Spinocerebellar degeneration (SCD), a syndrome with its core symptom of ataxia, is sometimes associated with depression and cognitive impairment. Transcranial magnetic stimulation (TMS) is a noninvasive but direct way to stimulate the central nervous system. Several controlled studies have concluded that slow frequency repetitive transcranial magnetic stimulation (rTMS) alleviated symptoms of SCD. However, the mechanism of this effect has not been clarified. We administered occipital rTMS (0.2 Hz, figure-eight coil, 100% of output at 150% to 300% of resting motor threshold, 30 times daily for 3 days per week over 8 weeks; total 720 sessions) to 31 patients with SCD, in order to examine the effects on depression and motor function. Before initiating and after concluding the course of rTMS, patients were assessed with the International Cerebellar Ataxia Rating Score (ICARS) and Beck Depression Inventory (BDI). Additionally cognitive function tests, SPECT and electrophysiologic examination were carried out, and catecholamines and free radicals were measured in cerebrospinal fluid. We then analyzed data from four diagnosis-defined patient subgroups : spinocerebellar ataxia type 6 (SCA 6), cerebellar cortical atrophy (CCA), multiple system atrophy (MSA) and others. Mean ICARS scores before and 8 weeks after treatment were 44.1 and 40.1 respectively with the SCA 6 group showing more improvement than the others. However, improvement was not statistically significant. As no significant harmful effects occurred, rTMS proved relatively safe and painless. The pretreatment BDI in patients with severe symptoms was significantly worse than in others. Two patients with depression treated with antidepressant, showed improvements, and other patients also showed reduction in depressed mood after rTMS, overall, however, the BDI showed only a slight improvement. Improvements in BDI showed no relationship to motor improvement, gender, age, or other background factors. Patients with a high BDI scores (>15) were significantly more improved after rTMS than those with low BDI scores (<=15). Three affective pattern were observed : (1) depression severity decreasing with improvement of motor function; (2) depression worsening despite improvement in motor function, excessive expectations; and (3) acceptance of disease, depression severity decreasing without improvement in motor function. We believe that rTMS had some therapeutic effect on mental function and depression in SCD patients. We also examined cerebral blood flow and catecholamines in cerebrospinal fluid to clarify the relationship with rTMS, depression and mental function in SCD.

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This study was conducted as part of an outcome study comparing patients with eating disorders accompanied by a alcoholism and those without alcoholism in Japan, and we concluded that the outcome of patients with eating disorders associated with alcoholism was more severe than that of those without alcoholism. This study examined symptoms and outcomes of patients having eating disorders with alcoholism in relation to prior treatment for eating disorders. The subjects were 32 females with eating disorders and alcoholism, who were 30 years old or younger. They were examined as inpatients of National Hospital Organization Kurihama Alcholism Center in 1990-1998 and subjected to semi-structured interviews concerning symptoms of eating disorders, alcohol dependence syndromes, other psychiatric disorders, and life histories. A follow-up survey was conducted from October to December 2000 and the mean follow-up period was 5.8 years. Twenty-five out of 32 patients had previous onset of eating disorders and 7 developed eating disorders at the same time or after onset of alcoholism. Among 25 patients who had previous onset of eating disorders, only 8 patients (32%) had been treated for eating disorders, and the remaining 17 patients had not been treated for eating disorders when they started treatment in our hospital. Patients with prior treatment of eating disorders differed from the other two groups in terms of symptoms on the first admission and at outcome. They were younger at first admission, and had earlier onset of eating disorders, earlier onset of problem drinking, higher rate of anorexia nervosa purging type, and less experience of marriage than the other groups at first admission. At outcome, they had similar mortality rates to those of the other groups, but a lower decrease in eating disorder symptoms than in the other groups. In conclusion, female patients with prior treatment of eating disorders accounted for a small percentage of Japanese patients with eating disorders and alcoholism and had severe symptoms of eating disorders.

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Objectives : Group social skills training (group SST) was used for teaching in patients with eating disorder to be more assertive. The purpose of this study is to assess the effect on the nursing staff's participation in this program. Methods : Changes in the degree of assertiveness were measured in the participant group (7 subjects who participated 3 times or more) and the non-participant group (7 subjects) by use of the Rathus Assertion Inventory and an assertiveness check sheet. The participant and non-participant groups were compared prior to participation, immediately after the final session, and 12 months after the final session. Results : Overall assertiveness significantly improved immediately after participation (p=0.01). "Nurse to nurse" and "nurse to patient" assertiveness also significantly improved at this time (p=0.03 for both). When surveyed 12 months later, the significant changes observed in the participant group had disappeared. However, in the members of the participant group who had participated at least five times, the significant changes continued (p=0.03). Conclusion : Less than five group SST sessions were effective in increasing the assertiveness scores of the nursing staff members immediately after participation, but the changes were not longstanding. In the members who participated at least five times, however, the changes continued for at least 12 months.

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Objective : We produced a Japanese version of the Eating Disorder Examination (EDE) and investigated its reliability and validity. Methods : EDE Japanese version was trial administered to 69 Japanese patients with eating disorders. The inter-rater reliability, internal consistency, and discriminant validity using eating disorder diagnoses as external standard were examined. Results : High inter-rater reliability was obtained for evaluation item, subscale and global scores. Satisfactory internal consistency was obtained for 4 subscales and global score. Bulimia nervosa (BN) group showed significantly higher values than anorexia nervosa (AN) group in Weight Concern, Shape Concern and Bulimia subscales. Discussion : Japanese version of EDE is a measure instrument that can be expected to have high interrater reliability and a satisfactory level of internal consistency with respect to evaluation item, subscale and global score. Three EDE subscales discriminated AN from BN, indicating EDE as a highly valid and useful evaluation method for eating disorder psychopathology. Lower scores in Japanese than Western patients for Restraint, Weight Concern and Shape Concern in AN and Restraint in BN suggested cross-cultural issues.

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Various methods of body-to-mind approaches, including biofeedback (BF), have been applied in psychosomatic medicine. We had been practicing BF at the BF section of our department, where we tried to focus on an awareness of bodily feelings, cognitive aspects and the combination methods. Especially we tried to practice "Stretching and Active Biofeedback (SABF)", combined methods with BF and stretching. In the stretching, smooth breathing and adjusting body asymmetries are emphasized. In SABF, there are 3 processes; 1) to notice a tense or relaxed region through muscular stretching and relaxation, 2) to train and learn changes in the bodily sensation through muscular stretching and relaxation, 3) to apply the SABF session to a home training in daily life. Through the processes, patients confirm effects of stretching by BF, come to be aware of their physical conditions, and are accelerated to awake mind-body correlations. We showed 2 case reports and made discussions. As for the first case, a 32-year-old woman was admitted to our hospital because of headache, dizziness and giddiness. At first, EMG levels on buccinator were high muscle range in rest term and she could realize the muscle strain. Following on SABF, She realized muscular relaxation, after then EMG levels got lower. SABF prompted the patient's awareness of mind-body correlation. In the second case, a 37-year-old woman was admitted because of bend neck to the left. At first, EMG levels on trapezius were high range in rest term, but she couldn't realize muscular strain and relax. Following on SABF, she realized muscular strain and relaxation, after then EMG levels got lower. SABF prompted the patient's awareness of mind-body correlation. At last it makes her confident by success experience with stretch and extended the amount of activities of daily life. These cases suggest that the process in SABF makes patients realize and confirm muscle strain and relaxation. SABF makes patients aware of mind-body correlation and confidence. We can use the result obtained in this study as it is for the evaluation of condition support.

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