Many doctors in general practice have been embarrassed by complaints and symptoms which cannot be medically explained. These symptoms have been recently called "Medically Unexplained Symptoms ; MUS". And, from an aspect of functional disorders, a term "Functional Somatic Syndromes ; FSS" is also used. In Japan, "Psychosomatic Disease" is defined as related condition by the Japanese Society Psychosomatic Medicine. In DSM-IV, relevant condition is defined as "somatoform disorder", and it has revised as "Somatic Symptom and Related Disorder" in DSM-5. I tried to clarify the relationship between these conditions. In addition, I introduced a training program to manage these functional disorders for general practitioners in Denmark.

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The pathophysiology of the disease, chronic fatigue syndrome (CFS) has been becoming clear. Lots of people are suffering from unexplained prolonged fatigue, low grade fever, headache, myalgia, arthralgia, a sense of exhaustion, cognitive dysfunction, depression, and sleep disturbance because of CFS. Most of patients with CFS are housebound for a long time. The US Centers for Disease Control and Prevention is now responding to these issues causing by CFS. In 1998, we proposed the new hypothesis of the pathogenesis of CFS. That is, CFS can be understood to be a special condition based on the abnormality of the psycho-neuro-endocrino-immunological system caused by the psychosocial stress and some genetic components. Under these conditions, a reactivation of various kinds of herpes virus infections and/or chronic mycoplasma infection might occur as a result of immune dysfunction, causing the abnormal production of several cytokines. A distinctive feature of CFS is thought to be the secondary brain dysfunction caused by the abnormal production of such cytokines. More recently, we studied the neuroinflammation in nine CFS patients and ten healthy controls by using 11C(R)-PK11195 and positron emission tomography, and found that a neuroinflammation was present in widespread brain areas in CFS patients, and was associated with the severity of neuropsychological symptoms. In this paper, we describe not only the pathophysiology of the CFS, but also an overview of the neuro-molecular mechanisms falling into CFS.

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Fibromyalgia (FM) is a disease of the models of chronic pain characterized by the widespread muscular skeletal pain of the whole body. The patients of FM also complain various unidentified symptoms such as chronic headache, easy fatigability, hypersensitive gastrointestinal disorder, menstruation-related disorder, dizziness, tinnitus and urination disorder. Psycho-neurological symptoms include sleep disorder, nervousness, dejection, uneasiness and extensive strain. The onset and clinical course of FM involve genetic background and personal constitution as well as external factors such as mental and physical exhaustion or overload and an illness or physical traumatic event of some kind. Personality trait and distorted lifestyle and at times psychiatric disorders such as depression, bipolar disorder, anxiety disorders may be involved in the formation of the pathological condition of FM. The comorbidity of FM and mental disorder needs to be considered for understanding the condition of patient and treatment. It may be important to understand from the psychosomatic or psychiatric points of view that FM is not a single disease entity but a kind of spectrum disorder including heterogenic element. The enough and appropriate pharmacological approach to the pain is indispensable for treatment of FM, and also providing the treatment for the comorbidity of mental disorder is essential. As for the non-pharmacological approaches, receptive manner and consensual posture is necessary to support the long-term treatment of FM. To treat the problems of psychological stress and personality, psychological counseling and advanced psychotherapy such as cognitive behavioral therapy (CBT) based on the "personal growth model" may be more important. The cooperation with practitioners of psychosomatic medicine and the psychiatrist with knowledgeable skills will be likely to become most important for the treatment of comorbid mental disorders.

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Temporomandibular disorder (TMD) appears to be prone to fibromyalgia (FMS) and chronic fatigue syndrome (CFS). TMD has been most often diagnosed and treated by dentists. So dentists often encounter patients who ask for occlusal adjustments or other bite-changing procedures to treat persistent general symptoms that they believe are caused by their "wrong" occlusion. But available evidence suggests that those symptoms cannot be improved by occlusal treatments. These patients preoccupied with occlusion has been called phantom bite syndrome (PBS). It appears that a central somatosensory mechanism, rather than a peripheral structural discrepancy, is involved in PBS. Recent researches doubt whether this syndrome is truly a psychosis. Dentists should treat their occlusal discomfort in the psychosomatic way without depending excessively on psychiatrists.

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There are three relations in the cerebrospinal fluid (CSF) hypovolemia and the psychosomatic disorder : 1) Sometimes patient with CSF hypovolemic is diagnosed as the psychosomatic disorder : 2) A patient with CSF hypovolemia shows the symptom of psychosomatic disorder : 3) Treatment of psychosomatic disorder is needed in the treatment of CSF hypovolemia. CSF hypovolemia is the disease in which various symptoms such as headache, dizziness, visual disability, memory disturbance and fatigue last due to decreased CSF. There are two causes of CSF hypovolemia : spontaneous and traumatic. Diagnosis is made according to various symptoms by positional change, and the diagnostic imaging such as MRI, RI cisternography and CT myelography. The epidural blood patch is effective to stop the leakage of CSF.

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Irritable bowel syndrome (IBS) is characterized by sustained or recurrent lower gastrointestinal symptoms especially abdominal pain and abnormal bowel movement but lacks existence of organic diseases with routine clinical examinations. IBS is very common, disturbs quality of life of patients, and has high co-morbidity with depression, anxiety and somatization. Pathophysiology of IBS has been clarified by integration of digestive physiology, microbiology, genome science, neuroscience, and psychosomatic medicine. Brain-gut interactions are main features of IBS. The influence of psychological disorders in the pathology of IBS increases as the severity of IBS increases. Although a cohort study revealed that depressive or anxiety disorder is a risk factor for the development of IBS, IBS itself is not a risk factor for depressive or anxiety disorder. However, functional gastrointestinal disorder including IBS and functional dyspepsia increases the incidence of depressive or anxiety disorder. Early life trauma and alexithymia are risk factors for IBS development. In response to colorectal distention, mid cingulate, amygdala, and brain stem are more activated and dorsolateral prefrontal cortex is less activated in IBS patients. These features are also present in individuals with early life trauma or alexithymia. Depression and somatization are risk factors of developing post-infectious IBS. The fact of chronic fatigue syndrome after infectious mononucleosis and IBS after Campylobacter infection suggests organ-specific pathogenesis in these disorders. Brain dysfunction in patients with IBS, depression, anxiety, and somatization can be detectable with recent modalities. Identification of pathogenic gene and molecule of IBS are warranted in the near future.

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Objective: Although fibromyalgia (FMS) is a functional somatic syndrome (FSS), it is also a certain disease to reduce QOL greatly and sometimes to lead a patient to despair (existential vacuum). Comprehensive Health Check for Workers (CHCW) was made out for the early diagnosis of pre-symptomatic disease (unorganized disease) caused by stress. It was examined whether a FMS patient's global image could be grasped using CHCW. Object and Methods: In 78 FMS patients who suited the diagnostic criteria of ACR, CHCW was conducted and the feature was examined. CHCW was made after the whole person health/medical model (biopsychosocial-existential model). It is a questionnaire which consists of 4 categories with 30 items. Before inquiring, the approval of International Foundation of Comprehensive Medicine Ethics Committee was obtained, and the subjects consented to it. The control group included 55 absolutely healthy persons and 78 average citizens. Result: The CHCW total score was higher in the order of absolutely healthy person > average citizen > FMS (less than three years) > FMS (three years ormore). In the FMS groups, the former was statistically higher. The same result was seen even if the component of CHCW was analyzed respectively. In the latter, all the members had a treatment history. Examination of correlation with the pain VAS at the time of CHCW enforcement and the total score of CHCW showed significant negative correlation (y=-0.5952x+94.036, r=0.600884, p<0.01). Discussion: The evaluation of FMS patients by CHCW has made it clear that they had latent distortion of lifestyles. When treating FMS, not only "pain free", but also "correction" of his/her disturbed QOL and self-actualization are indispensable. Moreover, the fact that evaluation of CHCW was low in the patient group with a treatment history will suggest that there was lay a problem in the general medical treatment strategy of FMS. The total score of CHCW and the pain VAS showed negative correlation. It is considered that comprehensive assessment like CHCW may contribute greatly to pain evaluation.

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