The purpose of this study was to investigate the effects of adopted coping strategies on relationship between dispositions of spouse and state of psychological stress in spouse with cancer patient. The dispositions of spouse were evaluated using three variables, which were age of spouse, cancer stage of the patient, and the years after surgical operation of the patient. State of psychological stress was evaluated usingindices for mental health and subjective burden. Subjects were 57 female spouses (age 64.8±6.0) of gastric cancer patients who were operated after having informed cancer (year after surgical operation : 1.9±1.1). In this study, Tn-axial Coping Scale (TAC-24), Subjective Burden Scale (SBS), General Health Question-naire (GHQ) and Face sheet were used. The answers for questionnaires were obtained through a mail survey. Result of structural equation modeling analysis, this model revealed best fitting (Chi^2=5.60,p=0.69 ; GFI=0.97 ; CFI=1.00). According to this model, it was revealed that the longer time passed after surgical operation, the more families of patients adopted coping strategies of problem-avoidance. As a result, state of psychological stress was evaluated to be getting worse. Furthermore, the older they grew, the more they adopted coping strategies of emotional control. In conclusion, it is very important to support the spouse who has taken care of cancer patient after surgical operation for a long time. Furthermore, these results suggested that the effective support for spouse of cancer patient could be achieved if one could find a way to prevent the tendency of the spouse to use coping strategies of problem-avoidance. Results of this study were discussed from the viewpoint of support system for spouse with cancer patient.

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We investigated the QOL of outpatients consulted at the department of psychosomatic medicine. A total of 183 consecutive patients (58 males and 125 females, mean age 32.1±15.8 years) visited our department for the first time from October, 1999 to May, 2000. These patients and 58 healthy controls (17 males and 41 females, 34.8±13.1 years) were asked to complete the questionnaire of QOL 26, STAI and GHQ 28. Moreover, QOL 26 was repeated for 73 patients and 58 healthy controls a month later. Patients consisted of 47 cases of generalized anxiety disorder, 37 of Mood disorder, 29 of Irritable bowel syndrome (IBS), 16 of somatoform disorder, 13 of panic disorder, 15 of bulimia nervosa (BN), 7 of anorexia nervosa, 6 of tension headache (TH), and 13 of other diseases. The results of QOL 26, STAI and GHQ 28 were compared between patients and healthy controls. All sub-scale scores of QOL 26, STAI and GHQ 28 in patients were significantly different from those of healthy controls (p<0.001). In patients, "Psychological domain" and "Environment" sub-scale scores of QOL 26 were significantly lower in females than in males. There was a significant negative correlation between age and "Physical domain" in patients, and a positive correlation between age and "Environment" in healthy controls. We compared the difference of QOL 26, STAI and GHQ 28 among each disease group. Sub-scale scores of QOL 26 of patients with IBS and TH were slightly lower than those of healthy controls, and they were higher than those of other patients groups. Those scores of patients with BN were especially lower. Almost all sub-scale scores of QOL 26, except for "Social relationships", were significantly improved in patients a month later, but there was no change in healthy controls. These results suggest that QOL was harmed in patients consulted at the department of psychosomatic medicine as compared to healthy controls. QOL of patients with IBS and TH was slightly on the lower level than healthy controls, and on the higher level than other patients groups. QOL was markedly harmed in patients with BN. It was thought that QOL 26 was a useful questionnaire to speculate QOL of the subjects.

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The authors present the clinical characteristics of 975 female patients with eating disorders who were treated at hospitals in Japan. The patients were diagnosed according to DSM-IV criteria in 1999. Our discussions included similarities and differences of the physical signs, physical symptoms, eating behaviors, individual conditions and family status among anorexia nervosa (restricting type and bulimic/purging type), bulimia nervosa (purging type and non-purging type) and eating disorders, not otherwise specified. These data will be useful for the diagnoses of eating disorders by primary care doctors.

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Three car-accident sufferers who had been diagnosed as posttraumatic stress disorder (PTSD) elsewhere and 7 litigated cases of PTSD after traffic accidents were analysed and discussed from the medicosocial standpoint. Result None of 3 cases who had been diagnosed as PTSD elsewhere fulfilled the DSM-IV criteria. Two litigated cases were certified as PTSD, while other latest 5 cases were denied by the court. Conclusion Patients in Japan should be diagnosed as PTSD only when they are strictly characterized by DSM-IV or ICD-10 criteria. Pure PTSD is thought curable, but recovery of some patients in Japan could be prolonged because of chronic incompleted grief. These patients should be differentiated from PTSD, because their main problem is in the sadness and depressive mood due to unfinished grief.

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A 37-year-old woman with a 20-year clinical history of anorexia nervosa was successfully treated at the Psychosomatic Medical Department of Fukuoka Tokusyukai Medical Center. She was admitted to our department after repeated hospitalizations at several other hospits and unsuccessful treatment as an outpatient of our hospital. The latest series of admissions included a voluntary admission to a psychiatric hospital with remarkably low body weight of 26 kg (BMI 10.4 kg/m^2) and serum potassium level of 2.1 mEq/l. Because her condition continued to become worse, she was transferred to the psychiatric department of B General Hospital where she was treated with 6-month bed rest and long-term intravenous hyperalimentation (IVH) for nutrition management. After her body weight recoverd to 34 kg, she and her family requested transfer to our hospital because she had become dependent on IVH and for the purpose of rehabilitation of muscle atrophy. Because of psuedo-ileus and constipation, two months were necessary for recovering from the dependency of IVH and establishing regime of ingested meals. With a combined approach of supportive psychotherapy, cognitive therapy and drug therapy using haloperidol, her prejudice against ingested meal was greatly mitigated compared with at the time of admission. Other aspects of her behavior also changed little by little. Occupational therapy was conducted along with the mitigation of gastrointestinal symptoms to promote conversion of negative emotions and to facilitate communication with co-medical staff members such as occupational and physiotherapists. At the time of discharge after five months of hospitalization, her body weight recovered to 37 kg and the serum potassium level became normal. This was the best condition she has ever attained since the onset of her anorexia. She has been maintaining this condition for six months after discharge. The prognosis for anorexia nervosa with a long clinical history has been reported to be poor. In our case, our comprehensive, multi-dimensional approach with the nutrition management to eliminate patients dependence on IVH was successful.

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