Psychiatry - H.T. Sonnyk 2003

Methods of Examination of Psychiatric Patients
Stages of the Diagnostic Process

Diagnostics is a form of human cognitive activity to which all general laws of cognition can be applied. Skillful Diagnosis is one of the greatest assets in a physician's work. The stages of diagnostic reasoning represent a sequential framework for uncovering the specific patterns of a complex pathological process, culminating in the establishment of a definitive diagnosis. The core elements that guide a physician during the diagnostic process are symptoms, syndromes, and nosological entities.

A symptom is a discrete manifestation of a disease, a singular consequence of an ongoing pathogenetic process. We do not observe all the intermediate Links of the latter, dealing instead only with its manifestations, namely, symptoms.

A syndrome is a specific constellation of individual symptoms united by a common Pathogenesis.

A nosological entity (a disease proper) comprises a group of pathogenetically related syndromes that exhibit a distinct, individual trajectory of development.

Metaphorically speaking, symptoms form the individual bricks from which the walls (syndromes) are built, and the latter constitute the entire Structure (the nosological entity or disease), where the individuality of the clinical course (dynamics) acts as the mortar.

The diagnostic process consists of three interrelated stages: establishing the provisional, clinical, and definitive diagnosis.

The First stage unfolds According to the following scheme:

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According to this scheme, based on the gathered Complaints and the results of physical examination, symptoms are identified and then pathogenetically grouped into syndromes. Data from the medical and personal history reveal individual features and the dynamics of their development, guiding the diagnostician toward a specific disease. The physician thus formulates a preliminary opinion regarding the patient's health status, expressed in standard medical terminology. The Second Stage is the ESTABLISHMENT OF THE clinical diagnosis.

This takes place according to the following scheme:

As the diagram demonstrates, supplementary diagnostic Methods allow the clinician to delve deeper into The Essence of the pathological process, reveal its individual features, and modify or refine the provisional diagnosis.

Differential diagnosis is the most complex component of diagnostics. It is grounded in key cognitive operations—comparison, generalization, and Classification—thus reflecting the level of the physician's clinical reasoning.

The Third Stage of the diagnostic search is the establishment of the definitive diagnosis. It is based on the outcomes of the prescribed Treatment and the dynamics of the patient's health status during and after therapy. There is even a special form of diagnosis known as diagnostica ex juvantibus (diagnosis through treatment).

Depending on the final treatment outcomes, the physician's diagnosis is either confirmed (complete or partial recovery) or clarified through post-mortem examination (in the event of the patient's death). If the disease is chronic and complete recovery is out of the question, the diagnostic process is supplemented by observing the patient during remission (for instance, determining the subtype of Schizophrenia is possible only when data on the dynamics of exacerbations and remissions are available).