Syndromes in psychiatry

The general picture of mental illnesses consists of individual signs (symptoms), which are considered in combination with each other. Such combinations of signs are called syndromes. Syndromes in psychiatry are an important component for making a correct diagnosis. For the convenience of classification and recognition of mental disorders, specialists have identified a number of the most common symptom complexes, which we will briefly consider.

General characteristics

The characteristics of the syndrome play a very important role in making a correct diagnosis. Despite the fact that in other diseases it is most important to determine the cause of the pathology, in psychiatry this is not so relevant. In most cases, it is not possible to determine the cause of a mental disorder. Based on this, the emphasis is placed on determining the leading signs, which are then combined into a syndrome typical for the disease.

For example, deep depression is characterized by the appearance of suicidal thoughts. In this case, the doctor's tactics should be aimed at attentive attitude and, literally, supervision of the patient.

In patients with schizophrenia, the main syndrome is considered to be contradiction, or schisis. This means that the external emotional state of a person does not coincide with his internal mood. For example, when a patient is happy, he cries bitterly, and when he is in pain, he smiles.

In patients with epilepsy, the main syndrome is considered to be paroxysmal - this is the sudden appearance and equally sharp fading of symptoms of the disease (attack).

Even the international classification of diseases – ICD-10 – is based not so much on psychiatric diseases as on syndromes.

List of major syndromes in psychiatry

Syndromes associated with hallucinations and delusions.

• Hallucinosis is the presence of various hallucinations related to either hearing, or vision, or tactile sensations. Hallucinosis can be acute or chronic. Accordingly, with auditory hallucinosis, the patient hears non-existent sounds, voices addressed to him and forcing him to some action. With tactile hallucinosis, patients feel some non-existent touches to themselves. With visual hallucinosis, the patient can "see" something that is not actually there - these can be inanimate objects, or people or animals. This phenomenon can often be observed in blind patients.
• Paranoia syndrome is a primary delusional state that reflects the surrounding reality. It can be an initial sign of schizophrenia or develop as an independent disease.
• Hallucinatory-paranoid syndrome is a diverse combination and presence of hallucinations and delusional state, which have a common pathogenesis of development. A variety of such syndrome is the mental automatism of Kandinsky-Clerambault. The patient insists that his thinking or ability to move does not belong to him, that someone from the outside automatically controls him. Another variety of hallucinatory-paranoid syndrome is Chikatilo syndrome, which is the development of a mechanism in a person that begins to control his behavior. The syndrome develops over a long period of time. The discomfort that arises in the patient gives impetus to committing sadistic crimes based on sexual weakness or dissatisfaction.
• Pathological jealousy syndrome is one of the forms of obsessive and delusional ideas. This condition is further subdivided into several syndromes: the syndrome of the "existing third" (with real jealousy and passion, turning into reactive depression), the syndrome of the "probable third" (with obsessive states associated with jealousy), and the syndrome of the "imaginary third" (with delusional jealous fantasies and signs of paranoia).

Syndromes associated with intellectual disabilities.

• Dementia syndrome is a persistent, difficult to compensate loss of mental abilities, the so-called intellectual degradation. The patient not only refuses and cannot learn new things, but also loses the previously acquired level of intelligence. Dementia can be associated with certain diseases, such as cerebral atherosclerosis, progressive paralysis, syphilitic brain damage, epilepsy, schizophrenia, etc.

Syndrome associated with the state of affect.

• Manic syndrome is characterized by such a triad of signs as a sharp increase in mood, accelerated flow of ideas, motor-speech excitement. As a result, there is an overestimation of oneself as a person, mania of grandeur, emotional instability arises.
• Depressive state – on the contrary, is characterized by a depressed mood, slow flow of ideas and motor-speech inhibition. Such effects as self-abasement, loss of aspirations and desires, “dark” thoughts and a depressed state are observed.
• Anxious depressive syndrome is a combination of depressive and manic states, which alternate with each other. Motor stupor may occur against the background of an elevated mood, or motor activity simultaneously with mental retardation.
• Depressive paranoid syndrome can manifest itself as a combination of features of schizophrenia and other psychotic conditions.
• Asthenic syndrome is characterized by increased fatigue, excitability and mood instability, which is especially noticeable against the background of vegetative disorders and sleep disorders. Usually, the signs of asthenic syndrome subside in the morning, manifesting themselves with renewed vigor in the second half of the day. Asthenia is often difficult to distinguish from a depressive state, so specialists distinguish a combined syndrome, calling it astheno-depressive.
• Organic syndrome is a combination of three symptoms, such as deterioration of the memorization process, decreased intelligence and inability to control emotions. This syndrome has another name – Walter-Buell triad. At the first stage, the condition manifests itself as general weakness and asthenia, instability in behavior and decreased performance. The patient’s intelligence suddenly begins to decline, the range of interests narrows, speech becomes poor. Such a patient loses the ability to memorize new information, and also forgets what was previously recorded in memory. Often, organic syndrome turns into a depressive or hallucinatory state, sometimes accompanied by epileptic seizures or psychosis.

A syndrome associated with impaired motor and volitional functions.

• Catatonic syndrome has such typical symptoms as catatonic stupor and catatonic excitement. Such conditions manifest themselves in stages, one after another. This psychiatric syndrome is caused by pathological weakness of neurons, when quite harmless irritants cause an excessive reaction in the body. During stupor, the patient is lethargic, shows no interest in the world around him or himself. Most patients simply lie with their face against the wall for many days and even years. A characteristic sign is the "air cushion" - the patient lies with his head raised above the pillow. Sucking and grasping reflexes, which are inherent only to infants, are resumed. Often, at night, the manifestations of catatonic syndrome weaken.
• Catatonic agitation manifests itself as both a motor and emotionally excited state. The patient becomes aggressive and negatively disposed. Facial expressions are often two-sided: for example, the eyes express joy, while the lips are clenched in a fit of anger. The patient may either stubbornly remain silent or speak uncontrollably and senselessly.
• Lucid catatonic state occurs in full consciousness.
• Oneiroid catatonic state manifests itself with depression of consciousness.

Neurotic syndrome

• Neurasthenic syndrome (the same asthenic syndrome) is expressed in weakness, impatience, exhausted attention and sleep disorders. The condition may be accompanied by headaches, problems with the autonomic nervous system.
• Hypochondriacal syndrome manifests itself in excessive attention to one's body, health condition and comfort. The patient constantly listens to his body, visits doctors without reason and takes a large number of unnecessary tests and examinations.
• Hysterical syndrome is characterized by excessive self-suggestibility, egoism, imaginativeness and emotional instability. Such syndrome is typical for hysterical neuroses and psychopathies.
• Psychopathic syndrome is a disharmony of emotional and volitional states. It can proceed according to two scenarios – excitability and increased inhibition. The first option implies excessive irritability, negative mood, desire for conflicts, impatience, predisposition to alcoholism and drug addiction. The second option is characterized by weakness, sluggish reaction, hypodynamia, decreased self-esteem, skepticism.

When assessing the patient's mental state, it is important to determine the depth and extent of the symptoms detected. Based on this, syndromes in psychiatry can be divided into neurotic and psychotic.