It is well-known that Helicobacter pylori (H. pylori) infection and Non-steroidal anti-inflammatory drugs (NSAIDs) are major two risk factors of peptic ulcer, but whether or not psychological stress independently could induce peptic ulcer is still controversial. Non-H. pylori/non-NSAID ulcers can also be caused by several known risks as fellow ; viral infection, eosinophilic gastritis, Crohn’s disease, Zollinger-Ellison syndrome, and stress. Physical stress like severe injury was known independent risk of peptic ulcer. According to recent researches, psychological stress under large scale disaster was newly recognized as an independent risk factor of peptic ulcer. In seven major hospitals in Miyagi prefecture, we investigated comparison between three months after the Great East Japan Earthquake and the same length of time in 2010. The number of patients with peptic ulcer after the Great East Japan Earthquake increased 1.5 times, especially those with peptic ulcer bleed increased 2.2 times from 2010. The proportion of non-H. pylori/non-NSAID ulcers in 2011 is 24%, which is significantly higher than 13% as compared with the proportion in 2010. As a result, psychological stress after the large-scale disaster possibly induced peptic ulcer.

Japanese Red Cross Kobe Hospital was the headquarter for the Japan Red Cross disaster relief response to the Great Hanshin-Awaji Earthquake of January 1995.

In the following January, the Department of Psychosomatic Internal Medicine was established. Its objective was to offer psychosomatic care for patients who had been traumatized by the earthquake. We recognized importance of the psychosomatic medicine in the reconstruction period of the disaster while we gave the medical treatment at the stricken areas. We were engaged in relief activities in Niigata Chuetsu earthquake (2004), the derailment accident of JR Fukuchiyama Line (2005), the Great East Japan Earthquake (2011), afterwards. We associated with people who are engaged in disaster medicine. Then we keenly realized that there were needs of “the psychosomatic medicine” during all periods from the disaster acute period to the disaster reconstruction period. I put together those experiences into this manuscript.

The role of social capital in disaster restoration is gaining attention. Social capital means “society-related capital,” and it pertains to the strength of human relationships that are evaluated based on trust towards others, consciousness of mutual cooperation, network, social participation, etc. Previous studies reported low risk of onset of mental illnesses such as PTSD and depression in regions with high social capital when a disaster occurs.

The present study investigated the relationship between the social capital and mental health of evacuees from the Fukushima Daiichi Nuclear Power Plant disaster. The surveys on the elderly and on mothers raising children revealed that the higher the individual’s level of social capital was, the less likely it was for his/her mental health to worsen.

In future, it is important to implement a disaster recovery policy that incorporates methods to foster social capital.

A new system for specialists in psychosomatic internal medicine was developed with the collaboration of the Japanese Society of Psychosomatic Medicine and Japanese Society of Psychosomatic Internal Medicine. The new system is independent of these two societies and consists of ‘specialists in the subspecialty of internal medicine.’ It was named, ‘specialists in psychosomatic medicine.’ It is expected that this specialty would be accepted for registration by Japanese Medical Specialty Board. The development of this system is expected to clarify the image of specialists in psychosomatic internal medicine, their originality, as well as the independence of their field. Moreover, their relationship with the basic field of internal medicine is hoped to be developed. This article explains the new system, its history, and its future tasks.

In stress-related or psychosomatic diseases, negative emotions and physical strain persist because of psychosocial factors. Relaxation methods are techniques that ease and buffer the psychological and physiological reactions to stressful stimuli. Although psychotherapies used at large in psychosomatic medicine include relaxation techniques in a broad sense, I primarily focused on a technique used to improve physical tension in this lecture. Progressive muscle relaxation, autogenic training, biofeedback training, and breathing technique are among the main techniques used in psychosomatic medicine. A relaxed state is acquired when such techniques are used for the treatment of stress-related diseases. Furthermore, practicing relaxation methods in daily life raises awareness about the state of mind and body, helps learn self-control power, and prevents the recurrence of stress-related diseases (Matsuoka, 2006). In this lecture, I outlined a typical technique of relaxation and explained how I have used it in my psychotherapy.

This review is the summary of the Educational Symposium of the 57th Annual Conference of the Japanese Society of Psychosomatic Medicine, and sequel to the report of that of the 52th conference. At the previous conference organized five years ago, two previous studies of our own were exemplified to learn how to create and utilize EBM ; one was a meta-analysis of treatment effects of biofeedback in essential hypertension (2003), and the other was a randomized controlled study of cognitive-behavioral therapy (CBT) in hypochondriacal patients (2011). In the latter study, a total of 182 hypochondriacal participants were randomly assigned to a CBT or control group. CBT consisted of six, weekly 90-minute sessions. The control subjects received the usual medical care during the same period. Of greater interest, baseline anxiety was a significant predictor of outcome, measured in terms of reduced hypochondriacal symptoms at follow up, after controlling for the effects of depression and demographic variables. These findings are comparable to those of our previous study with a different sample which had shown that anxiety, rather than depression, was a significant predictor of the outcome of a 10-week behavioral medicine intervention combining CBT and relaxation training, even though this previous study did not include a control group. The findings are plausible in the context of the association between hypochondriais and anxiety, and more evidence is needed to clarify such relationship.

Concerning the example 1, the results of recent meta-analysis showed that there were no statistically significant findings for treatment effects of biofeedback on hypertension, suggesting that EBM continues to change according to the accumulation of literature. Concerning the example 2, it is suggested that some findings are clinically meaningful even when they are statistically insignificant. Based on these two examples, the importance of health communication and problem oriented approach is referred in this review.

Even when medical practitioners, patients, and family members experience the same medical phenomenon, their judgments over the treatment plan may differ from one another as the values through which they understand the phenomenon are varied for each person. In clinical settings, ethical issues refer to medical decision-related problems that arise from this conflict of values. When dealing with ethical issues, it is important to clearly distinguish between the fact and value judgment, and then evaluate the differences in values between the parties concerned (including oneself). In the case that the parties fail to reach an agreement on the treatment plan, one option is to use a type of service called ethics consultation. However, before taking this option, the parties can first explore how to act in the patient’s best interest, a process that does not require one to be an expert in bioethics or medical ethics. Communication techniques that have a high affinity with the field of psychosomatic medicine are an effective way to gather and organize the information necessary for forming a final decision and to facilitate deliberation between the parties.

Objectives : Adolescents with type 1 diabetes tend to have poor medication adherence and many experience difficulty in achieving their target glycemic control. However, psychological interventions to help adolescents with type 1 diabetes achieve glycemic control have not been examined. To develop an effective psychological intervention, it is necessary to clarify the psychological factors related to glycemic control in adolescents with type 1 diabetes. This study aimed to examine how psychological factors (self-efficacy, outcome-expectancy, and depression) would affect self-management behavior and HbA1c.

Methods : Participants were children and adolescents (aged 10-18 years) who were diagnosed with type 1 diabetes (male : 39, female : 38, mean age=13.50, SD=2.47). Participants provided demographic information (i. e., age and gender), as well a information about their condition (i. e., duration, comorbidity, self-monitoring of blood glucose count and HbA1c, and method of insulin administration). Participants also completed following questionnaires : 1) The short Japanese version of Self-Efficacy for Diabetes Self-Management (SEDM), 2) Outcome Expectancy of Diabetes Self-Management (OEDM), 3) Self-care Behavior Scale for type 1 diabetes, and 4) Japanese version of Children’s Depression Inventory (CDI).

Results : OEDM had sufficient reliability (OEDM-P : α=0.79, OEDM-N : α=0.77) and criterion-related validity. Hierarchical multiple regression analysis showed that self-efficacy is affecting the self-management behavior and HbA1c.

Conclusion : Adolescents with type 1 diabetes experience difficulty in achieving glycemic control due to physical and psychological factors. Results from this study clearly suggested that out of the three factors examined, self-efficacy was an important variable.

In the fields of psychosomatic medicine, we often encounter depressed patients who are resistant to treatment with conventional antidepressants. In modern western medicine, these cases are usually recognized as “treatment resistant depression” but in Kampo medicine, by using thermal therapy, we can approach some of these cases effectively.

In this paper, we will present three cases who are successfully treated with thermal therapy using Kampo medicine. Case 1 was a 66 year-old female who experienced a stoma surgery as a result of rectal cancer resection. She was suffering from depressive state, nausea and appetite loss since she had to experience the stoma management. We first administered antidepressants without any amelioration of the symptoms. Because she complained about the coldness throughout the body, we administered the combination of Shimbuto extract and Ninjinto extract. After two weeks, her appetite and depression were improved dramatically, with the sense of the whole body warmed up.

Case 2 was a 33-year-old female. Her complaints were low grade fever, diarrhea, and depressive mood. The combination of Simbuto extract and Ninjinto extract improved her fever and abdominal pain. Thereafter, we administered Tsumyakushigyakuto (decoction) in reference to the results of electrothermo-acupuncture instrument. After that, her coldness of extremities and scores of psychological tests improved markedly.

Case 3 was a 35-year-old female. She was diagnosed depression four years ago, and had administered various types of antidepressants and Kampo formula without any improvement. When she visited our outpatient department, she complained about her coldness urgently. Focusing on her subjective coldness, we changed the drug regimen to Tsumyakushigyakuto. As a result, she could go out in just two days after administration, and two weeks later, her appetite and coldness were dramatically improved. Six weeks later, she could comfortably sleep without the use of a sleep medication.

Based on our cases, it is possible that internal cold modulates not only physical symptoms but also psychological symptoms, such as depression those are treatment resistant in modern western medicine. In such cases, thermal therapy with Kampo medicine, would be an effective approach in the fields of psychosomatic medicine.