There are a lot of patients referred to the department of psychosomatic medicine complaining severe pain with a prolonged and chronic clinical course. Because various psychosocial stress factors in addition to the physical back-ground participate in the onset of chronic pain, the diagnosis and treatment tend to be complicated and difficult. For desirable treatment, it is important not only for physicians but also for psychotherapist to understand pain patient from physiological and psychosocial points of view. As the chronic pain is often a pathologic reaction against the stress and the correlation between physical symptoms and psychological stress factors is observed, the chronic pain can be regarded as a representative form of psychosomatic disease. Psychological reactions such as anxiety, anger, depression, hypersensitivity, or irritation experienced in our life or daily living are often related to the onset of chronic pain and sometimes modulate the state of illness very dramatically. To know the mechanism of perception of pain or pain control system is essential. To expect more definite efficacy in the medical treatment or psychotherapy, it is important to understand the psychosocial condition of chronic pain through the proficient history taking or appropriate psychological examination. Because the ordinary general analgesics are not effective, a combination of antidepressants or anticonvulsants may be more effective for the pharmacological treatment of such a chronic pain. Application of opioid agents is becoming another choice gradually these days. For the resolving and treatment of their emotional stress and personality problems, various combinations of pharmacological and psychosomatic approach such as cognitive behavioral therapy, transactional analysis, brief psychotherapy and other specialized psychotherapies are expected to be contributory. We conclude that consideration from the viewpoint of psychosomatic medicine is indispensable to the evaluation of pathogenesis and treatment of intractable chronic pain.

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This paper focuses on the pain in fibromyalgia patients and discusses the characteristics of the pain felt all over the body. It emphasizes the importance of a multi angle treatment, including methods of alleviating the pain and of orienting patients towards a regular everyday life. It also discusses the influence of various forms of patient behavior - behavior triggered by pain, by excessive patience, and by avoidance patterns - on the self-management of the pain. From a cognitive behavioral standpoint, we also experimented with the clinical application of this treatment to Fibromyalgia patients, using self-assessment tools focused on self-cognizance induced by pain, expression of emotions, and problems of behavior. The result obtained was as follows. At the stage of the self-evaluation of pain, the patients acquired the skill of verbally describing to others what the pain feels like, which led them to better understand the pain. At the stage of the self-management of pain, identifying the causes of the pain was helpful in clarifying the goals of the treatment, as well as in the prevention of pain. Adopting an at-a-glance self-assessment sheet in which patients could record their self-evaluation of the pain and a self-management plan of pain has enabled us to realize that the "unmanageable pain" mentioned by patients in daily consultation was indeed a psychosomatic symptom caused by interrelated factors of the body and the mind, which thus required psychosomatic treatment.

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Adults usually perceive pain to be physical ! however children do not differentiate between heart pain and body pain. Children's pains imply not only sharp physical pain, but various pains such as mental pain or "anxious feelings" of strain from the environment. To evaluate such pains objectively and to understand them correctly, the consideration on their developmental ages is inadequate. Furthermore, if the child produces physical jitters from a sense of fear at medical examination, parents and doctors often will not acknowledge that pain because it is not a "sharp" physical pain caused by a particular functional disease or injury. The child's response to such a lack of empathy might cause a psychological condition of "self-doubt" and "self-inadequacy". Then the child might say "I should not say that I have such a pain" even when the pain does exist and consequently he loses "positive self-image and self-confidence". The situation of such an "embarrassing pain" leaves behind a problem of parent-child relationship at home as well as a difficulty in giving precise treatment. In understanding children's "embarrassing pain", the existing scale is useful, but we utilize the drawing using the human form at our Hospital and Clinics. In this paper, the author presents actual cases of this method with some comments on children's "embarrassing pain".

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The purpose of this study was to explore the factor structure of the Japanese version of Interpersonal Sensitivity Measure (J-IPSM). The J-IPSM assesses the tendency for being sensitive to rejection (interpersonal rejection sensitivity). This study comprised 301 undergraduate students who completed the J-IPSM. The J-IPSM included 27 items loading on 5 factors - "fear of breakup of a relationship", "unassertive interpersonal behavior due to fear of hurting others", "fear of criticism by others", "discrepancy between social self-image and true self-image", and "obsequence to others". The internal consistency of the scale and each subscale explored by the factor analysis were suffi-ciently high (α=0.78-0.91). Furthermore, among atypical depressive patients, the scores of J-IPSM correlated strongly with the score of the self-reported measures of depressive symptoms. The J-IPSM, therefore, may be highly valid and potential for clinical and research applications. Finally, differences in the results of original IPSM and J-IPSM were discussed from the viewpoint of culture.

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Purpose: It has been reported that medical schools have a higher suicide rate than other faculties and depression and suicide among doctors and nurses is becoming a social problem. The purpose of this research was to conduct mental health surveys by the medical and nursing education and training process and to determine the current situation and develop a suicide prevention program based on early intervention for those at risk due to depression. The subjects consist of medical and nursing students as well as the interns and nurses, who are in the first year on the job. Subjects and method : First-, third- and fifth-year medical students and first- and third-year nursing students were surveyed in April using the Self-rating Depression Scale (SDS). Interns and nurses in their first year of employment were surveyed in April and June and again in March the following year using the SDS and General Health Questionnaire 30 (GHQ30) in addition to the Brief Job Stress Questionnaire (BJSQ) and a survey of their working hours. Interviews were conducted with participants whose SDS score of 50 or more indicated that they might be in a depressive state. Results: While few of the medical students showed signs of depression, after three months as interns, approximately 20% of the trainee doctors were suspected of being in a depressive state due to the burden of high qualitative demands. Among the nurses and nursing students, depression was suspected in 20% of the students in their third year of study, which involves practical nursing experience, and in 30% of the nurses, both when surveyed in June in their first year of employment and also in March the following year, due to the high qualitative and physical demands of their work. Conclusion: Having identified the periods during the medical and nursing education and training process when depression is likely to occur, this research could lead to suicide prevention through timely use of mental health surveys and intervention, enabling early diagnosis and treatment.

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Our hospital is a disaster medical center located 44 kms from the Fukushima Daiichi Nuclear Power Station (FDNPS). We report two cases of nurses who were not able to carry out their duties immediately after the nuclear accident. Case 1: A 32-year-old female nurse had been working after the nuclear accident. She sometimes experienced palpitation. On March 14, her parents took refuge at their relative's home in another district. After that, she had strong anxiety. She visited our department accompanied by her chief nurse in the morning of March 15. It appeared that she was not able to control her emotions. Her blood pressure was elevated to 175/104 mmHg. She was diagnosed as having acute stress reaction. Anti-anxiety medicine was prescribed, and she was instructed to take rest and to stay with her parents. After two weeks, she visited our clinic again and said that "I feel almost no anxiety now and I want to return to work and apologize to my colleagues for leaving the hospital". She returned to work at the same ward on April 18. Case 2 : A 24-year-old female nurse became mentally unstable and said that she wanted to quit her job on March 24. Her chief nurse brought her to our department. The patient said that two senior colleagues had not come to work on March 15 and that she was deeply shocked. She had loss of appetite, insomnia, and fatigue. She said, "Today, I am panicky and dizzy and I feel I don't care about anything". She was diagnosed as being in a burned-out state and was recommended to take days off. However she refused to take days off saying that "If I take days off, I will become the same as voluntary evacuees, and so I would rather quit my job". After consulting with the chief nurse, she was given three days off as a working shift and we prescribed her sleeping pills. She was given supportive psychotherapy and earned the gratitude of the chief nurse and nursing director by her work after nuclear accident. Without taking a sick leave, she recovered completely in three weeks. After the nuclear accident at FDNPS, our hospital staff had intense psychological stress due to the fear of radioactivity and the conflict relating to voluntary evacuation.

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In recent years, the measured return to work on the issue of prolonged depression is one of the most important problems. In this paper, we clarified the psychosocial factors that inhibit the return to work in prolonged depression through three cases, and approached them with a psychosocial way for the return to work. The purpose of this study is to investigate its progress, effect and to adding discussions. Objects are three patients of prolonged depression who visited our hospital. We analyzed interventions, psychological tests and interviews. Interviews and tests of three patients suggested that factors inhibiting the return to work involve images of the fear from trauma (interpersonal / company). Therefore, we made the following intervention. (1) Improvement of life rhythm, (2) Graded exposure for the company phobia and going out phobia, (3) Modification of the cognition such as perfection with discussions and a diary, (4) Improvement of sleep rhythm. Consequently, three patients who had been unable to return to work with only phar-macotherapy were able to return to work making satisfactory progress. It is necessary to assess images of fear from trauma and approach to behaviors and cognitions for prolonged depression. Therefore, it is important to combine phar-acotherapy and psychosocial approach.

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