In order to clarify the brain mechanism of a failure in adaptation to stress. We conducted neuroimaging studies by using fMRI and MEG in order. At first, to investigate which areas of the brain play an important role in the perception of stressful events, we performed a functional magnetic resonance imaging (fMRI) study that involved recognition of unpleasant words concerning interpersonal relationships. Secondly, we evaluated the effect of various stresses on the sensory gating system by magnetoencephalography (MEG) to show whether or not stress could affect the brain mechanism. Finally, we studied the neural activity associated with the expectancy of emotional stimuli using fMRI and MEG, considering the importance of expectancy in adaptation to stress. These results suggested that stressful events might be recognized in some brain regions, that acute stress might affect part of the brain mechanism, and that expectancy might suppress incoming stressful stimuli.

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We have employed a multi-disciplinary approach to the treatment of 24 inpatients with chronic pain. The treatment program consists of cognitive behavioral therapy, rehabilitation (physical therapy, exercise therapy, occupational therapy, and training outside hospital), orthopedic therapy (nerve block etc.), family adjustment and counseling. The symptoms in 16 patients (67%) were improved by our treatment program. Fourteen patients (58%) had good outcome two years after discharge and they returned to work. Eight patients whose symptoms did not improve had irresoluble chronic stress and 5 patients of them had psychiatric and somatic complications ; they had poor outcome two years after discharge and they could not return to work. With regard to the team approach that consists of orthopedics, psychosomatic medicine, rehabilitation, and counseling, persevering attitude toward patients with chronic pain was necessary. However, for the patients with severe chronic pain who have irresoluble chronic stress and complications of psychiatric and organic disorders, the cooperation of social workers, specialists, and family or other persons concerned with the patients was essential.

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We present a case of a child with food allergy who refused oral ingestion as a result of respondent conditioning. The patient was an 11-months old boy with food allergy. Owing to severe food restrictions enforced on him by doctors for atopic dermatitis and chronic diarrhea, his weight did not increase during the period between his first four and nine months. His weight began to increase after he underwent special medical treatment at the Department of Allergy of The National Center for Child Health and Development. When the patient was 11 months old, an inpatient food-challenge-test was performed in order to increase the variety and amount of food he could tolerate. Since he tolerated very little food, he was forced to eat by his parents and medical staff, but he then started to refuse food. His food refusal was also brought about by the food challenge test to find safe foods for him. As a result, he lost his weight. Behavioral analysis showed that the action of parents and medical staff forcing the child to ingest food became a precedence stimulus and eventually conditioned his aversive response. His refusal to eat induced in turn the care-givers'enforcement action. Thus, once conditioning was established, a negative interaction developed. Prior to intervention, parents and medical staff concerned recognized some of the basic issues including Need to avoid a precedence stimulus/Not to force oral ingestion/To give food only when the child wants it/Need for sufficient personal contact. When behavioral therapy was commenced, his food intake improved within 1 month. His weight and total intake of milk increased the following 2 months. His weight increased from 6,625 g to 7,520 g, and total intake of milk from 30-60 ml to 250 ml per feed. His communication and motor development also improved. After the discharge from hospital, he continued to make good progress under continued consultations. Six months after this intervention when the patient was 18 months old, he still was smaller than average, but his growth curve was approaching the normal range step by step. When certain foods are found to cause the child's allergic symptoms, potential sources of nutrition become limited. Therefore, parents and medical staff tend to force the child to eat food that he or her can tolerate in order to ensure healthy growth. However, contrary to the child's wish, eating behavior may decline and growth may slow down or stop. As shown in this case, the emphasis of care only on the physical aspects of illness tends to encourage negative conditioning. It is important to remember that medical care which focuses only on physical symptoms of children may interfere their healthy development. When caring for pediatric patients, it is necessary to assess their environment, to resolve inappropriate conditioning, and to encourage their development. This case shows the necessity of understanding illness and problem behavior not from a bio-medical but rather from a bio-psycho-social point of view.

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Refeeding syndrome has been used to describe those phenomena such as severe hypophosphatemia and other metabolic complications, which are seen in malnourished patients receiving concentrated calorie intake, mostly via total parenteral nutrition. A case of refeeding syndrome in anorexia nervosa is reported. A 20-year-old woman was admitted because of body weight loss (body weight 29.3kg; -44.5% of standard body weight) and diarrhea. To improve the nutritional state, total parenteral nutrition was started and on the 15th hospital day, blood pressure fell to 70/50 mmHg, the respiration rate increased to 40/min and the patient became delirious. Serum potassium and ECG were normal and there was no definitive cause of symptoms, especially delirium. However, serum phosphorus was significantly decreased (1.6mg/dl). Therefore, we considered her symptoms to be refeeding syndrome. After she was started on intravenous fluids and other supportive therapy was performed, the delirium resolved slowly and serum phosphorus was normal. Because anorexia nervosa is characterized by intentional starvation and extreme weight loss with psychological disturbances, the disease is the classic modern potential setting for refeeding syndrome.

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This case report discusses the psychoanalytic meanings of autogenic training given to a patient with somatoform disorder with aerophagia, which later on considered as borderline level. The patient was a housekeeper in her thirties who came to a hospital because of aerophagia. As an initial treatment, autogenic training was performed by a clinical psychologist under the so-called A-T splitting (administrator-thera-pist) setting for eight weeks. During the course of treatment, the therapeutic approach was shifted from autogenic training to supportive psychotherapy by the psychologist. With a progress of therapy, the patient's somatic symptoms turned into interpersonal dissatisfaction toward medical staff. A histrionic personality trait of the patient gradually appeared, and then, the feature of borderline personality organization became manifest. These changes of symptoms are considered to be the result of influence from growing transference. Through the staff meetings, the initial psychologist decided to suspend the psychotherapy. Thereafter, psychoanalytic psychotherapy aiming at patient's self-understanding was performed by the doctor in charge for about 11 months. The authors suggest that psychoanalytically oriented autogenic training has therapeutic potentials, transforming physical complaints to psychological conflicts during the treatment of somatoform disorder. It is necessary to keep aware the of therapeutic structure and psychoanalytic understanding in order to prepare for approaching severe psychopathology.

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