There are increasingly many cases who are suffering from mental illness or psychosomatic disorder due to the stress in the field of education. In this paper, I described the problems causing stress in the field of education and their coping methods. There are many students with developmental disorders not only in elementary and junior high schools but also in universities. Many school teachers are struggling to find a way of solving the problems and how to support them. Developmental disorders are basically communication disorders, therefore those students cause maladjustment to school. Non-attendance at school and bullying have become common problems in the field of education. Bullying has become more violent recently, taking on a social problem. Due to the spread of internet and mobile phone, "cyber bullying" is increasing. It has become a stress for teachers to deal with problematic parents, who are so-called "Monster Parents". As the results, teachers and students develop mental health problems, suffering from psychiatric and psychosomatic disorders.

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Immune responses against various neuronal auto-antigens cause encephalitis/encephalopathy with discriminative clinical features. As the first symptoms, depression, personality disorder, amnesia, insomnia, schizophrenia-like symptom occur. In many cases, cranial MRIs and CSF findings may be normal. In psychosomatic and psychiatric fields, we should pay more attention to these phenomena. Various autoantibodies are associated with autoimmune-mediated neurological disorders. Anti-Yo, Hu, Ri, Ma2, and amphiphysin are found in the paraneoplastic condition. Most of these antibodies are against intracellular antigens, and not pathogenic but diagnostic markers. A new category of treatment-responsive encephalitis has been proposed in association with antibodies to neuronal cell membrane antigens, including voltage-dependent or ligand-dependent ion channels and these related molecules. Anti-NMDA receptor encephalitis is a distinct disorder characterized by the predictable sequential development of symptoms ; prodromal symptoms are initially noted, followed by prominent psychiatric symptoms, seizures, an unresponsive/catatonic state, hypoventilation, and involuntary orofacial-limb movements. This disorder usually affects young women with ovarian teratoma but may also affect women of any age or even men. Anti-NMDA receptor encephalitis should be treated with tumor resection and immunotherapy (corticosteroids, intravenous immunoglobulin, or plasma exchange) responded faster to treatment and less frequently needed second-line immunotherapy (cyclophosphamide or rituximab, or both). Antibodies to voltage-gated potassium channels (VGKC) were first identified by radioimmunoassay of radioisotope labeled alpha-dendrotoxin-VGKCs solubilized from rabbit brain. These antibodies were found only in a proportion of patients with acquired neuromyotonia (Isaacs' syndrome). VGKC antibodies were also detected in Morvan's syndrome and in a form of autoimmune limbic encephalitis. Recent studies indicated that the "VGKC" antibodies are mainly directed toward associated proteins (for example LGI-1, CASPR-2) that complex with the VGKCs themselves. The "VGKC" antibodies are now usually known as VGKC-complex antibodies. In general, LGI-1 antibodies are most common in limbic encephalitis with SIADH. CASPR-2 antibodies are present in the majority of patients with Morvan's syndrome. These patients develop combinations of CNS symptoms, autonomic dysfunction, and peripheral nerve hyperexcitability.

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Recent advances in genetic analysis technology have enabled a surprising progress in genetic diagnosis in the field of neurological disease research. High-throughput molecular biology techniques, such as microarrays and next-generation sequencing, are the major contributors to this progress and to new discoveries. Recent genetic studies have discovered numerous causes of genetic neurological diseases, such as familial motor neuron diseases, spastic paraplegia, and inherited neuropathies. In addition, genetic causes or related factors have been reported to be associated with non-inherited diseases such as idiopathic Parkinson's disease or multiple sclerosis by genome-wide association studies. We have also noted progress in genetic diagnosis. For example, genetic studies have revealed at least 40 disease causing-genes responsible for Charcot-Marie-Tooth disease (CMT). Concomitant with the increase in the number of genes that must be screened for mutations, the labor and reagent costs for molecular genetic testing have increased significantly. Therefore, new methodology for detecting gene mutations is required. Based on the recent progress in DNA analysis methods, resequencing microarray appears to be an economical and highly sensitive method for detecting mutations. We have been screening CMT patients for mutations using originally designed microarray DNA chips since 2007. In addition, next generation genome sequencers, which are advancing rapidly, seem to be more cost effective. This system promises to be one of the most valuable methods for genetic diagnosis and also genetic research.

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The apparatus to evaluate the brain function has been improved recently. In the former psychology, the brain itself was treated as a black box. The relationship between cognitive function and lesion site was precisely examined in the neuropsychology. It has become possible nowadays to visualize working brain. It will contribute to the research for the mind and body and to the clinical treatment in the psychosomatic internal medicine.

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The elderly easily fall into multiple problems on psychological, physical, economical, and social issues in their daily lives. We have already known that their disorders are partially improved by changing their habits in daily life such as taking healthy food, supplements and medicines. However, solutions through typical medical model against aging involving dementia and chronic regressive changes are inadequate. Now we need to construct the holistic care model based on subjects of the development stages in life history such as life functional model. It seems that all clinical health care workers are demanded to change their attitude from diagnosis and therapy to spending time together as the family of society. And the all-around development in holistic care model must be achieved through this attitude. The activity on Comprehensive Geriatric Assessment : CGA is essential. Out-reaching care programs performed by multi professions are examples for that. This paper introduces the activity in Tanegashima : one of the remote islands in Japan where I was engaged in health care work for psychiatry to help future progress in the geriatric care. That is Community Oriented System of Medical Intent Care for Psychiatry : COSMIC-P. COSMIC-P named after the island's location where the "COSMIC" rockets in Japan are launched. Generally, we experience good-relationships with patients and their family, and provide good services to them. Additionally, health care workers can have better motivation to geriatric care through this activity. But income and expenditure balance is a problem when a hospital in psychiatry tries to change its form from hospitalization to care in their community. A short time summary from initial sessions to 14 months for COSMIC-P activity reveals some important and affirmative aspects in that island where the population was about 32000 people and the aging rate was estimated about 32% around 2011. The number of clients was increasing every month but finally subtle. At the last session, 74 subjects for the activity were over 65 years in 88 persons, with 58% physical complication rates. Diagnosis of the most of clients were dementia (62/74 persons) especially Alzheimer type (30/62 persons). The common degree of dementia in that group was ranged from moderate to severe, FAST stage 4 or 5. Then the care performed by the activity resulted in some improvements, CGI-I 3.5. I hope this paper shows that one of the good solutions for geriatric care in the present time is outreach care.

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A patient who had had chronic gastrointestinal symptoms went to our psychosomatic clinic after the bereavement of her close relative. The psychosomatician took charge of pharmacological and psychosomatic approaches to her somatic symptoms, and the psychologist took charge of psychotherapy for her mental problems. In this paper the psychologist reports on the progress of her treatment. The patient agreed to the publication of her case. Script analysis of TA-oriented psychotherapy was performed. Her script showed that it was worthy for her to go on living, as long as she repressed her anger and wanted to care for and please others, but the fact is that others always were not satisfied with her actual help, making her always feel unsuccessful in the end. Her repressed feelings caused her somatic symptoms. But after she verbalized her anger and need, she found she could succeed in getting what she wanted even if she did not follow her script. As a result, she became able to make relationships with her family and friends that were different from those before the treatment. Her chronic symptoms subsided and she ended medication.

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Fasting therapy (FT) has been indicated for the patients with chronic pain of psychosomatic origin. However, pain assessment in FT has heretofore been limited to subjective assessment by patients. We herein report our experience with a patient for whom pain was assessed by using Pain Vision (NIPRO Corporation), a device for quantitatively analyzing perceived pain, to record changes in the degree of pain during FT. Case : The patient was a 53-year-old man who developed persistent lower back pain, headache, and leg pain without any clear organic factors in three years. He was diagnosed with somatoform pain disorder and advised and encouraged to undergo FT as a psychosomatic approach. The patient subsequently underwent FT, which comprised a 10-day fasting period followed by a 5-day refeeding period. Pain assessment using Pain Vision was performed prior to FT, the 4^<th> and 9^<th> days of FT, and four days after the conclusion of FT. In addition, pain was also assessed using an autonomic function test (heart rate monitor SA3000P) as well as a pain scale. Results : The minimum current, which indicates the threshold value for perceived pain in assessment using Pain Vision, did not change during the study. However, the corresponding degree of pain increased from 89.2 to 614, 899, and 1607 from the beginning of FT. As for autonomic function, which was simultaneously measured, the low frequency/high frequency ratio increased from 1.127 to 2.427, 3.438, and 15.729. Scores on the pain scale for each measurement point were 7/10, 2/10, 2/10, and 5/10, respectively. Conclusion : These findings suggest that the effects of autonomic function were involved in the mechanism of the present disorder. In addition, Pain Vision enabled objective measurement of changes in the degree of pain during FT, and may be applied in the future in various assessments of chronic pain, including in combination with pain scales.

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