Grief after bereavement is a normal reaction and most people adjust spontaneously. In the current DSM-IV, the normal grief reaction is placed with a V code classification (V 62.82) and so is definitely excluded from mental disorder. On the other hand, severe traumatic bereavement exposes the bereaved person to a high risk for pathological grief, the phenomenological symptoms of which manifest as several complex types of psychiatric disorder; Major depression, panic disorder, posttraumatic stress disorder (PTSD), and psychosomatic disorder etc. When clinicians deal with traumatic grief reactions, diagnosis can be confusing. There are some problems relating to when and how we can diagnose because of lack of consensus in the theoretical conceptualization of grief and trauma. The result is that, PTSD is readily applied in Japan. In this article, we describe the similarities and differences of grief and trauma, and try to present a conceptual model. We also discuss the importance of preventive support for pathological grief.

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Of the various conditions encountered in the emergency room (ER), psychosomatic and psychiatric disorders are not uncommon. The present study investigated organic and stress-related disorders among patients transported by ambulance to the ER of a general hospital that had a large number of emergency admissions. Of the 641 patients transported to this ER over one-year period, traumatic injury accounted for 209 (32.6%), and stress-related disorders for 129 (20.2%). Hence one of five patients had stress-related disorders. Attending doctors specializing in psychosomatic medicine considered psychosocial aspects significantly more frequently than other specialists. Non psychosomatic specialists only diagnosed stress-related disorders in 15 of 81 patients (18.5%). Furthermore, although 34 (26.4%) of the 129 patients diagnosed as stress-related disorder presented at the facility more than twice, only 13 (16.0%) were referred for psychosomatic medicine/psychiatric evaluation. In the ER setting, we strongly believe consideration of psychosomatic factors to be important as many patients present with conditions in which these factors are significant. It is also necessary for the mind-body approach to spread to other medical fields including those involved in ER consultation and liaison.

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Objectives : The present study, using 485 subjects who received health examination, tested the hypotheses that the four personality types of Short Interpersonal Reactions Inventory influenced the biological factors involved in life-style related diseases. Methods : The subjects of the present study consisted of 485 people who gave informed consent, among 650 members working at general hospital in sendai City. The subjects were asked to complete a questionnaire, entitled "A survey on life style and awareness of life", as part of a health examination in 1998. The survey was conducted after having been approved by the Ethical Committee of the hospital. To investigate the relationship among four personality types, multiple regression analysis was performed on the personality types, life-style, eating behaviors, and biological factors. Results : As a result of path diagram, Type 1 showed smoking behavior and irregular eating behavior. Type 2 showed high cholesterol level and Type 2 showed irregular daily life. Conclusion : The results of the present study indicated the relations among personality, life style and biological factor. A further long-term longitudinal study should be performed to investigate the relations among life-style, biolgical factor and personality.

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This study investigated ways to avoid the continuing increase in medical lawsuits. Suits involving a lack of communication with the patient are particularly important. In psychosomatic medicine, communication with the patient is significant. Based on questionnaire responses, precedent education appears to be important. There has been no legal classification of medical precedents to date nor there is classification of precedents in psychosomatic medicine. To classify the legal issues and a precedent of psychosomatic medicine, I examined the number of winning cases based on a precedent, then selected a representative precedent. In a lawsuit, informed consent and communication with a patient are important. To find a solution for a dispute, precedent analysis can be performed. I have suggested that this can be improved by taking measures that assume ethical thought ability among doctors treating a patient.

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Objectives : The purpose of this study is to examine the relationship between physical activity and exercise and tendencies toward anxiety and depression in male university students. Subjects : Male freshmen (n=1159) in an institute of technology in Japan were recruited to serve as participants in this study. Method : Three measures were obtained : 1) The Japanese version of the Hospital Anxiety and Depression Scale (HADS), was used to measure anxiety and depression. 2) The Physical Activity Assessment Scale (PAAS), was used to evaluate physical activity patterns. In this study, we used two subscales of the PAAS : Exercise/Sports and Daily Activity. 3) The stages of change for exercise behavior were assessed using a five-item scale. Participants were asked to select the one statement that best represented their readiness and/or involvement with regard to physical activity and exercise behavior. The stages of exercise behavior were assessed as follows : Precontemplation (PC) : "I currently do not exercise and do not intend to exercise"; Contemplation (C) : "I currently do not exercise, but I intend to exercise within the next six months"; Preparation (PR) : "I currently get some exercise, but not regularly"; Action (A) : "I currently exercise regularly, but I have only begun doing so within the past six months"; Maintenance (M) : "I currently get some exercise and have been doing so for longer than six months." The term "regularly exercise" was defined as exercising at least 2-3 times per week for at least 20-30 minutes per session. A cross-sectional design was employed for the present study. Results : The relationship between the scores on the HADS (anxiety and depression) and PAAS was examined using a corelational analysis. The anxiety score was found to have no significant relationship with either the Exercise/Sports score (r=0.04) or the Daily activity score (r=0.04). However, the depression score had a significant negative correlation with the Exercise/Sports score (r=-0.12) and the Daily activity score (r=-0.12). A between subjects analysis of variance (ANOVA) was performed with stage of change as the independent variable and the HADS score (anxiety and depression) as the dependent variable. The ANOVAs showed a significant main effect for only the depression score [F(4, 1058)=6.91, p<0.001]. Interestingly, the participants in the PC group reported a significantly higher depression score as compared with those in the C, PR, A, and M groups. Conclusion : The results of this study suggested that physical activity and exercise were not related tendency toward anxiety, but were related tendency toward depression. As these results about depression raise the possibility that the data may be affected by sample size for above one thousand, the interpretation of these results about depression must be careful.

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Many eating disorder patients have a fear of gaining weight or a desire to be thinner. A fear of gaining weight is one of the criteria of anorexia nervosa. Some eating disorder patients, however, have other phobias, such as vomiting phobia, which cause a body weight decrease not associated with a fear of weight gain. These patients are often diagnosed as phagophobia, food avoidance emotional disorder, or eating disorder not otherwise specified. We report a case of severe ematiation caused by vomiting phobia. A 13-yaer-old girl was admitted to our hospital because of sever emaciation (body weight 31.3kg, -43.5% of standard body weight) and difficulty with oral ingestion. After seeing one of her classmates vomiting, the patient developed a fear of vomiting, after which she stopped eating. No fear of gaining weight was seen. The patient was successfully treated with cognitive-behavior therapy with behavior restriction, as is usually done for anorexia nervosa patients, to help her learn to reduce her anxiety.

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