Background : The physical symptoms of stress-related diseases with hypocortisolemia are similar to those of a typical physical disorder of adrenal insufficiency (e.g., fatigue, anorexia, weight loss, excessive sleepiness, nausea, diarrhea, joint pain, muscle pain, dizziness, and low-grade fever).

Methods and results : Patients presenting at a psychosomatic clinic with prolonged fatigue were examined using a diagnostic algorithm for adrenal insufficiency. One-fifth of patients were diagnosed with central adrenal insufficiency. Two-thirds of these patients had depression, 1/3 had experienced trauma, and 2/5 had a history of exogenous steroid use due to pre-existing conditions, such as bronchial asthma.

Conclusion : In the treatment of stress-related disorders associated with hypocortisolemia, it is necessary to be aware of physical comorbidities, such as autoimmune and allergic diseases and a history of exogenous steroid use, and to keep in mind the differentiation of central adrenal insufficiency.

Due to the complexity of the pathophysiology of chronic headaches, their management requires a psychosomatic perspective. Psychosocial factors play a significant role in the development of chronic headaches. Like other forms of chronic pain, this involves a vicious cycle of anticipatory anxiety, hypervigilance, and avoidance. Cognitive behavior therapy, utilizing behavioral analysis through a headache diary, may be included in its management. Additionally, exercise and relaxation techniques, such as exercise for relief of headache, autogenic training, and progressive muscle relaxation, are also effective. Though pharmacotherapy is effective, special attention should be placed in evaluating its efficacy, monitoring its use, and dosage adjustments, to avoid medication-overuse headaches.

Migraine is a disease that is highly disruptive to daily life, affects the quality of life of patients, and causes a significant burden on patients and social loss. It is now known that not only biological but also psychosocial factors influence migraine induction and maintenance. Headache perception, responses to pain, and coping are considered as factors in symptom maintenance. Cognitive behavioral therapy is expected to be effective when medication alone is insufficient or when psychosocial factors are thought to underlie the symptoms. Many overseas studies have suggested the effectiveness of cognitive behavioral therapy for migraines; however, there have been few reports on practice and research in Japan, and further practice and validation are needed. Against this background, a manual for cognitive-behavioral therapy for patients with refractory migraine was developed.

Children and adolescents with headaches are mostly diagnosed with migraines and/or tension-type headaches. Migraine is a headache attack of moderate or severe intensity ; however, medication is usually effective. They usually occur for less than 2-4 days per month during various periods of the day. However, chronic headaches are diagnosed as tension-type headaches, for which medications are ineffective. They sometimes cause frequent school absenteeism. Chronic headaches are considered chronic daily headaches (CDH) if they last more than 4 hours a day and occur on average for more than 15 days per month for more than 3 months. Children and adolescents with CDH complain of severe headaches in the morning before going to school, and sometimes stay in bed later. This leads to frequent school absenteeism. It is important for children and adolescents to understand that CDH will continue despite medications and that they should spend their daily lives with CDH looking for something interesting. Describing headache diaries or creating calendars of attendance at school are sometimes useful behavioral therapies. Supportive psychotherapy, separate from guardians, is also necessary and useful for children and adolescents with CDH and frequent absenteeism at school. They require early intervention to address psychosocial factors.

Tension-type headache (TTH) has the fundamental biological background of continuous activation of the cervico-trigeminal relay (CTR), above which each personal characteristic overlaps to construct the pathology. Stimulus to the CTR is a unique biological background of headaches, fulfilling the TTH diagnostic criteria of the International Classification of Headache Disorders. Beyond this, stimuli to the CTR itself may comprise personal characteristic traits that generate the pain behavior of chronic headaches. Sleep disorders and migraine predisposition are factors that enhance chronification of TTH. The inflammatory hypothesis regarding the pathogenesis of TTH was reviewed, and the diagnosis and treatment were reported, conforming to this hypothesis.

Background : Approximately 15% of patients with rheumatoid arthritis (RA) have depression. In previous studies, depressed mood and sleep disorders have been reported separately, and no studies have examined the factors that constitute depression. In addition, no studies have examined the relationship between these factors. This study investigated factors associated with depressive states in patients with RA.

Methods : One hundred and twenty-four patients with RA attending Showa University Hospital, who provided written consent to participate in the study, were included. Age, sex, body mass index, smoking history, hypertension, presence of diabetes, steroid use, methotrexate use, erythrocyte sedimentation rate, CRP levels, and serum MMP-3 levels were also investigated. The Simplified Disease Activity Index (SDAI) was used to assess disease activity in patients with RA. The Health Assessment Questionnaire Disability Index (HAQ-DI) was used to evaluate activities of daily living, and the Hamilton Depression Rating Scale (HAM-D) was used to assess depression. All patients were interviewed for HAM-D by the same interviewer, and the relationship between each item on the HAM-D and each index was examined.

Results : Forty-two patients (33.9%) reported experiencing a “depressed mood.” In contrast, a higher percentage of patients reported “anxiety somatic” (79, 63.7%), “somatic symptoms general” (69, 55.6%), “work and activities” (57, 46.0%), “hypochondriasis” (53, 42.7%), and “genital symptoms” (49, 39.5%). “Depressed mood” was correlated with SDAI (r=0.32, p＜0.001) and HAQ-DI (r=0.28, p=0.004), whereas “somatic symptoms general” was associated with SDAI (r=0.30, p＜0.001) and HAQ-DI (r=0.29, p＜0.001). “Anxiety somatic” was associated only with age (r=0.21, p=0.007), while the other factors showed no correlation.

Conclusions : A higher percentage of patients with RA reported “somatic symptoms” than “depressed mood” as a factor of depression. These factors were mildly correlated with RA disease activity and HAQ-DI.

Objectives : This study investigated the effects of psychological interventions on coping self-efficacy (CSE) and affective state in patients undergoing cardiac rehabilitation.

Subjects : Male patients aged 65 years or older undergoing cardiac rehabilitation were classified into two groups : intervention group (n=21) and non-intervention group (n=15). Community-dwelling older adults (n=74) comprised the control group.

Method : The intervention group received group psychoeducation on stress management and individual interviews during hospitalization. A questionnaire survey regarding CSE and affective states of patients was conducted before and after the intervention and one and a half months after discharge for the intervention group, as well as for the other groups.

Results : After discharge, CSE in terms of cognition, problem solving, and distractive acting declined in the non-intervention group. In the intervention group, CSE in terms of problem solving and distractive acting was maintained, but no CSE improvement in terms of cognition was observed.

Conclusion : Preventive intervention is necessary because CSE levels decrease in patients undergoing cardiac rehabilitation after discharge. In particular, interventional approaches to improve CSE in terms of cognition should be considered.