[in Japanese]

View full abstract

The immunologically induced fatigue was conducted in rats by intraperitoneal (IP) injection of a synthetic double-stranded RNAs, poly I : C. An IP injection of poly I : C (3mg/kg) decreased the daily amounts of spontaneous running wheel activity to about 40-60% of the preinjection level until day 9, then gradually returned to the baseline level by day 14. In the open field test, the locomotor activity of the poly I : C-injected rats decreased on day 1, but it was not different from the saline-injected group on day 7, suggesting that the poly I : C-induced fatigue on day 7 was not due to the peripheral problems such as muscle/joint pain, but involved the central nervous system. Quantitative analysis of mRNA levels using a real-time capillary reverse transcriptase (RT)-PCR method revealed that the amount of mRNA for interferon-c! (IFN-α) increased in the medial preoptic, paraventricular, ventromedial hypothalamic nuclei, and cortex on day I and even on day 7. Serotonin transporter (5-HTT) mRNA, which is known to be induced by IFN-α in astrocytes, also increased in the same brain regions on day 7. Interleukin-1β (IL-1β) and inhibitor of nuclear factor κB (I-κB) mRNAs increased on day 1, but recovered within a week. In vivo brain microdialysis revealed that the extracellular concentration of 5-HT in the prefrontal cortex decreased after poly I : C injection. Since this decrease in 5-HT was blocked by a selective 5-HT reuptake inhlbitor, fluoxetine, it was thought to be due to an enhanced expression of 5-HTT. Furthermore, the poly I : C-induced suppression of the running wheel activity was attenuated by a 5-HT_<1A> receptor agonist, 8-hydroxy-2-(di-n-propylamino) tetraline (8-0HDPAT). Finally, the poly I : C-induced decrease in activity was conditioned using poly I : C (IP) as an unconditioned stimulus and saccharin drinking as a conditioned stimulus, and this conditioned response was completely blocked by 8-0H-DPAT, indicating the presence of neuronal circuit for the central fatigue. These findings, taken together, suggest that brain IFN-α and 5-HT system play an important role in the neuronal mechanisms of the immunologically induced fatigue by poly I : C.

View full abstract

[in Japanese]

View full abstract

The aim of this paper is to explain how we will develop psychosomatic medicine in the Department of Psychosomatic Medicine of The University of Tokyo now and in the future, featuring the research methodologies and clinical activities. We will focus on the three research methodologies such as the Ecological Momentary Assessment (EMA), brain functional studies, and neuroendocrinology. The EMA is a method to assess and record biopsycho-socio-ecological data of human subjects in their daily lives, which makes possible the scientific studies on mind-body relationship in natural settings. The major problem to be solved is how to apply or develop relevant data analysis methods to compress huge amount of data and get a concise conclusion. We illustrated one of our studies on multiple chemical sensitivities for indicating the merit of the EMA. Brain functional studies using positron emission tomography, functional magnetic resonance imaging, or eventrelated brain potentials can assess real-time brain functions of human subjects that have been regarded as a black box, which makes possible the studies on 'mind-brain-body' relationship. The relevant issue here is to set parameters of each function of brain, body, and mind and to formulate their relationship. The target of neuroendocrinology is the complex network of various variables of homeostasis control systems including stress hormone, sex hormone, and feeding substances. The relevant issue to be tackled is to include psychobehavioral variables in the above-mentioned network and to investigate the relations among various kinds of variables. The main targets of our clinical activities are psychosomatic diseases, eating disorder, panic disorder, and mild depression. Although the range of our targets naturally overlaps with that of psychiatry, we are much inclined to view patients from the aspects of their body and behavior, and firmly maintain the position that we would see patients under the condition that a patient and a doctor can understand verbally each other. We use pharmacotherapy, lifestyle modification, relaxation, and cognitive behavioral therapies as treatment modalities. Having concrete methodologies of behavior modification and understanding of doctor-patient relationship is one of the major differences between our department and the other departments of internal medicine. We can establish our identity only by living in our own environment day by day. The identity of psychosomatic internal medicine should be also established by exercising what only psychosomaticists can do every day under the request of clinical and research activities and in responding to social demands.

View full abstract

Although the term ""psychosomatic"" is defined as the inseparable interaction of the ""psyche"" and ""soma"", some recent American studies have reported that it was most commonly used to describe psychological problems or problems in which the mind affects the body rather than as a reciprocal interaction. Such a phenomenon is also observed in Japan. Therefore, it is urgent that our Japanese Psychosomatic Society design a new vision of psychosomatic medicine for Japan. In this article, we summarize the state of the clinical, educational, and research activities of our department and further discuss where we are and where we should be going. Because things are changing quite rapidly, we have been forced to realign some of our fundamental attitudes. At the same time, we are responsible for preserving psychosomatic medicine in Japan in all its original beauty 'and for handing it down to the next generation. Surely, this is most difficult and in some ways a contradictory problem ; however, we must sincerely discuss the issues and build a new system to meet the demands of the times.

View full abstract

In 2009, the Japanese Society of Psychosomatic Medicine will mark its 50th anniversary. Ironically enough, the Ministry of Health and Welfare (now Ministry of Health, Labour and Welfare) gave approval to ""psychosomatic internal medicine"" as a new medical specialty in 1996, and with this move, psychosomatic medicine has gone into a decline. The role of psychosomatic medicine in Japan lies in the clinical practice, education and research of holistic medicine. The role of the Japanese Society of Psychosomatic Medicine is to have the medical science of integrity and relatedness studied and transmitted in each medical specialty, dentistry, psychology, and nursing science. In this sense, the Society is quite interdisciplinary. The present paper deals with the path which psychosomatic medicine should follow, in view of clinical practice, education and research of bio-psycho-social medicine practiced at our Department of Psychosomatic Internal Medicine. It is our ambition to create and pass down a uniquely Japanese psychosomatic medicine in which Western and Eastern medical sciences and practices can be integrated. Our key word is bio-psycho-social medicine.

View full abstract

We have discussed the future development psychosomatic medicine in Japan from the standpoint of psychiatry with the focus on its academic base, clinical practice, education and research. With the basic change of the academic concept of psychiatry due to DSM-III from nosological entity to clinical entity, it becomes necessary to clarify more the image of psychosomatic medicine as compared to psychiatry. In clinical practice, it becomes more important to share the standpoint of psychiatry ; i.e. physical symptoms mainly at the Psychosomatic clinic, mental symptoms mainly in at the Psychiatry clinic, for patients suffering from anxiety, somatoform, eating, sleep, and mood disorders. Especially patients suffering from mild, masked, involutional and/or panic type of depression are much popular at the Psychosomatic clinic. Therefore the psychosomatist must receive adequate training for prevention of suicide. On the other hand, the psychiatrist must receive adequate training for psychosomatic practice, because psychosomatic education in Japanese medical schools and universities is quite inadequate at the present time. Establishment of the system for the specialists of psychosomatic medicine is the most expected assignment in Japan. And establishment of Department of Psychosomatic Medicine at all medical schools and universities in Japan is also very highly expected in the near future. Recent remarkable development of biological psychiatry utiliging neuro-imaging, gene technology etc. such as functional MRI, PET would present many resources for proceeding to the progress of psychosomatic medical researches ; i.e. intracerebral mechanism based on neurogenesis of psychosomatic correlation in the brain, mechanism of psychoneuroendocrinoimmunomodulation, selection of organs and/or individuals, tolerance against stressful situation. On the other hand, the concept of the bio-psycho-socio-ethico-ecological model in Psychosomatic Medicine would present a humanistic existential research in psychiatry. Progress of psychosomatic research of health promotion (salutogenesis) will contribute to the longevity in human being.

View full abstract

[in Japanese]

View full abstract