Stuttering is a well-known language disorder. However, most adults and children tend to misunderstand people who stutter and even specialists who consult them. Recent brain and DNA researches reveal that the cause of stuttering was not due to bad environments. And stuttering causes four times as many as social anxiety disorder. Thus, in case of consulting stuttering we should approach stuttering and social anxiety disorder.

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Purpose : Introduction of current Eating Disorder Service in the UK, which consists of glances of(1) Healthcare system in the UK, (2) Guidelines, i. e. NICE, MARSIPAN : Management of Really Sick Patients with Anorexia Nervosa & Junior-MARSIPAN, (3) Current practice in the Sussex, England. Method : This paper comprises narratives and reports gathered by writer from his clinical contacts over 3 years during he has worked in the National Health Service (NHS) as a trainee psychiatrist. Results : UK healthcare system has clear divisions between primary care and secondary care services and is mostly based on the NHS. Patients with eating disorder are usually managed by layers of multidisciplinary teams and mental healthcare teams are involved when needed. Specialized care teams for patients with eating disorder are in their embryonic stage and I introduce one of them, Family-Eating-Disorder-Service (FEDS) which started as a pilot project in the West Sussex for a supplemental intensive care team on top of community mental healthcare team service. In this paper, the Recovery model of mental healthcare was also explained in the context of UK mental healthcare service provisions. UK healthcare system is also facing the challenge of aging society with financial difficulties like Japanese one faces, and some figures of number regarding staff members and catchment population were also explained in this report which I hope will support you as a reader to grasp and compare the situation around eating disorder care in Japan.

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It has been more than 30 years since the specialized eating disorder program started in the United States. UCLA (University of California, Los Angeles) Neuropsychiatric Hospital was one of the pioneer to have started the specialized program in Southern California. Currently, UCLA has an adolescent eating disorder inpatient unit, an adolescent combined partial program, and an adult eating disorder partial program. This writer has been working on the adolescent eating disorder unit as a registered nurse since 2001. The specialized eating disorder program and the nursing care for this population at UCLA will be presented here. The program is very structured and a multidisciplinary approach is utilized. Recovery model and a relationship based care model are fundamental in our nursing care.

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Eating disorders are among the most refractory diseases in Psychosomatic Medicine. In recent years, the number of patients with eating disorders has increased in Japan. However, there are no special institutions for eating disorders in Japan. In Europe, they have special institutions for eating disorders. Therefore, we will show some institutions for eating disorders in the Netherlands and Germany, which we visited to see their treatment for patients with eating disorders. There is national eating disorder centre in Leiden, the Netherlands. Most staff members include psychologist, nurse, art therapist, physiotherapist and other staffs. Only a few number of medical doctors work in this instruction. They offer many different kinds of treatments, which are cognitive behaviour therapy, art therapy, group therapy, drama therapy, family therapy, cooking therapy, relaxation and other treatments, in in-patient, out-patient and day treatment. On the other hands, there is no special institution for eating disorders in Germany. In this country, psychosomatic medicine medical doctor, psychotherapist, nurse and other therapists (for example, art therapist, music therapist and so on) are doing treatment for eating disorders with patients in the department of psychosomatic medicine. They carry out treatment programme including many different kinds of treatments, for instance cognitive behaviour therapy, art therapy, music therapy, group therapy, cooking therapy, relaxation and other treatments in inpatient, out-patient and day treatment. In European institutions, they have multi-disciplinary approach system, so they can have different kind of treatments for eating disorder with patients.

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Multidisciplinary treatment team approach is a standard medical practice for eating disorders in the United States. The treatment approach has been widely accepted among American medical professionals. The multidisciplinary treatment team typically includes medical professionals (i.e., psychiatrists, physicians, nursing staff), registered dietitians, and mental health professionals (i.e., therapists). In addition, exercise specialists/physiologists, art therapists, and music therapists are involved as a part of the treatment team members in many eating disorder programs in the United States. It is well known that these non-medical professionals play a significant role in the treatment of eating disorders in the United States. Regardless of cultural and racial differences between the United States and Japan, there may be some benefits to learn how treatment strategies for eating disorders have been functioning in the United States. Since eating disorders have been gradually recognized as one of severe mental illnesses in Japan, it may be necessary to start discussing how the current medical practice for eating disorders in Japan can integrate new treatment approaches.

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Objectives : The aim of this study is to examine of the validity of Namake (a state of maladaptation to schoolwork) tendency scale. This study clearifies the characteristics of schoolwork, health and recognition in Namake tendency scale. Methods : Two hundred five college students (109 men and 96 women, average age 19.9±1.3 years) were analyzed for Namake tendency scale, GHQ28, POMS-Brief Form, questions about schoolwork, and Irrational Belief Scale. Results : Pearson correlation analysis found positive correlations between hedonistic, procrastinative and apathetic factors of Namake tendency scale and the rate of credits, most items of the subscales of GHQ28, POMS. Regression analysis, using the rate of credits as dependent variables, found procrastinative and apathetic factors to be negative explanatory variables. The results of path analysis found paths of procrastinative and apathetic factors had significant influences on the rate of credits. Conclusion : The results of this study indicated that Namake tendency scale was valid one. And interaction of three factors of Namake tendency scale were found to hinder adaptation to schoolwork.

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Objective : The concept of premonitory depression proposed in 1973 by Lauter suggests that a severe physical disorder can cause depression. Premonitory depression can precede discovery of a malignant tumor by a few weeks or months, particularly in the elderly. Herein, we report a case in which myelodysplastic syndrome was diagnosed during an examination for depression. Case : An 82 year-old woman experienced pain and a burning sensation in both ankles and knees in year X-3 and loss of joy and lethargy in January year X. She lost 5 kg in 3 months, but a blood test, ultrasound, upper and lower gastrointestinal endoscopy, and abdominal computed tomography scan conducted by a local physician showed no organic disorder. She was referred to our hospital in May year X. The Center for Epidemiologic Studies-Depression (CES-D) scale was 68, Self-rating Depression Scale (SDS) was 26, State-Trait Anxiety Inventory-Scale (STAI) Trait-Anxiety was 61, State-Anxiety was 70. Course: In June year X, the patient was admitted to our department for examination. She was diagnosed with depression on the basis of sadness, weight loss, insomnia, and lethargy. A blood test at admission showed 1,900/μL white blood cells, 437/μL neutrophils, 7.7g/dL hemoglobin, 143,000/μL platelets, and cytopenia in 3 systems. Blood cell loss was not caused by drug use, viral infection, or vitamin deficiency. Megakaryocytes and blast cells were detected in the peripheral blood ; as determined via bone puncture, 4.6% of total blast cells were in the bonemarrow. Myelodysplastic syndrome was diagnosed. During hospitalization, in which the patient was compromised, a supportive interview was conducted, and pain, burning, and depression symptoms declined progressively. Since her discharge from the hospital, she has not suffered any episodes of depression. Conclusion : Myelodysplastic syndrome was discovered in an elderly patient during an examination for depression. Organic diseases should be sufficiently excluded during the course of depressive disorders, especially in the elderly.

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