Symptoms (A)

Absence of menstrual periods
This is called amenorrhoea and it has many causes. Menstrua­tion usually begins after the age of 11 and should be oc­curring by 16. If periods have not started by this age, see your doctor. When periods stop after they have been oc­curring regularly, it may be due to a number of factors, the commonest being preg­nancy. Stopping the contra­ceptive pill after using it for a time usually results in ab­sent periods for six to eight weeks but sometimes for much longer — even up to a year. Other causes include:
• severe emotional disturbance;
• anorexia nervosa;
• intense and prolonged
athletic activity;
• cysts or tumours of the
ovaries;
• the menopause.
The menopause may occur as early as 40 but more usually when a woman is between 45 and 50. Amenorrhoea is per­manent, of course, if the womb is removed surgically (hysterectomy).
Accident proneness
Some people are certainly more prone to accidents than others, but this is not a symp­tom of any particular disease. People who are emotionally upset and preoccupied and, as a result, less watchful than normal, have an increased ten­dency to mishaps. The same is true of aggressive men who often behave in such a way as to cause accidents to them­selves and others. Some peo­ple are just plain careless.
Ageing
Ageing is not a disease but it is sometimes blamed for symptoms that are caused by disease. Although the tis­sues of the body do gradually deteriorate with age, many of the disorders that affect el­derly people are due to other factors. These include:
• lack of exercise;
• the wrong kind of food; • too much exposure to sunlight;
• smoking;
• excessive drinking;
• conforming to expected patterns of behaviour (in a way that elderly people think they should behave rather than how they feel).
Memory need not decline se­verely with age and is usually well preserved in people who are in the habit of using their
minds. Elderly people are more conscious of normal lapses of memory than the young and are liable to wor­ry unnecessarily about these, thinking that they might be developing dementia or Alz­heimer's disease. The first real indication of either is when someone gets lost in formerly familiar areas. This is called disorientation. However, great philosophers and scien­tists have been known to get lost simply because their minds were on other things.
Sexual activity need not decline much with age. The reason some elderly people are less sexually active is of­ten only because of a lack of opportunity.
Age spots
See Skin spots in elderly people.
Agitation
This shows itself by constant, aimless, physical restlessness, and it is usually caused by anxiety. If there is a real cause for the anxiety, agita­tion is normal and is known
as reactive anxiety. But if there is no appropriate cause, agita­tion suggests an anxiety dis­order, often with an underlying physical cause, possibly alcohol or drug with­drawal. Depression in the el­derly often causes agitation. Some drugs, especially those used to treat psychiatric con­t.litions, cause constant move­ments of the body. This is called akathisia and it is not the same as agitation.
Air swallowing
Everyone swallows some air from time to time, but greedy or anxious people, or those who regularly feel the need to belch, may swallow a great deal of air. This causes a feeling of fullness that is relieved only by bringing the air up again. People who belch frequently at times other than after eating are usually air swallowers. There is no great harm in this but it can be boring for others. Air swallowing is sometimes a symptom of stomach ulcera­tion or indigestion from unsui­table diet and eating at irregular times.
Allergies
See Contact reactions.
Amnesia
See Loss of memory.
Anal protrusions
The commonest protrusions are internal piles (haemor­rhoids) that have slipped down. These cause a lot of irritation (see Itching anus).
A more major and dramatic condition causing anal protru­sion is prolapse of the rectum. This is a condition in which the mucous membrane lining of the anus (the lower part of the rectum) turns inside-out and passes out of the anus. In incomplete prolapse, only the lining of the anus appears, but in complete prolapse the whole thickness of the bowel pro­trudes as a thick cylindrical mass with the mucous mem­brane lining on the outside.
Incomplete prolapse is common in young children and usually requires no treat­ment. At the most, they will have their buttocks strapped together or be given a small injection to encourage internal adhesion of the lining. Com­plete prolapse occurs in adults, mostly in women, be­cause of weakness of the mus­cle ring around the anus (anal sphincter), or of the supporting floor of the pelvis, following childbirth. Anal surgery or haemorrhoids may also pre­dispose adults to the condition.
Prolapses are easily pushed back in but tend to recur. Complete prolapses usually require a surgical operation to tighten the anal sphincter or to fix the rectum internally.
Antisocial attitudes
People with persistent diffi­culty in getting on with others may have what is sometimes described as a bor­derline personality disorder. This is a rather vague name for a vaguely defined condi­tion, lying somewhere be­tween a social disorder and an actual mental illness. The unfortunate people in this ca­tegory may be:
• moody;
• unreasonable;
• prone to outbursts ofanger;
• incapable of forming or maintaining long-term relationships;
• addictive gamblers; • petty criminals;
• prone to self-damaging or even suicidal behaviour.
Changes of mood are rapid and often inappropriate. Psy­chiatrists argue about this condition; some say that it is a psychiatric condition calling for treatment, others claim that it is not. It seems likely that the condition arises from unfortunate early life experi­ence with lack of parental affection and the absence of consistent guidance on acceptable conduct.
People who consistently behave without regard to the rights or safety of others, and who refuse to conform to normally accepted standards of behaviour, are said to have an antisocial personality dis­order. They used to be called
psychopaths or sociopaths
and many of them are actual criminals. Antisocial personal­ity disorder almost certainly
originates early in life as a result of defective training or conditioning and often a ser­ious lack of parental affection and concern. Occasionally par­ents insist, however, that such people were 'born bad'. It is possible that there might be a hereditary element. Behaviour therapy or residence in thera­peutic communities is some­times successful in correcting the defect.
'Ants' crawling under skin See Itching.
Anxiety
No one is wholly free from anxiety, which is a normal and necessary part of life. Anxiety - an unpleasant sense of uneasiness or fear - becomes medically significant only when these fear reactions occur without obvious exter­nal cause and interfere with normal living. There is a fair range of disorders in which anxiety is the main feature. These affect about one person in 25 and include generalized anxiety disorder (previously known as anxiety neurosis),
panic attacks, phobias, post- traumatic stress disorders and obsessive/compulsive disorders. If you have an anxiety disorder you will cer­tainly be aware of the fact.
Anxiety, from whatever cause, is always associated with the release within the body of the hormone adrena­line, and with overaction of the part of the nervous system con­cerned with involuntary con­trol of the internal organs (the autonomic nervous system). As a result, there are few parts of the body that are not affected by anxiety. These effects are purely physical. They include:
• fast pulse;
• awareness of the heartbeat;
• 'butterflies in the stomach';
• dryness of the mouth; • trembling of the hands; • tightness in the chest; • sighing and
overbreathing
(hyperventilation);
• tense muscles.
Tightening the muscles per­sistently soon results in ach­ing and tiredness. (Prolonged muscle tension is a common cause of backache and neck pain.) It also affects the urin­ary system, causing frequent desire to empty the bladder, and even affects the skin, causing blushing or pallor and sweating.
Anxiety is additionally known to disrupt the intest­inal system causing:
• loss of appetite;
• a sense of fullness;
• difficulty in swallowing (sometimes);
• nausea;
• vomiting;
• belching;
• irritable bowel with frequent diarrhoea:
Abnormal anxiety features con­stant fears. These might be fear of death, serious illness, psy­chiatric breakdown, financial loss, social disasters or work inadequacy. With this anxiety comes an increased depen­dency on others, fatigue, insom­nia and frightening dreams. A strong and persistent convic­tion that one is suffering from a serious disease is common. This is called hypochondriasis - sufferers are hypochondriacs.
Anxiety is the hallmark of most neurotic disorders and, although various theories have been put forward to ex­plain it, no one really knows its cause. Anxious people de­serve every sympathy and need help. There is little evi­dence that psychoanalysis can cure anxiety, but there are effective remedies. Wise psy­chotherapy by a mature and experienced counsellor, beha­viour therapy, learning re­laxation techniques or carefully selected drug treat­ment can help greatly. The tricyclic antidepressant drugs are often useful in panic conditions. Fluoxetine (Prozac) is really only appro­priate if the condition is basi­cally a depression. It is best to
avoid the benzodiazepines - drugs like Valium — if possi­ble, because it is all too easy to get addicted. Beta-blockers can help anxiety, and much can be done to relieve the problem, especially if you have a sympathetic doctor.