Effects of the biopsychosocial approach (BPSA) on exercise-induced asthma (EIA).

The Biopsychosocial Approach (BPSA) is a treatment program for allergic patients which includes therapy for psychological, behavioral and social factors as well as for physical problems, following basic principles of psychoneuroimmunology. BPSA was applied to patients with bronchial asthma and favorable results were obtained. The mechanism of the therapeutic effects of BPSA included normalization of the patient's autonomic nervous function, levels of blood histamine, and circadian rhythm of lymphocyte activity. BPSA was also used in patients with exercise induced asthma (EIA) and the same parameters were evaluated. Results showed that patients with EIA recovered physiological homeostasis after BPSA therapy normalized blood levels of histamine and substance P (SP), skin reactions to histamine and SP, and autonomic nervous function. We conclude that BPSA is effective for treating patients with EIA.

Long-term follow-up investigation of the effects of the biopsychosocial approach (BPSA) to bronchial asthma.

The recent rapid increase in the number of allergic patients is becoming a social problem. Studies of the causes of this phenomenon involve various fields, with much attention focused on finding new antigens in food, air, articles encountered in daily living, etc. Recent studies of psychoneuroimmunology (PNI) also suggest a strong influence of emotions on allergic reactions. The number of allergic patients is increasing in all civilized countries without exception, and the stress prevalent in modern civilized society is related to this increase. Modern allergology does not yet have sufficient countermeasures for such stress states. We applied a biopsychosocial approach (BPSA) to treatment programs for allergic disease, incorporating treatment of physical and psychosocial problems en bloc. We studied the long-term effects of BPSA therapy on 82 patients who were treated for more than 3 months in the hospital and were examined 2 to 3 years after discharge. Results showed that more than 80% of patients maintained improvement and 45% of those with intractable asthma were able to withdraw from steroid hormones. BPSA achieved better results than those with standard medication administered only to the body. Improvements after treatment included physical changes, normalization of MV (microvibration) type, decreased levels of plasma histamine, and normal circadian rhythms of lymphocyte subsets. These changes reflect part of the physical mechanisms by which BPSA improves asthma symptoms. From a psychological view point, the patients' feelings, personal relations, behavior, etc. were changed after BPSA, allowing a new life style and improved QOL. It is important for asthma patients to maintain good overall condition over long periods. After BPSA, 80% of our patients were able to do so. It is difficult for the therapist to approach asthma from different aspects at once, including biological, psychological, and social, so we developed a five-stage program of BPSA therapy and found that this obtained favorable results.

[Psychosomatic study of inhalation therapy in patients with bronchial asthma. I. Evaluation by questionnaire].

We investigated the use of metered-dose beta agonist inhalers (MDIs) by means of 17-item questionnaires from the standpoint of psychosomatic medicine in 56 subjects with bronchial asthma. The results can be summarized as follows: 1) Many asthmatics with neurotic characters used MDIs frequently; Thirteen percent of them suffered adverse effects. The number of times the inhalers were used increased in proportion to the severity and the duration of illness. Fifteen percent of the subjects used MDIs frequently because of anxiety. 2) Fifty percent of the subjects, most of them had neurotic or alexithymic characters, used MDIs without suffering from dyspnea or wheezes; the subjects who used MDIs because of anxiety increased in proportion to the duration of illness. 3) Seventy eight percent of the subjects were anxious about asthmatic attack when they did not carry any MDI; sixty two percent of the subjects, most of them had neurotic or alexithymic characters, actually experienced asthmatic attack. 4) Seventy three percent of the subjects used MDIs secretly; sixty percent of the subjects did not like to inhale in the presence of others. 5) There were some subjects who acted incorrectly on or after asthmatic attack when MDIs were not effective.

Application of psychoimmunotherapy in patients with alopecia universalis.

Mental stress and immunological abnormality have recently been listed as causes of alopecia universalis. This disease is difficult to treat with only ordinary pharmacotherapy. Thus, from the standpoint of psychoneuroimmunology, stress was relieved by relaxation and image therapy, and administration of small doses of a strong immunosuppressant was effective, leading to clinically favorable results. In addition, changes were recognized in the subpopulation of peripheral lymphocytes and in beta-endorphin before and after relaxation and image therapy. The treatment of alopecia universalis favorably changed the subpopulations of T cells. A patient suffering from alopecia is always under stress. Alleviating this stress facilitates recovery of immunological competence. Our method was effective in 5 of 6 cases with refractory alopecia universalis.

A case of pyruvate carboxylase deficiency with later prenatal diagnosis of an unaffected sibling.

A severely mentally retarded infant with congenital lactic acidosis due to pyruvate carboxylase deficiency is reported. The patient suffered from vomiting and convulsions soon after birth and developed severe mental and motor retardation at 3 months of age. The persistent elevation of pyruvate and lactate in both blood and cerebrospinal fluid and hyperalanaemia suggested an impairment of pyruvate oxidation. The enzyme activities of pyruvate carboxylase in both liver tissues and cultured skin fibroblasts of the patient revealed values of about 5% of controls. However, pyruvate dehydrogenase and alpha-ketoglutarate dehydrogenase activities in liver tissues were within normal limits. The patient had no response to administration of large doses of thiamine, lipoic acid and biotin, clinically and biochemically. A prenatal diagnosis was performed in the second pregnancy and the pyruvate carboxylase activities of the cultured amniotic fluid cells obtained by amniocentesis were within normal limits.