Recently it becomes more important to provide an appropriate psychological treatment for patients with cancer in Japan. Adjustment disorder, major depression and delirium are commonly seen among patients with advanced cancer. Although these patients often require mental care, they are overlooked in clinical practice. Therefore it is important to pay attention to the existence of psychological symptoms in the treatment of these patients. I would like to show the assessment and treatment of psychological symptoms in patients with cancer.

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Evidence-based medicine (EBM) is the integration of best external evidence with clinical expertise and patient values. The full-blown practice of EBM comprises the following 5 steps ; 1. converting the need for information (e.g. diagnosis, prognosis, therapy, and prevention) into an answerable question, 2. tracking down the best evidence with which to answer that question, 3. critically appraising that evidence for its validity, impact, and applicability, 4. integrating the critical appraisal with our clinical expertise and with the patient's unique biology, values and circumstances, and 5. evaluating our effectiveness and efficiency in executing steps 1 to 4 and seeking ways to improve them both for next time. Psychosomatic medicine is comprised of different approaches including internal medicine, psychiatry, behavioral medicine, psychology, and sociology, and it should be recognized and applied in the mainstream of medicine, and many researchers and practitioners are needed to be involved in establishing the EBM of psychosomatic medicine. In the education program at the 52th Annual Conference of the Japanese Society of Psychosomatic Medicine, two previous studies of our own were exemplified to learn how to create and utilize EBM ; one was a meta-analysis of treatment effects of biofeedback in essential hypertension (2003), and the other was a randomized controlled study of cognitive-behavioral therapy (CBT) in hypochondriacal patients (2011). In the latter study, a total of 182 hypochondriacal participants were randomly assigned to a CBT or control group. CBT consisted of six, weekly 90-minute sessions. The control subjects received the usual medical care during the same period. Of greater interest, baseline anxiety was a significant predictor of outcome, measured in terms of reduced hypochondriacal symptoms at follow up, after controlling for the effects of depression and demographic variables. These findings are comparable to those of our previous study with a different sample (2001) which had shown that anxiety, rather than depression, was a significant predictor of the outcome of a 10-week behavioral medicine intervention combining CBT and relaxation training, even though this previous study did not include a control group. The findings are plausible in the context of the association between hypochondriais and anxiety, and more evidence is needed to clarify such relationship.

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One might say that ethical issues in medicine come down to questions of decision-making that arise from conflicts between differing value systems in clinical settings. The purpose of learning about medical ethics is to obtain the "tools" -the concepts and frameworks of thinking- to employ when considering these questions. If these tools allow us to verbalize and organize the issues faced, and share and discuss problems and ideas among the medical team, it could be possible to identify the best option available. This paper focuses on the background of biomedical ethics, ranging from the Hippocratic Oath of ancient Greece to contemporary "bioethics" and "medical ethics," and the "Four Principles" (of respect for autonomy, nonmaleficence, beneficence, and justice), which represent one "tool," which we will critically analyze in view of actual cases. Learning about the basics of bioethics does not change the fact that decisionmaking is difficult when relationships between practitioners are emotionally strained and urgency is important. The key is not to avoid the difficulty of decision-making, but rather to learn and utilize the tools necessary to experience distress along with the patient and family members, while always searching out the better option.

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Background : It is pointed out that aging and the delaying healing among eating disorder (eating disorder ; ED) patients have generalized, which could affect their marriage and having children. Method: We examined the problems of social life in ED patients and non-ED patients at our hospital. We analyzed 175 female patients with ages between 30 to 49 who visited our hospital and divided them into 82 ED patients (ED group) and 93 non-ED patients (non ED group). Statistical analysis was done by χ^2 analysis on marital status and child's presence. Result : The marital rate was lower in all of the ED group compared to the non ED group. The divorce rate showed no significant difference. The ED group had a significant lower rate of having children regardless of marital history. Conclusion : We found the possibility of delaying healing exerting a significant influence upon marriage and having children in ED patients.

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Objectives : To contribute to developing a strategy to prevent depression in the community-dwelling elderly, this study examined the relationship between depressive state, and physical, social and spiritual factors in this population. Subjects and Method : A questionnaire was completed during a semi-structured interview conducted in participants' homes or community centers between November and December 2010. Participants were among residents aged 65 years or older living in the community (n=475) in Village A, Okinawa, who were randomly stratified by age, sex, and community listed in the basic resident register. Univariate or multiple logistic regression analysis was performed to assess the association of factors with depressive state, with the Geriatric Depression Scale-5 score as the independent variable and basic attributes, spirituality rating scale score, quality of life-related health score, provided support, and received support as the dependent variables. Results : As a result, 31% of the subjects were classified as depressive state. Univariate analysis showed that high age, bereaved, unmarried, living alone, low subjective economic status, low income (<2 million yen/year), low physical health, low spirituality, low provided support, and low received support were associated with depressive state. After adjusting for age, family structure, subjective economic status, and income, multiple logistic regression analysis revealed that physical health and spirituality were significantly associated with depressive state. Conclusion : These results indicate the importance of physical health and spirituality to the prevention of depression among the community-dwelling elderly in order to maintain and improve their mental health, and suggest especially the usefulness of spirituality for the development task "loss and integration" in old age.

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Background : Although mental health issues of human service professionals working in the fields of medicine, education and welfare has gained attention in recent years, the number of human service professionals on sick leave has been increasing year by year. Many researches on emotional burdens and burn-out of nurses and teachers have been conducted, finding the needs for reducing work burdens and the importance of social support. Few researches have been conducted, however, on the nature of the support in paying attention to how human service professionals sense and articulate helping situations. In this research, an approach utilizing Focusing was carried out to support human service professionals. Focusing involves articulating the felt sense, a bodily sensation that is hard to put into words and not yet clear, but which is a distinct feel of a certain issue or situation. The purpose of this research was to examine the characteristics of the support where human service professionals use Focusing to sense and articulate the helping situations. Method : Focusing sessions were conducted with all 5 Occupational Health Nurses (OHN) working in a manufacturing corporation. 3 Focusing sessions and 2 semi-structured interviews were also conducted for each OHN. The OHN gave feedback about the Focusing sessions in writing after each session. Each Focusing session was approximately 50 to 60 min in length. All sessions were recorded and transcripts were made. The characteristics of support specific to the Focusing process were examined from these transcripts. Results and Discussion : After carefully reviewing the transcripts of focusing sessions and feedbacks from OHN, the following 5 characteristics were elaborated : 1) the benefit of individual support ; 2) the possibility of supporting OHN without disclosing personal information about clients ; 3) the support provided by being listen to ; 4) the enhancement of OHN's understanding of the relationships with clients and facilitating change in them ; 5) the enhancement of the understanding of OHN themselves. Conclusions : This study showed the possibility that Focusing is effective as a method to support psychosomatic health of human service professionals.

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