Psychiatric syndromes: main groups and examples

In clinical practice, a "syndrome" is a recognizable cluster of mental symptoms that regularly occur together (e.g., depressive, manic, psychotic, catatonic, delirious, obsessive-compulsive). A syndrome helps quickly describe "what's going on now" with a patient's attention, thinking, affect, psychomotor skills, and behavior before making a specific diagnosis. Such phenomenological language remains useful even in the era of standardized criteria because it expedites initial routing and the selection of emergency interventions. The ICD-11 explicitly focuses on clinical utility, cultural sensitivity, and the validity of descriptions—this is evident in its updated clinical guidelines (CDDR, 2024). [1]

It's important to distinguish "syndrome" from "disorder." A disorder is a diagnostic category with a set of requirements (duration, degree of impairment, exclusions, etc.). The same syndrome can occur in different disorders: catatonia is found in schizophrenia spectrum disorders, bipolar disorder, depression, and somatic/neurological conditions; delirium is a separate nosology, but the phenomenon of "acute confusion" can arise from a variety of causes. This "cross-cutting" logic is taken into account in ICD-11: for example, catatonia has received its own entries and coding rules. [2]

In parallel with categorization, a dimensional view of psychopathology is also developing. In the ICD-11, personality disorders are now coded by severity and trait domains, rather than "types," which better reflects the continuity of traits. In science, this shift is reinforced by the RDoC (Research Domain Criteria) framework: researchers describe mental disorders through basic systems (e.g., negative valence, cognition) and levels of analysis—from genes to behavior. For practitioners, this translates into more precise targeting of interventions by dysfunctional domains.

The DSM-5-TR (2022) updated criteria and texts for more than 70 conditions, introduced "prolonged grief disorder," and clarified codes and wording. The ICD-11 went further: it harmonized many provisions with the DSM, but also revised entire sections (for example, personality disorders) and moved a number of topics to other chapters (for example, sexual health). This reflects a general shift away from stigmatizing labels toward clinical usefulness and human rights. [4]

Brief map of key psychiatric syndromes (with descriptions)

In our practice, we recognize several "core" syndromes; they describe the current picture and suggest the first steps in diagnosis and treatment. Below is a guide with phenomenological markers and ICD-11 correspondence. These formulations are intended for clinical description, not as a substitute for diagnosis.

Table 1. Guide to syndromes: what they look like to the eye

Syndrome	What does it look like in the office?	Where is it most often "sewn" into ICD-11?	What you shouldn't miss at the start
Depressive	Depressed mood, anhedonia, fatigue, slowness, guilt; variable somatic complaints	Depressive episodes and bipolar/depressive spectrum disorders	Suicidal risk, psychotic features, mixed symptoms
Manic/hypomanic	Increased affect or irritability, accelerated thinking, decreased sleep, risky behavior	Bipolar disorder	Convulsive-resistant insomnia, dangerous behavior, psychosis
Psychotic (positive)	Delusions, hallucinations, disorganized speech/behavior	Schizophrenia and other primary psychotic disorders	Acute somatoneurological causes of psychosis, intoxication
Psychotic (negative)	Avolition, alogia, abulia, flattening of affect, social asociality	Schizophrenia (PANSS assessment, etc.)	Masking with depression/side effects
Catatonic	Motor stupor/stupor, mutism, waxy flexibility, negativism, echophenomena	Catatonia as a condition in various disorders	Urgency: risk of dehydration, thromboembolism; diagnostic test with lorazepam
Obsessive-compulsive	Obsessive thoughts/images and/or compulsions with temporary relief	Obsessive-compulsive disorder and related disorders	Diagnosis according to ICD-11 6B20; differentiate from schizotypal and tic disorders
Delirious ("acute confusion")	Acute onset, fluctuations, disturbed attention and consciousness	Delirium (6D70)	It's not just "psychiatry": finding a medical cause is essential

Sources: ICD-11 clinical descriptions (CDDR 2024), classification updates and validated scales. [5]

How to describe a syndrome: the language of phenomenology

A good description begins with the level of consciousness and attention: is the patient alert and communicative, does their level of alertness fluctuate, are there any fluctuations? This is how we differentiate delirium (acute confusion) from other conditions and decide whether urgent somatic diagnostics are needed. Next comes affect: mood, its stability, reactivity, and relevance to context. Anxiety and irritability are also noted as frequent "superstructural" emotions over the basic affect. [6]

The next block is thinking and perception. Here, delusional ideas (type, systematicity, degree of conviction), hallucinations (modality, frequency, distress), and the flow and pace of thinking (acceleration, viscosity, leaps) are recorded. Speech disorganization (disorganization, "verbal hash") is a marker of severe psychotic disorganization and prognosis. [7]

Psychomotor analysis provides a wealth of clues: from psychomotor retardation in depression and "motor acceleration" in mania to the catatonic range—stupor, frozen postures, echolalia/echopraxia. The presence of catatonia changes the emergency management strategy (benzodiazepines, electroconvulsive therapy in cases of resistance) and requires active somatic screening. [8]

Finally, the insight, severity, and impact of symptoms on functioning are always described. According to the ICD-11, the degree of impairment in daily life is no less important a criterion than the list of symptoms. It is the functional description that guides the treatment plan, including for personality disorders, where the ICD-11 has shifted to a "severity + trait domain" model. [9]

Clinician's tools: rapid screening and syndrome-marking scales

In emergency and general medicine, the 4AT has become the recommended tool for primary screening of delirium in adults: it takes approximately 2 minutes, requires little training, and has demonstrated high accuracy in meta-analyses. In intensive care, CAM-ICU/ICDSC is used. When in doubt, 3D-CAM and combined protocols (e.g., UB-2 → 3D-CAM) are helpful in patients with dementia. [10]

In psychiatry, highly specialized scales clarify the severity of domains. The PANSS, which separately assesses positive, negative, and general psychopathological symptoms—this is convenient for dynamic observation—is widely used for schizophrenia. For obsessive-compulsive disorder, the severity of obsessions/compulsions and their interference with life are assessed (scale assessment helps select the intensity of exposure and response prevention). [11]

The key is that scales do not replace clinical interviews and examinations. They standardize language and allow for comparison of dynamics and examinations, but diagnosis and treatment planning remain based on the patient's context, risks, and goals. ICD-11 emphasizes the clinical utility and cultural adaptability of descriptions—this also applies to the selection of scales. [12]

Table 2. Quick entry tools

Tool	What is it aimed at?	Where to apply
4AT	Delirium screening in approximately 2 minutes	Admissions department, hospital, geriatrics (outside the RAIT) [13]
CAM-ICU / ICDSC	Delirium during mechanical ventilation/in the intensive care unit	Intensive care, postoperative wards [14]
3D-CAM / UB-2→3D-CAM	Confirmation of delirium, including in the setting of dementia	Therapeutic departments, geriatrics [15]
PANSS	Severity of positive/negative/general symptoms	Psychotic disorders, treatment dynamics [16]

Clinical portraits: what key syndromes look like

Catatonic syndrome. The presentation ranges from stupor with mutism to agitation; negativism, waxy flexibility, echolalia/echopraxia, and catatonic postures are common. In ICD-11, catatonia is coded independently of the underlying disorder (affective, psychotic, or medical), facilitating care routing. First-line treatment is benzodiazepines (most commonly lorazepam, including the "diagnostic test"); if ineffective, electroconvulsive therapy is a proven and lifesaving option; alternatives and adjuvants are discussed in special scenarios. [17]

Delirious syndrome ("acute confusion"). This is an acutely onset, fluctuating impairment of attention and awareness. The cornerstones of diagnosis are 4AT outside the intensive care unit and CAM-ICU in the intensive care unit. Treatment is always etiotropic: identification and correction of medical causes (infection, hypoxia, electrolyte disturbances, drug effects) plus multicomponent non-pharmacological measures (orientation, sleep, hydration, hearing/vision correction); psychopharmacology is only used in cases of safety threat and distress. [18]

Psychotic syndrome: positive and negative domains. Positive symptoms include delusions, hallucinations, and disorganization; negative symptoms include avolition, alogia, anedonia, and flattening of affect. In ICD-11, the description of schizophrenia and related disorders is balanced across domains, and scales (e.g., PANSS) allow for an objective assessment of the dynamics and the planning of psychosocial rehabilitation. A key clinical challenge is to distinguish primary negative symptoms from depression, extrapyramidal inhibition, and social isolation. [19]

Obsessive-compulsive disorder. Obsessive thoughts/images and/or compulsions performed to reduce anxiety form a characteristic cycle of "obsession → ritual → brief relief." ICD-11 classifies obsessive-compulsive disorder within the "anankastic" category of disorders, emphasizing its differences from schizotypal and tic disorders. First-line treatment is exposure response prevention (ERP) and selective serotonin reuptake inhibitors; in severe forms, a combination of methods is used. [20]

What's new in ICD-11 and why is it important for practitioners?

ICD-11 has revised a number of areas. New nosologies have been introduced (e.g., complex post-traumatic stress disorder, "prolonged grief," and gaming disorder), and descriptions of obsessive-compulsive and related disorders, as well as bipolar disorders, including type II, have been expanded and clarified. These are not simply cosmetic changes: the updates are intended to improve recognition, eliminate "borderline gray areas," and improve the comparability of research and reporting.

A major shift is the new model of personality disorders: a single category, "personality disorder," with gradations of severity and trait domains (e.g., anankasticity, negative affectivity). This dimensional approach better aligns with reality, where personality traits lie on a continuum, and helps develop targeted treatment and rehabilitation plans.

The approach to sexual health and gender identity has also changed. In the ICD-11, "gender dysphoria/incongruence" has been moved to the chapter on sexual health, rather than mental disorders. This reflects the integration of biological and psychosocial factors and reduces stigma in accessing care. The focus is on access to medical and psychological support and human rights.

Finally, the World Health Organization released updated clinical descriptions and diagnostic requirements (CDDR, 2024), which affirm the ICD-11's goal of "clinical utility" and global applicability. For clinicians, this means more guidance on "how to describe," "what to exclude," and "how to document" syndromic presentations without losing the nuances of a specific context. [24]

Table 3. ICD-11 changes that most often affect practice

Region	What has changed?	Why does the clinic need this?
Personality disorders	One category + severity + trait domains	More prognostic and therapeutic benefit; fewer “labels”
New/clarified conditions	Complex PTSD, prolonged grief, gaming disorder, bipolar II	Improving recognition, routing, research comparability
Catatonia	Individual codes and descriptions	Rapid initiation of specific care (lorazepam/ECT), interdisciplinarity [27]
Sexual health/gender	Transfer of topics from the chapter on disorders	Reducing stigma, interdisciplinary care pathways

Treatment principles based on syndromes: what's important to remember at the patient's bedside

The first principle is safety and etiology. Delirious syndrome always requires a search for a medical cause and multi-component non-pharmacological measures; antipsychotics are used briefly and only when safety is threatened and severe distress is present, and not "for prevention." Catatonia is an emergency: start with benzodiazepines (usually lorazepam, a diagnostic test is possible); if the effect is insufficient, electroconvulsive therapy (ECT) is a method with proven efficacy, taking into account risks, consent, and local regulations. [29]

In obsessive-compulsive disorder, the baseline treatment is exposure response prevention (ERP) psychotherapy and/or selective serotonin reuptake inhibitors (SSRIs); in severe forms, a combination is preferred. This is reflected in both the literature of specialized associations and in modern reviews and guidelines. It is important not to confuse "perfectionist traits" with obsessive-compulsive disorder; the key is the presence of obsessions/rituals, time, and distress. [30]

For psychotic syndromes, the strategy is twofold: managing the severity (antipsychotics, sleep, safety) and early integration of psychoeducation, family work, cognitive-behavioral, and rehabilitation approaches, including those targeting negative symptoms. Assessing negative symptoms using scales helps avoid "losing" the domain that most significantly reduces functionality. [31]

Affective syndromes (depressive, manic) are managed according to guidelines for bipolar and depressive disorders, but at the "syndrome" level, the clinician is obligated to: assess suicidal risk, exclude mixed symptoms, adjust sleep and rhythms, and consider somatic interactions. The ICD-11 and DSM-5-TR largely converge here, and clinical descriptions (CDDR) offer clear "red flags" and tactical guidelines. [32]