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

Definition of Disease and Syndrome

Disease and syndrome are important terms in medicine especially with respect to making a diagnosis. As such, the terms disease and syndrome are explained first in the article.

What is disease?

Disease is the disruption of the physical, mental, and social well-being of a person. It is to be differentiated from ill-health. However, a review of the factors involved in the definition of disease above shows that such a distinction is difficult as a healthy patient can feel ill and people sick might not suspect anything about their actual condition.

Moreover, someone who is apparently healthy can actually get sick of an imagined illness alone and, a patient could suspect a disease but may not have it diagnosed for various reasons.

Differentiating disease and health could be problematic in certain cases. This means that the physician must not deem the patient as healthy simply because there is no diagnosis. Even if an imaginary disease is suspected—the patient is sick. In this case, although the suspected disease is not present, there are mental health problems that require treatment if they cause great psychological suffering.

However, it must always be acknowledged that an error may have occurred during the diagnosis and the patient is indeed physically ill.

What is a syndrome and what are its symptoms?

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

Symptom is not a disease, but merely an indication of a disease. 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 a symptom complex with an unknown cause. 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 currently no treatment.

down syndrome

Image: Down syndrome. By: BruceBlaus. License: CC BY 3.0

Sometimes the terms ‘disease’ and ‘syndrome’ may indicate varying degrees of medical knowledge. While ‘disease’ can be understood as an entity that has a well-defined etiology and pathogenesis, a “syndrome” may be understood as an entity with a defined etiology but unknown pathogenesis.

Physical and Mental Illnesses

Diseases can be physical or 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. One must 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 provider.

Dementia as a syndrome

Dementia is also a syndrome. Here, symptom complexes occur as well that are indeed associated with dementia but seem unassociated with the disease itself. Dementia occurs mainly in elderly individuals and can, for instance, be the result of deposits, which increasingly hinder brain function.

Alzheimer’s is just one example and shows that dementia is a syndrome that can mask many diseases. Dementia can also be the result of a brain injury, as it can be caused by an accident, for instance. Moreover, cerebral infarctions can be potential triggers of dementia. Therefore, if symptoms of dementia appear, such as concentration, forgetfulness, and perhaps even phases of disorientation, they are referred to as dementia until the trigger is identified.

Stockholm syndrome

A syndrome is not necessarily a physical illness. Psychological effects such as 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 unhealthy relationships. Possible explanation for this is that they perceive every little attention given by the perpetrator as an act of mercy. As such, there could be difficulties in breaking free from such associations. In the worst-case scenario, victims could even support the perpetrator in harming other people.

It is also possible that victims cover and protect the perpetrator. The patient is a victim here and finds himself/herself in psychological dependence. Rational judgment is no longer possible (trauma bonding). Classic examples are women in relationships with narcissistic personalities.

Safe Decision-Making For or Against Treatment

Harmless diseases can lead to complications that could rapidly lead to life-threatening situations. Even in cases of moderate disease, exacerbations can occur if the right time is missed when treatment could bring about a cure.

Physicians without sufficient experience are more at risk of mistakes. To recognize one’s own abilities and limitations is the responsibility of the physician, and this implies consulting experts or experienced colleagues promptly. The fear of making mistakes must not lead to uncertainties.

If physicians question themselves more than is necessary, it will hinder their daily decision-making processes. However, unfounded confidence in one’s abilities can endanger the patient. The physician will most certainly encounter situations, and not only at the beginning of a medical career, in which the decision for or against a specific or basic treatment is difficult.

Decision to Take Action or Watch and Wait

syringeParticularly in cancer therapy, the question between waiting and acting is common. It has been indicated that immediate action is not necessary in all cases.

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 recently changed. This is largely due to new drugs that are highly effective against lymphomas and are used alone or in combination with other drugs. 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 for non-Hodgkin lymphoma. Early start of therapy is particularly useful in patients with rapid disease progression.

Advantages of watch-and-wait behavior

Upon the diagnosis of a disease and the realization that progression is imminent, the physician can still justify a watch-and-wait behavior. This is so in cases where disease progression is foreseen but no immediate intervention is absolutely necessary.

Examples include some cancers, such as prostate cancer. If the tumor is very small, it is obvious that it is growing slowly and if it is confined to the prostate, a watch-and-wait behavior can be justified. The patient has the opportunity to review the available treatment methods and to consult with his family. Careful monitoring is, however, a prerequisite for watch-and-wait behavior.

Waiting may also be advised if the patient is elderly and treatment options are exerting for the patient. In this case, it has to be considered which measures are required to sustain the quality of life for 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 can they lead to impairment. Watch-and-wait is a treatment strategy and is not an actual therapy or treatment. It is to be distinguished from the need for treatment.

It must be clarified that watch-and-wait or treatment must not be a fundamental decision, but rather 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 is an important topic. This could occur if the patient sees any treatments as pointless or refuses the treatment for personal reasons. Hereby, the doctor should advise the patient in order to allow the patient to reevaluate the situation more objectively and comprehensively. In this context, the physician must also accept the patient’s decision to ultimately refuse treatment. However, the prerequisite is that the patient is in full possession of his mental capacity and can realistically assess the situation.

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