Symptoms And Syndromes

The first stage in the establishment of syndromes is the conceptualization of individual symptoms. Symptoms in psychiatry are formulations of aspects of human experience that are held to indicate abnormality. Examples include abnormally depressed mood, impaired concentration, loss of sexual interest, and persistent wakefulness early in the morning. They sometime conflate what is abnormal for the individual and what is abnormal for the population, but they can generally be defined in terms that are reliable. Signs (which are unreliable and rarely discriminating in psychiatry, and thus tend to be discounted somewhat) are the observable concomitants of such experiences, such as observed depressed mood, or behaviour that could be interpreted as a response to hallucinations. Different symptoms (and signs) often coexist in people who are psychologically disturbed, and this encourages the idea that they go together to form recognizable syndromes. The formulation of syndromes is the first stage in the disease approach to medical phenomena, as syndromes can be subjected to investigations that test the various types of theories described above.

While syndromes are essentially lists of qualifying symptoms and signs, individuals may be classed as having a syndrome while exhibiting only some of the constituent symptoms. Moreover, within a syndrome, there may be theoretical and empirical reasons for regarding some symptoms as having special significance. Other symptoms may be relatively nonspecific, occurring in several syndromes, but, even so, if they cluster in numbers with other symptoms, they may achieve a joint significance. This inequality between symptoms is seen in the syndrome of unipolar depression: depressed mood and anhedonia are usually taken as central, while other symptoms (such as fatigue or insomnia) have little significance on their own. This reflects serious problems with the raw material of human experience: it does not lend itself to the establishment of the desired mutually exclusive and jointly exhaustive categories.

In an ideal world, all the symptoms making up a syndrome would be discriminating, but this is far from true, and decisions about whether a given subject's symptom pattern can be classed as lying within a syndrome usually show an element of arbitrariness. The result is that two individuals may both be taken to suffer from unipolar depression despite exhibiting considerable symptomatic differences.

This is tied in with the idea of symptom severity: disorders may be regarded as severe either from the sheer number of symptoms, or because several symptoms are present in severe degree. In practice, disorders with large numbers of symptoms also tend to have a greater severity of individual symptoms.

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