When I was a medical student, through an encounter with a high school student with leukemia at a terminal stage, I decided to be a specialist of psychosomatic medicine. Thirty years have passed since I reported that cancer therapy based on the truth including notification of cancer resulted in a good patient-doctor relationship at the meeting of PSM on digestive diseases. After more than five-year-long practical experience as an internist and gastroenterologist at a middle class of the public hospital where the certified mentor of psychosomatic medicine had been working, I belonged to the Aichi Medical University and Fujita Health University School of Medicine for 23 years during which I did a basic medical research on brain-gut interaction at University of California, Los Angeles (UCLA) for one and a half year. Relationship between functional dyspepsia (FD) and psychological characteristics/gut hormone had been researched at the universities. We have established a nutrient drink test for measuring the human gastric function including threshold of discomfort sensation and adaptive relaxation volume in an easy and non-invasive way. The visual and auditory stress which induced discomfort feeling in normal volunteers resulted in appearance of stomach pain (epigastralgia) and reduction of maximal drinking volume which was among the characteristics of FD. Noise stress applied to the rats increased the contraction of gastric antrum and number of immunoreactive thyrotropin-releasing hormone (TRH) positive cells in the brain stem. These lines of experimental results in humans and rats suggested that discomfort feeling derived from a certain stressor may cause epigastralgia accompanied by changes of the motility and sensation of the stomach. The evidence-based clinical practice guidelines for FD 2014 recommends hypnotherapy by a specialist for intractable patients with FD, however, only a few institutes have performed the therapy. Under the tuition of Professor Yvette Taché at UCLA who discovered that TRH injected into the central nervous system increased the rat gastric acid secretion for the first time in 1980, gastric protective action of endogenous TRH in the brain stem was demonstrated and published in “Gastroenterology”. In terms of irritable bowel syndrome (IBS), central oxytocin which has been reported to be closely related with trust and love decreased the water-avoidance stress (that is among the typical animal models of IBS) -induced hyper-contraction of the rat colon. Necessity of the viewpoint of developmental disorders and usefulness of electroencephalogram-based biofeedback (neurofeedback) has been proved in a certain group of IBS patients.

I had received training at the psychosomatic department of General Hospital. Now I work in a psychiatric clinic. From my past experiences I reviewed important duties and roles for psychologists in the medical field and what kind of training I need. In our clinic I mainly conduct preliminary interview, psychological examination, and psychotherapy. In the medical field, it is essential to cooperate with doctors and the co-medical staff as a psychologist, and for that purpose it is a prerequisite to have “medical knowledge that can be a common language” as a medical professional. Also, in cooperation, he not only doses his psychological tasks but also explains their contents. Individual clinics may expect the psychologist other than psychological tasks. It seems necessary for psychologists to respond to the required roles, such as patient-based role models and staff care. In the case of a single psychologist, I considered it necessary to take self-care measures through workshops and supervisors.

Currently, there are an increasing number of students and their families who wish to consult about mental health, admission, graduation, employment etc. In some cases, students should consult doctors or psychologists at medical institutions. Cooperation between student counselors and medical psychologists is an important element for problem solving. It is one of the social responsibilities of the Japanese Society of Psychosomatic Medicine to train medical psychologists to be familiar with student counseling.

Certified Public Psychologist have an obligation to receive instructions from the attending physician. Although the affairs of Certified Public Psychologist are not recognized as an act helping doctor. We must deal with various problems about the role of Certified Public Psychologist. Recently, the bio-psycho-social model has been emphasized, and licensed psychologists will come to intermediate between “bio” and “social”. In this article, I consider the role of Certified Public Psychologist, and then state my opinion about the future.

It is important for medical psychologists in the department of psychosomatic medicine in university hospital to play the roles of clinical practice, education, and research. In clinical practice, medical psychologists should support patients on the basis of mind-body interaction, holistic approach and psychosomatic view. They also should have a broad physiological knowledge which will be useful at the treatment of multiple organ systems. As the members in the team of the clinical practice, they should try to improve the quality of life of patients based on deep understanding of each specialist. They also should utilize educational lectures and e-learning to renew medical knowledge. In education, medical psychologists should teach students based on the pathophysiology of psychosomatic diseases. Practical education by skillful medical psychologists is especially indispensable. In research, medical psychologists should renew psychotherapy including cognitive behavioral therapy based on the known mechanism of psychosomatic diseases which patients in the department of psychosomatic medicine most frequently have. Medical psychologists should have knowledge and skills with a special reference to clinical practice and clinical medicine.

In Faculty of Medicine, Kagawa University, the Department of Clinical Psychology was established in 2018. The aim of this establishment is to educate and train clinical psychologists who have more medical knowledge than usual education units in non-medical department of psychology. We performed an investigation about needs of clinical psychologists having enough medical knowledge to several medical or welfare institutions and municipal corporations in preparation of application to the Ministry of Education, Culture, Sports, Science and Technology. As a results, many institutes agreed our image of clinical psychologist and had positive thinking about employment of those psychologists. In association with authorization of Certified Public Psychologist, social concern and expectation for psychologist are thought to be rising. I will discuss expected role and talent of clinical psychologist in this paper.

Objectives : Evaluating bipolar spectrum in patients experiencing episodes of depression can be challenging and must be handled with caution ; thus, the development of novel evaluation tools is an area of high demand. Herein, we report a facial expression recognition task that was conducted for elucidating characteristics of facial expression recognition by depressed patients with and without bipolar spectrum.

Subjects and Method : We evaluated patients using depression assessment scales (BDI-Ⅱ and HAM-D) and administered bipolar disorder screening questionnaires (MDQ and BSDS), Mini-International Neuropsychiatric Interview (MINI), and a facial expression recognition task (JACFEE). The subjects comprised 23 patients diagnosed with major depressive disorder who were being treated in the psychosomatic medicine department of a university hospital in Tokyo between October 2014 and December 2016. Based on assessment results, we classified the patients into the major depressive disorder group (11 patients) and the bipolar spectrum group (12 patients), and compared their performance in the facial expression recognition task.

Results : Each group×the correct response rate for each facial expression recognition was evaluated using a t-test, and we found that compared with the major depressive disorder group, the bipolar spectrum group had a significantly lower rate of correct responses for identifying expressions of “happiness” [t (21)=−2.06, p<0.05]. Furthermore, a Pearson correlation test of the correct response rate for each expression recognition and the bipolar disorder screening questionnaire revealed a significant negative correlation between the rate of correct responses for expressions of “happiness” and MDQ (r=−0.61, p<0.01).

Conclusion : Despite the same severity of depression, patients with bipolar spectrum were not able to correctly recognize expressions of “happiness.” Furthermore, the results indicated that a wide range of symptoms in patients with bipolar spectrum may be associated with more difficulty in recognizing the expression of “happiness.” This finding potentially demonstrates the possible involvement of information processing related to facial expression recognition and the possible associated features of these diseases. Furthermore, it suggests that facial expression recognition tasks can be used as potential evaluation tools for differentiating the type of diseases.

Background : Psychosomatic skin disorders are strongly influenced by stress on their onset and during their course. In the previous studies, group psychotherapy aimed to improve stress coping skills was revealed to have the possibility of encouraging patients to cope with stress in more positive ways.

The purpose of this study was to investigate the effects of group psychotherapy on the patients’recognitions of their problems, stress coping styles, and their skin conditions, using semi-structured interviews.

Patients and methods : We recruited patients who had attended the group psychotherapy at least twice in the past year. In the interviews we asked them the following main questions ; “How was the group experience?” and “What are the influences of the group psychotherapy on their daily life?”. The interview data were analyzed using the modified grounded theory approach (M-GTA).

Results : Seven patients participated in the current study and each patient went through a semi-structured interview between June and November 2016. The participants were all female with a mean age of 45 years. The most frequent diagnosis was atopic dermatitis (3 patients), followed by urticaria, prurigo, multiple alopecia areata, nummular eczema (1 patient each). The mean frequency of the attendance of the group psychotherapy was 3.6 times.

As a result, we found five categories in total regarding the group psychotherapy. Among them, three categories ; ≪The influences of observation and interaction with other patients≫, ≪The effects of learning and experiencing stress coping skills≫, and ≪The attitudes toward their problems≫ were directly related to the group psychotherapy, while two categories ; ≪The effects of treatments of skin diseases and psycho-educations about the stress≫, and ≪The attitudes toward skin treatments≫ were directly related to the dermatological treatments.

The two categories, ≪The influences of observation and interaction with other patients≫ and ≪The effects of learning and experiencing stress coping skills≫, showed interactions with ≪The effects of treatments of skin diseases and psycho-educations about the stress≫. In addition, these two categories positively influenced ≪The attitudes toward their problems≫. The latter showed also an interaction with ≪The attitudes toward skin treatments≫ which was influenced by ≪The effects of learning and experiencing stress coping skills≫.

Conclusion : The group psychotherapy seemed to have positive effects on patients’ recognitions of their problems, the stress coping styles, and the treatment behavior of their skin diseases, in association with regular dermatological treatments.