Since the onset of modern psychosomatic medicine decades ago. it has made significant at contribution to general medicine in terms of understanding the patient as a whole person suffering from an illness rather than as a disease per se. However, initial expectation of delineating specific psychogenesis and developing specific treatment modality has not been fulfilled. Consequently, it has raised substantial concern about the continuing utility of psychosomatic medicine in modem medicine. The author attempted to review critically the evolution of psychosomatic medicine from the perspective of the present and to make projections into the near future. It is concluded that psychosomatic medicine in the future will continue to contribute to development of modem medicine not only as the scientific principle but also as the practical methodology, working as creative interface among disciplines and fusing ideas from rapidly developing molecular biology and neuroscience with psychosomatic concepts. Finally, suggestions for further developing psychosomatic medicine in Korea are made.

The author discussed present problems and future prospects of psychosomatic medicine in clinical, educational, research, and social aspects. In general, psychosomatic field. particularly. consultation-liaison(C-L) psychiatry in Korea seems to remain on early developmental phase. However, positive change in the general publics' and societal view of psychiatry, specialization of medicine and development of medical technology, implementation of delivery system in medical care could contribute to development of this field. In future, clinically, liaison activity will be more activated. and this field will be developed as main subspecialty of psychiatry. In addition. C-L psychiatry will be subspecialized. and prevention and humanization of medical care could be more emphasized. In education. the main place of education for medical students and psychiatric residents will be changed from closed ward to general ward in which consultation-liaison activity can be performed. In research. consultation liaison model suitable for Koreans will be developed and studies on disease mechanism will be more promoted. In social aspects, this field could influence the general publics' view of psychiatry and change the whole areas of medicine and society toward integration. In order to achieve these goals, medical insurance system and cost relevant to C-L activity should be essentially improved.

The author reviewed the general principle in the use of psychotropics for patients with renal diseases. who have psychiatric problems. Durgs which are dialyzable and metabolized or eliminated by kidney should not be used for patients with renal failure. However, lithium can be effectively used in a single dose$(300{\sim}600 mg/day)$ after each dialysis. though lithium has the double negative components. It is recommended that serum lithium level should be frequently monitored and the dose of lithium should be gradually increased to minimize its side effect Most of other psychotropics such as benzodiazepine anxiolytics tricyclic or tetracyclic antidepressants, and neuroleptics are metabolized in the liver, and they can be used in renal patients. The dose of these drugs should be reduced in two-thirds of the standard dose. In addition. it is necessary for liaison psychiatrists and other physicians to understand the interactions between psychotropics and drugs often used for treatment of renal diseases in order to prescribe psychotropics safely and effectively in renal patients.

This study was aimed at investigating the relationship of stress perception and psychopathology with biological variables such as systolic and diastolic blood pressure. serum total cholesterol high density lipoprotein and triglyceride in 50 adult patients with essential hypertension and 50 normotensive individuals. Both of the groups were matched to each other regarding age, sex, the level of education and BMI(body mass index). Stress perception and psychopathology between the two groups were compared using GARS and SCL-90-R scales. Biological variables such as blood pressure(systolic. diastolic), serum total cholesterol, high density lipoprotein and triglyceride were measured in all the subjects. The results were as follows ; 1) Hypertensive patients scored significantly higher than normotensive individuals in stress perception related to unusual happenings, change or no change in routine and overall global area, respectively. 2) Regarding psychopathology, hypertensive patients scored significantly higher than normotensive individuals in depression. hostility and interpersonal sensitivity. respectively. 3) Systolic blood pressure had a significantly positive correlation with scores of stress perception related to sickness and injury, and change or no change in routine, respectively. Diastolic blood pressure had a significantly positive correlation with scores of stress perception related to change or no change in routine. 4) In hypertensive patients. the level of serum total cholesterol had a significantly positive correlation with scores of stress perception related to unusual happenings. However, the level of serum triglyceride had a significantly negative correlation with scores of stress perception related to changes in relationships, sickness or injury, and change or no chang in routine. 5) There were no significant correlations between scores of stress perception and biological factors in the normotensive group. 6) The level of serum triglyceride correlated negatively with phobic anxiety in hypertensive group. whereas it correlated positively with PSDI in normotensive group. In conclusion, these results suggest that hypertensive patients have higher level of stress perception and psychopathology than normal individuals. In hypertensive patients, their stress perception is suggested to be correlated with serum cholesterol.

Stress perception was investigated in 53 outpatients with extrinsic type of bronchial asthma, using GARS scale and other questionnaires. 40% of the patients were found to be psychosomatic. The patients were more likely to consider their physical symptoms as severe than the allergist Severity of symptoms rated by the allergist had significantly positive correlation with scores of stress perception related to changes in relationship. However, no significant correlation was found between severity of symptoms rated by patients and scores of stress perception. Psychosomatic group was significantly higher in scores of stress perception related to illness and injury, financial burden, and change or no change in routine than non-psychosomatic group. Female. older age, higher education. presence of religion. and presence of psychological stressors at onset and/or aggravation of the illness were found to increase stress perception. These findings indicate ant extrinsic asthmatics an less likely to perceive psychological stress than physical symptoms, and that they are less vulnerable to psychological stressors than patients with other diseases.

Before studying the effectiveness of amitriptyline in alleviating the pain of diabetic neuropathy, this study was designed to compare the severity and nature of depressive symtoms of diabetic patients with neuropathy with those of diabetic patients without neuropathy and patients with somatoform disorder whose complaints were mainly somatic pain, respectively. The authors administered Beck Depression Inventory(BDI) to the three groups of patients. The mean total scores of BDI were relatively low in all groups and not significantly different among the three groups. The mean scores of four subscales of BDI were also not significantly different among the three groups. These results might suggest that the pain of diabetic neuropathy did not influence on the severity and the nature of depressive symptoms of preexisting diabetes.

저자들은 GARS(Global Assessment of Recent Stress)척도와 SCL-90-R(Symptom Checklist-90-Revision)을 사용하여 동일한 산업장에서 유기용제에 노출된 근로자들과 노출되지 않은 근로자들 간의 스트레스지각과 정신병리를 비교하였다. 유기용제 노출군은 비노출군보다 일-직장, 대인관계의 변화, 질병 및 상해, 경제적 문제, 그리고 전체적인 스트레스지각점수에 있어서 유의하게 더 높았다. 정신병리에 있어서는 유기용제노출군이 비노출군보다 신체화척도점수에 있어서만 유의하게 더 높았다. 그러나 유기용제에 노출된 기간과 정신병리 간에는 유의한 차이가 없었다. 양군 모두에서 여자는 남자보다 정신병 리가 유의하게 더 현저하였고, 연령은 정신병리와 유의하게 음 상관성을 보였다. 이상의 결과들은 유기용제노출군이 비노출군보다 스트레스지각 및 정신병리가 더 현저함을 시사해 준다. 따라서 기업주는 물론 보건정책 수립자들이 유기용제에 노출되는 근로자들의 건강 특히 정신건강에 대해 관심을 기울여야 할 것이다.

The authors investigated the relationship among stress, mental health and academic performance of high school students(322 males and 320 females). using stress questionaires and Korean version of SCL-90-R. The problem related to academic achievement was highest stressful. The percent of disturbed subjects was 30.68% Interpersonal sensitivity(12.4% ) in the male and depression(15.6%) in the female were prevalent mental health problems. The scores of the stress questionaire positively correlated with the SCL-90-R scores. It suggests that stress is highly related to mental health problem. However, there was no significant correlation between the academic records and SCL-90-R scores. The results were discussed with respect to adjustment problems of the high school students, and implications for prevention and educational program were suggested.

To understand and evaluate the patients who were referred for psychiatric consultation from medical departments, the authors reviewed the concept of disease, psychological reaction to disease, problems on psychiatric diagnosis and evaluation which were encountered at the medical ward. In addition, we reviewed what psychiatrists should do during consultation.

The consulting internist will encounter patients with psychiatric symptoms and those who take psychotropic medications in many settings. The internist must loam to feel comfortable interacting with patients who display psychiatric symptoms. while maintaining an open and unprejudiced attitude toward their evaluation. The proper delineation of psychiatric disorders from normal emotional reactions resets on a careful history, a mental status evaluation. and a knowledge of psychiatric syndromes. Many physicians tend erroneously to view behavioral changes only in a psychological framework Abrupt changes in behavior, personality, mood. or ability to function should be evaluated for possible organic causes. Then, the internists should take their consultation to psychiatrists and freely discuss psychologic problems of the patients.

Successful management of mental symptoms requires proper diagnostic tools and comprehensive treatment including psychotherapy, physical therapy and psychopharmacotherapy. For this purpose. valid and reliable diagnostic instruments need to be developed. and the data regarding various treatment methods in medical and psychiatric comorbid conditions should be available. Because mental symptoms originate from various aspects of biological, psychological and social factors. each aspect may have slightly different therapeutic goal. Alterations in pharmacokinetics and pharmacodynamics of medically ill and/or old patients may complicate the treatment outcomes. Best psychopharmacological treatment needs to be elaborated in various states. Mental symptoms of the medically ill patients may be treated more effectively with an eclectic approach.

To become an effective and successful consultation-liasion psychiatrist the psychiatrist should consider two aspects of consultation before he/she meets his/her patients. First the psychiatrist should understand the internal need and psychological state of patients who visited their physician before being refered to a psychiatrist So psychiatrists should be careful in the evaluation of the patient's intention whether they are willing to accept the psychiatric treatment approach or not Second the psychiatrist should understand the situation and the physician's internal need in the consultation. Psychiatrists should recognize whether there are any factors which interfere with the mutual understanding and cooperation between physicians and psychiatrist.

A case of a 38 year-old woman with histrionic personality who had chronic epigastric pain, dyspepsia and alternating bowel habit for more than 10 years was presented in detail on its course of two times of admission and follow-up. The diagnosis was thought as psychophy-siological disorder or gastrointestinal motility disorder of undefined etiology rather than hypo-chondriasis or Briquet's syndrome. She was characterized by sustained illness behavior and combined several physical illnesses. i.e. tuberculosis. anemia and hepatic stone. These physical diseases led to a blurring of psychological and physical boundaries regarding symptom formation. The points on consultation from medical part to psychiatric department were discussed and the supposed causal mechanisms in non-organic functional gastrointestinal disturbances were also reviewed. Physical and psychological modalities for the treatment and the abnormal illness behavior were mainly emphasized in this case.