2: Functional Disorders Flashcards
What are somatoform disorders
Group of disorders where individual repeatedly presents to medical care with symptoms, requesting investigations. Is not reassured when investigations are negative or reassurance by doctor there is no physical pathology
What are two somatoform disorders
- Somatisation disorder
- Hypochrondial disorder
Define somatisation disorder
Multiple, recurrent and frequently changing symptoms persisting beyond 2-years duration.
If symptoms of somatisation disorder, but is has persisted less than 2-years what is it called
Undifferentiated somatoform disorder
What age group is somatisation disorder more common
under 40
Which gender is somatisation disorder more common in
Female
What are two risk factors for somatisation disorder
Parental anxiety towards illness
FH
How does somatisation disorder present clinically
- Complex medical history
- Often symptoms entail multiple systems (and
specialities) - Patient’s life revolves around illness
- Discrepancy between subjective (10/10) and objective assessment (eg. patient laughing with others)
What are three differential diagnosis for somatisation disorder
- Hypochondriasis
- Factitious disorder
- Malingering
How is hypochondriasis different too somatisation.
Hypochondriasis = individual believes they have a specific disorder. Somatisation disorder = multiple systems
What is factitious disorder
Individual invents symptoms to occupy sick role
What is malingering
Individual invents symptoms of external gain
how should individuals with somatisation disorder be managed
- Avoid over investigation
- Periodic reviews with same practitioner (to avoid over-attendance)
- CBT
what is a risk with somatisation disorder
Iatrogenic harm due to over investigation
define hypochondriasis
preoccupation with possibility of having one or more progressive physical disorders which persist despite medical investigations and reassurance, with subsequent distress and impaired function
which gender is hypochondriasis more common
equal
what is a risk factor for hypochondriasis
- Parental or childhood serious illness
- Neglect or emotional abuse
how does hypochondriasis present clinically
- Pre-occupation significant serious progressive disorder
- Rumination
- Interprets normal bodily functions as signs of serious illness
- Seeks medical advice but is un-reassured by negative results
how should hypochondriasis be managed
- Allow patient to vent anxieties
- Explain results negative test
- TCA
- Behavioural therapy
what is dissociative disorder also known as
conversion disorder
define dissociative disorder
loss or disturbance of motor, sensory or cognitive functions that initially thought due to physical or neurological cause and later found to be due to psychological causes
what was the initial theory behind dissociative disorders
suppression of unacceptable conscious leads to manifestation as physical symptoms
what is important to note about dissociative disorders
symptoms are not consciously invented by the individual (different to malingering and factitious disorder)
what are common features of dissociative disorders
- Paralysis unilateral face or arm
- Sensory loss
- Patchy amnesia
- Aphonia
explain paralysis in functional disorder
Usually flaccid paralysis.
Individual is unable to consciously move limb, however, synergistic movement does occur
what sign is visible in functional disorder
Hoover sign
what is unique about sensory loss in functional disorders
Fits with individual’s anatomical beleifs
how are functional disorders usually diagnosed
Clinical - inconsistent nature of signs and symptoms
how are functional disorders identified
- Exclude organic diagnosis
- Identify positive signs
- Supportive psychological cause underlying symptoms
explain management of functional disorders
- Frame as positive diagnosis: no serious underlying pathology
- Discourage use of aids that may reinforce sick role (eg crutch)
Define chronic fatigue syndrome
presence of disabling fatigue for 4-months affecting physical and mental function more than 50% time, in absence of any organic pathology
What time period is required to diagnose chronic fatigue
4-months
In which gender is chronic fatigue more common
Female
what is the main symptom of chronic fatigue
Disabling fatigue
what are other symptoms of chronic fatigue syndrome
Cognitive: impaired short-term memory Flu-like illness Headache Muscle pain Painful lymph node enlargement Nausea Palpitations
what does NICe recommend in chronic fatigue syndrome
Screen for organic causes
what is used to manage CFS
- Pacing
- Graded exercise therapy
- CBT
- amytryptiline
what is pacing
organising activities to avoid tiring
what is factitious disorder also known as
Munchausens
what is Muchausen’s disorder
Individuals fabricate symptoms and signs and past medical history, with primary intention of gaining medical attention and treatment
