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Rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia characterized by dream enactment behavior during REM sleep. It has been demonstrated that patients with idiopathic RBD are at a significantly increased risk of developing one of the α-synucleinopathies later in life, and this is called "phenoconversion". Although some physicians argue against disclosing information that could cause patients psychological stress, the patients also have a "right to know" about their own disease. Therefore, determining when and how to disclose this information, in addition to appropriate follow-up, is important. Clonazepam is the first choice of treatment for RBD associated with α-synucleinopathies. Since RBD is one of the premotor symptoms of α-synucleinopathies, and enables its early diagnosis, a combination of RBD and other examinations may contribute to the realization of a disease-modifying therapy. It is hoped that the early establishment of biomarkers could help predict the phenoconversion from RBD to α-synucleinopathies.

We defined a spiritual pain as feelings of failure and regret at end-of-life, followed by hopelessness and worthlessness in patient's own life. In Japanese, spiritual pain should be assessed in patient's dignity, psycho-social factor, and prognostic stage, not only in religious context. And patient's spirituality should be supported with providing pain and symptom relief based on human relationships. "Sterbebegleitung" is a German proverb, introduced by Alfons Deeken, and seemed to be a suggestive word for such hope-recovering relationships.

This study investigated heterosexual undergraduates' behavior with a same-sex close friend and their attitudes toward homosexuality after this friend disclosed his/her sexual orientation. The study also examined whether the heterosexual friend was regarded as a romantic love object or not. Participants were 77 male and 139 female undergraduates. Males decreased their behaviors with their close friend and adopted more positive attitudes toward gay men after they knew their friend's sexual orientation. Females decreased their behavior with their close friend more after learning that they were a romantic love object of their friend, compared to when tehy were not. Also females adopted more positive attitudes toward lesbians only after knowing they were not a romantic love object. These gender differences are discussed.

Objectives: Patients with malignant gliomas have an even worse prognosis than other cancer patients, and they sometimes undergo surgery and chemo-radiotherapy without having been informed of the nature of the disease and its prognosis in Japan. Often, patients with glioblastoma are only told that they have a brain tumor, although other family members are told of the real diagnosis and prognosis. Since patients with glioblastoma, often experience a rapid deterioration in their condition, they usually do not have enough time to seek a second opinion regarding their disease. We surveyed neurosurgeons in Japan with regard to their policies and attitudes concerning the disclosure of a diagnosis of glioma and their thoughts on the end-of-life care of glioma patients., Methods: A survey was performed in November, 2007. A questionnaire was sent by e-mail to 259 participants who planned to attend the 25th Brain Tumor Conference in Japan., Results: One hundred and thirty-two participants (51%) returned the questionnaire. Almost all the respondents were neurosurgeons specializing in malignant brain tumors. The percentages of respondents who informed their patients of a diagnosis of grade 2 astrocytoma, grade 3 or grade 4 glioblastoma were 73%, 57% and 37%, respectively. More than 80% of all glioblastoma patients were only told that they had a malignant brain tumor. Sixty-eight percent of the doctors told the family members, but not the patients, of the real diagnosis. The neurosurgeons' policies and attitudes toward end-of-life care for patients with gliomas were also analyzed., Conclusions: Most neurosurgeons have difficulty disclosing a diagnosis of glioma and providing end-of-life care. This survey will help to develop guidelines regarding disclosure and the decision to pursue end-of-life care for patients with gliomas. (Received : March 19, 2009, Accepted : June 8, 2009)

Depression and anxiety are common psychiatric syndromes in the cancer population, but are not always managed very well due to the barriers to psychiatric consultation in Japan. We have tried to care for cancer patients with depression or anxiety through our psycho-oncology outpatient clinic. We have found that some anxiety in cancer patients derives from miscommunications between patients and physicians in charge because physicians do not tell the conditions of diseases clearly to patients. Needless to say, physicians should learn the communication skills regarding breaking bad news but we would like to emphasize the importance of smooth communication among health care professionals through this case report which makes us reconsider how we should have told the patient the truth (the time for stopping anti-cancer treatment, prognosis and so on) to a patient.

The process of parental acceptance of a child's disability is complex and involves a myriad of factors, including the nature of the child's disability, factors related to the parents and societal factors. Despite the type of disability and the severity of that disability often being the most significant factors related to the process of acceptance, the majority of previous studies have combined multiple disabilities into a single category. For example, the point at which parent and child begin to live together with a disability marks a "beginning." The nature and timing of this beginning differs depending on the disability and thus has a large impact on the process of acceptance. Moreover, despite acceptance patterns diverging between sexes, the majority of previous studies have sampled only mothers and not fathers. Future research needs to use a more detailed analysis of disability type and its severity, and examine the modality of telling a patient and his or her family of a disability. Further studies also need to sample both mother and father, and consider the familial and social aspects of the process of parental acceptance.

On the path to psychiatric care, many patients who experience their first episode of mental disorder consult general practitioners or physicians of general hospitals before consulting psychiatrists. Some patients receive proper care promptly while others experience a delay in treatment. We investigated treatments and psycho-education given to patients by general practitioners or physicians of general hospitals, particularly focusing on informed diagnosis. We conducted a multi-center collaborative study in Japan. In this study, 15 facilities participated, including 4 university hospitals, 3 general hospitals, and 8 psychiatric hospitals. A total of 382 patients experiencing their first episode of mental disorder were enrolled. Among them, 157 patients primarily consulted general practitioners or general hospitals. We divided the 157 patients into 3 groups according to the kind of psycho-education given by general practitioners or physicians of general hospitals: those who were told nothing about their diagnosis nor mental condition (N = 74, 47.1%), those who were not given a direct diagnosis but were informed about their condition in some way (N = 55, 35.0%), and those who were directly informed of their diagnosis (N = 28, 17.8%). We found that almost half of the patients were told nothing about their diagnosis nor mental condition by general practitioners or physicians of general hospitals. Patients who were likely to be directly informed of their diagnosis were those who were recommended to see a doctor by someone, or those with a lower global psychosocial function. The patients who were told nothing about their diagnosis nor mental condition were mainly covered by national health insurance, and had decided to go to hospitals or clinics under their own volition. Sorted by ICD-10 F code, patients diagnosed as F0, F3, or F4 accounted for 89.9% of all subjects. We compared treatment delays among these 3 categories. The median treatment delay in patients diagnosed correctly as F0 by general practitioners or physicians of general hospitals was 50 weeks, that in patients diagnosed as F3 was 4 weeks, and that in patients diagnosed as F4 was 5 weeks. These findings suggest that patients might be treated in different ways according to their diagnosis by general practitioners or physicians in general hospitals. Our results suggest the importance of further educating general practitioners and physicians of general hospitals about mental disorders, in order to not only shorten the duration of untreated psychosis, but also for patients to be given proper primary care.

The Japanese Psycho-Oncology Society (JPOS) was founded in 1987, while the Japanese Society of General Hospital Psychiatry (JSGHP) in 1988. Inspired by the International Congress of Psycho -Oncology Society (IPOS) meeting which was held in 1995 in Kobe, many general hospital psychiatrists joined to the activity of the JPOS. In these ten years, many studies were conducted on the following topics: truth-telling, psychiatric co-morbidity, psychosocial intervention, etc. And recently, the activity of palliative care team including a psychiatrist has been reimbursed, which will be hopefully a new step to the progress of psycho-oncology in Japan. Also, a collaboration between the JPOS and the JSGHP will be strongly needed to make a remarkable progress.

Unlabelled: "Togo-shiccho-sho"--the integration ataxic disorder--which has been recommended as the alternative Japanese translation of schizophrenia rather than "Seishin-bunretsu-byo", had the approval of the Japanese Society of Psychiatry and Neurology (JSPN) at the 98h annual meeting in August, 2002., Objective: This study aims to know the prevalence of the informed consent for people with schizophrenia and to find out the factors related to the informed consent among the Japanese psychiatrists., Methods: Subjects of this study were all psychiatric members of JSPN. They received the self-report questionnaire entitled "The Actual State of Informed Consent" by the return cards and sent it back by the return at around mid November every year between 2002 (right after the change) and 2004 (after 2 years). Author took 3 months for recovery., Results: Rates of the psychiatrists who informed the patient himself have been relatively increasing for 3 years (37%, 2002; 65%, 2003; 70%, 2004), while the rates of the one who didn't have been decreasing (44%, 2002; 21%, 2003; 15%, 2004). The users of Togo-shiccho-sho for the informed consent have been increasing (68%, 2002; 86%, 2003; 90%, 2004), while the non-users have been decreasing (19%, 2002; 9%, 2004). The non-users of Seishin-bunretsu-byo increased from 63% in 2003 to 71% in 2004 and the other-name-users also increased from 18% in 2003 to 42% in 2004., Discussion: The prevalence of togo-shiccho-sho became about 90% among the Japanese psychiatrists and they seem to use it not accompanied with Seishin-bunretsu-byo or any other names. Moreover, 70% of psychiatrists informed their patients himself of their diagnosis, especially eagerly among younger generation. As well as the disease condition of patients and doctor-patient relationship, whether patient and his/her family could understand or not affected to the decision of informed consent. There were also differences among districts on informed consent, especially negative at Kinki district.

Purpose: In Japan, sometimes a patient with malignant fatal disease is not informed the diagnosis. We tried to investigate if the informed consent of cancer notification is acceptable and suitable for aged Japanese prostate cancer patients., Materials and Methods: From January to June 2003, we distributed a questionnaire to outpatients who had been followed up for more than 6 months after the diagnosis of prostate cancer. These patients declared a wish to be notified the true diagnosis in their first visit to our department and were informed that they had prostate cancer just after the diagnosis. Ninety-one per cent of patients (54 patients, mean age was 74.8 +/- 6.1 years old) answered to our questionnaire. Clinical stage consisted of 14 cases of B1, 13 cases of B2, 15 cases of C, 3 cases of D1, and 9 cases of D2. The histopathological grade consisted of 6 cases of well differentiated carcinoma, 32 cases of moderately differentiated carcinoma, and 16 cases of poorly differentiated carcinoma. Eleven cases underwent total prostatectomy (B1 and B2) and 44 cases had androgen deprivation therapy., Results: Seventy-six per cent of patients understood and accepted their illness within a few days. However, 11% of patients took more than 3 months to accept their malignant disease. They answered that they could accept their illness given with a relationship of mutual trust between themselves as patients and the medical staff, effective medical treatment, and with the help of their family. They also answered that the most important emotional support was given by their wives (46.3%) and doctors (27.8%). In the early days following the diagnosis, they worried about their remaining days, the risks or side effects of the treatment, their family, and their job. Several months following the diagnosis, they were concerned about recurrence of the disease, their family, medical expenses, and their old age. Those who did not worry at all doubled from 11.1% immediately after the diagnosis to 22.2% several months later. More than 90% of the patients were satisfied with our medical care. And none answered that they might have been happier without cancer notification., Conclusions: Cancer notification is acceptable and suitable in aged Japanese prostate cancer patients who declare a wish to know their malignant illness. A good relationship between the patients and the medical staff, and emotional support from the wife are important.

"Truth telling" which was focused on just telling patients they have cancer, is gradually developing into "informed consent (IC)" which is focused on patients' understanding of their disease after careful explanation by their doctors. The major goal of IC is to respect the patients' self-determination and self-selection of the therapies they will receive and to establish close relationships between patients and doctors. Although truth telling about patients' prognosis is not yet fully established, providing such information to patients is basically unavoidable to obtain true IC. In delivering the bad news and obtaining IC as part of patient medical care, it is very important for doctors to brush up their communication skills with patients.

Purpose: The objectives of this study were to examine the degree of psychological distress during the first 6 months after diagnosis of gastric cancer and investigate the relation to psychological support from public health nurses and family members., Methods: One hundred and five patients with stomach, colorectal, or esophagus cancer were mailed a questionnaire. They were asked questions concerning the level of shock on the day of diagnosis, at 1-week after the diagnosis, and at 6 months post diagnosis. In addition, their physical and psychological status was assessed at the 6-month time point. They were also asked about perceived psychological support from public health nurses and family members. The relation between psychological distress and such psychological support was then assessed using multiple regression analyses., Results: The levels of shock on the day of diagnosis and after 1-week were both significantly related to the psychological support from public health nurses. Physical and psychological status at 6 months post diagnosis was significantly related to the level of psychological support from the patient's family members., Conclusion: The study revealed that psychological support from public health nurses improves the level of patient psychological distress during the first 1 week after the cancer diagnosis. Psychological support from family members facilitates the physical and psychological adjustment at 6 months post diagnosis. The results indicate that psychological support is important just after cancer diagnosis and for longer term adjustment, pointing to a major role of health care professionals alleviating problems associated with cancer diagnosis.

Since its foundation, general medical care as well as home medical care for patients with terminal cancer are provided at the hospital. In order to clear the doubt if patients/family members feel secure or insecure about home medical care provided since the initial consultation till death at home only by the hospital staffs, the opinion survey was conducted for family members who were also member of the team. At the hospital, home medical care is initiated if the patient himself/herself accepts the pathological condition. It is impossible to continue such a medical care without establishing the reliable relationship between patients/family members. Medical providers like us are just the advisors and collaborators to help patients peacefully accept the terminal disease. This survey reminded us of the necessity of conducting the opinion survey so that medical care won't be centered on medical providers.

Mothers of 14 children (10 boys, 4 girls) with childhood autism answered the self-report questionnaire regarding the disclosure of a diagnosis of autism and their acceptance of the disability. The children's mean age at the study was 8.6 years, and their ages at the time of the disclosure and acceptance were 4.0 and 5.2 years, respectively. The age at acceptance exhibited a statistically significant positive correlation with the age of disclosure indicating that early disclosure was related to early acceptance. The results obtained in the questionnaire suggested that the increased understanding of autistic behavior, the accumulated experience as to how to communicate with their own child and the existence of a self-care group to support the parents were important factors for the acceptance of the disability. The significance of the professionals' sympathetic manner at the time of disclosure, full explanation of the disability, instruction as to how to cope the disability and providing the information on social resources available in the local district was also discussed in relation to the acceptance of the disability.

Recent developments in molecular biology have increased our understanding of the genetics of familial tumor syndromes. Isolation of the responsible genes has made it possible to identify gene carriers before they manifest clinical symptoms, which enables early detection of disease and at times prophylactic surgery. Indications for genetic testing of susceptible family members, however, should be carefully considered. Genetic counseling must be provided to clients before genetic tests. Patients should be provided with the latest knowledge on the disease and appropriately informed of the benefits and possible problems associated with genetic test, as such information is essential for clients to decide whether they will undergo such tests. Genetic medicine is not sufficiently available at present in Japan. Establishment of genetic services that deal with genetic counseling, family support and ethical, social and legal issues is strongly desired.

To investigate patient attitudes towards open disclosure of malignant disease, we conducted a questionnaire survey of 17 patients with malignant lung tumors, to whom the nature of their disease was revealed. The questionnaire used a 100 mm analog scale. Ten of the patients were treated by chemotherapy and their questionnaire results before and after treatment were compared. It was found that they were mostly satisfied about being truthfully informed and that, indeed, they were anxious to know their true diagnoses. They were also keen to have their true prognosis revealed, but not as much as the diagnosis. They also wished to be informed about treatment and its effects. These attitudes showed no marked changes resulting from the administration of chemotherapy, and we therefore concluded that chemotherapy itself had no influence on patients' feelings about disclosure. The questionnaire was well accepted and was useful in judging attitudes to open disclosure.

Unlabelled: Disclosure of medical records to patients has been assessed, but the influence of disclosure on medical care has not been well researched. To address this situation, this study was conducted to test three hypotheses: 1) doctors think that the disclosure can influence medical care, 2) whether doctors think disclosure can influence medical care depends on how they rank medical records (for example, as evidence for diagnosis and treatment, a process to reach a diagnosis, a tool to communicate with other medical staff, etc), and on whether they think medical record disclosure could change the content of the record. Questionnaires were sent to 881 doctors who work at two hospitals affiliated with N Medical School and K Medical University., Results: Four hundred eighty-eight doctors responded. The findings related to the hypotheses were as follows: 1) Those who answered that the disclosure could have an influence on medical care were 49.1% of the total. 2) There was no relation between how doctors ranked medical records and whether they thought disclosure could influence medical care. 3) Doctors who answered that there were things that they would not be able to write if medical records were disclosed accounted for 73.5% of the total. These doctors answered "yes" significantly higher to the question that the disclosure could influence medical care than others (Odds 3.6, P < 0.01). Doctors who thought they would not be able to enter the diagnosis, the name of the disease for insurance, self-evaluation, information that could be judged and subjective information answered that disclosure could influence on medical care (P < 0.05). It was assumed that disclosure of medical records to patients could change the content of the medical records and that could influence medical care. How to deal with information will become an important issue if records are disclosed.

Much has been said about the importance of informed consent in Japan, but informing cancer to the patient has not been popular so far. We, as anesthesiologists, often treat pain in cancer patients, who occasionally, are not informed about the cancer. And we sometimes have patients with whom cautious consulting is necessary. This report presents our experience with a patient uninformed about the cancer but suspicious of his lung cancer. We met him as anesthesiologists, and this made the patient convinced that he had a cancer and was about to die soon.

To assess current trends in the disclosure of cancer, we studied patients with primary lung cancer. Ninety-nine of 101 surgical patients (98.0%) and 96 of 128 non-surgical patients (75.0%) had been informed of their illness. Family members of 2 surgical patients refused to allow disclosure due to concerns about mental intolerance. Reasons for non-disclosure to non-surgical patients ranged from rejection by family members (29 patients) to a lack of ability to understand (3 patients). No mental problems were observed after disclosure. All but 11 patients were informed of their cancers by their physicians. Decisions regarding disclosure were not related to the pathological type or clinical stage of the cancer. For example, small cell carcinoma did not influence methods of or decisions concerning disclosure. Among non-surgical patients, the frequency of disclosure decreased with aging. However, no clear-cut factor appeared to influence the disclosure of metastatic sites. Views about informed consent are still at a transitional stage in Japan. The doctrine that patients have the right to be informed of their cancers and to choose their treatment has not always been the best policy in practice. Nevertheless, it seems desirable that approaches to disclosure adequately reflect the special needs of each patient and provide as much information as possible to allow each patient to make an accurately informed decision about treatment options. Such approaches would foster better relationships between physicians and their patients and relieve physicians from pressure to tell a medical lie.

One of the biggest problems to perform terminal care is how to communicate with patient's families. Mental stresses of patients who are expected to die and of their families are extremely serious. To release their stresses, kind and detailed explanation of patient condition should be given every day by the clinical team consisted of doctors and nurses. We should realize that mental support given by the clinical staff would be an important care point to alleviate the stresses of patients and to alleviate the stresses and the strains of their families. And we can say that performing terminal care is essential to promote informed consent.

Cancer treatment in medical centers traditionally provide high-quality medical care but are often perceived by patients to be lacking in humanity, respect for individual dignity, and personal comfort. The most important features of approach are that patients are more informed about their condition and medical options than before, and another point is growing recognition of the importance of caring not only for the body but also for the personal, emotional, educational needs of cancer patients and their families.

Since April 1994, we have provided visiting nurse care for patients with end-stage of cancers. A questionnaire was sent to 72 families of patients who died of cancer and who received after visiting nurse care. The response rate to the questionnaire was 76.4% (55 patients). One group of 27 patients died at home (Group A), and the other group of 28 patients died in the hospital (Group B). Patients who knew they had cancer accounted for 85.2% in Group A, and 57.1% in Group B. Of all patients, 69.1% desired home nursing, with 77.8% in Group A, and 60.7% in Group B. The satisfaction of families with the visiting nurse was evaluated. In Group A, satisfaction was 66.7% and relative satisfaction was 18.5%. In Group B, satisfaction was 50.0% and relative satisfaction was 25.0%. Satisfaction of patients with the place of death was 81.5% in Group A, and 35.7% in Group B. Many families wished to have the nurse visit 2 times a week, and an hour at each visit. The great mental burden on the families who provide home care for patients with terminal cancer was clear for the questionnaire. Arrangement for a support system for patients and families, through visiting nurse services, is necessary in our hospital.

Unlabelled: 1., Introduction: Only about 10 years have passed since HIV was discovered but WHO presumes that there will be 30 to 40 million infected cases by the year 2,000. This then possesses the possibility of more frequent contact with such persons and thus means we must look for how to protect ourselves. I would like to discuss the present state of AIDS, particularly in eastern European countries such as Bulgaria, Hungary, Romania and Russia, based on recent data I have compiled. 2. AIDS-related laws at present in various countries. (1) Comparison of major laws (17 countries) including 1) patient (17 countries) and infected person (13 countries) notification, 2) protection of privacy (9 countries), 3) prohibiting infected person discrimination (3 countries) and 4) other matters including restraint on behavior to spread infection (6 countries). (2) Entry laws from foreign country (10 countries) applicable to patient and infected person for 1) entry (3 countries) and 2) long period of stay (8 countries). 3. Present countermeasures to AIDS. (1) Data for 8 countries including Japan, U.S.A. U.K., France, Germany and three eastern European countries with regard to 1) budgets, 2) examinations, 3) medical care, 4) consultation and guidance and 5) education. I shall also discuss the following 2 countermeasures in Japan. I have proposed to the Diet: 1) Examination to detect HIV-antibodies in donated blood. This measure is present in effect since Nov. 1st, 1986, as a result of my proposal made to the Diet on March 14th, 1986. 2) For person infected by transfusion of the blood products without heat treatment, I proposed that expenses should be defrayed according to the CD4 level at either CD4 < or = 200 or CD4 < or = 500. (2) Present situation in eastern European countries. Common features are as follows: 1) Infected person and patient are quarantined if they request, since they know their condition which was disclosed based on data from past mass screening test under communism. 2) At present infected persons are few in number. 3) This number will rapidly increase with greater active interchange with western countries following elimination of the Berlin Wall. 4) AIDS countermeasures such as blood and blood products examinations are inadequate due to insufficient funds. In Bulgaria, the government has conducted AIDS tests on more than half the population and in Romania, there is the tragic situation. (3) Guidelines for WHO-ILO countermeasures to AIDS at work places. 4. Present situation in research. The development of effective medicines and vaccines is the primary objective of AIDS research. Research programs may be enumerated as follows; 1) In the U.S.A., NIH and CDC are major organizations which lead research around the world. The major objective is synthetic medicine. 2) In U.K., the development of vaccines for monkey and cat is being sought. 3) In China, herb medicine is administrated to patients in Un-nan-sho where AIDS patients are quite numerous. 4) In Japan, a recombinant vaccine is being sought through use of BCG, vaccinia viruses and the like. 5. Topics related to AIDS include 1) informed consent to be treated by a AIDS-infected doctor, 2) suits against doctors who fail to make infected person known infection and 3) government control laws for AIDS in Russia.

Many uncertainties and fuzzinesses exist in the medicine itself and cultural differences greatly influence on the medical practice. The word "cancer" is still often considered to be synonymous with the word "death" and despite encouraging recent medical advances this dark image will most likely continue into the next century. Today the world is becoming increasingly estimated in terms of technical and economic effectiveness and the same holds true in the field of medicine. Such valuation will be-evaluated in the coming century for human beings. This paper will discuss the cultural and social significance of informing a cancer patient of truth as well as a patient's informed consent and living will. Such changes in the medical culture of Japan should be regarded positively since they should help to improve the overall trust between patients and doctors in the future.

AIDS patients/HIV positives have been increasing in Japan, but a large proportion of university students, who have high risk sexual behavior, are not aware of the danger of HIV infection. Because of little disclosure by AIDS patients/HIV positives in Japan, the students have a poor chance of knowing of their risk in sexual behavior situations. Discrimination or prejudice toward AIDS patients/HIV positives has suppressed disclosure. However, as the real risk changes of disclosure is unknown, a simulation study, using case vignettes, was carried out to measure risks. A total of 1,128 university students (487 male and 641 female) were asked to read one of six vignettes describing HIV positives, that consisted of three infection routes (one by blood preparation and two by sexual intercourse) with disclosure or without disclosure. After reading a vignette, they answered questions about the images of HIV positives and their attitudes to him or her. As a result of reading these vignettes, friendly images were enhanced and the disagreeable images were decreased, but students' attitudes were unchanged. Significant differences were recognized in attitudes concerning responsibility for the infection and sympathy toward HIV positives, depending on the infection routes (blood preparation or sexual intercourse). Female students had a tendency to be more favorable to HIV positives than the male students. This simulation study showed the difficulty of changing students' attitudes regardless of the image of HIV positives, and demonstrated the need for effective action toward reducing discrimination or prejudice.

Background: Telling cancer patients the true diagnosis is inevitable to acquire informed consent especially in the Western world. In Japan, however, no such consensus has been established yet. We investigated the influence of telling the true diagnosis on QOL of prostate cancer patients., Methods: We measured physical, mental and social aspect of prostate cancer outpatients by the General Health Questionnaire (GHQ) and the international Prostate Symptom Score (I-PSS). Using the general linear models we tried to explore which variables would attribute to "severe depression", "anxiety and insomnia" and "social dysfunction"., Results: No significant differences were found in any of the eight variables (age, performance status, clinical stage, I-PSS and Goldberg's four factors of GHQ) among the two groups that were informed the true diagnosis or not. The correlation structures of "severe depression", "somatic symptoms" and I-PSS are significantly different in the two groups. As a result of the analysis by the GLM, "somatic symptoms", I-PSS and clinical stages had main effect on "severe depression". Also, there was an interaction between the effect of telling the true diagnosis and "somatic symptoms"., Conclusion: These results suggest that the mental condition of prostate cancer patients remain stable when they are in good physical condition regardless of being informed the true diagnosis or not. However, the patients who weren't told the true diagnosis have a tendency to get depression accompanying deterioration of physical condition. It is therefore considered that telling the true diagnosis makes the patients understand the changes of their physical conditions and help their mind to be stable.

Actually most of unresectable solid cancers are incurable, except some pediatric cancers and germ cell tumors etc. For these patients, what doctors can provide is basically prolongation of life with acceptable quality. Without knowing the fact and possible advantage and disadvantage or side effect of any treatment, these patients cannot choose the treatment, either anti-cancer therapy or best supportive therapy. In such situation, prognosis is almost mandatory information. No body feels comfortable to hear severe facts of their diseases especially when they are hopeless. However, this information is essential to choose the treatment which has strong influence on their lives themselves. The 38 incurable patients and 33 with poor prognosis (cure rate will be less than 10%) treated by the author between 1993 and 1995 were analyzed to see the attitude of patients in such situation. After getting all information including effect and side effect of possible treatment, mean survival, and natural course of their disease, 24 out of 70 selected supportive care. 11 of 70 requested consultation of a psychiatrist but all recovered soon with minimum treatment. In such critical or life threatening situation, decision is completely personal and cannot be done by their family. When doctors and patients can make a good relationship with confidence, patients can create their own style of remaining life and even death.