Clinical psychologists working in the medical setting assist in intake interviews, administer clinical psychological tests, evaluate the mental state of patients, and do psychotherapy, among other functions. Therefore, the most important ability demanded of clinical psychologists working in the medical setting by physicians is concerned with the technical skills needed to conduct these functions. Moreover, clinical psychologists in the medical setting are considered to be an important member of an interdisciplinary medical team working alongside physicians and nurses. As a result, the next most important demand that is made of clinical psychologists is the ability to cooperate with the other members of the interdisciplinary medical team, in order to facilitate the smooth progress of therapy. The work of clinical psychologists in the medical setting is related to medical treatment and therefore, legally, clinical psychologists are regarded as assistants to physicians. As a result the third demand made of clinical psychologists is to acquire legal and medical knowledge needed for assisting in medical treatment. In order to achieve the above demands, it is necessary to establish a national system of licensing clinical psychologists as medical psychologist.

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Purpose : When the clinical psychologist takes part in the treatment of the patient who has been treated by the doctor of psychosomatic medicine, some difficulties arise due to the clinical feature of psychosomatic medicine. We attempted to make them clear using a questionnaire, and discussed the therapist's attitude and skill. Methods : We employed a questionnaire which consisted of 12 items (seven point scale) to investigate the ray conception of the psychological intervention and also a questionnaire with three questions (free comment) to investigate the difficulty of psychologist-doctor collaboration at the clinic of psychosomatic medicine. Results : Japanese people have positive feelings toward the psychological intervention for their somatic symptoms. They also have relatively strong feelings of stigma to receive psychological treatment. In the investigation for doctors and psychologists, they stated that they had difficulty in managing the therapeutic distance and controling the therapeutic structure. Conclusions : Psychologists who wish to take part in the therapeutic role at the clinic of psychosomatic medicine, have to learn about the approach of the doctor and also about how patient-doctor relationship should be in psychosomatic medicine.

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This paper discusses the role a medical doctor would envision for clinical psychologists. The Japanese Society of Psychosomatic Medicine is independently planning to institutionalize clinical psychologists in hospitals. I agree with the opinion that some qualifications are necessary for clinical psychologists to work in hospitals. However, I disagree with the idea that the Society should establish its own system for authorizing clinical psychologists to work in hospitals at this stage for the following reasons : a lot of clinical psychologists are working in various fields other than psychosomatic medicine; the applicable area of psychosomatic medicine has not yet been clearly defined; the education for and the examination ability of members of the Society have not been fully discussed; and the Ministry of Health, Labour and Welfare is planning to authorize clinical psychologists in hospitals in the near future. I expect that many members of the Society would participate in discussions on whether or not the Japanese Society of Psychosomatic Medicine should authorize clinical psychologists in hospitals. (This paper was written on the basis of the presentation of a panel discussion held on June 4, 2004.)

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I have been with a department of psychosomatic internal medicine for about three years and have worked closely with doctors. This paper outlines my situation as a clinical psychologist at the hospital where I work. Within the hospital we undertake specific work as health care professionals in addition to various other function. The doctors ask us to assist them in providing good patient care. In order to do this we need to know the effects of various drugs, the physical situations of the patients and other important medical information. It is necessary for a medical psychologist to acquire a minimum amount of medical knowledge by reading papers published by academic societies and to learn a wide range of psychological techniques. It is also essential for every medical psychologist to have good public relations skills.

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Background : Psychophysiological Stress Response (PSR) or Psychophysiological Stress Profile (PSP) is a method for assessment of autonomic response or muscle tension at the stress task, which is clinically used for biofeedback. Psychophysiological characteristics of various diseases had been already investigated and it was found that psychophysiological hyper-reactivity is one of the characteristics of illness state. But psychophysiological characteristics of psychosomatic disorders were less well known. We investigated PSR with psychosomatie patients compared with healthy controls to clarify the characteristics. Subjects : Thirty-six patients with psychosomatic disorders who visited the Department of Psychosomatic Medicine of our Hospital and 35 healthy controls who didn't receive regular medical care were participated. Methods : Surface-electromyography (SEMG), skin temperature (TEMP), skin conductance level (SCL), nonspecific skin conductance response (SCR), blood volume pulse (BVP) and respiration (RESP) were measured with procedures of 3 steps; baseline resting period, stress period (mental arithmetic task), and post stress period. The degrees of subjective tension experienced during each period (subjective tension score; STS) were also estimated. Results : Three characteristics were found; 1) Patients with psychosomatic disorders have psychophysiological hypo-reactive stress responses to the task, 2) Pulse rate and respiratory rate was significantly higher in the baseline and post stress period, 3) STS was higher during the baseline and post stress periods in the patient group compared to the control group. Discussions : These results provide a clue to help clarify the pathology of psychosomatic diseases. We proposed a hypothesis of pathologies of the diseases to explain the results, including the concept of hypofunctional stress systems.

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Rats stressed by specific alternation of rhythm in temperature (SART) show various symptoms of disautonomia, continuous hypotension and tachycardia. In our study, we investigated postural change-induced orthostatic hypotension (OH) in SART-stressed rats. Each rat was restrained on a board in a supine position under anesthesia. In the SART-stressed rats during rest, both systolic and diastolic blood pressure (BP) were low and heart rate was fast, as in awake rats. Postural change was caused by tilting the rat's head up at a 60°angle for 4min. As indexes of OH, three values were used : (1) the maximum decrease in BP, (2) the reflex ratio, and (3) the area enclosed by the baseline and the time-related BP curve (AUC). In comparison to unstressed rats, SART-stressed rats showed the following changes : the maximum decrease in BP was significantly larger, the reflex-induced recovery from the maximum decrease in BP was significantly smaller, and the AUC was significantly larger. Heart rate in the stressed rats decreased soon after tilting, while it increased in unstressed rats. We conclude that postural change in SART-stressed rats can be used as an animal model of OH.

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Recently, the prevalence of eating disorders has remarkably increased among adolescent girls. However, an insufficient number of medical institutions provide appropriate care and treatment for eating disordered patients. The establishment of a system for prevention, early detection, and treatment is necessary. Because the onset of these disorders is especially high among adolescent girls, especially those at the age of puberty, we focused on the situation of teenagers at school, because that is where they spend most of their time. We, therefore, did an eight prefecture survey of school nurses that inquired about the risk factors, early detection methods and prevention currently in place in their schools. The survey was conducted by a self-reported questionnaire (1,197 junior and 1,055 senior high schools in 8 prefectures : from November, 2002 to June, 2003). The recovery rate was 54.7% (59.9% for junior high schools; 48.7% for senior high schools). The questionnaire asked about the eating behavior observed by school health professionals, about any current student problems that might possibly be related to known risk factors for eating disorders, and about the cooperation between schools and medical institutions. The findings were as follows : Improper eating behavior and the eating lifestyle of many students has recently increased, along with the incidence of eating disorders. A shortage of community medical institutions suitable for referral and a lack of cooperative relationships between the schools and medical institutions were noted. This study revealed for the first time the feelings of school health professionals concerning disordered eating among junior and senior high school students in Japan. As such, it is an informative step toward developing programs for the early detection of the disorder and for the establishment of countermeasures.

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In recent years, the eating disorder is diversified from childhood to middle age. Asperger's disorder attracts attention in the field of child psychiatry. We experienced two patients with anorexia nervosa (AN) who seemed to originally have Asperger's disorder. Presence of Asperger's disorder became clear for the first time after they were referred to us as AN. Based on criteria of DSM-IV, both patients were diagnosed as AN and Asperger's disorder. The specific features of Asperger's disorder contributed to the episode of AN. Social interaction, verbal and non verbal communication ability, restricted behavior, interests and activities of Asperger's disorder were considered in the therapeutic process of AN. AN with Asperger's disorder is expected to increase, and a new viewpoint is necessary for the treatment of the eating disorder.

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