Primary medical care has many problems from the standpoint of psychosomatic medicine, and the care from both sides of mind and body is necessary. Although psychosomatic medicine is useful to learn the skill, still it is not familiar to specialists in general medicine.

25 to 35% of the chief complaints of new patients are caused by functional diseases. Most of them are applicable to psychosomatic disorders, and it is often possible to diagnose them or complete their treatments earlier in our division than in conventional departments of general medicine. These symptoms have been recently called “Medically Unexplained Symptoms ; MUS” or “Functional Somatic Syndromes ; FSS”. In this article, I introduce psychosomatic medicine mainly on FSS.

It takes more than half a century after publishing the famous book “Psychosomatic Medicine”. The disease which should be treated in psychosomatic medicine is piled up for the technical development such as medications or the laboratory procedure. The main stream about upper gastrointestinal disorders has moved from peptic ulcer to functional dyspepsia. Nowadays pylori association dyspepsia or gastroparesis is coming into the limelight with complications of some factors such as metabolic disease, Helicobacter pylori infection, mild inflammation of the membrane due to mental stress.

Reflux hypersensitivity and functional heartburn have been established as new subtypes of gastroesophageal reflux disease. The Chicago classification also supplies new subtypes of esophageal motility disorders such as Esophago-gastric junction outflow obstruction etc. In lower gastrointestinal disorders, main stream is moved from inflammatory bowel diseases such as the ulcerative colitis to functional disorders such as irritable bowel syndrome, functional diarrhea and functional constipation. Moreover dyssynergic defecation and Levator ani syndrome complicated with the urogenital dysfunction has recognized due to the malfunction of the pelvic floor muscles and nerves. This article explains about alternate gastrointestinal disease which should be dealt with in psychosomatic medicine in the future.

・At first, among many biological diseases with chronic cough and respiratory discomfort, we should make a careful diagnosis.

・Patients with chronic cough, such as cough variant asthma, are more depressed and anxious than patients with classic asthma.

・Psycho-social evaluation is needed to patients with respiratory discomfort, such as emphysema.

・The evaluation of biological, psychological and social problems is very important to control respiratory symptoms such as chronic cough and respiratory discomfort.

Almost all diseases and clinical conditions in cardiology are included in the category of psychosomatic disorder. Essential hypertension is the representative of them, however, in this article the highlights of psychosomatic aspect of other psychosomatic disorders (e. g. ischemic heart disease, heart failure) are introduced. The outline of the onset of psychosomatic mechanisms and psychosocial problems, and task of some relationships in ischemic heart disease are reviewed. The significance of comprehensive cardiac rehabilitation and the role of physicians as an effective facilitator in the medical team for ischemic heart disease are discussed. The diversity of underlying diseases and comorbidity, and distinctive clinical course of heart failure are introduced. The importance of holistic approach for patients with heart failure at each clinical stage is discussed. Psychosomatic medicine in cardiology has been widely spread out by requirement of cure and care in the medical practice of palliative care for patients with end-stage heart failure.

The authors introduced the knowledges of psychosomatic studies in the important psychosomatic disorders in endocrinology and metabolism after the 7 holy diseases.

Various psychosocial factors to influence in the onset and progress become clear for diabetes. In addition, as psychosomatic approaches, antidepressant is effective in the depression merger cases, and empowerment, ACT, solution-focused approach, coaching, narrative approach are also useful. Differentiation with the depression often becomes the problem by Cushing syndrome (pseudo Cushing syndrome). In addition, a series of studies of Sonino and others suggest psychosomatic aspects of pituitary-dependent Cushing's disease. According to DSM-5, eating disorders are divided into anorexia nervosa, bulimia nervosa, binge eating disorder, and at present psychotherapy with the most effective evidence is cognitive-behavioral therapy. The points for the psychological characteristic of obesity patients are ①low self-evaluation, ②a tendency of avoiding difficult problems, ③self control of all desires and impulse is poor. In addition, psychosomatic approaches such as stress management or cognitive-behavioral therapy are necessary for diet by all means.

Patients with rheumatic diseases, including rheumatoid arthritis, report a higher incidence of depression, anxiety disorders, etc. than healthy individuals.

In psoriatic arthritis, systemic lupus erythematosus, and vasculitis syndrome, multidisciplinary treatment combining corticosteroids, immunosuppressants, biologics, etc. has improved the outcome of the primary disease. Concomitant depression have also shown improvement. However, psychosomatic approaches are necessary for symptoms such as anxiety concerning the reorganization of the primary disease, drug side effects, fatigue, reduced vitality, tension, and agitation.

For Sjögren's syndrome and fibromyalgia, there are no established treatments to control the underlying disease. Therefore, a psychosomatic approach is important for complaints such as anxiety about the progression of the underlying disease, chronic pain in which the drug is ineffective, and malaise.

Psychonephrology is a study that deals with the common parts of nephrology and psychosomatic medicine, psychiatry, psychology and renal failure nursing. Psychonephrology covers the following areas : (1) Mental care for patients with chronic kidney disease, (2) Mental health of staff involved in renal replacement therapy, (3) Decision support for renal replacement therapy for patients with chronic kidney disease, (4) Non-cancer palliative care and (5) Mental illness and psychiatric symptoms in the medical treatment of patients with chronic kidney disease. Chronic kidney disease has a psychosomatic aspect in which psycho-social factors are strongly related to its course, and a psychosomatic approach is useful. There is a psychology of “subject loss” as the background to chronic kidney disease patients leading to renal replacement therapy. In addition, it may lead to depression, anxiety, non-adherence of treatment, etc., and it is expected that there will be a psychosomatic physician who can continue to be involved throughout the treatment of chronic kidney disease.

Background : Eating disorders are a widespread and serious problem, particularly among women. However, research on the recognition of this disease in general is limited. This study aims to clarify the awareness about the disease name of eating disorders and misunderstandings and prejudices about diseases among Japanese women. In addition, we examined the influence of acquiring information on eating disorders from five sources : TV, internet, magazines, school lessons, experts, and personal contact with people who have eating disorders on misunderstanding and prejudice.

Method : We conducted a WEB questionnaire for women members of a company specializing in epilation.

Results : Among 4107 respondents (average of 27.0±7.4 years), 27.8% were familiar with eating disorders ; 43.5% knew of them to some extent ; 27.8% had heard of the disease name, but did not know the symptoms ; and 6.5% had never heard of eating disorders. The decreasing order of awareness of disease name can be indicated as follows : “Depression” ＞ “Anorexia Nervosa” ≒ “Bulimia Nervosa” ＞ “Cervical Cancer” ＞ “Eating Disorders” ＞ “Schizophrenia.” Generally, more information acquired corresponded to less misunderstanding about or prejudice against eating disorders. However, obtaining information from specific means such as TV or expert led more women to think of diet as the primary reason for eating disorders and their own upbringing by their mothers as another reason for eating disorders. Respondents who have had personal contact with eating disordered patients have less misunderstanding about or prejudice against eating disorders.

Conclusion : The disease name eating disorders was recognized lesser than depression, bulimia, and anorexia. The study results can be used for educational activities to promote an accurate understanding of eating disorders