To examine factors related to health care professionals' attitudes towards patients' access to medical records in the field of psychosomatic medicine and psychotherapy, a self-administered questionnaire was sent to 482 members of the board of trustees of the Japanese Society of Psychosomatic Medicine. The survey was conducted in March 2000, and the recovery rate was 62% with 86% of the respondents being male and 91% physicians. About half of them specialize in internal medicine(including psychosomatic medicine)and 30% in psychiatry. More than 90% of the respondents are interested in the issue of medical record disclosure, while about half of them were familiar with the content of the Ministry of Health and Welfare's recent report in detail. The majority(69%)answered that they preferred partial disclosure of medical record in the field of psychosomatic medicine, while 29% answered that all the medical record should be disclosed. Only 2% of them said that no disclosure at all is better. Among those who agreed with partial disclosure, more than 90% would be comfortable with disclosing drug prescription, physiological test data, and results of self-administered psychological tests. However, only half of them agreed with disclosure of the results of psychological tests using projective methods, and less than 20% agreed with patients' direct access to nursing records and medical charts that include interview records and assessments by health care professionals. When the situation is limited to cases involving psychotherapy, their answers were split. Sixty-four percents of the respondents were against and 35% for patients' direct access to medical charts. The reasons against included that direct access would have a negative effect on patients, medical records contain information provided by third parties such as family and colleagues, and it would interfere with health care professionals freely writing down necessary information. The reasons for included that all treatment should be provided only with the patient's consent, patients have the right to know, and patients and therapists should be equals even in the case of psychotherapy, etc. As to the question of their experience, about 40% of the respondents reported experiencing some distress when explaining diagnosis to their patients or obtaining consent for treatment from their patients. A multiple regression analysis demonstrated that in the case of psychotherapy the experience and use of psychoanalytic psychotherapy showed significant correlation with negative attitudes towards patients' direct access to medical charts. This suggests that these issues should be discussed in relation to the specific characteristics of each psychotherapeutic mode, and of each disease and condition under treatment.

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The purpose of this study was to investigate the cognitive disturbance of eating disorders. Subjects were anorexia nervosa-restricting type(AN-R ; n=52), AN-binge eating purging type(AN-BP ; n=54)bulimia nervosa-purging type(BN-P ; n=39), and normal controls(n=55). As results of one factor ANOVA with Tukey comparison, all subtypes of eating disorders showed higher food preoccupation, more problem avoidance tendency, and more dysfunctional thinking related to diet and weight, and lower selfesteem. However, there were no significant differences between AN-R and normal controls in the scores of variables related to body shape. These cognitive disturbances were most prominent in BN-P, and then AN-BP, AN-R and normal controls. Objective evaluation by three therapists also suggested BN-P and AN-BP showed more severe cognitive dysfunction than AN-R.

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Somatosensory amplification refers to the tendency to experience somatic sensation as intense, noxious, and disturbing. It includes an individual's disposition to focus on unpleasant sensations and to consider them as pathological rather than normal. Barsky and his colleagues have reported that the concept of somatosensory amplification is helpful in understanding a variety of clinical conditions characterized by bodily complaints disproportionate to demonstrable medical disease. To examine the reliability and validity of the Japanese Version of Somatosensory Amplification Scale(SSAS), patients attending the psychosomatic medicine clinic and internal medicine clinic were recruited for the study in the university setting. Participants were 48 psychosomatic outpatients(psychosomatic group)and 33 outpatients with general medical problems(control group). All subjects completed four questionnaires : SSAS, Profile of Mood States(POMS), Medical Symptom Checklist, and Self-rated Stress Perception Scale. The SSAS had 10 items to ask the respondent a range of uncomfortable bodily sensations on an ordinal scale from 1 to 5. The POMS consisted of six mood state scales of tension-anxiety, depression, angerhostility, vigor, fatigue, and confusion. The Medical Symptom Checklist was used to assess 16 common somatic symptoms, i.e.headache, visual symptoms, dizziness, ringing in the ears, nausea/vomiting, diarrhea, constipation, abdominal pain, muscle pain, joint pain, back pain, chest pain, palpitation, shortness of breath, insomnia, and fatigue. The Self-rated Stress Perception Scale was to assess degrees of perceived stress to psychosocial situations. In the total sample, the SSAS had item-to-scale correlation of 0.27 to 0.84(all p<0.05)with adequate internal consistency(Cronbach's alpha=0.79). Also, the SSAS scores were positively correlated with the total number of somatic symptoms, degrees of perceived psychosocial stress, and the POMS tension-anxiety, depression, fatigue and confusion scale scores(all p<0.05) ; they were negatively correlated with the POMS vigor scale scores(p<0.0005). The SSAS scores were higher in the psychosomatic group than in the comparison group(p<0.005), and differentiated the psychosomatic group from the comparison group by the multiple logistic regression analysis(p<0.05), controlling for the effects of age(p<0.005), sex, total number of somatic symptoms, degrees of perceived psychosocial stress, and all the POMS scores. It was suggested that the SSAS may be a clinically useful tool to evaluate Japanese psychosomatic patients in terms of experiencing, reporting, and functioning in medical conditions.

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The medical response to the increase in cases of eating disorders has been slow to come in Japan and therefore there is at this moment an urgent need to create an adequate medical system to properly address these disorders. In order to clarify the current medical treatment situation, we conducted an inquiry among psychiatrists, medical practitioners and practioners of psychosomatic medicine between 1995 and 1997, collecting questionnaires with answers and valuable comments from 769 responders. In this report we present the results obtained as well as our personal interpretation and comments. In Japan, specialty centers for eating disorders are of great importance and are in high demand ; however, the concentration of patients in these specialty institutions presents many problems. Expanded treatment facilities are necessary to cope with an increasing number of patients, and for that purpose, adequate provisions for reimbursement of diagnosis and treatment are also desirable. Since there is a shortage in the number of medical doctors who specialize in the treatment of eating disorders in Japan, it is clear that there is a need to distribute treatment roles and responsibilities among different professionals based on the level of severity of the disorders. Eating disorders comprise a complex disease entity that include a broad and heterogeneous gruou of patients. It is therefore extremely important to be albe to address the therapeutical needs of different types of patients. In this respect, it would be desirable to have treatment guidelines conforming to the peculiarities of the Japanese health insurance system. Family therapy is also very important and improvements in this area are required. Advancements in providing guidance to patients on dental hygiene, education of the dentists themselves, group therapy and self-help groups, as well as adequate education of local clinics and support at the local district level will constitute topics for consideration in the near future. Other future needs of the medical system comprise the education of medical practitioners and the implementation of both post-graduate programs and training programs under the supervision of medical specialists. In addition, due to the fact that the treatment of eating disorders require a team-treatment approach, proper staff training including nurses, psychotherapists, nutritionists, and others. Nutritionists' understanding of the disease and how counseling on nutrition fits within the health insurance setting are also important issues. Finally, other activities that were considered necessary included demographic research such as information on the number of patients in a certain area or the clarification of incidence of events not usually observed in the treatment scene, discussion on the choice of therapy, evaluation of the efficacy of the treatment, consideration on long-term prognosis, and performance of clinical research directly related to this therapeutic area. These activities should be actively promoted in the future.

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