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1.  Isometric yoga improves the fatigue and pain of patients with chronic fatigue syndrome who are resistant to conventional therapy: a randomized, controlled trial 
Biopsychosocial Medicine  2014;8(1):27.
Background
Patients with chronic fatigue syndrome (CFS) often complain of persistent fatigue even after conventional therapies such as pharmacotherapy, cognitive behavioral therapy, or graded exercise therapy. The aim of this study was to investigate in a randomized, controlled trial the feasibility and efficacy of isometric yoga in patients with CFS who are resistant to conventional treatments.
Methods
This trial enrolled 30 patients with CFS who did not have satisfactory improvement after receiving conventional therapy for at least six months. They were randomly divided into two groups and were treated with either conventional pharmacotherapy (control group, n = 15) or conventional therapy together with isometric yoga practice that consisted of biweekly, 20-minute sessions with a yoga instructor and daily in-home sessions (yoga group, n = 15) for approximately two months. The short-term effect of isometric yoga on fatigue was assessed by administration of the Profile of Mood Status (POMS) questionnaire immediately before and after the final 20-minute session with the instructor. The long-term effect of isometric yoga on fatigue was assessed by administration of the Chalder’s Fatigue Scale (FS) questionnaire to both groups before and after the intervention. Adverse events and changes in subjective symptoms were recorded for subjects in the yoga group.
Results
All subjects completed the intervention. The mean POMS fatigue score decreased significantly (from 21.9 ± 7.7 to 13.8 ± 6.7, P < 0.001) after a yoga session. The Chalder’s FS score decreased significantly (from 25.9 ± 6.1 to 19.2 ± 7.5, P = 0.002) in the yoga group, but not in the control group. In addition to the improvement of fatigue, two patients with CFS and fibromyalgia syndrome in the yoga group also reported pain relief. Furthermore, many subjects reported that their bodies became warmer and lighter after practicing isometric yoga. Although there were no serious adverse events in the yoga group, two patients complained of tiredness and one of dizziness after the first yoga session with the instructor.
Conclusions
Isometric yoga as an add-on therapy is both feasible and successful at relieving the fatigue and pain of a subset of therapy-resistant patients with CFS.
Trial registration
University Hospital Medical Information Network (UMIN CTR) UMIN000009646.
doi:10.1186/s13030-014-0027-8
PMCID: PMC4269854  PMID: 25525457
Chronic fatigue syndrome; Isometric yoga; Fatigue; Treatment; Fibromyalgia
2.  Effects of Kampo on functional gastrointestinal disorders 
This article reviews the effectiveness of Kampo (traditional Japanese herbal medicine) in the treatment of functional gastrointestinal disorders, especially functional dyspepsia (FD) and irritable bowel syndrome (IBS). The results of four randomized, controlled trials (RCTs) suggested the usefulness of rikkunshito in relieving the subjective symptoms of patients with FD. Rikkunshito significantly improved not only gastric symptoms, such as epigastiric discomfort, but also extra-gastric symptoms, such as general fatigue, when compared with control drugs. The therapeutic effects of rikkunshito were more evident when it was prescribed to patients with “kyosho”, i.e., low energy. Two RCTs suggested the efficacy of keishikashakuyakuto for IBS.
Basic research studies have demonstrated that these Kampo medicines have multiple sites of action to improve subjective symptoms. For example, rikkunshito improves gastric motility dysfunction, including impaired adaptive relaxation and delayed gastric emptying, gastric hypersensitivity, and anorexia via facilitation of ghrelin secretion. It also exhibits anti-stress effects, i.e., it attenuates stress-induced exacerbation of gastric sensation and anorexia, as well as the hypothalamic-pituitary-adrenocortical axis and sympathetic activation. Keishikashakuyakuto exhibited not only an antispasmodic effect on intestinal smooth muscle, but also antidepressant-like effects. Case series suggest that other Kampo prescriptions are also effective for FD and IBS. However, further studies are necessary to evaluate their efficacy.
doi:10.1186/1751-0759-8-5
PMCID: PMC3906900  PMID: 24447839
Kampo; Rikkunshito; Keishikashakuyakuto; Functional dyspepsia; Irritable bowel syndrome
3.  Effect of 12 weeks of yoga training on the somatization, psychological symptoms, and stress-related biomarkers of healthy women 
Background
Previous studies have shown that the practice of yoga reduces perceived stress and negative feelings and that it improves psychological symptoms. Our previous study also suggested that long-term yoga training improves stress-related psychological symptoms such as anxiety and anger. However, little is known about the beneficial effects of yoga practice on somatization, the most common stress-related physical symptoms, and stress-related biomarkers. We performed a prospective, single arm study to examine the beneficial effects of 12 weeks of yoga training on somatization, psychological symptoms, and stress-related biomarkers.
Methods
We recruited healthy women who had no experience with yoga. The data of 24 participants who were followed during 12 weeks of yoga training were analyzed. Somatization and psychological symptoms were assessed before and after 12 weeks of yoga training using the Profile of Mood State (POMS) and the Symptom Checklist-90-Revised (SCL-90-R) questionnaires. Urinary 8-hydroxydeoxyguanosine (8-OHdG), biopyrrin, and cortisol levels were measured as stress-related biomarkers. The Wilcoxon signed-rank test was used to compare the stress-related biomarkers and the scores of questionnaires before and after 12 weeks of yoga training.
Results
After 12 weeks of yoga training, all negative subscale scores (tension-anxiety, depression, anger-hostility, fatigue, and confusion) from the POMS and somatization, anxiety, depression, and hostility from the SCL-90-R were significantly decreased compared with those before starting yoga training. Contrary to our expectation, the urinary 8-OHdG concentration after 12 weeks of yoga training showed a significant increase compared with that before starting yoga training. No significant changes were observed in the levels of urinary biopyrrin and cortisol after the 12 weeks of yoga training.
Conclusions
Yoga training has the potential to reduce the somatization score and the scores related to mental health indicators, such as anxiety, depression, anger, and fatigue. The present findings suggest that yoga can improve somatization and mental health status and has implications for the prevention of psychosomatic symptoms in healthy women.
Trial registration
University Hospital Medical Information Network (UMIN CTR) UMIN000007868.
doi:10.1186/1751-0759-8-1
PMCID: PMC3892034  PMID: 24383884
Yoga; Somatization; Psychological symptom; Stress; Biomarker; Anxiety; Depression; Anger; Hostility; Fatigue
4.  Psychological stress contributed to the development of low-grade fever in a patient with chronic fatigue syndrome: a case report 
Background
Low-grade fever is a common symptom in patients with chronic fatigue syndrome (CFS), but the mechanisms responsible for its development are poorly understood. We submit this case report that suggests that psychological stress contributes to low-grade fever in CFS.
Case presentation
A 26-year-old female nurse with CFS was admitted to our hospital. She had been recording her axillary temperature regularly and found that it was especially high when she felt stress at work. To assess how psychological stress affects temperature and to investigate the possible mechanisms for this hyperthermia, we conducted a 60-minute stress interview and observed the changes in the following parameters: axillary temperature, fingertip temperature, systolic blood pressure, diastolic blood pressure, heart rate, plasma catecholamine levels, and serum levels of interleukin (IL)-1β and IL-6 (pyretic cytokines), tumor necrosis factor-α and IL-10 (antipyretic cytokines). The stress interview consisted of recalling and talking about stressful events. Her axillary temperature at baseline was 37.2°C, increasing to 38.2°C by the end of the interview. In contrast, her fingertip temperature decreased during the interview. Her heart rate, systolic and diastolic blood pressures, and plasma levels of noradrenaline and adrenaline increased during the interview; there were no significant changes in either pyretic or antipyretic cytokines during or after the interview.
Conclusions
A stress interview induced a 1.0°C increase in axillary temperature in a CFS patient. Negative emotion-associated sympathetic activation, rather than pyretic cytokine production, contributed to the increase in temperature induced by the stress interview. This suggests that psychological stress may contribute to the development or the exacerbation of low-grade fever in some CFS patients.
doi:10.1186/1751-0759-7-7
PMCID: PMC3599992  PMID: 23497734
Chronic fatigue syndrome; Stress-induced hyperthermia; Psychogenic fever; Stress interview; Cytokine
5.  Age distribution and gender differences in psychogenic fever patients 
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.
doi:10.1186/1751-0759-3-6
PMCID: PMC2674591  PMID: 19379524
6.  Psychological and weight-related characteristics of patients with anorexia nervosa-restricting type who later develop bulimia nervosa 
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.
doi:10.1186/1751-0759-2-5
PMCID: PMC2275291  PMID: 18267038
7.  Green odor attenuates a cold pressor test-induced cardiovascular response in healthy adults 
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.
doi:10.1186/1751-0759-2-2
PMCID: PMC2259378  PMID: 18197969
8.  Rikkunshi-to attenuates adverse gastrointestinal symptoms induced by fluvoxamine 
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.
doi:10.1186/1751-0759-1-21
PMCID: PMC2204024  PMID: 18001480
9.  Cilnidipine lowered psychological stress-induced increase in blood pressure in a hypertensive man: a case report 
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.
doi:10.1186/1751-0759-1-16
PMCID: PMC2045659  PMID: 17900335
10.  Age and gender differences of psychogenic fever: a review of the Japanese literature 
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.
doi:10.1186/1751-0759-1-11
PMCID: PMC1888691  PMID: 17511878

Results 1-10 (10)