Reinstating the concept of ‘syndrome’ in psychiatric nosology: a strategic step back for moving the field ahead

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Claudio Banzato
Clarissa R. Dantas


Lately, reification of psychiatric diagnostic categories has been the rule, both in clinical practice and research. In everyday clinics, reification can be seen in the disorder-centered approach often adopted by clinicians and also in the cultural assimilation of psychiatric nomenclature by patients; the result being a rather superficial and naive diagnostic assessment process. Regarding research, the problem is that diagnostic categories are part of the background used in empirical studies, but are seldom put to test themselves. This has become critical now that these categories clearly did not live up to the expectations they generated. Arguably, the very issue of comorbidity is also dependent on reification: as long as the presence of multiple diagnoses is taken simply as multiple foci of clinical attention, there is no harm done; confusion arises when they are treated instead as if they were multiple co-occurring diseases. This trend is so widespread that reversing it represents a great challenge for psychiatry. In this paper, we put forth reasons for reinstating into the psychiatric realm the time-honored medical concept of ‘syndrome’. The adoption of a syndromic approach, with syndromes taken as grouping higher-order categories, could not only contribute to a desirable simplification of diagnostic classifications, but also lead to an increase of the validity of the diagnoses. Syndromes may have better defined boundaries than current categories of mental disorders. In order to advance the field, we suggest that this move should be coupled with the adoption of both a cross-sectional assessment of multiple psychopathological domains and a longitudinal framework, which could allow us to put into play the medical construct of 'clinical staging', still largely underutilized in psychiatry.

Article Details

Fourth Geneva Conference on Person-centered Medicine: Person-centered integrative diagnosis (PID)
Author Biographies

Claudio Banzato, University of Campinas - UNICAMP

He is currently Associate Professor of Psychiatry at the University of Campinas (Unicamp), Brazil. His main research interests are philosophy of psychiatry, psychiatric diagnosis and classification, psychopathology of schizophrenia, and person centered medicine. Former Secretary, World Psychiatric Association's Section on Classification, Diagnostic Assessment and Nomenclature (2002 – 2008). Former Chair, Brazilian Psychiatric Association's Department of Diagnosis and Classification in Psychiatry (2003 – 2007). Member of the Editorial board of the journal “Philosophy, Psychiatry, & Psychology” (PPP) (published by Johns Hopkins University Press).Editor (with J.E. Mezzich and C.E. Berganza) of "Philosophical and Methodological Foundations of Psychiatric Diagnosis" [Psychopathology 2005; 38(4): 155-230.] He has authored or co-authored about 60 papers published -- or in press -- in scientific journals (including Academic Psychiatry; American Journal of Psychiatry; Canadian Journal of Psychiatry; Current Opinion in Psychiatry; Dialogues in Philosophy, Mental and Neuro Sciences; Die Psychiatrie; General Hospital Psychiatry; History of Psychiatry; International Journal of Mental Health; Journal of American College Health; Journal of Evaluation in Clinical Practice; Journal of Medical Case Reports; Journal of the Neurological Sciences; Philosophy, Ethics, and Humanities in Medicine (PEHM); Philosophy, Psychiatry, & Psychology (PPP); Proteomics; Psychiatric Genetics; Psychopathology; Schizophrenia Research; and World Psychiatry).

Clarissa R. Dantas, Medical School, University of Campinas – UNICAMP, Campinas, Brazil

Assistant Professor, Department of Psychiatry, Medical School, University of Campinas – UNICAMP Campinas, Brazil 


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