A closed loop formed of brain and body is understood as a dynamical system. Because it can generate informative and specific spatiotemporal patterns under the resting state condition where no sensory input, movements or cognitive tasks exist, the loop is implied to be an autonomous dynamical system. Functional connectivity analysis for resting state fMRI data revealed a disorder-specific abnormality of functional connections. Artificial intelligence techniques enabled development of disorder-specific classifier or biomarker that can generalize to external validation datasets. By combining such biomarkers and decoding techniques with fMRI real-time neurofeedback methods, sophisticated neurofeedback interventions can be developed as future generation therapies for mental and developmental disorders.

An example of regional collaboration in cancer care and palliative care centering on psychosomatic physicians is shown. It is important to engage with emphasis on making “face-visible relationship” indicated by OPTIM-study. In Nara prefecture, we are making various opportunities to discuss hospital officials, medical personnel responsible for regional medical care, patient groups, and prefectural officials on an equal footing. In addition, in order to improve the quality of palliative care, it is necessary to evaluate outcomes using PDCA and the like, and we are also promoting the efforts.

Palliative care and psycho-oncology education are enriching programs, and dissemination at academic organizations and hospitals has advanced dramatically in the last ten years. In the Basic Plan for Promotion of Cancer Countermeasures Established in 2007, “the priority goal was set up for all doctors engaged in cancer diagnosis to acquire basic knowledge and skills on palliative care.” There is no doubt that the palliation of “palliative care workshops” at cancer hospitals has backed up this development. Approximately 80,000 physicians have already taken palliative care workshops for doctors of cancer treatment. Educational programs targeting on nurses, pharmacists, rehabilitation professionals, and cancer counselors are spreading little by little. It goes without saying that education on palliative care should be the center of attitude education. The current educational program centered around management is expected to be made in the common educational system for different professions and patients, when there are not only cancer patients but also wider categories of subjects for palliative care. In order to establish an educational program useful in this field where a multi-disciplinary team approach is essential, we may have to develop an educational program that can be used regardless of occupation and the target disease of palliative care.

In palliative care, the benefits of usual drug therapies are often denied in randomized controlled trials. Psychosomatic medicine aims to deliver medical care that is appropriate to each patient, however, patients ; their families, and medical staff have to be convinced through evidence that prescribed therapies are valid. In non-randomized controlled trials, there is a possibility that the treatment effect could be underestimated or overestimated. For this reason, it is necessary to conduct multicenter randomized controlled trials in the field of psychosomatic medicine. In this paper, I would like to introduce the education of psychosomatic medicine that I received, results from clinical research in cancer pain, and issues in psychosomatic medicine which came up while training in another department. Finally, I would like to discuss how we could conduct to multicenter studies.

Collaboration between Japan and other countries includes International Psycho-Oncology Society, IPOS Federation, Asia-Pacific Psycho-Oncology Network, where Japan Psycho-Oncology Society has been committed actively. In addition, communication skill training program developed in Japan has been adopted to East Asia countries. Therefore, Japan is expected to contribute to the field of Psycho-Oncology by IPOS.

Objectives : The aim of this study is to reveal the importance of assessing the pain which is not complained through identifying the characteristics of the patients who have pain as a comorbidity of other somatic symptoms. Methods : The participants were 155 outpatients for the department of psychosomatic medicine. They were categorized into three groups which had pain as a main symptom (MS), a comorbid symptom (CS), and no pain (NP), and then the groups were compared in the Numerical Rating Scale (NRS) rating severity of chief symptoms, Profile of Mood States (POMS), and Minnesota Multiphasic Personality Inventory (MMPI). Since there were significant differences between psychosomatic disease and panic disorder on the aspect of the characteristics of the patients, the comparison was applied to 123 patients with psychosomatic disease. Results : The comparison between the participants who had pain (MS and CS) and NP indicated no significant difference in NRS and POMS, but significant elevation in MMPI scales 1, 2, 3, and 8 on participants having pain. Furthermore, the group CS was revealed to be similar to MS with the exception of scale 5 of MMPI in females. Conclusion : The patients with physical pain have tendency to be hypochondriac, depressive, somatizing, and socially isolated. Pain which is one of the important vital signs should be assessed regardless of the complaint on all patients. We should consider the patients who have pain not as chief complaint to have the similar characteristics of the patients complaining physical pain.

Objectives : In the present study, we developed a questionnaire for determining the stability of autonomic function by focusing on heart rate, which is regulated by the autonomic nervous system and varies depending on the situation. Method : A questionnaire was created based on the question items created by the researchers as well as items described by female university students as settings in which they felt tension. Responses were obtained on a five-point Likert scale. The survey was conducted on 67 adolescent female university students, along with measurement of autonomic function using the active standing test. The reliability and validity of obtained data were investigated using factor analysis and discriminant analysis. Results : A total of 18 question items were eventually selected, and they were composed of the following seven factors : “tension felt in unpredictable situations”, “tension felt when facing an academic task”, “imminent tension in interpersonal relationships”, “tension in situations where the method of coping is vague”, “tension felt when facing an unexpected event”, “tension felt when at a loss as to how to cope”, and “tension felt when deciding on an action”. Conclusion : The results showed a factor loading of 0.782-0.484, the cumulative proportion for the amount of information in the seven factors as a proportion of the amount of information in all 18 items was 69.397%, the overall discriminant accuracy was 82.1%, and reliability and validity were thus virtually confirmed.