Initial evidence of the effectiveness of imipramine and the monoamine oxidase inhibitors(MAOI), phenelzine and tranylcypromine, was first observed in Europe and the United States in the early to mid-60s. By the late 80s, the high potency benzodiazepines(BZs), alprazolam and clonazepam, were demonstrated to be effective in trials around the world. Clomipramine, altough not an SSRI, was the first predominantly serotonergic drug shown to be quite effective in panic disorder(PD). However, the SSRIs have become the treatment of first choice at this point first because of how well tolerated they are as a class, particularly the absence of weight gain, overdose danger, or abuse liability. Recent well-designed, double-blind, placebo-controlled trials- first with paroxetine and then sertraline, fluoxetine and citalopram- have demonstrated their clear effectiveness in the treatment of PD. Recommendations for length of treatment generally suggest, continuation of effective pharmacotherapy for 12-24 months, generally averaging 18 months before consideration of taper and discontinuation. Dosage is generally begum at the lowest level and then raised to levels effective in depression. The only established target dose in 40 mg for paroxetine but generally accepted dosage ranges for other SSRIs are sertraline (100-150 mg/day), fluoxetine (20-40 mg/day), citalopram (20-60 mg/day), and fluvoxamine (150-300mg/day).

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Panic disorder(PD) and irritable bowel syndrome(IBS) have many common symptoms, which are psychological symptoms and dysautonomic symptoms. We hypothesized that there are common underlying mechanisms in PD and IBS. To test our hypothesis, we examined the prevalence and precise symptomatic analysis of IBS in patients with PD. Subjects were 85 PD patients diagnosed by DSM-IV and 75 healthy controls whose age and sex were almost matched. We developed panic symptoms questionnaire based on DSM-IV and IBS symptoms questionnaire based on Rome criteria. Both questionnaires were self-reported by the subjects and their symptoms were graded and quantified. Twenty PD patients (24%) and 8 controls (11%) satisfied diagnostic criteria for IBS. The prevalence of HBS was significantly higher in PD patients than controls (p<0.05, x^2 test). In PD patients with IBS (n=20), IBS preceded PD in 14 patients (70%), PD preceded IBS in 5 patients (25%) and two conditions occurred concurrently in 1 patients (5%). Psychosocial stress aggravated abdominal symptoms in 34 PD patients (40%) and 18 controls (24%), indicating significantly higher rate of exacerbation in PD patients than controls (p<0.05, x^2 test). During panic attacks, PD patients complained of nausea in 34 (40%), abdominal pain in 29 (34%) and abdominal discomfort in 34 (40%). The PD patients with IBS had significantly severe panic symptoms, nausea/abdominal distress, choking, chest pain/chest discomfort, dizziness, derealization, fear of losing control, and paresthesia, than the PD patients without IBS (p<0.05, Mann-Whitney U-test). Comorbidity of IBS in patients with PD likely aggravates panic symptoms. These data suggest that PD may have, at least in part, common pathogenesis with IBS.

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"Quality of Life" of terminal cancer patients is closely related with the way by which they recognize and cope with their impeding death. For example, active coping style may lead the patients to adjust themseleves well to that situation. This study tried to examine such cognitive process of terminal cancer patients through analysis of verbal behaviors obtained by interview on several cases. Eleven terminal cancer patients (6 men and 5 women) participated in this study. Interview transcripts were segmented by thematic units (TU) and judges scored each units for 10 topic categories and elaboration-dyselaboration measures, which assessed emotional and defensive discourse. Duration of TU was timed by seconds. Multidimensional scaling analysis and cluster analysis have classified the patients into several groups in terms of elaboration-dyselaboration measures. They revealed three patterns as follows: 1)the outpatient group had a pattern with both low emotional behavior and defensive behavior; 2)the inpatient-discharged group had a pattern with both high emotional behavior and defensive behavior; 3)the inpatient died group had a pattern with the middle feature between the outpatient group and the inpatient died group. These results mean that the severity of the patients have a great influence upon affective reactions in terms of verbal behaviors. That is, physical condition of the terminal cancer patients plays an important role in cognitive process that yields affective reactions. We conclude that the severer physical condition of the patients is, the bigger the discrepancy between expected self-image and real self-image is, and then this discrepancy causes affective reactions. In clinical settings, these discussion suggests that physical symptom controls are important for terminal cancer patients, and in addition to them, active psychological supports such as structured interventions are needed for enhancement of patients' QOL.

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Critical pathways define multidisciplinary staff members' responsiveness, time lines, and patient outcomes. Recently, medical and surgical care settings have started to use them in order to improve quality of care and fiscal outcome in Japan. Although psychiatric patients are thought to have individualities, a critical pathway has been used in psychiatric care setting in overseas. In general, it is said that the length of stay in hospital for eating disorder takes time because of its being one of refractory diseases. In order to design a critical pathway for eating disorder, the common therapeutic goal during the stay in hospital should be shared among doctors, nuring staff and the patient individually. Prior to hospitalization, the clarification of the patient' variances leads to exercise earlier care management. It is important to clarify the purpose of hospitalization that can be achieved by lending a small effort. It is also important for both doctors and nursing staff to recognize that hospitalization is not a real goal but mediates between hospital and home. We have described the development and implementation of a critical pathway for patients with eating disorder.

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