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Abstract Psychogenic fever is one of the most common psychosomatic diseases. In Japan, psychogenic fever has generally been reported to occur in adolescents, with a peak seen at age 13. However, in our department we have encountered many adults with psychogenic fever. Therefore, we investigated all outpatients who visited the Psychosomatic Department of the University of Occupational and Environmental Health between April 2003 and March 2007. Of the 2705 outpatients that were seen, 55 patients (2.0%) were diagnosed with psychogenic fever. The patients ranged in age from 11 to 82 years old, with a mean age of 33.6 ± 17.9 (mean ± SD) years. In addition to the adolescents, many of the patients were in their 20 s and 30 s, and the male:female ratio was 1:2.2. This study suggests that psychogenic fever commonly occurs not only in adolescents but also in adults.

Abstract Background Patients with anorexia nervosa-restricting type (AN-R) sometimes develop accompanying bulimic symptoms or the full syndrome of bulimia nervosa (BN). If clinicians could predict who might change into the bulimic sub-type or BN, preventative steps could be taken. Therefore, we investigated anthropometric and psychological factors possibly associated with such changes. Method All participants were from a study by the Japanese Genetic Research Group for Eating Disorders. Of 80 patients initially diagnosed with AN-R, 22 changed to the AN-Binge Eating/Purging Type (AN-BP) and 14 to BN for some period of time. The remaining 44 patients remained AN-R only from the onset to the investigation period. Variables compared by ANOVA included anthropometric measures, personality traits such as Multiple Perfectionism Scale scores and Temperament and Character Inventory scores, and Beck Depression Inventory-II scores. Results In comparison with AN-R only patients, those who developed BN had significantly higher current BMI (p < 0.05) and maximum BMI in the past (p < 0.05). They also scored significantly higher for the psychological characteristic of parental criticism (p < 0.05) and lower in self-directedness (p < 0.05), which confirms previous reports, but these differences disappeared when the depression score was used as a co-variant. No significant differences were obtained for personality traits or depression among the AN-R only patients irrespective of their duration of illness. Conclusion The present findings suggest a tendency toward obesity among patients who cross over from AN-R to BN. Low self-directedness and high parental criticism may be associated with the development of BN by patients with AN-R, although the differences may also be associated with depression.

Abstract Background Green odor, a mixture of equal amounts of 2E-hexenal (leaf aldehyde) and 3Z-hexenol (leaf alcohol) has been demonstrated to have an anti-stress effect in rats. This study investigated whether or not green odor also has an anti-stress effect in humans. Methods Changes in blood pressure, heart rate, and the skin temperature of a fingertip were observed after presenting green odor at a concentration of 0.03% or vehicle via inhalation through the nose for 10 min to eight healthy normotensive adults. We also assessed the pleasantness of green odor and its effect on mood states via assessment with the Profile of Mood States (POMS) questionnaire. Cardiovascular response to green odor and the vehicle were compared among 11 additional healthy adults by use of the cold pressor test. Results Of 19 subjects, 15 (79%) reported that the green odor was pleasant. Green odor had no effect on blood pressure, heart rate, skin temperature, or POMS score under non-stressful conditions. In the second experiment, green odor attenuated cold pressor test-induced increases in systolic and diastolic blood pressure and facilitated the recovery of skin temperature. Conclusion These findings suggest that green odor has an anti-stress effect in healthy humans.

Abstract Background Upper gastrointestinal (GI) symptoms such as nausea and vomiting are common adverse events associated with selective serotonin reuptake inhibitors (SSRIs), and may result in discontinuation of drug therapy in patients with depressive disorder. Rikkunshi-to (formulation TJ-43), a traditional herbal medicine, has been reported to improve upper GI symptoms and comorbid depressive symptoms in patients with functional dyspepsia. The aim of the present study was to determine if TJ-43 reduces GI symptoms and potentiates an antidepressant effect in a randomized controlled study of depressed patients treated with fluvoxamine (FLV). Methods Fifty patients with depressive disorder (19–78 years, mean age 40.2 years) were treated with FLV (n = 25) or FLV in combination with TJ-43 (FLV+TJ-43) (n = 25) for eight weeks. The following parameters of the two groups were compared: The number of patients who complained of adverse events and their symptoms; GI symptoms quality of life (QOL) score, assessed by the Gastrointestinal Symptom Rating Scale (GSRS), Japanese edition, before and two weeks after beginning treatment; and depressive symptoms assessed by the Self-Rating Depression Scale (SDS), before and 2, 4, and 8 weeks after beginning treatment. Results The number of patients who complained of adverse events in the FLV+TJ-43 group (n = 6) was significantly lower than the number complaining in the FLV group (n = 13) (P < 0.05). The number of patients who complained of nausea was also lower in the FLV+TJ-43 group (n = 3) than in the FLV group (n = 9) (P < 0.05). By two weeks after treatment, GSRS scores had improved in the FLV+TJ-43 group, but not in the FLV group. SDS scores were not different between the two groups at any of the assessment points. Conclusion This study suggests that Rikkunshi-to reduces FLV-induced adverse events, especially nausea, and improves QOL related to GI symptoms without affecting the antidepressant effect of FLV.

Abstract Background In some hypertensive patients, psychological stress makes blood pressure difficult to control and causes physical symptoms such as headache or dizziness. We report the case of a hypertensive man whose psychological stress-induced increase in blood pressure was attenuated by cilnidipine. Case Presentation The patient (a 72-year-old man) had hypertension and was on antihypertensive therapy. When mentally concentrating, he experienced occipital headaches and dizziness, and despite thorough testing, no abnormality was found. He was subsequently referred to our department. The mirror drawing test (MDT), a psychological stress test, increased blood pressure by about 40 mmHg, and the patient described occipital headache. Plasma noradrenaline level also increased from 212 to 548 pg/ml. We therefore switched the patient from nifedipine, an L-type calcium (Ca) channel blocker, to cilnidipine, an L-type/N-type Ca channel blocker with suppressive effects on sympathetic activity. Cilnipidine attenuated MDT-induced an increase in blood pressure and plasma noradrenaline level and prevented the development of headache during testing. Conclusion These findings suggest that cilnidipine is a useful antihypertensive agent for hypertensive patients in whom psychological stress causes marked fluctuations in blood pressure.

Abstract Background Psychogenic fever is one of the most common psychosomatic diseases. Patients with psychogenic fever have acute or persistent body temperature above normal range in psychologically stressful situations. In spite of numerous case reports on psychogenic fever, there are few epidemiological studies. Therefore, our goal was to investigate the age distribution and gender differences of psychogenic fever in Japan. Methods To achieve this goal, we searched Medline and Ichushi WEB, a Japanese medical database, and added other publications that were not included in these databases. Thus, we reviewed 195 Japanese cases of psychogenic fever published in 62 papers. Results Psychogenic fever patients ranged from 3 to 56 years old, with the highest number of cases occurring in 13 year-olds in both sexes. The male: female ratio of 1: 1.19 suggested a slight predominance of female cases. Psychogenic fever accounted for 18% of fever cases of unknown origin in children and 2–6% of the psychosomatic diseases of pediatric patients. Patients with psychogenic fever were not only found in pediatrics departments, but also in psychosomatic medicine, psychiatry, internal medicine, anesthesiology, dentistry, and obstetrics/gynecology departments. Conclusion The age of psychogenic fever patients ranged from 3 to 56 years old and the male: female ratio was 1:1.19. Psychogenic fever is seen especially in adolescence in Japan.

The effect of the specific endogenous pyrogen (EP1) receptor antagonist SC-19220 on fever in rats following intracerebroventricular infusion of recombinant interleukin-1beta (IL-beta) was investigated. The IL-1beta produced an increase in prostaglandin E2(PGE2) during fever. However, an inhibition of PGE2 in the blood was observed following the injection of SC-19220. These findings demonstrate that IL-1beta and PGE2 in the brain cause hyperthermia in fever or during inflammatory response.

Measurement of colonic temperatures, after injection of prostaglandin E2 (PGE2) and its receptor agonists into the lateral cerebroventricle, facilitates the examination of the type of prostanoid receptors associated with PGE2-induced hyperthermia. EP1 receptors in the brain mediate this hyperthermia at an ambient temperature of 23 + or -1 degree celsius.