In modern Japan, psychosomatic diseases in children jumped in number. The Japanese Society of Psychosomatic Pediatrics, therefore, was founded in 1983 as a subcommittee of the Japan Pediatric Society by the principle that all pediatricians must learn psychosomatic medicine. Along this idea we are continuing training for general practitioners, creating standard clinical practice guidelines (GL), multicenter studies. This paper introduces the outline of pediatric practical guidelines including orthostatic dysregulation (OD), abdominal pain, headache and school absenteeism, and these are configured in a complementary manner. When we suspect a child psychosomatic diseases, it is recommended to take advantage of these GL from an early stage. Furthermore, the advanced GL for refractory OD has recently been released. Mechanisms responsible for refractory OD includes biopsychosocial factors such as (A) physical function, mental development, personality trait, (B) family relation, and (C) school life. It is recommended, therefore, that specialists evaluate the factors and develop an effective strategy. According to the treatment algorithm, you can find a new evaluation of autonomic nervous by standing test, planning treatment strategy, promotion of the acceptability of parents and advice to academic courses.

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Metabolic syndrome (MetS) was first introduced in 2005, and has now been very popular in Japan together with the special health care system targeted to the coaching of diet and exercise in MetS patients. Because MetS is recognized as a high risk group for the future cardiovascular disease (CVD), the life-style modification for the prevention of CVD is the most urgent and important issue in MetS patients. On the other hand, type 2 diabetic patients have recently become obese in spite of its stereotypically lean feature in Japan. It is thus reported that almost half portion of Japanese type diabetic patients are now complicated by MetS. Therefore, treatment for diabetes should now be performed taking the influence of the background coexistence with MetS into account, including both coaching of life-style and the selection of anti-diabetic agents. In this review, we have briefly summarized the characteristics of Japanese diabetic patients complicated by MetS from the aspect of either inflammation (atherosclerosis) or body composition. Furthermore, some anti-diabetic agents have been described with regard to its unique actions for the treatment of MetS.

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Dietary habits are a crucial part of measures against metabolic syndrome. To prevent the disease, it is best to start eating an appropriate amount of well-balanced meals at regular times at a young age. However, company employees are greatly influenced by their job situation and changes that are occurring in living environments, and according to the 2006 National Health and Nutrition Examination Survey, over 50% of men aged 40 years or older either have metabolic syndrome or are at higher risk. At Company M, in addition to providing dietary advice for such workers, it has become increasingly important to provide young workers in their 20s and 30s with dietary guidance on dining out and home meal replacement for dinner. To promote successful and continuous behavior modification among employees, we recommend a 100-kcal diet plan and provide food-related information useful at work as well as home.

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Exercise and physical activity are important to health and the prevention and treatment of many chronic diseases including metabolic syndrome. Low levels of maximal oxygen consumption are associated with high risk of chronic disease, and improvements in fitness are associated with a reduced mortality risk. Many recommendations for exercise and physical activity by professional organizations have been published. Current recommendations advise that physical exercise with light to moderate-intensity (Niko-Niko exercise) is available for improvements of obesity, hypertension, insulin resistance, and dyslipidaemia. Exercise intensity is an important determinant of the physiological responses to exercise training. Additionally, the exercise program should be modified according to an individual's habitual physical activity, preferences, health status, psychological status, exercise responses, and stated goals. Health and fitness professionals need to play an integral role in educating their clients on the benefit of physical activity and exercise, and in supporing sustained behavior change.

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Most female type 2 diabetes patients with concurrent binge-eating disorder also have problems with obesity, hyperlipidemia, and hyperglycemia, which lead to a diagnosis of metabolic syndrome. The coexistence of psychiatric disorders is common. Improvement of diabetic control is necessary, but difficult. Because such patients usually have deep psychological problems, treatment focused on the psychological aspects, such as accepting their painful feelings toward life or diabetes, is essential. The treatment course of such a case is herein presented. Sympathy for the grief of patients who do not have sufficient meaning in life to adhere their diabetes treatment regimen and the accompanying process of "mourning work" "grief work" to restore meaning to their life play an important role in the treatment of these patients.

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A 16-year-old woman was referred and admitted to our hospital with a diagnosis of anorexia nervosa. At the first visit, the patient was underweight with a BMI of 13 and had hypoglycemia. At the same time, although obvious hallucination and thinking disorder were not observed, food refusal and fear of fatness were noticed. During the course of hospitalization, the patient's minute mental symptoms such as dysesthesis, paresthesis and depersonalization became obvious along with normalization of the eating behavior. Based on these observations, the patient was diagnosed as having "at risk mental state(ARMS)" and aripiprazole was administered. Along with the treatment for eating disorder, psychological education to the family members on ARMS and guidance of familial support were conducted, and improvements of mental symptoms, eating behavior and family relationship were obtained. We reconfirmed the importance of paying attention to the possibility of coexistence of eating disorder and ARMS, and of early therapeutic intervention.

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