Clinical guideline of functional dyspepsia, which is among representative psychosomatic diseases, has been published from the Japanese Society of Gastroenterology in April, 2014. The guideline 2014 includes 63 clinical questions (QCs), which are critical in general medical practice, and describes statements and recommendation levels for respective CQs in terms of concept/definition/epidemiology, pathology, diagnosis, treatment, and prognosis/comorbidity (overlap). The diagnostic and therapeutic flowchart in guideline 2014 shows acid suppressant and/or prokinetic agents as an initial line, and anti-depressant and/or anxiolytics as a second in regard to drug selection. Psychosomatic therapies (eg, autogenic training, cognitive-behavioral therapy, hypnotherapy, etc) have been recommended in refractory cases by the ordinary care and those are closely related to psychosocial factor (s). In addition, these should be performed by the specialists. The practical system in which the psychosomatic therapies are precisely done might be warranted.

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Evidence-based clinical practice guideline for irritable bowel syndrome (IBS) was published in Japanese in 2014 and in English in 2015. Sixty-two clinical questions (CQs) were set for concept, definition, epidemiology, pathophysiology, diagnosis, treatment, prognosis, and complications. Three to 10 key words per CQ were selected and articles were searched from the publication in the medical databases from 1983 to 2011. Evidence body consisted of more than one article was set for one CQ and it was evaluated as A : high, B : moderate, C : low and D : very low, evidence. Statement was made for based on evidence. For diagnosis and treatment, the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) wad judged as GRADE 1 : strong recommendation to do it, GRADE 2 : weak recommendation to do it, GRADE 2 : weak recommendation not to do it, and GRADE 1 : strong recommendation not to do it. Psychosomatic aspects and treatments play important roles in the IBS guideline in 2014. Appropriate use of this guideline will raise the probability to improving symptoms in patients with IBS.

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To improve the quality of the diagnosis and treatment of eating disorders, the Japan Society for Eating Disorders established a Guideline Development Group, which reviewed the evidence and developed the practice guideline for the treatment of patients with eating disorders based on internationally recognized guideline development methodology, described in Medical Information Network Distribution Service. This guideline is targeted for all parties concerned in the treatment of eating disorders, such as psychiatrists, physicians, psychologists, nurses, school nurses and so on. This guideline provides the information on the procedure from diagnosis to treatment；the method of assessments at the first examination, case formulation and the choice of specific treatments for eating disorders. This guideline is contrived to reveal the actual circumstances on the treatment of patients with eating disorders in Japan. The results of the study on the criteria for the recovery from eating disorders and outcome study in Japan are described in this guideline. This guideline was published from Igaku Shoin in February, 2012.

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The guideline of management of chronic headache was published from mainly Japanese Headache Society in 2006. This guideline contained the content of clinical questions and explanations. This guideline was used in dealing with mechanism, diagnosis and treatment for the doctors who manage the headaches. Since the change of the therapy for headaches, the guideline was revised in 2013. The psychosomatic approach was mentioned as one of the important therapies in the guideline. There can be two clinical questions, such as “Is cognitive-behavioral therapy effective for primary headaches?” and “Do anxiety and depression coexist with primary headaches?” in the guideline.

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To promote evidence-based diabetes treatment, the Japan Diabetes Society (JDS) publishes “Evidence-based Practice Guidelines for the Treatment of Diabetes in Japan”. The first edition was published in 2004, with revised editions released every three years since. The latest version was published in 2013. The JDS publishes another set of guidelines related to diabetes, the “Treatment Guide for Diabetes”. This is written based on the first mentioned guidelines and is intended to spread the latest scientific findings widely to all doctors in the clinical diabetes field in a style that is understandable and easy for non-specialists to incorporate in their practices. On the other hand, the Certification Board for Diabetes Education publishes “Guidebook of Diabetes Education”, which devotes pages to the details of psychology and behavior of diabetes patients. This paper introduces the newest contents and reviews the psychosomatic aspects of diabetes as presented in these guidelines.

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Current guidelines for management of atopic dermatitis are published on the Japanese Journal of Dermatology in 2009. In the guidelines, definition, diagnostic criteria, severity classifications and recommended treatment are described in detail. In severity classification, evaluation of itch and quality of life of the patients (Japanese version of Skindex-16 and DLQI) are introduced besides classification of affected area and eruption severity. This indicates that atopic dermatitis is not only dermatological disorder but has psychosomatic aspect. In the treatment, topical corticosteroids and oral antihisitamines are described in detail. As for psychosomatic treatment, it is located as a complementary method or in case of severe or intractable patients.

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Introduction : The vestibular dysfunction is one of the most important causes of vertigo or dizziness. Many of the cases spontaneously recover without any specific intervention, however some patients suffer from persistent and intractable dizziness despite conventional therapy. In this study we investigated the factors associated with intractable dizziness among the patients with persistent dizziness. Subject and Methods : This cross-sectional study was conducted in a medical center in 2012. Our study participants were 210 adult patients (mean age, 65 years) who were hospitalized due to intensive therapy for persistent dizziness lasting at least 3 months despite conventional therapy at outpatient clinic. The patients were asked about gender, age, job, educational background, and four psychological inventories, based on self-administered questionnaire on the first day of hospitalization before the introduction of intensive therapy. The psychological inventories included Somatosensory Catastrophizing Scale (SSCS), Somatosensory Amplification Scale, Medical Symptom Checklist, and Self-rating Depression Scale (SDS). We defined intractable dizziness when a patient perceived dizziness once a week or more. We investigated what factors were associated with the intractable dizziness by statistical methods. Result : The patients were more likely to be young (p=0.001), have jobs (p=0.001), high educational backgrounds (p=0.013), and high scores on SSCS (p<0.0001) and SDS (p=0.049). Multivariate logistic regression analyses performed in two models where total SSCS score was included (model 1) and where five components of SSCS were included (model 2), found that patients were more likely to have intractable dizziness by approximately 3 folds when patients had work (OR 3.47, 95%CI : 1.51-8.00 in model 1 and OR 3.18, 95%CI : 1.36-7.45 in model 2), and by 3% in one unit increase of SSCS total scores (95%CI : 1.01-1.05) and by 11% in one unit increase of the second component of SSCS (95%CI : 1.03-1.19) (handicap of daily activity) adjusting for age. Discussion : The result of this study suggested that intractable dizziness might be associated with somatosensory catastrophizing perception. Among other associated variables, being at work may require future investigation of psychological stress at work.

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Objectives : We are facilitating a yoga therapy group for people with Eating Disorder (ED). This is a case-study of yoga therapy as an effective intervention for a participant of the group whose main complaint was feeling inconsistency between mental and physical conditions after she had recovered from binge eating and purging. Overview of Yoga Therapy : Yoga Therapy is a system of psychotherapy that aims to increase physical, mental, social and spiritual health. It has its own pathology, therapy and instruction theory, techniques, philosophy, and theory of what comprises human beings. Panca Kosa, or the “Five Layered Existence,” is yoga's unique theory of humans as beings comprised of five layers. Yoga Therapy's pathogenic mechanism is based on this structural understanding. It is consistent with the pathogenic mechanisms in modern psychosomatic medicine. Participant/case study : Housewife in her 40's. 160cm. BMI over 30. Previously diagnosed as an eating disorder, but had no active symptoms at the beginning of this yoga therapy program. Main complaint was a sense of inconsistency between mind and body. Method : Yoga Therapy sessions were held once a week for 90 minutes each session. The program lasted 3 months. The program consisted of asanas, pranayama, meditation, and psycho-education. The yoga therapist paid particular attention to the participant's alexisomia (the condition of having difficulty in feeling physical sensations) and emphasized physical interventions. Psycho-education was incorporated into the yoga therapy program, which brought attention to changing physical sensations using slow movements. This was a practice in accepting the physical condition “here and now” and is similar to other mindfulness-based practices. Results : After the 3-month program, POMS results (T%) were as follows : Tension-Anxiety (50→41%) ; Depression-Dejection (66→48%) ; Anger-Hostility (51→42%) ; Vigor (53→48%) ; Fatigue (47→38%) ; Confusion (49→40%). The Shitsu-taikan-sho Scale results decreased significantly (70→52 pts). From the above results, improvements in mood states and alexisomia were inferred. In addition, the participant felt improvement in subjective physical symptoms. She expressed feeling more consistency between body and mind. There was also time for feedback about her awareness and experiences after each session. Conclusion : Yoga therapy's combination of physical and mental approaches facilitated improved physical awareness, and it was effective for this participant to alleviate alexisomia and the sense of inconsistency between body and mind. Another advantage of yoga therapy is that it can be practiced on one's own, making it a good practice for self care. In this way, because somatic aspects play such a large role in eating disorder pathology, yoga therapy's intervention in both body and mind is effective at the various stages of prevention, recovery, and recurrence of eating disorders.

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