Kubler-Ross' concept of the psychological responses of people approaching death has the same construction as Mozart's Requiem. In fact, those psychological responses manifest not just in regard to impending death : they can also be observed in ordinary clinical settings. If we take a fresh look at the development of such symptoms as conflict, personality disorder, adjustment disorder and obsessive-compulsive eating disorder in neurotics, extra-punitive responses seen in modern-type depression, alleviated schizophrenic patients, etc., from the perspective of Kubler-Ross' five "stages of dying", we can understand that each symptom corresponds to one of those stages. Here, with regard to "mind-body correlations" in women, we investigated how the changing psychological response relates to the development of psychosomatic symptoms. We focused on acute psychosis, especially atypical psychosis, which is common in women. Particular attention was given to self-healing power, for which the hormonal cycle in women can be thought to be the engine. Borrowing from catatonia, the hormonal cycle in women has discriminatory power. If we look at the development of symptoms in terms of polarity and periodicity, we see that it is characterized by oscillation and fluctuation. We thus surmised that the hormonal cycle in women must have the power to regulate the periodicity of symptoms of atypical psychosis.

View full abstract

Background : Studies have suggested that both depression and sleep disordered breathing (SDB) are strongly associated with circulatory disease. However, the relationship between SDB and sleep or depressive symptoms is still uncertain. Methods : Cross-sectional, analytical and exploratory study. The sample consisted of 628 patients. Data were collected from consecutive adult patients referred to the Department of Cardio-Vascular Medicine, Kurume University School of Medicine Unit from May 2010 to October 2012. All patients routinely completed a comprehensive questionnaires that included question about QOL (EQ-5D), sleep habits (PSQI), subjective sleepiness (Epworth Sleepiness Scale), and depression (Patient Health Questionnaire-9). All patients were screened for SDB using pulse oximeter and were performed echocardiography. Furthermore, of the 628 patients, 250 were performed full polysomnography. Results : Depression was present in only 5.7% of patients. But the degree of the depression symptoms had associations with insomnia, QOL, sleepiness and the right ventricle afterload. SDB (AHI≧5) was present in 83.5% of patients (10.6% central [CSA], 72.9% obstructive sleep apnea [OSA]). 3%ODI (or AHI) was not correlated with PHQ-9, PSQI, ESS, QOL ; left atrial diameter (LAD) and the early mitral annular velocity (E/e) were correlated with SDB severity (p<0.001). On the other hand, most of patients (91.2%) with both heart failure and SDB did not complain of sleepiness. Of the 138 patients who meet the clinical criteria for CPAP therapy, 83 patients refused to use CPAP and the rest of 55 patients (39.9%) were prescribed CPAP The SAS patients refused to use CPAP showed significantly lower scores in ESS, PHQ-9 and obstructive apnea index than patients using CPAP. Conclusion : This study demonstrates that SDB induces a functional burden on the left atrium, while depression symptoms had association with right ventricle afterload. In the patients with heart failure, the absence of subjective sleepiness may decrease the rate of utilization of CPAP.

View full abstract

Two multi-focused studies using subjective and objective measurements were carried out so as to clarify the relationship between sleep disturbance and gastrointestinal symptoms. The subject of each study was patient with functional dyspepsia (FD) and patient with psychiatric disorders (PD) of our clinics. As the result of the study regarding patients with FD, Pittsburgh Sleep Quality Index (PSQI) did not correlate to gastrointestinal motility and abnormal gastric perception, measured by ^<13>C-acetate breathe test and drink test. Whereas, there were significant correlations between Gastro-intestinal Symptom Rating Score (GSRS), psychological scales (STAT and SDS) and PSQI score. In addition, the somatization score of Symptom Checklist-90-Revised (SCL90R : psychological symptom scale) was strongly related to FD diagnosis using the binary logistic analysis. On the other hand, as the result of the other study in terms of 128 patients with PD, the total GSRS score was significantly higher than that of healthy subjects and correlated to the total PSQI score (r=0.396, p<0.01). GSRS subscales besides diarrhea also correlated to the PSQI score. Moreover, Global Severity Index of the SCL90R was significantly correlated with PSQI score and GSRS total score (r=0.364, p<0.01). However, GSRS score did not correlate to equivalent dosages of antipsychotics, antidepressants, benzodiazepines, and antiparkinsonian. Therefore, our findings suggested that the reciprocal relationships could exist between gastrointestinal symptoms, sleep disturbance, and psychiatric symptoms. Furthermore, these mutual relations might be affected by dysfunctions of immune system and HPA-axis, which were reported as the mechanisms that may cause somatization.

View full abstract

In recent years, sleep problems including sleep disordered breathing, restless legs syndrome, and periodic limb movement disorder have been frequently reported in patients with cancer compared with the general population. Sleep problems as well as depression and pain have also recently been revealed to a strong negative impact on the quality of life of patients with cancer. Moreover, having sleep problems may increase the risk of delirium and depression. Effective intervention for sleep problems is indispensable for treating extreme anxiety when patients learn of their cancer or relapse, depression at the exhaustion due to extended struggle with cancer, and delirium in case of advanced cancer. Both pharmacological and nonpharmacological interventions in sleep disturbances have progressed over the last decade and could therefore become valuable treatment options for patients with cancer. In the context of psychosomatic medicine, intervention for sleep problems can be considered effective to restore body and mind and to facilitate the natural self-healing power of the mind.

View full abstract

Insomnia is one of the sleep disorders strongly associated with psychiatric and physical disorders such as depression, anxiety, cancer, and chronic pain. However, comorbid insomnia is typically treated using sleep medications, and psychological treatment is rarely conducted for this disorder. Cognitive behavioral therapy for primary insomnia (CBT-I) is a highly effective treatment for insomnia symptoms, and is a recommended and well-established standard-level treatment. CBT-I is traditionally conducted with four to six weekly individual treatment sessions, of 60 min each, or with six to eight weekly group-treatment sessions, of 90 min each. Recently, it has been revealed that CBT-I is effective for insomnia comorbid with psychiatric or physical disorders. This paper discusses the components of CBT-I and its effectiveness in treating primary and comorbid insomnia.

View full abstract

Background : Body image dissatisfaction (BID) tendency is a diagnostic item for an eating disorder (ED) and body checking (BC) is a behavioral feature of ED. A relationship between BID and BC has been hypothesized. It has been reported that mirror exposure (ME) is an effective intervention method for improving BID and BC. In ME, the client looks at the whole body in a mirror for about 1〜2 minutes, doing as little evaluation as possible. However, the precise relationship between BID and BC has not been shown and the cognitive processing style during ME has not been clarified. The purpose of this research was to clarify the relationship between BID and BC by using questionnaire survey, and to experimentally examine the subjective way of viewing the whole body in a mirror based on the differences in BID tendency. Method : Participants were female college students (n=382 : mean age 20.0 years, SD=1.69) attending the Waseda University, in Tokyo, Japan. Participants responded to the following questionnaires : (1) Eating Attitude Test-26 Japanese version (EAT-26), (2) Body Image Dissatisfaction measure (BID measure), and (3) Body Checking Cognitions Scale Japanese version (BCCS). Seven participants (Mean age 21.7 years, SD=5.02) who consented to the participation in an experiment were divided into two groups based on their BID measure ; namely those with an average score of 59.1, +0.5 SD were included in the high BID group (H group) and the others in the normal BID group (N group). In the experiment, participants were asked to freely look at their whole body in a mirror for 5 minutes. After that, the participants responded to a questionnaire inquiring about their feelings when looking at the mirror, as well as their usual feelings about their body. Results : In EAT-26, BID measure, and BCCS, a moderate significant positive correlation was shown, respectively (r=0.412〜0.538, p<0.01). Moreover, a weak but significant positive correlation was shown in the partial correlation of BID measure and BCCS, after controlling EAT-26 score (r=0.253, p<0.01). When the numbers of body parts that H and N groups intentionally looked at were compared using a Wilcoxon rank sum correlation test, H group inclined to look at larger numbers of body parts than N group did (p=0.0692). Similarly, H group showed a significantly larger difference represented by the absolute value between the degree of usual negative feelings about the most disliked body part and negative feelings when looking at it in a mirror than N group did (p=0.0498). Considerations : The study indicated a relationship between BID and BC regardless of ED tendency. Moreover, people with strong BID experienced different feelings when they usually think of their body and when they look at their body in a mirror. It is suggested that this could be because they avoid looking at the parts of their body resulting in negative feelings in their daily life when looking in a mirror. Conclusion This study indicated a relationship between ED and BID and BC, and a possibility that people with strong BID avoid looking at the parts of their body. Therefore, it is expected that presenting ME to people with strong BID will stop avoiding their body image and improve body image overestimation (/underestimation).

View full abstract

This study aimed to show the structure of clinical psychologist's intervention during cancer treatment in general hospital. We reported three model cases based on clinical data of a psychological consultation team in Osaka University Hospital which illustrate the flows of psychologist's intervention provided for patient, patient's family member and medical staff. In these cases, a psychological environment of patient, patient's family member and medical staff during cancer treatment were improved as the result of psychologist's intervention. Through three model cases, we found three common points required for psychological intervention ; focusing on medical compliance events, sharing information of patient and patient's family member with medical staff, and approaching based on total care viewpoint not limited to a psychological aspect. We considered that the effective and strategic intervention of providing a total care medical strategy promotes remaking a good medical staff-patient relationship. From this viewpoint, one may say that such action seems to take a part of holistic medicine provided for patients, and to support the practice of holistic medicine by the medical staff.

View full abstract