In Japan, little is known about pharmacotherapy for somatoform disorders (somatic symptom and related disorders). Here, I discuss the effectiveness of pharmacotherapy for somatoform disorders on the basis of my studies and clinical experience as well as overseas studies. From a pharmacotherapy perspective, the pathologies classified under somatoform disorder include obsessive-compulsiveness, anxiety or fear, and anger. Selective serotonin-reuptake inhibitors (SSRIs) are effective in obsessive-compulsiveness. When the effect of SSRIs is inadequate, augmentation therapies with antipsychotics, especially those that have high D2 receptor affinities, may be effective. When an immediate improvement is needed, mirtazapine may be effective. Both benzodiazepine anxiolytics and SSRIs are effective in anxiety or fear. When these are not adequately effective, antipsychotics, especially multi-acting receptor-targeted antipsychotics (MARTAs), may be effective. Pregabalin can also be one of the alternatives, because it can alleviate the hyperactivity of amygdala, the nucleus associated with fear. In some cases of anger, prescription of antipsychotics, especially MARTAs, may be considered.

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The mental health of children is an important problem in the modern society. But it has been regarded as not so important at school and at home. The investigation on the mental health has gradually been carried out, and the measures have begun to be taken recently, In this discussion, we had better consider psychosomatic disorders. Here, we took up sleep disorders, eating disorders, prevention, early detection, and resilience. We should always take the cooperation with school into consideration to maintain the mental health of children.

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Nowadays, it is noteworthy that behind the mental health problems of children may exist developmental disorders such as autistic spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), learning disorder (LD). The common stress reactions of children with ASD are separation anxiety, oppositional defiant behavior, somatization such as headache, abdominal pain, exaggeration of sensory hypersensitivity and stereotypic behavior, panic, moving around and run-away from the class room, and non-attendant at school. Children with ASD have low stress tolerance, and react to stressful situation with greater emotion, so they are apt to be avoidant. However, supporters need to look at the adaptive aspect of their avoidant behavior. They also have to understand the psychological meaning of children's problematic behavior as well as ASD characteristics.

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As adolescents experience many changes both physically and mentally, therapists need to have multi-focal views to understand psychosomatic diseases in this phase. Familiarity with the developmental process of adolescence, especially identity formation, loneliness, and social isolation, will be helpful to understand this difficult phase. In addition, assessment of personal factors such as inborn traits as well as the growing environment is also helpful to understand the meanings of symptoms young patients show. Inborn traits include verbal abilities, social adaptabilities, and cognitive characteristics. The growing environment includes relationships with caregivers and possible social support. These factors are inevitable to assess and treat young patients in adolescence as well as adults.

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Recently, with the rapid increase in Internet users, Internet addiction (IA) has reportedly become a serious health and social problem. In a 2012 survey, approximately 520,000 junior and senior high school students were found to exhibit IA. People in many countries have regarded IA as a disorder. Attention deficit hyperactivity disorder (ADHD), sleeping disorders, depression, obsessive compulsive disorder, and anxiety disorder are extremely common comorbid mental disorders with IA. Some psychotherapies (e.g., cognitive behavioral therapy) and medical treatments for comorbid mental disorders as well as rehabilitation (e.g., treatment camp) are effective for IA remission. Preventive coping strategies are important for all types of dependency diseases including IA. Cooperation among medical, educational, and administrative institutions and the home environment is essential for coping with IA.

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After the number of suicide deaths had continued to exceed 30,000 per year in Japan over 14 years since 1998, it has declined from 2011, falling to below 26,000 in 2014. However, the suicide rates among juvenile and young people still remain considerably high, and "suicide" ranks as the leading cause of death in each age group between 15 and 39 years. This paper presented characteristics of suicide among juvenile and young people by referencing the National Police Agency Statistics, White Paper on Suicide Prevention, Comprehensive Measures to Prevent Suicide, and various review materials. Next to it, some of school and community-based suicide prevention activities and those implemented in medical emergency centers were presented. Then, a description was provided with respect to points that the psychiatrist might heed when treating the suicide attempter at a medical emergency center. Finally, among cases of people who attempted suicide in adolescence and young adulthood and in which the author was thereby involved, three cases were presented, in which a brief description and author's viewpoint were provided respectively.

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University students tend to face identity problems and develop mental health problems. Especially, the freshmen experience a big environmental change due to their entrance to school worrying about their new life resulting in depressive and anxiety symptoms. These symptoms at the beginning of their campus life are important issues regarding campus mental health. These symptoms are risk factors of school refusal, therefore, early detection and treatment are extremely important. The number of university students with mental health problems who visit the health service center is increasing. Many of them suffer from mental symptoms of depression, anxiety disorders, and developmental disorders. Efforts to support university students with mental health problems and to provide early detection and treatment are suggested.

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Workers with mental health disorder have been increasing in numbers. Social factors such as developing information technologies and individual factors such as philosophy are inferred to be the background of the phenomenon. Among youth in the occupational field, mental health disorders such as depression or adjustment disorder are found. Doctors are requested to treat them not only with drug therapy but with consideration of growing environment and working situation. On the other hand, the occupational health staff treat such youth with mental health disorders not from the aspect of Illness but from Caseness (the fact that workers cannot work continuously as usual). Doctors should know that judgements in occupational field differ from those in medical field, and cooperate with the occupational staff considering national guide lines and road maps which are response standards in occupational fields.

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Objective : When evaluating patients with dizziness or vertigo the most important thing to do is to listen to the patients carefully. Also sometimes it is quite helpful to use a medical interview sheet when time is limited at an outpatient clinic. There are two types of interview sheets. One involves freestyle writing, which is suitable for qualitative analysis, and the other is a scoring-type questionnaire like the Dizziness Handicap Inventory (DHI), which is suitable for quantitative analysis. In the former type, there is a space for freestyle writing in which the patients can express their requests for treatment. It is certainly important to see the written contents in free-style writing, but it may be more important to note the presence or absence of the description itself. We postulated that patient characteristics may differ depending on the presence or absence of free-style writing in their demand for treatment on the medical interview sheets. Subjective and Methods : Retrospective chart review was conducted from medical records. The participants were 555 patients complaining of dizziness or vertigo who visited our department from 2013 to 2014. We instructed them to complete both types of questionnaires immediately before the medical examination. These questionnaires were original interview sheets inviting free-style writing in which the participants could express their desire for treatment, the DHI, and a Hospital Anxiety and Depression Scale (HADS). The physician was blinded to the free-style writing. After diagnosis, patients could choose from two types of treatments : short-term (5 days) hospitalization for vestibular rehabilitation or conventional outpatient treatment. The description types were categorized depending on the contents. The participants were divided into two groups depending on the presence (Group A) or absence (Group B) of a free-style writing description in the sheet. The DHI and HADS scores and the final treatment chosen were compared across groups. Results : There were several types of free-style writing content. The scores on the DHI and levels of anxiety in the HADS were significantly higher in Group A. The patients in Group A had a greater tendency to choose short-term hospitalization treatment than did Group B (p<0.01). Conclusion : Based on the results obtained in this study, we can see the patient characteristics depending on the presence of any type of description. The presence of free-style writing on the interview sheet may reflect an assertive attitude toward the treatment and anxiety in the patient. We should focus not only on written contents but also on the presence or absence of free-style writing on the medical interview sheet.

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Background : Patients with olfactory reference syndrome (ORS) or jikoshu-sho erroneously believe that they emit malodor. In such cases that complain about flatulence malodor, the patients are convinced that they have anorectal disease, and frequently believe they have irritable bowel syndrome (IBS). Although most clinicians believe that the gastroenterological complaints of these patients are based on delusional thoughts, in the present study, we examined the abdominal symptoms of patents with ORS who complain about flatulence odor. Method : We enrolled 47 patients with ORS (20 males/27 females ; age,27.4±12.4 years) who visited our clinic. All the patients complained about flatulence malodor, although 2 patients also were concerned about body malodor. The control group comprised 82 healthy volunteers (48 males/34 females ; age, 37.3±9.7 years). All the subjects were asked to fill the original inventory for the assessment ofIBS and the related symptoms according to the Rome III criteria. Results : Abdominal pain or discomfort was observed in 42 (89%) patients with ORS; its prevalence was significantly greater than that in the control group (22 [27%] patients) (p<0.001). The prevalence of IBS in patients with ORS (53%) was significantly greater than that in the control subjects (21%, p<0.001). ORS patients with IBS showed significantly higher frequencies of straining during bowel movement, feeling of incomplete bowel movement, and sensation of anorectal obstruction/blockage as compared to the control subjects with IBS (p<0.001, for each). Although abdominal pain and the sensation of anorectal obstruction/blockage exhibited a significantly higher frequency in the ORS patients with IBS as compared to ORS patients without IBS (p<0.05), the other IBS-related symptoms did not differ among ORS patients with and without IBS. Conclusion : IBS comorbidity is high in patients with ORS who complain about flatulence malodor. It is suggested that the ORS pathophysiology may be influenced by functional bowel and anorectal disorders. We believe that the realization of this phenomenon would facilitate the acceptance of such patients' complaints and the treatment of ORS.

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