Symptomatology

from Wikipedia, the free encyclopedia

In medicine, symptomatology is understood to mean the teaching of characteristic signs or symptoms (the theory of symptoms ). Characteristic of a certain disease are those signs that have been defined as essential in textbooks or with the help of a diagnostic glossary for recognizing and determining a disease and accordingly classified systematically and scientifically. They are differentiated from the general symptoms that occur in a large number of diseases and are therefore regarded as unspecific . Symptomatology is to be understood as a semiology .

On the other hand, the presented arbitrary totality of disease symptoms, as it arises on the basis of a concrete examination in a certain disease case, i. H. in the case of a disease process that is systematically possibly still undefined and therefore still needs to be diagnosed in more detail, referred to as symptomatology. This meaning corresponds to the original definition of the syndrome . It also includes the possibility of the presence of unspecific or different diseases or disorders to be taken into account in differential diagnosis .

Basic assumptions

The basic assumption of symptomatology can be that both individual signs of illness, which u. U. are assumed to be key symptoms or cardinal symptoms , as well as a certain larger number of symptoms are considered to be characteristic of a specific disease process present in each case. This multitude of symptoms, which are very precisely outlined and more precisely defined according to a disease theory , is also viewed as the totality of all the phenomena characteristic of a disease. It is also known as a clinical picture . If not all the symptoms required by textbooks or listed in a glossary are observed in a particular case of illness, one speaks of a weaker or blander or of a mitigated and oligosymptomatic manifestation of the disease (forme fruste). Illnesses can exist without manifest symptoms. They are then called asymptomatic. This shows that it is not the symptom that is the cause of the disease, but, conversely, that the disease is the cause of the symptoms, cf. Cape. Philosophical Approaches .

criticism

The symptoms that occur simultaneously at a specific point in time during the course of an illness can be understood as a cross-sectional characteristic of an illness. The assumption that a large number of characteristic symptoms at a very specific point in time in the course of the disease increases the probability of an accurate diagnosis ( validity ) purely statistically, seems plausible. However, this assumption must be put into perspective. Certain symptoms are to be understood only as being typical of the overall stages of a disease, such as the pathogenesis of a disease and the like. a. describes. As an example, the formation of defects in the end stage of the course of a mental illness should be mentioned. This course-related longitudinal characteristic of diseases was only obtained during the 19th and early 20th centuries. During this time, attempts were made to differentiate certain disease units from the plethora of prognostically unfavorable cases. Representatives of this view were Antoine Bayle (1799–1858), Karl Ludwig Kahlbaum (1828–1899), Emil Kraepelin (1856–1926), and Eugen Bleuler (1857–1939). The observation of the process of diseases had already begun with Jean-Étienne Esquirol (1772-1840). He distinguished the four stages of melancholy → monomania → mania → dementia . He also assumed a progression of illnesses through the development from the functional-psychic to the structural-physical stage.

The prognosis is less favorable, the less promising treatment concepts are available. Furthermore, pathological-anatomical findings to be collected are to be regarded as characteristic of a particular disease. They are supplemented by pathohistological and pathochemical findings that may need to be collected . Pathology was therefore also regarded as the determining science for a general theory of diseases. Also etiologic factors include. a. important for the characteristics of the disease.

Psychiatry does not claim a special position in the assessment of symptoms. In principle, a purely physical illness, such as a diphtheric swallowing disorder, can be associated with considerable social consequences and thus also contribute to psychologically-related symptoms. According to Thure von Uexküll (1908–2004), it is a question of which integration area a certain symptom, such as a “swallowing disorder”, can be assigned to. According to the inventory of the ICD-10 , several axes are available that take into account various factors relating to physical and mental , social and individual coping with life as well as possible environmental factors .

Philosophical Approaches

Symptomatology as the study of the symptoms of illness was often combined with phenomenological approaches. The distinction between phenomenon (= "thing of meaning") and noumenon (= "thing of understanding" according to Kant KrV A 248 f. Or " original phenomenon " according to Goethe ) was used, not just since Immanuel Kant (1724–1804) , cf. philosophical meaning of the term cause ). According to Kant and his epistemological theory , the empirically straightforward and therefore easily comprehensible phenomenon, such as is the case in the description and portrayal of symptoms of illness, should be distinguished from the historically substantiated and sometimes only slowly emerging conceptual formation and classification of diseases. The concrete appearance is to be separated from what the appearance - or here in the case of medicine, the symptomatology - indicates. Symptomatology tells of the disease . In other words, a distinction is to be made between the phenomena that are empirically directly to be grasped and those that cannot be empirically grasped directly, such as the various types of diseases which, according to the current teaching of symptomatology, can only be recognized with the help of essential or characteristic symptoms. In medical history, this distinction was not always a matter of course. Certain abnormalities, nowadays seen more as psychological symptoms, were originally classified as illnesses, especially monomanias . For Esquirol, monomania was the disease of his time. Madness was a disease in the old days, and so was hallucination .

Todays situation

psychiatry

As far as the current classification of mental illnesses is concerned, a tendency towards regression can be felt with regard to the historically gradual delimitation of illness units. The chap. V of the classification of mental disorders of the ICD-10 completely or at least partially - more or less consciously - dispensed with a large number of traditionally used nosological concepts of psychiatry . The nosographic-descriptive character of the psychiatric classification was strengthened, but terms such as illness were largely avoided. Instead, the term disorder was introduced. In psychiatry, in addition to the symptomatology as a cross-sectional view, the disease criteria traditionally also included the longitudinal view of the course of the disease including the pathogenesis , the pathological-anatomical findings , heredity , endogeneity , the distinction between neurosis and psychosis , epidemiology as the principle of comorbidity and the etiological classification more easily recognizable Causes of disease. By strengthening the descriptive character of the ICD-10 glossary and at the same time avoiding the term disease, there was inevitably a clear expansion and increase in diagnostic classifications.

Compared to the edition of the ICD-9 in 1978, the ICD-10 glossary has more than doubled in size from 1991. The expansion u. a. Relevant treatment indications within the meaning of the statutory health insurance and thus also the drug treatment had considerable effects, which led to an increase in sales in the pharmaceutical industry. This aroused public criticism of the prescription of drugs, for example for ADHD .

The introduction of the term “mental disorder” appears questionable in view of the medical practice of billing flat rates , since in this respect disorders are handled in the same way as previous illnesses. Since illness is an abstract term, it wonders whether it makes sense to replace it with another abstract term, such as disorder, which seems to emphasize more functional considerations .

With regard to the doctor-patient relationship , the growing bureaucratisation was not only lamented with regard to the flat rate case, whereby, for example, too little weight was given to the individual factors. The treatment principle of Ludolf von Krehl was invoked , that sick people should be treated, not illnesses. In this context it is also worth remembering the position of Karl Jaspers, who dismissed excessively phenomenologically determined conceptions as “registrations ad infinitum” (= ›endless symptoms‹), cf. History of Psychiatry . However, they are not outdated, but have experienced a renaissance, as the representatives of this predominantly symptomatic attitude today call themselves Neo-Kraepelinians.

Emil Kraepelin (1856–1926) was shaped by scientific thinking and thus represented a largely aetiologically based view, according to which one cause always brings about the same condition. In the context of the symptomatology, the question of the reversibility of this relationship arose. Carl Wernicke (1848–1905) believed that psychopathological syndromes do not allow any reliable conclusions to be drawn about their cause. He proceeded from considerations relating to the localization of the brain and, in contrast to Kraepelin, from aspects of basic psychological types. His view was later to gain general acceptance in classical German psychiatry . For example, Gerd Huber (1921–2012) still took the view with regard to the observable correspondence of psychological symptoms in different disease processes that a community of expressions of mental illnesses should be assumed in advance and not causal commonalities.

In psychiatry in particular , the delimitation of disease units is complicated by the fact that there is not only an external, purely objectively ascertainable symptomatology, but also a highly subjectively determined evaluation of the state of mind .

Since the introduction of the term “disorder”, traditional critical positions in the clarification of previous illnesses have been dispensed with. This criticism seems to resonate even with the editors of the German translation of the ICD-10 diagnosis key when they finally state in the foreword of the German edition that “broader aspects of psychopathology” such as psychodynamics and psychophysiology as well as the individual characteristics of the individual patient do not emerge from the Eyes are losing.

Other areas of expertise

As of August 1994, the ICD-10 diagnosis code is divided into 21 main chapters, which are designated with Roman numerals. These largely correspond to the individual medical specialties, including psychiatry (Chapter V). While the ICD-10 emphasized the descriptive criteria of symptomatology in the psychiatric field, in the non-psychiatric medical fields the criteria of the nosological classification according to ICD-10 were presented according to very different, more or less eclectic criteria. So were z. B. the infectious diseases according to etiological , respiratory diseases according to topographical or the pregnancy complications according to situation-dependent aspects. This contradicts the requirement for uniform criteria of the disease units to be distinguished (requirement no. 4).

Individual evidence

  1. ↑ a b c Norbert Boss (Ed.): Roche Lexicon Medicine . 2nd Edition. Hoffmann-La Roche AG and Urban & Schwarzenberg, Munich, 1987, ISBN 3-541-13191-8 ; (a) + (b) p. 1657 on lexical lemmas “Symptomatology” and “Symptomatics”; (c) p. 127 on Lex. lemma “asymptomatic”; Gesundheit.de/roche
  2. ↑ a b c Erwin H. Ackerknecht : Brief history of psychiatry . 3. Edition. Enke, Stuttgart 1985, ISBN 3-432-80043-6 ; (a) pp. 16, 44; 51, 55 re. “Symptom as a classification principle”; (b) pp. 2–5, 16, 44, 51, 55, 75 on stw. “Critique and Relativity of Symptom Assessment”; (c) p. 78 on head “direct psychology, psychotherapy”.
  3. ^ A b Klaus Dörner : Citizens and Irre . On the social history and sociology of science in psychiatry. (1969) Fischer Taschenbuch, Bücher des Wissens, Frankfurt / M 1975, ISBN 3-436-02101-6 ; (a) p. 175 on head. “Course of the disease”; (b). P. 176 to Stw. "Sociological diagnosis of the times by Esquirol".
  4. ^ Thure von Uexküll : Basic questions of psychosomatic medicine. Rowohlt Taschenbuch, Reinbek near Hamburg 1963; P. 125 f. to Stw. "Swallowing disorder".
  5. ↑ a b c H. Dilling et al .: International Classification of Mental Disorders . In: World Health Organization (Ed.): ICD-10 , Chapter V (F). 2nd Edition. Hans Huber Verlag, Göttingen, 1993, ISBN 3-456-82424-6 ; (a) p. 7 on tax "multiaxial system"; (b) p. 9 (foreword to the German translation) on stw. “atheoretical approach”.
  6. ↑ Martin Heidegger : Being and time . [1926]. 15th edition. Max Niemeyer-Verlag, Tübingen 1979, ISBN 3-484-70122-6 ; P. 29 on head. "Symptoms of illness"; P. 23 on Stw. "Reference to Kant and the 'temporality' emphasized by him in the assessment of phenomena".
  7. ↑ a b c d Karl Jaspers : General Psychopathology . 9th edition. Springer, Berlin 1973, ISBN 3-540-03340-8 ; 4th part: The conception of the totality of mental life. Cape. 1 The synthesis of the clinical pictures. (a) p. 472 on district “Monomania”; (b) p. 472 on tax “delusion, hallucinations”; (c) p. 472 on tax “Registration ad infinitum”; (d) p. 472 f. to Stw. “Wernicke's Criteria of Disease Unity”.
  8. ↑ a b c d Rolf Adler (Ed.): Psychosomatic Medicine. Models of medical thought and action . Founded by Thure von Uexküll. Urban & Schwarzenberg, Munich 2003, 1564 pp., Chap. 24 - ICD-10 and DSM-IV - a critical opinion on the use of the international diagnostic codes. Pp. 389–395, in particular pp. 389–391 on Stw. “Increase in diagnostic classifications”.
  9. ^ WM Compton, SB Guze: The neo-Kraepelinian revolution in psychiatric diagnosis . Eur Arch Psychiatry Clin Neurosci. 1995; 245 (4-5): 196-201. Review. PMID 7578281 .
  10. ↑ a b Rudolf Degkwitz et al. (Ed.): Mentally ill . Introduction to Psychiatry for Clinical Study. Urban & Schwarzenberg, Munich 1982, ISBN 3-541-09911-9 , Part II. Description and structure of mental illness; Cape. 5.1 Terms from general pathology, chap. 5.2 Structure of disease units; P. 49 f. to Stw. "History of Psychiatry, Conceptual Requirements of a Disease Unit".
  11. ↑ Gerd Huber : Psychiatry. Systematic teaching text for students and doctors. FK Schattauer, Stuttgart 1974, ISBN 3-7945-0404-6 ; Pp. 40, 165, 246, 252 on Stw. “Expression community of psychogenic and encephalogenic disorders”.
  12. ↑ Otto Bach : About the subject dependence of the image of reality in psychiatric diagnosis and therapy . In: Psychiatry Today, Aspects and Perspectives . Festschrift for Rainer Tölle. 1st edition. Urban & Schwarzenberg, Munich 1994, ISBN 3-541-17181-2 ; Pp. 1-6.
  13. ↑ Hans-Georg Gadamer : About the concealment of health . Library Suhrkamp, ​​Volume 1135, Frankfurt / M 1993, ISBN 3-518-22135-3 ; Pp. 125, 138 on Stw. “Symptom as a term related to an 'individual case' (case of illness)”.