the state of psychosomatic medicine in japan (prof chiharu kubo)
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The State of Psychosomatic
Medicine in Japan
Chiharu Kubo
Director, Kyushu University HospitalPresident: Japanese, Asian Societies of
Psychosomatic Medicine
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Kyushu University
HospitalFukuoka
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The State of Psychosomatic
Medicine in Japan1. What is Psychosomatic Medicine?
2. The development of Japanese PsychosomaticMedicine
3. The Research of Psychosomatic Medicine
4. World Congress on Psychosomatic Medicine
5. Asian College of Psychosomatic Medicine
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1. What is Psychosomatic
Medicine?Psychosomatic medicine can bedefined as a holistic medicine
which considers not only physical,but also psychological ,social andexistential aspects of illness and
which offers a more general andintegrated approach to medicine.
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Definition of Psychosomatic
DisordersPathophysiological state of somatic
disorders that have been closely affected
by psychosocial factors in their onset anddevelopment, and in which organic and/
or dysfunctional lesions are found, Rule
out psychiatric disorder, anxiety disorderor depression accompanied by mainly
somatic symptoms
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StressPsychological factors affecting medical conditions
Physicaldysfunction
Psychosomaticdiseases
Acting out
Absent from school andAnti-social behavior
Psychologicaldysfunction
Anxiety disorders,Depression, etc.
Healthy ventilation
Hobby, Sport, etc.
Alexithymia
Overadaptation
Disease-pronepersonality
DSM-V Axis-I
DSM-V Axis-III
DSM-V Axis-I
DSM-V Axis-II
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Psychosomatic treatment
1. Physical therapy in internal medicineand other clinical fields
2. Pharmacotherapy (psychotropic drugs,Chinese herbs)
3. Life guidance
4. Social casework5. Psychotherapy
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Psychotherapy
Counseling, Behavioral (cognitive) therapy,Autogenic training, Muscle relaxation,Hypnosis, Psychoanalytic therapy,Transactional analysis, Gestalt therapy,Biofeedback therapy, Cognitive therapy,Family therapy, Occupational therapy, Playtherapy, Music therapy, Group therapy
Oriental psychotherapy :
Herbal Medicine(Kampo therapy), Acupuncturemoxibustion therapy, Qi-gong therapy, Fastingtherapy, Morita therapy, Naikan therapy, Yogatherapy,
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2. The Development of Japanese
Psychosomatic Medicine(1)
1959 It was established in Kyushu University as The Japanese
Society of Psychosomatic Medicine.
1961 The magazine " Psychosomatic Medicine " was published.
The Faculty of Medicine of Kyushu University attached
Psychosomatic Medicine Research Institute was established.1963 The Department of Psychosomatic medicine, Faculty of
Medicine of Kyushu University was established
1975 The name The Japanese Society of Psychosomatic Medicine
was changed.
1976 The name of the magazine Psychosomatic Medicine waschanged.
1979 Joined The Japan Medical Association.
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The Development of Japanese
Psychosomatic Medicine(2)
1985 A system for the authorization of doctors began.1990 Psychosomatic medicine therapy permitted by the insurance
system.
1991 Treatment guidelines for psychosomatic medicine
were completed.
1996 Governmental approval of specialized departments ofpsychosomatic medicine.
2004 A medical psychological care system was started.
2008 Changed from the authorized doctor system to a specialist
system.
2013 3,300 doctors are members of the Japanese Society of
Psychosomatic Medicine.
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Member of Psychosomatic
Medicine in JapanIn June 2009, the Japanese Society of
Psychosomatic Medicine celebrated our 50th
anniversary.Since its foundation by Prof. Ikemi and
approximately 100 colleagues, we have grown
rapidly and currently have 3,300 active members,
including internal medicine specialists,
psychiatrists, psychologists, and co-medical staff
members.
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Prof. Yujiro Ikemi
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The Establishment of Psychosomatic MedicineDepartments at Universities in Japan 1961 Kyushu University
1972 Tokyo University
1974 Tohoku University
1979 Nihon University 1980 Toho University
1993 Kansai Medical University
1994 Kagoshima University
1999 Kinki University
2007/5/16 Department of Psychosomatic Medicine, Kyushu University
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Sub-association of
Psychosomatic MedicineWe have fiveassociated sub-associations:
1. pediatric psychosomatic medicine
2. women psychosomatic medicine
3. psychosomatic internal medicine
4. dermatology
5. dentistry
In addition to the national society, we have seven
regional psychosomatic medicine societies.
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Psychosomatic Medicine
Department and JournalThere are eightuniversities with psychosomatic
medicine departments.
There are two journals of psychosomatic medicine.
1. Shinshinigaku (Japanese language)
2. Biopsychosocial Medicine (English): Impact Factor 1
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Psychosomatic Education in JapanMost medical schools include psychosomatic
medicine as part of their basic educational
program for doctors, and continuing education isprovided by the many medical societies that focus
on such areas as allergy, pain disorder, eating
disorders, irritable bowel syndrome, psycho-
oncology, depression, et al. Our doctors arelicensed by the Ministry of Health and can receive
board certification by the Japanese Society of
Psychosomatic Medicine.
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Psychosomatic care in Japan
Psychosomatic care for Japanese patients
with mental health problems has progressed
dramatically over the past few decades. Thehealth ministry has included most
psychosomatic diseases for coverage under
the national health insurance system, andmost hospitals have sections that deal
specifically with psychosomatic diseases.
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3. The Research of
Psychosomatic Medicine
Cutting edge basic researchis being done
in areas such as psycho-neuro-endocrine-
immunology and brain imaging.
Clinical research is being done in the fields
of eating disorders, pain disorder, diabetes,
bronchial asthma, IBS, depression, and
cancer (psychooncology) all supported by
specialzed professional organizations.
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The Relationship of Host and Environment
Internal environment
Cardiovascular disease
Myocardial infarctionPeriarteritisHypertensionAtherosclerosis
Endocrine diseaseDiabetesObesity
Immunological disorder
AutoimmunityCancerInfection
Peripheral endocrine
Physiological
aging
External environmentNutrition, Exercise,Sleep, Stress,
Temperature, RadiationCarcinogen, Bacteria, Virus
Genetic Programmolecular, cellular,organ
Pathological aging
Neurological diseaseCerebral infarctionAlzheimer disease
Respiratory diseasePulmonary fibrosisPulmonary emphysema
Hypothalamus, Pituitary,
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The Current Status ofPsychoneuroimmunology
: Basic Research Using Animal Stress
Models
1. Stress and cardiovascular diseases2. Stressand Autoimmune diseases
3. Stress andAllergic diseases
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Takatoshi Hizume, KeikoMorikawa,
Aya Takaki, Kohtaro Abe, Kenji
Sunagawa, Mutsuki Amano, KozoKaibuchi,
Chiharu Kuboand HiroakiShimokawa
Sustained Elevation of Serum Cortisol
Level Causes Sensitization of Coronary
Vasoconstricting Responses in Pigs InVivo: A Possible Link Between Stressand Coronary Vasospasm
B k d
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Background1. Vasospastic angina pectoris is known to be induced
by various mental stress.
(Jiang W et al. JAMA.1996;275:1651-1656. )
2. Cortisol secreted by the activated hypothalamo-pituitary-adrenal axis, may play a key role in mental
stress.(McEwen BS. Biol Psych iatry .2003;54:200207.)
3. Rho-kinase, an effector of the small GTP-bindingprotein Rho, plays an important role in vascularsmooth muscle contraction. (Kandabashi T.Circulat ion.2000;101:1319-1323. )
Serotonin Induced Diffuse Coronary
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Before 5-HT
IC
After 5-HT IC
Control
group
Serotonin-Induced Diffuse CoronaryHyperconstriction in the Cortisol Group
(Hizume T, Kubo C et al. Circ Res.2006;99: 767
Cortisolgroup
A t I hibit Eff t f Rh ki
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Acute Inhibitory Effect of Rho-kinaseinhibitor on Serotonin-Induced
Hyperconstriction in the Cortisol Group
Hydroxyfasudil+ 5-HT IC
5-HT IC
(Hizume T, Kubo C et al. Circ Res.2006;99: 767
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1. Sustained elevation of serum cortisol levelscaused sensitization of serotonin-inducedcoronary hyperconstriction both in vivo and invitro.
2. Serotonin-induced hyperconstriction ofcoronary arteries under sustained elevation of
serum level of cortisol was inhibited byhydroxyfasudil, a specific Rho-kinase inhibitor,both in vivo and in vitro.
Summary
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Basic Research
1. Stress and cardiovascular diseases2. Stressand Autoimmune diseases
3. Stress andAllergic diseases
4. Stress and liver diseases
5. Stress and respiratory diseases
6. Stress and gastrointestinal diseases
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MRL/lprmouse (Lupus autoimmune animal
model)
Lymphadenopathy
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Social isolation stress
Control group
(5 mice/cage)
Isolation stress group
(1 mouse/cage)
Cardboard walls
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Material & Methods
Isolation stress5w
Body weight / 2wSerum corticosteroneUrinary protein/ 4wSurvival rateSerum dsDNA IgG/ 5w
Control(5 mice/cage)
Isolation stress(1 mouse/cage)
Cytokine production of invitroanti-CD3 Ab-stimulated
splenic cells (IFN-g, IL-4, IL-
20w
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Bodyweight(g)
5 9 13 17
21
25 29
(wks
)
20
30
40
50
60
***
***
***
*** ******
Control(n=15)Stress
(n=15)
The effect of isolation stress on the body
weight
(***p< 0.001)
The effect of isolation stress on the serum corticosterone
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5 14 19 (wks)
Serum
corticosterone(ng/ml)
Control(n=8)Stress
(n=8)
950
60
70
80
90
100
110
120
## ##
######
###
*
The effect of isolation stress on the serum corticosterone
levels
(*p< 0.05 vs Control; ## p < 0.01, ### p < 0.001 vs 5 wks d
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Control
(n=12)Stress(n=12)
Survival(
%)
0
20
40
60
80
100
5 15 25 35 45 (wks
The effect of isolation stress on the
survival
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0
100200
300
400
500
600
700
0
50100
150
200
250
300
350
IFN-g(ng/ml)
IL-4 (pg/ml) IL-10(pg/ml)**
0
100
200
300
400* **
n.d.n.d.
aCD3(-
)
aCD3(+
)
aCD3(-
)
aCD3(+
)
aCD3(-
)
aCD3(+
)(*p< 0.05, **p< 0.001)
Control
(n=8)Stress(n=8)
The cytokine production of in vitroanti-CD3 Ab-stimulated splenic
cells
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Conclusion (Stress &Autoimmune disease
Social isolation stress was shown toexacerbate the autoimmune disease of
MRL/lprmice.
1.
This stress also promoted a Th1/Th2 balanceshift toward Th1 predominance and inhibited
the blood corticosterone response to chronic
inflammation, both of which may be associatedwith stress-induced exacerbation of
autoimmune disease.
2.
(Chida Y, Sudo N, Kubo C. J Neuroimmunol 158: 138-144, 2005)
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The Current Status ofPsychoneuroimmunology
: Basic Research Using Animal StressModels
1. Stress and cardiovascular diseases2. Stressand Autoimmune diseases
3. Stress andAllergic diseases
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Psychological stressin childhood &Asthmainadults
Balb/c mice
Control (CON)
Communication box-induced stress (CS)
Stress 1hr
timesW
3W 8W 10W 11W
OVA 10mg +Alum 2mg
i.p.
2% OVA nebulizer30min/day 3days
Airway inflammation
Total number of MNCs inBAL
Subpopulation of MNCs
in BAL
(Wright-Giemsa)
24h
(MNCs: mononuclear cells, BAL: bronchoalveolar lavage)
Result 2Subpopulation of MNCs in BAL
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Result 2Subpopulation of MNCs in BAL
0
10
20
30
40
50
60
Celln
umb
er
(
103)
*
Eosinophil Neutrophil LymphcyteMonocyte
CON
CS
* P < 0.05
Eff t f RU 486( t id t t i t) B h l
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Effects of RU-486(steroid receptor antagonist) on Bronchoalve
CON+RU (n=11)
FS+RU (n=9)
CS+RU (n=8)
Eosinophil Neutrophil LymphcyteMonocyte
* P < 0.05
*
*
0
50
100
150
200
CON+RU
FS+RU
CS+RU
0
10
20
30
40
50
60
70
80
Celln
umber
(1
03)
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Conclusion (Stress & Asthma)
1. In a mouse model of asthma, psychological stress by communication box at
the age of 3 weeks significantly exacerbated airway inflammation at the age
of 11 weeks.
2. Pre-treatment with RU-486, a glucocorticoid receptor antagonist, before the
administration of OVA mist completely eliminated stress-induced
exacerbation of airway inflammation in BAL. In addition, the stressed mice
exhibited a significant increase in blood glucocorticoids after the
administration of OVA mist in comparison with the control mice.
3. These findings indicate that hyporesponsiveness of the HPA axis mediatessuch stress-induced exacerbation of asthma.
The Relationship between Stress and Neuro-Endocrin-
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Generalsensation
(Skin, Muscle)
Specialsensation
(Vision, Audition,Smell)
Sense ofequilibrium
Thalamus
Hypothalamus
Pituitarygland
Autonomic nervous
system
Immunesystem
Internal organs
Endocrine
system
OVLT
Stress
Central nervoussystem
Cerebralcortex
Association areas(Cognition)
Limbic system(Emotion)
Hormone
Cytokine
Metabolicmaterial
The Relationship between Stress and Neuro Endocrin
Immune systems
4. World Congress of Psychosomatic Medicine
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g yyear Place (Country)
The 1st 1971 Guadalajara Mexico
The 2nd 1973 Amsterdam Netherlands
The 3rd 1975 Rome Italy
The 4th 1977 Kyoto Japan
The 5th 1979 Jerusalem Israel
The 6th 1981 Montreal Canada
The 7th 1983 Hamburg Germany
The 8th 1985 Chicago USA
The 9th 1987 Sydney Australia
The 10
th
1989 Madrid SpainThe 11th 1991 cancelled
The 12th 1993 Bern Swiss
The 13th 1995 Jerusalem Israel
The 14th 1997 Cairns Australia
The 15th 1999 Athens Greece
The 16th 2001 Gothenburg Sweden
The 17th 2003 Hawaii USA
The 18th 2005 Kobe Japan
The 19th 2007 Quebec (Canada)
The 20th 2009 Torino (Italy)
The 21st 2011 Seoul(Korea)
The 22nd 2013 Lisbon(Portugal)
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5 A i C ll f P h ti M di i
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5.Asian College of Psychosomatic Medicine
Yujiro Ikemi
Singh A.N.
Mahadevan M.
Jinichi Suzuki
Hsien Rin
Chiharu Kubo
Liu ZengyuanByung Il Min
Sueharu Tsutsui
Ming-Been Lee
Hiroshi Ishizu
Lorreine Denerstein
Bong Yul Huh/Kyung Bong Koh
Zhao Zhifu
Lkhagvasuren Tserenkhuu
Rudi
The 1st 1984
The 2nd 1986
The 3rd 1988
The 4th 1990
The 5th 1992
The 6th 1994
The 7th 1996The 8th 1998
The 9th 2000
The10th 2002
The11th 2004
The12th 2006
The13th 2008
The14th 2010
The15th 2012
The16th 2014
TokyoJapan
New DelhiIndia
Kuala LumpurMalaysia
SendaiJapan
TaipeiTaiwan
FukuokaJapan
DalianChinaSeoulKorea
TokyoJapan
TaipeiTaiwan
Okinawa (Japan)
Melbourne(Australia)
SeoulKorea
Beijing China
Ulaanbaatar
Jakarta
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Perspective of PsychosomaticMedicineIncrease in psychosomatic diseases
Stress management
Preventive medicine
Health promotion
Integration of eastern and western medicine