Cancer of the pancreas can cause severe depression and insomnia. These emotional symptoms can occur early in the course of the disease. This kind of cancer kills nine out of ten of its victims within a year of being diagnosed. One reason for this tragedy is that pancreatic cancer frequently reaches an advanced stage before the appearance of its physical symptoms: loss of appetite and loss of weight, nausea, vomiting, and upper abdominal {107} pain that may spread to the back. It is believed that alert psychiatrists can save many lives that otherwise would be lost as a result of pancreatic cancer by detecting the disease in its early stages. ANEMIA Anemia is caused by an abnormal drop in either red blood cells or hemoglobin (the main constituent of red blood cells). Iron deficiency can cause anemia, as can vitamin B12 or folic acid deficiency. Inherited blood disorders such as sickle-cell anemia can also lead to anemia. The main emotional symptom of anemia is depression. Physical symptoms include weakness, breathlessness, and heart palpitations, which may occur as the heart attempts to compensate for anemia by circulating blood faster than normal. HEART CONDITIONS Mitral incompetence is a heart condition in which the flaps of the mitral valve, separating the upper and lower chambers of the heart, do not close properly. The heart of a person with this disorder must therefore work harder than normal. Physical symptoms may involve shortness of breath and fatigue. Paroxysmal tachycardia is another heart condition, in which the heartbeat suddenly speeds up to 160 beats per minute or more. An attack may last for from several minutes to several days. Physical symptoms include breathlessness, fainting, chest pain, and awareness of the rapid heartbeats. The emotional symptoms of both mitral incompetence and paroxysmal tachycardia may involve anxiety and panic attacks. MENOPAUSE Menopause is not a disorder but a natural condition of aging that involves changes in hormone levels in the body. Menopause in women can cause intermittent periods of strong anxiety, chronic nervousness, depression, irritability, lack of confidence, and headaches. Physical symptoms include hot flashes, sweating, and palpitations. Male menopause is increasingly being recognized by doctors; symptoms most frequently appear when a man {108} is in his fifties. Emotional symptoms may involve anxiety and depression; physical symptoms include hot flashes, sweating, fatigue, and insomnia. INFECTIOUS DISEASES Frequently, emotional symptoms are the first warnings of infectious disease. For example, fatigue and nervousness maybe the only early complaints of patients who have hepatitis, infectious mononucleosis, tuberculosis, and many other diseases. Anxiety and tiredness are symptoms that deserve careful diagnostic judgment; they are not always innocuous. REACTIONS TO MEDICATION