In order to develop psychosomatic medicine, it is necessary for various kinds of psychotherapy to be compared with each other, by which common and specific factors among them will be clarified. The progress of basic studies of brain science and stress science will make a contribution to the elucidation of the mechanism of clinical psychosomatic corelation, which is the main theme in psychosomatic medicine. Exploitation of clinically useful tests or questionnaires to evaluate psychosocial stress and stress-related disorders is also needed. In the practice of holistic, psychosomatic medicine, essentially important factors include the therapeutic self which implies expected personality as a doctor, good communication between doctor and patient, and friendly, cooperative teamwork among medical staff. More attention should be paid to the self-care of lifestyle-related disorders and terminal care. Specialized psychosomatic centers for patients with eating disorders who are recently increasing, and multidisciplinary-interdisciplinary pain management centers for patients with chronic intractable pain disorders, are expected to be built. The problem of generality and speciality of psychosomatic medicine, and the need for improvement in the fee structures for psychosomatic treatments in health insurance were also mentioned.

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From the viewpoint of psychiatrist, I made a review of what went on at the time of birth of psychosomatic medicine in Japan, especially about the First Meeting of Japanese Psychosomatic Medicine Society (Nihon Seishin-Shintai Igakkai). In addition, I pointed out some of the problems associated with the development of this field. I also made a few suggestions to the future directions and significans of this developing medicine.

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Depression is the most common of the major mental illnesses and affects 5% to 12% of men and 10% to 25% of women during their life time. Recently, many patients with depression have been successfully treated with antidepressants. However, the number of patients with protracted depression showing less response to antidepressants has deen increasing. Clonazepam, which is an antiepileptic drug and used as a mood stabilizer, has been found to be useful for the treatment of depressed patients who are not or less responsive to conventional pharmacotherapy. However, how clonazepam works has not been clarified. Therefore, studying the characteristics of treatment by clonazepam would be useful to determine what type of patients are likely to benefit from clonazepam. This study investigated predictors of response to clonazepam augmentation in protracted depression that was less responsive to antidepressants. We performed a retrospective cohort analysis among depression patients who were treated at the Department of Psychiatry, Kawasaki Medical School Hospital, Kurashiki, Japan, during the time between 1991 and 2000. We identified 101 patients who were receiving clonazepam augmentation to treat protracted depression. A variety of clinical factors including age at the onset of the first depressive episode, family history of psychiatric illness and gender were examined as possible predictors of response to clonazepam. Patients aged 40 years or older at the onset of first depressive episode showed significant improvement more frequently than those aged 39 years or younger. Among patients aged 40 years or older, those without family psychiatric illness history showed significant improvement more frequently than those with family psychiatric illness history. In patients aged 39 years or younger, there was a tendency toward a higher rate of improvement among males than females. Age at the onset of first depressive episode and a history of family psychiatric illness may be considered as a predictor of prognosis.

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In this study, self-monitoring without other psychotherapy techniques was provided for adult atopic dermatitis (AD) patients, and the effect of self-monitoring which reduces scratching behavior and improves skin symptom was compared with adult AD patients who received only standard medical care. Subjects were dermatological out patients in the Kansai region. For eight weeks, the self-monitoring group (n = l2, mean age = 24.4 years, SD = 5.2) recorded time, strength, length, and situations of scratching behavior using a simple self-monitoring booklet. Subjects were instructed that they didn't have to write all items of the booklet, so that they could get used to recording for two weeks. At the latter six weeks, we told them that they needed to write all items. Effects of self-monitoring on skin symptom, and strength and length of scratching behavior were evaluated, before and after self-monitoring. For a control group (n = l9, mean age = 28.3 years, SD = 6.0), skin symptom and scratching behavior were also evaluated. There was no significant difference in the improvement of symptom and scratching behavior between the self-monitoring group and the control group after the intervention. There was no difference in the number of improved patients between two groups. But there was a tendency of symptom improvement in patients with moderate symptom in self-monitoring group. Self-monitoring could not reduce scratching behavior, but improved skin symptom in some patients. It was concluded that short-term and simple self-monitoring would be useful for dermatological out-patients to improve skin symptom and to reduce scratching behavior.

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Cenesthopathy is characterized by bizarre or strange sensations at various parts of the body, and it is not rare at the oral area (oral cenesthopathy). In such cases, the patients seek dentists for medical care, but will mostly fail to find any causes of the disease. It is also difficult for psychiatric treatments to reduce their sufferings from various symptoms. Although the relationships between cenesthopathy and some psychological factors have often been pointed out, there have not been the systematic researches in this field yet. In this study 13 cases of oral cenesthopathy (1 male, 12 females) were examined with the use of the Rorschach test, which is one of the well-known projective methods for exploring personality. The results were as follows. Eight of 13 cases were positive for the CDI (Coping Deficit Index), which indicates social immaturity or ineptness. They are limited in social skills and are vulnerable to problems in coping with the requirements of everyday living, and therefore more vulnerable to losing control of problems than others. Moreover, almost all of them are unable to express proper feelings, because of their poor emotional control. As to the cognitive activities, the limited information processing is likely to lead to their dysfunction in translating stimuli and it will be reflected into problems in reality testing. But no evidence was found to identify those problems in ideational clarity or bizarre thinking.

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We report on a case of dissociative disorder in adolescence. The patient was a 15-year-old girl who had various dissociative episodes. She was given supportive psychotherapy and administered medication ; at the same time her parents were given parental guidance. As a result, by the end of the therapy regimen, the symptoms of the dissociative disorder had disappeared. In the treatment of dissociative disorders in adolescence, we believe it is necessary to promote patients' developmental aspects with understanding their regression and at the same time, to provide a stable environment and an objective goal. Moreover, we have found the importance for the people helping the patient to show empathy, but not to be deeply involved in the patient's acting-out and traumatic experiences by keeping a safe distance. This is useful to avoid promoting the patient's regression as a means of defense mechanism. The use of medication in conjunction with the psychotherapy was effective in alleviating anxiety and stress that are particular to dissociative disorder.

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