In 2007, the Cancer Control Act and the 1st Cancer Program Master Plan (2007-11), and then in 2013 the 2nd Master Plan (2012-16) were enacted in Japan. Studies focusing on the palliative care have been progressed since then. In accordance with the plan, we have been studying a translational research focused on the development of palliative care field. Pain control in Japan has been performed along with the "WHO three-step ladder for cancer pain control" but is still not enough for all patients with cancer pain. We have developed an animal model for assessment of intolerant cancer pain, and with this model we found that systematic infusion of low-concentration of lidocaine relieved intolerable cancer pain. In another study to find drugs effective for symptom control of cancer cachexia, we discovered that a Japanese harbal medicine "rikkunshito" was effective for improving appetite and weight loss of cancer cachexia. In addition, we have started the randomized phase II clinical study for the effects of rikkunshito on the cachexic symptoms in patients with pancreatic cancer. Diagnosis and therapies for cancer patients are up-to-date and according to such progress, the number of cancer survivors is gradually increasing. Based on the results, it is going to be very important to study improvement in QOL for cancer patients.

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Irritable bowel syndrome (IBS) is a prevalent syndrome in gastroenterology and one of stress-related disorders. IBS was conceptualized when Cannon-Bard theory on emotion formation was proposed. Onset and exacerbation of gastrointestinal symptoms in IBS under psychosocial stress were investigated with focus on signals from the brain to the gut. Corticotropin-releasing hormone (CRH) is the first substance that activates hypothalamic-pituitary-adrenal axis. Because CRH evokes IBS-like symptoms, CRH likely plays important roles in IBS. Moreover, recent progression of IBS research clarified that IBS patients have visceral hypersensitivity. Therefore, IBS research supported revival of James-Lange theory on emotion formation. The future research on IBS is in the same direction with brain science and science of genome, proteome, and microbiome. IBS is thus ideal representative disorder for research on psychosomatic medicine.

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The manifestation of lupus psychosis is characterized by the lack of 'rapport', i. e. sympathetic relationship, based on depression. As Sir William Osler once described the patient with lupus psychosis as 'the patient who imagines all sorts of things', the signs and symptoms of lupus psychosis can be a psychological state full of imagination often accompanied by innocent illusion or hallucination. The time of the onset of lupus psychosis can also be characteristic : it emerges so often after the peak of systemic disease activity when the patient resumed to recover. The pathological studies done in the patients who died in the era before institution of any modern interventions revealed no remarkable pathognomonic changes that can explain the patients' diffuse psychological manifestation. We show that interferon α (IFNα) is significantly increased in the cerebrospinal fluids of patients in a disease-specific fashion. It subsequently decreases to disappear after the resolution of lupus psychosis. Further, studies have shown that the signs and symptoms akin to lupus psychosis were raised in the patients with viral hepatitis or cancer after therapeutic administration of IFNα, and they disappeared after cessation of IFNα therapy. Thus, the findings indicate that IFNα now fulfills the triad of Koch, i. e., the cause can be found in the lesion, the cause can be extracted from the lesion, and the cause can induce same manifestation when administered again, and that IFNα causes lupus psychosis.

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In recent years a new holistic concept of the functional diseases is proposed as "Functional somatic syndrome." The term functional somatic syndrome has been applied to several related syndromes which are characterized more often by symptoms, suffering, and disability than by consistently demonstrable tissue abnormality. We can see these patients very often among outpatients in general hospital. The main diseases of this syndrome include irritable bowel syndrome, functional dyspepsia, fibromyalgia syndrome, and chronic fatigue syndrome. However, these syndromes are already established as a certain type of functional diseases, therefore some doctors think the holistic concept is of no use. Here I would like to consider the usefulness of this concept by discussing the differences between the holistic concept and other similar general concepts, such as medically unexplained symptoms, psychosomatic disease, and somatoform disorder. This concept offers the common foundation to discuss and collaborate for considering the useful treatment of the functional somatic syndrome, among doctors of different fields such as general physician, psychosomatist, psychiatrist, and specialist of the certain organ.

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Objectives : We improved the scales for measuring the frequency of self-injurious behaviors in young adults. The existing scales contained only factors about behavior and some questions of the scales were directly expressing on self-injury, which gave examinees much stress and gave bias to the results. We modified the existing scales and created new categories of the scales as psychosocial factors to improve the accuracy of the measurement. Method : We made an improved questionnaire without direct expressions on self-injury And we added new questions including psychosocial factors into the questionnaire that were expressing indirectly on self-injurious behaviors and could capture the comprehensive personalities of self-injurors. Improved scales were administered to 209 undergraduates. Improved scales and STAI (State-Trait Anxiety Inventory-JYZ), STAXI (State-Trait Anger Expression Inventory), and YGPI (Yatabe-Guilford Personality Inventory) were administered to 54 college students to test the correlation with personality. 13 samples of self-injurious behaviors in young adults were obtained and used for validation. Results Explanatory factor analysis and confirmatory factor analysis indicated that 20 questions derived from 4 categories ("Oppression state", "Self-reproach thinking", "Approval desire", and "Parent and child conflict") were most suitable to measure the tendency of self-injurious behaviors in young adults. Comparison with personality tests and an examination of seif-injurors in young adults suggested that these new scales were reliable in appropriate correlation with personality tests and were able to measure the tendency of self-injury in criterion-related validity. Conclusion : The improved scales we made were very effective to the research of self-injurious behaviors. We avoided direct expressions on self-injury and it reduced mental stress of respondents. Psychosocial factors made it possible to find the character of self-injuror comprehensively. These improved scales will reduce bias from the results of questionnaire and accordingly it is expected that the accuracy of the measurement will be enhanced.

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We experienced a case of hypothyroidism who presented acute hallucination and delirium that could be easily mistaken as schizophrenia. A 42-year old woman was admitted to our psychiatric hospital because of a sudden onset of hallucination and delusion. She was diagnosed as Hashimoto hypothyroidism because of severe hypothyroidism, presence of thyroid autoantibodies and both her sociable premorbid character and her good adjustment to society. Her mental state and hypothyroidism were improved after administration of both levothyrine sodium and risperidone. In conclusion, we recommend to evaluate the thyroid function test when the patient presents hallucination and delusion at the time of the admission to hospital.

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Purpose Patients with eating disorders, including anorexia nervosa are increasing. There are many patients who remain untreated for the longtime. We analyzed the risk factors affecting complications in patients with eating disorders. Methods : We examined 159 patients with eating disorder, who were hospitalized and treated at our department in the years from 2001 to 2010, and analyzed the risk factors of complications. Results : In our department, patients over the age of 30 were increasing. It suggested that patients untreated for a long time were increasing. The most common type was anorexia nervosa-restricting type and bulimia nervosa non-purging type showed a tendency to increase significantly. Complications of high incidence include leukopenia and mild hepatic dysfunction, and some cases had serious complications, such as disseminated intravascular coagulation, ileus. When body mass index became lower, the incidence of complications was higher. In addition, serious complications developed early in treatment. The patients with severe complications showed severe lean, BMI< 13, and severe weight loss as compared with the previous. Conclusion : To reduce the risk of complications, early detection and early treatment are most important.

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