From the Guidelines
High-yield symptoms for a diagnosis are those that are most indicative of a specific condition and can help guide diagnostic efforts.
Key Symptoms
- Psychotic symptoms, such as delusions, hallucinations, disorganized speech, and catatonic behavior, are high-yield symptoms for schizophrenia 1.
- Manic symptoms, including irritability, emotional reactivity, grandiosity, and decreased need for sleep, are indicative of bipolar disorder 1.
- Organ-specific symptoms, such as heart failure with preserved ejection fraction, nephrotic range proteinuria, and peripheral neuropathy, can suggest amyloidosis 1.
- Neurodevelopmental symptoms, including emotional dysregulation, ADHD, anxiety, and autism, can be associated with genetic disorders such as deletion 22q11.2 syndrome 1.
- Systemic symptoms, such as weight loss, fatigue, and organomegaly, can be indicative of Erdheim-Chester disease 1.
Importance of Context
It is essential to consider the context in which these symptoms occur, as they can be non-specific and overlap with other conditions. A thorough diagnostic evaluation, including a comprehensive medical history, physical examination, and laboratory tests, is necessary to establish an accurate diagnosis.
Diagnostic Approach
A step-wise approach to diagnosis, including screening for high-risk populations, confirmation of a monoclonal component, and tissue biopsy, can help identify underlying conditions such as amyloidosis 1. In clinical practice, it is crucial to remain vigilant for these high-yield symptoms and to consider a broad differential diagnosis to ensure timely and accurate diagnosis, particularly in complex cases where symptoms may be non-specific or overlap with other conditions 1.
From the Research
High-Yield Symptoms for Diagnosis
The following symptoms have been identified as high-yield for diagnosis in various studies:
- Respiratory symptoms and fatigue are common in sarcoidosis 2
- Congenital heart disease, hypocalcemia, immunodeficiency, facial dysmorphia, palate anomalies, velopharyngeal dysfunction, renal anomalies, and speech and feeding disorders are associated with 22q11 deletion syndrome 3
- Hallucinations and delusions are common symptoms of psychosis, but high-yield cognitive behavioral techniques for psychosis (HYCBt-p) can be effective in reducing overall symptom burden, depression, and negative symptoms 4
- Symptoms such as frailty and mental illnesses can be used to diagnose underlying conditions, but the diagnostic accuracy of symptoms depends on various epidemiological measures 5
Diagnostic Accuracy of Symptoms
The diagnostic accuracy of symptoms can be influenced by various factors, including:
- Epidemiological measures such as proportions diseased, baseline symptom incidence, and risk ratios 5
- The number of symptoms used for disease diagnosis, with more symptoms increasing or decreasing the area under the curve (AUC) of the receiver operating characteristic (ROC) curve depending on the risk ratio 5
- Genetic testing can have a high diagnostic yield in certain conditions, such as childhood sensorineural hearing loss 6
Specific Conditions
The following conditions have been studied in relation to high-yield symptoms for diagnosis:
- Sarcoidosis: respiratory symptoms and fatigue are common, and histological confirmation is not needed for Löfgren's or Heerfordt's syndrome and asymptomatic bihilar lymphadenopathy 2
- 22q11 deletion syndrome: congenital heart disease, hypocalcemia, immunodeficiency, facial dysmorphia, palate anomalies, velopharyngeal dysfunction, renal anomalies, and speech and feeding disorders are associated with the condition 3
- Psychosis: high-yield cognitive behavioral techniques for psychosis (HYCBt-p) can be effective in reducing overall symptom burden, depression, and negative symptoms 4
- Childhood sensorineural hearing loss: genetic testing with next-generation sequencing (NGS) has a high diagnostic yield 6