It is important to examine psychosomatic patients from different angles. I usually diagnose them from the following 4 directions : gynecological diagnosis, mental diagnosis (DSM-Ⅳ), psychosomatic diagnosis and oriental (Kampo) diagnosis. We examined 11,647 cases of psychosomatic patients whom we treated between 1976 and 2016. Only 2 or 3% of the new patients of Sapporo University Hospital were psychosomatic patients from 1976 to 1993, but we treated 20 to 40% of the total number of new patients in our clinic from 1995 to 2016. Those patients who have been diagnosed by gynecology are 3,190 cases, 27.4% of climacteric syndrome, 2,086 cases, 17.9% of vegetosis, 1,866 cases, 16.0% of pelvic congestion syndrome, l,077 cases, 9.2% of premenstrual syndrome, 860 cases, 7.4% of dysfunctional uterine bleeding, 438 cases, 3.8% of senile colpitis, 420 cases, 3.6% of dysmenorrhea, 244 cases, 2.1% of postpartum depression, 212 cases, 1.8% of sexual disorder, 207 cases, 1.8% of secondary amenorrhea and 1,057 cases, 9.1% of others. From the psychosomatic viewpoint, they can be sorted into the following four groups : ①somatic type (S-type, 5,928 patients, 50.9%), ②depressive type (D-type, 2595 patients, 22.3%), ③neurotic type (N-type, 1,906 patients, 16.4%), and ④psychosomatic type (P-type, 1,218 patients, 10.5%). When they have been diagnosed by DSM-Ⅳ at our clinic from 1995 to 2016, there have been 7,216 cases, 68.0% of somatoform disorders, 2,105 cases, 19.8% of mood disorders, 371 cases, 3.5% of panic disorders, 339 cases, 3.2% of anxiety disorders, 101 cases, 1.0% of eating disorders, 82 cases, 0.8% of adjustment disorders, 56 cases, 0.5% of sleep disorders, 26 cases, 0.2% of premenstrual dysphoric disorders, 20 cases, 0.2% of bipolar disorders, 14 cases, 0.1% of developmental disorders and 277 cases, 2.6% of other cases. 8,534 cases, 73.3% were treated by oriental (Kampo) diagnostic medicine. 2,515 cases, 21.6% were treated by hormone therapies. Many S-type patients were treated by Kampo therapy and counseling therapy rather than other types. Many D-type patients were treated with antidepressants and tranquilizers rather than other types. 9087 cases, 78.0% of all cases were improved. Prognoses of S, P and D-types were better than N-type. At the end of this paper we presented 4 cases in order to prove that “therapeutic self” and “spirituality” were of great importance for the treatment of psychosomatic patients.

Menopausal symptoms are unexplained complaints among women around menopause. The main cause of these symptoms is deterioration of ovarian function, but many other factors including aging and socio-cultural and environmental effects are thought to contribute to make up the symptoms. Although hormone replacement therapy (HRT) is effective to the symptoms derived from estrogen deficiency, the psychosomatic aspect of menopausal transition may be useful in some cases where HRT is ineffective. During the perimenopausal period, women have to begin searching the different life-style from reproductive age, through experience of several losses, feeling of impending aging and death. The psychological conflict of women around menopause is very similar to, or almost coincident with the concept of midlife crisis. A part of menopausal symptoms is derived from difficulties of acceptance of transitional changes, and for patients with such symptoms, a psychosomatic approach is useful to help them accept these changes and adapt to the next stage of their lifecycle.

The foundation of medical education in today’s Japan is based on the ideas of pioneers who introduced psychosomatic medicine to Japan. Based on this premise, we reviewed the existing training methods and curriculum of psychosomatic medicine along with the transition of medical education for women at our medical school.

During studying psychosomatic medicine relating to women’s health, our most important realizations include an essential understanding of the overall effects on women’s mental and physiological states, and of hormonal changes due to the age of patients and specific female diseases. These findings make it possible to treat female patients accordingly.

Above all, for this purpose we have designed curriculums for psychosomatic medicine with the focus on woman’s health and by utilizing simulation workshops and clinical practical training.

Our basic objective is to formulate the most appropriate curriculum for medical students and resident physicians, primarily focusing on the psychosomatic symptoms of periodic female hormonal changes and decreases in the female hormone level of perimenopausal patients with different psychological and social backgrounds.

In summary we would like continuously to identify the overriding psychological and social circumstances through which medical personnel may learn to understand a patient’s specific disease. We would also attach importance to the learning environment where medical persons may come to understand psychosomatic symptoms affecting patients and their measurable correlation to the mental state and the social background.

Pelvic pain is one of the most frequent complains in gynecologic patients. Usually, in the case of the menstrual pain due to endometriosis of the uterus, or ovarian tumor torsion, we treat with common gynecologic treatment. However, when pathological origin is unknown, we apply contra-point acupuncture treatment. We have applied this treatment to the gynecologic field and this treatment has precious merits for pelvic pain patients. According to our experience, female patients feel safer rather than receiving a stimulus to the painful points. Pain on ishchiadic nerve 37, pubic symphisys 30, ingunal area 25, coccyx 9, hip point 5 and otheres 9 were treated. Out of the 100 cases, 94 cases showed immediate pain improvement and only one case needed some more time. Among 5 ineffective cases, 3 cases were blood stasis, 1 case was organic inflammation and the other, schizophrenia.

Living-related kidney transplantation improves recipients’ QOL, but it has a major impact on the mental health of recipients because the surgery is a heavy burden not only physically but psychosocially as well. On the other hand, donors also have a high anxiety due to organ donation and recipients’ life or physical condition after the operation. Therefore, in performing transplant surgery, the medical staff involved in kidney transplantation focuses on the mental health of the recipient and it is important to consider necessary care and clinical psychological approach. Also, though support to donors is less measurable than to recipients, it is necessary to accurately understand mental health of donors and to provide appropriate psychological intervention.

Good adherence to immunosuppression is essential in kidney transplant recipients to maintain the function of the transplanted kidney. However, the rate of poor adherence is not small among kidney transplant recipients, and health-care providers are not fully aware of this reality.

Various factors are associated with poor adherence, such as poor mental health including depression, adverse effects of medicine, complicated prescriptions, and the relationship between health-care providers and recipients. In particular, depression has been shown to be associated with loss of function and death of the transplanted kidney. This is because depression not only decreases the motivation for taking immunosuppressive medication but also affects various health behaviors including exercise and diet. Combined educational and behavioral interventions for improving adherence to immunosuppression are effective.

This is a practical report on the third party confirmation of live-donor kidney transplants by our psychologists team during the past ten years. The confirmation included sharing basic information of the patients with the transplantation coordinator, interviewing with recipients, interviewing with donors, and information feedback to the transplantation coordinator. Before interviewing, recipients and donors are asked to fulfill the questionnaire about living-related transplantation. The answers from the questionnaire are helpful and time saving. Patients can be interviewed freely by a psychologist in a separate room apart from the department of transplantation surgery. In addition to making a decision about transplantation, psychologists report information concerning patients need, their anxiety about transplantation and their mental states. Also, psychologists can inform the transplant staff about concrete strategies to deal with patients.

It is essential to build therapeutic trust between a patient and a therapist in the practice of psychosomatic therapy. I report a case of severe obesity with alexithymia and depressive state in whom showing a correlation diagram among good me, bad me and a therapist was effective in building therapeutic trust through gaining objective point of view. A 28-year-old male had been suffering from headache, chest pain, general fatigue, loss of concentration for a few years. He was admitted to our hospital and was treated following behavior restriction therapy. He wrote papers describing his feelings and thoughts every day. His social activities were reduced. A series of medical interviews were conducted by the therapist referring to the papers written by the patient. He developed a feeling of distrust against the therapist because of poor relief of his symptoms. The concept of good me and bad me was introduced to him and the relationship among good me, bad me and the therapist was explained orally. He understood the concept and distinguished his thoughts between good me and bad me. Nevertheless, his feeling of distrust against the therapist expanded and he exploded with rage against the therapist. The treatment fell into a tense critical situation. The relationship among good me, bad me and the therapist was explained again showing the correlation diagram among good me, bad me and the therapist. He took an objective look at himself and the relationship with the therapist. His negative affect projected onto the therapist was relieved and the patient-therapist relationship improved subsequently. He learned to reflect his own feelings and thoughts. His symptoms, obesity, alexithymia and depressive state were eventually relieved. In conclusion, visual intervention showing the correlation diagram was implied to be effective in facilitating patient’s introspection and building therapeutic trust through gaining objective point of view.

Here, we report a case of aerophagia in which the integration of an organic, multifaceted treatment approach led to an improvement in intractable gastrointestinal symptoms. A 27-year-old man complained of repetitive belching and abdominal bloating. After excluding the possibility of organic gastrointestinal disorders by clinical examination, he was diagnosed as aerophagia using RomeⅢ criteria. The patient was poorly responsive to standard treatment. We initiated a biopsychosocial treatment approach for this patient, because maladjustment at work was one of the background causative factors. From a biological perspective, we improved the patient’s pathophysiology of aerophagia by showing him videos and images of the associated biological changes, such as the changes in intestinal gas patterns that can be seen on abdominal x-ray. From a psychological perspective, we encouraged emotional expression and acceptance of his condition because this patient exhibited alexithymic tendencies. We explained the importance of spending time on personal hobbies and encouraged behavioral changes considering his over-adaptive tendencies. From a social perspective, we made environmental intervention to his workplace to account for the patient’s significantly low intellectual processing speed.