"Alexisomia" is a concept proposed by Dr. Yujiro Ikemi as one of the characteristics observed in patients with psychosomatic diseases, and is difined as the condition of having difficulty in experiencing and expressing bodily feelings. Although a considerable number of papers on alexisomia have been published, there still remain many questions including-how alexisomia influences pathophysiology and which underlying characteristics alexisomia represents in individual diseases. Therefore, in the present study, we reviewed several papers on alexisomia to determine the current status of alexisomia research and to establish salient problems for future studies to address. Seventeen papers have been published so far. Alexisomic features are observed in patients with many physical diseases including diabetes mellitus, myocardial infarction, and bronchial asthma. However, definitions of alexisomia and methods to evaluate alexisomic features were inconsistent, possibly because the original definition of alexisomia given by Ikemi is vague. Furthermore, as he had made several descriptions of alexisomia, specific subcomponents of alexisomic features were different from researcher to researcher. Therefore, to pursue studies on alexisomia further, it is crucial to critically define alexisomia and to develop standardized methods to evaluate it.

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In recent years, occupational stress has increased among Japanese workers because of changes in their working environments and systems, such as organizational restructuring, or decreased consideration for others at the workplace. For example, about 60% of Japanese workers perceive stress due to interpersonal relationships, job demands, difficulty of their job, and so on. Occupational stress is extremely important for workers owing to its adverse effects on physical issues, as well as mental health, and work-related issues, such as performance, accidents, absenteeism and illnesses. It has been estimated that about 8% of workers are absent from work beyond a year because of illness. In particular, considerable attention has been paid to cardiovascular and cerebrovascular diseases, including Karoshi, and mental illnesses. The number of these diseases covered by the workers' accident compensation insurance is generally increasing in recent years. It is noteworthy that power harassment has become one of the major reasons of mental illness at the workplace. These problems are important not only for occupational doctors, but also for medical specialists, such as those in psychosomatic medicine and psychiatry. To prevent stress-related diseases and to promote individual and occupational health, the assessment of stress levels by means of an objective and quantitative method is desirable. It has been suggested that salivary alpha-amylase (sAMY) reflects sympathetic activity and is a useful stress-related biomarker, because saliva collection is easy, stress-free and noninvasive. We practiced several kinds of studies to investigate the possibility of using a hand-held monitor. The investigated levels of sAMY were not significantly changed by speech stress or mental arithmetic stress. However, the levels showed a tendency to increase in response to a color word test and decrease following relaxation using autogenic training. Inter-individual, and possibly intra-individual, differences in the reactivity of sAMY are considered to affect the results.

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Changes in today's labor environment have an impact on the onset and the course of stress-related diseases such as psychosomatic diseases and depression. When a clinician treats a patient of such disease, it is helpful to use a document called "medical certificate" for encouraging people in the workplace to recognize and understand problems of their labor environment. At the same time, early detection of worries and concerns of workers before they develop into a stress-related disease is a key issue in the mental health strategies of workplace. Changes in the labor environment weaken informal organizations in the workplace and reduce opportunities for talking about any topics among workers. In addition to "Care by line," workplaces are required to provide an environment where workers can show up for consultation of their own will.

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Since issues relating to the mental health of workers, particularly centering on depression, have been worsening, companies and organizations have taken various measures. Yet, they are struggling with judgments of reinstatement or ways of supporting workers who have suffered from mental illness. A typical problem of this sort can be seen in systems or measures of an inappropriate rehabilitation at workplaces. In order to take some actions, I would like to propose an effective use of re-work facilities outside workplaces. In fact, immediate director who becomes a core of linecare is a lay man in mental health, so it is just impossible for him or her to understand or judge in the same manner as an expert. Making up for this problem needs a perspective which distinguishes problems classifies two; "caseness" and "illness". In the occupational field, it is necessary to prioritize "caseness".

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Recently, various problems are revealed concerning the medical situation in Japan. Those are as follows: 1) insufficient number of doctors, 2) violence in hospitals, 3) medical accidents, 4) lawsuits against a medical staff, 5) biased distribution of nurses, and so on. These problems may impair the health of the medical staff because of an increase in workload and/or work-related stress among them. So we researched on the actual condition of these problems and considered as to the relationship between workload in the medical staff and these problems. Furthermore, we also considered how to promote their health. The number of doctors in Japan is not so large in OECD member countries and the number of hospitals is on the decrease in our country. According to the survey released by the Japan's Ministry of Health, Labor, and Welfare, average working time of the hospital doctor in a week was 63.3 hours. This working time is extremely longer and much more than so-called "Karhosi line" according to the Japan's Ministry of Health, Labor, and Welfare. Moreover, lawsuits against a medical staff are increasing. Judging from these actual conditions, it seems that hospital doctors are working under bad conditions and are forced heavy work. The Japanese Medical Association has reported that there are many hospital doctors with sleep disorder and there are very few hospital doctors who consult other doctors about their health conditions. Furthermore, there are not a few doctors who have consciousness of grief and think about death or suicide. Also there are doctors who are considered to need layoff and/or medication because of their depressive state. According to the report from the National Police Agency, the number of suicide in doctors was 90 in 2005, and their suicide incidence is 1.3 times as many as general people. These bad working conditions and consequent unhealthiness in hospital doctors are considered to be related to a medical policy for suppressing the total medical expenses, the latest clinical training system for doctors, and decreased mutual confidence between patients and doctors, and so on. To promote the health of hospital doctors, the countermeasure by doctors, hospitals, and area are basically necessary. But the most important countermeasure must be done by nation from a standpoint that citizen's health and life are protected by promoting health of medical staff as "human resources".

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Background: Vertiginous patients are more likely to have psychological fear according to dizziness. The psychological fear may make dizziness obstinate and greatly influences prognosis, too. Moreover, previous researches reported that improvement of QOL is not enough for the patients with depression who constitute about 10% of vertiginous patiens. Method: We provide the in-hospital group with vestibular rehabilitation in our hospital. In this study, patients received the SDS test at the time of admission, and the patients were divided into 3 groups (group-a with SDS≧50, group-b with 50>SDS≧40, group-c with SDS>40) to estimate the efficacy of group rehabilitation combined with SSRI (fluvoxamine) in group a and rehabilitation only in groups b and c. Result and Conclusion: PCS and MCS of SF8 of 3 groups improved significantly after the treatment compared with the baseline (p>0.05), but they did not reach the average score of Japanese patients. The improvement of D, A-H, and V of POMS was not observed in groups a and b. Improvement of this symptom was necessary to bring forth the enough improvement of psychological function (MCS etc.) in the depression group a that scores 50 or more and b in SDS test.

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