The author had an impression that an increasing number of students who came to consult with the psychiatrist in the Health Care Center of Yamagata University presented narcissistic psychopathology. Typical cases are the cases of narcissistic personality disorder. However, idealized narcissistic self image was often found in cases of eating disorders or student apathy. Behind their omnipotent grandiose self-image, injured helpless self-image was hidden. The author recognized that they had problematic parent-child relationships in which the feeling of Amae could not be perceived. In the present study, a case of a fefmale student with eating disorder and a case of a male student with narcissistic personality disorder ware examined from a psychodynamic point of view. The psychodynamics of their narcissism were clarified. The author thought the procedure described below might be effective in treating the late adolescent patients with narcissistic psychopathology : In the first step, it is important for the therapist to maintain mild positive transference and accept their idealization of their psychotherapist. In the second step, the therapist should clarify their narccissistic self image. In the third step, the therapist should invite them to abandon their narcissistic self-image and encourage them to raise their self esteem through more realistic efforts.

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The author reported twelve "social withdrawal" cases of university students. Attributes of the cases were as follows, 1) Sex : male 11, female 1 2) Residence : with patient(s) 6, in privete lodgings 6 3) Past history of school refusal : experienced 4, none 8 4) Degree of social withdrawal : mild 3, moderate 6, severe 3 5) Psychosomatic diseases : atopic dermatitis 5, asthma 2 6) Academic programs in university : discontinued 8, completed 4 All the twelve subjects were not diagnosed as either schizophrenia or manic-depressive psychosis. They presented symptoms of neurotic disorders, such as obsessive traits and/or anthropo-phobia, and showed psychological conflicts between high self respect and low self esteem. This study also revealed that they tended to suffer from psychosomatic diseases, which were atopic dermatitis and asthma. The author experienced that applying both bio and social approaches to their treatment was effective in some cases, although establishing firm patient doctor relationship was very difficult. Recently, an increasing number of social withdrawal cases among university students were observed, although their existence and problems were easily overlooked due to their latent aspect. Therefore, the author eagerly suggested that the medical staff working in the area of mental health of adolescence and psychosomatic medicine should pay careful attention to the matter of social withdrawal.

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Twenty-two college students who stayed in the same class more than 2 years were treated by a psychosomatic approach. More than 80% of the subjects had complaints of psychosomatic problems and/or adaptation disorders. The subjects were divided into 3 groups according to the number of treatment sessions they had ; Group A had 8 students who received cognitive behavior therapy (CBT) and counselling, Group B had 4 students who were dropped out of treatment, and Group C had 11, who refused CBT and wanted other treatments at their first several sessions. The results showed that in Group A, 6 out of 7 students graduated from college and 1 was readmitted to an other college after one year of leaving. In Group B, 1 graduated, and 3 left college. In Group C, 3 students graduated from college and 8 remained in or left collge. This report suggests that for college repeaters, it is necessary to make an early interventions because the rate of progress is low when the class is repeated in the 2nd or 3rd year. On the other hand, an increasing number of treatment sessions bring about better results. To prevent dropouts, it seems to be important to proceed with interventions and consultation in the early stage of dealing with psychosomatic problems and adaptation disorders.

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During the 1980s and 1990s, there appears to have been a noteworthy increase in the incidence of eating disorders among college students. One fourth of eating disorder patients who were referred to the outpatient clinics of the Department of Psychosomatic Medicine, Faculty of Medicine, The University of Tokyo were college students. About forty percent of these students were underweight and seventy percent of them were bulimic. Some factors in the college environment may contribute to the development of eating disorders. The need for prevention, education and treatment should be discussed.

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What is the effect of university students' mental hygiene upon their mental conditions after graduation? To evaluate the relationship between university students' mental hygiene and their mental prognosis, we conducted a clinical research concerning social support. Method : The subjects included 24 university graduates who were under treatment at our clinic for more than six months. Healthy 24 university graduates were selected as controls. Both the subjects and the healthy controls filled out a questionnaire on their social support networks. We also presented a case study by which we could evaluate the relationaship between the effect of our treatment and patients' social support network. Result : Factor analysis of the questionnaire shows that family is the most important social supporter for either patients or healthy controls at any time. Also, patients consider that they had less social supporters during their university life than healthy controls. Another result is that such support as listening and empathy by surrounding people was meaningful to both patients and healthy controls. Furthermore, our case study shows that as our treatment progressed, the patient developed more social support networks. Conclusions : First : family is the most important social support network. Second : patients consider that they had less social support networks during their university life than healthy controls. Third : a supportive or empathetic attitude is the most impressive social support behavior. Fourth : from the case study we learned that as the patient's communication with was getting her doctor improved, her social skill also improved, which resulted in the expansion of her social support network. Through this study we learned that, the patients were lacking in social support networks, but after our treatment promoted their communication skill, they expanded their social support networks.

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The onset of two cases of psychosomatic disorder occurred after matriculation. Successful therapeutic processes of these two cases were already published. Long term prognoses covering over 10 years in each case after the termination of therapy ware investigated and the present conditions were confirmed. Case A hated his father and did not apply for a teacher's position which his father had wanted. He began suffering from pharyngolaryngeal paresthesia. But no organic lesion was found in his symptoms and he was referred to the author. Through psychotherapy he became able to objectify both himself and his father. Gradually he came to accept his father. At the unconscious level, he had been strangled by his father for his rebellion. It is 11.5 years since the therapy was terminated and now he is married having one child. His wife values highly his attitude towards business and concern for his father. Case B began to have problems with her club activities and relationships with others after matriculation. She was suffering from bulimia and wanted to quit university. In her therapeutic process, four tasks were presented to her as agendas, which she accepted and solved. She was released from adherence to food. It is 8 years and 2 months since the therapy was terminated. During this period, she worked as a teacher of primary school for four years. She has resigned from her school to help her husband's business. Now she says, "I am ashamed at having such damned ideas at that tiem." "I will face many problems in the future. I want to overcome difficulties by myself." Concerning the onset, they had problems with human relations which were caused by their concern about future plans. But their experience of accomplishment gave them confidence in the way they live in the future. Case presentation such as shown in the therapeutic process of cases A and B to students can help them to deepen the recognition of psychosomatic disrders and to participate in the prevention of psychosomatic disorders. Findings based on the long term prognosis indicate the following points for mental health of both students and adults : 1) Setbacks can lay a foundation for mental growth and development. 2) The meaning of unconsciousness expressed as somatic symptoms should be therapeutically applied.

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We examined multiple factors concerning effectiveness of fasting therapy (FT). The objects consisted of a completion group and a dropout group, 40 and 7 cases respectively. They were compared regarding their background, physical and psychological factors between pre and post therapy, and between the two groups. As a result, it was revealed that impairment of mood state was ameliorated regardless of effectiveness after FT in the completion group. Moreover, it was also revealed that BMI, values of depression and fatigue in the better improvement group after FT were significantly lower than those in the worse group. On the contrary, value of doctor's forecast of effectiveness in the better improvement group after FT was significantly higher. On the other hand, better improvement after FT could be expected in patients having three characteristics that were higher doctor's forecast of effectiveness, lower BMI, and elder through multivariate analysis. Finally, as no significant differences could be revealed in comparison between the completion group and the dropout group, we concluded that it was difficult to forecast whether or not the patient would complete FT prior to FT.

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In out preliminary studies, it was evident that obese people had a distorted eating style such as poor chewing and fast eating, and that chewing actually reduced the consumption of a meal in normal-weight subjects. In the present study, chewing exercise was undergone for 21 moderate obese inpatients using the chewing chart. Patients were served with 390 kcal very low calorie diet (VLCD) or 700 kcal low calorie diet made of Japanese conventional food materials which are rich in dietary fiber, and told to chew 30 times per a mouth during every meal and record whether it was successful or not for every mouth on the chart. At 7-8 months after discharge, we investigated their body weight, eating style and satiety sensation using a brief questionnaire. Twelve obese patients answered to the questionnaire at pre- and post-treatment. Seven patients out of 12 showed further weight reduction compared to that at discharge (responders), but 5 failed to do (non-responders). Interestingly, the scores of eating style and satiety sensation were significantly improved in responders, but not in non responders. With previous and present results, it was strongly suggested that habitual chewing is effective for the reduction and maintenance of body weight, and that chewing charting method combined with Japanese conventional VLCD is useful for the treatment of obesity.

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