"Cancer Control Act" has been executed since April 1st, 2007. The aims of the law are to promote prevention and early detection of cancer and to facilitate general improvement of cancer treatment. The latter one includes implementation of palliative care including psychosocial aspects from the initial stage of treatment for cancer patients. Therefore, the role of psychosomatic medicine in oncology will get greater. In the present manuscript, I will show the current measures in oncology by the government in Japan. Then, I would like to discuss the role of psychosomatic medicine in oncology. Finally, I will show our liaison activity in oncology as an example of team medicine by psychosomatic physicians.

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It is essential that patients with eating disorders receive psychotherapy for acquisition of sufficient coping skills. However, eating disorders are frequently accompanied with lethal malnutrition, serious complications, and difficulties in family or social life. Therefore, patients with eating disorders require collaboration from a variety of medical departments, including emergency, internal medicine, pediatrics, obstetrics, psychosomatic medicine, and psychiatry departments, as well as primary-care physicians, therapists, dietitians, social workers and other collaborators through long-term consultations in schools or workplaces. Patients with eating disorders often repudiate to have eating disorders, appear dissociation of personalities, and suffer from starvation-induced psychological symptoms, which can disrupt the collaborative treatment. To improve the efficacy of collaborative treatment in a medical team, the doctor responsible for care should supply information using a digital chart system, and inform all staffs of the collective treatment plan. Primary-care physicians or other collaborators outside of a medical team experience difficulties in the school or workplace due to their abnormal attitudes. Therefore, if they can receive accurate information about the disease and the skills necessary to take care of patients, they can benefit treatment for eating disorders. Collaboration between physicians, specialists and other collaborators in the treatment of eating disorders might reduce the psychological burden of themselves and caregivers.

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Long-term effective continuation of the treatment for morbid obesity is often difficult. This is because a daily therapeutic fact is entrusted to the patient, even though the demand by the medical staff is a difficult task, which requires a change of everyday life as a whole as well as a change of diet. Actually the demand tends to be abstract, and it is expected that the patient is puzzled in everyday life. To give the patients appropriate measures and lead the treatment successfully, it is necessary for the medical staff to analyze detailed environment of living and eating habits, investigate a change of body weight and grasp human relations in society and family at present as well as in past. Therefore, organization of a medical care team is very important, which includes physicians, psychiatrists, nutritionists, nurses, clinical psychologists and physical therapists. For the further grasp of psychological problems of a case, personality analysis is important. We reported that "high lambda style", suggested in Rorschach test, was present significantly more in the group of obese patients with above BMI30 as compared with a healthy control group. As for the frequency, it showed a tendency to increase with aggravation of obese degree. These results may indicate the importance of psychological approach to the treatment of obesity. The most important point in the treatment by the team is that each member communalizes his/her problems and unified treatment strategies. Furthermore, the strategy must be concrete and have the long-term prospects for the future not to mention of the past or the present of the patient. Presence of the medical care team which has comprehension of a psychological approach and common recognition of patient's problems is very important for the treatment of obesity.

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For the patient with chronic pain and disability caused by pain, the orthopedic doctor considers first whether or not any organic and psycho-social/psychiatry problem exists. BS-POP (Brief Scale for Psychiatric Problems in Orthopedic Patients) was routinely used to evaluate the magnitude of psycho-social/psychiatry problem. When the patient is assessed to have some psycho-social/psychiatry problem and he accepts to go to psychiatrist, we hold a liaison conference. The members of this liaison conference consist of orthopedic doctors, a psychiatrist, nurses, and other co-medical staff. The main purpose of this conference is to share the information of patient and to confirm the policy of treatment. At the recent liaison conference, out of 32 patients 15 patients were judged as improved, 12 as no change and 5 as invalid. This clinical outcome seems to be good because all patients had been judged as intractable cases and especially, 22 of them came from various parts of Japan.

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Introduction: Barostat is an equipment for studying sensory thresholds in the gastrointestinal (GI) tract. Moreover barostat is one of the most important procedures for studying gastrointestinal function. On the other hand, barostat is so expensive that any limited facilities use barostat for research. In this study, it is examined whether functional MRI without Barostat system tolerates to evaluate brain-gut interaction in irritable bowel syndrome. Method: Eleven right-handed male subjects, aged 20-21 years, were recruited for this study. Six subjects were healthy control and 5 subjects were non-patient IBS who met the Rome II criteria for IBS. None of the subjects were on pain medications, serotonin re-uptake inhibitors, serotonin antagonists, or tricyclic antidepressants. The tube and balloon were inserted into the rectum. The rectal distention protocol consisted of 3 sets of repeated 30-seconds rectal distentions separated by a 30-seconds rest period in the following order: There was a lag time of 10 second to reach peak pressure and to deflate down to the baseline. All images were acquired on a SIGNA MR/I Echospeed 1.5T, GE. A SPM2 was used to analyze images. Result: In the control subjects, the insular cortex and the posterior cingulated cortex (PCC) were activated while in the non-patient IBS, the insular cortex, the anterior cingulated cortex (ACC), and PCC were activated. For both of the control subjects and the non-patient IBS, significant activation was observed in the insular cortex and PCC during stimulation. Conclusion: Visceral and emotional stimulation significantly correlates with activation of specific regions in the brain including the limbic system and the association cortex, especially ACC, the prefrontal cortex, and the insular cortex. This study showed that the insular cortex, ACC and PCC were activated in the visceral stimulation without Barostat system. We conclude that the distension protocol without Barostat system is one of the practical ways in evaluating the brain-gut interaction by functional MRI.

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Objectives: In recent times, there has been an increase in the number of patients with type 2 diabetes, which has become a major social concern. The purpose of this study is to obtain the basic data that can assist us in developing useful psychological support for diabetics. Subjects and Method: Seventy-one patients with type 2 diabetes were administered the Problem Areas In Diabetes (PAID) scale, and forty-nine of them were administered the Profile Of Mood States (POMS) and the Tokyo University Egogram, New Version (TEG). Results: We eliminated 6 of the 20 items in PAID that were likely to cause floor effects. Factor analysis of the remaining items revealed one factor: "the diabetes-related burden." Further, through multiple regression analysis, we investigated the relationships between the PAID scale, which we developed using items that were contributable to this factor, and the subscales of the POMS or the TEG. The results showed that the PAID scale was affected by the "Fatigue" (F) subscale of the POMS. In addition, we classified high and low groups in the total score of the PAID scale and compared the mean of the POMS T-scores of the subscales and the mean of the subscales of the TEG in each of the two groups. We found that the responses of subjects in the high-PAID groups were significantly stronger in the "Tension-Anxiety" (T-A), "Depression-Dejection" (D), and "Confusion" (C) subscales of the POMS. On the other hand, there was no relationship between the PAID scale and the TEG. Conclusion: The result of this study suggests a strong relationship between the PAID scale and the POMS. The diabetics with high scores on the PAID scale tended to have sufficiently high emotional burdens to necessitate psychological support. Therefore, the PAID scale can be used in conjunction with the POMS in order to be able to understand in detail the state of mind associated with diabetes-related burden and provide psychological support for diabetics.

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Background: While Western medicine has been based on the religious concept of the distinction between body and soul, Japanese psychosomatic medicine, on the other hand, is based on the concept of mind-body unity. The term shinshin-ichinyo (心身一如mind-body unity) has been thought to have its origin in the term shinjin-ichinyo (身心一如body-mind unity) of Dogen. However, Yuasa et al. have recently claimed that its origin is the term shinjin-ichinyo (心身一如mind-body unity) of Eisai. Method: The author consulted their original source texts and studied the meaning of both shinshin-ichinyo (心身一如) and shinjin-ichinyo (身心一如). Results: Eisai (1141-1212) had studied Buddhism in China, where he copied the Zen-on Shingi (1103), which he subsequently carried back with him to Japan. In 1198 he wrote his book the Kozengokokuron. Though the original manuscript is now lost, the text of Kozengokokuron was later published in 1666 and then disseminated after 1778. Here the expression does appear as shinjin-ichinyo (心身一如), but only in a passage on zazen quoted from the Zenon Shingi, where the phrase appeared as shinjin-ichinyo (身心一如) instead. It is thus likely that the phrase was shinjin-ichinyo (身心一如) in the original Kozengokokuron as well, and that this was mistakenly reversed to shinjin-ichinyo (心身一如) at some point between 1198 and 1666 in the course of the manuscript being copied and recopied. From the above, the author concludes that Eisai's term shinjin-ichinyo (心身一如) is not the correct origin of the term shinshin-ichinyo (心身一如). Dogen (1200-1215) used the expression shinjin-ichinyo (身心一如) in his book Shobogenzo Bendowa, written in 1231. The problem of how the first two characters 身 and 心 could have been reversed to produce the term shinshin-ichinyo (心身一如) is satisfactorily explained by the author. Historically, the expression shinjin-ichinyo (身心一如) has emphasized the first character 身, meaning body, while shinshin-ichinyo (心身一如) has emphasized the first character 心, meaning mind. Conclusion: The term shinshin-ichinyo (心身一如) has its origin in the term shinjin-ichinyo (身心一如) that was written by Dogen and probably by Eisai as well. The original meaning is shinjin-ichinyo (身心一如), with the emphasis on the first character 身, meaning body. The concept of shinjin-ichinyo (身心一如) lives on in psychosomatic medicine in Japan.

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