[in Japanese]

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[in Japanese]

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Thirty-four patients (23 are male) suffering from stress-related diseases caused by corporate restructuring were examined, and the following results were obtained. 1. In the study group, 13 patients were in their 50's, who comprise the largest proportion, followed by nine in their 30's and eight in their 40's. 2. Disease Causing Factors 1) Occupational Factors : Thirty patients were related to corporate downsizing, who comprise the largest proportion, followed by 13 patients who were involved in start-up business development in a project team or in a similar situation, and nine patients who were related to the consolidation and abolition of departments, sections, offices, and factories. 2) Personal Factors : The analysis of character traits showed that 17 patients, i. e. half of the study group, were methodical, too serious, and rigid. Eight patients were found to be energetic and hard-working, and another eight were described as passive and negative. 3. Diagnosis and Treatment, and Prognosis 1) The diagnosis found 22 patients with adjustment disorders, seven with mood disorders, and five with psychosomatic disorders. 2) In the prognosis, 16 patients (the majority) were in slightly impuroved, followed by 13 in good condition, and five unchanged. 4. From the examination of onset mechanism mainly associated with occupational factors, two distinctive types of disorders were identified ; one develops in people who work in a project team for a start-up business and have methodical, too serious, and rigid character traits ; the other develops in those who experienced corporate consolidation and abolition and have passive and negative character traits. The results above were examined from the clinical view.

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The Department of Psychosomatic Internal Medicine has been visited by a number of patients with job stress symptoms. These patients have been referred to us by an industrial physician or have come on their own volition. The purpose of this study was to investigate background factors relating to stress, the reason why people chose to visit us, the actual conditions of job stress and the details of disorders from the two clinical researches we performed. Subjects taking part in the first study consisted of 136 patients referred to us by industrial physicians and 236 patients who visited us took part in the second study because they exhibited symptoms which were thought to be related to job stress. Based on the results, the findings were as follows : 1. The most prevalent diagnosis was depression. 2. Classifying the stressors into four categories, i. e. the contents of the job (quality or quantity), human relationships, working environment and physical trauma, revealed that the content of the job was the most frequently cited stress factor. 3. The role of psychosomatic internal physician is not well discriminated from that of the industrial physician, and cooperation between them is not adequate at present. We found that the percentage of depression in the disorders increased in comparison with our prior research. (From 37.5% to 60.2%) It is necessary to develop close cooperation between the industrial sites and clinical sites, and to develop educational activities for stress related diseases, especially depression and mental health.

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Trends and characteristics in occupational stress management in the post-industrialized countries, especially in the EU and in the US are overviewed. Job stress and stress management have emerged as key issues in health promotion in the workplace in all of the post-industrialized countries. In these countries, worker-oriented and secondary or tertiary preventive activities have been prevalent so far. Priority strategy for intervention, however, now begins to shift towards work-oriented and primary preventive activities. In addition, several "tools" or "Interfaces" have been developed which connect stress theorres or models with practice in occupational stress management. In a practice of psychosomatic medicine, it is necessary to manage not only workers as patients but also work organization or psychosocial work environment as a source of health risk. Further research will be needed to clarify the mechanisms linking occupational factors and psychosomatic diseases. Finally, well designed, interventional studies to prove the effectiveness of occupational stress management should be strongly recommended.

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Mental health is consider seriously on the industrial scene in recent years. Its experts are more needed for occupational health and psychosomatic medicine professionals concerned will be related more strongly to occupational medicine. The concept of work-related disease includes the disease in which work acts as a precipitating or recurrent or aggravating factor. The psychosocial factor is contained in those factors and its concept is similar to that of psychosomatic disease. In occupational health, we lay stress on disease prevention or health promotion, dealing with organizations and groups. And the experience and the treatment technique of psychosomatic medicine for the individual can be used for the prevention and the improvement of life-style related diseases in addition to mental health healthcare. Also, when the doctors of psychosomatic medicine work as the industrial physician, they can understand patients' work contents and the work environment and it will be possible for them to do the more effective treatment.

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Objectives : The short-term influence of Dance Movement Therapy (DMT) on postmenopausal middleaged women was considered mainly from emotional changes and the subjective feeling of sleep. Methods : Eight healthy postmenopausal women aged between 55-60 years old were allocated a DMT day and a control day so as to avoid order effect. DMT day : After supper (19:00-20:50), two subjects were asked to perform fifty minutes of DMT with a therapist at comfortable self-controlled pace while listening to BGM in the laboratory. Each subject rested in a chair in a climate-controlled chamber (26℃, 40% R.H.) for 30 minutes both before and after DMT. The Heart Rate Reserves of DMT (%HRR) were calculated by heartbeat, and the Rating of Perceived Exertion (RPE) was verbally assessed during DMT. Control day : each subject looked at a photographic collection for fifty minutes at the same time in the same chamber while listening to the same BGM. On both days, emotion was monitored using the Mood Check List-Short Form I (MCL-S.1) and the State-Trait Anxiety Inventory (STAI (X-1)). In order to learn the subjects' impressions, they were asked to complete questionnaires after each activity. The subjective feelings of sleep on each day were investigated by OSA subjective sleep rating scale. Subjective mind and body states were also asked until supper the next day by Visual Analog Scale (VAS). Statistical analyses of the change of each variable by each activity, the difference on the both days of each variable were carried out by ANOVA, Fisher PLSD, paired t-test, and so on. Results : As one subject had experienced a high stress event on the control day, only seven persons (age ; 57.4±1.7 SD) were actually analyzed (only OSA ; n=6, because of missing data). The exercise load of DMT was of slight-moderate intensity (%HRR ; 37.0±7.7, RPE ; 11.9±0.9). The subjects liked DMT. By practicing DMT, the subjects'emotions (pleasantness, relaxation and state-anxiety) and subjective feelings of sleep (sleepiness) improved significantly (p<0.05), and they awoke the next morning feeling more refreshed. Moreover, after DMT, the subjects suffered less body pain and stiffness, and experienced increased appetites before lunch the following day (p<0.05) . Conclusion : Fifty minutes of DMT Iate in the evening had a positive influence not only on emotions and the feeling of sleep, but also on the body states of middle-aged women. This positive influence began at the start of DMT and lasted until taking lunch of the following day. Comfortable self-paced DMT is a psychosomatic treatment suitable for menopausal \vomen to easily continue. It may be useful in the reduction of unidentified complaints of menopausal women.

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We reported a case of paraplegia with an obvious secondary gain that was successfully treated usin! a confrontation technique. A 38-year-old man was admitted to the department of neurology in our hospital because of paraplegia of sudden onset. He had been admitted twice, each time for a period of 6 months, for treatment of paraplegia and had been diagnosed as having anterior spinal artery syndrome 8 years earlier and transverse myelitis 7 years earlier. This time the neurologists diagnosed him as having multiple sclerosis, and steroid therapy was started. However, magnetic resonance imaging of the head and spine showed no abnormalities, and there was a marked discrepancy between his disability and objective findings. On the 18th hospital day, the neurologists suspected conversion symptorn and referred the patient to our department. Inteviews with his parents and wife revealed that the patient had repeatedly embezzled money and accumulate debts, which his father had paid without any criticism of the patient's action. Just before this addmission, it had been revealed that he had again embezzled money. A secondary gain to evade his responsibility obviously existed. Since childhood, he had been doted on by his parents and had never been scolded by his father. We explained the concept of secondary gain and psychological origin of symptoms to his parents and asked them whether they intended to continue paying his debts. Since the parents said they would not continue paying his debts, we decided to use a confrontation technique to treat the patient. We instructed the father to tell the patient that this was the last time he would pay his debts and that if he embezzle money again, he must take resposibility by himself and might be put in jail. The patient began to walk on that day and was discharged three days later. Immature development of superego due to doting by parents is thought to have been associated with the symptoms in this patient. Differentiation between conversion disorder and malingering was actually difficult in this case.

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