| Peer-Reviewed

Psychiatric and Functional Physical Symptoms: The More Telling “Fifth” Vital Sign

Received: 3 December 2021    Accepted: 17 December 2021    Published: 24 December 2021
Views:       Downloads:
Abstract

Historically, psychiatric symptomatology has been looked upon with a mixture of bewilderment and derision—the evidence of some kind of psychological or spiritual problem—but not of a medical or biological one. However, an explosion of new research suggests that psychiatric symptomatology may actually reveal as much about the physiological functioning of the body as heart rate, respiratory rate, temperature, and blood pressure. For example, there is growing evidence that psychiatric symptoms are associated with autonomic dysregulation and the early development of chronic debilitating diseases, such as diabetes, cardiovascular, hypertension, and cancer. These diseases then take the lives of the mentally ill at a much earlier age than the general population. In addition, an association has been found between upper-end-of-normal resting vital signs and the later development of major psychiatric illnesses, such as generalized anxiety disorder, obsessive-compulsive disorder, and schizophrenia. Notably, a similar association has been found between upper-end-of-normal resting vital signs and the early development of the same illnesses that shorten the lives of the mentally ill. These associations raise the possibility that subtle elevations in resting vital signs and psychiatric symptomology are different manifestations of a shared physiological abnormality. The identification of a core abnormality that influences such diverse emotional, psychological, and biological conditions could completely reshape the way we think about mental illness. It could unify mental disorders and medical disorders and raise psychiatric symptoms to the level of a “fifth” vital sign. This article will explore the links between mental illness, physical illness, and resting vital signs in an effort to utilize, if appropriate, psychiatric symptomatology as a barometer of physiological function. The unique value of psychiatric symptomatology in this regard is that it could reduce the need to distinguish psychiatric symptoms from medical symptoms while at the same time more clearly revealing, without any physical instrumentation, what is happening inside the body.

Published in American Journal of Clinical and Experimental Medicine (Volume 9, Issue 6)
DOI 10.11648/j.ajcem.20210906.17
Page(s) 233-237
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Psychiatric Symptoms, Chronic Pain, Neuronal Hyperexcitability, Vital Signs, Biomarkers of Disease, Preventive Medicine, Anticonvulsants, Neuroregulators

References
[1] Latvala A, Kuja-Halkola R, Rick C, et al. Association of resting heart rate and blood pressure in late adolescence with subsequent mental disorders: A longitudinal population study of more than 1 million men in Sweden. JAMA Psychiatry 2016; 73 (12): 1268-1275.
[2] Blom EH, Serlachius E, Chesney MA, Olsson EMG. Adolescent girls with emotional disorders have a lower end- tidal CO2 and increased respiratory rate compared with healthy controls. Psychophysiology 2014; 51 (5): 412-418.
[3] Kannel W, Kannel C, Paffenbarger R, Cupples A. Heart rate and cardiovascular mortality: The Framingham study. Am Heart J 1987; 113: 1489-1494.
[4] Baumert M, Linz D, Stone K, et al. Mean nocturnal respiratory rate predicts cardiovascular and all-cause mortality in community-dwelling older men and women. European Respiratory Journal 2019; DOI: 10.1183/13993003.02175-2018.
[5] Yano Y, Kario K. Nocturnal blood pressure and cardiovascular disease: a review of recent advances. Hypertension Research 2012; 35: 695-701.
[6] Gottesman RF, Schneider ALC, Albert M. Midlife hypertension and 20-year cognitive change: the atherosclerosis risk in communities neurocognitive study. JAMA Neurol 2014; 71 (10): 1218-1227.
[7] Barletta G-M, Flynn J, [...], Furth S, et al. Heart rate and blood pressure variability in children with chronic kidney disease: a report from the CKiD study. Pediatr Nephral 2014; 29 (6): 1059-1065.
[8] Dalal J, Dasbiswas A, Sathyamurthy I, et al. Heart Rate in Hypertension: Review and Expert Opinion. International Journal of Hypertension 2019; 2019.
[9] Tsuji H, Larson MG, Venditti FJ, et al. Impact of reduced heart rate variability on risk for cardiac events. The Framingham Heart Study. Circulation 1996; 94: 2850–2855.
[10] Thanou A, Stavrakis S, Dyer JW, et al. Impact of heart rate variability, a marker for cardiac health, on lupus disease activity. Arthritis Res Ther 2016; 18 (1): 197.
[11] Jouven X, Empana J-P, Schwartz PJ, et al. Heart-rate profile during exercise as a predictor of sudden death. N Engl J Med 2005; 352: 1951-1958.
[12] Cole CR, Blackstone EH, Pashkow FJ, Snader CE, Lauer MS. Heart rate recovery immediately after exercise as a predictor of mortality. N Engl J Med 1999; 341: 1351-1357.
[13] Ó Hartaigh B, Gill TM, [...], Hardy R, et al. Association between resting heart rate across the life course and all-cause mortality: longitudinal findings from the Medical Research Council (MRC) National Survey of Health and Development (NSHD). J Epidemiol Community Health 2014; 68 (9): 883-889.
[14] Binder MR. The multi-circuit neuronal hyperexcitability hypothesis of psychiatric disorders. AJCEM 2019; 7 (1): 12-30.
[15] Johnstone T, van Reekum CM, Urry HL, Kalin NH, Davidson, RJ. Failure to regulate: counterproductive recruitment of top-down prefrontal-subcortical circuitry in major depression. J. Neuroscience 2007; 27 (33): 8877-8884.
[16] Leuchter AF, Cook IA, Hunter AM, Cai C, and Horvath S. Resting-state quantitative electroencephalography reveals increased neurophysiologic connectivity in depression. PLoS One 2012; 7 (2): 1-13. e32508.
[17] 70 Herr RM, Barrech A, Reidel N, et al. Long-term effectiveness of stress management at work: Effects of the changes in perceived stress reactivity on mental health and sleep problems seven years later. Int J Environ Res Public Health 2018; 15 (2): 255.
[18] Larsen BA, Christenfeld NJS. Cardiovascular disease and psychiatric comorbidity: the potential role of preservative cognition. Cardiovascular Psychiatry and Neurology 2009; Article ID: 791017.
[19] Brainstorm Consortium; Anttila V, Bulik-Sullivan B, Finucane HK, et al. Analysis of shared heritability in common disorders of the brain. Science 2018; 360 (6395): eaap8757.
[20] Binder MR. FLASH Syndrome: tapping into the root of chronic illness. AJCEM 2020; 8 (6): 101-109.
[21] Scher C, Meador L, Van Cleave JH, Reid MC. Moving beyond pain as the fifth vital sign and patient satisfaction scores to improve pain care in the 21st century. Pain Manag Nurs 2018; 19 (2): 125-129.
[22] Crofford LJ. Chronic Pain: Where the Body Meets the Brain. Trans Am Clin Climatol Assoc 2015; 126: 167-183.
[23] Cousins N. Anatomy of an illness - as perceived by the patient. W. W. Norton Company, 2005.
[24] Gallo S, Tatu L, Bogousslavsky J, Aybek S. Conversion, Factitious Disorder and Malingering: A Distinct Pattern or a Continuum? Front Neurol Neurosci. Basel, Karger 2018; 42: 72-80.
[25] The Neuronal Excitability Spectrum: A New Paradigm in the Assessment, Treatment, and Prevention of Mental Illness and its Relation to Chronic Disease. AJCEM 2021; 9 (6): 193-209.
[26] Binder MR. Gabapentin—the popular but controversial anticonvulsant drug may be zeroing in on the pathophysiology of disease. AJCEM 2021; 9 (4): 122-134.
Cite This Article
  • APA Style

    Michael Raymond Binder. (2021). Psychiatric and Functional Physical Symptoms: The More Telling “Fifth” Vital Sign. American Journal of Clinical and Experimental Medicine, 9(6), 233-237. https://doi.org/10.11648/j.ajcem.20210906.17

    Copy | Download

    ACS Style

    Michael Raymond Binder. Psychiatric and Functional Physical Symptoms: The More Telling “Fifth” Vital Sign. Am. J. Clin. Exp. Med. 2021, 9(6), 233-237. doi: 10.11648/j.ajcem.20210906.17

    Copy | Download

    AMA Style

    Michael Raymond Binder. Psychiatric and Functional Physical Symptoms: The More Telling “Fifth” Vital Sign. Am J Clin Exp Med. 2021;9(6):233-237. doi: 10.11648/j.ajcem.20210906.17

    Copy | Download

  • @article{10.11648/j.ajcem.20210906.17,
      author = {Michael Raymond Binder},
      title = {Psychiatric and Functional Physical Symptoms: The More Telling “Fifth” Vital Sign},
      journal = {American Journal of Clinical and Experimental Medicine},
      volume = {9},
      number = {6},
      pages = {233-237},
      doi = {10.11648/j.ajcem.20210906.17},
      url = {https://doi.org/10.11648/j.ajcem.20210906.17},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajcem.20210906.17},
      abstract = {Historically, psychiatric symptomatology has been looked upon with a mixture of bewilderment and derision—the evidence of some kind of psychological or spiritual problem—but not of a medical or biological one. However, an explosion of new research suggests that psychiatric symptomatology may actually reveal as much about the physiological functioning of the body as heart rate, respiratory rate, temperature, and blood pressure. For example, there is growing evidence that psychiatric symptoms are associated with autonomic dysregulation and the early development of chronic debilitating diseases, such as diabetes, cardiovascular, hypertension, and cancer. These diseases then take the lives of the mentally ill at a much earlier age than the general population. In addition, an association has been found between upper-end-of-normal resting vital signs and the later development of major psychiatric illnesses, such as generalized anxiety disorder, obsessive-compulsive disorder, and schizophrenia. Notably, a similar association has been found between upper-end-of-normal resting vital signs and the early development of the same illnesses that shorten the lives of the mentally ill. These associations raise the possibility that subtle elevations in resting vital signs and psychiatric symptomology are different manifestations of a shared physiological abnormality. The identification of a core abnormality that influences such diverse emotional, psychological, and biological conditions could completely reshape the way we think about mental illness. It could unify mental disorders and medical disorders and raise psychiatric symptoms to the level of a “fifth” vital sign. This article will explore the links between mental illness, physical illness, and resting vital signs in an effort to utilize, if appropriate, psychiatric symptomatology as a barometer of physiological function. The unique value of psychiatric symptomatology in this regard is that it could reduce the need to distinguish psychiatric symptoms from medical symptoms while at the same time more clearly revealing, without any physical instrumentation, what is happening inside the body.},
     year = {2021}
    }
    

    Copy | Download

  • TY  - JOUR
    T1  - Psychiatric and Functional Physical Symptoms: The More Telling “Fifth” Vital Sign
    AU  - Michael Raymond Binder
    Y1  - 2021/12/24
    PY  - 2021
    N1  - https://doi.org/10.11648/j.ajcem.20210906.17
    DO  - 10.11648/j.ajcem.20210906.17
    T2  - American Journal of Clinical and Experimental Medicine
    JF  - American Journal of Clinical and Experimental Medicine
    JO  - American Journal of Clinical and Experimental Medicine
    SP  - 233
    EP  - 237
    PB  - Science Publishing Group
    SN  - 2330-8133
    UR  - https://doi.org/10.11648/j.ajcem.20210906.17
    AB  - Historically, psychiatric symptomatology has been looked upon with a mixture of bewilderment and derision—the evidence of some kind of psychological or spiritual problem—but not of a medical or biological one. However, an explosion of new research suggests that psychiatric symptomatology may actually reveal as much about the physiological functioning of the body as heart rate, respiratory rate, temperature, and blood pressure. For example, there is growing evidence that psychiatric symptoms are associated with autonomic dysregulation and the early development of chronic debilitating diseases, such as diabetes, cardiovascular, hypertension, and cancer. These diseases then take the lives of the mentally ill at a much earlier age than the general population. In addition, an association has been found between upper-end-of-normal resting vital signs and the later development of major psychiatric illnesses, such as generalized anxiety disorder, obsessive-compulsive disorder, and schizophrenia. Notably, a similar association has been found between upper-end-of-normal resting vital signs and the early development of the same illnesses that shorten the lives of the mentally ill. These associations raise the possibility that subtle elevations in resting vital signs and psychiatric symptomology are different manifestations of a shared physiological abnormality. The identification of a core abnormality that influences such diverse emotional, psychological, and biological conditions could completely reshape the way we think about mental illness. It could unify mental disorders and medical disorders and raise psychiatric symptoms to the level of a “fifth” vital sign. This article will explore the links between mental illness, physical illness, and resting vital signs in an effort to utilize, if appropriate, psychiatric symptomatology as a barometer of physiological function. The unique value of psychiatric symptomatology in this regard is that it could reduce the need to distinguish psychiatric symptoms from medical symptoms while at the same time more clearly revealing, without any physical instrumentation, what is happening inside the body.
    VL  - 9
    IS  - 6
    ER  - 

    Copy | Download

Author Information
  • Department of Psychiatry, North Shore University Health System, Highland Park, USA

  • Sections