The purpose of this study is to reveal the role of the sociocultural background played in eating disorders (EDs) in Japan based on the clinical experience of EDs. Three studies were conducted. The incidence of EDs in Kyoto University Hospital was studied from 1965 to the present time. A modified two-stage survey of EDs was carried out among the students aged 1224 in Kyoto prefecture in 1982, 1992 and 2002. The risk factors for EDs were studied. Detailed description of anorexia nervosa (AN) in Japan was first reported around 1960. The number of patients with AN has been increasing since 1970. The prevalence of bulimia nervosa (BN) has been increasing since 1980, and the recent trend shows an increase in the prevalence of binge eating disorder (BED). The overview of EDs in Japan indicated at the 1^<st> stage (1960-1980) the focus was on a participation of the family in classical AN, at 2^<nd> stage (1980-2000) on weight and diet pressure in BN and the 3^<rd> stage (2000-present time) on the awareness of female role and stress in BED.

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Little is known about the prevalence and risk factors for the development of irritable bowel syndrome (IBS) in Japan. It is reported that heredity and social learning contribute to the development of IBS. In the previous study from our laboratory, a sample of 417 adults seen for annual health screening examinations and 56 patients diagnosed as IBS by gastroenterologists were recruited to estimate the prevalence of IBS, to confirm that subjects with IBS are more likely to have parents with a history of bowel problems, and to determine whether this risk factor interacts with psychological distress. In this study, 14.2%(15.5% of females and 12.9% of males) of the community sample met the criteria for IBS diagnosis, of whom 22.0% consulted physicians. Patients and non-consulters with IBS were more likely than controls to have the parental history. Moreover, it was found that patients with such a family history show more psychological distress than other patients. These findings suggest that illness behaviors learned from parents may affect the development of IBS.

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In Japan, the subacute rehabilitation unit (SRU) was established in 2000 which aimed to provide an effective rehabilitation for post stroke patients admitted within 3 months after the brain attack. In Yufuin Koseinenkin Hospital there are 180 beds for the unit. Most patients suffer from not only physical disablement but also various mental problems. In this study we first picked up and classified the mental problems which we experienced during recent 5 years, and then we examined the prevalence of post stroke depression (PSD) and delirium using the records of patients who left the SRU during January and September of 2003. We then statistically analyzed the predictable factors related to PSD or delirium and how they influenced the result of the rehabilitation. Mental problems included a conflict against acceptance of illness, PSD, delirium, insomnia, emotional incontinence, dementia, sexual harassment, social disadvantage, physical and psychotic isolation from family, distrust against the stuff etc., among which PSD and delirium were most common complications (46% and 23%). PSD and delirium tended to increase in relation to impaired physical or cognitive function. Delirium also occurred in relation to age, damage of the right brain and severity of the dementia rating. In the SRU, psychosomatic medical doctor and clinical psychologist supported patients resolving various mental problems with the use of consultation, liaison or counseling. Although both PSD and delirium groups showed significantly longer hospitalization, early detection and proper intervention for such mental issues prevented drop out and provided significant improvement of ADL level for the post stroke patients in the SRU. These findings indicate that psychosomatic medicine which aims at whole human care should play an important role in this field.

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Kobe Red Cross Hospital was the headquarter for the Japan Red Cross disaster relief response to the Great Hanshin-Awaji Earthquake of January 1995. In January 1996, the Department of Psychosomatic Internal Medicine was established. Its objective was to offer psychosomatic care for patients who had been traumatized by the earthquake. Many disaster victims complained of physical symptoms such as autonomic imbalance, depression masked by somatic disorders, and various types of psychosomatic disorders. The Niigata-Chuetsu Earthquake occurred in October 2004. Our entire psychosomatic internal medicine staff was sent to the disaster area under the Japan Red Cross's disaster rescue plan. They learned the fact that many had needed immediate care for acute psychosomatic disorders such as common cold, hypertension, insomnia, anxiety and constipation, due to their stressful living environment. To examine the current state ten years after the earthquake, we repeated the survey that we had done 5 years earlier with our outpatients. We sent out 151 questionnaires and had a 95% response rate. To the question:"Do you think your current illness is related to the earthquake experience?" 9% of the subjects responded "Largely or directly related," and 30%"Somewhat or indirectly related," with a total affirmative response of 39%. The persentage of these 2 types of answers to the same question 5 years ago was 13, 24 and 37 respectively. The percentage rose to 62% among 62 subjects who had the most difficult experiences, such as total destruction of their residence caused by earthquake or fire, death of family members or acquaintances, being trapped or buried under rubble, or living in emergency shelters for more than one week. Of the group who had experienced grate changes in their daily lives such as moving to a new residence, job loss, job transfer or a change in the family structure, 68% thought that these were related to their illnesses. It has been ten full years since the earthquake, but we still find many complaints of various psychosomatic symptoms resulting from earthquake experiences. The victims experience the following continuous generalized or integrated pains: Physical pain from injuries and illnesses; Psychological pain such as fear, anxiety, anger or depression; Social pain from destruction of or damage to their houses, job loss, worsening of financial situation, or loss of their community; as well as Spiritual pain such as confusion about the meaning of life or wondering whether or not there is a God. In order to care for the patients with such bio-psycho-socio-spiritual pains, we must provide a comprehensive team care by networking not only with medical and psychological specialists but also with various other professions. To prevent psychosomatic disorders under such circumstances, it is necessary to have psychosomatic intervention based on the long-term plan. In other words, a great disaster means the time for us to initiate immediate bio-psycho-social medical care.

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Objective: The problems on patients' cultural background have not been sufficientry discussed in the field of psychosomatic medicine. It is often said that this is the age of globalization. Going to and coming from other countries are becoming popular. Many people from other countries live in Japan and many Japanese live overseas. In this connection, it has been reported that these people develop psychosomatic problems such as gastric ulcer and bronchial asthma under stressors which they face in other countries. Our aim is to describe the concept and meaning of transcultural psychosomatic medicine and to transmit it to the world as one of the new fields of Japan's psychosomatic medicine. Method: We introduce the concept and meaning of transcultural psychosomatic medicine by taking examples of eating disorder and other psychosomatic disorders. Result and discussion: Transcultural psychosomatic medicine is a clinical and practical medicine which deals with mind-body medical problems caused by various different cultural issues. Social and environmental changes often trigger off and aggravate psychosomatic disorders. This fact is closely related to cultural elements. Transcultural stressors work both in favorable and unfavorable directions. Eating disorder can be understood better as a culture change syndrome rather than a culture-bound syndrome. These socio-cultural changes keep a suitable psychological distance between patients and their family and can contribute to symptomatic amelioration. Conclusion: The modern psychosomatic medicine requires a transcultural viewpoint independent of and in addition to the bio-socio-ethical point of view.

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Objectives: This study evaluated the relationship between subjective sleep quality, physical activity, and psychological adjustment (anxiety or depression) in male students in an evening university. Subjects: The subjects in this study were 186 males who were freshmen in an evening university. Method: The Japanese version of the Pittsburgh Sleep Quality Index (PSQI-J) was used to measure subjective sleep quality. The subjects were rated based on the following two scales: the Physical Activity Assessment Scale (PAAS) for the measurement of exercise behavior and daily physical activity and the Japanese version of the Hospital Anxiety and Depression Scale (HADS) for the measurement of anxiety and depression. A cross sectional design was used in this study. Results: Correlational analysis revealed that lower exercise and daily physical activity correlated with longer sleep duration and more use of sleep medication, while greater daily physical activity correlated with lesser sleep disturbances and daytime dysfunction. Further, to predict the PSQI scores, a two-step hierarchical regression analysis was performed by entering anxiety and depression as a set in the first step and exercise and daily physical activity as a set in the second step. The results confirmed that exercise did not predict the PSQI scores, while daily physical activity predicted sleep duration, habitual sleep efficiency, sleep disturbances, and daytime dysfunction. Furthermore, the R^2 changes identified by the hierarchical regression analysis at the second step were significant in sleep duration and daytime dysfunction. Conclusion: In conclusion, the present study partly supported the hypothesis that physical activity was related to subjective sleep quality.

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