Irritable bowel syndrome (IBS) is a representative disorder in the field of psychosomatic medicine because most of patients have stress-related pathophysiology. The publication number of IBS along the recent years is dramatically increasing. As a committee chair of guideline for IBS in the Japanese Society of Gastroenterology, the author published the evidence-based clinical practice guideline for IBS in Japanese in 2014 and in English in 2015. Evidence-based clinical practice cannot completely predict the response to the treatment in individual patient. However, if we successfully gather patients with large numbers, the response rate with high probability would be predictable from the probability density function based on the published evidence. The importance of psychosomatic medicine has mathematically been proven in the section of stress-related pathophysiology, psychological abnormality, brain imaging, psychosomatic attitude/understanding of attending physicians, diet therapy, exercise, antidepressants, and cognitive behavior therapy. As the Japanese evidence-based clinical practice guideline for IBS is highly reliable and useful, this guideline should be used in the daily care for patients with IBS.

Recently, the Japanese guideline for functional dyspepsia (FD) has been published in 2014, which introduces many papers including randomized placebo controlled studies showing accumulating evidences about the pathogenesis of FD in Japan. However, the pathogenesis of FD still remains unknown. Physiological dysfunctions of gastric acid secretion and gastrointestinal motility may cause dyspeptic symptoms. Therefore, it is focused on the efficacy of acid suppressant and prokinetic agents for the treatment of FD. In addition, it proposes the diagnostic and therapeutic flow for management of patients with dyspepsia. Although this is based on the useful data derived from multiple clinical trials, this flow alone cannot be always effective for all patients with FD. If poor outcomes occur after the recommended treatment using such standard drugs, alternative therapy is required. As a next step after the gastroenterological treatment, psychosomatic treatment is often selected. However, gastroenterologists are generally unfamiliar with psychosomatic treatment. This review summarizes the Japanese guideline for FD and proposes present clinical problems including visceral hypersensitivity in relation to the role of psychology.

Clinical guideline is a conventional summary of clinical researches of good quality in effective therapeutic approaches. However, it is not enough for a clinical practice only to follow the guideline. Doctor has to make his own decision as to whether or not follow the guideline for each patient and treat properly. Generally speaking, 40% of functional dyspepsia (FD) patients have psychosocial problems which affect their clinical conditions. Two-thirds of the FD patients with psychosocial problems have no need to be treated specifically by psychosomatists. Therefore, the training program of psychosocial management for functional disorder is needed for generalist and gastrointestinal specialist. So far such training program hasn’t existed in Japan. We psychosomatists are responsible for making this program.

The guidelines of functional gastrointestinal disease were published in 2014. In the therapy of irritable bowel syndrome (IBS), hypnosis, cognitive behavior therapy (CBT) and relaxation are recommended in the third stage. These therapeutic methods should be used actively by physicians of psychosomatic medicine, but actually only a few therapists have been trained to manage all of these methods. Judging from common sense, modern hypnosis is more flexible than the classic one and less dominant and safer than autogenic training (AT) because the therapist can use hypnotherapy tailored to individuals. However gut directed hypnotherapy (GDH) which has a lot of therapeutic evidence is a classical hypnosis. CBT adopts meditation and relaxation. So both hypnosis and CBT can treat the altered state of consciousness. In this paper, I introduce clinical evidence and essence of hypnotherapy, and AT in relation to hypnosis and CBT. I also review merits and demerits of each therapy.

Background : Nutrition therapy is the basis of treatment for type 2 diabetes, but its adherence is not easy. To support the patient’s self management, the dietitian participates in their nutrition therapy when needed as well as from when the patient has been diagnosed with diabetes. According to the position statements by the American Diabetes Association there is no standard meal plan or eating pattern of ideal percentages of carbohydrates, proteins and fats, so the nutrition therapy is specifically tailored to each patient based on their goals. Furthermore, the method of motivational interviewing (MI) by Miller and Rollnick has been applied to type 2 diabetes patients, because it helps them find motivation within themselves to follow the treatment plan which might lead to better adherence to the nutritional treatment. Method and Results : In our outpatient department 58 patients (32 men and 26 women, median age ; 65 years old) who have high HbA1c (≧7.0%) were treated by both MI and nutrition therapy from January 2014 to August 2014. Nutritional counseling by dietitians and MI by the physician were conducted several times according to each patient’s needs. The patients’ HbA1c before the study was 8.3±1.1% (mean±SD). After both the treatments, HbA1c was sustained at 7.7±1.1% during the 12 month study. In half of the patients the HbA1c decreased by over 0.5% in the same period. The number of nutrition counseling sessions might correlate to the reduction of HbA1c (p=0.0822). Conclusions : The combination of nutrition therapy and MI might be effective against the poor glycemic control of type 2 diabetes patients.

The nutritional knowledge is indispensable to understand pathophysiology and treatment for eating disorders. We should suspect the existence of binge eating disorder or night eating syndrome when we see a patient with treatment-resistant obesity or metabolic syndrome. Abnormal attitudes and behavior related eating, bulimia, emotional changes and social activities that resembled an anorexia nervosa or bulimia nervosa were recognized in the semi-starvation clinical trial of healthy men performed in the 1940s, indicating absolute proof that starvation brings abnormal psychology and behaviors. Most nutrients including vitamins and the trace elements are short in anorexia nervosa patients. Since patients with anorexia nervosa need more caloric requirement for weight maintenance than healthy women, it is hard for them to gain body weight. Short stature is an aftereffect of a patient with early pubertal onset of anorexia nervosa due to malnutrition-induced decrease in insulin-like growth factor-I. Approximately 80% of patients with anorexia nervosa of Japan are lacking in vitamin D, and are complicated with osteoporosis or osteomalacia. In re-nourished period after long-standing malnutrition, patients with anorexia nervosa are prone to reactive hypoglycemia and refeeding syndrome.

Cachexia is characterized by anorexia, weakness, weight loss, and muscle wasting. The understandings of the pathological mechanism of anorexia and muscle metabolism in view of the crosstalk between brain, gut, adipose tissue and muscle will open the new way for the management of cachexia. Cytokines-induced systemic inflammatory in cachexia causes anabolic/catabolic imbalance. Cachexia represents a continuum with three stages of clinical relevance : pre-cachexia, cachexia and refractory cachexia. In the refractory cachexia stage, the burden and risks of artificial nutritional support likely outweigh any potential benefit, and therapeutic interventions focus typically on alleviating the suffering associated with cachexia. It is important to appreciate the stage of cachexia and perform appropriate nutritional management.

Objectives : We investigated the psychosomatic aspects and psychological value attitude for sports by using Anti-Aging common Questionnaire for QOL (AAQOL) in the subjects of the masters’ athletics. Subjects and methods : Subjects were 140 masters athletics aged 64.3±12.1 years, attending the international goldmasters athletic game at Kyoto in 2013. The methods encompass collecting and analyzing of responded for questionnaires of AAQOL and psychological inquires. Results : Average exercise days were 4.10-4.25 days per week all the year round. Diet habit, self-esteem for health and satisfaction with daily life were replied in 5 degree level, indicating good to excellence evaluation. There are 4 main kinds of intentional goal for masters’ athletes (record/victory, maintaining health, recreation, communication group), resulting different responses due to age and male/female of the subjects. A value attitude of sports showed 4 kinds with the following data (male vs female) : 1) recreation type (49.5 vs 62.2%), 2) leisure type (18.5 vs 8.1%), 3) inner-worldly asceticism type (15.5 vs 5.4%), 4) agon type (12.4 vs 18.9%). Conclusion : These results suggest that our research may be the fundamental data for psychosomatic and intentional goal in masters’ athletes, and may indicate the direction of future investigation in this field.

Introduction : Psychosomatic skin disorders, such as atopic dermatitis and urticaria, are strongly influenced by stress on their onset and during their course. Group-psychotherapy may improve each patient’s ability to cope with stress and may lead to prevention of the exacerbation of skin diseases and consequently improve patients’ quality of life. However there have been only a few controlled studies until present. The purpose of this study is to understand the effect of group psychotherapy on the patients’ psychosocial aspects of life including stress coping skills, the skin symptoms and quality of life. Patients and methods : Patients with psychosomatic skin diseases were recruited at the outpatient clinic of our institute. After obtaining their consent for participating in this study, they were asked to choose the treatment group with or without group psychotherapy. The following group-psychotherapy sessions were conducted every two weeks ; session 1 (visit 1, week 0, baseline) : stressors and stress reactions, and relaxation methods ; session 2 (visit 2, week 2) : personal relationship patterns ; session 3 (visit 3, week 4) : assertive communication skills ; and a final observation (visit 4, week 8). Each session was comprised of a lecture and work following the above themes. The patients were asked to complete questionnaires at visit 1, 2, 3, and 4. The questionnaire battery included WHO-QOL26, Skindex-16, and Tri-axial Coping Scale. Results : Among 22 patients recruited, 10 patients participated in group-psychotherapy. Data from one patient without the group-psychotherapy were excluded from all statistical analyses due to the lack of the data on visit 4. The patients were all women and aged between 22 and 79 years with the mean age of 42 years. The most frequent diagnosis was atopic dermatitis (10 patients), followed by urticaria (5 patients), and others. As for quality of life, Skindex-16 scores in the emotional aspect significantly decreased in the group without group psychotherapy on visit 4. The scores of WHO-QOL26 didn’t change in both groups. Concerning stress coping strategies, the difference in scores of “resignation and abandonment (giving-up)” between visits 1 and 4 was higher in the group that underwent group-psychotherapy though the change was not significant. Conclusion : These results indicated that the group psychotherapy was useful to encourage patients to cope with stress more positively. Further investigations, including qualitative research are required to provide more evidence on the psychosocial effects of group-psychotherapy on patients with psychosomatic skin diseases. The main limitations on this study were the small participant group size and the lack of randomization in patient selection.