I excerpted content related to psychosomatic medicines in the learning criteria of undergraduate and post-graduate medical education. Additionally, I introduced actual psychosomatic education in Japanese medical schools. During under graduation, I used the model core curriculum of medical education, learning and assessment items of common achievement tests, examination criteria of the national examination for medical doctors, and standards of the international accreditation of medical schools. In these criteria, most of the content is included in the criteria of the national examination. In actual education, only one or two classes are provided in medical schools without the department of psychosomatic medicine. In the internal medicine textbooks, psychosomatic content is increasing in general remarks, however, such content cannot be found in individual diseases. In postgraduation, I used attainment targets of initial clinical training of medicine and those of specialty training of general medicine. I also introduced programs rerated with psychosomatic medicine in the Kagawa University medical school.

Smoking is affected by personality and is a big factor in asthma death. Therefore, interventions for smoking cessation, which focus on the personality related to smoking, may help to reduce the risk of death from bronchial asthma. However, the results of previous studies of personality related to smoking vary from study to study.

Previous studies have reported that depression encourages smoking, and smoking exacerbates depression. Depression also exacerbates bronchial asthma. Character is one of the constituent factors of suppressing depression. In this study, we compared the personality of smokers and nonsmokers with depression, examined the personality of smoking bronchial asthma patients, and effect of interventions for smoking cessation focusing on their personality.

From the results of this study, we found that smoking behavior is encouraged by continuous depression, since smokers with depression have a stronger closed and careless attitude toward the problem than nonsmokers, and tend to not solve the problem. From this result, we predicted that the bronchial asthma patient who smoke share the same personality. Therefore, it was considered that strengthening the attitude toward positive problem solving would prevent chronic depression and help to stop smoking.

Patients with bronchial asthma (BA) are often influenced by psychosocial factors and may exhibit indefinite symptoms ; however, these symptoms may also be the result of adrenal insufficiency (AI). If the patients have a history of systemic steroid use, as well as of indefinite symptoms, AI is suspected as the cause of their conditions. Cortisol measurement in blood and urine was carried out to determine the actual status of adrenal function in a group of 128 patients with asthma of various severities. The following tests were conducted to measure adrenal function : 1) diurnal variation at 6 am, 11 am, 16 pm, and 23 pm ; 2) average/day total 24 h urinary cortisol for 2 d ; and 3) ACTH provocation test. The results of these tests were used to classify the patients according to their severity of AI. Percentage of Group A at 15.6% is close to the rate of sudden asthma death rate at 13.6%. Those in group A seem to avoid stress as measured by CMI, YG and TEG. Though significantly higher scores are marked for cardiac symptoms, fatigue and frequency of illness compared group B, C and D.

The complications of depression in bronchial asthma and chronic sinusitis are well known. However, there are few reports on the improvement of psychiatric symptoms with proper treatment. In this study, we analyzed the changes in depressive symptoms before and after the introduction of dupilumab in asthma patients with eosinophilic chronic rhino-sinusitis (ECRS). Thirty-one patients with ECRS-complicated asthma, who received dupilumab, were analyzed. Asthma Control Test (ACT) and Asthma Quality of Life Questionnaire (AQLQ) were used to assess asthma symptoms, before and 4 months after dupilumab introduction. Sino-Nasal Outcome Test (SNOT-22) was used to assess sinusitis symptoms, and Patient Health Questionnaire (PHQ)-9 was used to assess the depressive state. Pre-treatment PHQ-9 values were correlated with the SNOT-22 scores. The PHQ-9 score decreased significantly after 4 months of dupilumab use, especially in the group of patients where the ACT score improved by more than 3 points and those who showed a clear decrease in their SNOT-22 score. There have been few reports of improvement in depressive symptoms by therapeutic interventions for current illnesses, and the present results may be considered as evidence of the high clinical efficacy of biologics.

Introduction : The involvement of psychological factors in bronchial asthma has been pointed out since the time of Hippocrates.

At present, the possibility of the involvement of various emotions such as anxiety, apathy, depression, lack of confidence, anger, conflict, loss of motivation and hopelessness in bronchial asthma is strongly recognized, but in reality a universal psychotherapy based on EBM has not yet been established.

The “Parentectomy” advocated by Peshkin was regarded as the standard therapy for severe and intractable childhood asthma in Japan, and has a history of being practiced as a long-term inpatient therapy (institutional therapy). Among various reports of the time, there were some reports showing that the control of emotions such as anxiety, dissatisfaction, indulgence, jealousy, and apathy was more effective than systemic steroids in childhood asthma. Here, improving emotions such as anxiety and naivety may itself be a potential psychotherapy.

Objectives : To examine the possibility that parenting guidance (psychotherapy) may affect the exhaled nitric oxide concentrations (FeNO) in childhood asthma.

Methods : Children with asthma were given standard medication, allergic and training therapy, while parents were given parenting guidance to help their children grow up with “toughness and reliability”.

Thirty-four children (20 boys and 14 girls), aged 4-12 years at the time of the first visit, were cross-sectionally examined for treatment steps, improvements, FeNO and personality traits.

FeNO was measured by Bedfont Scientific’s NO Breath, and personality traits were assessed using the TS Style Personality Test for Preschool Children and Preteen.

Results : (1) Including significant trends, neuroticism (p<0.05), dependence (p<0.05), and emotional instability (p<0.1) were associated with FeNO in childhood asthma.

(2) Children with better personality in above mentioned traits had a higher probability of having a low FeNO concentration.

Considerations : (1) Parenting guidance to grow their children up to “toughness and reliability” could be a useful psychological therapy in childhood asthma.

(2) This report is only the result of a small number of cross-sectional surveys, and further longitudinal surveys and multifaceted verification are needed.

Dysfunctional breathing (DB) is a clinical condition characterized by irregular breathing patterns. Asthmatic patients with DB show more severe symptoms, and therefore, early diagnosis and early therapeutic intervention for DB are critical for improving the clinical condition of these patients. The Nijmegen Questionnaire (NQ) has been used as a screening tool for DB, translated into various languages, and used globally. However, a Japanese version of the Nijmegen Questionnaire (JNQ) is not available. The purpose of this study was to develop the JNQ, verify its reliability and validity, and demonstrate its clinical benefits for Japanese patients with asthma. We developed the JNQ with the consent of the NQ author. The answers to self-administered questionnaires, including the JNQ, an asthma control test (ACT), an asthma control rating scale (ACQ), a quality of life (QOL) rating scale for asthmatic patients (MiniAQLQ), and a depression rating scale (PHQ-9), were obtained from 68 consenting asthmatic patients (average age 52.04±12.43) who visited Nihon University Itabashi Hospital. The reliability of the JNQ was assessed using Cronbach's alpha coefficient. A comparative test was conducted for each questionnaire (ACT, ACQ, MiniAQLQ, and PHQ-9), using a JNQ score of 23 as the cutoff value. Patients with a JNQ score of 23 or higher were assigned to the DB group, whereas patients with a JNQ score less than 23 were assigned to the non-DB group. The correlations between the JNQ score and scores for each questionnaire were also analyzed. The JNQ showed sufficient reliability. The JNQ score showed a negative correlation with the MiniAQLQ score and a positive correlation with the PHQ-9 score. Significant differences were observed in the MiniAQLQ and PHQ-9 scores between the DB and non-DB groups. The JNQ was found to be beneficial for evaluating DB in Japanese asthmatic patients and a high JNQ score reflected decreased QOL and a depressive state. Early therapeutic intervention (such as breathing exercises and psychosomatic approaches) for asthmatic patients with DB may prevent the deterioration of their clinical condition.

Objectives : The purpose of this study was to investigate the psychological process from onset to remission by focusing on the narrative story of patients with anorexia nervosa (AN).

Methods : To this end, four patients with AN who were in remission were interviewed. The analysis was conducted using the grounded theory approach, which is a qualitative research method. Subsequently, a theoretical model diagram was constructed based on the psychological process from the onset, aggravation, and remission of AN.

Results and Conclusion : The analysis had the following results : The psychological background of patients’ inability to eat was intricately intertwined with problems of self-concept and relationship with others. Moreover, patients had a psychological conflict between “fear of eating” and “a sense of danger to the body”. The timing of the small meal which the patient consented to in the subjective story may be a starting point of treatment for achieving remission. Thus, psychological support in a form that concurs with the subjective story of the patient is important.

“Hikikomori” (or social withdrawal) which refers to a state in which an individual dose not participate in society for prolonged periods is a significant problem in Japan. Several reports outline the process of medical treatment for Hikikomori, but to our knowledge, there are no case reports of individuals whose parents have died. The purpose of this study is to identify the focus of bio-psycho-social approach for Hikikomori patients whose parents have died.

We reported a case of a 49-year-old woman who had withdrawn to her home for 35 years. After her mother’s death, she became extremely underweight and was admitted to our hospital. She was diagnosed with suspected autism spectrum disorder. She appeared nervous in the first several days after hospitalization. Thus, to ensure she felt secure, we spoke to her briefly and calmly and presented to her a written message. Treatment consisted of dietary therapy to promote weight gain with a doctor, life skills training and facilitation of mourning with a psychologist, and environmental adjustment with a social worker. She was discharged six months later and subsequently improved.

In conclusion, we experienced a case of Hikikomori with extremely low weight who responded to the bio-psycho-social approach. This case study emphasizes the criticality of creating an environment in which the patient can feel safe.