The Department of Psychosomatic Internal Medicine of our hospital has been conducting the following activities in response to the needs of our society. 1. Crisis Intervention to Prevent Suicides : The 3rd emergency medical care center attached to the hospital deals with seriously injured patients who have attempted suicide. We endeavor to prevent the recurrence of such attempts by introducing the patients and family members to a psychiatrist at the earliest possible stage. 2. Grief Care Education : We are engaged in the education and furthering of the concept of "grief care," with lectures on this concept having been made available not only to medical professionals, but also to medical service workers, health nurses, welfare service workers and all the other local related support groups personnel as well as the general public. 3. Disaster Medicine Intervention in the Acute Phase : The Amagasaki JR Derailment Accident made it painfully clear that the perspectives of victims' families should be taken into full consideration when providing care, even at the phase immediately after disasters. We and emergency physicians and forensic medical experts have therefore come together to organize study sessions around the theme of grief care in times of disaster. Individuals who are engaged in psychosomatic medicine should be mindful of the need to respond to diverse needs of society when working in their own areas of expertise and related fields.

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Recently in Japan, distrust for medical care of the nation becomes inveterate. Mass communication has reported almost day after day that actions of medical researchers and medical doctors have been brought into question. I think that in the background there may be an omission (or defect) of the therapeutic self among medical researchers and doctors. The idea of "therapeutic self" was announced by J. G. Watkins. He stated therapeutic self from two sides, "doing (what to do)" and "being (how to be)". And he thought "being" is more important than "doing". It brings the human happiness to improve "doing" (progress such as cures). However, there is a dangerous problem. If persons neglect an aspect of "being" as a medical worker, they will act inappropriately and bring a disadvantage to patients. Medical students and medical workers have to learn about therapeutic self and recognize the importance of therapeutic self. I think that the meaning of "social needs for medical care" is for people to be able to use good medical care appropriately. To meet social needs for medical care, it is important that persons who are engaged in psychosomatic medicine take the lead in enlightening importance of therapeutic self to medical students and medical workers and aiming at reconstructing the relationship between patients and medical workers.

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The social requirements concerning psychosomatic medicine are considered to lie in the importance of psychosomatic medicine itself, because it seems that little is known about an idea of psychosomatic medicine by general public. The significance of psychosomatic medicine, I think, consists of establishment of good patient-physician relationships, and higher effectiveness of the treatment for psychosomatic disorders. These characteristics may make patients who visit a department of psychosomatic medicine relax at the consulting room, and be satisfied with the treatment they received. Furthermore, the cognition and behavior of patients who received psychosomatic treatment may alter a great deal. Another essential element of the psychosomatic medicine is that the target symptoms are physical symptoms especially caused by somatic diseases. I suppose that the ideal model of the department of psychosomatic medicine is that staff consists of various clinical specialists who also have received adequate training on psychosomatic medicine. Educational function accordingly becomes more important in the department of psychosomatic medicine, that is to say, the educated clinical specialists start psychosomatic approaches in their clinical fields. As a result, psychosomatic approach will be generalized. For the development of psychosomatic medicine, we must disseminate information about the nature of psychosomatic medicine to people, and promote the idea that psychosomatic approach will be done by primary care physician. To actualize this promotion, it is necessary for the members such as authorized physicians by Japanese Society of Psychosomatic Medicine to play an active part in enlightening psychosomatic medicine at their local areas.

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Objectives : There are various things that the society demands from psychosomatic medical care. The school psychosomatic medical care is naturally included in part of them. The measures toward the problems of mind and body including psychosomatic disorders in schools these days seem to be an urgent issue. By taking this opportunity, we would like to address how we can meet the social needs through the attempts that Nishi-Kobe medical center is making in the field of school psychosomatic medical care. Methods : We will introduce the practice and results which psychosomatic medical care can contribute to school teachers through case conferences, study meetings, seminars, and often team medical care programs which Nishi-Kobe medical center offers. Results : We have practiced school psychosomatic medical care through the case conferences (which we started for the purpose of taking away the boundaries of school health instructors between junior high school and senior high school), the infant case study meetings (where a place is offered to discuss how to grasp the minds and bodies of infants), Nishi-Kobe children's psychosomatic disease study meeting (people with various occupations gather and discuss recent topics of psychosomatic medicines through a case study), the study meeting in cooperation with the Board of Education (a teacher presents a case), seminars to school counselors and teachers, participation of school health instructors to the team medical care that we developed in our hospital. In these meetings, the wide topics of psychosomatic care such as asthma, a irritable colon syndrome, eating disorder, and brief therapy were discussed. By these practices, we were able to contribute not only to specific treatment and collaboration but also to the personnel training. Conclusions : In the school psychosomatic medical care, what we should do is to practice in wide collaboration with school teachers. By doing so, we believe we could train talented people and eventually that will lead us to meet the needs of society, and schools in particular.

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Objective : Depression is known to be an important complication in patients with rheumatoid arthritis (RA). Availability of Infliximab (Ifx) treatment for RA is high. Therefore we determined whether depressive states of RA patients are improved by Ifx treatment. Method : We performed Self-rating Depression Scales (SDS) and disease activity score 28 (DAS28 ESR4) to 10 RA patients using Ifx treatment before and after treatment for 2,6,14,22 and 30 weeks. We compared SDS with DAS28 before and after Ifx treatment and reviewed. Nineteen patients started methotrexate (MTX) monotherapy as a control group. Analysis methods included repeated measure analysis of variance (ANOVA) , Mann-Whitney's U test and Fisher's exact probability test by Stat View, ver5.0 (SAS company Co. Ltd.). Results : No significant difference was found in the two groups as to age, sex and dosage of steroid by Mann-Whitney's U test and Fisher's exact probability test. SDS and DAS28 before treatment also showed no significant difference in the two groups. Comparison of SDS in the two groups showed no interaction (p=0.779) in both groups and variation between individuals and intra-subject variation showed significant difference (p=0.006 and p=0.001) according to the repeated measure analysis of variance (ANOVA). However when DAS28 was compared in the two groups, interaction was found (p=0.001). Not yet being scientifically accurate, Ifx showed no significant difference in variation between individuals (p=0.456), but significant difference in intra-subject variation (p=0.001). Conclusion : Although this is a pilot study, it is suggested that Ifx may improve depressive state by decreasing disease activities of RA by way of direct action to the central nerve system.

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