Article

When do symptoms become a disease?

University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Annals of internal medicine (Impact Factor: 13.98). 06/2001; 134(9 Pt 2):803-8. DOI: 10.7326/0003-4819-134-9_Part_2-200105011-00002
Source: PubMed

ABSTRACT When do symptoms become a disease? Are there rules or norms, currently or in the past, that tell us when a particular collection of largely symptom-based criteria has enough specificity, utility, or plausibility to justify the appellation disease ? The history of numerous symptom-based diagnoses in use today suggests partial answers to these questions. The 19th-century shift to understanding ill health as a result of specific diseases, increasingly defined more by signs than symptoms, led to a loss of status for illnesses that possessed little clinical or laboratory specificity. Nevertheless, clinicians then and now have used symptom-based diagnoses. Some of these diagnoses owe their existence as specific diseases to the norms and practices of an older era much different from our own. Others have not only thrived but have resisted plausible redefinition done by using more "objective" criteria. Many strategies, such as response-to-treatment arguments, quantitative methods (for example, factor analysis), and consensus conferences, have been used to find or confer specificity in symptom-based diagnoses. These strategies are problematic and have generally been used after symptom-based diagnoses have been recognized and defined. These historical observations emphasize that although biological and clinical factors have set boundaries for which symptoms might plausibly be linked in a disease concept, social influences have largely determined which symptom clusters have become diseases.

0 Bookmarks
 · 
149 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: To evaluate the efficacy and efficiency of a system set up to overcome the current disparity between primary and specialist health care and with the capacity to detect patients with significant diseases. To describe the activity of the Unit for Connection with Primary Care Centres (UCPCC) in the Alcoy Health Area (Alicante) during its first year. A total of 450 visits were made, with 6.5 (95% CI 5.7-7.3) first visits, and 3.9 (95% CI 3.1-4.8) successive ones per day. There were more than 50 reasons for consultation, and more than 60 final diagnoses (65.6% non-significant, 14% undefined and 12.4% significant). Digestive (31%) and functional (14.4%) diseases were the most frequently defined diagnoses, with neoplasic and autoimmune diseases among those defined as significant ones. The great majority (86.9%) of patients required 1-2 visits, with 40% diagnosed by just reviewing the hospital files. More than 20 different complementary examinations were performed, with 38.8%, 34.4%, 21.6%, and 5.2% of patients requiring 0, 1, 2, or ≥3, respectively. Patients with a significant pathology were diagnosed more quickly (12.4±19.4 vs. 45.3±52.8 days; P=.001), with less complementary examinations (0,5±0,7 vs. 0,9±0,9 per patient; P=.032. 58.6% vs. 39.6% patients without complementary examinations; P=.052), and were more frequently referred to specialised medicine (58.6% vs. 18.3%, P<.0001). The demonstrated differential management of patients with potentially significant pathology using existing resources, make the UCPCC with internists an efficient model for the connection between health care levels.
    SEMERGEN - Medicina de Familia 10/2013; 39(7):361-369.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The category of autism has undergone huge changes over the past 20 years. This study was undertaken to analyze the changes and how parents have experienced the diagnostic process in France. Data were obtained from in-depth interviews with parents and psychiatrists, and from 248 questionnaires with open-ended questions filled in by parents. We compared the experiences of parents with adult autistic children to those of parents with young autistic children. Progressively earlier age at diagnosis was evidenced. These changes occurred later than in North America and the UK, due to the reluctance of French professionals to adopt the new classifications of diseases which they viewed as undervaluing both the physician's holistic clinical skills, and psychoanalytical interpretations. Parents' experiences and interviews with psychiatrists were analyzed in order to document changes over time in the diagnostic process following tensions between parents and professionals, and intra-professional debates in psychiatry. Our data support the notion that the diagnosis of autism is historically and nationally contingent. The interactions between changes in the diagnostic process, policy, and parental experiences have led to changes in the way autism is defined, understood, and experienced.
    Culture Medicine and Psychiatry 07/2013; · 1.29 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: IntroductionThe Borderline Intellectual Functioning (BIF) is conceptualized as the frontier that delimits “normal” intellectual functioning from intellectual disability (IQ 71-85). In spite of its magnitude, its prevalence cannot be quantified and its diagnosis has not yet been defined.Objectives To elaborate a conceptual framework and to establish consensus guidelines.MethodA mixed qualitative methodology, including frame analysis and nominal groups techniques, was used. The literature was extensively reviewed in evidence based medical databases, scientific publications, and the grey literature. This information was studied and a framing document was prepared.ResultsScientific publications covering BIF are scarce. The term that yields a bigger number of results is “Borderline Intelligence”. The Working Group detected a number of areas in which consensus was needed and wrote a consensus document covering the conclusions of the experts and the framing document.Conclusions It is a priority to reach an international consensus about the BIF construct and its operative criteria, as well as to develop specific tools for screening and diagnosis. It is also necessary to define criteria that enable its incidence and prevalence. To know what interventions are the most efficient, and what are the needs of this population, is vital to implement an integral model of care centred on the individual.
    Revista de Psiquiatría Biológica y Salud Mental 01/2013; 6(3):109–120. · 0.31 Impact Factor