According to psychosomatic researches in Graves' hyperthyroidism after Alexander, life events, daily life stresses as the onset factors, life events, daily life stresses, depression, anxiety, alexithymia, eating disorder, AC of the egogram as the exacerbation factors and A and FC of the egogram as the improvement factors were found. Some studies about psychosomatic approaches suggest that antianxiety drug and counseling combination raise the remission rates by an antithyroid drug treatment.

Workplace-related stress, sleep disorder, feeling of pressure to time, feeling of irritation, achievement effort/emulousness, hostility, depression, anxiety were found as risk factors for the essential hypertension by the behavior medicine introduction. In addition, it is known recently that primary aldosteronism is included in essential hypertension in a high rate, and some studies suggest the connection with the primary aldosteronism and anxiety disorder. According to the meta analysis of the psychosomatic approaches, the combination of biofeedback and somatic technique seems to have the biggest depression effect.

The book “Psychosomatic Medicine” written by Franz Alexander continues providing us many suggestive interpretation theories of psychosomatic disorders even now. It is hypothesized that an emotional stimulation of peptic ulcer has became chronic by one charcter of “failure of dependent desire and receptive tendency”. The symptom of “nervous stomach” means epigastralgia and heartburn occurs. These symptoms propose to chronic secretion of the gastric juice and reached the ulceration. Gastroesophageal reflux disease and functional dyspepsia which are equivalent to “nervous stomach” have existed as main disorders in psychomatic medicine of Japan now, though severe gastric and duodenal ulcer have been improved by antacid agents. On the other hand, it is noted for the ulcerative colitis that the default of the ambition to accomplish duty leads to onset factors of exacerbation and the recurrence of the disorder. Furthermore, noted the involvements with some contents such as nervous excitement of colon by the affective tangle, change of intestinal liquid movement, localization of anatomical ulceration participates. The relationship between chronic diarrhea and an aggressive dependence desire, chronic constipation and negative feelings such as the principle of pessimism and defeatism are also described. Finally pick up the similarity with irritable bowel syndrome that is one of a main stream of Psychosomatic lower gastrointestinal disorder in current, functional diarrhea and functional constipation.

Impacts of psychological stress on allergic disease were studied across sites. In this symposium, the following points were introduced from recent studies.

1. Diagnosis of chronic cough,

2. Mechanism that aggravates allergic disease by psychological stress.

3. Assessment of Bio-Psycho-Adherence (Social) factors in bronchial asthma

Depression occurs in about 15% of patients with rheumatoid arthritis (RA), due to ①disease activity, ②complication by other diseases (e. g., Sjögren's syndrome or fibromyalgia), and/or ③socioeconomic factors. Advances in treatment of RA using disease-modifying antirheumatic drugs (DMARDs), especially biological DMARDs, have been significant ; moreover, depression improves in proportion to the effectiveness of RA treatment. It has been shown that when treating depressed patients with RA, it is important to first adequately treat RA with DMARDs. Cytokines such as tumor necrosis factor-α and interleukin-6 and hormones such as dehydroepiandrosterone sulfate and oxytocin are associated with improvement of depression in patients with RA, but the mechanism is unclear. Unresolved problems requiring further research include ①an unknown mechanism for improvement in depression, ②residual depression in some patients even when RA disease activity is controlled, and ③inability to improve depression when RA is complicated by other diseases.

It is often said that the theory of transactional analysis is easy to understand but only used for explanation of Egogram, or that game analysis and script analysis are difficult to practice. In this article, how to use the ego state of therapist in daily practice and the racket system and personality adaptation as a tool for diagnosis of life script and an approach for treatment will be discussed by presenting report of cases.

In this paper, I will present a guideline for clinical medicine, focusing on behavioral medicine. Using ten-minute clinical interviews, I will show how behavioral medicine can be applied to pragmatic clinical medicine, on the basis of previous research and my own experiences. First, I will explain the basics of patients' behavioral change and therapeutic ego. I will then take two clinical examples on how to facilitate behavioral change in patients, focusing mainly on two diseases that are common in psychosomatic clinics : a case of irritable bowel syndrome and a case of adjustment disorder with insomnia leading to depression. Using these two cases, I would like to show how to manage an interview within ten minutes at outpatient services, including initial and follow-up interviews.

Autogenic training (AT) is often used as a relaxation method to moderate mental and physical disorders caused by persistent anxiety and tension. Beyond that, it is also a useful method for understanding the psychosocial characteristics of patients. In the presented case, the introduction of AT revealed hypersensitive reaction to body sensation, perfectionism, and negative thinking, and deepened the understanding of the disease state. The purpose of AT was reconfirmed, and at the same time, it was devised to make performing AT easier for patients. Once patients were motivated to train, a relaxation response occurred, changing not only how the patient interacted with herself, but also how she interacted with others. AT is a therapeutic method worth knowing as a treatment technique.

We describe a 16-year-old woman suffering from anorexia nervosa for two years. At the initial visit, her body mass index was 13.1kg/m². Although the patient regularly visited us, she refused any medical treatment. After one month of the initial visit, she complained of low-grade fever and leg edema. She did not experience any respiratory symptoms such as pleuritic chest pain, dyspnea, and tachypnea. However, breath sounds in her right lung were decreased. Chest X-ray revealed right-sided pneumothorax with minimal pleural effusion. She admitted the hospital for observation of primary spontaneous pneumothorax. Then, her pneumothorax was recovered within seven days. Interestingly, her anorexia also improved, and she demonstrated consistent body weight gain after discharge. We reviewed the literature and discussed the impact of spontaneous pneumothorax considering patient-doctor interaction.