Medically unexplained oral symptoms/syndromes (MUOS), so-called oral psychosomatic disorder, characterized by unknown and refractory chronic pain and uncomfortable feeling in the orofacial region, is a problem that needs psychosomatic approaches. We have been constructing an oral psychosomatic medicine system that integrates clinical practice, education and research.

In the treatment of patients diagnosed as “psychological problem”, we try to avoid overtreatment and use the minimum medication based on the evidence-based dentistry and appropriate examination. We also empathetically and carefully treat the patients and their families, who tend to be ignored at other medical institutions, with cognitive behavioral therapy or medical guidance to regulate their life. In addition, we introduce a Psychiatry In Primary Care (PIPC) employing a MAPSO (Mood, Anxiety, Psychosis, Substance-induced, Organic/Others) medical interview system, in order to efficiently obtain important information and to distinguish psychiatric diseases from MUOS.

In dental students’education, we focus not only on the conventional knowledge gained through lectures or books but also on the actual learning through a clinical experience, to develop dentists who can think from PDM (Physical Dental Mental). The 6th grade students have an opportunity to conduct a preliminary examination on a real patient with the MAPSO medical interview system in a comprehensive clinical practice.

Our research aims at revealing the nature of oral psychosomatic disorder by analyzing clinical data, and giving research outcomes back to clinical practices.

In this article, we report our clinical cases and discuss the approach to oral psychosomatic disorders.

We often encounter the difficulties in the treatment of the psychosomatic diseases in the oral region. A lot of patients of oral psychosomatic diseases complain oral pain or abnormal sensation, but it is not rare that they are intractable and often take a long time course with the symptoms changing the sights and the characters. Though oral psychosomatic diseases seem to have high morbidity, the precise pathology and the effective therapeutic methods are not still established. We often experience radical improvement in the symptoms of the oral psychosomatic diseases, when using appropriate drugs at the optimal timing, providing adequate explanations to the patient. Routine symptomatic treatments are usually not enough, otherwise it should be managed with careful psychological approaches. Here we try to describe the essential points of the treatment with some case reports indicating the importance of the collaboration with the dentists, selection of the adequate drugs for the symptoms, getting the grips of the rising of the effect, and how to direct patients to the curing courses.

It is not rare for the doctors in the department of otolaryngology encounter patients with psychosomatic disorders. The three most common symptoms of psychosomatic disorders are dizziness, tinnitus, and globus hysterica. These patients are usually treated as medically unexplained symptom. Almost half of the patients with medically unexplained symptom are depression. It is useful to use symptom specific questionnaire to evaluate these patients. DHI (dizziness handicap inventory) is used for the patients with dizziness. The application of questionnaires to daily practice will be presented.

One of the effective treatments for the head and neck region of psychosomatic patients is the cognitive behavioral therapy targeted for the behavioral factors such as avoidance behavior or safety behavior and cognitive factors related to their symptoms. For the treatment of burning mouth syndrome and dry mouth syndrome, the importance of cognitive factors was suggested in the previous studies, while there are no studies pointing out the influence of avoidance behavior and safety behavior. We demonstrated that combining the treatment for cognitive factors with behavioral factors might be effective in burning mouth syndrome and dry mouth syndrome by means of case reports. These results imply that cognitive behavioral therapy targeted for the behavioral factors such as avoidance behavior or safety behavior and cognitive factors related to their symptoms might be effective for other psychosomatic disorders in the head and neck region.

Present conditions and future challenges facing Japanese sports psychology were clarified by exploring its history and the features of research activities. The Japanese Society of Sport Psychology (JSSP) was established in 1973. However, the Japan Society of Physical Education, Health and Sport Sciences, which has a history of over 65 years, has been a major platform for sport psychology research since 1950. Moreover, an analysis of the encyclopedia and textbook published by the JSSP (2008) indicated four categories highlighting contemporary research fields in sports psychology : motor learning and control, sport motivation and social psychology, health psychology in sport and applied psychology of athletics (including mental training and clinical sport psychology). Furthermore, the topic lists of JSSP symposiums suggest that its research interests are focused on applied and clinical sport psychology that emerged especially after 2000, when the certification for sports mental training consultants was established and is geared towards the Tokyo Olympic and Paralympic Games in 2020. On the other hand, JSSP consultants are still struggling with athletes suffering from psychosomatic loss of motor skills known as Yips. This is a future challenge to be resolved by collaborating with researchers and practitioners specializing in psychosomatic medicine.

Japan Institute of Sports Sciences (JISS) actively engages in research and consultations with athletes to support them to be competitive internationally. “Individual consultations” are conducted as one of the supports at JISS, where certified sport mental training consultants and clinical psychologists are in charge. Although consultants are assigned with a role based on the athlete’s main complaint or requests, there are times when the athlete’s demand is beyond what the consultant is able to meet. When this happens, a team of two or three consultants from certified sports mental training consultants, clinical psychologists, and psychosomatic medical doctors work together to support him or her. As some athletes face a variety of psychological issues and challenges, it is ideal that the staff consist of a variety of specialized areas to deal with the issues. JISS is the only institution in Japan which makes it possible. The cooperation of different psychological fields is essential in supporting elite athletes who are competing internationally.

Objective : Eating disorders are known to relapse at a high frequency, however, no study has been reported from Japan. This is the first report concerning a relapse of eating disorders in Japan.

Methods : A follow up study was carried out of 75 Japanese women who had had eating disorders and had received treatment for at least 3 months at a rehabilitation center named “Mimoza” in Yokohama City, which is the only rehabilitation center for eating disorders in Japan. The mean age of the subjects was 34.7 years old, and mean period from the onset of the eating disorders was 17 years. Questionnaires were sent to the subjects concerning the status of their eating disorders, abnormal eating habits, socioeconomic status, comorbid psychiatric disorders, and episodes of relapse. The recovery rate of the subjects from the eating disorders at 17 years from the onset is reported elsewhere. This article focuses on the relapse of disorder in the subjects during the 17 years from the onset.

Results : Of the 75 subjects, 34 (45.3%) had experienced a relapse. The average age at occurrence of relapses was 26.2 years, and the mean interval from the onset of the eating disorder to relapse was 8.1 years. Of the subjects with a relapse, 76.5% had anorexia nervosa restricting type at the time of onset of the eating disorders ; in 67.7% of these cases, however, the type of eating disorder changed at the time of relapse to the binge-purging type (anorexia nervosa binge purging type and bulimia nervosa purging type). Crossovers of the subtype of eating disorder occurred frequently at relapse.

Comparison of the recovery rate from the eating disorders between the 34 subjects with relapses and 41 subjects without relapses revealed a recovery rate of 32.4% in the former group and that of 56.1% in the latter group, the difference being statistically significant. The subjects with relapses had a higher frequency of personality disorders.

Conclusion : Relapses occur commonly in patients with eating disorders, sometimes a long period from the onset of the disorder, and the type of eating disorder may change at relapse from the type of onset.

Objects and Subjects : Migraine is a heterogeneous heritable disease, and more frequently affects females than males. Migraine is associated with the menstrual cycle in 60% of female patients. Estrogen withdrawal that occurs immediately before menstruation is considered to be closely associated with the development of migraine. In this study, we analyzed SNPs at 3 sites of the estrogen receptor gene (ESR1 397T>C, ESR1 325C>G, ESR1 594G>A) and a SNP of the transient receptor potential melastatin 8 (TRPM8) as a cold and menthol receptor which had suggested to be associated with migraine by overseas meta-analysis. We characterized their association with migraine in 41 Japanese patients with menstrually-associated migraine and in 41 Japanese healthy controls.

Results and Conclusion : The results of this study suggest that SNPs at sites of the estrogen receptor gene (ESR1 397T>C and ESR1 325C>G) are associated with menstrually-associated migraine in Japanese patients. The results of the interviews revealed that 80.5% of patients have family histories, and in 82.9% of the patients migraine developed after the age of menarche, when estrogen begins to change with menstruation. Symptoms of “pain associated with coldness” and “carsickness” were observed in the patients significantly more than in the controls.

Time of visible life on earth began before “thought” and perception of “Belief Systems”. When Erwin Schrödinger asked “What is life?” he was facing out into life. He did not ask “What is death?” as might have done a philosopher facing into life―inwards towards death. With the increasing power of man, over time, to provide himself with all that he wanted ; with increased knowledge ; and with material progress ; ratio and science in general, took to concentrating on the mathematically expressible properties of the universe―size, shape, motion, material, change―the “real world”. Questions considering the purpose of life ; what makes life of value or worth living, of beauty, love, identity, the human nexus (bonding), of “Being” were left to men of religion or to philosophers.

Further, the acceleration of technology (applied knowledge), the world of Dirac’s quantum and mental models, proliferation of nuclear resources, and arguments that human beings are imperiling their own survival, urges reflection on the “middle ground” between Science and Religion―the “No-Man’s Land” ―that is the interest of this paper. Jung’s axiom that “Death is not the end” at least offers us continuity with Schrödinger’s problem, advanced now into reflections on Mind ; What is Mind? Is Consciousness eternal or instrumental in Mind? Is Intuition real? Wherein lies Faith? Have we already witnessed the “Power of the Negative” in the Stress Burden that contemporary life exacts, and How shall man go from Jung’s “valley” (Ego) ―war, tragedy, loss of life, agony to the “mountain top” (Self) where men―we ourselves―may face our collective unconsciousness?

Anyone who believes that we can fully explain how the immaterial human mind is related to the material body is not fully informed.