2.6 Functional disorders

Question 1

Some specific functional disorders:

Answer 1

Functional weakness
Fibromyalgia, CFS and ME
Non-epileptic attack disorder
Irritable bowel syndrome

Question 2

(not functional disorders)

Answer 2

Hypochondriasis
Factitious disorder
Malingering

Question 3

definition of functional disorder

Answer 3

Troublesome physical symptoms which after investigation are not fully explained by a physical disease process or injury. The symptoms are real and not imagined. Consequently, it is likely that brain activity involved in producing the symptoms is triggered by emotional change.

Question 4

dissociative disorders- ICD-10

Answer 4

Dissociative amnesia
 Dissociative fugue
 Dissociative stupor
 Trance and possession disorders
 Dissociative disorders of movement and sensation

Question 5

dissociative disorders of movement and sensation- ICD-10

Answer 5

Motor disorders, sensory loss and/or convulsions
Patient presents as having a physical disorder
Physical disorder doesn’t explain the symptoms
Can represent the patient’s concept of physical disorder
Usually (not always) helps the patient to escape conflict or express dependency or rejection indirectly

Question 6

somatisation- ICD-10

Answer 6

Multiple, recurrent and frequently changing physical symptoms
Long and complicated history of contact with medical services
Any body part or system may be involved
Causes impairment in social and family functioning

Question 7

somatoform disorders- ICD-10

Answer 7

Repeated presentation of physical symptoms
Persistent requests for medical investigations
In spite of repeated negative findings and reassurance that the symptoms have no physical basis
Usually resist attempts to discuss psychological basis
“Attention-seeking behaviour”

Question 8

functional SPECT imaging abnormalities in functional hemiparesis

Answer 8

Increased activity rCBF bilaterally in frontal and parietal cortex in resting state when stimulated bilaterally when recovered
Deficit - reduced rCBF to contalateral thalamus and basal ganglia
Hypoactivation resolved with recovery
Lower degree of activation predicted a poor recovery

Question 9

Hoover’s sign

Answer 9

ask pt to push down on affected ankle- no effect

ask pt to lift contralateral leg against resistance- affected leg pushes down (extension)

Question 10

non-epileptic attack disorder

Answer 10

10% also have epilepsy
more common in women
90% report previous traumatic experiences especially childhood abuse and/or neglect
comorbidity with depression, anxiety, PTSD
often difficult to differentiate from epilepsy- need witness account /EEG monitoring

Question 11

hypochondriasis

Answer 11

not a functional disorder

called health anxiety here