The aim of this study was to investigate the clinical course and the economic burden of somatoform disorder in adolescent. Of 81 patients who presented undifferentiated somatoform disorder at the first visit to our out-patient clinic, 12 patients participated in a follow-up study. The mean follow-up time was 6.1 years(SD 1.0). Examination was done for 2 patients using a questionnaire and for 10 patients using a questionnaire and telephone. The results showed that 6(50%)patients with undifferentiated somatoform disorder demonstrated high recovery from their symptoms at follow-up and there were only 2(17%)patients who showed inadequate help-seeking behaviors. However, in 80% of patients, functional impairments at work or study were observed. We estimated that the annual total cost of somatoform disorder was approximately \1, 520, 000. Of this total, 94% was attributable to indirect cost.

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The purpose of this study is to clarify the personality of elderly people in Okinawa where the average life expectancy of 65 years has been the longest in Japan. Although many surveys have been carried out about Okinawa, very few studies employed scientific scales which had been established based on personality theory. In the field of personality studies, FFM(Five Factor Model)has been improved after 1980's, which consists of neuroticism, extraversion, agreeableness, openness and conscientiousness. Our study focused on the difference between elderly people in Okinawa and those in other areas using ACL(Adjective Check List)based on FFM and also the reliability of revised ACL for which we had prepared in the previous year. The adjective check list with 61 items was pre-tested the elderly people of Okinawa in 1997, to check whether they were able to understand the meaning of each item, because these adjective words are not so familiar in daily conversation in this area. As a result, many words could not be understood by the participants. Referring to the result and other previous studies, we revised the adjective check list of 5 scales, which have 10 items each. In this study of 1998, participants were consisted of 2 groups, 759 people aged 65-97 years in Okinawa using an interview method and 609 people aged 65-89 years who live in other areas using a mail survey. The result shows the elderly people were able to catch the meaning of the words better than the previous year. Cronbach's α coefficient was computed on each factor scale to find it rather reliable with the score over 0.768. Comparing each 5 scale between Okinawa and other areas, we found that the elderly group in Okinawa was higher in the scale of agreeableness and lower in openness and conscientiousness than those in other areas. In the FFM theory, the person with a high score of agreeableness tends to care for and support others and also expects to receive support from others. This tendency seems to contribute to build a good social network among people. Lower score in conscientiousness is consistent with the result of previous studies in that the character of the people in Okinawa is rather easy-going and carefree. The statistical differences were not found in the scale of neuroticism and extraversion between two groups. As to gender, a score of men is less neurotic and more open than women in Okinawa. These findings are very similar to previous researches on the character of Okinawa's people.

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It is known that younger school children who can not attend primary school are mainly due to anxiety about separation from their mothers. Case 1 : T.M., an eight year-old girl who had a sister and a brother did not like her grandmother. She was suffering from bronchial asthma and did not attend school. She would not separate herself from her mother, and the school-nurse let her stay in her office. Case 2 : K.E., a six year-old girl who had 3 brothers did not attend school and one of her brothers was also a school refuser. These 3 children stayed together in the school-nurse's office and later moved to the annex room. The 2 girls were receiving the sand-play therapy at this hospital 33 and 25 times for 2 years respectively. After having cooperation with their school teachers and school counsellors by the consent of their parents, they started going to their classes and joining school activities. However, they refused to go into their class rooms recently when they were forced to stay there longer by their teachers. We should establish better ralationship and secure more cooperation with school staff and school counsellors, especially in the care of lower grade school children with school refusal.

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Four patients with neurological unexplained motor symptoms such as paraplegia, quadriplegia, or Guillain-Barre-like symptoms, visited the Emergence Room or Outpatient Clinic of the Department of Neurology, Fukuoka Tokushukai Medical Center. After the detail evaluation for motor symptoms of these patients by Neurologists, they were referred to the Department of Psychosomatic Medicine. Until the intervention by Psychosomatic Medical Specialists, they were not able to walk. However, the inact intervention for their motor symptoms such as eating symptoms of anorexic patients by Minuchin led them to walk without any supports. There is no recurrence of motor symptoms among them.

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We reported a case of enlarged adenoids associated psychological wheezing mimicking bronchial asthma. A 24-year-old male student presented with attacks of paroxysmal dyspnea and expiratory wheezing. He had been diagnosed as having bronchial asthma at the age of six months, which had been successfully managed medically ever since and generally asymptomatic between the ages of 12 and 14. In high school, wheezing and shortness of breath recurred and could not be controlled despite using methyl-predonisolone. On admission to our hospital, pulmonary function tests were normal. During attacks, wheezing sound was heard over the larynx, whereas rhonchi were not audible anywhere in the chest on auscultation. Blood gas findings showed PaO_2=110 mmHg, PaCO_2=25 mmHg, and spirometry revealed a normal loop. Laryngofiberscopy showed an enlarged adenoid, causing considerable airway narrowing during the expiratory phase, causing the wheezing sound. He was diagnosed as having adenoid induced wheezing. A psychological evaluation suggested a depressed state and he had difficulty in verbalizing his emotions. The frequency of wheezing decreased after psychological management with autogenic training. This is the first report that psychosomatic management is effective for patients with enlarged adenoids associated with psychological wheezing.

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Consultation for terminal cancer patients is often only requested when psychological problems become severe after their general condition deteriorates. Therefore, how to perform effective consultation in the limited time available presents a problem. We experienced a case of collaboration with a terminal cancer patient, who was encouraged to record a voice letter for her family in the short time available before death. The patient was a 42-year-old housewife who was found to have breast cancer 5 years previously. She was informed of the diagnosis and an operation was performed. She was hospitalized with metastasis to the brain, and was referred to our department because of anxiety about the future and restlessness. Her general condition was poor and she had disturbance of consciousness, so treatment by structured psychological interviews was difficult. The patient was worried about matters such as bullying recently experienced by her child and the fact that she could do nothing about it. Therefore, it was suggested that she tape record a voice letter to her family whom she could no longer meet very often, and several taping sessions were held. As a result, relations between the patient, her family, and the health care staff changed for the better. The patient's feeling of despair("I can't do anything about it myself")was eased. Communication within the family improved, and communication between the health care staff and the patient was also promoted. In terminal cancer patients with a poor general condition, structured interviews are not an effective means of communication, but intervention by such methods as tape recording is possible. Taping was useful for this patient, but in patients with a slightly better general condition, support should be given so that they can create their own materials in any way that they wich if it is possible in the hospital setting. These materials are very valuable mementos for the survivors when there are small children or others whom the patient regrets leaving behind.

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