[Factitious disorder mixed with somatoform disorder in a patient treated with a psychotherapeutic approach: psychopathology and treatment].

We encountered a case of somatoform disorder induced by bullying, and factitious disorder was revealed during treatment. This case was a 14-year-old female, who was admitted to a pediatric ward at first. However, she was transferred to a psychiatric ward after a serious suicidal attempt. She caused many problems, and demanded that medical staff treat her symptoms. We assumed that medical care promoted regression. We performed psychotherapeutic intervention based on consensus among medical staff, similar to behavioral therapy. During the patient's admission to the psychiatric ward, her mother was compulsorily hospitalized. After separation of the mother and child, medical staff could intervene, and this stabilized the mental state of her and her mother.

[A case of late-onset schizophrenia with the predominant symptom of delusional perception of the color of food].

Herein, we report the case of a woman in her late 60s with late-onset schizophrenia in which the predominant symptom was delusional perception of the color of food based on a delusional "rule of colors" system constructed by the patient. This paranoid type schizophrenia is considered a core type of schizophrenia in which first-rank Schneiderian symptoms are initially exhibited. After approximately four years, the chronic phase, characterized by a poor social function, is reached. In this respect, the main psychopathological characteristics of the present case of late-onset schizophrenia are the same as those of typical cases of schizophrenia in young patients. In this study, the patient's delusional "rule of colors" system is analyzed according to Matussek's theory of delusional perception.

[A case of Asperger's disorder with catatonia originally suspected of being catatonic schizophrenia].

We report the case of an adolescent male who presented with mutism, immobility, catalepsy, and mannerisms. The patient was admitted to our hospital with suspected catatonic schizophrenia; however, he was subsequently diagnosed with catatonia due to Asperger's disorder. The patient was a 16-year-old male. More than six months before presentation, his grandfather displayed bizarre and violent behavior. Subsequently, he began to experience catatonia, which eventually led to hospitalization. Treatment with diazepam improved his condition and, as no causal disorders other than Asperger's disorder were identified, he was diagnosed with catatonia. The patient had experienced persistent abuse by his mother during childhood; therefore, it is important to consider reactive attachment disorder (DSM-IV-TR) as a differential diagnosis. Among child and adolescent psychiatrists, catatonia is considered to occur at a high frequency among patients with autistic spectrum disorders. In contrast, general psychiatrists tend to consider catatonia as related to schizophrenia, which may be the reason why the diagnosis of our patient was difficult. We assume that the pathogenesis of catatonia in this case was death mimicry due to the subjective perception of a life-threatening situation. For the treatment of catatonia with autistic spectrum disorders, the efficacy of benzodiazepines and electroconvulsive therapy has been established. When a patient with an autistic spectrum disorder presents with motor functional disturbances, it is important to consider these disturbances as catatonia. Furthermore, it is also important to begin the treatment mentioned above even in the presence of definite psychogenic or situational factors.

[Clinical study of depression accompanying diabetes mellitus].

The appropriate management of chronic diseases is important to ensure a high quality of life. In particular, depression has been reported to occasionally accompany diabetes mellitus. Here, we investigated depression onset in individuals with diabetes mellitus. Subjects were outpatients with a clinical diagnosis of depression in combination with diabetes mellitus between August 1, 1998 and September 30, 1998 of the psychiatry clinic of Jichi Medical School. Of 34 individuals (20 males, 14 females) included in the preliminary investigation, 22 were interviewed. We investigated the social demographic background, the treatment, family history of depression and diabetes mellitus, and measured the Hamilton's Rating Scale for Depression and the value of HbA1c. The overall male/female ratio was 13/9, indicating that this pattern of disease onset was more common in males than in females. The Hamilton's Rating Scale for Depression correlated closely with the percentage of patients being treated with insulin. Furthermore, the timing of the diagnosis of these two diseases correlated closely with each other. The ratio of males to females suggested that the different gender roles and lifestyles and the biological bases of these differences may play roles in the onset of depression among diabetic patients. Moreover, as more patients with insulin dependence developed depression than patients without insulin, insulin was implicated in the onset of depression. Furthermore, as the onset of the two diseases correlated closely with one another, the onset of one disease may have hastened the onset of the other.

[A clinical study of hypochondriac symptoms in patients with depression].

In this study, the authors investigated the features of depression associated with hypochondriac symptoms. The subjects were inpatients of the psychiatry clinic of Jichi Medical School who were clinical diagnosed with depression and enrolled in the study between June 1, 1997, and June 30, 1999. Of 86 subjects enrolled, 49 exhibited hypochondriac symptoms ("hypochondriac group"). Patients in the hypochondriac group tended to be older at diagnosis and admission than those in the "non-hypochondriac group". Our findings suggested that symptoms of both hypochondriasis and depression are related to situational, psychological and organizational factors. As many patients consulted health professionals in specialties other than psychiatry, we emphasize that primary-care doctors need to keep the possibility of depression in mind when examining patients. The frequency of delusions associated with depression was higher in the hypochondriac group than in the non-hypochondriac group. We therefore suggest that hypochondriac attitudes are related to the three major diagnostic features in depressive delusions. Many hypochondriac subjects complained of constipation and pain as concrete symptoms, but the sites of hypochondriac symptoms showed considerable variation. In terms of symptoms of pain, however, affected sites were more localized, with many patients reporting headache or lumbago.