If the picture of the disease had to be divided into levels of complexity, I would prefer three main gradations: symptoms-syndromes-the actual disease in its entirety. Moreover, the disease should include not only a set of symptoms and syndromes characteristic of each particular nosology, but also reflect the dynamics of these symptoms and syndromes: what was, what will be, than the heart will calm down — and you can no longer go to the fortune-teller.
So, syndromes are the next (after symptoms) step to understanding what happened to the patient. Syndrome (from Greek. syndrome, a cluster, confluence) is not just a set of symptoms. There is no arbitrary combination of them, simply because the card is so laid. Pathogenesis with the layout is not joking, then cry “stick to the soap!” no way. All symptoms are combined in strict accordance with what kind of disease, and what stage we are now seeing. And if the diagnosis was made correctly — and at all it is possible to make cautious predictions.
Of course, the syndrome is not a disease, and to complete the clinical picture often need a lot: from properly collected history (born-baptized-married-what’s amiss) to analyses and abusive-rave reviews specialists. However, the correct recognition of the syndrome can help determine the tactics of further management of the patient (delirium, oneiroid and catatonic syndrome — in the hospital, asthenic-can be treated on an outpatient basis), with prescriptions of drugs (Yes, already at this stage). What can I say — the international classification of diseases 10th revision, aka ICD-10, is mainly based on syndromic approach to classification. And again, knowing the syndromes, we can easily identify a simulant that demonstrates some symptoms, but can not show the whole picture of the disease (there are, of course, the master in this case, but such units).
There is one more subtlety of medical practice: each syndrome it is necessary though time in life to see in the presence of a teacher who will tell you: “Watch and remember, it’s paraphrenic syndrome, and this syndrome Kandinsky — clerambault, it’s the asthenic syndrome of the neurotic, and the depletion of mental activity of a schizophrenic, I feel the difference in each pair and look for patients, is something that words cannot Express or describe it so that you can avoid misunderstandings and double interpretation“. That’s why there is no correspondence study at the doctor. Only personally, internally, through the stage of joyful recognition — “that’s it, I was taught this!” – to the shining peaks of intuition and infallible medical guess (this is almost the same as the military savvy — allows one fleeting glance at the grenade flew into the trench to determine that in fact it mimicked the Northern fur-bearing beast).
All psychopathological syndromes can be divided into positive and negative.
Positive psychopathological syndromes (they are “plus-symptoms”) are new, previously absent in the psyche syndromes, which normally should not be. In other words, it was not — there was add on (however, the pros and positivism come to an end).
Recognizing a certain conventionality of disposition, by the degree of increasing complexity, severity and totality of manifestations, as well as by the degree of disturbance of mental activity and as reversibility decreases, positive syndromes could be arranged in the following order:
- Asthenic syndromes (positive);
- Affective symptoms;
- Neurotic syndromes;
- Hebeny syndrome;
- Syndromes of overvalued ideas;
- Hallucinatory-delusional syndromes;
- Lucene catatonic syndromes;
- Syndromes of impaired consciousness;
- Convulsive disorders;
- Psychoorganic syndrome (aka organic psychosyndrome — Faberge, self-portrait, fragment, different camera angles).
Negative psychopathological syndromes (they are deficit syndromes, they are “minus symptoms”) are characterized by the fact that from mental activity (such as it should be normal) with the inherent set of qualities and properties of a normal person something of these falls, is lost. Accordingly, damage is caused to mental activity and a personality defect is formed.
According to the degree of increase of negative syndromes can be arranged as follows:
- Asthenic syndrome (as negative);
- Change of the subjective “I” (or subjectively perceived change “I”),
- Objective personality changes;
- The disharmony of the individual;
- Reduction of energy potential (REP);
- A decrease in the level of the individual;
- The regression of the individual;
- Amnestic disorder;
- Total dementia;
- Mental insanity.
Now we can proceed to a more or less thoughtful consideration of each group of syndromes.