Explaining medically unexplained symptoms Flashcards
What are functional disorders at a “systems” level
A functional disorder is where a person experiences abnormal function in a system that can be demonstrated to be capable of normal function
Patient might present with weakness, but you can show on clinical examination that there is no deficit
Psychology and biology both play a role
Describe the attentional phenomena
People with functional disorders attention is abnormally directed to the body, involuntarily and often without conscious awareness
examples of a functional disorder
ME CFS Fibromyalgia IBS Atypical chest pain Chronic breathlessness Tinnitus
3 factors to consider when thinking about functional symptoms
predisposing factors
precipitating factors
perpetuating factors
example of biological perpetuating factors
Loss of muscle/cardiovascular conditioning
Contractures
Side effects of medications
examples of psychological perpetuating factors
Development/persistence of psychiatric disorders e.g. depression, anxiety.
Beliefs about illness that are incompatible with treatment available/lead to conflict with healthcare
examples of social perpetuating factors
loss of job/role
interdependence within the family
treatment for functional disorders
Treatment model is primarily one of rehabilitation i.e. retraining/relearning normal control over and access to the body
The nature of treatment depends a great deal on the symptoms, the predisposing and perpetuating factors and the presence of other medical/psychiatric illnesses
An essential first step in any successful treatment is a shared understanding of what the problem is, and a trusting relationship between the patient and the healthcare team.
Unfortunately coordinated services for people with functional symptoms are rare and therefore are difficult to assess.
psychological treatment methods
Mindfulness/meditation Exercise (yoga, tai chi, physio, graded program) CBT Acceptance and commitment therapy Self-hypnosis Group support Imagery Biofeedback Breathing techniques
