Physical Symptoms & Signs
Physical health problems may be real or imaginary and also the product of a person’s mental state rather than its cause.
How these problems are categorized may be summarized as follows.
A. Physical symptoms
- Conversion symptom
A conversion symptom is a loss or alteration of physical functioning that suggest a physical disorder, but that is actually a direct expression of a psychological conflict or need.
The disturbance is not under voluntary, and is not explained by any physical disorder.
Hypochondriasis denotes an unrealistic belief or fear that one is suffering from a serious illness despite medical reassurance.
B. Physical signs involving the eyes
Nystagmus is a condition in which there is involuntary movement of the eyes, usually horizontally and in a manner resembling the action of windscreen wipers. Occasionally, one eye is affected.
Persistent nystagmus appears in later life usually indicates a disorder of the nervous system such as multiple sclerosis, brain tumor or an alcohol related disorder.
- Oculogyric crisis
An oculogyric crisis is a state of fixed gaze lasting minutes or hours in which the eyes are turned in a particular direction, usually upwards, sometimes with accompanying spasms of the head, mouth and neck.
The condition may be drug-induced, the product of emotional stress, a sequela of encephalitis or a sign of Parkinson’s disease Opens in new window.
Exophthalmus is protrusion of the eye ball and is indicative of a thyroid disorder.
Photophobia means an uncomfortable sensitivity or intolerance to light. It is most often seen as an adverse effect of antipsychotic medication although it may be a feature of meningitis.
Blepharospasm is the involuntary, prolonged contraction of one of the muscles that controls the eyelids, causing the eyes to close. This may be the result of photophobia, an inflammation of the eyelids, anxiety or hysteria.
|Other Physical Conditions|
|Eyelids||Lid-lag is a momentary delay in the normal downward movement of the upper eyelids that occurs when the eye looks down. In Lid retraction, a rim of white sclera is seen above the iris when the patient looks ahead. Both are characteristic of hyperthyroidism. Ptosis is the drooping of an upper eyelid when the eyes are open.|
|Face||Facies is the expression of the face. Hirsuties, mooning and reddening of the face may be features of Cushing’s syndrome.|
|Limbs||As to movement disorders, see here Opens in new window.|
|Trunk||Truncal obesity with relatively thin matchstick legs and a buffalo-lump are classically features of Cushing’s syndrome.|
|Genitalia||Psychotropic medication may cause sexual problems. Antipsychotics may be associated with enlargement of the breasts in men. In other cases, the absence of menstrual periods may be a feature of anorexia nervosa, an endocrimal disorder, Turner’s syndrome, or secondary to emotional stress or depression, or a side-effect of certain drugs.|
|Skin||Skin problems are most often an adverse effect of medication. The greater the amount of melanin present the darker the coloration. Darkened skin may therefore be caused not only of exposure to the sun but by a hormonal disorder such as Addison’s disease or Cushing’s syndrome. It may also be caused by an excess of other types of pigments in the blood, such as the bile pigment bilirubin (in jaundice) or iron.|
|Weight||Pronounced weight loss is seen in eating disorders, depression, physical illness.|
C. Disturbed sleep
Insomnia Opens in new window is a general germ denoting dissatisfaction with the duration or quality of sleep. In depression, the sufferer commonly wakes early in the morning, often between 3 am and 5am — early morning waking. In contrast, the tendency in anxiety states is to experience difficulty getting to sleep — initial insomnia.
Narcolepsy describes short periods of sleep which occur irresistibly during the day.
Hypersomnia means an excess of sleep, whether at night or because of periods of day-time somnolence. In manic states, the over-active individual feels a decreased need for sleep and may go several days without sleeping.
Somnambulism means sleep-walking. More often, what a client describes as sleep-walking is in fact a ‘night terror’, which occurs early on during sleep.
The individual imagines that there is a person at the window or that the ceiling is about to fall in and suffocate them. Feeling that one is in profound danger, s/he may run from the bedroom in a state of panic. On coming to, s/he is amnesic for the event Opens in new window and is initially confused about how he came to be in another room or outdoors.
Some people suffering from schizophrenia Opens in new window may feel that other people have entered their room and that they have been violated during sleep, either sexually or in some other way. For example, the patient’s hair was cut.
D. General appearance and physical signs
Physical signs may be pointers to the fact that the patient’s mental state has an organic cause and the elements on the previous section describes some of these features.
The patient’s physical health may also be a pointer towards his mental health in other, generally obvious, ways. There may be signs of recent physical injury, possibly sustained in the course of a suicide attempt.
Superficial, multiple, lacerations of the arms and wrists are most often not indicative of attempted suicide but a way of relieving acute tension. “Track-marks” on the arms may indicate the use of injectable street drugs.
What may cruelly be referred to as physical deformities are sometimes, for that very reason, relevant to the client’s mental health since they carry with them a considerable psychological burden.
- Self-care and self-neglect
If a patient has not washed, shaved or recently changed his clothes, or is inadequately dressed given the temperature and conditions on the ward, this may be a sign of poor self-care due to an incapacitating mental disorder.
Self-neglect of this kind may be a consequence of the negative symptoms of schizophrenia, and part of a general picture of apathy, poor motivation and social withdrawal.
In other cases, poor self-care may be attributable to grandiose delusions (the client has let his beard grow and cultivated a Jesus-like appearance); depression with retardation or stupor; dementia; mental impairment; and obsessive-compulsive disorders characterized by incapacitating rituals about dressing and bathing.
- Other reasons for disheveled appearance
There are, of course, many other reasons why a patient’s general appearance may be poor, including poverty, the sedative effects of medication, an inefficient hospital laundry service, and the fact that no one has collected any spare clothing or toiletries for them since their detainment.
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- J.D. and J.A. Spillane, An Atlas of Clinical Neurology (Oxford Medical Publications, 3rd ed., 1982), p.263.