Irritable bowel syndrome (IBS) is a common disorder characterized by abdominal pain in the setting of altered perception of visceral stimuli. Visceral hyperalgesia occurs in the absence of detectable organic disease in the peripheral organs and may cause normal or physiologic contractions to be perceived as painful. Although the pathogenesis of IBS remains speculative and is probably multifactorial, a prevailing paradigm is that transient noxious events lead to sensitization of the neural pain circuit, despite complete resolution of the initiating event. This opened the door to the study of many other factors that contribute to the clinical expression of these disorders, including visceral hypersensitivity, sensitization, altered mucosal immunity, and dysfunction in brain-gut regulatory processes. New knowledge has been gained in areas of genetics, central nervous system and enteric nervous system neurotransmitters of motility, sensitivity and secretion, the effect of altered mucosal inflammation on cytokine and paracrine activation, and neural sensitization, postinfectious disorders, the influence of psychologic stress on gut functioning. A central concept to these mechanisms is the development of hyperexcitability of neurons in the dorsal horn, which can develop either in response to peripheral tissue irritation or in response to descending influences originating in the brainstem. Taking clinical characteristics and the concept of central hyperexcitability into account, a model is proposed by which abdominal pain from inflammatory, colonic distention stimulus, and conditions of the IBS.

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Several features of irritable bowel syndrome (IBS) suggest involvement of the emotional limbic system in the brain. Abnormalities which upregulate afferent signal intensity anywhere in this system, from the gastrointestinal tract to the brain, could induce hypersensitivity, leading to the pain and discomfort in IBS. Functional gastrointestinal disorders are likely to be heterogeneous given the complexity of the afferent system, and a number of different perturbations are possible. Intestinal hypersensitivity to pain and discomfort might explain the symptoms of functional bowel diseases. Recent breakthroughs in the neurophysiology of visceral perception and emotion are providing a series of plausible mechanisms to explain the development of hyperalgesia within the human gastrointestinal tract. Taking clinical characteristics and the concept of central sensitization into account, a model is proposed by which visceral perception and emotion from colonic distention and stimulus conditioning.

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1. At the 47^<th> Annual Congress of the Japanese Society of Psychosomatic Medicine, I had the opportunity to give the President's lecture entitled "The 30year History of the Department of Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo". The University of Tokyo's Department of Psychosomatic Medicine (within the Graduate School of Medicine) was established at the branch hospital of the University of Tokyo in 1972. At that time, key players in the hospital were associate professor Hitoshi Ishikawa and department manager, Takenori Kikuchi. After Dr. Ishikawa became the first professor at the Department of Psychosomatic Medicine, he introduced five principles of cybernetics in psychosomatic medicine, developed the TEG (Tokyo University Egogram), and established cybernation therapy. In addition, he proposed "Awareness and Self-control Medicine", served as director of the Japanese Society of Psychosomatic Medicine, was Chairman of the editorial board for the Japanese Journal of Psychosomatic Medicine, and was executive director of the 4^<th> World Congress of Psychosomatic Medicine (the 4^<th> WCPM; chaired by Dr. Ikemi, in Kyoto in 1977). Furthermore, he contributed to the accession of the Japanese Society of Psychosomatic Medicine to the Japanese Association of Medical Sciences. 2. As the third professor of the Department of Psychosomatic Medicine, I attended, as a committee member, the WHO's World Study Group of Panic Disorder (chaired by Dr. G. Klerman) and World Study Group of Eating Disorder (chaired by Dr. B. Liana). In Japan, I hosted the Psychosomatic Symposium in Tokyo for three consecutive years. In addition, I participated in the integration of the main and branch hospitals of the University of Tokyo Hospital, as well as established the Psychosomatic Medicine Ward. Furthermore, in 2005, I served as the chair of the Organizing Committee of the 18^<th> WCPM in Kobe. 3. Finally, from recent studies, the following 4 topics were reviewed: 1) Mind-body correlation matrix, 2) Regional brain glucose metabolism in patients with panic disorder at rest using PET, 3) Ecological Momentary Assessment (EMA) , and 4) The development of diagnostic criteria for mild depression.

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Background: The influence of obsessive compulsive symptoms on subjective Quality of Life (QOL) among the woman nursing staff has been scarcely studied. Subject and methods: We examined the correlations of the scores on the Toronto Alexithiymia Scale (TAS-20) with the scores on the Maudsley Obsessive Compulsive Inventory (MOCI). We also assessed the influence of obsessive compulsive symptoms measured by the MOCI or depressive symptoms by the Zung Self-rating Depression Scale (SDS) on subjective QOL by the Brief Version of World Health Organization Quality of Life Assessment (WHO-QOL26) in the staff of 221 female nursing at a general hospital. The correlations of the MOCI or the SDS scores with the WHO-QOL26 total (t-QOL) and the domain scores ("physical", "psychological", "social", and "environmental" domains) were assessed by Spearman rank-correlations. Results: The TAS-20 total scores and the subfactor scores of "Difficulty identifying feelings", and "Difficulty describing feelings" positively correlated with the MOCI scores. Spearman rank-correlations showed negative correlations of the t-QOL with the MOCI and the SDS scores. The MOCI scores revealed significant negative correlations with "physical" and "psychological" but no correlation with "social" and "environmental", though the SDS scores showed significant negative correlations with each domain. The MOCI scores revealed significant negativecorrelations with the t-QOL only in the group in their twenties but the SDS scores showed significant negative correlations with the t-QOL in the group ranging from twenties to fifties. Only in over-fifties-group the MOCI scores revealed positive correlations with "social" domain. Conclusions: Among Japanese female nursing staff in the present study, alexithiymia by the TAS-20 affects on obsessive compulsive symptoms by the MOCI. Both obsessive compulsive symptoms and depressive symptoms had negative effects on their subjective QOL. While depressive symptoms showed negative correlations withsubjective QOL in each age bracket and on each domain, obsessive compulsive symptoms had negative correlations on the subjective QOL only in the younger age group and just on subjective "physical" and "psychological" well-beings. Obsessive compulsive symptoms would improve subjective "social" functioning in the mature age group.

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Objectives: Benzodiazepines are remarkably useful drugs for psychological illnesses. However, because of dependency and withdrawal symptoms, it is difficult for the patients to stop taking the medication once it is started. The purpose of the present study was to determine the tendency of benzodiazepine prescriptions at a university teaching hospital setting and clinical characteristics of patients in long-term prescription for benzodiazepines. Subjects: This cross-sectional study was performed by using data from the database of a computer ordering system at our university hospital. Subjects were 34422 outpatients (female ratio: 52%) who visited the university hospital and were prescribed some kind of drugs between July 2002 and June 2003. Method: The prevalence of patients receiving benzodiazepines was estimated and they were further categorized into two groups (a long-term group prescribed 4 months or longer, and a short-term group prescribed 3 months or shorter). Clinical characteristics were compared between the two groups including patients' sex and age, department clinics visited ('internal medicine', 'surgery', 'psychiatry', and 'others'), kind of benzodiazepines (anxiolytics and hypnotics), and their pharmacological half-life ('ultra-short', 'short', 'intermediate', 'long', and 'ultra-long'). Statistical analyses were performed based on chi-square test. In the long-term group, the patterns of prescription among department clinics from the perspective of pharmacological half-life were additionally investigated in anxiolytics and hypnotics. Results: Among the 34422 patients, 5959 patients (17%) were prescribed benzodiazepines during the study period: 4135 receiving anxiolytics and 3209 receiving hypnotics. The long-term group included 4470 patients (female 58%, mean age 59±17 years) and the short-term group included 1489 patients (female 61%, mean age 50±18 years). Compared to the short-term group, the proportion of male patients was higher (p=0.025) and patients' age was older (p<0.0001) in the long-term group. With regard to department clinics visited, patients prescribed at 'internal medicine' department and 'other' groups were more likely to have long-term prescription, compared with 'psychiatry' department group. Anxiolytics were found to be more frequently prescribed in the short-term group whereas hypnotics were more prescribed in the long-term group regardless of pharmacological half-life. In the long-term group, those in the 'psychiatry' group were more likely to prescribe 'intermediate' half-life agent, while those in the 'internal medicine', 'surgery', and 'other' groups were more likely to use short agent (p<0.0001 in both anxiolytics and hypnotics). Conclusion: Long-term use of benzodiazepines causes adverse effects which lead to serious health problem in the elderly. The future implications of the present study are that physicians should prescribe benzodiazepines based on appropriate mental assessment and that such rational prescription should be included in educational program at a university hospital setting and needs to be carefully monitored.

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