[in Japanese]

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In Japan more than 30,000 people die of suicide annually, and the number has dramatically increased with the Japanese economic recession. Many employees are forced to work hard because of the ongoing business restructuring, and some workers who have committed suicide have been officially acknowledged as victims of depression caused by overwork for the recent 5 years. There is little doubt that depression is closely associated with the course of committing suicide. It is clinically important to detect depression earlier in a workplace because the natural disease course can be changed by anti-depressive regimens. It is economically important as well. Earlier detection of depression reduces the direct costs of prolonged depression, including the costs of medications, hospital cares, and community-based cares ; as well as the indirect costs, such as loss of earnings, lost productivity, and unemployment. Evidence has suggested that depressed persons are likely to complain of a variety of somatic symptoms and that the total number of somatic symptoms is a powerful predictor of functional impairment in physical, psychological, and social functioning. Although self-perception of general somatic symptoms is commonly reported in Japanese health checkups, the results have not adequately been utilized for the screening of specific medical conditions. Thus, we attempted to assess screening practices for detecting major depression in workers complaining of somatic symptoms at the health checkups. A total of I , 443 Japanese white-color employees (991 men and 452 women, mean age=34 years old) completed a medical symptom checklist (major 12 somatic symptoms) , and were then diagnosed using the structured clinical interviews of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). There were 42 cases (2.9%) with major depression in the total sample. Concerning the 902 subjects without any somatic symptoms, only one case (O.1%) was identified as having major depression. The prevalence of the disorder was positively associated (p <0.001) with the total number of somatic symptoms, and the area under the receiver operator characteristic (ROC) curve was O . 92 for men and O . 81 for women, which showed the sensitivity and specificity of the total number of somatic symptoms for detecting major depression. The reporting of any of somatic symptoms might be a practically useful predictor of major depression. Medical staff working in a workplace should be aware of the close association between somatic symptoms and depression in the screening practice and management of their workers. Within the context of a thorough evaluation of depression, the reporting of somatic symptoms may be an important signal to consider further examinations for the diagnosis of depression.

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[in Japanese]

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Milnacipran, a serotonin and noradrenaline reuptake inhibitor (SNRI), was administered to patients with chronic pain to study its efficacy. Criteria for patients with chronic pain in the study were as follows : Patients who visited this hospital complaining of some kind of pain lasting for six months or more, where tests had revealed no clear organic abnormality (or organic abnormality that could explain the pain that they complained of) , and there had been no response to a wide range of treatment options. According to the classification for mental disorders, chronic pain is close to pain disorder as defined in DSM-IV or persistent somatoform pain disorder as defined in ICD-10, which is a syndrome excluding clear depression and anxiety disorders. In this study, pain was periodically evaluated before and after administration of milnacipran, using a "zero to 10" pain assessment system known as VAS (visual analog scale) where zero indicates no pain and 10 is the strongest level of pain. The VAS score improved in all 39 patients after milnacipran administration. From among these subjects, 19 received milnacipran alone for pain relief. The remaining 20 received an antidepressant in addition to milnacipran. Milnacipran demonstrated its efficacy in improving symptom for patients given milnacipran alone and those given milnacipran combined with the antidepressant drug. However, it was more effective in the latter group. Also, the findings suggested that milnacipran has a positive effect on some patients with chronic pain who had shown a lower response to SSRls.

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Eating disorders (ED) including anorexia nervosa (AN) and bulimia nervosa (BN) are stress-related disorders that strongly disturb the patients' life. Their low assertive behavior is thought to be connected with low self-esteem and pathogenesis of ED. However, none of the studies has conducted assertion training with cognitive-behavioral therapy (CBT) for ED. We hypothesized that the acquirement of assertive behavior would influence their self-esteem and psychological state, which would then lead to reduction of abnormal eating patterns. Seventeen patients with eating disorders were allocated in this study. Ten patients were assigned to group-CBT program and seven patients to the control group. Psychometric tests, behavioral assessment, body mass index (BMI) were investigated before and after the treatment. ANOVA indicated a significant group ×period interaction in state anxiety (p <0.05), suggesting remarkable reduction of anxiety in patients treated with group-CBT. Anxiety management is an important factor for acquiring the assertive behavior. Thus, it is necessary to increase the number of cases and to repeat the further studies. Group-CBT may be a new effective treatment for ED.

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Itching is an unpleasant sensation that triggers scratching. The degree of itching (subjective symptoms) is reflected in the dermal symptoms (objective findings) through scratching. Itching causes scratching, and aggravates dermal symptoms. However, both are not always correlated. Chronic and intractable atopic dermatitis patients develop a scratching habit, and often scratch their skin obsessively or as a ritual with stress as the reinforcing factor. The itching is often not as strong compared to the state of the exanthema. On the other hand, patients sometimes complain of strong itching despite the state of exanthema. This is seen in the case of strong obsession for itching or the existence of dermatitis providing a pretext to escape from real problems. The dissociation between subjective and objective symptoms more often suggests the need for psycho1ogical intervention in treatment. The Morita therapy approach aims to transfer the lifestyle of a strong sense of incompleteness to a lifestyle of leaving symptoms as they are. The transition in lifestyles naturally liberates the patient's sensation and behavior dependent on the skin, decreases the degree of dissociation and leads to the improvement of dermal symptoms.

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Objective : This study aimed at investigating the significance of the participation of teachers in charge of health education (school nurses) in the integrated treatment of childhood onset anorexia nervosa (AN). Subjects and methods : The subjects were 22 patients with AN admitted to the pediatric ward and they were matched on family environment. Non-school attendance, readmission and outcome (third year from discharge) were examined for 11 cases (a mean age of 12.9 years) in which school nurses took part and 11 cases (a mean age of 13.5 years) in which they did not. Result : In case of the participation of school nurses, there were 3 cases for non-school attendance (27%). O case for readmission and I case for poor outcome (9.1%) . In case of non-participation, there were 8 cases for non-school attendance (73%) , 6 cases for readmission (55%) and 4 cases for poor outcome (36%). Discussion : The roles of school nurses were (1) identification of AN, (2) persuading the patients and their family to see a doctor, (3) care for patients' mind and body before hospitalization, (4) liaison with visiting class teachers after hospitalization, (5) attending conference and exchange information, (6) assisting the patient in joining at activities and tests conducted by school during hospitalization, (7) follow-up at school after leaving hospital, (8) enlightening general teachers on the disease, (9) educating pupils about the disease and health. Conclusion : School nurses were inevitableas members of the multidisciplinary team. The activity done by medical institutions and schools are based upon constant efforts in developing a collaboration system for continuing long-term support.

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Japanese law governs the titles given to outpatient clinics. For example, neurology is called shinkei-ka (or shinkei-naika ) , and psychiatry is called seishin-ka in Japanese. Seishin-shinkei-ka and shinkei-seishinka are not allowed to be used as an officially approved clinical title, although both terms are allowed to be used on signs displayed inside the clinic. This is also true for shinshin-igaku-ka or shinshin-iryo-ka (psychosomatic medicine) and shinryo-shika or kouku-shinryo-ka (psychosomatic dentistry) as a title of inpatient clinic. The World Health Organization (WHO) recommends the use of ICD-10 for classification of diseases since 1990. Furthermore, ICD-NA is used in neurology, ICD-DA is used in dentistry, and DSMIV is used in psychiatry. It is necessary to understand classification of diseases and outpatient clinics for each hospitals to keep going well one another and to perform high quality medicine. It is hoped that the psychosomatic/holistic medicine becomes common in all fields of clinical medicine based on a bio-psychosocial-ethical approach!

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[in Japanese]

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[in Japanese]

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