Among some patients seeking treatment for self-diagnosed irritable bowel syndrome (IBS), our concern regards that intestinal gas is more troubling than abdominal pain or bowel movement disturbances. At the beginning of this article, we focused on diagnosis and discrimination for the patients with a chief complaint of intestinal gas. Next the patients were classified into the following categories based on major clinical presentations : functional gastrointestinal disorders (FGIDs) centering on IBS and functional bloating, aerophagia and Jikoshu-kyofu. In addition to the clinical presentation, we described treatment for each category. After that, we focused on Jikoshu-kyofu, which is relatively more difficult to be treated than the other two clinical presentations. Jikoshu-kyofu refers to a subtype of taijin-kyofusho, a form of social anxiety first described in Japanese patients who were characterized by a fear of offending others. In Jikoshu-kyofu, patients experience distress due to the fear of giving off an offensive smell to others. Jikoshu-kyofu had been thought once as a Japanese culture-specific syndrome, but more recent studies have revealed that the same clinical condition occurs in Western countries, where it is referred to as olfactory reference syndrome (ORS). Thus, we performed a literature search of the recent studies regarding the use of pharmacotherapy/psychological therapy in the treatment of Jikoshu-kyofu. As our search revealed no comparative studies nor randomized controlled trials, we then went into the detail of a systematic review. The systematic review shows that pharmacotherapy with antidepressants and behavioral interventions improved clinical symptoms. Interestingly, we found similarities between behavioral interventions as previously cited, Morita therapy−a form of psychotherapy that has been utilized in the treatment of Jikoshu-kyofu among Japanese patients for a long time−and Acceptance and commitment therapy (ACT)― a form of third-wave cognitive behavioral therapy (CBT). Symptoms regarding intestinal gas may associate with wide variety of pathophysiology and clinical features, further studies are necessary in order to understanding pathophysiology and developing efficient treatment.

Vertigo/dizziness is a result of disturbance of spatial orientation. To maintain the spatial orientation, inner ear sensors for linear (otolith organs) and angular acceleration (semicircular canals) play an important role in visual and trunk stabilization through vestibulo-ocular and vestibulo-spinal reflexes, respectively. Once they are disturbed, loss of spatial orientation induces the vertigo/dizziness.

Seventy % of chronic dizziness patients have comorbid anxious and depressive disorders. The psychiatric diseases are the cause or accelerating factors of dizziness, and therefore, chronic dizziness is a psychosomatic disease. For its treatment, both of psychiatric and somatic approaches are important.

Some sicknesses are well known to be provoked by inadequate adaptation to physical and/or psychogenic stress in daily life. Attacks of Meniere’s disease characterized by vertigo, fluctuating hearing loss and tinnitus due to inner ear pathology represent a common example. Furthermore, this disease has been proposed to occur especially in civilized people living a stressed lifestyle, i. e. “Menierization is civilization”. However, it is very difficult to prove a significant relationship between stress and inner ear pathology, since the definition of stress is too obscure for scientific analysis of these aspects. Since the oto-pathology in Meniere’s disease was first revealed to be inner ear endolymphatic hydrops through temporal bone studies in 1938, it has gradually become understood that inner ear endo-organ tissues, including the endolymphatic sac, prepare the fluid homeostatic system via water metabolism-related molecules such as vasopressin and aquaporin. Subsequently, it was proposed that the pathogenesis in Meniere’s disease could be inner ear endolymphatic hydrops due to a disorder of water metabolism-related molecules. In the present paper, we would like to discuss the neuroscientific relationship between stress and inner ear pathology by reviewing plasma vasopressin (an anti-diuretic stress hormone) and its receptor, V2 receptor, in the endolymphatic sac (an inner ear endo-organ for endolymph absorption) in patients with Meniere’s disease.

The role of vestibular rehabilitant to the patients with intractable dizziness was investigated. We treat patient with chronic dizziness by group in-hospitalized vestibular rehabilitation for 5 days. In this program the patients have to perform group rehabilitation 3 times a day. After discharge, they perform the same program at home. Several questionnaires including DHI (Dizziness Handicap Inventory), SSCS (Somatosensory Catastrophizing Scale), SSAS (Somatosensory Amplification Scale) were used before and after the rehabilitation. The static posturography was also conducted. The main outcome was DHI.

The vestibular rehabilitation significantly improved the DHI score, the SSCS score, depression, and anxiety. Multivariate analysis indicated that the improvement in the DHI score was poorer in patients who showed high SSCS score before intervention. A higher revalue of the DHI was associated with greater improvements in this perceived handicap after the rehabilitation. Small body sway pre-rehabilitation was related to positive effects on the DHI score in patients with a high prevalue of the DHI.

The vestibular rehabilitation contributed to the improvement of perceived handicap due to dizziness, catastrophization of bodily sensation, and emotional distress. Patients who catastrophized their bodily sensations before vestibular rehabilitation saw smaller improvements in perceived handicap due to dizziness.

It is known that psychological factors are related to chronic dizziness, and evidence of cognitive behavioral therapy is strong in the treatment of chronic dizziness. In addition, since vestibular rehabilitation, physical therapy for vertigo or dizziness, can be incorporated as a therapeutic component of cognitive behavioral therapy, both play an important role in the treatment of chronic dizziness. In this article, I first outlined the transition of disease concept, diagnostic criteria, and pathological hypothesis of chronic dizziness. Next, I introduced the preliminary study of cognitive behavior therapy combined with vestibular rehabilitation for chronic dizziness. Finally, I explained about the application of acceptance and commitment therapy to chronic dizziness.

The most patients with dizziness complicate psychiatric disorder, especially anxiety disorder. Concerning the pattern as to which comes first dizziness or anxiety disorder, both were reported in the clinical observation. In this study, we investigated the interaction between dizziness and stress by using animal models. During hypergravity stimulation, vestibular information induced Fos protein expression as a marker of neural activation in the amygdala, which is the center of anxiety. Hypergravity also induced the gene expression of preprotachykinin, a precursor of substance P, in amygdala. Administration of the antagonist for NK-1 receptors inhibited nausea induced hypergrabity. These results suggest that vestibular stimulation activate the substance P neuronal system in amygdala and this activation would be related to the development of autonomic symptoms. On the other hand, social defeat stress did not affect the rotation behavior suggesting suffering dizziness although anxiety-like behaviors were increased.

Diabetic patients need to carry out their daily glycemic control by themselves (self-care). However, half of them cannot achieve good glycemic control. To support self-care of diabetes, we have built a team using a communication method “Coaching”. Our team practiced 4 fundamental coaching skills. Four skills are as follows ; 1) empathic active listening, 2) open question for the future, 3) acknowledgement, and 4) transmission with permission. A doctor also learned motivational interviewing. In the routine visit, patients talked with a nurse or a dietitian. After then, patients met a doctor’s examination. We investigated a questionnaire about the attitude of listening, 90.2% of patients felt very good at attitude of our staffs. Change in behavior concerning diabetes self-care appeared 81%. The mean HbA1c improved 0.6%. Application of coaching changed the minds of the staff. Thereafter, desirable self-cares appeared in many diabetic patients.

Coaching was not invented by a person and nor is it based on a theory. Moreover, coaching was mainly developed and thrived outside the academic world. Therefore, coaching has certain disadvantages in providing scientific evidence of its effectiveness. In this paper, the author discusses the requirements of coaching for contributing to the medical and health fields and clinical practice, as well as to academic research. Firstly, we reviewed the brief history of coaching, and then we examined its current situation and problems, especially concerning coaching in medical and health fields in Japan. Next, we analyzed the theories and skills introduced in Japanese health coaching books. There are more than thirty skills mentioned in these books, but only 40% of them refer to theories and models of coaching. Based on these analyses, we suggest developing more theories and undertaking model-based coaching to improve the quality of leading coaches. Moreover, it is necessary for Japanese health professionals to distinguish utilizing coaching skills in health conversations from authentic health coaching. To attain these goals it would be useful for those using ‘coaching’ in health settings to obtain international coaching certifications and experience professional coaching as coachees.

Objectives : Training was performed for new multidisciplinary healthcare professionals, using “Successful Self”, a psychoeducational program to prevent psychosocial distress and also to educate team-based medical practice. The purpose of this report is to analyze the usefulness of this training.

Subjects : Sixty-seven first-year multidisciplinary healthcare professionals ; (5 physicians, 54 nurses, 3 pharmacists, 1 medical technologist, 2 physical therapists, and 2 medical social workers) who had started working in a general hospital since X year participated in the training program.

Methods : The group training program was organized by an occupational health physician, a nursing director, a head nurse in charge of education and a clinical psychologist. The program included 5 one-hour lessons using a work book (two lessons in April, one lesson each in June, September and November). Participants answered the self-administered questionnaires regarding usefulness and impressions of the training program. We investigated about the data.

Results : Forty-two participants out of fifty-two subjects who answered the questionnaires answered the training program was useful. The qualitative analysis of impressions by the participants revealed that the program offered them the chance “to communicate among multidisciplinary healthcare professionals who had started work at the same time”, “to share their thinking and feelings, opinions and distress”, “to promote their self-understanding” and “to develop their perspectives”.

Conclusion : This training may be useful for first-year multidisciplinary healthcare professionals.