Self-esteem has been considered an important psychological factor in the primary to tertiary prevention of bulimia nervosa for quite a long time now. Recently, researchers introduced pathogenic models and intervention strategies apart from the heitherto-prevailing concepts that consider self-esteem a risk factor (Kendler, Maclean, Neale, et al., 1991) ; a moderating variable, which alleviates some symptoms (Van der Ham, van Strien, & van Engeland, 1998) ; and a sustaining factor (e. g. Fairburn, 2008).

In the present research, we summarize all the newly-introduced models and discuss the future prospects of the treatment of bulimia nervosa. We arrived at the conclusion that the most-advanced models and intervention strategies are aimed at diminishing, directly or not, the relation between concerns about one’s body shape and bulimia nervosa. This relation we consider being bulimia nervosa’s core symptom.

In addition, we concluded that the development of approaches which strengthen one’s self-esteem is essential for synthesizing various psychotherapeutic methods. To this end, it is important to clarify the theoretical systems behind the intervention strategies and enrich the understanding of the self-esteem concept itself.

Corticotropin-releasing factor (CRF) neurons in the paraventricular nucleus of the hypothalamus (PVH) play the pivotal role in the regulation of the endocrine stress responses. However, CRF neurons are distributed broadly in the brain besides the PVH and implicated in various physiological functions. Recently, we developed mouse lines in which Venus (modified yellow fluorescent protein) or iCre was inserted to the CRF genomic locus by homologous recombination. These mice are utilized for visualizing CRF neurons and carrying out physiological studies, but they are also useful for elucidating the distribution and morphological characteristics of CRF neurons in the mouse brain. These mouse lines will serve as tools for studying the functional roles of CRF neurons and may contribute to the development of novel means for the prophylaxis as well as treatment of stress-related disorders.

Mammals including humans are thought to have acquired and evolved neuronal mechanisms for negative emotion, such as depression and anxiety, as a biological defense system that protects themselves by suppressing their activities and raising vigilance against the surroundings, when they are in dangerous places and time zones and suffering from diseases and injuries. Therefore, in order to understand the neuronal mechanisms of depressive disorders, anxiety disorders, psychosomatic disorders, it is necessary to clarify the neuronal mechanisms for negative emotion from the viewpoint of a biological defense system and to analyze the changes of such mechanisms in patients and disease model animals. We have been doing research focusing on the brain region called the bed nucleus of the stria terminalis (BNST), and demonstrated the possibility that activation of the type 2 BNST neurons by CRF or noradrenaline suppresses the dopaminergic neuron activity in the ventral tegmental area through three GABAergic neurons to produce pain-induced negative emotion. The neuronal circuit originating from the BNST plays an important role as a common neuronal basis for pain-induced negative emotion, depression and other mental diseases as well as psychosomatic disorders.

TMS is a powerful tool for manipulating brain activity. However, how exactly it works still remains poorly understood. Here, we recorded electrocorticograms (ECoG) before and after repetitive trans-cranial magnetic stimulation (rTMS). We also recorded motor evoked potentials (MEP) evoked by single-pulse TMS before and after rTMS. After low-frequency (1 Hz) rTMS, MEP amplitude was suppressed and we observed a decrease in beta-band power of the ECoG ; conversely, after high-frequency (10 Hz) rTMS, MEP amplitude was enhanced and we observed an increase of gamma-band power in the ECoG. These results indicate that low-frequency and high-frequency rTMS induce systematic changes in the background cortical neural activity. We next examined the function of the medial frontal cortex (MFC) by applying low-frequency (1 Hz) rTMS inhibiting local neural activity. We used a double cone coil to stimulate the ventral part of the MFC including subgenual anterior cingulate cortex (sgACC), and figure-of-eight coil to stimulate only the dorsal part of MFC as control. Stimulation had a clear and profound impact on behavior only when a double-cone coil was used. Specifically the monkey exhibited changes in physiological and behavioral measures that indicated sustained depression of mood and emotion, such as elevated blood cortisol levels, decreased within-cage spontaneous activity, and social withdrawal (unwillingness to interact with research staff). These results reveal a critical involvement of the ventral part of MFC in the regulation of mood and motivation.

Social and environmental stress evokes stress responses through endocrine, immune and autonomic nervous systems. However, how these stress responses are integrated to promote emotional changes and mental illnesses remains poorly understood. Recent studies have established critical roles of inflammation-like responses in stress-induced emotional changes, and have been studying about the involvement of endocrine, immune and autonomic nervous systems. In the periphery, stress-induced endocrine responses activate myeloid cells and increase proinflammatory cytokines, whereas stress-induced sympathetic activation increases the numbers of neutrophils and monocytes in the blood. Stress also alters the composition of gut microbiota and activates immune systems. In the brain, stress activates microglial cells and suppresses dopaminergic system in the prefrontal cortex through inflammation-related molecules. These findings suggest that multiple stress responses are converged to inflammation-like responses inside and outside the brain, thereby promoting emotional changes and mental illnesses, and have led us to propose that stress-induced inflammation-like responses are a target for therapeutic development of novel antidepressants.

Industrial Safety and Health Act was revised in 2014 and enterprises hiring more than 50 employees were obliged to execute stress check to examine the psychological burden of workers. This system aims at primary prevention ; however, it is insufficient to ensure mental health at the workplace. It is suggested that these tests should be executed as part of different activities conducted according to mental health guidelines. This article describes the roles of psychosomatic medicine in stress check systems, from the perspectives of industrial physicians and psychologists.

In the stress check system enforced since December 2015, the roles of clinical psychologist and industrial counselor are limited. However, they are expected to have an interview to collect basic information from individuals who are diagnosed as highly stressed, prior to the medical interview by physicians. They are requested to know the stress check system, to conduct adequate assessment, and to master how to interview. In this workshop, we introduced the outline of the stress check system and Brief Job Stress Questionnaire, and discussed the role of psychologist.

In 1990, a definite step towards the national qualification of psychologists was taken by the Ministry of Health, Labour and Welfare through investigations into a clinical psychologist qualification system. The investigative committee was functional until 2001 and was then rebranded as the Ministry of Health and Welfare Science Research Project, and the results of about 15 years of efforts by stakeholders were realized in September 2015 as the Certified Psychologist Law. In September 2016, a review was undertaken to give a concrete form to the contents of the law, including training curriculums at universities and graduate schools, examination subjects, and special measures for those working as psychologists. On May 31, 2017, it was published as the “Review Committee Report on the Certified Psychologist Curriculum et al.,” and the specific content of the Certified Psychologist Law was clarified. Particularly in the field of medicine, the situation until now was such that even under the guidance and instructions of a doctor, various psychological clinical activities such as psychotherapy and psychological examinations were conducted by those without qualifications. With the Certified Psychologist Law taking effect, the functions and responsibilities of psychologists are clarified, and an environment is fostered in which members of medical care teams have specific responsibilities.

While tracing the process of establishment of the Certified Psychologist Law, I have summarized the challenges in relation to initiatives to prevent stress among workers with whom certified psychologists will be involved in the course of psychosomatic medicine in the future.

Objective : The purpose of this study is to develop the high-quality and reliable questionnaire : Self rating questionnaire for depression (Ji test) in order to use conveniently in a general outpatient.

Methods : Among depressive symptoms, the typical symptoms were selected as 9 subscales, which were “persistent sadness or low mood”, “loss of interests or pleasure”, “fatigue or low energy”, “existence”, “suicidal thoughts or acts”, “anxiety”, “low thoughts, low attention and poor concentration”, “somatization”, and “disturbed sleep”.

We judged the symptoms in each item as dairy-life disorder and carried out a statistical analysis on the basis of a comprehensive indicator of the total score (0 to 90 points) by the respondents in the 4 methods.

Results : 91 new patients participated in this study. Their average age was 45.3, male and female ratio was 27 male/64 female, the average score was 40.0 points. Cronbach α coefficient was 0.938.

Conclusions : The comparison with SDS revealed that a correlation coefficient between Ji test and SDS was very strong, reliability and validity of Ji test was sufficiently high. Also, the comparison with a comprehensive evaluation in clinical diagnosis revealed sufficient reliability of Ji test. Currently, from the point of view of prospects for the Stress Check Program that has been performed, we would like to report upon the present study in detail with deep consideration.