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>

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.

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>

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.

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。

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.

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.

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.

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

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.

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.

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.

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 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.

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.

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.

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.

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.

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.

本稿では，心身相関の基盤となる脳の働きについて，心身相関を研究する手段として多用されてきたストレス研究における知見を踏まえて解説を行った。 心身相関では，感覚器でストレッサーが知覚されると，大脳皮質と大脳辺縁系において認知的反応と情動的反応とがやりとりをしながら負担の程度を認識し，その信号が視床下部に伝達されていくことで末梢臓器・行動面・心理面のストレス反応が表出するという脳の経路が基盤として働いている。 心身症とうつ病や不安症はともに心身相関の観点から病態を理解できるが，脳内における病態の責任部位が異なっている。心身症を理解する上で強調される脳部位は，生体機能調節系の中枢である視床下部・下垂体である一方で，うつ病や不安症を理解する上で強調される脳部位は，大脳皮質・大脳辺縁系である。 心身症は身体疾患であるということから，内臓感覚器から入力される身体反応が心理的反応に影響を及ぼす「身心相関」の視点も重要である。 心―脳―身相関の解明が進んだことによって，うつ病や不安症を心身相関の観点から捉えやすくなった。うつ病や不安症は精神疾患であるが，どちらも様々な自律神経失調症状を呈するため，心身相関の脳内基盤を理解しておくことが重要である。

日本語版Eating Disorder Inventory-91(EDI-91)を新たに作成し,Eating Attitude Test(EAT)とともに首都圏在住の514名の健常女子(12〜36歳)を対象に実施した。因子分析を行った結果,91項目,11の原尺度と異なり,68項目からなる解釈可能で高い信頼性をもつ6つの因子が抽出された。各因子と原尺度との関係は以下のようであった;第I因子,"痩せ願望","過食";第II因子,"ボディーイメージ";第III因子,"衝動統制","内界への気づき","対人不安","無力感";第IV因子,"成熟恐怖";第V因子,"他人不安","対人不信";第VI因子,"禁欲主義","完壁主義","無力感"。相関分析の結果,各因子とEATとの間には有意な相関がみられた。

大うつ病に対する注意訓練法(ATT)の有効性を検討するために、10名の大うつ病患者を対象に7週間にわたるATTを実施し、その効果を心理・行動・脳機能指標で明らかにした。その結果、介入前後でネガティブな反芻、特性不安が低減し、分割的注意が向上することが示され、抑うつ症状が低減し、距離を置いた注意深さ(DM)が促進される傾向が認められた。そして、各変数の変化量同士の相関パターンより、分割的注意が向上することでDMが高まり、抑うつが低減することが示唆された。また、介入前後の注意制御機能の向上は、左背外側前頭前野(DLPFC)、右DLPFC、右中側頭回の脳血流の増加と関連していることが示された

アレキシサイミアとは自己情動の同定や表現困難を主徴とする心身症での重要な病態生理である。今回は,自己の身体―情動状態の変化とその認知の脳内基盤に関する知見を,fMRIを用いて得ることが目的である。'自伝的記憶に立脚した自己継続感’について日常の出来事を記録するwebシステムにより,ポジティブな記憶の方が保持され,海馬の活動の関与を明らかにした。情動刺激の際の脳活動と心拍変動との同時測定では,心拍変動の副交感成分と島皮質・腹側前帯状回の活動・機能的結合が関連していた。さらに、内受容感覚の認知の鋭敏さが不安を増大させ,内受容感覚への気づきに重要な島皮質の活動が,アレキシサイミア群で低下していた

本研究では、心身症・精神障害患者および健常者を対象として、生態学的・経時的測定装置を用いて身体活動、心身症状、認知機能の測定を行い、気分や各疾患の特徴を抽出可能とする身体活動パターンの解析法および評価指標の開発を行った。その結果、以下の知見が得られた。(1)慢性疲労症候群患者調査身体活動時系列の変動の方向性を考慮に入れた評価法の開発を行った。身体活動時系列が負の方向に変動する場合(身体活動の急激に中止する時点)のみを抽出して局所相関を求めた結果、慢性疲労症候群患者では約5発から35分までの時間スケールにおいて健常者に比べて有意に長期相関性が弱いこと、すなわち急激な動作停止が起こることが示された。(2)健常中学生調査(1)健常な中学生においては、日中に比して夜間に多動傾向がみられる場合では、心身症状の訴えが多くなる傾向がみられた。(2)日中に複数回実施された各テストの30分前の身体活動時系列より求めた各種指標と、気分・疲労感には有意な相関関係がみられた。(3)「疲労」の程度を身体活動時系列の統計量から推定するための重回帰モデルを構築した結果、局所平均値・局所トレンド周りの負の歪度(これも急激な動作停止と関連する)、平均値およびそれらの交互作用において有意な結果が得られた。(3)大うつ病患者調査測定期間中の身体活動データより求めた平均活動量を連続して下回っている継続時間(休止期間)と連続して上回っている継続時間(活動期間)の累積分布関数を導出した。その結果、休止期間の累積分布関数は健常者、大うつ病患者共に約2分から200分にかけてべき分布に従い、大うつ病患者では健常者よりも長期休止期間の分布度数が大きいことが示された。また、べき指数αは、健常者(α=0.96±0.14)と大うつ病患者(α=0.75±0.17)で有意な差がみられた。一方、活動期間の累積分布関数はべき分布よりも指数分布に近い形状を示し、大うつ病患者と健常者には有意な差は見られなかった。本研究の結果により、疲労やうつ気分といった幅広い心身症・精神障害で見られる症状に対応する客観的兆候として、身体活動が休止する局面でのダイナミクスに着目した統計指標を抽出できる可能性が示された

本研究では、心身症・精神障害患者および健常者を対象として、生態学的・経時的測定装置を用いて身体活動、心身症状、認知機能の測定を行い、気分や各疾患の特徴を抽出可能とする身体活動パターンの解析法および評価指標の開発を行った。その結果、以下の知見が得られた。(1)慢性疲労症候群患者調査身体活動時系列の変動の方向性を考慮に入れた評価法の開発を行った。身体活動時系列が負の方向に変動する場合(身体活動の急激に中止する時点)のみを抽出して局所相関を求めた結果、慢性疲労症候群患者では約5発から35分までの時間スケールにおいて健常者に比べて有意に長期相関性が弱いこと、すなわち急激な動作停止が起こることが示された。(2)健常中学生調査(1)健常な中学生においては、日中に比して夜間に多動傾向がみられる場合では、心身症状の訴えが多くなる傾向がみられた。(2)日中に複数回実施された各テストの30分前の身体活動時系列より求めた各種指標と、気分・疲労感には有意な相関関係がみられた。(3)「疲労」の程度を身体活動時系列の統計量から推定するための重回帰モデルを構築した結果、局所平均値・局所トレンド周りの負の歪度(これも急激な動作停止と関連する)、平均値およびそれらの交互作用において有意な結果が得られた。(3)大うつ病患者調査測定期間中の身体活動データより求めた平均活動量を連続して下回っている継続時間(休止期間)と連続して上回っている継続時間(活動期間)の累積分布関数を導出した。その結果、休止期間の累積分布関数は健常者、大うつ病患者共に約2分から200分にかけてべき分布に従い、大うつ病患者では健常者よりも長期休止期間の分布度数が大きいことが示された。また、べき指数αは、健常者(α=0.96±0.14)と大うつ病患者(α=0.75±0.17)で有意な差がみられた。一方、活動期間の累積分布関数はべき分布よりも指数分布に近い形状を示し、大うつ病患者と健常者には有意な差は見られなかった。本研究の結果により、疲労やうつ気分といった幅広い心身症・精神障害で見られる症状に対応する客観的兆候として、身体活動が休止する局面でのダイナミクスに着目した統計指標を抽出できる可能性が示された

本研究は、がん患者の情動変化を客観的に脳画像として評価する方法を開発し、心理テストを補足する情動検査法を確立することを目標とする。昨年度の研究により全身ポジトロン断層検査(PET)を用いてがん診断を行った72症例の脳画像を用い、帯状回、視床下部、海馬等の大脳辺縁系における広範なブドウ糖代謝の低下を認めた。この変化が脳器質障害によるものなのか、あるいは心因性の障害なのか不明であった。そこで、ドイツのアルバート・ルートヴィヒ大学核医学科との共同研究として、ドイツでのがん患者の脳の解析を行った。年齢・性別をコントロールした正常患者10名との比較をおこない、がん患者と比較した結果、前頭前野、側頭頭頂葉皮質、前・後部帯状回、大脳基底核、などにおいて代謝の低下が確認され、東北大学データを近い結果を得ることができた。また、癌患者21名を、(1)抑鬱度、(2)不安、(3)化学療法の有無、(4)残存癌組織の有無、の四項目に関してサブグループに分け、サブグループ間解析を施行した。その結果、前頭前野、側頭頭頂葉皮質、前部帯状回における代謝低下は、抑鬱度および不安と強い負の相関を示すことがわかった。化学療法の影響が前部帯状回で、腫瘍組織の残存という因子の影響は、小脳および後頭葉において観察されたが、がん患者に観察されるこのような代謝異常は、癌組織による脳に対する生物学的影響というよりも患者の心理的な間題により引き起こされている可能性が高いという結論を得た。一連の研究結果は、スペイン、バルセロナにおけるヨーロッパ核医学会で注目すべき演題として紹介された。

本研究は、がん患者の情動変化を客観的に脳画像として評価する方法を開発し、心理テストを補足する情動検査法を確立することを目標とする。昨年度の研究により全身ポジトロン断層検査(PET)を用いてがん診断を行った72症例の脳画像を用い、帯状回、視床下部、海馬等の大脳辺縁系における広範なブドウ糖代謝の低下を認めた。この変化が脳器質障害によるものなのか、あるいは心因性の障害なのか不明であった。そこで、ドイツのアルバート・ルートヴィヒ大学核医学科との共同研究として、ドイツでのがん患者の脳の解析を行った。年齢・性別をコントロールした正常患者10名との比較をおこない、がん患者と比較した結果、前頭前野、側頭頭頂葉皮質、前・後部帯状回、大脳基底核、などにおいて代謝の低下が確認され、東北大学データを近い結果を得ることができた。また、癌患者21名を、(1)抑鬱度、(2)不安、(3)化学療法の有無、(4)残存癌組織の有無、の四項目に関してサブグループに分け、サブグループ間解析を施行した。その結果、前頭前野、側頭頭頂葉皮質、前部帯状回における代謝低下は、抑鬱度および不安と強い負の相関を示すことがわかった。化学療法の影響が前部帯状回で、腫瘍組織の残存という因子の影響は、小脳および後頭葉において観察されたが、がん患者に観察されるこのような代謝異常は、癌組織による脳に対する生物学的影響というよりも患者の心理的な間題により引き起こされている可能性が高いという結論を得た。一連の研究結果は、スペイン、バルセロナにおけるヨーロッパ核医学会で注目すべき演題として紹介された。

本研究の目的は、心療内科に受診することが多い心身症やパニック障害患者などを対象にして、携帯情報端末による症状・気分・体動・心拍変動等の生態学的・経時的評価法であるEcological Momentary Assessment (EMA)を用いた「治療の科学化」(治療過程の科学的定式化)推進システムの開発を進めることである。1、各病態の臨床データベースの解析頭痛とパニック障害に対して詳細なデータの収集・解析を行い、computerized EMA (cEMA)を用いた病態評価の利点や、この方法を用いることによって初めて明らかになる病態メカニズムの特徴などが示された。2.過程制御的な介入を行うためのアルゴリズムの開発と介入の実施パニック障害の広場恐怖症状をターゲットにして、外出・乗車訓練などをする際の不安感の推移を5分毎にグラフ化し、フィードバックをすることで過程制御的な介入を行なうWindows Mobile携帯情報端末上で動作するプログラムを作成し、パニック障害患者4名に対して介入を実施した。その結果、高い有効性と介入過程の詳細なデータが得られた。認知行動療法による介入のためのセルフモニタリング手帳を用いて、うつ状態の強い大学生を対象に介入とデータ収集を実施した。その結果、思い出しによる方法の方が効果が大きいことが示された。3.生態学的・経時的データ及び治療過程データの解析・解釈手法の開発上記1の通り頭痛とパニック障害のcEMAによるデータ解析結果に基づいて、日常生活下での病態の評価や病態メカニズムの考察が可能になり、上記2では抑うつ傾向のある大学生と広場恐怖を伴うパニック障害患者に対する日常生活下での介入を実施した結果に基づき、EMAによる評価の必要条件(生態学的妥当性の最大化)と対比させた場合の、行動変容を可能にするデータ収集・フィードバック法の必要条件の一部が明らかになった

化学物質過敏症患者に対して、呼気中化学物質の測定及びTVOC 曝露濃度と心拍変動のリアルタイムモニタリングを行った。呼気分析では、日常生活での曝露を示す体負荷量がわかり、身体状況との関連が確認された。また、曝露濃度と心拍変動のリアルタイムモニタリングでは、曝露濃度と自律神経機能の関連が示唆され、患者によって異なる傾向が得られたことから、患者個々の病態を客観的に捉え、症状の予防対策を提言するために役立つと考えられた

化学物質過敏症やシックハウス症候群は微量な化学物質により起こる健康障害であり、世界的に患者の増加が問題になっている。しかし、世界的にも診断基準や病態などはよくわかっていない。また、これらの疾患患者の診断やスクリーニングに役立つ問診票は確立していない。そこで、本研究では、日本のMCS 患者の病態を明らかにしながら、MCS・SHS 患者の診断やスクリーニングに役立つ問診票を作成した