain in the chest, suggesting myofascial pain syndrome. Drug induced hyper-ventilation and strong feeling of dying brought the diagnosis of PD. Alprazolams and other drugs could make her condition much better. Case 3 was a 57-year old male who had had the multi-operated back because of his right hand and thoracic back pain. He developed analgesic agents abuse, which caused him gastrointestinal bleeding. He was introduced to our hospital as a surgical candidate for nerve sectioning. His chief complaint was painful squeezing sensation around his chest, which sometimes made him hyperventilating and severely anxious. He cleared the diagnostic criteria of myofascial pain syndrome but the MRI or CT studies of his back revealed no evidence of organic lesions. Psychologically he was egoistic, easily somatising and highly neurotic. These facts brought us to a conclusion that he had had a myofascial pain in his back, which had been misdiagnosed as thoracic back lesions. The relationship between the myofascial pain and the chest pain in some panic disorder patients were discussed.

View full abstract

We experienced a case of anorexia nervosa (AN) complicated by severe reflux esophagitis. The patient was an 18-Year-old female high school student, whose weight was 37 kg and height was 163 cm when she visited our hospital for the first time. Her chief complaints were amenorrhea and body weight loss. She had no episode of binge eating nor self-induced vomiting. She was admitted on the purposes of going through a full examination and improving nutrition. Her 0 days of hospitalization were over ten weeks, but her body weight did not increase, because she ate every meal but a small quantity. Ten months after the discharge, she underwent a gastro fiber scopic examination for epigastric pain. The findings indicated esophagitis ot grade B by LA classification. One year later, she underwent the same examination again due to epigastric pain and difficulty in swallowing, and severe reflux esophagitis of grade D was revealed. After administration of proton pump inhibitor for one month, the result of a gastro fiberscopy (GFS) was grade A. We considered that adding of the fragility of esophageal mucosa resulted from poor nourishment to the increase of transient lower esophageal sphincter relaxation caused by the delay of gastric emptying was the etiological cause in this case. It is known that bulimic patients are often complicated by esophagitis, and, consequently, we emphasize that, when patients complain pyrosis or epigastric pain, even in AN cases, gastro-esophageal reflux disease should be suspected and GFS should be carried out in early phases.

View full abstract