The epidemiology series of brain-related disorders in Mongolia: nationwide registry-based epidemiological study on CNS tumours in Mongolia, 2015-2019.

No epidemiological study on central nervous system tumours is available for Mongolia. The aim of this study was to determine the incidence, mortality and survival of people diagnosed with central nervous system tumours in Mongolia. It reports cancer data for the entire population (3.3 million) during the period between 2015 and 2019. Data was obtained from the National Cancer Registry of Mongolia. Diagnosis of tumours was established according to the diagnostic criteria of the International Classification of Diseases-10 (ICD-10). Incidence and mortality rates were calculated as mean annual numbers per 100,000 population. Age-standardized incidence and age-standardized mortality rates were calculated from age-specific rates by weighting directly from the World Standard Population. The three-year survival from 2015 through 2017 was calculated between treatment types by the Kaplan-Meier survival analysis. It found 515 (adults: 83 %; children: 17%) newly diagnosed central nervous system tumour cases over the five year period. The national age-standardized incidence of central nervous system tumours for the entire population was 3.7 per 100,000. The rate was higher for males than females (4.2 versus 3.4 per 100,000, respectively). Only 23% of the diagnosed cases were confirmed histologically. The most common tumour was glioma (57.6% of histologically verified tumours). In children (age 0-19 years) the age-specified incidence rate of tumours was 1.4 per 100,000. Geographically, the age-standardized incidences of the Eastern region were higher than the country average rates for both genders. During the period, 381 deaths were registered with an age-standardized mortality rate of 3.0 per 100,000 population. Furthermore, the overall three-year survival rate was 40.6% (out of 283 patients, 115 survived). The five-year prevalence of tumours was 183 and the mean per 100,000 population was 5.5. In conclusion, the data from the National Cancer Registry indicate that the incidence and survival rates of central nervous system tumours in Mongolia are relatively low. The most common location of central nervous system tumours was the brain. Glioma was the most common tumour among histologically confirmed cases. Despite the limitations, data from this study should provide information for national health policy and health care assessment. To improve the diagnosis, prognosis and treatment of central nervous system tumours, expansion of the cancer registry through collecting data on non-malignant tumours, increasing the rate of histological verification, conducting studies on cancer epidemiology and the introduction of advanced treatment technologies for central nervous system tumours are recommended.

Disabling symptoms associated with increased axillary temperature in patients with functional hyperthermia.

BACKGROUND: I previously reported a case of functional hyperthermia (FH) in a patient with an axillary temperature just slightly above 37.0 °C who persistently requested treatment. Because the severity of her fatigue increased remarkably when her axillary temperature increased above 37.0 °C, she felt that the temperature of 37.0 °C was disabling. In the present study, I analyzed a larger number of patients with FH to investigate the incidence of disabling symptoms with increasing body temperature, the kinds of symptoms associated with increased body temperature, and the temperatures at which these symptoms became disabling. MAIN BODY: Twenty patients with FH (7 men, 13 women; mean age ± standard deviation, 31.2 ± 10.9 years) who visited my department were asked whether they had any disabling symptoms associated with an increase in axillary temperature and, if so, at what temperature the symptoms became disabling. Sixteen of 20 patients (80.0%) responded that they had such symptoms, which included worsening of general fatigue (n = 12, 75.0%), feelings that their brain did not work properly (n = 5, 31.3%), inability to move (n = 4, 25.0%), hot flashes/feeling of heat (n = 3, 18.8%), headache (n = 2, 12.5%), dizziness (n = 2, 12.5%) and anorexia (n = 1, 6.3%). The axillary temperatures at which patients felt worsening fatigue ranged from 37.0 °C to 37.4 °C in 7 of the 12 patients (58.3%) who experienced worsening fatigue. The patients also reported that the disabling symptoms, with the exception of headache, were not alleviated by antipyretics. CONCLUSIONS: Many patients with FH reported worsening fatigue as a disabling symptom associated with increased axillary temperature; more than half of those patients experienced worsening fatigue in the temperature range of 37.0 °C to 37.4 °C. These findings suggest that the reasons patients with FH consider 37 °C disabling and seek medical treatment are that physical symptoms such as fatigue worsen at 37 °C, although this temperature is assumed by many physicians to be within the normal range or just above the normal range of axillary temperature, and that most hyperthermia-associated symptoms are not alleviated by antipyretic drugs.

Psychometric properties of the Mongolian version of shitsu-taikan-sho (alexisomia) in young adults.

Objective: Alexisomia is characterized by difficulty in identifying and describing bodily feelings. Shitsu-taikan-sho scale (STSS) is a self-report tool that assesses alexisomia. This study aimed to validate the Mongolian version of STSS in a nonclinical student sample. Methods: A total of 593 undergraduate students (217 males, 376 females, 18-25 years), who were studying at medical universities, were recruited. Participants completed the Mongolian version of STSS, which was translated from Japanese to Mongolian, back-translated, and finalized by an expert committee. Construct validity was examined using exploratory and confirmatory factor analyses for a three-factor structure. Internal consistency and test-retest reliability were measured using Cronbach's α and the intraclass correlation coefficients (ICC), respectively. Results: The mean scores of STSS were 18.6 ± 5.7 for difficulty identifying bodily feelings (DIB), 18.8 ± 4.0 for overadaptation (OA), 23.7 ± 4.1 for lack of health management (LHM), and 61.1 ± 10.5 for the total score (possible range: 7-35 for DIB, OA, LHM, and 21-105 for the total score, respectively). Exploratory factor analysis indicated a three-factor structure consisting of 21 items that explained 40.3% of the variance (KMO = 0.916, RMSEA = 0.049, χ2 = 372, p < .001). Confirmatory factor analysis provided a good fit to the data (CFI = 0.876, TLI = 0.861, RMSEA = 0.068, χ2 = 703, p < .001). Cronbach's alpha for the STSS was 0.860, indicating good internal consistency. Test-retest reliability analysis demonstrated good reliability (ICC = 0.791). Conclusion: The 21-item Mongolian version of STSS demonstrated evidence of good reliability and validity for assessing alexisomia in a nonclinical population in Mongolia. This suggests that the Mongolian version of the STSS may allow for the comparison of alexisomia among adults in Mongolia with those in other countries.

Anxiety, depression, and brain overwork in the general population of Mongolia.

In Mongolia, there is limited data on the prevalence and correlates of common mental health conditions. This study addresses this data gap by exploring anxiety, depression, and brain overwork. The aim of this study was to determine normative data on these conditions in the general population of Mongolia. This nationwide, population-based, cross-sectional study was conducted in 48 sampling centers across Mongolia in 2020. A total of 613 participants (190 men and 423 women) with a mean age of 41.8 ± 12.4 years were recruited. The participants completed the Hospital Anxiety and Depression Scale (HADS) and the Brain Overwork Scale (BOS-10). Vital signs, body measurements, and lifestyle determinants were also assessed. The prevalence of anxiety was 9.9%, depression was 4.9%, and brain overwork was 18.3% among the participants. Anxiety and depression were correlated with brain overwork symptoms. Brain overwork was associated with young age, unemployment, low income, and alcohol use. These findings suggest that anxiety, depression, and brain overwork are a significant problem in the general population of Mongolia. Further research is needed to develop effective interventions to reduce the prevalence and risk factors of anxiety, depression, and brain overwork.

A patient who recovered from post-COVID myalgic encephalomyelitis/chronic fatigue syndrome: a case report.

BACKGROUND: Some patients infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) complain of persistent fatigue, dyspnea, pain, and cognitive dysfunction. These symptoms are often described as "long COVID". Whether a patient with long COVID might develop myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is of interest, as is the treatment and management of ME/CFS in a post-COVID patient. Here I report a patient, who, after an infection with SARS-CoV-2, developed ME/CFS and recovered after treatment. CASE PRESENTATION: The patient was a previously healthy 55-year-old woman who worked as a nurse and became ill with COVID-19 pneumonia. She then presented with severe fatigue, post-exertional malaise, dyspnea, pain, cognitive dysfunction, tachycardia, and exacerbation of fatigue on physical exertion, which persisted for more than 6 months after her recovery from COVID-19 pneumonia. She was bedridden for more than half of each day. The patient was treated from multiple perspectives, which included (1) instructions on eating habits and supplements; (2) cognitive and behavioral modifications for coping with physical, emotional, and cognitive fatigue; (3) instructions on conditioning exercises to improve deconditioning due to fatigue and dyspnea; and (4) pharmacotherapy with amitriptyline and hochuekkito, a Japanese herbal (Kampo) medicine. The patient made a complete recovery after completing the prescribed regimen and was able to return to work as a nurse. CONCLUSIONS: To the best of my knowledge, this is the first detailed report on a patient infected with SARS-CoV-2 followed by long COVID with the signs/symptoms of ME/CFS who recovered after treatment. I hope this case report will be helpful to health care practitioners by its presentation of some of the therapeutic options for alleviating disabling signs/symptoms in patients with post-COVID ME/CFS.

Validation of the abbreviated version of the World Health Organization Quality of Life in Mongolia: a population-based cross-sectional study among adults in Ulaanbaatar.

There is currently no validated tool to measure the quality of life (QOL) in the Mongolian language. This study aimed to validate the Mongolian version of the World Health Organization Quality of Life - Brief (WHOQOL-BREF) questionnaire for the general population of Mongolia. The subjects were 301 adults aged 18-65 years selected randomly by a computer from 30 centers in 8 districts of Ulaanbaatar, Mongolia, in 2020. Reliability was measured using Cronbach's α and intraclass correlation coefficients. Convergent, discriminant, and construct validities were examined using exploratory and confirmatory factor analyses for a four-domain factor structure. Among the participants, 56.1% were women, 32.9% held a bachelor's degree or higher, 48.8% were employed, and 61.8% were married. The overall Cronbach's α coefficient of the WHOQOL-BREF questionnaire was 0.804. Correlations between the component scores of the WHOQOL-BREF ranged from 0.581-0.822. All items showed higher item-total correlations with their corresponding domains than with other domains, except the mobility item from the physical domain. Discriminative validity was evident in physical and psychological domains. Exploratory and confirmatory factor analyses revealed a four-factorial structure consisting of 24 items that provided an acceptable fit to the data (RMSEA=0.084; CFI=0.860). In conclusion, the Mongolian version of the WHOQOL-BREF demonstrated evidence of good reliability and validity for assessing QOL in the general population of Mongolia. These findings indicate that it allows the comparison of QOL of adults in Mongolia with those in other countries.

Quality of life in the general population of Mongolia: Normative data on WHOQOL-BREF.

No data on the quality of life (QOL) of the general population are available for Mongolia. This study aimed to determine normative data on the World Health Organization Quality of Life-Brief Version (WHOQOL-BREF) in the general population of Mongolia. This nationwide, population-based, cross-sectional study was conducted in 48 sampling centers across Mongolia in 2020. We used the WHOQOL-BREF and the Hospital Anxiety and Depression Scale (HADS) in our study and evaluated their associations with vital signs, body measurements, and lifestyle determinants. A total of 714 participants (261 men and 453 women) with a mean (standard deviation) age of 40.7 (13.2) years were recruited. The mean scores of WHOQOL-BREF subscales were 61.5 for physical health, 73.5 for psychological health, 70.1 for social relationship, and 67.2 for environmental health domains. The prevalence of poor QOL was 16.9% among the participants. Participants living in an apartment in urban areas with high HADS scores had a low QOL. All domains of WHOQOL-BREF were inversely correlated with anxiety score (r = -0.353 - -0.206, p < 0.001) and depression scores (r = -0.335 - -0.156, p < 0.001). Physical health was predicted by residency location, anxiety, and depression (R2 = 0.200, p < 0.001); psychological health by anxiety and depression (R2 = 0.203, p < 0.001); social relationship by residency location, age group, anxiety and depression (R2 = 0.116, p < 0.001); and environmental health by employment, anxiety, and depression (R2 = 0.117, p < 0.001). This is the first report on normative data on the QOL in the general population of Mongolia. Physical health was low compared with that determined using international data. Poor QOL was observed among those with mental health issues living in the urban areas.

Heart rate variability and tension-type headache: A population-based cross-sectional study.

Background: The relationship between tension-type headache (TTH) and autonomic functions is poorly understood, although TTH is one of the most prevalent disorders in the general population. The aim of this study was to investigate the direct and indirect effects of TTH on the autonomic functions measured by heart rate variability (HRV). Methods: This population-based cross-sectional study was carried out in the general population of Ulaanbaatar between July and September in 2020. After physical examination, trained researchers applied structured interviews to examine the remote history of TTH and mental distress, followed by a recording of HRV to detect autonomic activity. Psychological factors and the quality of life were measured using Hospital Anxiety Depression Scale (HADS), Pittsburgh Sleep Quality Index (PSQI), and the World Health Organization Quality of Life-Brief (WHOQOL-BREF). Binary logistic regression and GLM mediation model analysis were used to examine the effects of risk factors on the associations between TTH and autonomic functions. Results: Among participants (n = 217, mean age=41.8 ±â€¯11.5 years), a total of 117 (53.9%) participants had a remote history of TTH. The age and sex-adjusted prevalence was 43%. Groups did not differ statistically in the HRV indices. LF/HF (ratio of low-frequency to high frequency), the index of sympathovagal balance, was correlated with the HADS anxiety. TTH was associated with mental distress. Binary logistic regression analysis confirms the relationship suggesting that TTH was associated with increased likelihood of mental distress, and decreasing RMSSD (root mean square of the sum of the squares of differences between adjacent NN intervals) and pNN50 (NN50 divided by the total number of NN intervals) were the independent predictors of TTH. GLM mediation model indicated that the relationship between TTH and RMSSD was mediated by mental distress. Conclusions: The present study suggests that mental distress is a critical factor in the association between TTH and autonomic dysfunction. Additionally, our findings demonstrate the influence of age and gender on TTH. These results highlight the need to understand the mechanisms underlying pathophysiology to facilitate targeted and efficacious prevention and management approaches for TTH.

Japanese clinical guidelines for chronic pain in children and adolescents.

Chronic pain is a common problem in pediatric practice. The prevalence of chronic pain in children is >30%. Because pain indicates emotional expression as well as the physiological reaction toward infection, injury, and inflammation, both physiological and psychological assessments are essential to determine primary interventions for chronic pain. The Japanese Society of Psychosomatic Pediatrics Task Force of clinical practice guidelines for chronic pain in children and adolescents compiled clinical evidence and opinions of specialists associated with the primary care of pediatric chronic pain in the Japanese 'clinical guidelines for chronic pain in children and adolescents' in 2009, which are presented herein. The guidelines consist of three domains: general introduction to chronic pain; chronic abdominal pain; and chronic headache. Each section contains information on the physiological mechanism, psychological aspects, assessment methods, and primary interventions for pediatric chronic pain. These guidelines are expected to help disseminate knowledge on primary interventions for chronic pain in children and adolescents.

[The use of psychotropic drugs for functional gastrointestinal disorders: are they beneficial?].

This article reviews the therapeutic role of psychotropic drugs in the treatment of functional gastrointestinal disorders based on the Japanese Diagnostic and Therapeutic Guidelines for Psychosomatic Disorders(2006). As an initial step, primary care physicians should establish a therapeutic relationship with their patients, provide instructions on diet or lifestyle modification, and treat them symptomatically. If these treatments are not satisfactory, as a next step, they should evaluate the patient's stressors, coping styles, and comorbid psychiatric disorders, especially anxiety disorders and depression, and prescribe psychotropic drugs such as antidepressants and anxiolytics. If these treatments are unsatisfactory, as a third step, physicians should refer their patients to psychosomatic medicine specialists to inquire about psychotherapy, hypnosis, fasting therapy, or relaxation training.

Effects of practicing yoga on alexisomia: an open-label trial.

BACKGROUND: Alexisomia refers to difficulties in the awareness and expression of somatic feelings. This idea was proposed by Dr. Yujiro Ikemi as a characteristic observed in patients with psychosomatic diseases and is based on his observations that patients with psychosomatic diseases have difficulty in the awareness and expression of not only their emotions, i.e., alexithymia, but also somatic feelings and sensations, i.e., alexisomia. He also proposed that treating alexisomia is important in the treatment of psychosomatic diseases and that yoga might help improve alexisomia. However, no study has investigated if yoga actually affects alexisomia. This open-label pilot study investigated whether practicing yoga in a class results in change in patients with alexisomia and alexithymia. METHODS: The Shitsu-taikan-sho Scale (STSS) and the Toronto Alexithymia Scale (TAS-20) were administered to 305 participants, including 64 healthy participants, 111 participants who had subjective symptoms without abnormal findings, and 130 participants with chronic diseases. Participants were tested before and 3 months after attending yoga classes. RESULTS: Yoga practice reduced the STSS and the TAS-20 difficulty in identifying feelings (DIF) subscale scores. Multiple linear regression indicated that a reduction in the TAS-20 DIF subscale scores predicted a decrease in the STSS score, whereas reductions in the STSS difficulty in identifying bodily feelings (DIB) and the lack of health management based on bodily feelings (LHM) subscale scores predicted a decrease in the TAS-20 scores. CONCLUSION: We found that regular yoga practice improves alexisomia. Yoga-induced improvement of alexisomia may be mediated, at least in part, by an improvement of DIF in alexithymia. Yoga would be a promising therapeutic approach to improve alexisomia.

Relationships between alexisomia and the presence of latent trigger points in the upper trapezius of healthy volunteers.

BACKGROUND: Alexisomia is characterized by difficulties in the awareness and expression of somatic feelings. Trigger points are classified into two types, active and latent, according to the presence or absence of identifying spontaneous pain. OBJECTIVE: We aimed to examine the association between alexisomia and the presence of latent trigger points (LTrPs) in the upper trapezius of healthy volunteers. METHODS: This study was designed as a cross-sectional survey. A correlation analysis between the Shitsu-Taikan-Sho Scale (STSS) and LTrPs was performed on 154 healthy volunteers. The LTrP odds ratio for healthy volunteers with alexisomia was selected as the primary endpoint. RESULTS: LTrPs were seen in the upper trapezius of 82 healthy volunteers (53.2%). There was no significant difference between the LTrP and non-LTrP groups in STSS total score (p= 0.11). However, there was a significant difference between them in STSS difficulty of identifying bodily feelings (DIB) score (p= 0.03). In the alexisomic versus non-alexisomic groups, the LTrP odds ratio for STSS total score was 2.30 (95% confidence interval [CI] 1.03-5.10) and for STSS DIB score, 2.08 (95% CI 1.05-4.11). CONCLUSIONS: In STSS DIB in particular, alexisomia was associated with the presence of LTrP in the upper trapezius of healthy volunteers.

Clinical effects of wasabi extract containing 6-MSITC on myalgic encephalomyelitis/chronic fatigue syndrome: an open-label trial.

BACKGROUND: Wasabi (Eutrema japonicum) is a common pungent spice used in Japan. 6-Methylsulfinylhexyl isothiocyanate (6-MSITC) found in the rhizome of wasabi has been shown to have anti-inflammatory and antioxidant effects, as well as improve neuroinflammation and memory. Therefore, we hypothesized that these effects would be beneficial for treating myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). The present study was conducted to investigate the effectiveness of wasabi extract containing 6-MSITC on ME/CFS in an open-label trial. METHODS: Fifteen patients (3 males, 12 females, 20-58 years old) were orally administered wasabi extract (9.6 mg of 6-MSITC/day) for 12 weeks. The following parameters and test results were compared pre- and post-treatment: performance status (PS), self-rating questionnaires, pressure pain threshold (PPT) on the occiput, Trail Making test-A (TMT-A), and hemodynamic patterns determined by an active standing test. RESULTS: After treatment with 6-MSITC, PS improved significantly (p = 0.001). Although the scores on the 11-item Chalder Fatigue scale (CFS-11) and numerical rating scale (NRS) of fatigue did not show significant changes, subjective symptoms improved significantly, including headache frequency (4.1 to 3.0 times/week, p = 0.001) and myalgia (4.1 to 2.4 times/week, p = 0.019), NRS brain fog scores (5.7 to 4.5, p = 0.011), difficulty finding appropriate words (4.8 to 3.7, p = 0.015), photophobia (4.8 to 3.5, p = 0.008), and the Profile of Mood Status vigor score (46.9 to 50.0, p = 0.045). The PPT of the right occiput (17.3 to 21.3 kPa, p = 0.01) and TMT-A scores (53.0 to 38.1 s, p = 0.007) also changed, suggesting reduced pain sensitivity, and improved cognitive function, respectively. Orthostatic patterns determined by a standing test did not show remarkable changes. There were no serious adverse reactions. CONCLUSION: This study suggests that 6-MSITC improves PS as well as subjective symptoms such as pain and cognitive dysfunction, and psychological vitality of patients with ME/CFS. It also improved cognitive performance and increased pain thresholds in these patients. 6-MSITC may be a promising therapeutic option especially for improving cognitive dysfunction associated with ME/CFS.

Social defeat stress induces hyperthermia through activation of thermoregulatory sympathetic premotor neurons in the medullary raphe region.

Psychological stress-induced hyperthermia is a fundamental autonomic response in mammals. However, the central circuitry underlying this stress response is poorly understood. Here, we sought to identify sympathetic premotor neurons that mediate a hyperthermic response to social defeat stress, a psychological stress model. Intruder rats that were defeated by a dominant resident conspecific exhibited a rapid increase in abdominal temperature by up to 2.0  °C. In these defeated rats, we found that expression of Fos, a marker of neuronal activation, was increased in the rostral medullary raphe region centered in the rostral raphe pallidus and adjacent raphe magnus nuclei. In this region, Fos expression was observed in a large population of neurons expressing vesicular glutamate transporter 3 (VGLUT3), which are known as sympathetic premotor neurons controlling non-shivering thermogenesis in brown adipose tissue (BAT) and thermoregulatory constriction of skin blood vessels, and also in a small population of tryptophan hydroxylase-positive serotonergic neurons. Intraperitoneal injection of diazepam, an anxiolytic agent, but not indomethacin, an antipyretic, significantly reduced both the stress-induced hyperthermia and Fos expression in these medullary raphe neuronal populations. Systemic blockade of ß3 -adrenoreceptors, which are abundantly expressed in BAT, also attenuated the stress-induced hyperthermia. These results suggest that psychological stress signals activate VGLUT3-expressing medullary raphe sympathetic premotor neurons, which then drive hyperthermic effector responses including BAT thermogenesis through ß(3) -adrenoreceptors.

Health-related benefits and adverse events associated with yoga classes among participants that are healthy, in poor health, or with chronic diseases.

BACKGROUND: Our previous study demonstrated that 42% of yoga class participants in Japan had chronic diseases requiring medication. This raises the question as to whether those with chronic diseases would benefit from practicing yoga or if they are at higher risk for specific adverse events compared to healthy individuals receiving the same instruction. METHODS: To address these questions, 328 adults who started practicing yoga for the first time were asked to complete the Profile of Mood States (POMS), Perceived Stress Scale (PSS), and Medical Outcomes Study Short Form 8, standard version (SF-8™) and to record any adverse events on the first day of the yoga class and again three months later. The participants consisted of three groups: a healthy (H) group (n = 70), a poor health (PH) group (n = 117), and a chronic disease (CD) group (n = 141). The degree of subjective symptoms was also compared between the pre- and post-intervention period in the PH and CD groups. RESULTS: Typically, yoga classes were held once a week for 60-90 min. The programs included asanas, pranayamas, meditation, isometric yoga, and sukshma vyayama. In the PH and CD groups, the POMS tension-anxiety and fatigue scores decreased and the vigor score increased significantly after the first class. Furthermore, PSS scores decreased and the SF-8™ scores increased significantly three months later. The degree of subjective symptoms such as easy fatigability, shoulder stiffness, and insomnia also decreased over three months. Individuals in these groups experienced more frequent adverse events than those in the H group. The PH and CD groups also experienced a greater variety of symptoms, including psychological ones, not reported by the H group. Adverse events were not so serious that participants stopped practicing yoga during the class. About 60% of all participants were highly satisfied with participating in yoga classes. CONCLUSIONS: If yoga classes are conducted with attention to possible adverse events, yoga practice in a yoga studio may have beneficial effects for people with functional somatic symptoms and chronic diseases, as well as healthy participants. These benefits include reductions in perceived stress and uncomfortable symptoms as well as improved mood and quality of life.

Shitsu-taikan-sho (alexisomia): a historical review and its clinical importance.

"Shitsu-taikan-sho" is a clinical concept that refers to characteristics of having difficulty in the awareness and expression of somatic feelings or sensations. This concept was first proposed in 1979 by Dr. Yujiro Ikemi, the founder of psychosomatic medicine in Japan, as a characteristic observed in patients with psychosomatic diseases, i.e. physical diseases in which psychosocial factors are closely involved in their onset and progress. Soon after Dr. Ikemi introduced to Japan the concept of alexithymia, coined by P. E. Sifneos in 1973, he noticed that patients with psychosomatic diseases have difficulty in describing not only their emotions, but also somatic feelings and sensations. Dr. Ikemi proposed naming the concept of the trait of lacking somatic awareness "shitsu-taikan-sho" in Japanese ("alexisomia" in English), meaning "shitsu" a lack, "taikan" bodily feelings/sensations, and "sho" condition/symptoms. Dr. Ikemi observed characteristics of both alexithymia and alexisomia in patients with psychosomatic diseases, but considered alexisomia to have a more fundamental pathophysiological role in the understanding of psychosomatic diseases. He also emphasized the importance of treating alexisomia when treating psychosomatic diseases. Recently, alexisomia has again come into focus for various reasons. One is the availability of the Shitsu-taikan-sho Scale (STSS), a self-rating questionnaire to evaluate alexisomic tendency. Another is recent advances in basic research on interoception. The former will facilitate clinical studies on alexisomia, and the latter will enable a deeper understanding of alexisomia. This article is an overview of the historical development of the concept of alexisomia which was conceptualized by Dr. Ikemi, introduces the STSS, and discusses the current understanding and clinical importance of alexisomia in psychosomatic medicine.

Pyrogenic cytokines did not mediate a stress interview-induced hyperthermic response in a patient with psychogenic fever: a case report.

OBJECTIVE: To investigate if pyrogenic cytokines mediated psychological stress-induced hyperthermic response in a patient with psychogenic fever. Despite many case reports on psychogenic fever, the mechanism responsible for how psychological stress increases core body temperature (Tc) in humans is not yet known. CASE PRESENTATION: A 13-year-old girl with fever (>38 degrees C) of unknown causes was referred to our department because psychogenic fever was suspected. To determine if the fever was actually induced by psychological stress, we conducted a 60-minute stress interview. Her baseline oral temperature was 36.60 degrees C and it began to increase immediately after commencement of the interview, reaching a maximum of 37.42 degrees C 20 minutes after the end of the interview. The plasma level of prostaglandin E(2) and the serum interleukin-6 level were increased 90 minutes after the interview. Serum levels of interleukin-1alpha, interleukin-1beta, and macrophage inflammatory protein-1alpha were all less than their minimum detectable level throughout the observation period. We also measured the patient's thermal preference by immersing her hands in warm (40 degrees C) and cold (20 degrees C) water. Her preference changed from cold to warm only during the increasing phase of oral temperature. CONCLUSIONS: This case report shows that a stress interview actually increased Tc in a patient with psychogenic fever. This study suggests that, although pyrogenic cytokines are not involved, the stress interview-induced increase in Tc was an active hyperthermia under the control of the brain, as is infection-induced fever.

[Biomedical and psychosocial treatment of fatigue in functional somatic syndrome].

Fatigue is one of the most common complaints of patients with functional somatic syndrome (FSS), which includes chronic fatigue syndrome (CFS). Although the etiology of fatigue related to FSS remains unclear, accumulating evidence has shown that cognitive behavioral therapy and graded exercise therapy are effective for treating fatigue in patients with CFS. This suggests that psychosocial intervention and physical rehabilitation, as well as biomedical treatment, play an important role in treating fatigue in FSS patients. Here we provide an overview of the biomedical and psychosocial treatments for fatigue in cases of FSS.

Changes in circulating microRNA after recumbent isometric yoga practice by patients with myalgic encephalomyelitis/chronic fatigue syndrome: an explorative pilot study.

BACKGROUND: Yoga is a representative mind-body therapy. Our previous studies have demonstrated that isometric yoga (i.e. yoga programs that we developed so individuals can practice yoga poses with a self-adjustable isometric load) reduces the fatigue of patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS); however, the underlying mechanisms remain unclear. Several studies have suggested that the micro-ribonucleic acid (miRNA) expression of ME/CFS patients is different from that of healthy subjects. However, it has not to date been determined if the practice of isometric yoga can affect miRNA expression. Therefore, we sought to investigate if isometric yoga is associated with changes in the expression levels of serum miRNA of patients with ME/CFS. METHODS: The study included nine patients with ME/CFS who failed to show satisfactory improvement after at least 6 months of treatment administered at our hospital. Patients practiced recumbent isometric yoga for 3 months; they met with a yoga instructor every 2 to 4 weeks and participated in daily in-home sessions. The effect of recumbent isometric yoga on fatigue was assessed by comparing pre- and post-intervention scores on the Japanese version of the 11-item Chalder fatigue scale (CFQ 11). Patient blood samples were drawn pre- and post-intervention, just prior to practicing recumbent isometric yoga with an instructor. The serum was used for miRNA array analysis with known human miRNAs. RESULTS: The average CFQ 11 score decreased significantly (from 25.3 ± 5.5 to 17.0 ± 5.8, p <  0.0001) after practicing recumbent isometric yoga for 3 months. The miRNA microarray analysis revealed that four miRNAs were significantly upregulated, and 42 were downregulated after the intervention period. CONCLUSIONS: This explorative pilot study is the first to demonstrate changes in the serum levels of several miRNAs after regular practice of recumbent isometric yoga. These miRNAs might represent biomarkers for the fatigue-relieving effects of isometric yoga of patients with ME/CFS. TRIAL REGISTRATION: University Hospital Medical Information Network (UMIN CTR) 000023472. Registered Aug 4, 2016.