Psychological stress induces various physiological responses by affecting the central neural circuit controlling the sympathetic nervous system. Body temperature elevation is one of those stress responses, and strong psychological stressors often induce the symptom called psychogenic fever. Psychological stress responses are fundamental in mammals, and therefore, the central circuit mechanisms for these responses have been a focus of research. It may be helpful to compare between the circuit mechanisms of stress-induced hyperthermia and inflammation-induced fever. Both hyperthermic responses share the descending sympathoexcitatory pathway from the dorsomedial hypothalamus through the rostral medullary raphe to the spinal cord, which stimulates thermogenesis in brown adipose tissue. However, the mechanisms to excite the sympathoexcitatory neurons in the dorsomedial hypothalamus are different between the two hyperthermic responses. Inflammation or infection induces fever by exciting the dorsomedial hypothalamus neurons through neuromodulation by the action of prostaglandin E₂ in the preoptic area. In contrast, psychological stress activates neural pathways from the corticolimbic system to the dorsomedial hypothalamus to drive stress-induced hyperthermia and other sympathetic responses.

Mammals including humans have two types of fat tissue, white and brown adipose tissues. White fat is a site for energy storage, while brown fat is a specific site for non-shivering thermogenesis, thereby being involved in the regulation of body temperature in response to cold exposure and also to inflammatory and stressful stimuli. As brown fat also contributes to the regulation of whole-body energy expenditure and body fat content depending on its thermogenic activity, it gathers much attention as a therapeutic target for obesity. Here, I review our current understanding about human brown fat obtained from prospective studies using FDG-PET.

Fever is a common symptom in children and is caused by various physical disorders, psychosocial stress is also induced the fever. In general, a diagnosis of “psychogenic fever” is made when there are no accompanying symptoms or inflammatory findings other than fever, and fever is observed in a specific situation or trigger, or when the effects of chronic psychosocial stress are estimated. Psychogenic fever is a stress-related, psychosomatic disease especially seen in teenagers and young adults.

In children, if the patient is unaware of the psychosocial stressors or is unable to verbalize well, the psychological factor may not become clear and diagnosis may be difficult. Also, if parent and child are worried about a physical illness or they cannot accept the diagnosis, they may fall into doctor shopping. As for the treatment, lifestyle guidance, psychotherapy, and pharmacotherapy are provided but environmental adjustment is most important for children. In group life such as school, there is a problem peculiar to childhood, such as a measure of correspondence at the time of fever. In addition, consideration for comorbidities is necessary, and attention is paid to neurodevelopmental disorders, especially autism spectrum disorder. In this paper, we will describe the precautions treatment and dealing with psychogenic fever in children.

Treatment includes lifestyle guidance, psychotherapy, and pharmacotherapy, but environmental adjustment is important for children. In group life such as school, it is necessary to know how to cope with fever. This is an issue specific to childhood. In addition, consideration for comorbidities is necessary, and attention is paid to neurodevelopmental disorder, especially autism spectrum disorder. In this article, we will describe the points of care for and treatment of psychogenic fever in children.

Fever and hyperthermia are different. This is the core knowledge for understanding functional hyperthermia, and thus appropriately diagnosing functional hyperthermia from patients with fever of unknown origin (FUO). Functional hyperthermia was originally excluded from classic FUO. However, in Japan, the value of being free from symptoms and pains is becoming more prevalent even in a condition that does not have a poor prognosis, and functional hyperthermia has become a relatively independent problem. To diagnose functional hyperthermia, after chronic inflammation is excluded, it is necessary that clinical judgment is made while examining diseases such as systemic lupus erythematosus, Sjögren syndrome, acquired idiopathic generalized anhidrosis, and familial Mediterranean fever. Unlike pediatric and adolescent hyperthermia, where selective serotonin reuptake inhibitors are more effective, treatment is extremely difficult in adults. The basic skeleton of treatment for adults is to identify first and then improve coexisting organic diseases. In order to improve hyperthermia as a subsequent psychosomatic stress, it is better to approach multiple factors in multiple ways, and psychosomatic intervention is important as a component.

This article outlines the treatment that the author performs for psychogenic fever or functional hyperthermia. In the treatment of psychogenic fever, what is important is an individualized prescription for the patient's stress, and not follow-ups without a prospect for improvement, repeated tests, or administration of antipyretics. Therefore, monotherapy is insufficient, and a multidimensional approach is often necessary. Specifically, approaches are combined as needed, such as patient education of the disease, daily-living guidance, adjustments of the environment, psychotherapy via verbal and non-verbal methods, psychophysiological techniques (relaxation training), pharmacotherapy, and treatment of comorbid conditions. To understand the pain of patients accompanying fever, I ask them, “What difficulties do you have when your body temperature increases?” Furthermore, I use the disease name of functional hyperthermia instead of psychogenic fever if the patients deny the psychogenic cause of their condition or if the term “psychogenic” can be stigmatizing to the patients or their families.

Objective : Positive and negative metacognitive belief is considered to effect sleep-onset insomnia mediated by cognitive arousal. In previous studies on relationships between sleep-onset insomnia and metacognitive beliefs indicate that positive metacognitive belief rather than negative metacognitive belief is correlated with sleep-onset insomnia. However, these studies have two major problems : (a) Do not include “uncontrollability of worry” when evaluating negative metacognitive belief, (b) Lack investigation on the indirect effect of each metacognitive belief on sleep-onset insomnia and cognitive arousal as mediation role. Therefore, it is unclear whether for treatment of sleep-onset insomnia to target negative metacognitive belief or positive metacognitive belief. From these considerations, the present study aimed to evaluate the association between metacognitive belief and sleep-onset insomnia, mediated by cognitive arousal.

Methods : A cross-sectional survey was conducted on 414 undergraduate students. The questionnaire included Pittsburgh Sleep Quality Index (evaluating sleep-onset insomnia), Pre-sleep Cognitive Activity Scale (evaluating cognitive arousal), and Metacognitive Beliefs about Worry Questionnaire (evaluating negative metacognitive belief including “uncontrollability of worry” and positive metacognitive belief). Three hundred seventy-nine valid responses (male : 155, female : 224, mean age : 20.21, SD : 1.88) were analyzed.

Results : The mediation analysis indicated that negative metacognitive belief was significantly correlated with sleep-onset insomnia indirectly [β=0.18, 95%Confidence interval (CI) : 0.12, 0.25, p<0.01]. On the other hand, no significant correlation was demonstrated between positive metacognitive belief and sleep-onset insomnia (β=−0.02, 95%CI : −0.12, 0.08, p=0.66).

Conclusions : The present study indicates that negative metacognitive belief correlated with sleep-onset insomnia was mediated by cognitive arousal. It is important to target negative metacognitive belief rather than positive metacognitive belief for sleep-onset insomnia treatments. Moreover, there is need to evaluate the “uncontrollability of worry” when assessing negative metacognitive belief.

The length of stay of palliative care patients has been shortened by promoting home care and community-based integrated care. What kind of role can we medical professionals play in supporting patients and families in diverse psychosocial stress situations with less time contacted them? We also introduce the approach of psychology support to patients and families in palliative care unit of our hospital, and look back on the role of medical institutions in the community. The opportunity when patients and families could talk increased by our support system such as the setting of consultation service, multidisciplinary cooperation, regional cooperation, and grief care. In addition, by providing an opportunity to learn and discuss psychological support and to understand the needs of patients and families, we were led to the improvement of knowledge and technology related to the support of the entire ward. Furthermore, the regular interaction with the community has made it possible to offer a wide range of psychological care.