Abstract

The intentionality and content dimensions of mind wandering (MW) are important determinants of its costs and benefits. However, the relationship of intentionality with various combinations of different content dimensions has never been examined. In this study, we aimed to examine whether the content of intentional and unintentional MW differs in terms of temporal orientation, emotional valence, and combinations of these two factors. Results indicated that intentional and unintentional MW did not differ in the frequency of negative valence, whereas a difference was observed in the frequency of negative valence combined with temporal orientation. Unintentional MW was 4.88 times more likely than intentional MW to generate negative past-oriented content, while intentional MW was 2.61 times more likely to generate negative future-oriented content. Furthermore, when compared to intentional MW, unintentional MW was 1.94 times more likely to generate neutral past-oriented content, while intentional MW was 2.17 times more likely to generate positive future-oriented content. These findings show that intentional and unintentional MW have different effects on the content generated, depending on whether the content dimensions are considered separately or combined, which opens crucial new perspectives on understanding the functionality of MW.

本研究の目的は、日本語版Work-related Acceptance and Action Questionnaire（WAAQ）を作成し、その信頼性と妥当性を検討することであった。研究1では、日本語版WAAQを作成し、就業者180名を対象に構造的妥当性、内的一貫性、仮説検証（収束的妥当性）を検討した。その結果、日本語版WAAQが高い内的一貫性、一部の構造的妥当性および収束的妥当性を有していることが示された。研究2では、就業者2,071名を対象に構造的妥当性、仮説検証（収束的妥当性とサブグループ間の比較）を検討し、うち320名を対象に再検査信頼性と測定誤差を検討した。その結果、日本語版WAAQが高い収束的妥当性、十分な構造的妥当性を有していること、年代、業種、職種におけるサブグループ間を比較すると小さな効果量が見られること、また測定誤差が示された。一方、再検査信頼性には課題が残された。

Self-compassion is regarded as a mediating or moderating variable in mindfulness-based interventions (MBI). However, few studies have investigated the role of self-compassion on MBI. Therefore, we conducted a randomized controlled trial to examine whether (1) MBI decreases depression and trait anxiety, while increasing trait mindfulness, trait self-compassion, self-compassionate behaviors (SC behaviors), and behaviors, along with improving mood; and (2) SC behaviors moderate the effect of mindful behaviors on mood in daily life. Participants were patients with depression and/or anxiety (N=19) in Japan. Of the 27 participants recruited, 19 participated in the study. Using stratified randomization, we allocated 10 participants to the intervention group, with an 8-week standard MBI, and nine to the waitlist control group. Depression, trait anxiety, trait mindfulness, and trait self-compassion were assessed using questionnaires, while SC behaviors, mindful behaviors, and mood were measured using an ecological momentary assessment-a method used to repeatedly record events and behaviors in daily life. The results revealed that depression, trait anxiety, trait mindfulness, and trait self-compassion did not significantly change. However, SC behaviors, mindful behaviors, and mood significantly improved with MBI. Moreover, the interaction between SC behaviors and mindful behaviors was significantly shown in the pre-intervention, suggesting that SC behaviors moderate the effect of mindful behaviors on mood in daily life.

【背景】片頭痛と緊張型頭痛は、有病率が高く(Penzien et al.,2005)、症状の慢性化や痛みによる生活への支障が見られる(Keefe et al.,2004)。慢性疼痛患者において、セルフ・コンパッション(Self-compassion:SC)は痛みによる生活への支障と負の相関関係にある(Wren et al.,2012)。【目的】本研究は、片頭痛、緊張型頭痛を有する学生に対してSCをベースとしたプログラムを行うことによる、SCの上昇(仮説1)および頭痛による生活への支障の低減(仮説2)について検討することを目的とした。【方法】対象者は19名(21.84±2.39歳)であった。介入期間は4週間で週に1度、計4回の対面セッションを設けて介入を実施した。介入はSCとマインドフルネスを主要素とした。介入の前後で各変数のデータを測定した。さらに介入の前後各1週間には、SC行動と頭痛の程度を測定する質問をメールで送信し、回答を求めた。分析は、対応のあるt検定、マルチレベル分散分析、マルチレベルロジスティック回帰分析を用いた。【結果と考察】SC尺度の下位尺度であるマインドフルネスの得点が介入後に増加した。理由としてはマインドフルネスに時間をかけたことが関係するかもしれない。一方で、それ以外の下位尺度のスコア上昇は認められなかった。日常生活場面における行動に限定したSC行動の尺度は、ほとんど全ての項目において有意に増加した。SC行動の尺度のスコアが上昇した理由としては、対象者が有する特性としてのSCの上昇が認められる一歩手前として、日常的なSCの行動が増加した可能性がある。頭痛による生活への支障は低減しなかった。理由としては、対象者に対し、痛みの維持と生活への支障と、破局的思考、逃避・回避行動の相互の関連についての十分な心理教育を行っていなかったことが関係している可能性がある。(著者抄録)

<bold>Background:</bold> The symptoms of attention-deficit hyperactivity disorder (ADHD) are known to exacerbate the effect of cognitive-behavioral impairments on emotional burden. Although adults with ADHD frequently experience procrastination and internalizing symptoms such as depression and anxiety, few studies have examined whether the association between procrastination and internalizing symptoms differs by ADHD symptoms.

<bold>Objective:</bold> This study aimed to examine the moderating effect of ADHD symptoms on the association between procrastination and internalizing symptoms.

<bold>Method:</bold> A cross-sectional survey was conducted among 470 adults (mean age=26.57, standard deviation=2.93) using self-reported questionnaires: Adult ADHD Self-Report Scale, General Procrastination Scales, Patient Health Questionnaire-9, and State–Trait Anxiety Inventory.

<bold>Conclusion:</bold> Participants with more substantial ADHD symptoms experienced more procrastination and internalizing symptoms than those with the less substantial ADHD symptoms. Therefore, procrastination constitutes the treatment target for those suffering from ADHD and comorbid internalizing symptoms. Alternatively, there was no enhancing effect of ADHD symptoms on the association between procrastination and internalizing symptoms. It is necessary to examine more precise and valid hypotheses and underlying mechanisms of procrastination in high and low ADHD symptom groups.

<title>Abstract</title>Self-focused attention (SFA) and other-focused attention (OFA) are central maintenance factors of social anxiety. Tomita et al., Cognitive Therapy and Research 44:511–525, 2020 investigated brain activities when manipulating SFA and OFA during speech tasks, after controlling for social anxiety, using near-infrared spectroscopy (NIRS) and eye-tracking. Compared with the control condition, the SFA condition demonstrated greater activity in the right frontopolar area (rFPA) and right dorsolateral prefrontal cortex. In the OFA condition, relative to controls, activity was greater in the left superior temporal gyrus. We investigated whether the activity in these brain areas increased in healthy individuals in proportion to their social anxiety tendency without manipulating SFA and OFA. Thirty-nine participants performed speech tasks under a no attentional manipulation (no-instruction) condition and a control (looking at various places) condition. Brain activity was measured using NIRS (oxy-Hb responses), and eye movements were tracked. We found that higher social anxiety was associated with higher rFPA activity in the no-instruction condition compared to the control condition and that higher subjective SFA during the no-instruction condition with higher social anxiety was associated with increased rFPA between the no-instruction and control conditions. These results suggest that greater activity in the rFPA is a useful objective measure of SFA related to social anxiety during speech tasks.

"This preliminary investigation aims to develop a new measure for
momentary experiential avoidance in daily life using ecological momentary
assessment (EMA) and a small sample. To measure momentary experiential
avoidance, this study devised a new method that involves capturing
reductions in unwanted experiences after a behavior has occurred based on
negative reinforcement characteristics. A daily life investigation on students (N = 25) indicated that although “a momentary experiential avoidance index” did not correlate with acceptance and commitment therapy or symptomrelated questionnaires, it could partially predict a decrease in “irritation” and an increase in “satisfaction” after a behavior that is measured separately from an unpleasant private experience preceding the behavior. Moreover, the momentary experiential avoidance index predicted a number of positive mood states only in a group with high global experiential avoidance defined by a self-report questionnaire. Although the momentary experiential avoidance index may measure one aspect of experiential avoidance, consistent results were not obtained. Thus, this preliminary investigation only suggests the potential of expanding the measurement framework and reveals issues that require further examination."

This study aimed to investigate the neurocognitive effects of the Attention Training Technique (ATT) on brain activity in healthy participants. The participants included 20 university students who were asked to practice ATT as a homework assignment for 20 days. The intracerebral source localization of their electroencephalogram during rest and the ATT task, which comprised selective attention, attention switching, and divided attention conditions, was evaluated by standardized low-resolution brain electromagnetic tomography. Brain activity during rest was subtracted from that during the ATT task, and that was compared before and after the homework assignment. The results for the divided attention condition indicated significantly decreased alpha 1 frequency band power in the left orbital frontal cortex (OFC) and alpha 2 power in the right inferior temporal cortex. Further, decreased alpha 1 power in the left OFC correlated with reduced subjective difficulty during the divided attention condition. One possibility is that the brain activity changed as the effect of ATT practice, although this study cannot confirm causality. Further studies are required which include a control group that would complete similar training without the ATT task.

<p>パンデミック下の心療内科プライマリーケア施設において、遠隔認知行動療法を導入したプロセスについて報告する。対面カウンセリングからの移行に要した期間は1カ月余と比較的短期間であったが、これには留意点をまとめた文献と使い慣れたWeb会議ツールZoomの活用が有用であった。6カ月弱で22例が導入され、延べ92回のカウンセリングが実施されたが、診断、支援技法の内訳は対面時と同様であった。中断ケースはなく、昨年度の同時期よりも継続率は高かった。患者の満足度は昨年度と変わらず、主担当・副担当から見た支援の質では、デメリットよりもメリットに関する報告が多かった。修士課程1年生の陪席実習の結果では、同席して直接体験することによる効果は非常に大きく、今後の臨床実習の新しい形としても注目すべきであると思われた。</p>

マインドワンダリング（Mind Wandering：以下，MW）は，目前の課題や外界の環境から注意が逸れて自己生成的な思考を行う現象である。MWには，意図性・内容性といった構成次元の性質によって異なる機能性を持つ可能性が指摘されている。本研究では，意図的・非意図的MWそれぞれの内容と実行機能との関連を明らかにすることを目的とした。26名の大学生を対象とし，処理容量，抑制，切替，更新を測定する実行機能課題，MWの意図性と内容性（時間的指向性・感情価・概括性）を測定する注意課題を実施した。順位相関分析の結果，意図的MWの各内容の生起頻度の高さでは，過去思考は更新精度の低下と関連し，未来思考は更新時間の減少と関連し，ポジティブ思考は更新精度の低下と更新時間の減少と切替時間の減少と関連し，ネガティブ思考は切替精度の向上と切替時間の増加と関連し，概括的思考は更新精度の低下と関連し，内容を問わずに処理容量と抑制機能と関連しないことが示唆された。非意図的MWの各内容の生起頻度の高さでは，未来思考は抑制精度の低下と関連し，ネガティブ思考は処理容量の低さと切替時間の増加と関連し，内容を問わずに更新機能と関連しないことが示唆された。

【背景】

片頭痛と緊張型頭痛は，有病率が高く（Sakai ＆ Igarashi, 1997）痛みによる生活支障から症状の慢性化が見られる（Keefe, Rumble, Scipio, Giordano ＆ Perri, 2004）。慢性疼痛は，セルフコンパッション（Self-compassion: SC）が痛みの破局的な思考と負の相関があることが報告されている（Anava, et al., 2012）。

【目的】

本研究は，片頭痛，緊張型頭痛を有する学生に対してSCをベースとしたプログラムを行うことによる，SCの上昇（仮説1）および頭痛による生活支障度の低減（仮説2）を仮説検証することを目的とした。

【方法】

学生19名に対し，参加期間全6週間中4週間で介入を実施した。分析は対応のあるt検定，線形混合モデルを実施した。

【結果と考察】

SCの下位因子であるマインドフルネスの得点が介入後に増加した。また日常生活場面におけるSC行動に関する行動の指標は，ほとんど全ての項目において有意に増加した。一方，生活支障度は低減しなかった。介入プログラムでは頭痛の症状のメカニズムを学ぶ要素が不足していたと考察する。そのため，痛み，破局的思考，逃避・回避傾向と生活支障度の関連を十分に理解できるプログラムではなかったことが考えられた。

This research examined the reliability and validity of the Change Agenda Implicit Relational Assessment Procedure (CA-IRAP). Change agendas that lead people to think that "reducing or removing undesirable thoughts and feelings will solve problems and lead to a more successful life" are considered unworkable in acceptance and commitment therapy (ACT). For acceptance-based interventions to succeed, relinquishing change agendas is important. However, currently available methods for measuring these types of change agendas are limited to explicit measures, which are vulnerable to distortion from social desirability and demand characteristics. The authors attempted to measure change agendas using the IRAP. A total of 131 undergraduate and graduate students (40 male, 91 female; mean age = 21.93,SD= 3.19) participated. First, we examined the CA-IRAP's discriminant validity in relation to explicit measures such as the Acceptance and Action Questionnaire-II in 83 participants who were able to pass the CA-IRAP. The correlations between the CA-IRAP and the explicit measures were low, confirming the discriminant validity of the CA-IRAP. Second, we examined the predictive validity of the CA-IRAP. Nineteen respondents had learned ACT and 34 respondents had never learned ACT. Non-ACT learners' CA-IRAP scores were higher than those of ACT learners, which confirmed the CA-IRAP's predictive validity. Finally, we examined the CA-IRAP's test-retest reliability, which was confirmed across some CA-IRAP trial types. In conclusion, the authors submit that the CA-IRAP has strong potential as a valid instrument for measuring the relative strength of relational responses around change agendas while controlling for variables such as demand characteristics.

Recent studies have suggested that sensory-processing sensitivity correlates to poor psychological and physical health. However, it remains unclear how this occurs. Sensory-processing sensitivity can be understood as sensitivity to sensations without the presence of intentional awareness and a nonreactive attitude, which are the components of mindfulness. We tested the hypothesis that dispositional mindfulness mediates the relationship between sensory-processing sensitivity and trait anxiety, well-being and psychosomatic symptoms. We analyzed data from 563 participating young adults living in Japan. Multiple mediation analysis showed that the four facets (nonreactivity, nonjudging, describing, and acting with awareness) of mindfulness partially mediated the effects of sub-factors of sensory-processing sensitivity (low sensory threshold and ease of excitation) on trait anxiety. Nonreactivity, describing, and acting with awareness partially mediated the effect of low sensory threshold on well-being and fully mediated the effect of ease of excitation. Nonjudging and acting with awareness partially mediated the effects of low sensory threshold and ease of excitation on psychosomatic symptoms. As a whole, the mediation hypotheses were supported, and it was determined that the improvement of dispositional mindfulness may prove effective for the psychological and physical problems of people with high sensory-processing sensitivity.

The mechanisms of efficacy in mindfulness-based interventions for depression and anxiety are not fully understood. To clarify these mechanisms, we tested the hypotheses that mind-wandering, daydreaming, cognitive fusion, and experiential avoidance will decrease through mindfulness group therapy, and this decrease will correlate with improvements in depression and anxiety. Participants self-reported depression and/or anxiety (<italic>N</italic> = 28) took part in an 8-week mindfulness group therapy program. They were assessed using self-report scales at pre- and post-intervention, and at 2-month follow-up. Results indicated that depression and trait-anxiety decreased between pre- and post-intervention with moderate effect sizes, which were maintained at follow-up. Mind-wandering and cognitive fusion also decreased between pre- and post-intervention with small to moderate effect sizes, and maintained at follow-up. The decreases in mind-wandering and cognitive fusion moderately correlated with improvements in depression and anxiety, suggesting that decreases in mind-wandering and cognitive fusion might underlie efficacious mechanisms of mindfulness group therapy.

社交不安においては、自己注目（自己の思考や身体感覚への過度な注意）と外部環境への注意バイアス（他者へ の過度な注意）という注意の問題が指摘されている。本研究は、自己注目と注意バイアスを生じさせるメタ認知的信念を測定する 尺度を作成し、信頼性と妥当性を検討することを目的とした。自己注目と注意バイアスのそれぞれについて、ポジティブなメタ認知 的信念とネガティブなメタ認知的信念の2因子構造を想定し、「高社交不安者における注意の向け方に関するメタ認知的信念尺度」 を作成した。その後、学生253名に対して質問紙調査を実施した。探索的因子分析によって項目を抽出し、確認的因子分析で構 造的妥当性を確認した後、内的整合性を確認するためにα係数を算出した。また、基準関連妥当性を検討するために、社交不安症 状を測定する尺度との相関係数を算出した。さらに、構成概念妥当性を検討するために、各下位尺度と、それぞれに類似する概念 もしくは異なる概念を測定する尺度との相関係数を算出した。信頼性の検討については、2週間の間隔をあけた再テスト法を用いた。 分析の結果、自己注目に関するメタ認知的信念を測定する2因子8項目と注意バイアスに関するメタ認知的信念を測定する2因子8 項目から構成される質問紙が作成された。信頼性と妥当性については、「自己注目に関するポジティブなメタ認知的信念」の基準関 連妥当性および構成概念妥当性を除いて、概ね十分な信頼性と妥当性が示された。今後、本尺度を用いることで、メタ認知的信 念を含めて社交不安における自己注目と注意バイアスの関係性を検討することが可能になると考えられる。

Several studies have revealed that fear recovery is prevented when extinction training is conducted after retrieval of a fear memory. Postretrieval extinction training is related to modification of memory during reconsolidation. Providing new information during reconsolidation can modify the original memory. We propose that avoidance behavior is a relevant factor that prevents subjects from obtaining new safety information during reconsolidation. Postretrieval extinction training without avoidance behavior reduced the fear response to conditioned stimulus and prevented spontaneous recovery in the current study, which corresponded with previous studies. Under the condition of postretrieval extinction training with avoidance behavior, the fear response was not reduced as much as it was in the condition without avoidance. It is possible that avoidance behavior prevents receiving new safety information during postretrieval extinction training.

【問題と目的】不登校の児童生徒に対する支援の提供は、喫緊の課題である。しかしながら、不登校経験者が不登校期間中の自身の心理面・行動面・身体面の変化や家族機能についてどのように捉えているかという観点から研究したものは十分ではない。本研究では、不登校を経験したことのある当事者からのインタビューによって、不登校から回復するまでの共通する通過点となる出来事や要因や変容のプロセスを検討すること、また、どのような周囲の関わりが不登校当事者の社会再接続に作用するのかを検討することを目的とした。【方法】思春期に不登校を経験し、現在18歳以上で研究協力の同意が得られた7名を対象とした。得られたデータは、録音内容を文字に起こし、複線径路・等至性モデル(TEM)の技法に基づき分析を行った。【結果】TEMの分析の結果、不登校の回復のプロセスにおいて、4つの時期をたどることが示された。回復のプロセスでは、第2期において家族が不登校改善のために主体となる必要があり、それによって外部機関との関わりが増大した。登校開始に至るまでには、第3期で自分自身の変化を知覚し、不登校の状態を抜け出していく様子が確認された。登校開始後では、ソーシャルサポートの知覚や認知の変化、コーピングスキルの獲得がみられ、不登校の回復を自覚し、長期的な社会と関わりのある生活を送り始めることが示された。【考察】TEMを用いることで、個々の事例の具体性や時系列を捨象せずに、プロセスを検討することが可能となった。不登校の回復過程に関しての研究において、本人の語りから時期区分をしたことは、本人からみた不登校への理解の一助となり、時期ごとにおける研究や支援の必要性を示すことができたと考えられる。(著者抄録)

セルフコンパッション（Self-compassion：SC）とは、苦痛の緩和のために慈しみをもって自分に接することである。SC特性は、精神的健康と関連があることが、様々な調査研究で明らかにされてきた。しかしながら、先行研究において、SCは特性あるいは状態として測定されてきたため、SCが日常生活場面で具体的にどのように実行されているかは不明である。また、実際の日常生活場面におけるSCをアセスメントするツールがないため、臨床現場などにおいて、SCに対する介入効果を十分に検討することができない。これらの問題を解決するための方法の1つに、SCを特性や状態としてではなく、具体的な行動として測定することが考えられる。そこで、本研究では、臨床行動分析の機能的アセスメントの枠組みに基づき、行動の形態および行動の結果の2つの観点からSC行動を測定する方法を開発し、その妥当性を検討することを目的とした。大学生および大学院生31名を対象とし、日常生活場面における、SC行動を測定する質問項目を用いて、携帯端末を用いた調査を実施した。SC行動の形態（項目は「自分自身をなだめる」「優しさをもって自分に接する」「苦痛を緩和しようとする」「セルフヴァリデーションをする」）および行動の結果（項目は「落ち着きの増加」「自分への優しさの増加」「苦痛の緩和」「自己批判の減少」）をそれぞれ説明変数とし、状態SC、状態well-being、アクセプタンスをそれぞれ目的変数としたマルチレベル単回帰分析を行った。分析の結果、SC行動の形態の項目「自分自身をなだめる」、「優しさをもって自分に接する」、「苦痛を緩和しようとする」は、状態SCの高さを有意に予測した。また、SC行動の結果の項目「落ち着きの増加」、「自分への優しさの増加」、「苦痛の緩和」は、状態SCの高さを有意に予測し、「自己批判の減少」は、状態SCの高さを有意傾向で予測した。これらの結果から，本研究で作成したSC行動を測定するおおよその項目は、妥当であることが示唆された。SC行動の形態の項目「自分自身をなだめる」は、状態well-beingの高さを有意傾向で予測し、SC行動の結果の項目「苦痛の緩和」は状態well-beingの高さを有意に予測した。しかし、それら以外のSC行動の形態および結果の項目は、状態well-beingの高さを有意に予測しなかった。これらの結果から、SC行動後の60分以内における状態well-beingは増加しない可能性がある。今後の研究では、SC行動がその後のwell-beingを増加させるかどうかをより詳細に検討するために、SC行動と（1）本研究で測定されなかった状態well-beingの要素との関連性を検討、（2）60分以降あるいは1日全体の状態well-beingとの関連性を検討、（3）well-being特性との関連性を検討することが必要である。SC行動の形態の項目「自分自身をなだめる」、「優しさをもって自分に接する」、「苦痛を緩和しようとする」は、アクセプタンスの高さを有意に予測した。また、SC行動の結果の項目「自分への優しさの増加」「自己批判の減少」は、アクセプタンスの高さを有意に予測し、「落ち着きの増加」は、アクセプタンスの高さを有意傾向で予測した。これらの結果から，SC行動の種類によって，アクセプタンスの高さを予測する程度が異なることが示された。本研究の限界点として、SC行動の先行条件および確立操作を検討できなかったことが挙げられる。今後の研究で、どのような文脈下でSC行動が生起しやすいのかを検討することや、ルールなどを含めた確立操作がSC行動の生起に与える影響を検討することが望まれる。そうすることにより、SC行動を生起・維持させる変数に関する知見が蓄積され、機能的アセスメントの枠組みからSC行動をより詳細に捉えることが可能となると考えられる。

Our own ongoing motor actions are perceived through sensory feedback pathways, and are integrated with neural processes to modulate further actions. This sensory feedback mechanism is known to contribute to the rehabilitation of impaired motor functions. Recent evidence also suggests that mindfulness meditation improves our awareness to sensation; therefore, enhancement of awareness to sensory feedback through mindfulness meditation training may have potential clinical applications. This study investigated an effect of eight-week practice of mindfulness meditation on speech perception/production processes. Among the thirty healthy participants, half of them engaged in regular meditation practice of 10 min per day for eight weeks, and the other half were not given any instructions for their daily life. The change of speech performance in sentence reading under 200 ms delayed auditory feedback (DAF) condition were assessed compared to without delay condition. Also, event-related potential response to the short sound of /a/, were measured. The result showed that, after the eight-week practice, the meditation group showed significantly improved speech fluency in the DAF condition, when 16-min meditation was introduced before the experiments. Furthermore, significantly increased auditory evoked potentials were observed in the central-parietal region when the participants listened to the delayed auditory feedback sound of their own voice. These findings provide the first glimpses into the possible relationship between mindfulness meditation and auditory feedback. Different instructions for daily activity between the meditation and control groups should be considered in further studies.

<p>所属訂正，連名発表者追加</p><p>（誤）</p><p>[責任発表者] 内田 太朗(早稲田大学)，[連名発表者・登壇者] 仁田 雄介#(早稲田大学), 髙橋 徹(早稲田大学)</p><p>（正）</p><p>[責任発表者] 内田 太朗(早稲田大学大学院人間科学研究科)，[連名発表者・登壇者] 仁田 雄介#(早稲田大学大学院人間科学研究科), 髙橋 徹(早稲田大学大学院人間科学研究科)，熊野 宏昭#(早稲田大学人間科学学術院)</p>

<p>連名発表者追加</p><p>（正）</p><p>熊野 宏昭#(早稲田大学)</p>

連名発表者削除

（誤）

立石 七海（早稲田大学）

BACKGROUND:
The purpose of this study was to determing which psychological traits of Japanese type 2 diabetes patients would provide reliability and validity to the Japanese version of the Acceptance and Action Diabetes Questionnaire (AADQ-J).
METHODS:
Various questionnaires were administered to type 2 diabetes patients who were registered on the database of the research service provider; data from a total of 600 patients (mean ± SD age was 57.50 ± 9.87 years, female 21.83%) were analyzed.
RESULTS:
Three items were excluded because of psychometric concerns related to the original 11-item AADQ. Confirmation factor analyses revealed that the eight-item version demonstrated the best indicators of a goodness of fit. The questionnaire showed adequate internal consistency. The questionnaire demonstrated high measurement accuracy in broad trait values by the test information function of Item Response Theory. The questionnaire showed stronger positive correlations with self-care activities and HbA1c than with diabetes distress and depressive mood.
CONCLUSIONS:
The eight-item Japanese version of AADQ has reliability and validity for type 2 diabetes patients.

<p>本研究の目的は、成人2型糖尿病患者の抑うつ・不安がセルフケア行動に及ぼす影響を検討することであった。外来通院中の2型糖尿病患者65名を対象に質問紙調査を実施した。階層的重回帰分析の結果、セルフケア行動のうち、患者の食事療法遵守行動は不安から有意な負の影響が認められた。また、フットケア遵守行動では、抑うつから負の影響が認められた。一方、運動療法遵守行動には抑うつ・不安いずれからも有意な影響性は認められなかった。抑うつ・不安の高い外来通院中の2型糖尿病患者には、食事療法やフットケアに関する療養指導に先立って、セルフケア行動遵守場面における抑うつ・不安が生じる際の対処行動について、行動分析によるアセスメントと介入を行っていくことが有効であると考えられた。</p>

Background: The neurophysiological mechanisms of cognitive reactivity, the primary vulnerability factor of major depressive disorder (MDD) recurrence, remain unclear in individuals with recovered MDD (rMDD). Because gamma-band responses (GBRs) can be used to measure cognitive processing, they may also be useful for elucidating the mechanisms underlying cognitive reactivity. Identifying these mechanisms may permit the development of an index for predicting and preempting MDD recurrence. Here, to identify the neurophysiological mechanisms of cognitive reactivity, we examined the characteristics of the GBRs evoked/induced by emotional words in participants with and without rMDD after inducing a negative mood. Methods: Thirty-three healthy control participants and 18 participants with rMDD completed a lexical emotion identification task during electroencephalography along with assessments of cognitive reactivity after negative mood induction. Results: No between-group differences were identified for the task reaction times; however, the rMDD group had significantly higher cognitive reactivity scores than did the control group. Furthermore, the power of late GBRs to positive words was significantly greater in the rMDD group, with the greater power of late GBRs being related to higher cognitive reactivity. Limitations: Considering the population studied, our findings cannot be completely generalized to populations other than adolescents, people with rMDD, and those without a history of co-morbid disorders and early life stress. Conclusions: Our findings indicate that the dysfunction of neural circuits related to higher-order processes like memory and attention might underlie cognitive reactivity. Altered late GBRs to positive information may be persistent biomarkers of the depression recurrence risk.

Mind-wandering (MW), task-unrelated thought, has been examined by researchers in an increasing number of articles using models to predict whether subjects are in MW, using numerous physiological variables. However, these models are not applicable in general situations. Moreover, they output only binary classification. The current study suggests that the combination of electroencephalogram (EEG) variables and non-linear regression modeling can be a good indicator of MW intensity. We recorded EEGs of 50 subjects during the performance of a Sustained Attention to Response Task, including a thought sampling probe that inquired the focus of attention. We calculated the power and coherence value and prepared 35 patterns of variable combinations and applied Support Vector machine Regression (SVR) to them. Finally, we chose four SVR models: two of them non-linear models and the others linear models; two of the four models are composed of a limited number of electrodes to satisfy model usefulness. Examination using the held-out data indicated that all models had robust predictive precision and provided significantly better estimations than a linear regression model using single electrode EEG variables. Furthermore, in limited electrode condition, non-linear SVR model showed significantly better precision than linear SVR model. The method proposed in this study helps investigations into MW in various little-examined situations. Further, by measuring MW with a high temporal resolution EEG, unclear aspects of MW, such as time series variation, are expected to be revealed. Furthermore, our suggestion that a few electrodes can also predict MW contributes to the development of neuro-feedback studies.

While dichotic listening (DL) was originally intended to measure bottom-up selective attention, it has also become a tool for measuring top-down selective attention. This study investigated the brain regions related to top-down selective and divided attention DL tasks and a 2-back task using alphanumeric and Japanese numeric sounds. Thirty-six healthy participants underwent near-infrared spectroscopy scanning while performing a top-down selective attentional DL task, a top-down divided attentional DL task, and a 2-back task. Pearson's correlations were calculated to show relationships between oxy-Hb concentration in each brain region and the score of each cognitive task. Different brain regions were activated during the DL and 2-back tasks. Brain regions activated in the top-down selective attention DL task were the left inferior prefrontal gyrus and left pars opercularis. The left temporopolar area was activated in the top-down divided attention DL task, and the left frontopolar area and left dorsolateral prefrontal cortex were activated in the 2-back task. As further evidence for the finding that each task measured different cognitive and brain area functions, neither the percentages of correct answers for the three tasks nor the response times for the selective attentional task and the divided attentional task were correlated to one another. Thus, the DL and 2-back tasks used in this study can assess multiple areas of cognitive, brain-related dysfunction to explore their relationship to different psychiatric and neurodevelopmental disorders.

東日本大震災に伴う福島第一原子力発電所事故により、2016年3月現在でも避難指定区域外の多くの住民が自主的に避難を続けている。自主避難者の中でも特に、子育て中の母親は経済的な負担や放射線被曝への心配に加え、子育て負担の増加や家族関係の変化、避難先での人間関係の希薄化等よるメンタルヘルスの悪化が指摘されている。本研究では、子どもを持ち自主的に避難を続ける20歳から49歳までの母親241名を対象とし、家族関係及びソーシャル・キャピタルとメンタルヘルスとの関連について明らかにすることを目的とした。同居家族の有無と母親の抑うつ状態(CES-D:26点以上)との関連について多重ロジスティックモデルによる分析を行ったところ、母子のみで生活する母親は家族と同居する母親に比べ2.502倍(95%CI:1.125-5.563)抑うつが疑われる状態にあることが明らかになった。また、近隣住民への信頼感が高い母親に比べ、低い母親は5.434倍(95%CI:1.384-21.339)、地域活動への参加頻度が高い母親に比べて、低い母親は3.244倍(95%CI:1.083-9.718)抑うつが疑われる状態にあることが明らかになった。今後、特に母子のみで避難する母親の支援においては、子育てサークル等の地域で行われるインフォーマルな組織への参加を通して、他者への信頼感や地域活動への参加度を高め、ソーシャル・キャピタルを醸成していくことが重要であると考えられる。(著者抄録)

<p>本研究の目的は、アクセプタンス&コミットメント・セラピー（ACT）のコア・行動的プロセスである価値づけ、コミットされた行為を測定する尺度を作成し、その信頼性と妥当性を検討することであった。研究1における探索的因子分析の結果、本尺度は【動機づけ】・【行動継続】・【強化の自覚】の3因子から構成された。本尺度は、十分な内的整合性、収束的および弁別的妥当性が確認された。研究2では、構成概念妥当性を、共分散構造分析により検討した。その結果、【強化の自覚】・【動機づけ】が高まることで【行動継続】が高まり、主観的幸福感が増加することで、結果的に体験の回避が減少する可能性が示唆された。今後は、臨床群、異なる年齢層などの幅広い属性を持つ被験者を対象として、信頼性と妥当性を検討していくことで、本尺度の有用性を確認する必要がある。</p>

<p>本研究では、第三世代の認知・行動療法で重視される行動的プロセスである"アクセプタンス"を測定するAcceptance Process Questionnaire（APQ）を作成し、その信頼性と妥当性を検討することを目的とした。学生を対象に調査を実施し、因子分析を実行した結果、APQはアクセプタンスの中長期的結果を測定する【行動レパートリーの拡大】と【現実の感受】、行動内容を測定する【私的出来事から回避しない選択】と【リアクションの停止】の4因子パタンをもつ、13項目で構成された。APQは、十分な構造的妥当性、内的整合性を有し、全体でアクセプタンスを測定すると判断されたが、収束的妥当性、再検査信頼性に課題を残した。今後、再検査信頼性についてはサンプルサイズを増やして検討を進めるともに、日常生活下での行動傾向とAPQの尺度得点の関係性を検討し、その有効性を確認する必要がある。</p>

<p>本研究は, 原発事故によって福島県から東京都・埼玉県に避難されている高齢者の個人レベルのソーシャル・キャピタル (以下, SC) とメンタルヘルスの関連を明らかにすることを目的とした. 調査は2014年3, 4月に実施し, 3,599世帯を対象に自記式質問紙調査を行った. 回収できた772世帯分 (回収率21.5%) の中から, 65～85歳までの高齢者229名分を分析の対象とした. 多重ロジスティックモデルにより, 個人レベルのSCとストレスとの関連について分析したところ, 性, 年齢, 経済状況, 持病の有無, 転居回数を調整しても, 近隣住民への信頼・助け合いの意識などの認知的指標や近隣であいさつを交わす人数, 趣味・娯楽活動への参加頻度といった構造的指標が低い群ほど, 高いストレス状態にあることが統計学的に有意に認められた. したがって, 豊かなSCを醸成することによりメンタルヘルスを向上させる支援が今後重要になると考えられる.</p>

The purpose of the present study was to evaluate the validity and reliability of a Japanese version of an electromagnetic hypersensitivity (EHS) questionnaire, originally developed by Eltiti et al. in the United Kingdom. Using this Japanese EHS questionnaire, surveys were conducted on 1306 controls and 127 self-selected EHS subjects in Japan. Principal component analysis of controls revealed eight principal symptom groups, namely, nervous, skin-related, head-related, auditory and vestibular, musculoskeletal, allergy-related, sensory, and heart/chest-related. The reliability of the Japanese EHS questionnaire was confirmed by high to moderate intraclass correlation coefficients in a test-retest analysis, and high Cronbach's coefficients (0.853-0.953) from each subscale. A comparison of scores of each subscale between self-selected EHS subjects and age- and sex-matched controls using bivariate logistic regression analysis, Mann-Whitney U- and (2) tests, verified the validity of the questionnaire. This study demonstrated that the Japanese EHS questionnaire is reliable and valid, and can be used for surveillance of EHS individuals in Japan. Furthermore, based on multiple logistic regression and receiver operating characteristic analyses, we propose specific preliminary criteria for screening EHS individuals in Japan. Bioelectromagnetics. 37:353-372, 2016. (c) 2016 The Authors. Bioelectromagnetics Published by Wiley Periodicals, Inc.

Objective
This study investigated post-traumatic stress symptoms in relation to the population affected by the Fukushima Nuclear Disaster, one year after the disaster. Additionally, we investigated social factors, such as forced displacement, which we hypothesize contributed to the high prevalence of post-traumatic stress. Finally, we report of written narratives that were collected from the impacted population.
Design and Settings
Using the Impact of Event Scale-Revised (IES-R), questionnaires were sent to 2,011 households of those displaced from Fukushima prefecture living temporarily in Saitama prefecture. Of the 490 replies; 350 met the criteria for inclusion in the study. Multiple logistic regression analysis was performed to examine several characteristics and variables of social factors as predictors of probable post-traumatic stress disorder, PTSD.
Results
The mean score of IES-R was 36.15 +/- 21.55, with 59.4% having scores of 30 or higher, thus indicating a probable PTSD. No significant differences in percentages of high-risk subjects were found among sex, age, evacuation area, housing damages, tsunami affected, family split-up, and acquaintance support. By the result of multiple logistic regression analysis, the significant predictors of probable PTSD were chronic physical diseases (OR = 1.97), chronic mental diseases (OR = 6.25), worries about livelihood (OR = 2.27), lost jobs (OR = 1.71), lost social ties (OR = 2.27), and concerns about compensation (OR = 3.74).
Conclusion
Although there are limitations in assuming a diagnosis of PTSD based on self-report IES-R, our findings indicate that there was a high-risk of PTSD strongly related to the nuclear disaster and its consequent evacuation and displacement. Therefore, recovery efforts must focus not only on medical and psychological treatment alone, but also on social and economic issues related to the displacement, as well.

<p>本研究は, 東日本大震災から1年経過した時期および2年経過した時期に, 埼玉県内または東京都において避難生活を送る福島県民の世帯に対して行ったアンケート調査の結果である. 2011年に発生した東日本大震災は, 原子力発電所事故を伴ったことによって, 全国に県外避難者を生み出したことが, これまでの自然災害と決定的に異なる特徴である. 震災から1年後の2012年調査の結果からは, 男性において生活費の心配や失業がストレス反応に影響していることが示され, 女性において住宅の被災状況や人間関係, 原発に対する賠償問題などがストレス反応に影響していることが示された. 一方, 2013年調査の結果からは, 男女ともに苦しい経済状況, 健康状態の悪化, 避難者というスティグマ, 家族関係や近隣関係, 住環境などがストレス反応に影響していることが示され, 年月の経過とともに, ストレスが, 震災の直接的影響よりも避難生活に起因するものになってきていることが明らかとなった.</p>

<p>消去訓練を行うと消去学習が成立し，恐怖条件づけによる恐怖反応が抑制される。しかし，消去学習は恐怖記憶を改変しないため，恐怖反応の再発が起こる。消去学習を利用した技法はエクスポージャー療法と呼ばれており，不安症の治療に用いられている。エクスポージャー療法後にも不安症が再発する可能性が示唆されており，再発を防ぐ治療法が必要とされている。そこで，記憶再固定化というメカニズムが注目されている。記憶痕跡は固定化すると改変できないと従来は考えられていた。しかし近年，想起によって固定化された記憶痕跡が不安定になり，その後再固定化することが明らかになった。再固定化が進行している間は，想起した恐怖記憶を改変できることが示されている。そして，再固定化進行中の消去訓練は恐怖反応の再発を防ぐことが，近年の研究によって示唆されている。今後，不安症に対する再固定化を利用した介入の有効性の検討を進める必要がある。</p>

<p>Post-event processing (PEP) とは社交状況の回顧を意味し，社交不安の維持要因とされる。近年，反芻や心配と注意制御機能の関連が報告されているが，同様の反復的思考であるPEPとの関連は明らかでない。また，PEP時の観察者視点を測定する指標も作成されていない。本研究では，PEP時における想起視点機能尺度の作成とともに，実験的な社交状況で生じるPEPと注意制御機能の関連性を明らかにした。大学生を対象に，注意制御に関する質問紙と認知課題，スピーチ課題を行った。翌日にPEPを測定し，PEPと注意制御との相関分析を行った。その結果，想起視点機能尺度の下位尺度を用いてPEPの観察者視点を測定できることが示唆された。また，PEPおよび回避的な観察者視点と選択的注意との間に有意な相関が示された。したがって，PEPを低減するためには特に選択的注意に着目することが有用であると考えられた。</p>

本研究は, 東日本大震災に伴って発生した福島原子力発電所事故の2年後に, 福島県内の仮設住宅において避難生活を送る住民の心的外傷後ストレス症状と, そのストレスに影響を与える身体・心理・社会的要因を明らかにしたものである. 2,425世帯に対して無記名で任意回答のアンケート用紙を配布し, 745名 (回答率30.7%) の回答を得た. 欠損値を除く661名の解析を行ったところ, IES-Rの平均値が34.20±20.56であり, PTSDの可能性に対する高いリスクを示すカットオフ値24/25を超えた者が62.56%であった. PTSDの可能性との関連を多重ロジスティック回帰分析で検討した結果, 「経済的困難」 (OR : 2.34, 95%CI : 1.30～4.24), 「賠償の心配」 (OR : 4.16, 95%CI 1.26～13.76), 「持病の悪化」 (OR : 2.94, 95%CI : 1.63～5.30), 「新疾患の罹患」 (OR : 2.20, 95%CI : 1.21～3.99), 「相談者の不在」 (OR : 1.92, 95%CI : 1.07～3.42) が有意な予測因子として認められた. これまでに世界各地で報告されてきた他の災害と比較しても, 原発事故被災者にきわめて高い外傷後ストレス症状が認められた理由として, 事故に対する補償や賠償といった問題など, 本災害の人為災害としての要素が重要であると考えられた.

Recently, it has been demonstrated that children who stutter (CWS) have attentional difficulties. But little is known about attentional function in adults who stutter (AWS). Two groups of 17 AWS and 18 adults who do not stutter (AWNS) participated in the present study. We aimed to confirm (1) whether AWS also show attentional difficulties like CWS and (2) how attentional function relates to stuttering severity in AWS. Results indicated that AWS and AWNS showed similar levels of attentional function, but those who tended to react faster and more incorrectly to the experimental task showed worse stuttering severity. This outcome suggests that cognitive strategies non-specific to speech production can influence stuttering severity. We discussed intervention for the attentional function in AWS.

近年，吃音児は注意機能の脆弱性を抱えうることが示されているが，青年期以降の吃音者を対象として網羅的な注意機能の検討，および注意機能と吃症状との関連の検討を行った研究は見られない．本研究は，青年期以降の吃音者20名，非吃音者 18名を分析対象とし，青年期以降の吃音者においても注意機能の脆弱性が認められるのかどうか，吃音者群内において注意機能と吃症状はどのように関連するのかを検討することを目的として行われた．その結果，吃音群と統制群で注意機能に関して統計的に有意な差は認められなかったものの，実験課題に対する反応が速く，エラーが多いものほど吃音の重症度が高いことが示され，発話に限定されない，より広範な文脈での注意の使い方が吃音の重症度に影響を与えている可能性が示唆された．青年期以降の吃音臨床において，注意機能に対する介入方略が有用である可能性について議論した．

本研究は、思考内容と現実を混同する「認知的フュージョン」を測定する質問紙である、改訂CFQ13項目版および7項目版の信頼性と妥当性の検討を目的とした。大学生対象の調査の結果、13項目版は改定前同様に2因子構造を示し、7項目版は原版同様に1因子構造を示した。項目分析の結果、各下位尺度は個別に扱うことが適切であると判断された。これまでは第1下位尺度が認知的フュージョン、第2下位尺度が認知的フュージョンから抜け出す「脱フュージョン」に相当するとされてきたが、本研究の結果、第2下位尺度は脱フュージョンの機能の一部に相当する可能性が示唆されたため、第1下位尺度および7項目版を「認知的フュージョン」、第2下位尺度を脱フュージョンの機能の一部としての「自己と思考の弁別」とみなすことが適切である。そして今後は、外顕的な行動指標との関連も検討することで、別の側面から妥当性の有無を確認する方法も必要であると考えられる。

In-situ real-time monitoring of volatile organic compound (VOC) exposure and heart rate variability (HRV) were conducted for eight multiple chemical sensitivity (MCS) patients using a VOC monitor, a Holter monitor, and a time-activity questionnaire for 24 h to identify the relationship between VOC exposure, biological effects, and subjective symptoms in actual life. The results revealed no significantly different parameters for averaged values such as VOC concentration, HF (high frequency), and LF (low frequency) to HF ratio compared with previous data from healthy subjects (Int. J. Environ. Res. Public Health 2010, 7, 4127–4138). Significant negative correlations for four subjects were observed between HF and amounts of VOC change. These results suggest that some patients show inhibition of parasympathetic activities along with VOC exposure as observed in healthy subjects. Comparing the parameters during subjective symptoms and normal condition, VOC concentration and/or VOC change were high except for one subject. HF values were low for five subjects during subjective symptoms. Examining the time-series data for VOC exposure and HF of each subject showed that the subjective symptoms, VOC exposure, and HF seemed well related in some symptoms. Based on these characteristics, prevention measures of symptoms for each subject may be proposed.

本稿では，社交不安症（SAD）の脳構造と機能に関する研究について概説した。脳構造に関する研究では，SAD患者は扁桃体，海馬などの灰白質体積が小さいことに加えて，鉤状束における白質の構造的異常が報告されている。脳機能に関する研究では，スピーチ課題や否定的な顔表情に対して，SAD患者の扁桃体が過活動になることが一致した結果である。薬物療法や認知行動療法（CBT）によって，辺縁系および前頭前野領域の機能に変化が生じる。CBTに対する治療反応性の予測には，扁桃体などの皮質下領域でなく，視覚野や前頭前野（背外側，腹外側部）の皮質領域が関与する。また，安静時では扁桃体―眼窩皮質のネットワーク異常が示されている。これらの研究結果から，SADの脳病態に恐怖・不安に関わる辺縁系（扁桃体，海馬，前帯状皮質など）―前頭前野領域（腹内側部など）の構造および機能異常があると推察できる。

The purpose of this study was to examine variations of coping during depressive moods in terms of behavioral activation and the relationship between patterns of coping and severity of depression.First, we collected items of coping during depressive moods by interviewing 29 undergraduate students. Then, based on the data the COPING ASSESSMENT QUESTIONNAIRE during depressive moods (CAQ-D) was developed. To investigate the factor structure of CAQ-D, CAQ-D was completed by 209 undergraduates. The results of a factor analysis indicated that CAQ-D consisted of three factors: (a)Activation , (b)Observing One's Experience , and (c)Distraction. Activation was positively related to Behavioral Activation for Depression Scale(BADS), and Observing One's Experience was positively correlated with Observing (Five Facet Mindfulness Questionnaire; FFMQ). However, Distraction showed no correlation with the Acceptance and Action Questionnaire-II(AAQ-II).Secondly, we defined coping style against depressive mood based on the CAQ-D, and investigated the relationship between coping styles and depression. The results showed that there were 4 coping styles : (a)all high Coping group, (b)high Activation and Distraction group, (c)Distraction group, and (d)Activation and Observing One's Experience group. Moreover, the high Activation and Distraction group felt more positive feelings than Distraction group. Although no consideration was placed on the relation between coping styles and stressors, these results suggest that one who has many variations of coping can gain more positive reinforcements.

Social anxiety disorder (SAD) is characterized by strong fear and anxiety during social interactions. Although ventrolateral prefrontal cortex (VLPFC) activity in response to emotional stimuli is related to pathological anxiety, little is known about the relationship between VLPFC activity and social anxiety. This study aimed to investigate whether VLPFC activity was involved in SAD and whether VLPFC activity was related to the level of social anxiety. Twenty-four drug-naive patients with SAD and 35 healthy controls underwent near-infrared spectroscopy (NIRS) scanning while performing a verbal fluency task (VFT). Results indicated that, compared to the healthy controls, the SAD patients exhibited smaller changes of oxygenated hemoglobin (oxy-Hb) concentrations in the VLPFC during the VFT. Furthermore, the right VLPFC activation was negatively correlated with social avoidance. In contrast to the latter, the healthy controls exhibited a positive correlation between changes of oxy-Hb concentrations in the bilateral VLPFC and social fear. Our findings provide evidence for VLPFC dysfunction in SAD, and indicate that the VLPFC dysfunction may contribute to the difference between normal and abnormal social anxiety. (C) 2015 The Authors. Published by Elsevier Inc.

本研究の目的は、ACTが注目する三つの自己の体験を測定する尺度を作成し、探索的因子分析と共分散構造分析を行うことで、その尺度の信頼性と妥当性を検討すること、そして、三つの自己に含まれるさまざまな行動の機能の重なりや相違点に基づいてより妥当性の高い行動クラスを見いだすことであった。33項目からなる尺度の原案を作成し、首都圏の大学生を対象に調査を行った。探索的因子分析の結果、本尺度は【アクティブ】・【概念化】・【視点取り】・【今この瞬間】の4因子20項目から構成されることが示され、さらに共分散構造分析の結果も踏まえて、三つの自己の体験は二つの行動クラスを含むことが明らかになった。また、それぞれを下位尺度とした場合、十分な内的整合性と収束的妥当性が確認された。今後は、本尺度を用いてACTが介入対象とするほかの行動的プロセスや臨床症状との関連性を検討し、精神的苦痛を促進・緩和する自己の体験についての理解をより深めていく必要がある。

摂食障害(eating disorder : ED)の診断項目の一つである身体像不満足感(body image dissatisfaction : BID)傾向は,EDの行動的特徴であるボディチェッキング(body checking : BC)と関連があるといわれている.鏡エクスポージャー(mirror exposure : ME)は介入方法として効果を有しているが,ME実施中の認知処理様式は明らかになっていない.そこで本研究は,ED傾向,BID傾向,BCを行う認知を測定する尺度を用いて関連性を検討すること(研究1)と,BID傾向の差異による鏡の自覚的な見方を実験的に検討すること(研究2)を目的とした.結果より,研究1ではED傾向の程度にかかわらず,BIDとBCとの関連があることが示唆された.研究2ではBIDが高い者は,普段の身体像と鏡で確認したときに知覚される身体像に差があることが示された

パニック障害と広場恐怖に対する認知行動療法は，精神疾患に対する根拠に基づく心理的治療法としては最も成功したものの一つであり，多くの効果研究やメタ解析が報告されている。実証的に支持された認知行動療法プログラムには，エクスポージャーや行動実験，リラクセーションや呼吸の再訓練法，心理教育と認知的介入，ホームワークなどの共通の要素が含まれているが，近年のメタ解析の結果からは，エクスポージャーとリラクセーションの効果が高い。エクスポージャーでは，恐怖条件づけを消去するために，一つの状況で喚起される恐怖や不安が十分に低減されるまで継続することが必要とされてきたが，近年の研究では，むしろ新たな連合学習である制止学習が成立することの重要性が指摘されている。制止学習を促進するためには恐怖や不安が低減される必要はなく，むしろ安全確保行動をすることなく恐れている症状や知覚などを十分に体験し，それでもパニック発作は起こらないことを学習することが必要である。安全確保行動を行わずに十分に制止学習を進めるために，エクスポージャーを行う際のアクセプタンスの役割が注目されるようになってきている。

本研究の目的は、心理士による集団認知行動療法がうつ病患者のうつ症状の改善に及ぼす効果について、統制群を設定した対照比較を用いて検証することであった。集団認知行動療法は、認知療法や問題解決療法を基盤に構成された計12回のプログラムであった。薬物療法などの通常の治療に加えて、集団認知行動療法プログラムを受けた10名(CBGT併用群)、通常の薬物療法のみを受けた10名(TAU群)の2群のうつ症状の変化を測定した。うつ症状の評価にはBDI-IIが用いられ、計3時点(pre期、mid期、post期)において回答を求めた。ベースラインであるpre期のBDI-II得点を共変量として、群(CBGT併用群、TAU群)と測定時期(mid期、post期)を独立変数、BDI-II得点を従属変数とした2要因の共分散分析を行った。その結果、mid期に群間差はみられなかったものの、post期におけるCBGT併用群のBDI-II得点が、TAU群と比較して有意に低いことが示された。以上の結果から、通常の薬物療法に、心理士が行う認知行動療法を併用することで、うつ病患者のうつ症状の改音効果が高まり、その効果が維持されることが実証的に示された。

Experienced Qigong meditators who regularly perform the exercises "Thinking of Nothing" and "Qigong" were studied with multichannel EEG source imaging during their meditations. The intracerebral localization of brain electric activity during the two meditation conditions was compared using sLORETA functional EEG tomography. Differences between conditions were assessed using t statistics (corrected for multiple testing) on the normalized and log-transformed current density values of the sLORETA images. In the EEG alpha-2 frequency, 125 voxels differed significantly; all were more active during "Qigong" than "Thinking of Nothing," forming a single cluster in parietal Brodmann areas 5, 7, 31, and 40, all in the right hemisphere. In the EEG beta-1 frequency, 37 voxels differed significantly; all were more active during "Thinking of Nothing" than "Qigong," forming a single cluster in prefrontal Brodmann areas 6, 8, and 9, all in the left hemisphere. Compared to combined initial-final no-task resting, "Qigong" showed activation in posterior areas whereas "Thinking of Nothing" showed activation in anterior areas. The stronger activity of posterior (right) parietal areas during "Qigong" and anterior (left) prefrontal areas during "Thinking of Nothing" may reflect a predominance of self-reference, attention and input-centered processing in the "Qigong" meditation, and of control-centered processing in the "Thinking of Nothing" meditation.

本研究は、嚥下失敗を含む身体的症状および窒息恐怖を示す40代男性に対して、内潜的な認知的反応と嚥下の反応連鎖に関する行動分析に基づいて介入を行うことで改善をみた症例の報告である。行動分析の結果、本症例では、口腔内の食塊と窒息に関する認知的反応が同時に提示されることで嚥下失敗が生じ、嚥下失敗が回避行動を強化する結果事象となっている可能性が考えられた。そこで、嚥下中の認知的反応の妨害と、嚥下に伴う身体感覚の単独提示を行った。具体的な治療手続きとしては、飲食物を口に含んでから飲み込みがすむまでの身体感覚を言語的に記述し続けることで、「死ぬかもしれない」といった認知的反応の抑止を行った。介入の結果、症状の軽減が認められ、介入効果は1カ月後および3カ月後のフォローアップ期においても維持されていた。

This chapter focuses on depression and stress-related conditions to discuss possible strategics for the prevention or early management of such conditions. Health education constitutes the first important strategy, and we outline a school-based educational activity using a case-method approach. We next illustrate the impact of stressful events on psychological health with the results of a survey among Chinese individuals conducted after an unexpected epidemic of severe acute respiratory syndrome in 2003. Communication plays an important role in the assessment and management services provided by medical practitioners to sick individuals, with very diverse backgrounds and levels of medical knowledge, who consult health care providers with concerns about their health. In this context, we introduce a recent advance in patient-doctor communication. Finally, we address the cognitive and behavioral features of those who suffer from depression and psychosocial stress. Based on our recent activities and on evidence pertaining to health promotion and education, we emphasize the importance of health education and communication in the prevention of stress-related diseases and the promotion of physical and psychological health.

While various volatile organic compounds (VOCs) are known to show neurotoxic effects, the detailed mechanisms of the action of VOCs on the autonomic nervous system are not fully understood, partially because objective and quantitative measures to indicate neural abnormalities are still under development. Nevertheless, heart rate variability (HRV) has been recently proposed as an indicative measure of the autonomic effects. In this study, we used HRV as an indicative measure of the autonomic effrects to relate their values to the personal concentrations of VOCs measured by a real-time VOC monitor. The measurements were conducted for 24 hours on seven healthy subjects under usual daily life conditions. The results showed HF powers were significantly decreased for six subjects when the changes of total volatile organic compound (TVOC) concentrations were large, indicating a suppression of parasympathetic nervous activity induced by the exposure to VOCs. The present study indicated these real-time monitoring was useful to characterize the trends of VOC exposures and their effects on autonomic nervous system.

Background: This study was performed to examine whether patients with type 2 diabetes have cognitive deficits associated with the prefrontal cortex (PFC).Methods: Twenty-seven middle-aged patients with newly diagnosed type 2 diabetes and 27 healthy controls underwent physical measurements and neuropsychological tasks. Response inhibition, reward prediction, and executive function were assessed by the Go/NoGo task, the reversal and extinction tasks, and the Wisconsin Card Sorting Test (WCST). To examine the interactions of being overweight with diabetes on cognitive performance, performance data were analysed by two-way ANCOVA with diabetes and overweight as factors and age as a covariate.Results: Patients with type 2 diabetes showed significantly decreased response inhibition in the Go/NoGo task (discriminability index: P = 0.001). There was an interaction of being overweight with diabetes on reaction time in the Go trials of the Go/NoGo task (P = 0.009). Being overweight was related to retained responses to the presentiment of reward in the extinction task (P = 0.029). The four groups showed normal cognitive performance in the WCST.Conclusions: Our results showed that middle-aged, newly diagnosed and medication-free patients with type 2 diabetes have a particular neuropsychological deficit in inhibitory control of impulsive response, which is an independent effect of diabetes apart from being overweight. © 2010 Ishizawa et al
licensee BioMed Central Ltd.

Many meditation exercises aim at increased awareness of ongoing experiences through sustained attention and at detachment, i.e., non-engaging observation of these ongoing experiences by the intent not to analyze, judge or expect anything. Long-term meditation practice is believed to generalize the ability of increased awareness and greater detachment into everyday life. We hypothesized that neuroplasticity effects of meditation (correlates of increased awareness and detachment) would be detectable in a no-task resting state. EEG recorded during resting was compared between Qigong meditators and controls. Using LORETA (low resolution electromagnetic tomography) to compute the intracerebral source locations, differences in brain activations between groups were found in the inhibitory delta EEG frequency band. In the meditators, appraisal systems were inhibited, while brain areas involved in the detection and integration of internal and external sensory information showed increased activation. This suggests that neuroplasticity effects of long-term meditation practice, subjectively described as increased awareness and greater detachment, are carried over into non-meditating states.

Objectives The Quick Environment Exposure Sensitivity Inventory (QEESI) has been used as a questionnaire to evaluate subjective symptoms of patients with multiple chemical sensitivity (MCS), also known as idiopathic environmental intolerance, in Japan. However, no cutoff value for Japanese subjects has yet been established. We designed this study to establish a cutoff value for Japanese subjects using QEESI(©) for screening of MCS patients. Methods A questionnaire using the QEESI© was administered to 103 MCS patients and 309 healthy control subjects matched for age and sex. QEESI© scores of the two groups were compared using logistic regression analysis, receiver operating characteristic analysis, and the Mann-Whitney test. Results Cutoff values for Japanese subjects were determined for the Chemical Intolerance subscale (40), Symptom Severity subscale (20), and Life Impact subscale (10). The subjects whose scores exceeded the cutoff values in any two subscales accounted for 88.4% of the patients but only 14.5% of the controls. Conclusions Our results suggest that subjects meeting two out of three subscale criteria can be screened as patients suffering from a low level of environmental chemicals such as MCS in Japan. © 2009 The Japanese Society for Hygiene.

Objective: This meta-analysis was conducted to investigate the effects of mindfulness-based stress reduction (MBSR) on the mental and physical health status of various cancer patients.
Methods: Tell studies (randomized-controlled trials and observational studies) were found to be eligible for meta-analysis. Individual study results were categorized into mental and physical variables and Cohen&apos;s effect size d was computed for each category.
Results: MBSR may indeed be helpful for the mental health of cancer patients (Cohen&apos;s effect size d = 0.48); however, more research is needed to show convincing evidence of the effect on physical health (Cohen&apos;s effect size d = 0.18).
Conclusion: The results suggest that MBSR may improve cancer patients&apos; psychosocial adjustment to their disease. Copyright (C) 2008 John Wiley & Sons, Ltd.

A consistent association between low endogenous 5HT function and high alcohol preference has been observed, and a number of serotonergic manipulations (uptake blockers, agonists) alter alcohol consumption in animals and humans. Studies have also shown an inverse relationship between alcohol use and cerebrospinal fluid levels of serotonin metabolites, suggesting that chronic alcohol consumption produces alterations in serotonin synthesis or release.
The objective of the study was to characterize regional brain serotonin synthesis in nondepressed chronic alcoholics at treatment entry in comparison to normal nonalcoholic controls using PET and the tracer alpha-[(11)C]-methyl-l-tryptophan.
Comparisons of the alcoholics and controls by SPM found that there were significant differences in the rate of serotonin synthesis between groups. Serotonin synthesis was significantly lower among alcoholics in Brodmann Area (BA) 9, 10, and 32. However, serotonin synthesis among the alcoholics group was significantly higher than controls at BA19 in the occipital lobe and around the transverse temporal convolution in the left superior temporal gyrus (BA41). In addition, there were correlations between regional serotonin synthesis and a quantity-frequency measure of alcohol consumption. Regions showing a significant negative correlation with QF included the bilateral rectus gyri (BA11) in the orbitofrontal area, the bilateral medial frontal area (BA6), and the right amygdala.
Current alcoholism is associated with serotonergic abnormalities in brain regions that are known to be involved in planning, judgment, self-control, and emotional regulation.

本稿ではパニック障害の脳内機序を検討した脳機能画像研究をレビューし,その成果が心身医学の発展にもつ意義について提言する.パニック障害の神経解剖学的仮説としては,GormanとCoplanのものが有力であり,過去5年間に裏づけとなるエビデンスが蓄積され,脳の病気として十分に説明可能になった.非発作時の脳機能異常,課題遂行時の特徴,脳の構造異常を解析したものがあるが,上記モデルの核である扁桃体・海馬と中脳水道周囲灰白質の異常とともに,前頭前野の機能・構造異常も共通して示されている.その一方で薬を使わない認知行動療法のみでも十分な改善が認められ,その際に扁桃体の活動には変化はないが,「気づき」にかかわる左背内側前頭前野の活動亢進が示されている.これは心の変化が脳の変化をもたらすことを意味しており,心身相関成立の基盤として重要な事実を指し示していると考えられる.

本研究の目的はQuick Environment Exposure Sensitivity Inventory(QEESI)を用いて一般人の中から化学物質過敏症(MCS)の疑いがある人をスクリーニングするための日本独自のカットオフ値を設定すること、また、喫煙などの常時に曝露する化学物質がMCSの発症に及ぼす影響を検討することである。北里研究所病院臨床環境医学センターでMCSと診断された103名とこれらの患者群と年齢性別をマッチングした対照群(健常者)309名に対し、QEESIを用いたアンケート調査を行った。患者群と対照群の自覚症状は、QEESIの4下位尺度40項目得点をロジスティック回帰分析および受信者動作特性曲線(ROC曲線)を用いて比較した。常時曝露化学物質の影響はマスキング尺度10項目のロジスティック回帰分析で検討した。MCSの自覚症状は、化学物質不耐性、症状、日常生活障害の3下位尺度で評価でき、カットオフ値は、それぞれ、40、20、10点と設定された。3下位尺度中いずれか2尺度がカットオフ値以上の人は、患者群では88.4%、健常者群では14.5%であった。そこで、日本では、化学物質不耐性40点以上、症状20点以上、日常生活障害10点以上のいずれか二つに該当する人を"MCSの疑いがある"としてスクリーニングできることが示唆された。常時曝露化学物質10項目のロジスティック回帰分析では、患者群が対照群より得点が高いもの(オッズ比1以上)と、患者群が対照群より得点が低いもの(オッズ比1以下)に明白に分類された。オッズ比15.0の仕事・趣味での化学物質使用とオッズ比4.7の殺虫剤・防虫剤は、日本のMCSの発症要因の一つである可能性が高い。一方、オッズ比1以下の5項目(喫煙、受動喫煙、飲酒、カフェイン摂取、柔軟剤使用)は患者の多くがこれらの要因で症状が悪化するため回避するようになった項目だと考えられる。(著者抄録)

Background: Panic disorder is one of the anxiety disorders, and anxiety is associated with some locomotor activity changes such as "restlessness". However, there have been few studies on locomotor activity in panic disorder using actigraphy, although many studies on other psychiatric disorders have been reported using actigraphy. Therefore, the aim of the present study was to investigate the relationship between panic disorder and locomotor activity pattern using a wrist-worn activity monitor. In addition, an ecological momentary assessment technique was used to record panic attacks in natural settings. Methods: Sixteen patients with panic disorder were asked to wear a watch-type computer as an electronic diary for recording panic attacks for two weeks. In addition, locomotor activity was measured and recorded continuously in an accelerometer equipped in the watch-type computer. Locomotor activity data were analyzed using double cosinor analysis to calculate mesor and the amplitude and acrophase of each of the circadian rhythm and 12-hour harmonic component. Correlations between panic disorder symptoms and locomotor activity were investigated. Results: There were significant positive correlations between the frequency of panic attacks and mesor calculated from double cosinor analysis of locomotor activity (r = 0.55) and between HAM-A scores and mesor calculated from double cosinor analysis of locomotor activity (r = 0.62). Conclusion: Panic disorder patients with more panic attacks and more anxiety have greater objectively assessed locomotor activity, which may reflect the "restlessness" of anxiety disorders. © 2008 Sakamoto et al
licensee BioMed Central Ltd.

Multiple chemical sensitivity (MCS), a syndrome in which multiple symptoms occur with low-level chemical exposure, has not been clarified in detail. The aim of our study was to clarify the clinical characterisitics of physician-diagnosed MCS patients in Japan. We analyzed patient characerisitics based on the medical records of 106 patients diagnosed with MCS according to the 1999 Consensus and the Japanese diagnostic criteria for MCS. We evaluated subjective symptoms using the Quick Environment Exposure Sensitivity Inventory (QEESI) and compared the QEESI scores with those of four MCS patient groups in the US reported by Miller and Prihoda [Miller, C.S., Prihoda, T.J., 1999b. A controlled comparison of symptoms and chemical intolerances reported by Gulf War veterans, implant recipients, and persons with multiple chemical sensitivity. Toxicol Ind Health 15, 386-397].
Female patients accounted for 74.0%. Most male patients were in their 30s, whereas female ages ranged widely from 10 to 65 years. Among estimated onset factors, those seen in males tended to be workplace related, while female patients showed a variety of factors. Co-morbid allergic disease was present in 84.0% of patients. A significant difference in the QEESI score between male and female patients was found in only one item out of 10 in symptom severity and life impact. However, all 10 items in chemical intolerance were significantly higher in females than in males. The mean QEESI score in the patient group in our study was lower than those in any of the four self-reported patient groups in the US. (C) 2007 Elsevier GmbH. All rights reserved.

Aims: Sociocultural factors are thought to be important in the pathogenesis of eating disorders. However, there have been few studies comparing eating behavior among various cultural populations. The aim of the present study is to compare attitudes towards bodyweight and shape, and desire for thinness in Japanese male and female subjects with those in people from other countries and of different ethnic origin.
Methods: The subjects were 411 Japanese, 130 Indian, 135 Omani, 113 Euro-American and 196 Filipino adolescents. The Eating Attitude Test-26 and the Drive for Thinness subscale of the Eating Disorder Inventory-2 were used to assess eating attitudes and fat phobia.
Results: Subjects from India, Oman and the Philippines demonstrated eating attitudes that were similar to or worse than subjects from Western countries and Japan, although their desire for thinness was not as strong. The relationship between body mass index and eating attitudes or fat phobia in Indian, Omani and Filipino subjects differed from that in subjects from Western countries and Japan. In addition, both males and females showed disturbed eating attitudes in the Indian, Omani, and Filipino subjects. Conclusion: There are differences in eating attitudes and the drive for thinness among different cultural groups.

Objective. To investigate the relationship between subtypes of irritable bowel syndrome (IBS) and severity of symptoms associated with panic disorder (PD). Material and methods. The study comprised 178 consecutive new PD outpatients. Sixty-four patients met the Rome-II criteria for IBS (IBS[+]; 29 diarrhea-predominant IBS (IBSD), 14 constipation-predominant IBS (IBSC), 21 other types of IBS). Results. IBSD patients with agoraphobia avoided a greater number of scenes owing to fear of panic attack than did PD patients without IBS (IBS[-]) and with agoraphobia. IBS[+] patients with avoidant behavior due to fear of IBS symptoms had significantly higher Beck Depression Inventory (BDI) scores and avoided a larger number of scenes owing to fear of panic attack than IBS[+] patients with agoraphobia and without avoidant behavior due to fear of IBS symptoms or IBS[-] patients with agoraphobia. Conclusions. The results suggest that the presence of IBSD or avoidant behavior because of fear of IBS symptoms may be associated with a more severe form of agoraphobia, and the latter may also be associated with depression.

本研究の目的は日本の化学物質過敏症(MCS)患者の臨床的特徴を明らかにし、診断に有効な他覚的臨床検査について検討することである。そこで、北里研究所病院臨床環境医学センターの外来患者で、MCSと診断された患者106名のカルテを基に、性別、年齢、発症要因、アレルギー疾患、自覚症状の性差及び他覚臨床検査結果について解析した。患者の74%は女性であった。84%の患者が何らかのアレルギー疾患を有していた。男性は若年者が多く発症要因は職場関連の化学物質曝露が大部分を占めたのに対し、女性は幅広い年齢分布を示し推定発症要因も多彩であった。自覚症状はquick environment exposure sensitivity inventory(QEESI)で評価し、男女の得点を比較した。症状と日常生活障害は男女で有意差がなかったが、化学物質不耐性は全項目で女性が男性より有意に得点が高かった。他覚的臨床検査(滑動性眼球追従運動、視空間周波数特性、瞳孔反応、神経反射)の陽性率は、それぞれ、85.8、69.8、46.7、54.1%であり、これら4つの検査がすべて陰性だった患者はいなかった。神経眼科的検査結果からは、MCS患者の多彩な自覚症状は高位の中枢神経や自律神経系の機能異常に起因することが示唆された。(著者抄録)

Patients with chronic fatigue syndrome (CFS) report substantial symptom worsening after exercise. However, the time course over which this develops has not been explored. Therefore, the objective of this study was to investigate the influence of exercise on subjective symptoms and on cognitive function in CFS patients in natural settings using a computerized ecological momentary assessment method, which allowed us to track the effects of exercise within and across days. Subjects were 9 female patients with CFS and 9 healthy women. A watch-type computer was used to collect real-time data on physical and psychological symptoms and cognitive function for 1 week before and 2weeks after a maximal exercise test. For each variable, we investigated temporal changes after exercise using multilevel modeling. Following exercise, physical symptoms did get worse but not until a five-day delay in CFS patients. Despite this, there was no difference in the temporal pattern of changes in psychological symptoms or in cognitive function after exercise between CFS patients and controls. In conclusion, physical symptoms worsened after several days delay in patients with CFS following exercise while psychological symptoms or cognitive function did not change after exercise. (C) 2007 Elsevier Inc. All rights reserved.

Serotonin (5-hydroxytryptamine; 5-HT) 2C receptors and the downstream melanocortin pathway are suggested to mediate the appetite-suppressing effects of 5-HT drugs such as m-chlorophenylpiperazine (mCPP) and fenfluramine. Here, we report that fluvoxamine (3-30 mg/kg), a selective serotonin reuptake inhibitor (SSRI), in the presence of SB 242084 (1-2 mg/kg), a selective 5-HT(2C) receptor antagonist, exerts appetite-suppressing effects while fluvoxamine or SB 242084 alone has no effect. The appetite-suppressing effects were attenuated in the presence of SB 224289 (5 mg/kg), a selective 5-HT(1B) receptor antagonist. Moreover, CP 94253 (5-10 mg/kg), a selective 5-HT(1B) receptor agonist, exerted appetite-suppressing effects and significantly increased hypothalamic pro-opiomelanocortin (POMC) and cocaine- and amphetamine-regulated transcript (CART) gene expression and decreased hypothalamic orexin gene expression. These results suggest that fluvoxamine and inactivation of 5-HT(2C) receptors exert feeding suppression through activation of 5-HT(1B) receptors, and that 5-HT(1B) receptors up-regulate hypothalamic POMC and CART gene expression and down-regulate hypothalamic orexin gene expression in mice.

Objective: To compare Omani and western teenagers attending schools in Muscat, Sultanate of Oman and Filipino teenagers residing in Manila, Philippines on indices of deliberate food restriction and dieting behavior. Methods: The sample consisted of 444 students who were assessed using the cross-culturally valid measure, Eating Attitude Test-26, a subscale of Eating Disorder Inventory to gauge the presence of the drive for thinness or 'fat phobia' and the Bradford Somatic Inventory to elicit the presence of somatization. Result: Significant differences in attitudes to eating, body image and somatization between the western and non-western teenagers were found. Conclusion: This paper suggests that trajectories of eating disorder, such as body image disturbances as expressed in fat phobia and somatization, tend to vary from culture to culture and underscore the view that some of the health related behavior among adolescents need to be examined within socio-cultural contexts. © 2007 Elsevier Ltd. All rights reserved.

While various VOCs are known to show neurotoxic effects, the detailed mechanisms of VOCs on autonomic nervous system have not been fully understood partly because objective and quantitative measures to indicate neural abnormalities are still under development. Nevertheless, heart rate variability (HRV) has been recently proposed as an indicative measure of the autonomic defect. In this study, we used HRV as an indicative measure of the autonomic defect to relate their values to the personal concentrations of VOCs measured by a real-time VOC monitor. The measurements were conducted to 7 healthy subjects for 24 hours. The results showed HF powers were decreased for 6 subjects when the TVOC concentration changes were high, indicating the suppression of parasympathetic nervous induced by the exposure to VOCs. The present study indicated these real-time monitoring was useful to characterize the trends of VOC exposures and their effects on autonomic nervous system. Application of the present method is expected to lead to diagnosis and cure for the patients such as MCS and sick building syndrome in the future.

パニック障害(panic disorder ; PD)の脳内機構に関する仮説として,Gormanらは"恐怖ネットワーク"仮説を提唱した.この"恐怖ネットワーク"は,扁桃体を中心とした,海馬や内側前頭前野などとの相互神経回路網を想定しており,扁桃体から視床下部,脳幹への投射は,恐怖条件づけされたさまざまな反応を引き起こすとされている.これまでわれわれは,FDG-PETを用いてPD患者の脳内糖代謝に関する研究を行ってきた.この研究の目的の1つとしては,この"恐怖ネットワーク"仮説を検証し,PDにおける脳内機構を明らかにすることである.さらに,もう1つの目的としては,ヒトの脳内に"認知行動療法"がどのような影響を及ぼしているのかということを調べることである.この研究において,われわれは,まず治療前のPD患者の脳内糖代謝を,正常統制群と比較したうえで,認知行動療法により治療が奏効した後に生じた脳内での変化について調べた.治療前の状態において,両側扁桃体,海馬および脳幹や小脳の一部の糖代謝活性が,正常統制群に比較して,PD患者において有意に上昇していた.認知行動療法治療後においては,両側前頭前野領域における糖代謝の亢進が認められた一方,右海馬,左小脳,橋などの領域において糖代謝が低下していた.しかし,扁桃体の有意な糖代謝変化は認められなかった.これらの結果は,GormanによるPDにおける恐怖ネットワーク仮説を脳機能画像解析的アプローチにより初めて検証した.また,認知行動療法後の結果より,この仮説に基づいた認知行動療法の脳内における治療的メカニズムをも明らかにした.

近年,心身医療における物語りに基づく医療(narrative-based medicine; NBM)に関する研究では,病者の語りを質的に分析していく意義が理解されつつある.医療人類学によるNBM研究への貢献の一つは,病いの語りの質的調査において,病者・医療者・調査者間の交感的な関わりを含めた相互作用を理解しようとする点にあるだろう.病いの語りの医療人類学研究では,質的調査の中で生じた相互作用を考慮しつつ,病者の生活世界を精緻に理解しようとするからである.今回の報告では,精錬された病いの語りは病者の証言(witness)であり,その証言が証人である医療者と外部の第三者から確認されていくことが,NBMの実践においてきわめて重要であることを提示したい.本報告における証言は,全人的医療の理解に貢献し,NBM研究における重要な概念と考えられるからである.病者・医療者・第三者の相互作用は,病いの語りを精錬させ,病者が病いの専門家としての自負をもち,医療への過度な依存から脱していく臨床プロセスが確認される可能性がある.ここで問うべきは,病者の個人的経験に関する証言は,心身医療における治療の根拠となるのか,という点であろう.医療人類学は,病者の証言の理解を通して,NBMのあり方について根源的な問いを投げかけている.

The purposes of this study were to clarify the characteristics of physician-diagnosed MCS patients in Japan. Thus, based on the medical records of 106 patients diagnosed with MCS according to both the 1999 Consensus and the Japanese diagnostic criteria for MCS, we analyzed demographic characteristics (sex and age), onset factors, co-morbid allergic diseases. In addition, subjective symptoms were evaluated using the QEESI®, and we compared the QEESI® scores with those of four MCS patient groups in the U.S. reported by Miller and Prihoda (1999b). Female patients accounted for 74.0%. The peak age in males was 30-34 years, whereas females showed a wide age distribution with three peaks, 30-34, 45-49 and 60-64 years. The most common MCS onset factors included indoor air contaminants by new construction or renovation of home or work place (63.2%), followed by exposure to chemicals in workspace or hobby (26 3%). In addition, co-morbid allergic disease was presented for 84.0%.

Objectives: We introduce "Mobile Nurse" (MN)-an emerging platform for the practice of ubiquitous medicine.
Methods: By implementing in a dynamic setting of daily life the patient care traditionally provided by the clinical nurses on duty, MN aims at integral data collection and shortening the response time to the patient MN is also capable of intelligent interaction with the patient and is able to learn from the patient's behavior and disease sign evaluation for improved personalized treatment.
Results: In this paper, we outline the most essential concepts around the hardware, software and methodological designs of MN. We provide an example of the implementation, and elaborate on the possible future impact on medical practice and biomedical science research.
Conclusions: The main innovation of MN, setting it apart from current tele-medicine systems, is the ability to integrate the patient's signs and symptoms on site, providing medical professionals with powerful tools to elucidate disease mechanisms, to make proper diagnoses and to prescribe treatment.

Recalled evaluation of headache intensity is often affected by several factors. Recently, computerized ecological momentary assessment (EMA) has been developed to avoid such problems as recall bias. Here, we compared recalled headache intensity with momentary headache intensity using EMA in tension-type headache (TTH). Forty patients with TTH wore watch-type computers for 1 week to record momentary headache intensity and also rated their headache intensities by recall. We calculated intraclass correlation coefficients between recalled headache intensity and indices from EMA recordings in the whole study population and in two subgroups divided by variability of momentary headache intensity. The results showed that consistency and agreement of momentary and recalled headache intensity were low, and this was especially marked in the subjects whose headache varied widely. These observations suggested that variability of headache intensity may affect recall of headache intensity and this should be taken into consideration in both clinical and research settings.

Several neuroanatomical hypotheses of panic disorder have been proposed focusing on the significant role of the amygdala and PAG-related "panic neurocircuitry." Although cognitive-behavioral therapy is effective in patients with panic disorder, its therapeutic mechanism of action in the brain remains unclear. The present study was performed to investigate regional brain glucose metabolic changes associated with successful completion of cognitive-behavioral therapy in panic disorder patients. The regional glucose utilization in patients with panic disorder was compared before and after cognitive-behavioral therapy using positron emission tomography with F-18-fluorodeoxyglucose. In 11 of 12 patients who showed improvement after cognitive-behavioral therapy, decreased glucose utilization was detected in the right hippocampus, left anterior cingulate, left cerebellum, and pons, whereas increased glucose utilization was seen in the bilateral medial prefrontal cortices. Significant correlations were found between the percent change relative to the pretreatment value of glucose utilization in the left medial prefrontal cortex and those of anxiety and agoraphobia-related subscale of the Panic Disorder Severity Scale, and between that of the midbrain and that of the number of panic attacks during the 4 weeks before each scan in all 12 patients. The completion of successful cognitive-behavioral therapy involved not only reduction of the baseline hyperactivity in several brain areas but also adaptive metabolic changes of the bilateral medial prefrontal cortices in panic disorder patients. (c) 2006 Elsevier Inc. All rights reserved.

Objective: To find differences in heart rate before and after refeeding and to identify which parameters of autonomic activity and endocrine function are associated with these differences.
Methods: Before and after the start of refeeding, body weight, RR interval (RRI), heart rate variability, endocrine function, and energy expenditure were measured in nine female anorexia nervosa patients.
Results: After short-term refeeding, mean daytime heart rate rose from 54.9 to 69.4 bpm (P &lt; .05). The changes in sympathetic activity were correlated negatively with the changes in RRI (r = -.933, P &lt; .001). Urine C-peptide, IGF-1, and fT3 increased significantly, and norepinephrine tended to increase.
Conclusion: We demonstrated that autonomic nervous activity was relevant to changes in heart rate during refeeding, and it is speculated that the increases in insulin secretion, thyroid function, and IGF-I were responsible for the mechanisms. (c) 2006 Elsevier Inc. All rights reserved.

OBJECTIVE: The objective of this study was to investigate associations between accelerometer measurements of physical activity and psychosocial variables in older people. METHODS: Subjects were 184 Japanese aged 65-85 years. An accelerometer provided step count and physical activity intensity data throughout each 24-hour period for 1 year. At the end of the year, anxiety, depression, and cognitive function were assessed. RESULTS: Controlling for age, the daily number of steps, and the daily duration of moderate-intensity physical activity showed significant negative correlations with depressive mood. CONCLUSION: A depressive mood is associated with the quantity and quality of habitual physical activity.

The authors prospectively assessed the causal relationship between psychosocial factors and glycemic control in 256 Japanese outpatients with Type 2 diabetes. Using structural-equation modeling, they first developed a causal model in which glycosylated hemoglobin (HbA(1c)) at 6 months after assessment was influenced by the baseline psychosocial factors. Then, the reliability of the causal model was investigated with measurement of HbA(1c) at 12 months after baseline. Self-efficacy directly reinforced adherence, and adherence had a direct association with future HbA(1c) Other psychosocial factors, including social support, diabetes-related distress, daily burden, and emotion-focused coping prospectively influenced HbA(1c) indirectly through self-efficacy.

「医療人類学」は社会・文化人類学の一分野として,健康や病いと社会・文化システムとの関係を探求してきた.本稿では,はじめに病いの経験の社会的・文化的な相互作用を明らかにするうえでとても有用な,(1)多元的ヘルスケアシステム,(2)説明モデル・アプローチ,(3)病いの語りと臨床民族誌,という三つのキーコンセプトについて解説する.次に,われわれがこれまでに取り組んできた,医療人類学的アプローチを応用した質的研究3点を具体的に提示し,物語りに基づく医療(ナラティプ・ベイスト・メディスン; NBM)の理論的骨格の一つとも言える,「医療人類学」の目指す学問的姿勢を明らかにする.

Objectives: The objectives of the study were to find the prevalence of major depressive disorder (MDD) in male climacteric outpatients in Japan, and to determine whether symptoms on the Aging Males' Symptoms (AMS) scale scores differed between patients with and without MDD, with the aim of increasing the specificity of future symptoms scales for partial androgen deficiency of the aging male (PADAM).
Methods: Eighty-three patients aged 40-70 who visited the male-climacteric services as outpatients were assessed using three items: a self-administered questionnaire corresponding to diagnosis for MDD, the Beck Depression Inventory, and the AMS scale.
Results: Almost half the patients had MDD. The total AMS score, the scores on the AMS psychological, somatic and sexual subscales, and the scores for all except three questionnaire symptoms were higher in patients with MDD. There were strong correlations between the AMS scale and the Beck Depression Inventory.
Conclusions: There is a higher prevalence of MDD in male-climacteric outpatients and scores on most items of the AMS scale were higher for patients with MDD. We suggest that only those symptoms whose scores did not differ between patients with and without MDD are used to assess symptoms of PADAM in the presence of MDD, or that the current AMS is used only after diagnosis of MDD and elimination of these patients. Then the relevance of each item of the AMS to testosterone levels should be simultaneously examined in the future study, which will determine the items highly specific to PADAM symptoms. (c) 2005 Elsevier Ireland Ltd. All rights reserved.

Objective: Eating disorders (ED) are thought to be risk factors for sudden death, and arrhythmias are one of the major causes of sudden death in ED patients. Late potentials (LPs) are a predictor of arrhythmias and can be measured using signal-averaged electrocardiography (SAECG). We examined arrhythmogecity by LPs in ED patients. Methods: We performed SAECG on 48 female ED patients [21 with anorexia nervosa (AN) and 27 with bulimia nervosa (BN)] and on 20 healthy women. An LP was judged positive if two or more of the following criteria were fulfilled: QRS duration &gt; 120 ms, root-mean-square voltage &lt; 20 mu V, and a high-frequency, low-amplitude duration &gt; 38 ms. We compared the occurrence of LPs among subgroups. Results: Compared with the controls, BN patients with a history of AN had significantly more SAECG abnormalities. Conclusions: BN patients with a history of AN may be prone to ventricular arrhythmias. (c) 2006 Elsevier Inc. All rights reserved.

国際的にみて,精神的外傷を引き起こすような死別に対し,十分に対処がとられている社会は少ない.これにもかかわらず,死別に対する反応を社会的特性という観点でとらえる人類学的研究はごくわずかであり,死への非嘆反応は,心身医学的問題としてとらえられている傾向がある.本稿では,オマーンの伝統的な社会に存続する不慮の死における死者の生き返り(zombification), そして呪術や魔法に関する信仰(信念)を紹介する.これらの反応は社会的に容認されており,死者の死の否定を基礎としている.さらに考察では,これらを説明モデルという概念を用いて分析し,世界各地で観察される類似する悲嘆反応を欧米のタナトロジー(死亡学)研究におけるそれと比較し,新たな視点で論じる(著者抄録)

Resting energy expenditure (REE) increases in anorexia nervosa patients after refeeding; however, the associated mechanisms remain unclear. We hypothesized that changes in autonomic nervous activity are relevant to changes in REE during refeeding. The objectives of this study were (1) to confirm differences in REE during refeeding and (2) to identify the parameters associated with these differences. The subjects were 9 female inpatients with anorexia nervosa receiving cognitive-behavioral therapy. Both before and after the start of refeeding, which was defined as the first increase in food intake of 1675 kj or more per day, body composition, REE, endocrine function, R-R interval, autonomic nervous activity evaluated in terms of heart rate variability, and physical activity were measured and psychological tests completed. The differences in measurements before and after refeeding and specific associations between changes in REE and other factors were assessed. Resting energy expenditure increased significantly by 22.7% from 3190 to 3910 kj/d (P &lt; .01) with the increase in energy intake. Fat-free mass and physical activity did not change. The increase in REE was accompanied by higher insulin-like growth factor-I, free triiodothyronine, and norepinephrine and decreases in parasympathetic activity and R-R interval. Some factors might be responsible for the increases in REE observed with refeeding. No previous study has simultaneously observed multiple variables related to energy metabolism during refeeding. (c) 2005 Elsevier Inc. All rights reserved.

生活習慣病に罹患しやすい危険因子としてのパーソナリティ傾向を測定するShort Interpersonal Reactions Inventory(SIRI)の日本語短縮版を用い,識別される4つのパーソナリティ傾向と,生活習慣や食行動とどのような関連性をもっているか,さらにそれが,生理指標にどのような影響を及ぼすかを検討した.仙台市内にある総合病院職員650人のうち,インフォームド・コンセントを得られた485人を対象に「生活習慣と生活意識に関する調査」の質問紙調査を行った.この調査は病院倫理委員会の承認を受けて行われた.4つのパーソナリティ傾向と,生活習慣,食行動との関連性について最終目的変数を生理学的指標としてパス解析を行った.その結果,パーソナリティ傾向と生理学的指標との関連では,タイプ2傾向では,コレステロール値が高いことが示された.今回の研究では,パーソナリティ傾向と生活習慣,生理学的指標の関連性が示唆された.今後さらに対象を広げ同様の結果が得られるか検討する必要がある(著者抄録)

The objective of this double-blind, placebo-controlled randomized withdrawal study was to evaluate the efficacy and safety of sertraline for 8 weeks in treating Japanese patients with DSM-IV panic disorder. Patients (n=394) were initially treated with 8 weeks of open-label sertraline followed by 8 weeks of double-blind treatment with either sertraline (50-100 mg/day) or placebo. Responders during the open-label phase were eligible to be entered into the double-blind phase. Two hundred and forty patients were entered to the double-blind phase and randomly assigned to receive sertraline (n=119) or placebo (n=121). On the primary efficacy measure (relapse), there was no significant difference between the two treatment groups (sertraline 10.1 %; placebo 13.2%). However, the frequency of panic attacks was significantly (P=0.012) lower for sertraline compared to placebo. The proportion of sertraline-treated patients who met response criteria (Clinical Global Impression-Improvement Scale score of 1 or 2) at the end of double-blind phase treatment was also significantly (P=0.003) higher for sertraline (89.9%) compared to placebo (74.4%). Panic Disorder Severity Scale total score was significantly (P=0.012) lower in the sertraline group compared to the placebo group. Adverse events during acute treatment were consistent with the known adverse event profile of sertraline, and the incidence of adverse events during the double-blind phase treatment was not different between sertraline and placebo. Int Clin Psychopharmacol. (c) 2005 Lippincott Williams & Wilkins.

Objective: This semiprospective case-control study was performed to investigate the relationship between harmony-seeking personality and the occurrence of prostate cancer. Methods: Out of 217 consecutive participants admitted to hospital for biopsy, 86 and 81 were classified into the case and control groups, respectively, based on their initial diagnosis and eligibility criteria. The participants answered several questionnaires after admission. The logistic regression model was used for multivariate analyses to assess the association. Results: "Harmony-seeking personality" was selected as the only psychological variable significantly contributing to the model, while "family history of prostate cancer" as the only somatic variable. "Harmony-seeking" maintained a significant contribution to the model, also including "family history" and even to the model adjusted by "patient prediction of cancer diagnosis" and "prostate-specific antigen" (PSA), probably related to the consequences of the disease. Conclusion: The harmony-seeking personality could differentiate between groups of men with and without prostate cancer. (c) 2005 Elsevier Inc. All rights reserved.

The present study was performed to assess cerebral glucose metabolism in patients with panic disorder using positron emission tomography. F-18-fluorodeoxyglucose positron emission tomography with voxel-based analysis was used to compare regional brain glucose utilization in 12 nonmedicated panic disorder patients, without their experiencing panic attacks during positron emission tomography acquisition, with that in 22 healthy controls. Panic disorder patients showed appreciably high state anxiety before scanning, and exhibited significantly higher levels of glucose uptake in the bilateral amygdala, hippocampus, and thalamus, and in the midbrain, caudal pons, medulla, and cerebellum than controls. These results provided the first functional neuroimaging support in human patients for the neuroanatomical hypothesis of panic disorder focusing on the amygdala-based fear network. NeuroReport 16:927-931 (c) 2005 Lippincott Williams & Wilkins.

The present study was performed to examine how intention to learn and explicit knowledge in sequence learning are reflected in event-related potentials. Participants responded to numerals presented in a repeating order, which were replaced infrequently by deviant numerals. The participants were given incidental or intentional learning instructions. Sequence parts for which they acquired explicit knowledge were identified for each participant by post-task memory tests. Reaction times indicated that sequence learning occurred under both types of instruction. The N2 enhancement for deviants was primarily associated with explicit sequence knowledge, and the P3 enhancement showed a weak association. These results suggested that N2 and P3 reflect different aspects of explicit learning. NeuroReport 16:705-708 &COPY; 2005 Lippincott Williams & Wilkins.

Feedback negativity is a negative component of the event-related brain potential observed 250-300 ms after feedback stimuli. The present study investigated the effects of value (correct or incorrect) and reward magnitude (no, small or large) on feedback negativity and P300. Feedback negativity was larger after incorrect feedback than after correct feedback, irrespective of reward magnitude. In contrast, P300 amplitude increased with reward magnitude, irrespective of value. The amplitude of feedback negativity was correlated with a trait score of negative affect and not positive affect, whereas P300 amplitude was correlated with positive affect and not negative affect. These results suggest that value and reward magnitude are processed separately in the brain. (c) 2005 Lippincott Williams F Wilkins.

Objective: This study was conducted to confirm the definition of multiple chemical sensitivity (MCS) in actual life: that multiple symptoms are provoked in multiple organs by exposure to, and ameliorated by avoidance of, multiple chemicals at low levels. We used the Ecological Momentary Assessment to monitor everyday symptoms and the active sampling and passive sampling methods to measure environmental chemical exposure. Methods: Eighteen patients with MCS, diagnosed according to the 1999 consensus criteria, and 12 healthy controls participated in this study. Fourteen patients and 12 controls underwent 1-week measurement of physical and psychologic symptoms and of the levels of exposure to various chemicals. Linear mixed models were used to test the hypotheses regarding the symptom profile of MCS patients. Results: Some causative chemicals were detected in 11 of 14 MCS patients. Two other patients did not report any hypersensitivity episodes, whereas passive sampling showed far less exposure to chemicals than control subjects. Another subject reported episodic symptoms but was excluded from the following analyses because no possible chemical was detected. Eleven of the 17 physical symptoms and all four mood subscales examined were significantly aggravated in the interview based on "patient-initiated symptom prompts." On the other hand, there were no differences in physical symptoms or mood subscales between MCS patients and control subjects in the interview based on "random prompts." Conclusions: MCS patients do not have either somatic or psychologic symptoms under chemical-free conditions, and symptoms may be provoked only when exposed to chemicals.

Objective: The aim of this study was to assess the possible interactive effects of age, sex, duration of hemodialysis (HD), educational and income levels, and stress coping mechanisms on depression and anxiety in patients on maintenance HD. Methods: Uremic patients (N = 416), regularly undergoing HD for more than I year, who did not have apparent cerebrovascular disease or serious intellectual impairment, were investigated. The interactive effects of age, sex, duration of HD, and educational and income levels, in relation to stress coping mechanisms, on depression or anxiety were assessed by hierarchical multiple regression analyses. Results: Regression lines illustrating significant (P&LT;.05) interactions were constructed. The decrease in depression accompanying the increase in task-oriented stress coping was greater in highly educated patients than it was in the other patients. Anxiety levels decreased when patients had both high income and demonstrated a range of task-oriented stress coping mechanisms. For patients undergoing HD for tong duration, or with a relatively high income, the decrease of depression and anxiety accompanying a decrease of emotion-oriented stress coping was greater, as compared with other patients. The decrease of depression accompanying an increase of avoidance-oriented stress coping was greater in patients with low income and in older patients than it was in the other patients. Conclusions: These findings may lead to the development of specific and focused interventions for depression or anxiety in maintenance HD patients. &COPY; 2005 Elsevier Inc. All rights reserved.

東京大学心療内科が今後心身医学をどう発展させていくかという主題に関して,研究の方法論と臨床活動を中心に述べる.研究の方法論としては,Ecological Momentary Assessment(EMA),大脳機能検査,神経内分泌学の3つを中心に据えたい.新しい方法論であるEMAは,日常生活中で生物,心理,社会,生態学的データを継続的に記録する方法で,通常の生活環境での心身相関の問題に科学的に取り組むことを可能にする.臨床の対象としては,心身症,摂食障害,パニック障害,軽症うつ病などが中心である.精神科と比較して,心療内科ではあくまでも身体や行動の側からアプローチする特徴があり,「話せばわかる」という立場を堅持することになる.治療法では,薬物療法,生活習慣の是正,リラクゼーション,認知行動療法が中心となり,他の内科との違いは,行動変容,治療関係理解の具体的な方法論をもっていることである.

本研究では, クラインマンが提唱した「説明モテル」を鍵概念として, わが国における民俗セクター医療を利用する患者の社会文化的背景に対して, 医療人類学的視点に基づいた質的研究法による解明が試みられた. 対象は東洋医学, 仏教医学, スピリチュアリズム理論に基づく治療実践を行う治療家Aのクライエントらとし, 自由記述式のアンケート調査および聞き取り調査が行われた. その結果, 民俗セクター医療を利用しやすい病態群や受療行動パターンが持定され, 病いの物語りからは, 人々が多元的医療システムの中でそれぞれのライフストーリーに裏づけられた価値観に基づいて, 自分に合った医療を主体的に選択していくありさまが認められた. 研究の背景と目的 「医療」が「人間の病気に対する対処行動の全体系」であると定義されるように, 現代社会には治療の基盤となる根本原理がまったく異なる複数のヘルス, ケア, システムが多元的, 多様的, 多層的に存在しており, そのありさまは「多元的医療システム(pluralistic medical systems)」とよばれる.

宮城県内の一般人440名を対象とし,QEESIを実際に化学物質過敏症(MCS)患者用のスクリーニング用問診票としての使用を試みた.MCSの疑いが非常に強い「Very suggestive」に分類された17例に対し電話での詳細な聞き取り調査を行った.17例中13例が自宅の室内空気汚染物質測定に参加し,内7例は専門医の検診も受診し全員がMCS患者と診断された.室内空気汚染物質測定ではホルムアルデヒド,アセトアルデヒド,TVOCs,パラジクロロベンゼンが室内指針値以上の濃度で検出され,MCS・シックハウス症候群の発症または症状悪化要因である可能性が示唆された.QEESIは日本のMCSやシックハウス症候群患者のスクリーニング用問診票として有効であることが示唆された

本研究は, 文化人類学の研究手法を用いて病いの語りと医師-患者関係を分析したものである. 文化人類学者による質的分析は, 病いの語りの意味と機能の考察から語りの動態性と医師-患者関係の推移を抽出し, "物語りに基づく医療(Narrative-Based Medicine)"との関連性を明らかにした. 本研究における臨床プロセスの4段階モデルは, 難治性の慢性疾患を患う患者が心身の相関性と自己の身体の固有性を自覚していくプロセスである. 病者は各段階を経るにつれて"疾病(disease)"を"慢性の病い(chronic illness)"として受容するようになり, 病いの語りは精錬され, より自省的かつ解釈的になっていくことが明らかになった.

Hikikomori, a form of acute social withdrawal, is becoming a silent epidemic in Japan. As it has not been reported from other parts of the world, hikikomori fulfills the criteria for "a culture-bound syndrome." We report a case from Oman, in the southern part of Arabia, with all the essential features of hikikomori. We speculate that the social environment of Japanese and Omani society could reinforce behavior akin to hikikomori although this condition may also transcend geography and ethnicity.

本研究は文化人類学の立場から病いの語りを分析する質的研究である.分析対象は, 第1報において報告された臨床プロセスの第3段階における病者の語りと聴き手との相互作用である.第3段階の医師-患者関係は, 疾病を慢性の病いとして受容していく関係性であり, 病者が自らの病いの経験を意義あるものとして語り, 医師がその語りに対して感嘆しつつ傾聴する姿勢が確認された.本研究では, この治療関係が外部の第三者から確認されることによつて, 病いの語りにおける"証言(witness)"というべき現象が生成されていく仮説が導き出された.この現象は, 全人的医療の理解に貢献し, "物語りに基づく医療(Narrative-Based Medicine)"の核となる重要な概念と考えられた.病者・医師・第三者の相互作用は, 病いの語りを精錬させ, 病者が病いの専門家として自立していく臨床プロセスを導くと分析されたからである.

過敏性腸症候群(IBS)を伴うパニック障害(PD)患者の臨床的特徴を調査することを目的とし, DSM-IVの基準を満たすPD患者150名(平均年齢33.7±9.5歳)を対象に調査を行った.その結果, PD患者中36.0%がIBSを伴っていた.IBS先行例は38.9%, PD先行例は29.6%, 同時発症例は14.8%であった.IBSを伴う患者は伴わない患者と比較して, 広場恐怖併存率と抑うつの程度が有意に高く, 予期不安頻度に高い傾向がみられた.さらに, IBSと広場恐怖両方を伴う患者とIBSを伴わず広場恐怖を伴う患者はIBSと広場恐怖両方を伴わない患者と比較して予期不安の程度・頻度および抑うつの程度が有意に高かつた.

Error-related negativity (ERN) is a negative deflection in the event-related potential elicited in error trials. To examine the function of ERN, we performed an experiment in which two within-participants factors were manipulated: outcome uncertainty and content of feedback. The ERN was largest when participants expected correct feedback but received error feedback. There were significant positive correlations between the ERN amplitude and the rate of response switching in the subsequent trial, and between the ERN amplitude and the trait version score on negative affect scale. These results suggest that ERN reflects detection of a negative reward prediction error and promotes subsequent response switching, and that individuals with high negative affect are hypersensitive to a negative reward prediction error.

We investigate long-duration time series of human physical activity under three different conditions: healthy individuals in i) a constant routine protocol and ii) in regular daily routine, and iii) individuals diagnosed with multiple chemical sensitivities. We find that in all cases human physical activity displays power law decaying temporal auto-correlations. Moreover, we find that under regular daily routine, time correlations of physical activity are significantly different during diurnal and nocturnal periods but that no difference exists under constant routine conditions. Finally, we find significantly different auto-correlations for diurnal records of patients with multiple chemical sensitivities.

The authors' purpose in this study was to test the hypothesis that laterality and imbalance of muscle stiffness relate to personality. The authors selected 23 healthy volunteers and divided them into two groups based on the predominance of muscle stiffness on the left or right side. Imbalance of muscle stiffness was calculated as the absolute value of the difference of muscle stiffness between the right and left sides. The authors evaluated personality with the Japanese version of the Eysenck Personality Questionnaire. Subjects with left predominant muscle stiffness of the rectal abdominis had significantly higher neuroticism score than those with right predominant muscle stiffness. Subjects with more imbalance of muscle stiffness in the latissimus dorsi and in the trapezius had significantly higher neuroticism and psychoticism scores than those with less imbalance. The findings suggest that laterality and imbalance of muscle stiffness relate to personality.

OBJECTIVES: Irritable bowel syndrome (IBS) is considered to be a transcultural functional bowel disorder with high comorbidity and psychiatric disorders; but well-designed epidemiologic studies have never been performed in Japan. The purpose of this study was to establish the prevalence of IBS, together with the comorbiclity rates of panic disorder (PD) and agoraphobia, employing a large-scale survey based on stratified random sampling.
METHOD: A total of 4,000 subjects aged 20-69 years completed a questionnaire and the results were weighted to ensure representativeness of the Japanese general population. The questionnaire covered key symptoms of IBS, PD, and agoraphobia. The prevalence of IBS and its subtypes was calculated by gender. The comorbidity of PD and agoraphobia with IBS was compared with morbidity in non-IBS subjects; and comorbidity in IBS subjects who had consulted medical practitioners regarding their symptoms and in those who had not was also compared.
RESULTS: The prevalence of IBS was 6.1% in total. It was significantly higher in females than in males. Diarrhea-predominant IBS was more prevalent in males and constipation-predominant IBS in females. The morbidity rates of PD and agoraphobia were significantly higher in IBS than in non-IBS subjects. Comorbidity did not differ between female and male IBS subjects, while morbidity was significantly higher in female than in male non-IBS subjects; and comorbidity did not differ between consulter and nonconsulter subjects.
CONCLUSIONS: The prevalence of IBS and its comorbidity with PD and agoraphobia in Japan were demonstrated to be similar to those reported in Western industrialized countries.

Background: Eating disorders are thought to be risk factors for cardiac sudden death secondary to arrhythmia. Results in previous studies on QT interval and QT dispersion, markers of fatal arrhythmia, have been inconsistent. Methods: We prospectively examined 179 female eating disorder patients, being over 18 years old and diagnosed according to the DSM-IV criteria between January 1995 and December 2002, and 52 healthy women. Patients with abnormal plasma electrolytes or taking medications that might influence the electrocardiogram (ECG) were excluded from the study. QT intervals were corrected for heart rate using Bazett's formula and the nomogram method, which is more reliable at extremely low heart rates than Bazett's formula. QT dispersion was measured as the difference between the longest and shortest QT intervals. QT intervals and QT dispersion in each patient group were compared with those in the control group. Results: The 164 eligible patients consisted of 43 patients with anorexia nervosa restricting type, 35 with anorexia nervosa binge eating/purging type, 63 with bulimia nervosa purging type, and 23 with bulimia nervosa nonpurging type. There was no significant difference in age between eating disorder patients and controls. QT interval and QT dispersion were significantly longer in all eating disorder subtypes than in the control group. QT interval and QT dispersion were significantly correlated with the rate of body weight loss in bulimia nervosa. Conclusions: QT interval and QT dispersion were prolonged in both anorexia nervosa and bulimia nervosa. Examination of ECG in eating disorder patients without extremely low body weight also appears to be clinically important. Copyright (C) 2004 S. Karger AG.

The purpose of this study is to test our hypothesis that muscle relaxation is effective on the psychological well-being of juvenile delinquents. Subjects were 16 juvenile delinquents who had entered a reform school. Subjects were divided into two groups. The muscle relaxation group received muscle relaxation therapy once a week for a total of 4 times. The control group spent an ordinary daily life in the reformatory. Psychological questionnaires used were the Rosenzweig Picture Frustration Study (P-F study), the Psychological Stress Response Scale (PSRS), and the Eysenck Personality Questionnaire (EPQ). There was a significant Group x Time interaction of the Group Conformity Rating (GCR) of the P-F study (F [1, 14] = 10.1, P = 0.007). There were no significant interactions in the other psychological subscales.
Thus, muscle relaxation therapy may improve frustration tolerance among juvenile delinquents.

本研究の目的は,社会不安障害を簡便にスクリーニングできる尺度を開発することである.社会不安障害患者97名,パニック障害患者37名,健常者542名を対象に自記式の調査を行った.探索的因子分析の結果,本尺度は「人前でのパフォーマンス不安と他者評価懸念」,「身体症状」,「対人交流に対する不安」の3因子28項目と日常生活支障度に関する項目で構成された.各因子および全項目の内的整合性は高かった.また「人前でのパフォーマンス不安と他者評価懸念」得点,「身体症状」得点,合計得点は,社会不安障害群と他の2群を弁別可能であった.したがって,本尺度は高い信頼性と妥当性を有することが明らかにされた.

Objective: The aim of this study was to assess the possible variances of blood urea nitrogen (BUN), serum potassium (SK) and serum phosphorus (SPO4) levels and interdialytic weight gain (IWG) accounted for compliance of uremic patients on hemodialysis (HD). Methods: BUN, SK and SPO4 levels and IWG of uremic patients (n = 310) regularly undergoing three HD sessions per week for more than I year in Japan were assessed. Patients suffering from problems influencing dietary intake and those with malnutrition were excluded. The variances accounted for self-efficacy for health-related behavior and avoidance-oriented coping (AOC) with stress were assessed by hierarchical multiple regression analyses. Results: BUN and SPO4 levels were not significantly (P&lt;.05) associated with self-efficacy or AOC. SK levels and IWG were significantly (P&lt;.05) associated with self-efficacy and/or AOC. The variances of SK levels and IWG accounted for self-efficacy and/or AOC, independent of age, sex, duration of HD and facilities, were 1.6% and 5.0%, respectively. Conclusions: Although the variances of SK levels and IWG accounted for self-efficacy and/or AOC were rather small, the significance of their relationships may suggest that intervention for self-efficacy or AOC could improve compliance and reduce SK levels and IWG of uremic patients on HD. (C) 2003 Elsevier Inc. All rights reserved.

Background: The pathogenesis of restless legs syndrome (RLS) is still unclear. The purpose of this study is to determine relationships of the presence of RLS in uremic patients regularly undergoing hemodialysis (HD) with demographic, clinical, and psychological factors. Methods: In 490 uremic patients on HD therapy in Japan, RLS was diagnosed based on diagnostic criteria established by the International Restless Legs Syndrome Study Group. Data were compared between patients with and without RLS. Results: There were univariately significant (P &lt; 0.05) differences in serum phosphorus levels, anxiety levels determined using the Hospital Anxiety and Depression Scale, and degrees of emotion-oriented and avoidance-oriented coping determined using the Coping Inventory for Stressful Situations. In multivariate, analyses, low hemoglobin levels, high serum phosphorus levels, high anxiety levels, and a great degree of emotion-oriented coping were independently related to the presence of RLS in uremic patients on HD therapy, with statistical significance (P &lt; 0.05). Conclusion : Hyperphosphatemia, anxiety, and a great degree of emotion-oriented coping with stress were independently related to the presence of RLS in uremic patients on HD therapy. The pathogenesis of RLS seems to involve more than one mechanism, which leads to restless legs as the final common pathway. These findings may provide new clues to the pathogenesis of RLS. (C) 2003 by the National Kidney Foundation, Inc.

The purpose of this study was to investigate the effects of coping processes on psychophysiological and psychological responses in stressful settings. In particular, we focused on the effects of a combination of active and avoidant coping processes. Subjects were 40 healthy undergraduate male students (mean = 19.80, S.D. = 0.97) who were randomly divided into four groups: (a) an effort coping group in which a subject faced a controllable stressor mobilizing an effortful and active coping behavior for a reward; (b) a distress coping group in which a subject faced a distressful stressor mobilizing an avoidant coping behavior for threat of punishment; (c) an effort-distress coping group in which a subject faced an ambivalent stressor mobilizing active coping behavior for a reward and avoidant coping behavior for threat of punishment; and (d) a control group. Initially, the effects of effort coping, distress coping, and effort-distress coping on psychophysiological and psychological responses were investigated. It was found that effort coping and effort-distress coping intensified cardiovascular responses, particularly blood pressure, and that distress coping and effort-distress coping intensified skin conductance level (SCL). Secondarily, the relationships between effort coping process, distress coping process, psychophysiological responses, and psychological responses were investigated. As a result of cluster analysis, the changes of heart rate and blood pressure were correlated to the change of the effort score, and the changes of SCL and psychological responses were correlated to the change of the distress score. These findings suggest that active coping processes and avoidant coping processes independently affect different response systems. (C) 2002 Elsevier Science B.V. All rights reserved.

The purpose of this study was to test the hypothesis that, in anorexia nervosa, patients with a low premorbid weight are associated with a low weight at referral and that premorbid weight, referral weight, and weight loss are associated with mood states. The changes of Body Mass Index from premorbid to referral, the duration of illness, and the psychological scores on the Profile of Mood States and the Cornell Medical Index-Health Questionnaire were examined in 49 anorexia nervous patients. Body Mass Index at referral of patients with lower premorbid Body Mass Index was significantly lower than that of patients with higher premorbid level. For patients with a larger relative decrease, scores on depressive mood were lower. These findings suggested that in anorexia nervosa patients, lower premorbid Body Mass Index was associated with lower Body Mass Index at referral, and that the patients with higher relative decrease in Body Mass Index might be satisfied with their weight loss.

The rapid increase of patients with eating disorders in Japan has made necessary the reliable and valid measurement of psychological factors in eating disorders. The purpose of this study was to examine the reliability and validity of the Japanese version of the Eating Disorder Inventory. 766 females without eating disorders and 139 female patients with eating disorders responded to the Eating Attitude Test and the Eating Disorder Inventory. Principal factor extraction with promax rotation isolated 9 interpretable factors with satisfactory internal consistency (Cronbach alpha range = .74-.90). Compared with controls, patients scored significantly higher on all factors after minimizing the influence of Body Mass Index, There were strong correlations among factor scores and scores on the Eating Attitudes Test, particularly among patients. These results indicate the Eating Disorder Inventory as showing psychometrically sound internal consistency and concurrent validity.

うつ病にも軽症群が存在するという考えをもつ臨床家は多いものの,軽症群の概念や特徴を捉えることを目的とした過去の研究は少ない.本研究では,大うつ病と小うつ病の患者(n=34)を対象に,軽症群と中等症以上の群で,うつに関連した扇状の出現率の差異を検討した.「軽症うつ病」(うつ病軽症群)を,大うつ病エピソード(DSM IV)に記載されている9症状のうち6症状以下の該当数にとどまる群と仮定したところ,「憂うつ感・沈んだ気持ち」(p-0.007),「睡眠障害」(p-0.009),「無価値観・罪悪感](p-0.000),「希死念慮](p-0.002)の出現率および現時点での自殺危険性(p-0.031)は,中等症以上の群と比較して有意に低いことが明らかになった.さらに,「憂うつ感・沈んだ気持ち」,「無価値観・罪悪感」の2項目による両群の判別率は85.3%であった.なお,両群間でSDS得点に有意な差は認められなかった.今後は,さらに専門科およびプライマリ・ケア施設での調査を進め,最終的には,治療対象とすべき「軽症うつ病」の見過ごしを避けるため,プライマリ・ケアの現場で使用可能な「軽症うつ病」の概念や診断基準を作成する予定である.

Purpose. The aim of this study was to assess the relationships of compliance with age, sex, and duration of hemodialysis (HD) simultaneously in a large population of uremic patients on HD.
Methods. Uremic patients (n = 484) who were regularly undergoing 3 HD sessions/week in Japan were investigated with regard to age, sex, duration of HD, and compliance measures (i.e., blood urea nitrogen [BUN], serum potassium [SK], and serum phosphorus levels [SPO4] levels and interdialytic weight gain [IDWG]). Associations and interactions among them were assessed by correlations and hierarchical multiple regression analyses.
Results. Older age was significantly associated with low levels of BUN, SPO4, and IDWG (p&lt;0.05), but not with SK levels. Longer duration of HD was significantly associated with high levels of SK, SPO4, and IDWG (p&lt;0.05), but not with BUN levels. The regression lines illustrating significant (p&lt;0.05) interactions predict that in men, the longer the duration of HD, the higher the levels of BUN and SK, and the higher the IDWG; this was not the case in women.
Conclusions. In uremic patients on HD, compliance was likely to be different based on the patient's sex and duration of HD.

The proportion of the population over 65 has been increasing rapidly in industrialized countries. Recently, innovative devices for unconstrained monitoring of health variables at home have been developed. Previous studies focused mainly on the physical aspects, yet mood disturbances are also important in the elderly. To investigate the relationship between subjective symptoms including mood states and behavioral patterns, unconstrained monitoring of the usage of ubiquitous home appliances such as a refrigerator and a television was performed on 100 elderly people for 31 consecutive days. Using inter-event intervals for the use of the appliances, the probability density function (PDF) and cumulative distribution function (CDF) were calculated. The power-law exponents α and β were then obtained as the slopes of the linear regression in log-log plots of the PDF and CDF, respectively. Subjects with higher depression, confusion, fatigue and total mood disturbance scores had significantly smaller α and β. The more fatigued group tended to have a smaller β for the use of the refrigerator. These results suggested that the usage patterns of these ubiquitous appliances could be used to detect changes in mood states in the elderly.

本研究の目的は,広場恐怖を伴うパニック障害患者を対象に,一般性セルフ・エフィカシー尺度(坂野,他:GSES,1986)を実施し,尺度の構造を確認するとともに,その信頼性と妥当性を検討し,広場恐怖を伴うパニック障害患者の一般性セルフ・エフィカシーの特徴を明らかにすることである.DSM-IVの診断基準を満たす広場恐怖を伴うパニック障害患者102名(男性22名,女性80名,平均年齢36±10歳)を対象にGSESを実施し,因子分析を行つとその結果,「失敗に対する不安」,「行動の積極性」,「能力の社会的位置づけ」という3因子15項目が抽出された.Cronbachのα係数によって内的整合性を検討した結果, GSESは広場恐怖を伴うパニック障害患者においても高い信頼性を有することが示された.また, GSESとSTAI-Tを用いて平行検査を行った結果, GSESは高い基準関連妥当性を備えていることがわかった.最後に,広場恐怖を伴うパニック障害患者の一般性セルフ・エフィカシーの特徴が論議された.

The authors' purpose in this study was to assess the interactive effects of stressors, coping with stress, and self-efficacy on depression and anxiety in maintenance hemodialysis (HD) patients. Patients (n = 453) undergoing HD for more than 1 year in Japan were investigated. The regression lines illustrating significant (p &lt
.05) interactions predict that itching HD patients with low self-efficacy will be more depressive and anxious than nonitching patients. In HD patients who report a high degree of emotion-oriented coping, itching patients will he more anxious than nonitching patients. These new findings may lead to the development of specific and focused interventions for depression or anxiety in maintenance HD patients. © 2003 Taylor &amp
Francis Group, LLC.

We examined the relationship of health factors and social support to life satisfaction in older adults dwelling in a rural town. The gender difference in variables related to life satisfaction was also discussed in this study. One hundred and forty-two older adults (86 females and 56 males) who completed a self-administered questionnaire and participated in a health examination in 1998 or 1999 comprised the study participants. The t-test and chi-square test were used to assess the differences between the two genders. Correlation measure and multiple regression analysis were used to assess the relationship between life satisfaction and other health related or socially related factors for each gender. Significant gender differences were observed in living status and several health related factors. According to the results of the multiple regression analyses, life satisfaction was related to mental health and age in females, while it was related to mental health status and social support from others in males. Gender differences in the variables associated with life satisfaction were observed among the community-dwelling older adults. These data suggest the importance of mental health for older adults. When preparing health promotion strategies for older adults, results of gender differences as they related to social support and life satisfaction should be applied in practice.

To examine the relationship between somatosensory amplification and three factors of alexithymia (difficulty identifying feelings, difficulty describing feelings, and externally oriented thinking), 48 outpatients attending a Japanese psychosomatic clinic and 33 comparative outpatients completed the Somatosensory Amplification Scale (SSAS), 20-item Toronto Alexithymia Scale (TAS-20), Profile of Mood States (POMS), and other self-rating questionnaires. The scores on the SSAS and the first and second TAS-20 factors were higher (all P&lt;0.001) in the psychosomatic group than in the comparison group. The SSAS was positively associated (both P&lt;0.01) with these two TAS-20 factors, controlling for the effects of age, sex, group, and POMS tension-anxiety and depression. Somatosensory amplification appears to be associated with difficulties identifying and describing feelings, not externally oriented thinking, in Japanese patients.

心療内科不登校入院治療例67例をDSM-III-R,IVに準じた形式で多軸評定した.各軸ごとに診断名を1〜8カテゴリーに分類した後,結果を集計,さらにその結果を基に性差と年齢差を検討した.この結果,1軸は摂食障害,不安障害,気分障害,2軸は未熟性,4軸は家庭内問題ストレス,いじめストレスがそれぞれ多症例に確認された.また,3軸になんらかの診断がなされた者は26例(39%)であった.年齢差,性差については, 1 軸診断数(カテゴリー該当数) : 中学生・高校生<大学生, 2 軸になんらかの診断を有する率 : 男<女であった.以上,不登校症例の病態特徴は多様であり,多側面からのアセスメントと対応が必要であると考えられた.

本研究では,内科・心療内科標榜の施設Aと、神経科・心療内科標榜の施設Bで、過去5年半に認知行動療法(CBT)に基づくカウンセリングに導入された121例のデータに基づき、心療内科および神経科プライマリーケアでのCBTの適用の実際を報告した。診断では、不安障害と適応障害が両施設とも多い一方で、一般身体疾患に影響を与えている心理的要因と身体表現性障害は施設Aで、摂食障害は施設Bで多いという特徴がみられた。治療法では、両施設で共通して気分障害には段階的タスク割り当て・認知行動論的カウンセリング、不安障害にはエクスポージャー・自律訓練法、身体表現性障害・睡眠障害・一般身体疾患に影響を与えている心理的要因には自律訓練法、適応障害には認知行動論的カウンセリングが多く適用されていた。そして一般身体疾患に影響を与えている心理的要因、適応障害、不安障害は症状が改善して終結となる割合が高かったことから、CBTは心療内科および神経科プライマリーケアでも十分に活用可能であると考えられた。

癌に罹患し易いタイプCパーソナリティを測定するShort Interpersonal Reactions Inventoryの日本語短縮版(SIRI33)の弁別的妥当性を検討した.癌患者40名にSIRI33への回答を依頼し,タイプ別人数を算出し,健常者のデータベースと比較した.40名中タイプC に相当するタイプ1(社会的同調性)とタイプ5(反情緒的)の人数は25名と多く,タイプ2(虚血性心疾患親和性)とタイプ4は殆ど含まれず,性別・年齢をマッチングした健常者との比較でも有意にタイプCが多かった.SIRI33はタイプC測定に関する弁別的妥当性を有することが示された

The purpose of this study is to examine the relationship between psychological factors, regional brain activity and natural killer cell activity (NTKA). Eight patients with malignant diseases were studied by FDG-PET under a resting condition. NKA and degree of anxiety and depression were measured using Taylor's manifest anxiety scale (MAS) and Zung's self-rating depression scale (SDS). Linear correlation of NKA and psychological measures to the regional brain metabolism in cancer patients was examined using statistical parametric mapping (SPM).
Positive linear correlation between NKA and regional metabolic rate ratios was identified in the visual association cortex, anterior cingulate gyrus (CG) and sensorimotor area, and negative correlation was identified in the inferolateral prefrontal cortex (ILPFC), prefrontal cortex (PFC), orbitofrontal cortex (OFC) and anterior temporal cortex. Positive linear correlation to the MAS score was identified in the visual association cortex, anterior CG, primary sensorimotor area and the posterior parietal cortex, and negative correlation was detected in the ILPFC, PFC, OFC and anterior temporal cortex. The NKA and MAS scores positively correlated with each other (p &lt; 0.001).
The result might serve as supporting data for a hypothesis that psycho-immune interaction is also mediated by the cerebral cortex and limbic system. Copyright (C) 2001 John Wiley & Sons, Ltd.

本研究の目的は, 摂食障害に特徴的な非機能的思考である体型や食事に関する不合理な信念を測定する尺度(Beliefs related to Shape and Diet Scale;BSDS)を開発することであった.まず, 項目の整理検討のために女子学生512名を対象に予備調査を実施し, 次に, 女子学生2, 861名を対象に信頼性・妥当性の検討のために本調査を実施した.因子分析の結果, 6因子32項目(自己評価, 承認, ダイエット, 体重, 被保護, 性格と人気)が抽出された.Cronbachのα係数による内部一貫性や再テスト法による検討の結果, BSDSは高い信頼性を, そしてEAT, Binge Eating尺度, JIBT-20を用いた平行検査の結果, 高い妥当性を備えていることが示された.さらに, EAT-20によって推定された摂食障害傾向が高いほど体型や食事に関する非機能的な思考をもっていることが示唆された.

AN-R52名, AN-BP54名, BN-P39名, 健常女子学生55名を対象に摂食障害(ED)に特徴的な認知的障害を検討した.その結果, いずれのED群も健常群より食事強迫, 問題回避傾向, そしてダイエットや体重に関する非機能的思考をもっている傾向が高く, そしてセルフ・エスティームの低いことが示された.また, やせ願望など体型と関わる変数においてはAN-R群と健常群の間に差は認められなかった.全体的な傾向として認知的障害の程度はBN-P, AN-BP, AN-R, 健常群の順に顕著であり, その傾向は治療担当者3名による評定によっても支持された.

身体感覚の増幅に関連する心理特性を明らかにするため, 日本語版の身体感覚増幅尺度(Somatosensory Amplification Scale ; SSAS)を作成した.大学病院の外来患者81人(心療内科48人, 内科33人)を対象に10項目からなるSSASを施行し, 身体症状数, 心理社会的ストレス度, 気分状態の心理身体指標を併せて質問紙で評価した.SSASは各項目間の相関がよく(Cronbachのα係数0.79), 他の心理身体指標と有意な関連があった(p<0.05).心身症患者群の方が内科患者群よりSSAS得点が高く(p<0.005), 多重logistic回帰分析で年齢, 性別, 心理身体指標の影響を統制しても両群は有意に識別された(p<0.05).心身症の訴えや機能障害を簡便に評価する指標としてSSASの臨床的有用性が示唆された.

本研究は, 視覚障害への心理的適応を測定する尺度「The Nottingham Adjustment Scale;NAS」の日本語版(NAS-J)を作成することを目的とした.全国の国立リハビリテーションセンターで訓練を受けている視覚障害者を対象に調査を行い, 計量心理学的な評価を行った結果, 信頼性・妥当性ともに十分な日本語版が作成された.この尺度は, 視覚障害だけでなく, 他の障害や慢性疾患への適用の可能性も考えられる.また, この尺度を使用して, 現在, 視覚障害への心理的適応の構造に関する研究が進行しており, 改めて報告する予定である.

Objective: To examine the effectiveness of Ninjin Yoei To (NYT; Ren-Shen-Yang-Rong-Tang in Chinese medicine; Kotaro Pharmaceutical Co., Ltd., Osaka, Japan), one of the traditional herbal medicines, against lung carcinoma.
Setting: The Nursing Center Himawari
Design, Patient, and Preparation: The regular dosage of NYT (15g/d) was prescribed for 7 weeks to one elderly patient with lung carcinoma. The daily standard dose of NYT is prepared from dried extract obtained from 12 crude natural substances, ginseng, cinnamon bark, Japanese angelica root, astragalus root, peony root, citrus unshiu peel, rehmannia root, polygala root, atractylodes rhizome, schisanda fruit, poria sclerotium, and glycyrrhiza. NYT is certified by the Japanese Ministry of Health and Welfare.
Results: The tumor marker levels (CEA and CA19-9) decreased and the scores of yin-yang and xu-shi inverted from negative and positive during 7 weeks. The patient's cough disappeared and her appetite recovered.
Conclusion: NYT has a positive effect on life expectancy for patients with malignancy. The diagnostic scoring system in yin-yang and xu-shi and prescription of Chinese herb may be available to gain control over a patient's health.

Short Interpersonal Reactions Inventory(SIRI)の日本語短縮版を改訂した.SIRIと並行検査を含む質問紙調査を,健常成人1,262名を対象にして行った.因子分析により,原版に含まれる6因子33項目からなる日本語短縮版SIRIへと改訂された.6下位尺度の標準得点により,六つのパーソナリティタイプが識別できることが示唆された.並行検査との関連より,従来から癌の発症と関連があるといわれてきた社会的同調性はタイプ1によって,合理性・反情緒性はタイプ5によって測定できることが明らかになった

We examined changes in brain waves and blood levels of serum cortisol during yoga exercise in 7 yoga instructors and found that alpha waves increased and serum cortisol decreased. These two measures were negatively correlated (r = -.83). Comparison with a control group of nonpractitioners is desirable.

Objective: To examine the effectiveness of Mao-bushi-saishin-to (Ma-Huang-Fu-Zi-Xi-Xin-Tang in Chinese medicine) (Tochimototenkaido Co, Ltd., Osaka, Japan), one of the traditional herbal medicines, against resistant bacterial infection.
Setting: The Nursing Center Himawari, Izumo, Japan
Design, patient, and preparation: Half of the standard dose of Mao-bushi-saishin-to was prescribed for 7 days to one elderly patient with fever and positive C-reactive protein (CRP) levels suffering from drug resistant Pseudomonas aeruginosa. The daily standard dose of Mao-bushisaishin-to is prepared from 1200 mg of dried extract obtained from three crude drugs, Ephedrae Herba (4 g), Asiasari Radix (3 g), and Aconiti Tuber (1 g). It is certified by the Japanese Ministry of Health and Welfare.
Results: The patient's fever and CRP level returned to normal levels.
Conclusions: In cases in which the fever does not fall in response to antibiotics for at least 3 days, half of the standard dose of Mao-bushi-saishin-to for 7 days might be worth trying to induce remission, especially for elder patients.

Photic Feedback treatment of a patient diagnosed with Miller Fisher syndrome has resulted in the rapid and permanent remission of symptoms. During Photic Feedback treatment, the CD20 appeared to be slighty increased. This map have been associated with changes in humoral immunity. The present clinical observation of a single patient suggests that Photic Feedback treatment should be investigated as a possible adjunct therapy for patients who suffer from polyneuropathies, such as Miller Fisher syndrome. within a carefully controlled clinical trial.

The relationship between psychosocial factors and the occurrence and aggravation of peptic ulcer was studied in elderly people. Thirty-nine (14 male) ulcer patients and 79 (30 male) elderly people aged 65 years and over and living in the community were tested. Information on health status, medication, lifestyle, and psychosocial status was obtained by means of interviews using a questionnaire and from the clinical records of the ulcer patients. The same questionnaire was distributed to the residents. Logistic regression analysis adjusting for age disclosed that peptic ulcer was significantly associated with having an occupation and low exercise practice in men. However, the relationship weakened below statistical significance after adjusting for some physical risk factors besides age Low education was significant but low instrumental support fell short of statistical significance with peptic ulcer in women even after adjustment for several physical risk factors besides age. Thus, the specific psychosocial factors might be independently associated with the occurrence and aggravation of peptic ulcer in at least elderly women.

Short Interpersonal Reactions Inventory(SIRI)の日本語短縮版を作成した.SIRIと平行検査を含む質問紙調査を,病院職員485名を対象にして行った.因子分析により,原版に含まれる4因子20項目からなる日本語短縮版SIRIが作成された.因子分析の結果と平行検査との相関分析の結果より,従来からがんの発症と関連があるとされてきた合理性・反情緒性と社会的同調性のうち,より関わりが大きいとされる後者を,日本語短縮版SIRIは測定できることが明らかになった.4下位尺度の標準得点を算出することにより,4つのパーソナリティタイプが識別できる可能性が示唆された

To clarify the effects of ego states on anorexia nervosa (AN) and bulimia nervosa (BN), the questionnaire of the Tokyo University Egogram (TEG) with critical parent, nurturing parent, adult, free child and adapted child scales was administered to 32 female AN patients aged 14 to 32 years (mean age 20 years) and 49 female BN patients aged 14 to 33 years (mean age 23 years). The scores on the critical parent and adapted child scales for AN were significantly lower than those for BN, A multiple logistic regression analysis including all of the TEG scales, age, duration of illness and education showed that the adapted child scale significantly discriminated between AN and BN. The adaptive ego state is suggested for differentiating between the two disorders.

We examined the effective amplitudes of alpha waves (using a mean frequency with a range of +/- 0.5 Hz), and activity of natural killer cells in six subjects, before and after a short-distance (43 km, 1 hr.) drive, and after a midnight (am 0:00 similar to am 7:00 to 8:00) long-distance (550 km on average, for 7 to 8 hr.) drive. Following a long-distance drive, the activity of natural killer cells tended to decrease, and the effective amplitudes of alpha waves in the photic feedback period were greater than those observed during the rest period, showing that photic driving had occurred even under physically and mentally stressful conditions. However, after short-distance driving, no photic driving response occurred and activity of natural killer cells tended to increase, possibly related to mental concentration. Avoiding midnight long-distance driving may help prevent excessive stress and preserve high activity in natural killer cells.

Objective: Although psychological stress and smoking have been proposed as factors contributing to Graves' disease, their independent roles in the course of this disease have not been determined. We assessed the association between the course of Graves' disease and psychosocial factors by using multivariate analysis. Methods: We investigated the association between the short-term outcome of Graves' disease (assessed 12 months after the beginning of antithyroid drug therapy) and stressful life events, daily hassles, smoking, drinking habits, coping skills, and social support (before and 6 months after beginning therapy) in 230 patients (182 women and 48 men) with newly diagnosed Graves' disease, using a logistic regression model. Results: After adjustment for smoking, coping skills, and thyroid function, daily hassles scores in women at 6 months after beginning therapy were significantly associated with a hyperthyroid state 12 months after beginning therapy. The relative risk was 3.9 for women with higher daily hassles scores compared with women with lower daily hassles scores (95% confidence interval, 1.1 to 13.2; p &lt;.05). Smoking was not significantly associated with a hyperthyroid state 12 months after beginning therapy in either women or men. Conclusions: Chronic psychological stress is associated with the course of Graves' disease in women.

In order to clarify the differences in mood states between anorexia and bulimia nervosa, the Profile of Mood States (POMS) with tension-anxiety, depression, anger-hostility, vigour, fatigue and confusion scales was administered to 32 female patients with anorexia nervosa (age range 14 to 32 years, mean age 20 years), 49 female patients with bulimia nervosa (age range 15 to 33 years, mean age 23 years) and 410 &apos;normal&apos; female subjects (age range 14 to 35 years, mean age 23 years). The scores on the depression, fatigue and confusion scales for both anorexia and bulimia nervosa and those on the tension-anxiety and anger-hostility scales for bulimia nervosa were significantly higher tt;an those for the control subjects. The score on the fatigue scale for bulimia nervosa was significantly higher than that for anorexia nervosa. Moreover, the result of the multiple logistic regression analysis including all of the POMS scales indicated that the fatigue scale significantly discriminated between the two disorders, Fatigue mood appears to be a principal indicator for differentiating between the two disorders.

Objective: Although psychological stress and smoking have been proposed as contributing factors to Graves' disease, their independent roles in the pathogenesis of this disease have not been determined. We assessed the association between Graves' disease and psychological stress and smoking by using multivariate analysis. Methods: By a matched case-control method, we investigated the association between Graves' disease and stressful life events, daily hassles, smoking, drinking habits, coping skills, and social support in 228 patients (182 women and 46 men) with newly diagnosed Graves' disease; we used the conditional maximum likelihood method. Results: After data were adjusted for daily hassles, smoking, drinking habits, social support, and coping skills, we found that stressful life events were significantly associated with the risk of Graves' disease in women. The relative risk was 7.7 for women with the highest stress score compared with women with the lowest stress score (95% confidence interval, 2.2 to 27, p for trend &lt;.001). Smoking was also independently associated with the risk of Graves' disease in women. The relative risk for women with the highest number group compared with women with the lowest number group for smoking cigarettes was 5.1 (95% confidence interval, 1.0 to 27; p for trend &lt;.001). These factors were not significantly associated with Graves' disease in men. Conclusions: Psychological stress and smoking were associated with Graves' disease in women, but not in men.

心身症群と神経症群の臨床的差異を明らかにするため, 年齢が25〜65歳までの心身症患者191名(男性39%)と神経症患者164名(男性43%)を対象に, DSM-III-Rによる半構造化面接を行った.心身症群では「特定不能の身体表現性障害」が, 神経症群では「空間恐怖を伴う恐慌性障害」と「心気症」が最多であった.心身症群は神経症群に比べ心理社会的ストレスなしと評価される者が有意に多<, 心理社会・職業的機能尺度が有意に高かった.今回, 両群間で異なる結果が得られたが, 心身症診断名と「身体的病態に影響を与える心理的諸因子」の対応が悪かった点など, DSM-III-R評価の限界も明らかにされた.

Background: The aim of this study was to investigate the clinical features of psychosomatic disorders in Japan. Methods: A total of 1,432 outpatients (515 males and 917 females; 9-95 years of age, mean age 36) attending a psychosomatic clinic for the first time were assessed by the DSM-III-R or DSM-IV semistructured interview, Results: Major ICD-10 diagnoses found were eating disorder, other anxiety disorders, autonomic nervous dysfunction, somatoform disorders, and irritable bowel syndrome. The most frequent diagnosis on the DSM-III-R and DSM-IV axis I was 'somatoform disorders not otherwise specified', followed by bulimia nervosa,'depressive disorder not otherwise specified', anorexia nervosa, conversion disorder, major depression or depressive disorder,'panic disorder with agoraphobia', and 'psychological factors affecting physical or medical condition'. On axis II, 11-17% of the patients met the criteria for personality disorder. On axis IV, 78-80% had mild or moderate psychosocial stress; major psychosocial and environmental problems classified by the DSM-IV were the problems with primary supports and occupation. Conclusions: The results seem to reinforce the belief that the diagnoses on the DSM-III-R and DSM-IV axis I are inadequate for describing psychosomatic phenomena. A new diagnostic system in combination with the multidimensional assessments by the DSM-III-R and DSM-IV is needed to form the common guidelines of diagnoses and therapies in psychosomatic medicine.

After administering 15 g/day of Ninjin-Yoei-To (NYT) for one week to healthy people whose NK activity had already been increased by physiological response, a further increase in NK activity was observed after two days. This increased level of NK activity continued during the administration of NYT for a one-week period. The maintaining and reinforcing effect on the immune surveillance system by NYT may be useful for prevention of carcinogenesis.

本研究の目的は, 自律神経機能, 心理・行動特性の面から, 医療環境下と非医療環境下にみられる血圧格差と, 心理的ストレス負荷時昇圧の類似点および相違点を比較することにより, 「白衣現象」の機序を明らかにすることである.対象は, 3回以上の外来受診にて収縮期血圧140mmHg以上または拡張期血圧90mmHg以上を満たし, 重度の臓器障害を伴わない未治療本態性高血圧症患者86例(年齢20〜75歳, 平均55歳;男性33名, 女性53名)である.非服薬下に外来随時血圧と24時間自由行動下血圧の測定を行い, 随時血圧と昼間(6〜12時)血圧の平均値の差を白衣効果と定義した.次いで, 十分な臥位安静の後に, 無負荷の状態で10分間, 数列逆唱による心理的ストレス負荷状態で6分間, 立位負荷状態で7分間, 血圧とRR間隔を一拍ごとに記録し, 心理的ストレス負荷時昇圧度を評価すると同時に, スペクトル解析により血管支配性交感神経活動と圧受容体反射感受性を評価した.さらに心理テストと半構造化面接を施行し, 種々の心理・行動特性を評価した.以上の自律神経機能の指標と心理・行動特性を説明変数に, 白衣効果と心理的ストレス負荷時昇圧を目的変数としたステップワイズ法による重回帰分析を行った.心理的ストレス負荷時昇圧には, ストレス負荷時血管支配性交感神経活動が正の関連を示したのに対して, 白衣効果には安静臥位時血管支配性交感神経活動が負の関連を示した.一方, 心理的ストレス負荷時昇圧には「神経症傾向」, 「怒り」, 「生活習慣の歪み」が正の関連を, 「タイプA行動」が負の関連を示したのに対して, 白衣効果には「抑うつ」が正の関連を, 「不適応」と「怒り」が負の関連を示した.また, 白衣効果と心理的ストレス負荷時昇圧との間には, 有意な相関はみられなかった.以上の成績から, 白衣現象は自律神経機能, 心理・行動特性のいずれの側面からも, 心理的ストレス負荷時昇圧とは異なる現象であることが示唆された.

本研究の目的は, ストレス対処過程のeffort-distress次元における心理・生理的反応を検討することであった.被験者は男子大学生22名であり, 実験群と統制群に振り分けられ, effort条件とdistress条件の実験に参加した.測定指標は心拍数, 収縮期血圧, 拡散期血圧, 皮膚電気伝導水準, 末梢皮膚温, effort-distress得点, 心理的反応, であった.分散分析と回帰分析の結果, effort状態では心臓血管系の反応が顕著であり, 拡散期血圧がeffort状態の変化に対応して変化すること, distress状態では抑うつ・不安反応が顕著であり, 皮膚電気伝導水準がdistress状態の変化に対応して変化することが明らかにされた.本研究の結果は, ストレス状況における認知・行動的状態とストレス諸反応との対応関係を明らかにするものであると考察された.

The effect of EEG-driven photic stimulation on stress-related endocrine function was studied. Subjects were 16 healthy males divided into a photic stimulation group (n=8) and a control group (n=8). Electrodermal and emotional lability measures were assessed by nonspecific skin conductance response and the Maudsley Personality Inventory, respectively Plasma cortisol and beta-endorphin concentrations were measured both before and after EEG-driven photic stimulation as well as the resting condition. Subjects with electrodermal, emotional or both lability showed comparable decreases of plasma beta-endorphin on photic stimulation as did the stable subjects. Under resting control conditions, however they showed significant increases of beta-endorphin compared to both stable subjects as well as the photic stimulation condition. In addition, labile subjects showed significant alpha enhancement on photic stimulation compared to stable subjects and to the resting control condition. The data suggest that increases of plasma beta-endorphin in labile control subjects may denote a stress response to the conditions of these experiments, and that any decrease by EEG-driven photic stimulation may indicate a reduction of responsiveness to an acute stress.

For 8 medical students influences of psychological stress or humor on T-cell subset percentages and natural killer cell activity were investigated by measuring these parameters before and after an examination and before and after watching a comedy video. Although T-cell subsets were nor significantly affected by either stimulus and natural killer cell activity was not affected by the examination. the latter was significantly decreased after watching the comedy video.

Although biofeedback has been reported to be efficacious in the treatment of hypertension, the degree of response has varied. :This study investigated the mechanisms of blood pressure reduction by biofeedback. Method: Thirty outpatients with essential hypertension (10 men and 20 women) aged 38 to 65 years were studied. Subjects were randomly assigned to group A or B. Subjects in group A underwent biofeedback treatment once a week for a total of four sessions. Those in group B self-monitored their blood pressure during the sessions as the control period and later underwent the same biofeedback treatment. Results: Blood pressure measured by doctor was reduced by 17 +/- 18/8 +/- 7 (p &lt; .01) and elevation of pressure induced by mental stress testing was suppressed by 8 +/- 9 (p &lt; .05)/4 +/- 8 during the treatment period in group A (mm Hg). In group B, both blood pressure measured by doctor and elevation of pressure by mental stress testing remained unchanged during the control period and they were later suppressed by 20 +/- 15/9 +/- 7 (p &lt; .01) and 11 +/- 10 (p &lt; .05)/5 +/- 9 by the biofeedback treatment. Self-monitored pressure in both groups tended to decrease by the biofeedback treatment. Systolic and diastolic pressures as well as pulse rate decreased, skin temperature increased, and alpha-wave amplitude on electroencephalography increased during the therapy (p &lt; .05). Conclusion: This treatment,Nas effective in suppressing the presser response to stress. Patients whose blood pressure increases with stress may be suited for biofeedback intervention.

To evaluate the reactivity to psychological stress in patients with essential hypertension we investigated hemodynamic and endocrinologic changes during a mental arithmetic task (MAT) and a mirror drawing test (MDT) in 10 hypertensive subjects. Hemodynamic changes were assessed continuously using an ambulatory radionuclide cardiac detector. There were significant increases in systolic blood pressure (Delta SBP: +37.8 +/- 11.1 and +41.0 +/- 9.4 mm Hg during MAT and MDT, respectively, P &lt; .01) and diastolic blood pressure (Delta DBP: +17.5 +/- 3.1 and +21.2 +/- 3.9 mm Hg, P &lt; .01) and in heart rate (Delta HR: +17.1 +/- 5.3 and +12.5 +/- 2.9 beats/min, P &lt; .01) during both tasks in association with an increase in cardiac output (GO). The plasma levels of norepinephrine and epinephrine increased during both the MAT (Delta NE: +0.074 +/- 0.022 ng/mL, P &lt; .01; Delta EP: +0.068 +/- 0.025 ng/mL, P &lt; .01) and the MDT (Delta NE: +0.067 +/- 0.034 ng/mL, P &lt; .01; Delta EP: +0.030 +/- 0.011 ng/mL, .05 &lt; P &lt; .1). Although the Delta NE was similar in response to the MAT and MDT, the Delta EP during the MDT tended to be less than half the Delta EP during the MAT (.05 &lt; P &lt; .10). The Delta EP was positively correlated with the Delta DBP and the Delta CO during both tasks and with the Delta SBP and the Delta HR during the MAT. These findings suggest that MAT- and MDT-induced increases in BP were attributable mainly to an increase in CO, possibly as the result of stimulation of the sympathoadrenomedullary system. However, the sympathoadrenomedullary system appeared to be more closely associated with the hemodynamic responses during the MAT than during the MDT. (C) 1997 American Journal of Hypertension, Ltd.

タイプA者は高ストレイン状況下で心身の問題を引き起こす危険性が上昇するといわれている。本研究では, 心身の不健康につながる媒介因子として生活習慣の歪みを想定し, タイプA行動と職場ストレス, 生活習慣の関連を分析した。その結果, タイプA者は高ストレイン状態と高活動性(精神的成長と発展につながるとされている)の双方に関連していた。一方, 高ストレインと高活動性の両者は, 生活習慣の歪みと部の望ましい生活習慣の変化とも関わっていた。以上より, 高活動性もある種のストレスになる可能性や, ストレスに対する望ましい対処行動の存在なども考えられる。このことも考慮して, タイプA, 職場ストレス, 生活習慣の相互関係を検討せねばならない。

成人型アトピー性皮膚炎(AD)患者48例の心理学的指標がその重症度・経過別, および気管支喘息・アレルギー性鼻炎合併の有無で違いがあるかどうかを検討した。まず, 対象全体における心理指標の解析の結果, 成人型AD患者は不安が高く, 抑うつ的で神経症的, 過剰適応的傾向が認められた。次に重症度別に比較した結果, 軽症よりも重症患者で現実検討が障害されていると考えられた。さらに経過別に比較した結果, 寛解増悪型が幼児発症型や成人発症型に比べ有意に心身両面で多愁訴であると考えられた。また, アレルギー性鼻炎合併群のほうが身体症状および精神症状は強いと考えられた。以上より成人型ADの治療や研究のうえで, 個々の重症度・経過およびアレルギー性鼻炎合併の有無に配慮することは重要であると考えられた。

絶食療法(FT)経過中の自律神経機能の変動の特徴を明らかにするため, コントロール群をおき, 容積脈波より求めた脈拍間隔を記録し, その変動を高速フーリエ変換によりパワースペクトル解析した。そして心臓副交感神経指標としてHFを, 心臓β作動性交感神経指標としてL/Hを採用した。同時にFT中の自律神経機能にFT前の心理テストの尺度が関係するか, またFTの効果の違いでFT中の自律神経機能の変動に違いが認められるかも併せて検討した。その結果, 以下の諸点が明らかとなった。(1)FT経過中の自律神経機能について, 有意に特徴的な変動は認められなかった。(2)FT群において, 疲労の程度がFT中の自律神経の反応に影響していると考えられた。(3)FT後の症状改善度別でFT経過中の自律神経機能の変化のしかたに特に相違は生じないと考えられた。

摂食障害患者は健常者よりも食事制限の程度の高いことが指摘されているが, これまでその具体的内容の違いについての検討は行われていない。そこで本研究では, ダイエット行動尺度, EAT-20,BingeEating尺度を女子高校生2,019名, 女子大学生847名に施行し, 実際にどのくらい, どのような食事制限を行っているのかというダイエット行動と摂食障害傾向, さらにbingeeatingとの関連の検討を行った。その結果, ダイエット行動には構造的ダイエットと非構造的ダイエットがあり, 摂食障害傾向が高くなるにつれて, 構造的ダイエットも非構造的ダイエットも高頻度で行うようになるが, 摂食障害群では特に非構造的ダイエットの頻度の高いことが示唆された。また, bingeeatingにはダイエット行動の中でも非構造的ダイエットのみが影響していることが明らかにされた。

成人型アトピー性皮膚炎(AD)患者48例について, その末梢血好酸球数(Eo), 血清immunogloblin E値(IgE), 血清lactate dehydrogenase値(LDH)がADの重症度および経過で違いがあるかどうかを検討した。さらに, 心理指標とEo, IgE, LDH値との相関およびEo, IgE, LDH値間の相関関係についても検討した。対象全体におけるEo, IgE, LDH値の各平均値はいずれも高値を示したが, 特にIgEは4,285±4.1IU/ml(基準値165IU/ml以下)と著明に上昇していた。重症度別に軽症・中等症・重症の3群に分けて1要因の分散分析を行い比較した。その結果, IgE・LDHでは重症群が有意に高値を示した(p=0.004,p=0.036)。また, IgEと日大版CMIの複数の項目との間に負の相関を認めた。LDHではTEGのAとの間で負の相関を認めた(r=0.414,p=0.007), およびEoとLDH値間(r=0.374,p=0.002)にそれぞれ有意な正の相関を認めた。

光フィードパック(PFB)を, 神経症傾向と抑うつ傾向がともに高い学生10名(高得点群)とそれ以外の学生10名(低得点群)に8回施行し, 脳波変化と心理的変化について検討した。結果, 高得点群では2回目と比較して8回目で後頭部α1(8〜10Hz)パワー値の増加と, 前頭部α1コヒーレンス値の増加およびセッション内の疲労感減少量の増加が示され, さらに, 高得点群のみで, 群間差はなかったが2回目から8回目にかけて増加した後頭部α1コヒーレンス値の増加量と, セッション内疲労感減少量の増加分との間に相関が認められた。以上, PFBはうつ状態を伴う神経症傾向者に対してα1コヒーレンス値の増大を引き起こし, それが疲労感減少をもたらす可能性が示唆された。

This study examined the effects of electroencephalographic- (EEG-) driven photic stimulation on a case of depressive disorder, as measured by a psychometric test of mood states, EEG parameters, and several autonomic indices. The EEG-driven photic stimulation enhances the alpha rhythm of brain waves using photic signals, the brightness of which is modulated by a subject's own alpha rhythm. The patient was a 37-year-old businessman, who was treated for depression with medication during the 13 months prior to his first visit to our hospital. He underwent two sets of inpatient treatment sessions, comprising first 16 and then 18 treatment sessions. The treatments brought about the following changes: an improvement in general mood state, alpha rhythm increase, cardiac parasympathetic suppression and increased skin conductance level. In addition, significant correlations between alpha rhythm increase and cardiac parasympathetic suppression or cardiac sympathetic predominance were observed with each inpatient treatment Significant correlations between alpha rhythm increase, cardiac parasympathetic suppression or cardiac sympathetic predominance and the improvement of general mood state were also observed. Thus, from these observations, it was concluded that the alpha enhancement induced by EEG-driven photic stimulation produced an improvement in the patient's depressive symptomatology connected with cardiac parasympathetic suppression and sympathetic predominance.

我々は, 行動科学的な方法論を心身医学に適用する試みの一つとして種々の治療研究を行ってきた。本論文では, 摂食障害の認知行動療法のコントロール研究と光フィードバックのシングルケース研究を例としながら, そういった研究の導入が心身医学の発展にどのようなインパクトを与えうるかについて考察した。現在までのところ, どちらの手法もかなりの時間と労力を費やし, また, 後者では結果の一般化にも問題があるなど, 不十分な点, 解決すべき点は多い。しかし, 不完全なものではあっても, これらのものを適用する試みは, 診断・評価法の洗練, 治療手段の公共化, 治療効果の客観的判定, 治療機序解明への寄与, 治療過程自体の解析方法の確立などを推進できることが示唆された。

摂食障害における死亡率の検討は現在までにいくつか報告されている。欧米および本邦でのそれらの報告では1〜10%とあり, 多数例による報告では4%とほぼ一致している。当科の23年間の外来患者中の摂食障害患者は724名である。これら全例についてその予後を調べ, どれほどの患者がどのような状況, 状態で死亡しているのかを調べてみた。当科の外来カルテ, 台帳およびデータベース, さらに担当医への質問紙などより資料を集め, 724名中データの得られた434名について該当者のリストをつくり, それぞれ担当医に直接依頼して, 症例サマリーと以下の項目についての回答を得た。全症例の中で死亡を確認できた症例数は9例あり, 全例女性で, 死亡時の年齢は17〜48歳(平均28歳)であった。発症時年端は14〜21歳(平均17歳)で, ANのみの症例は4例, AN+BNの症例が5例であった。また, 死亡時の体重は17〜66kg(平均35kg)で, 肝障害が確認されていた症例が6例, 浮腫が4例.低K血症が5例, 低血糖発作が4例であった。そして, 死因としては衰弱死3例, 飛び降り自殺2例.服薬自殺未遂後の心不全1例, 突然死2例, 癌死1例であった。さらに心理社会的な面では, やせ願望(肥満恐怖)は全例に強く認められ, 自殺企図4例, 人格障害4例, 母子共生6例, 強迫性5例, Hy傾向3例であった。また, 治療者側の反省点としては以下のことが挙げられた。(1)AN3例(No.1,3,9)→衰弱死この3例に共通する治療者側の反省点は, 治療関係の確立と治療動機づけができなかったことである。No.9の症例においては父親の単身赴任によって母親の負担が増加し, 母親が治療者へ陰性の転移を強く示し, 治療上の問題点とされていた。(2)AN+BN2例(No.5.8)→飛び降り自殺不安定な精神状態への対応が十分でなかったこと, 慢性的なうつ状態に対する評価と対策がとれなかったこと, さらに自殺の予知と対応が不十分であったこと。(3)AN+BN(No.6), AN(No.7)→突然死身体状況の的確な評価ができなかったこと。(4)AN+BN(No.4)→薬物自殺→心不全bulimia症例とのつき合い方, 治療者と患者との距甦の問題, identity crisisや大学への不適応などの問題が十分扱えなかったこと。(5)AN+BN(No.2)→癌死引きこもり(schizoid)への対応が不十分であったこと。両親への対応が十分でなかったこと。摂食障害における死亡は最悪のことであり, 今後さらなる検討が必要と考える。また, 長期化しsocial abilityの低下している症例も多く, Garfinkelらは25%と報告しているが, これらの症例についての今後の検討も重要な問題と考えている。

東京大学において, 我々は1987年より全医学生に対して心身医学教育を行ってきた。少人数グループによる臨床実習(BST)の目的は, 自分自身を教材として心身医学的診断法や治療法を実習することである。対象は7年間の675名の医学生(男性619名, 女性56名)であり, 自由記載の実習レポートを集計した。この結果, 体験学習が心身医学的モデルを理解する上で有用であったこと, 多くの学生がどの臨床科においても全人的医療の取り組みが必要であると認識したことが示された。心身医学的教育の目標は, 医学に生物学的視点のみならず心理社会的視点を導入すること, そして全医学生に全人的医療の姿勢を養成することであると考える。

阪神・淡路大震災の被災者における身体症状を中心とした心身医学的問題を探るため, 震災1カ月前後に神戸市灘区内の避難所にて80名に問診カード調査を行い, 心身の諸症状の出現率を健常者と比較したところ, 「不眠・易疲労・食欲不振・頭痛・動悸・胸痛」が多く, 被災者内要因として慢性疾患が「風邪症状・食欲不振・易疲労・抑うつ気分」に, 近親者死亡が「易疲労」に, 建物全壊が「不眠・抑うつ気分」に影響を与えていた。さらに震災後2週目および5週目に計408名の避難所生活者の血圧測定を行ったところ, 高血圧症の既往のない者の約45%に高血圧状態が認められた。なお本研究所では, 様々な被害状況の互いの交絡因子の影響を除外するために多重ロジスティック回帰分析を使用した。

In 46 normal subjects, we examined a) the component of respiratory sinus arrhythmia ( = HF) , b) the component coefficient of variance of HF (CCV-HF) , c) the component of Mayer wave related sinus arrhythmia ( = LF), and d) LF/HF ratio. Both of a) and b) are thought to reflect parasympathetic activity, and both of c) and d) are thought to reflect sympathetic activity. We studied how the heart rate variations are infiuenced by respiratory cycle (CY). At first, we performed the regression analysis between the heart rate variations and CY as an intrasubiect factor using all subjects' data. The square of partial correlation of each dependent variable and log CY was ; for log HF R^2=0.7334 (F(1,191)=526.25,p<0.0001), for log CCV-HF R^2=0.7307 (F(1,190)=515.57,p<0.0001), for log MWSA R^2=0.4568 (F(1,191)=106.37,p< 0.0001) , and for log (LF/HF) R^2=0.6703 (F(1,191) = 388.34,p < 0.0001) . Then we predicted the heart rate variations employing CY as the parameter, and examined the reliability by cross validation. For instance, Pearson correlation between the real value of LF/HF (CY = 15) and the value predicted from the real value of LF/HF (CY =20) for each subject was 0.9866 (p< 0.0001). With this study, we concluded that the heart rate variations could be assessed more accurately, considering the influence of respiratory cycle. The heart rate variations modified by respiratory cycle would be used clinically as a reliable index of autonomic nervous function in the future.

パニック・ディスオーダー患者は運動不耐容を訴えることが多い。この研究では, パニック・ディスオーダー患者における運動能力を, 最大運動負荷以下で測定が可能で, 被験者の動機づけによってほとんど影響されることのない嫌気性代謝閾値(AT)に基づいて評価した。被験者は, 10人(男性8名, 女性2名)のパニック・ディスオーダー患者と, 17名の座業を主とする男性対照者である。被験者のそれぞれは, トレッドミル運動負荷試験中に呼気ガス分析を受けた。そして, 酸素摂取量(V^^・_<O_2>), 心拍数(HR), 換気当量(V^^・_E/V^^・_<O_2>)のそれぞれを, 安静時, AT時, 最高運動負荷時に測定した。これらの指標のうちのいくつかは年齢と相関があり, 患者は対照者より全般的に若かったので(31.0±9.0歳vs.55.8±8.2歳;平均±標準偏差), 年齢を共変量とした共分散分析を用い, また比較は男性の被験者のみを対象にして行った。また, 不安障害患者で僧帽弁逸脱症(MVP)が運動能力の障害と関係しているという報告があるため, MVPの有無についても検討した。さらに, 主観的な不安感と運動不耐容との関係を明らかにするために, 運動中に感じる不安の度合いも測定した。その結果, 最高運動負荷時におけるV^^・_<O_2>(F(1,21)=0.12,p=0.7359)と同様, ATにおけるV^^・_<O_2>(F(1,21)=0.52,p=0.4771)にも両群の間でほとんど差はなかったが, 患者群のHRは, 安静時(t(23)=2.60,p=0.O162), AT時(t(22)=4.65,p=0.001)とも有意に高い値を示した。また, MVPを伴わない患者は, 運動開始前に最も強い不安を経験した(p=0.0351)。以上より, パニック・ディスオーダー患者には, AT時と最高運動負荷時のV^^・_<O_2>が正常であったことから, 客観的な運動不耐容はないが, HRの反応過敏性や運動に対する予期不安が認められ, それらが主観的な運動不耐容に関わりをもっている可能性が考えられた。本研究は予備的なものであり, 将来の研究には, より多人数のパニック・ディスオーダー患者と, 年齢, 性別をマッチングさせた座業を主とする対照者を含める必要がある。

Diabetes is challenging because of its chronicity and high demands for daily monitoring and care. Diabetic patients must modify their daily lives to comply with diet, exercise, medication taking and glucose testing. Although numerous clinical studies have emphasized the importance of behavioral and emotional influences on glycemic control among diabetic patients, relatively few studies have reported about noninsulin-dependent (NIDDM) adult diabetic patients in longitudinal studies. The present study was designed to predict change in glycemic control during 6 months based on demographic and psychosocial factors among middle-aged and older patients with NIDDM. Subjects were 61 outpatients with NIDDM who completed both the initial and the 6-month follow-up assessments (out of 74 at the beginning) at the Asahi Life Foundation Institute for diabetic care and research. Forty-five were male, sixteen were female and subjects' ages ranged from 36 to 80 years, with a mean of 58.0 years. Patients were requested to fill out diabetic checklist and several psychological questionnaires, from which 9 demographic and 10 psychosocial variables were selected as predictor variables. Level of glycemic control was assessed by glycosylated hemoglobin (HbA_1c) assays at the beginning of the study (pre-HbA_1c) and at the 6-month follow-up (post-HbA_1c) . '% change of HbA_1c' = { (post-HbA_1,c-pre-HbA_1c) /pre-HbA_1c} x 100 was then used as a criterion variable. Multivariate statistical analysis, the Quantification type I method, was conducted in order to take account of potential influence between each of predictor variables and to utilize categorical types of predictor variables. Mean % change of HbA_1c was 0.20% (range : -22.0% to 33.3%) . It was revealed that the combination of egogram pattern, treatment regimen and diabetic education could most accurately predict % change of HbA_1c (R-squared=0.344. F= 5.76,p=0.0002) . The egogram pattern based on transactional analysis which indicating the ways of interpersonal relationships was the best predictable factor. It was indicated that patients with NP dominant pattern had deteriorated the most and those with reverse 'N' pattern had improved the most. It is concluded that useful information to predict % change of level of glycemic control may be obtained from the longitudinal study using the combination of certain psychosocial factors. Future research should refine the measurement to evaluate diabetic self-care behavior, and increase the number of subjects from other institutes.

In recent years, cognitive-behavioral therapy has become prevalent not only in Western coun. tries but also in Japan. There are some reasons for this. First, cognitive-behavioral methods are directly concerned with thoughts and feeling that are imporatnt in psychiatric and psychosomatic disorders. Secondly, these methods have scientific basing and are more amenable to evaluation in clinical trials. Thirdly, cognitive-behavioral therapy is comparatively easy to use. It can be applied to depressive disorders, anxiety and obsessive disorders, eating disorders, and certain somatic problems, etc. Our research group made a manual of cognitive-behavioral therapy for anorexia nervosa supported by the Ministry of Health and Welfare in 1991. We also revised a manual for clinical study of anorexia nervosa in 1992. The aim of this study is to compare cognitive-behavioral therapy with an operant conditioning treatment with brief psychotherapy. This is a multi-center study that was begun in October, 1992. In this paper, we will outline our manual of cognitive-behavioral therapy, and the revised one for clinical study, and make an interium report of the study in our department.

The photic feedback therapy is a kind of therapy used for inducing a relaxation state in a subject. In this therapy, the electrcencephalogram (EEG) records of the subject are converted into photic stimuli, which are applied to his visual sensory system to activate EEG. The principle is based on a combination of the photic driving of EEG and biofeedback theory. The characteristic of this therapy is in that the subject can control the amplitude and freqliency of his EEG with no intentional efforts. We applied this therapy to our outpatients with various psychosomatic diseases and neuroses according to the prescribed protocol and assessed the effectiveness using the psychological and physiological measures. Ten outpatients (8 males and 2 females) aged 21 to 77 (average of 32.2) in our department of psychosomatic medicine participated in this study. Five therapeutic sessions and 2 baseline sessions each before and after the therapeutic sessions were performed once weekly. The extent of improvement of symptoms and the changes of psychological and physiological measures between pre- and post-therapeutic baseline sessions were recorded. The improvement rating showed marked improvement in 3 patients, mild improvement in 4,and no change in 3. The psychological examinations in all subjects revealed a significant decrease (p<0.05) in Self-rating Depression Scale (SDS) score, a tendency of increase (p<0.1) in A score (eye symptom) of the Cornell Medical Index (CMI) and tendencies of decreases (p<0.O1) in T score (extroverted thinking) of the Yatabe-Guilford personality test (Y-G) and NP score (nurturing parent) of the Egogram (TEG). The evaluation in the improved subjects (n=7) revealed a significant decrease (p<0.02) in T score of Y-G and tendencies of increases (p<0.1) in A and M (maladaptation) scores of CMI. The physiological examination using coefiicient of component variance of low frequency (CCV・LF), that of high frequency (CCV・HF), and L/H ratio showed no significant difference. The fact that marked improvement in 3 patients and signifcant changes in some psychological measure were achieved after this short-term therapy suggested that this therapy is suitable as psychosomatic therapy. We guess that these psychological changes resulted from the relaxation state induced by this therapy, which made patients to pay attention to and become aware of their body sensation and their feelings.

The purpose of this study was to develop and validate an instrument to measure the individual's mood state. After the selection of items which state the individual's temporary mood, and their factor analysis with 404 male and female subjects, scale development resulted in a 40-items Mood Inventory with five factors : tension and excitement, refreshing mood, fatigue, depressive mood, and anxious mood. Psychometric evaluation by test-retest method, odd-even method, and parallel test method suggested that the Mood Inventory is internally consistent and has well enough high reliability and validity. A comparative study among patients with psychosomatic diseases, patients with physical illness, and healthy subjects, revealed that patients with psychosomatic diseases showed signifcantly higher scores of tension and excitement, fatigue, depressive mood, and anxious mood than healthy subjects, and that the healthy subjects showed significantly higher refreshing mood score than other clinical subjects. It was suggested that the Mood Inventory has considerably high discriminant validity and enough potential for the clinical and research application.

The purpose of this study is to evaluate psychological and physiological effects of photic feedback system (αFB) which had been developed in order to facilitate relaxation response comparing with autogenic traming (AT). The subjects were 13 healthy individuals (8 AT practiced and 5 unpracticed). All subjects experienced αFB session and AT session in turn with their eyes closed. Each αFB session consisted of a sweep period of 3 min, a rest period of 7 min, an αFB period of 10 min, a rest period of 10 min. Each AT session consisted of a rest period of 10 min, an AT period of 10 min, a rest period of 10 min. Physiological monitoring of blood pressure, heart rate (HR) and respiratory rate (RR) was performed during the sessions. As psychological measures, State trait anxiety inventoryState form (STAI-S) and Profile of mood states (POMS) were administered before and after the sessions, and post-trial subjective feeling-state reports were requested after them. The mean value and the standard deviation (SD) of systolic blood pressure (SBP), diastolic blood pressure (DBP). HR, RR and the coefficient of variance of R-R interval (CVR-R) were calculated on each of three following periods ; 7〜9 min (pre), 17〜19 min (mid), 27〜29 min (post). The data were statistically analyzed with analyses of variance by General Linear Models (GLM) procedure of Statistical Analysis System (SAS). The results were as follows ; 1) According to the results of psychological measures, almost all measures were significantly decreased, and αFB was equally effective for calming mood as AT. 2) SBP-mean and CVR-R Significantly increased, HR-mean significantly decreased. 3) SBP-SD and DBP-SD significantly increased during αFB and AT period. 4) CVR-R increased in the αFB sessions more than in the AT sessions. It is concluded that αFB was equally effective for calming mood as AT and that αFB was prone to increase parasympathetic measures such as CVR-R more than AT.

A case is presented who has recovered from depressive neurosis by the photic feedback (PFB) therapy. The PFB system was developed in order to make body and mind relaxed by enhancing alpha waves of electroencephalogram (EEG) utilizing light signals made from subjects' own EEG. The patient was a 61-year-old male who had developed depressive neurotic symptomatology including insomnia, depressed mood, irritability and gastralgia five years before the first visit under stressful situations accompanying an annexation of his company and suicide of its president. His symptoms had persisted since then because he had been experiencing various distressful life events such as his wife's suffering from subarachnoidal hemorrhage, his symptoms including chest discomfort and palpitations diagnosed as 'angina pectoris', and death of his father and one of his classmates. We have treated this case by using PFB system following the A-B-A-B single-case experimental design. A questionnaire was used as psychological indices measuring depressive mood, cognitive and perceived physiological aspects of anxiety and irritability. Various physiological measures were also monitored such as EEG, skin surface temperature (SST), skin conductance level (GSR), plethysmogram (PLE), the coefficient of variance of the component of respiratory related sinus arrythmia (CCV-HF) and Mayer wave related sinus arrythmia (CCV-LF). Scores of psychological indices, especially depressive mood, decreased within each session until the middle period of the whole treatment. Increases of SST and CCV-HF were also observed, and these psychological and physiological changes were consistent with the state of relaxation. Sleep disturbance such as talking and roaring out during his sleep was improved after one session. and depressive mood was also improved in the first half of the treatment. However, depressive mood was again aggravated and intense anxiety about cardiac illness also appeared in the latter half of it because his close relatives and friends died one after another then. His conditions began to get better after we added cognitive interventions and extended feedback time of the therapy against this situation. We terminated the PFB therapy in the 41 st week. It is hypothesized that the efficacy of the PFB therapy is derived from relaxation induced by alpha wave enhancement. However, how alpha wave enhancement induces relaxation or what relaxation really is still remains to be elucidated. What kind of illnesses can be effectively treated by the PFB therapy should also be made clearer in the future.

Although psychosocia_1 stressors have long been felt to affect diabetes, prior research in this area had been hampered by methodologic difficulties. This study was designed in order to study the relationship between psychosocial factors and metabolic control of diabetes mellitus. Seventy-four middle or old aged outpatients with non-insulin dependent diabetes mellitus (NIDDM) were studied at the Asahi Life Foundation Institute for Diabetes Care and Research. The authors developed a "Diabetic Checklist" self-report questionnaire that measured psychosocial factors and demographic data. Results from this questionnaire and several psychological tests were compared to measurements of glycosylated hemoglobin (HbAic). Multivariate statistical analysis, the Quantification Type I method, was done in order to minimize the methodologic problems found in prior studies. This analysis revealed that the combination of six items (egogram, occupation, body weight, therapy method, diabetic education and eating behavior) could most accurately estimate diabetic control (R-squared=0.576). The egogram pattern based on transactional analysis which indicates the pattern of personal relationships, was felt to be the most useful measurement. The authors conclude that useful information to evaluate diabetic control may be observed from the study of certain psychosocial factors and are planning for the prospective study in this area.