This talk discusses the ways in which psychosomatic medicine has impacted public policy and government as well as what has been achieved because of it, based on my experience in medical practice and as a politician. The specific examples discussed include the push to recognize psychosomatic medicine as an accepted specialty, efforts toward the prevention of karoshi (death from overwork) and child abuse, and the establishment of a national system for certified public psychologists. I also report contemporary issues, such as lookism, eating disorders, work-style reforms, and remote work. Next, I discuss digital transformation (DX) in psychosomatic medicine and the possibilities for treatment as digital transformation continues. For example, with an increasing number of smartphone applications, it is becoming easier for patients to monitor their own status and guide them toward behavioral changes. I also contend that the growing pace of digitalization is, in fact, an opportunity to have a positive impact on issues, such as isolation and loneliness.

In conclusion, from the perspective of psychosomatic medicine, I propose compact cities as a way to create environments that are better for living. My conclusion is that it is critical that psychosomatic medical knowledge is reflected in urban planning, which would enable people to live in cities of the right size and leverage remote work to find fulfillment.

Pain is a common experience that everyone has felt ; however, it can be largely distressing when it persists even after an illness or injury has healed. The International Association for the Study of Pain (IASP) defines chronic pain as pain that lasts for 3-6 months and in cases where pain persists for longer periods, psychological and social factors often play a role in the continuation of pain, in addition to organic factors. Therefore, the WHO and IASP established a classification for chronic pain in ICD-11, with chronic secondary pain syndromes being categorized as those resulting directly from bone and joint or nervous system problems, and chronic primary pain being classified as those that are difficult to explain by organic factors alone, even if organic factors are present. Mechanisms underlying chronic secondary pain syndromes have been elucidated using animal models of neuropathic and nociceptive pain. The clinical categories of chronic primary pain include fibromyalgia, chronic low back pain, irritable bowel syndrome, and glossodynia, which are influenced by diverse nurturing experiences and environmental factors and often involve organic factors to some extent, resulting in the pathophysiology of nociceptive pain. Currently, the mechanisms underlying nociceptive pain disorders are being increasingly elucidated, and exploring the direction of comprehensive treatment is necessary.

Gastrointestinal diseases are one of the disease groups that have long been strongly associated with psychiatric symptoms, as exemplified by the term “brain-gut correlation.” In the past, depressive anxiety has often been considered as a complication of peptic ulcer and ulcerative colitis. Functional Gastrointestinal Disorders (FGIDs), as defined in Rome IV and other standards, are the cornerstone of modern psychosomatic medicine. Psychosocial factors are now being elucidated as the main pathophysiological factors affecting digestive motility and visceral perception. In fact, two-thirds of patients with FGIDs experience major psychiatric disorders ; therefore, the understanding of psychosomatic correlations is an important factor in therapeutic guidelines.

This article introduces and summarizes reports that have examined the relationship among FGIDs, anxiety, depression, pathophysiological factors, and clinical characteristics and focuses on the mechanism of the psychosomatic correlation among depression, anxiety, and gastrointestinal disorders.

Patients with respiratory diseases frequently experience depression and anxiety. However, a pharmacotherapy for depression and anxiety in patients with respiratory diseases has not yet been established. Additionally, the use of high-dose benzodiazepines in patients with chronic obstructive pulmonary disease (COPD) has been associated with mortality. Therefore, nonpharmacological therapies are preferred. In particular, respiratory rehabilitation, the standard treatment for COPD, has been shown to be effective for depression. In addition, cognitive behavioral therapy has been reported to reduce psychological distress in patients with COPD. In daily clinical practice, a multidisciplinary approach in collaboration with rehabilitation departments, nurses, and psychologists can improve the vicious cycle of cognitive models of patients with COPD. Thus, the role of psychologists in the palliative care of patients with respiratory diseases is expected to increase. A questionnaire survey conducted among respiratory physicians revealed that respiratory physicians expect psychologists to “alleviate psychological distress by getting information about distress experienced by patients and their families early and providing psychological support.”

Cardiovascular disease is a significant inducer of psychological distress, an uncomfortable subjective state that includes depression and anxiety. Depression is also associated with an increased risk of cardiovascular morbidity and mortality. This relationship is attributed to underlying biological and behavioral factors as well as perceived loss, which results in a continuous interplay between the two conditions. Furthermore, a synergistic amplification has been observed between cardiovascular disease and trauma, which often triggers distress. Therefore, it is important to recognize the presence of trauma in patients with cardiovascular disease and distress. By understanding the importance of providing a sense of safety and security from a trauma care perspective, healthcare providers can offer discreet and effective support to patients.

Previous studies have reported that depression and anxiety are associated with several endocrine and metabolic disorders.

Graves’ disease (GD) is a typical psychosomatic disorder, and depression and anxiety negatively affect remission rates in patients with GD.

A significant association between depression and glycemic control has been established in patients with diabetes mellitus. Depression influences glycemic control through both physiological and behavioral mechanisms. Recently, it has been reported that diabetes-related distress and self-stigma affect glycemic control. Both have been suggested to be associated with depression.

Only few studies have examined the relationship between anxiety and diabetes mellitus. Anxiety may be associated with poor self-care activities and exacerbation of glycemic control. However, a moderate level of anxiety may have a positive effect on alleviating the risk of diabetic complications.

Certain chronic diseases, such as rheumatoid arthritis, have been reported to be associated with depression. The rate of rheumatoid arthritis varies widely from 7 to 75%, depending on the report. Most studies were based on questionnaires. The questionnaires used were diverse and not standardized and included the SDS, CES-D, HADS, BDI, PHQ-9, and HAM-D. There are questions as to which questionnaire is the most appropriate, where the cutoff value should be set, and the validity of the questionnaire method in comparison with structured interviews conducted by psychiatrists. Differences in the backgrounds of the study participants (time period, country, age, sex, race, and duration of illness) also make a difference. In addition, because the depression questionnaire included questions about physical symptoms, care is needed when interpreting the results if a patient has an underlying disease. However, treatment methods for rheumatoid arthritis have greatly progressed over time, and it is expected that as the disease activity of rheumatoid arthritis improves, the concomitant depressive state will also improve, and the rate of depression will decrease ; however, this warrants further validation. Complications of other collagen diseases, especially Sjögren’s syndrome and fibromyalgia, can exacerbate depression. There are mixed reports on anxiety, with some reporting an intensification of rheumatoid arthritis, while others reporting no change ; the results vary depending on the assessment method used. This article summarizes these issues and discusses future directions.

A cross-sectional study was conducted to clarify the relationship between Internet Gaming and sleep, lifestyle habits, schoolwork, and mood among elementary school students. Internet Gaming Disorder (IGD) was assessed using the Diagnostic and Statistical Manual of Mental Disorders (DSM-5^th edition). The relationship between IGD and each factor was assessed using a logistic regression analysis. A total of 19.4% of boys and 10.6% of girls in the low grades (grades 1-3) and 15.1% of boys and 7.6% of girls in the high grades (grades 4-6) were diagnosed with IGD. A game time of＞2 h was significantly associated with difficulty falling asleep, difficulty waking up, lack of deep sleep, daytime sleepiness, nightmares, skipping breakfast, dislike of studying and sports, lack of motivation, and irritability. IGD was independently associated with lower grades, male sex, use of game consoles in bed, possession of media devices, lack of usage rules, and late bedtime. Increases in the odds ratio for IGD were larger in lower grades than in higher grades with delayed bedtime and in girls than in boys when gaming in bed. In the future, it would be beneficial to accumulate evidence and create guidelines for using gaming devices.