Neurogenesis occurs dramatically in embryonic stages and continues throughout life in certain brain regions including the hippocampus. Postnatal neurogenesis can be influenced by environmental factors ; neurogenesis is increased by voluntary exercise and reduced by stress in animal models. Various molecules such as intrinsic transcription factors and extrinsic growth factors, cytokines, fatty acids, and nucleic acids are involved in neurogenesis. We have noticed in rodent models that decrease in hippocampal neurogenesis can be a cause for impaired sensorimotor gating, an endophenotype for schizophrenia, scored by prepulse inhibition test. We were able to prove in mice that decreasing neurogenesis by administration of anti-proliferative drug during the critical adolescent stage can induce sensorimotor gating impairment, anxiety, and hyperactivity. We could rescue these phenotypes by introducing enriched environment (i.e., raising multiple mice in a large cage equipped with a running wheel and toys etc.) during the period including the critical stage, whereas we could only rescue hyperactivity if we introduced the enriched environment excluding the critical stage. We consider that neurogenesis can be a potential target for therapeutics and intervention for psychiatric diseases. Better elucidation of neurogenesis, as well as related gliogenesis (more precisely, proliferation and differentiation of oligodendrocyte precursor cells), can lead to our understanding resilience against mental illness in future.

The advent of functional neuroimaging around 30 years ago has made it possible to visualize invisible stress conditions as brain activities. In particular, the neuroimaging studies have made a great contribution to understand the pathophysiology in the field of psychosomatic medicine, psychiatry, and psychology. In the traditional brain mapping approach, we observed brain activity during psycho-cognitive tasks performance or physical condition such as pain. We investigate the brain areas that associated with some clinical states or clinical symptoms. Although it is a very interesting tool for elucidating the pathophysiology of the diseases, there has been a question how useful the neuroimaging is in the actual clinical situation. Recently a new approach using machine learning has changed brain imaging analysis dramatically. With the methods using machine leaning, the brain activity can predict the outcome, for example, feeling of pain or some clinical outcomes. Therefore, we can use this methods for diagnosis of some state from brain activity. Using the new technique by machine learning, a multivariate pattern analysis may provide new possibility to use the neuroimaging for clinical diagnosis and/or quantitative prediction of clinical outcome. We introduce some recent studies which adapted machine leaning to clinical settings.

Recent epidemiological studies have reported that diabetes mellitus is associated with an increased risk of the development of Alzheimer’s disease (AD). Owing to the recent progress in image analysis using brain magnetic resonance imaging (MRI) scans, volumes of total brain and its anatomical regions can be measured quantitatively. Accordingly, some epidemiological studies have investigated the association between diabetes and morphological changes in the brain. In the Hisayama Study, an epidemiological study in the town of Hisayama, Fukuoka, Japan, the prevalence of dementia, particularly Alzheimer’s disease, has increased rapidly beyond the aging of the population during the past three decades, and the prevalence of type 2 diabetes or prediabetes has also increased. The Hisayama Study previously showed that diabetes was significantly associated with the development of AD and the formation of neuritic plaque in the brain. Furthermore, we recently reported that diabetes was a significant risk factor for hippocampal atrophy using the brain MRI data of the Hisayama residents aged≥65 years in 2012. In this study, elevated 2-hour postload glucose levels, longer duration of diabetes, and younger onset of diabetes were significantly associated with hippocampal atrophy.

The default mode network (DMN) is a very noteworthy issue of the self-referential mental activity, and could be associated with maladaptive rumination on mental diseases such as depression.

In psychosomatic medicine, to investigate DMN is important because manifestations of various physical diseases are associated with maladaptive self-referential mental processing which might be related to neglect of their health and disorders of emotional processing such as alexithymia.

We showed our study about alterations of DMN in patients of anorexia nervosa, and discussed whether or not analysis of this network is useful for understanding the pathology of illness in psychosomatic medicine.

To clarify complex changes in human brain activity, the use of machine learning techniques for MRI is drawing attention. They are also used in medical fields for purposes, such as diagnosing dementia, schizophrenia, and depression, and analyzing the pathology of these central nervous system disorders. Now that such techniques have also been reported to be useful in psychosomatic medicine, the development of related studies is expected.

It is critical how a therapist deals with patient’s negative affect projected onto him in the treatment of psychosomatic diseases. I report a case of psychogenic dysphagia in whom writing papers in the form of a dialogue between good me and bad me was effective in relieving negative affect projected onto the therapist. A male in 40’s had been suffering from locked up feeling of throat and difficulty in swallowing since he was a junior high school student. While he had already been treated with a variety of pharmacotherapies and psychotherapies, his symptoms were not relieved and the amount of food intake and body weight were reduced. He was admitted to our hospital with alexithymia and depressive state and was treated following behavior restriction therapy. He wrote reports describing his feelings and thoughts every day. His social activities were reduced and the concept of good me and bad me was introduced to him. It was difficult for him to understand the concept in the beginning. A series of medical interviews were conducted by the therapist referring to the reports written by the patient. Step by step he learned to understand the concept and share it with the therapist. Nevertheless, he exploded with rage against the therapist because of poor relief of his symptoms. His negative affect projected onto the therapist expanded and the treatment fell into a tense critical situation. He was proposed to write reports in the form of a dialogue between good me and bad me by the therapist. He followed the proposal reluctantly. His negative affect projected onto the therapist was gradually relieved and the patient-therapist relationship improved subsequently. He learned to reflect his own feelings and thoughts. His symptoms were eventually relived. In conclusion, writing reports in the form of a dialogue between good me and bad me was considered to be effective in relieving patient’s negative affect projected onto the therapist, developing a good therapeutic relationship and facilitating patient’s introspection in the treatment of psychosomatic diseases.

Background : The patients who visit our Women’s Health Center often complain various symptoms. Their complains include not only the physical symptoms such as malaise, headache, sleep disorders, loss of appetite, and constipation/diarrhea, but also the mental symptoms such as anxiety, irritability, and depressed mood. The cause of their physical symptoms is mainly due to the functional factors and mental illness, but there are a few cases due to the organic diseases.

Cases : We report here three cases of Basedow’s disease (case 1), Basedow’s disease adding to hyperparathyroidism (case 2) and Hashimoto’s disease (case 3).

Conclusion : Women’s Health Center in Yamanashi Prefectural Central Hospital opened in March 2005. Since then, 3553 patients visited to our department. About 10% of them have the organic diseases. In the organic disease, endocrine disorders are often diagnosed. Especially the thyroid dysfunction are seen more in women than in men, so thyroid hormone test is considered to be important in women’s clinic.

We should consider actively the differential diagnosis for patients suspected of organic diseases and consult early with specialists. We take linkage with the specialists even after the patients are diagnosed organic diseases, and they need continuous psychosomatic approach, if necessary.