Objectives: In this study, the relationship between Ego-Shift patterns and Basic Positions about self and others based on Transactional Analysis was examined in order to understand the Self and total control over one's ego states. The Ego-Shift pattern refers to the shift of ego states [CP (Critical Parent), NP (Nurturing Parent), A (Adult), FC (Free Child), AC (Adapted Child)] from the first step (which is aroused on facing a new transactional situation) to the final step (which is one's response to each situation). Methods: Ninety-one university students (34 males, 57 females) had structured interviews so as to study the change in their feeling and thinking as a result of the change in their situation. They were also requested to choose one ego state among the five that expressed fit with their own feeling and thinking. Subjects indicated Ego-Shift pattern responses in 60 different situations. Their Basic Position was then assessed using TAOK. Results: Validity of the scenes was examined, using the chi-square test. All of them showed expected ego state except one of the CP-caused scenes. Additionally, the means of TAOK according to the Ego-Shift patterns were calculated. NP (permitting and encouraging) ego state related to the "I'm OK" and the "You're OK" scales. The shifts to A (rational and logical) and FC (optimistic and positive) demonstrated high scores on the "I'm OK" scale. Conclusions: The scenes causing each ego state were clarified; our study is important study for the purpose of examining total control over one's ego states. The "permitting and encouraging" ego state, the "gathering facts and considering alternatives" Ego-Shift, and also the "creating and playing" Ego-Shift were related to the healthy functional ego states.

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Objectives: We carried out a study with an aim to verify if: (1) there is a difference in respiratory responses between near-fatal asthma (NFA) patients and Non-NFA patients; (2) there is a difference in psychological characteristics between NFA patients and Non-NFA patients relating to respiratory responses. Subjects: The study population included 10 patients (5 NFA and 5 Non-NFA) referred from the outpatient clinic of Niigata University Medical and Dental Hospital. Method: We examined whether or not dyspnea and chemosensitivity to hypoxia and hypercapnia and resistive load are different between NFA patients and Non-NFA patients. Patients were administered a self-rated psychological measures, including the Japanese version of the Hospital Anxiety and Depression Scale (HADS). Results: The mean value of visual analog scale (VAS) (perception of dyspnea) during resistive loaded breathing was significantly higher in NFA patients than in Non-NFA patients (p=0.00). There was a relation between maximal values of VAS and both anxiety (r=-0.51) and depression (r=-0.67) during resistive loaded breathing in Non-NFA patients. The mean value of slope of the minute ventilation (V_E) (Change in V_E/Change in VAS) was significantly lower (p=0.03) in NFA patients than in Non-NFA patients during resistive loaded breathing. The mean value of duty ratio in hyperoxic hypercapnic responses was significantly higher in NFA patients than in Non-NFA patients (p=0.00). There was a relation between values of VAS and values of duty ratio in hyperoxic hypercapnic responses in NFA patients (r=0.82). Conclusion: These results have clinical implications for managing asthma. We need to know the characteristics of perception of dyspnea in asthma.

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Objective, Methods: The purpose of this study was to clarify the clinical features of outpatients diagnosed as Somatoform Disorder (SFD) (F45) by ICD-10. In a retrospective study, 130 outpatients with SFD, who visited the psychosomatic outpatient clinic at a university hospital between January 2001 and December 2002, were examined through medical records on subtype diagnosis, trigger, modalities of treatment, and clinical outcome. Results: 1) Fifty nine (45.4%) were diagnosed as undifferentiated somatoform disorder, and 19 (14.6%) autonomic dysfunction. 2) The major trigger was interpersonal conflict (38, 32.8%), unclear (30, 25.9%), physical illness (21, 18.1%) and cumulative occupational fatigue (18, 15.5%) 3) Among the medicated patients, 57 (68.7%) of them were prescribed only anxiolytics and 11 (13.3%) anxiolytics and antidepressants. Concerning psychotherapy, 90 (77.6%) of the patients received only supportive psychotherapy, and 17 (14.7%) combined the intervention of environmental stressors. 4) The outcome was as follows: Thirty-two (24.6%) had dropped out after first consulting, 54 (41.5%) of the patients were unchanged, and 30 (23.1 %) showed improvement in symptoms. The percentage of "unclear" in the group drop-outs after first consulting is the highest of the three outcomes. The patients who were unchanged followed two clinical courses. Patients in one group stopped the treatment in short term, while patients in another continued in long term. The latter had improvements soon after first consulting, but they could not maintain those conditions. The major triggers in patients who showed improvement were 'cumulative occupational fatigue' and 'interpersonal conflict'. Conclusion: There is some sort of relationship between patients with obvious trigger and outcome. It seems that they could easily understand mind-body correlation and are expected to continue the psychosomatic treatment. It is important for unchanged patients to have improvement once soon after first consulting. Most of the patients had improvement soon after first consulting, while some patients required more than three months until their symptoms improved.

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Insulin resistance is central to the pathogenesis of NASH and is also frequently observed in patients with depression. A 32-year-old woman began treatment for a major depressive disorder when she was 27. She was mildly obese (BMI of 26.7 kg/m^2) and had hypertriglycemia (406 mg/dl) and normal fasting plasma glucose value. Mild elevation of serum levels of transaminases (AST, 32 IU/l; ALT, 32 IU/l) was detected. Both hepatitis B surface antigen and anti-hepatitis C virus antibody were seronegative. Abdominal ultrasonography showed typical fatty liver. She had not been drinking alcohol. Her depression was treated with tricyclic antidepressants, an anti-anxiety drug, levomepromazine and a hypnotic. Her depressive symptoms gradually improved and she was able to begin working after two years. Her serum levels of transaminases has been remained within normal limits. After 5 years, her depression was aggravated by life events (marital conflict and her sister's diagnosis of and surgery for a brain tumor). She also gained weight (BMI of 30.2 kg/m^2) because of stress-related overeating. Her serum levels of transaminases increased (AST, 174 IU/l; ALT, 183 IU/l). She was referred to the Department of Gastroenterology, and a liver biopsy was performed. Liver specimens showed macrovesicular steatosis (>30% hepatocytes), hepatocellular ballooning, pericellular and perivenular fibrosis, and Mallory bodies, and she was diagnosed as having NASH. She was negative for antinuclear antibody. Although a 75 g oral glucose tolerance test showed a normal glucose profile, hyperinsulinemia and insulin resistance (homeostasis model assessment index: 2.28) were found. Treatment with pioglitazone (30 mg daily) resulted in normalization of serum aminotransferase levels. Aggravation of depression, which was induced by stressful life events, might have been a factor in the development of steatohepatitis from fatty liver in this case.

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