Disease and syndrome: These terms are a part of the daily routine for every physician. After all, the symptoms can so clearly point to a disease that the distinction presents the examining physician with a major challenge. This article is about the criteria for the distinction of diseases and syndromes as well as the behaviour of the physician after the respective diagnosis has been made. Afterwards, you can check your knowledge by answering the exam questions.
Image: “stethoscope” by Dr.Farouk. License: CC BY 2.0

Image: “stethoscope” by Dr.Farouk. License: CC BY 2.0

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Definition of Disease and Syndrome

Disease and syndrome are terms which are important in medicine and especially in the making of the diagnosis. Hereinafter, the terms disease and syndrome are explained first.

Even here it is shown that a distinction can be difficult to make but should not be neglected all the same. Furthermore, it is about the approaches to research and the task of the physician in caring for his patients as a part of the watch-and-wait behaviour despite the diagnosis of a serious illness.

What is a disease?

Disease (morbus) is the disruption of the physical, mental, and social well-being. It is to be separated from health. The mere listing of the factors involved in the definition, however, shows that a distinct separation is not possible. A healthy patient can feel ill and someone sick might not suspect anything about his actual condition.

Moreover, someone who is apparently healthy can actually get sick through an imagined illness alone. And, finally, the danger remains that a patient suspects a disease but does not have it diagnosed for various reasons.

The separation between disease and health is therefore extremely problematic. For the physician this means that he must not deem the patient as healthy simply because of the fact that there is no diagnosis. Even if he suspects that it is an imaginary disease, the patient is sick. In this case, although the suspected disease is not present, there are mental health problems instead, which require treatment if they cause great psychological suffering.

However, the thought must always be acknowledged that an error may have occurred during the making of the diagnosis and the patient is physically ill after all.

What is a syndrome? What are symptoms?

Symptoms are divided into mental symptoms, physical symptoms, and abnormal behaviours. Mental illnesses can be perceptual disorders but also the inability to process a particular experience. It can also, however, be about the disruptions in social relationships or problems with managing all types of bodily functions.

A symptom is not a disease but merely an indication or an accompanying symptom. The word syndrome comes from the Greek language and translates to “running together”. Various symptoms occur simultaneously in a syndrome. It is possible that these symptoms are an indicator of a certain disease.

One example is Sjögren’s syndrome, a chronic and inflammatory autoimmune disease. First it is, however, a symptom complex with a cause that is unknown. A syndrome also does not reveal anything about the disease itself. This is clearly reflected in Down’s syndrome as well, which can hardly be classified as an illness in the proper sense. This is also due to the fact that this is a genetic defect that is already present at birth and for which there is no treatment.

down syndrome

Image: “Down-Syndrom” by BruceBlaus. License: CC BY 3.0

Physical and Mental Illnesses

Diseases can be physical and mental. Furthermore, a connection can exist between the two. Prolonged and very painful diseases always have an effect on one’s mental state as well. This is particularly true for diseases that shorten one’s lifespan or permanently impair one’s quality of life.

During treatment, it is therefore not sufficient to limit therapy to the physical symptoms alone. Above all, one must have the foresight to take into account, whether the patient is able to withstand the progression of the disease and which supporting measures may need to be introduced at an early stage.

This is particularly important if these therapeutic approaches cannot be implemented at short notice but rather require certain preparation. In most cases it involves applications and discussions with the respective health insurance company.

Dementia as a Syndrome

Dementia is also a syndrome. Here, symptom complexes occur as well that are indeed associated with dementia, but still do not mention the disease itself. Dementia occurs mainly in elderly individuals and can, for instance, be the result of deposits, which hinder the brain in its work and increasingly impair it.

Alzheimer’s is just one example for this which shows that dementia is a syndrome behind which many diseases can hide. Dementia can also be the result of a brain injury, as it can be caused by an accident, for instance. But even cerebral infarctions can be potential triggers.

Therefore, if symptoms of dementia appear such as problems with concentration, forgetfulness, and perhaps even phases of disorientation, they are referred to as dementia until the trigger is identified. A syndrome must also not necessarily be a physical illness.

The Stockholm syndrome

Psychological effects such as the Stockholm syndrome are also possible. In cases of Stockholm syndrome, the victim of a kidnapping or hostage-taking generates positive feelings for the perpetrator which can intensify into deep feelings. Other “trauma bonds” fall into this category as well.

Stockholm syndrome also affects individuals who are unable to leave relationships that are unhealthy for them. The approach to an explanation for this is that they perceive every little attention given by the perpetrator as an act of mercy. It is almost impossible for them to break free. In the worst case scenario, they even support the perpetrator in harming other people.

It is also possible that they cover his behaviour in order to protect him. The patient is a victim here and finds himself/herself in a psychological dependence. Rational judgment is no longer possible (trauma bonding). A classic example are women in relationships with narcissistic personalities.

Safe Decision-Making For or Against Treatment

As a matter of principle, even harmless diseases can lead to complications which can take a threatening turn at any time. Even in cases of moderate diseases, exacerbations can occur if the right time is missed when treatment could bring about a cure.

Physicians without sufficient experience are more at risk to make mistakes. To recognize one’s own abilities and its limitations is the responsibility of the physician. This also includes consulting experts or experienced colleagues in a timely manner. The fear of making mistakes must not lead to uncertainties.

If the physician questions himself too much, it will hinder his daily decision-making processes which can indeed be challenging. Too much confidence in their own abilities can, however, endanger the patient’s life. The physician will most certainly encounter situations in his lifetime and not only at the beginning of his career, in which the decision for or against a specific or basic treatment is difficult.

Decision to Take Action or Watch-and-Wait

syringeEspecially in cancer therapy, the question between waiting and acting is common. It has been indicated that an immediate action is not necessarily required in all cases.

The Non-Hodgkin lymphoma serves as an example. While in the past the perception prevailed that the disease is not curable and leads to death in every case, this attitude has changed in the meantime. This is, in large part, due to new drugs that are highly effective in lymphomas and are used in combination with chemotherapy or alone. In elderly patients it has been shown that quality of life can be significantly increased and that life expectancy should no longer be considered as reduced. An early start of therapy is particularly useful in those patients where it becomes apparent that the disease is progressing rapidly.

Advantages of watch-and-wait behaviour

Upon the diagnosis of a disease and the realization that it will have a dangerous progression, the physician can still justify watch-and-wait behaviour. This is the case in diseases in which, although the progression is dangerous, no immediate intervention is absolutely necessary.

Examples for this are some cancers such as prostate cancer. If the tumour is still very small, it is obvious that it is growing slowly and if it is confined to the prostate, watch-and wait behaviour can be justified. The patient has the opportunity to review the available treatment methods in peace and to consult with his family.

Careful monitoring is, however, the prerequisite for watch-and-wait behaviour. Waiting may also be advised if the patient is of old age already and the risk exists that the treatment is too exhausting. In this case, it has to be considered which measures are required to sustain quality of life as long as possible. The use of pain medicines is particularly important here.

Waiting can be useful in thyroid nodules which rarely cause problems but can be felt and are visible in ultrasound images. Only if the nodules become too large, they lead to impairment. In this context of “watchful waiting” (ww)”, watch-and-wait is referred to in science. This means a treatment strategy which is not an actual therapy or treatment. It is to be distinguished from the need for treatment.

It goes without saying that watch-and-wait or treatment must not be a fundamental decision, but rather just the result of thorough deliberation in the individual case.

Considering the Personal Assessment of the Patient

In medical psychology, dealing with patients who are unwilling to receive treatment takes up a lot of space and even philosophy deals with this topic. The patient must not be reduced to his suffering. By the same token, the purpose of medical treatment cannot be to exclusively eliminate the suffering. Instead, the goal is overcoming the disease.

This should also apply if the struggle is pointless or appears to be pointless. Hereby, the doctor is active in conjunction with the patient and advises the patient so that he can self-assess his situation comprehensively. In this context, the physician must also accept the patient’s decision should he refuse treatment. The prerequisite is that the patient is in full possession of his mental capacity and can realistically assess the situation.

Popular Exam Questions Regarding Disease and Syndrome

The answers are located below the references.

1. A syndrome is…

  1. …a chronic disease.
  2. …a congenital disease.
  3. …a symptom complex.
  4. …an untreatable disease.
  5. …a tumor disease.

2. Dementia is…

  1. …the medical term for Alzheimer´s.
  2. …always the result of a brain injury.
  3. …not a syndrome.
  4. …a syndrome.
  5. …a barely researched disease.

3. Watch-and-wairt instead of treatment…

  1. …is allowed only in mild diseases.
  2. …is prohibited in cancers.
  3. …must only be decides on in elderly patients.
  4. …is only useful for acute illnesses.
  5. …is useful in some cancers.
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