We used immediate early genes (IEGs) of fos-and jun-families as markers of cellular activation to investigate the neural circuit of stress perception and stress response. Immobilization stress induced a marked expression of IEGs not only in the brain, but also in peripheral organs of rats. IEGs expression in the cardiac myocytes, together with changes in electrocardiomyogram, induced by immobilization were attributed to the activation of sympathetic system and α_1- and β_1-adrenergic receptors on cardiac myocytes. On the other hand, peripheral organs and tissues may also affect the central nervous system via various cytokines. For example, peripheral inflammation triggers synthesis of inflammatory cytokines, such as IL-1β, TNF-α, IL-6,in the brain, which may contribute to the activation of HPA axis and stress response. Leptin is a kind of cytokines synthesized in adipose tissue and released in response to elevated blood glucose and insulin. It then activates arcuate neurons via leptin receptors (OB-Rb) and regulate feeding behavior and energy metabolism.

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Although psychological characteristics in patients with bronchial asthma have been well studied, the effect of atopic diathesis on psychological aspects in asthmatic patients remains to be investigated. Therefore, we compared psychological characteristics between atopic and non-atopic asthmatics. The study group consisted of 100 asthmatic patients, 30 males and 70 females, in psychosomatic department of Kansai Medical University. In terms of pathophysiology of the disease, 62 subjects were atopic and 38 were non-atopic. Their mean ages at the onset of the disease and at the time of this study were 25.9±17.7 years and 51.9±12.5 years in the atopic subjects (Group A) and 38.6±15.2 years and 59.4±10.4 years in the non-atopic subjects (Group N). As psychometrical instruments, Maudsley personality inventory (MPI), Todai egogram(TEG), Comprehensive asthma inventory (CAI), and Toronto alexithymia scale (TAS-20) were employed. Average scores on the extroversion scale of the MPI were higher in the atopic group than in the non atopic group and higher in females than in males. Average scores on the neurosis scale of the MPI were higher in the non-atopic group. But no statistically significant difference was found as a whole between the atopic and non-atopic groups. Among five scales of the TEG, NP was the most highly scored in both groups. The atopic subjects showed higher average scores on FC than AC, and the non-atopic subjects showed higher scores on AC than FC. Average CAI scores were slightly higher in the non-atopic group than in the atopic group and significantly higher in females than in males. Average scores on the TAS-20 were relatively but not significantly higher in the non-atopic patients than the atopic and in females than males. Those who had scores over 61 (definitely alexithymic) were about 18% in both atopic and non-atopic groups. The present study revealed that non-atopic asthmatic patients are significantly more emotionally suppressive and socially over-adaptive than atopic patients. They also tend to be introvert, neurotic, and alexithymic. These features are remarkable in female subjects. It is suggested that subjects with non-atopic asthma have more psychological problems as precipitating factors of the disease compared with atopic asthma.

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Most of patients with atopic dermatitis are said to reach remission till their adolescence. But we experienced intractable cases of adolescent atopic dermatitis and the incidence is thought to be increasing in this decade. Our aim of this study is to report 19 cases of adolescent atopic dermatitis who experienced exacerbation at their teenage and their treatment procedure by the psycho sociological point of view. Ages of the patients are from 12 to 20 and all of them showed poor adherence to treatment advice although 18 of them expressed positive motivation to improve their atopic dermatitis. Twelve patients had school refusal at the starting point of psychotherapy. Eighteen patients had poor emotional relationship or poor communication with their mothers, and a 19 year old patient living alone did not refer to his relationship with his parents. Our psychotherapy mainly focused on the improvement of child-mother relationship that was thought to be the bar of eliciting good adherence behaviors and giving psychological support to improve their selfefficacy. After psychotherapy (one month at least, one year at most), all cases improved in their relationship with mother and 18 patients improved in their adherence to treatment advice and one moved to another hospital because of steroid phobia. Adolescence is a special period for a child to develop his/her self and establish self-care behavior. When patients reach adolescence, many of them experience psychological distress against their old relationship with their mother, who would think she should lead treatment for her child. Our psychological lntervention to mothers was effective to restructure child-mother relationship and improve their adherence behavior to the treatment advice for atopic dermatitis.

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The concept that bronchial asthma is a chronic inflammatory disease is established, and various guidelines based on this concept has been spread in recent years. Today most asthmatic patients are being controlled at the outpatient section on the basis of these guidlines. As for psychosomatic medicine, We are asked What can be done for the advancement of such asthma treatment. The possibility of psychosomatic medicine in the asthma treatment was presented through a case report of a patient who was introduced to our department. We assumed that personal traumatic experiences might affect the course of asthmatic process. When we investigated psychosocial backgrounds of the 11 intractable patients hospitalized from 1996 to 2000 in our department, there were four cases who experienced serious trauma which could be related to making these patients intractable. We conclude that psychosomatic approach including the care of traumtic experience may be needed in the treatment of intractable asthmatic patients in the future.

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The multiple chemical sensitivities (MCS), a concept advocated by Cullen (1987), refers to a syndrome induced after low-dose but continuous exposure or high-dose and one-time exposure to various chemicals. The concept of MCS is not yet generally accepted and there is much debate even on the name of the syndrome. The objective of this study is to clarify the relationship between stress-related factors and MCS from psychosomatic perspectives. Subjects : We surveyed 18 patients with MCS (male; n=7,female; n=11,) and 35 controls (male;n=7,female; n=28) to investigate the effects of stress-related factors on MCS. The patients were diagnosed as having MCS in the Clinical Environmental Center of the Kitasato Institute Hospital. We recruited controls through an advertisement on a family magazine, who are healthy persons aged 20-70 without medication, and not diagnosed as having sick-building syndrome in spite of having moved to a new house or a reformed house during the past three years. Fulfilling these requirements, the controls were considered not suffering from MCS under continuous exposure to low-dose chemicals. Measurements : All subjects underwent the life health questionnaire (LHQ) which evaluates life events, daily hassles, social support, stress coping, smoking and drinking habit, physical, mental and behavioral stress responses. They were also examined for the following tests : The Cornell Medical Index-health questionnaire (CMI) for physical and psychiatric subjective symptoms, the Profile of Mood States (POMS), the Eysenck Personality Questionnaire-Revised (EPQ-R), the Twenty-Item Toronto Alexithymia Scale-Revised (TAS-20R), the Somatosensory Amplitude Scale (SSAS) and the Tri-Axial Coping Scale (TAC-24). They were also examined for the heart rate variability as the function of autonomic nervous system. In order to diagnose psychiatric comobidity, one psychosomatic doctor interviewed all of them by using the Mini-International Neuropsychiatric Interview and the items of somatoform disorders extracted from the Structured Clinical Interview for DSM-IV. Results : The scores of life events during the past one year and the present stress scores of patients were significantly higher than those of controls. However, there was no Significant difference recognized in specific personality trend or stress-coping style. A remarkable difference was noted in the volume of smoking and alcohol drinking in the past One month. No patients had smoked at all and few patients had drunk alcohol. After occurrence of MCS, the patients felt various physical and psychological symptoms. The rate of psychiatric comobidity of patients was 83%, while 11% of controls. The details of psychiatric diagnoses on the patients were Somatoform Disorders (67%), Mood Disorders (61%), Anxiety Disorders (50%) and so on. As for the heart rate variability as the function of autonomic nervous system, there was no difference between patients and controls. Conclusion : Psychological stress may promote the occurrence of MCS, but there was no distinctive psychological or behavioral profile of patients except that they smoked or dranked less. And MCS patients had many psychiatric comobidities.

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The relationship between the severity of depression and the levels of taste perception was determined using one hundred and five healthy adults. Severity of depression was evaluated using the Zung's Self-rating Depression Scale (SDS). The levels of taste perception was evaluated using tomita's taste test modified (by us) with a paper disk. The general evaluation of the ability to perceive taste in which the total score for four tastes was calculated, was performed using the threshold levels for four tastes. There was no significant difference in threshold levels for four tastes with respect to sex. There were significant weak statistical positive correlations between age and threshold of three tastes and the total score for four tastes. Results suggest that older people have higher threshold levels for tastes perception. There were significant weak statistical positive correlations between the threshold levels for two tastes and the total score for four tastes and the total score of the SDS. There is no significant correlation between age and the total score of the SDS. Results suggest that more depressive people have higher threshold levels for taste perception. Thus, the relationship between the level of taste perception and the severity of depression was indicated in this study. In our next study, as an approach to treating patients with depression, we will attempt to determine whether taste disorder in patients with depression is a state marker or a trait marker.

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