Objectives : Medication-overuse headache (MOH) is caused by daily use of analgesics due to severe headache such as migraine. Withdrawal therapy is the only treatment of choice for this condition. In recent study, relapse rate after successful withdrawal therapy were 38% in the first year and around 42% after 4 years, therefore the prevention of relapse is the important issue. We will report experience of treatment for 10 cases of MOH and give consideration to availability of psychosomatic approach and treatment strategy. Subjects and method : We treated 10 MOH patients not only with medication but also with lifestyle guidance, headache-education and psychosomatic approaches including accepting, supporting, reassuring, self monitoring and clarifying the outcome. Result : Eight patients were introduced into withdrawal therapy and 5 patients have been discontinuing for over one year. Another patient was able to replace ergotamine with less detrimental drugs as the second best. One case had relapsed and three patients could not be followed up because of dropout and move. Common denominators of the patient who succeeded in discontinuing drugs suggest that they understood MOH mechanisms well enough and had a spontaneous will to stop drugs. The treatment of MOH requires the following four strategic stages : Awareness-Understanding-Decision-Action. Understanding will not be insured without awareness, so it is no use making a decision without understanding. Furthermore, patient will move into action and continue it consistently when they decided of their own will, and not by doctor's direction or enforcement. The framework of this approach is based on "the discount matrix" model of transactional analysis. Conclusion : In the treatment of MOH, it is necessary to treat patients not only with medical approach but also with psychosomatic approach which can bring their spontaneity step by step without discounting important information of reality.

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Purpose : Evidences show that strong association between mood disorder such as depression and CAD prognosis. Also, physical exercise is known to improve the hostility in patients with coronary artery disease (CAD). However, little is known on the effects of physical exercise on the mood change in healthy adults with reference to gender difference. The purpose of our study is to examine how aerobic exercise affects mood states in normal subjects. Method : 62 healthy subjects (16 males, 46 females, the mean age + / -SD was 52+ / -14 with ages ranging from 20-72) were recruited by a local public relations magazine. The subjects participated in an aerobic exercise program twice a week for three months. We assessed the pre-and post-program mood with the Profile of Mood States (POMS) and classified the subjects into two groups by T-scores (the "relatively bad mood" group was defined by T score≦50 for "Vigor" and T score≧50 for other subscales). Results : The mood states seemed to improve after the aerobic program only in those with low T-score for Vigor and high T-score for other subscales of POMS. Decrease in T-score was observed in Depression-Dejection, Tension-Anxiety, Confusion and Fatigues, and Increase in T-score in Vigor were observed in female subjects. Changes in these parameters in male were also observed in a limited umber of subjects, which may not be enough to draw conclusive comments on the effect of the aerobic program for mood status in male subjects. Conclusion : Our three month-long aerobic exercise program improved the bad moods in healthy subjects. This effect might be useful for prevention against CAD.

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Background : Panic disorder is characterized by the specific type of anxiety, sudden onset and rapid peak of autonomic arousal symptoms. The diagnostic criteria for panic disorder have been accepted as a nosological entity since DSM-III. Because of the increased number of patients diagnosed as panic disorder, this entity has become the focus of much research interest around the world. Various kinds of instruments are available to evaluate panic disorder severity and treatment outcomes, which prevent researchers from making direct comparisons between various research settings and treatment strategies. To address this problem, the Panic Disorder Severity Scale (PDSS), a seven-item measure to rate overall severity of panic disorder, was developed by Shear et al., and the Japanese version of the PDSS (PDSS-J) was found to be a reliable and valid measure of panic disorder severity. The self-report version of the PDSS (PDSS-SR), which is easy to administer and can be a useful tool when an interviewer is not available, was presented and demonstrated to be a reliable format by Houck et al. Objectives : The Japanese version of the PDSS-SR (PDSS-SR-J) was developed by the back translation method, and its reliability and validity were evaluated. Subjects : The current study examined 93 consecutive outpatients at Osaka City University Medical School Hospital, who fulfilled the DSM-IV criteria for panic disorder with or without agoraphobia. Method : All subjects gave informed consent to participate in this study after explanation of its purpose and significance. Subjects were administered the PDSS-J and Clinical Global Impression-severity (CGI-S), and then were asked to complete the PDSS-SR-J. Results : A one-factor solution fitted to the data of the PDSS-SR-J as it did to those of the PDSS-J, and its internal consistency was excellent. Individual items from the PDSS-SR-J were compared to those of the PDSS-J using a weighted Kappa, showing good to moderate agreement between the two forms. The total score of the PDSS-SR-J was strongly associated with that of the PDSS-J by analyses of the intraclass correlation coefficient. Each matched item between the two formats showed the strongest correlation. Using the anchor-based approach, the total scores of the PDSS-SR-J was interpreted ; scores below 10 corresponded to "mild panic disorder", those from 10 to 14 corresponded to "moderate panic disorder", and those over 14 corresponded to "severe panic disorder". Conclusion : The PDSS-SR-J is a simple, reliable, and valid instrument to rate severity in panic disorder patients with or without agoraphobia. The sensitivity of the PDSS-SR-J for measuring change in response to treatment should be systematically tested in the near future.

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Behaviors that express one's pain experience (pain behaviors) are often a main problem in managing patients with pain disorder. In the background of such pain behaviors lurks a strong desire for dependence often due to a conflict with the patient's mother. The object of the patient's desire for dependence becomes his or her nurse. If nurses accept and sympathize with the pain behaviors only when the pain behaviors are expressed. that would cause deterioration of the pain behavior and worsen the pain disorder. Although acceptance and sympathy for complaints are "paragons of virtues" in the education of nurses, such attitudes may contribute to the secondary deterioration of pain behaviors, espedally in the treatment of patients with pain disorders. Herein we report a case of a patient who had long received emotional abuse from her mother. A medical team of doctors,nurses and a psychologist was organized and responded to her desire for dependence to empower her adaptive behavior. As a result, the patient showed a remarkable behavioral improvement. In conclusion, nurses can utilize pain disorder patients' desire for dependence rooted in psychological conflict and can play an important role in the cognitive-behavioral team approach by showing regular nurturing reactions to them, while taking neutral attitudes toward their pain behaviors.

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