Functional and non-functional disorders Flashcards
Define a functional disorder
A functional disorder is a medical condition that impairs normal functioning of bodily processes that remains largely undetected under examination, dissection or even under a microscope
What are the main functional disorders ?
- Functional weakness
- Fibromyalgia, CFS/ME
- Non-epileptic attack disorder
- Irritable bowel syndrome
Describe the symptoms and presentation of functional weakness
Functional weakness is weakness of an arm or leg due to the nervous system not working properly. It is not caused by damage or disease of the nervous system.
Patients with functional weakness have normal scans and other tests. When they are examined, the doctor usually finds a pattern of weakness typical of this problems and does not find changes in reflexes or other evidence of a structural neurological disease (like stroke).
experience symptoms of limb weakness which can be disabling and frightening such as problems walking or a ‘heaviness’ down one side, dropping things or a feeling that a limb just doesn’t feel normal or ‘part of them’.
Collapsing weakness - this is a tendency for an arm or leg to ‘collapse’ when being tested.
A dragging kind of walk - Patients with functional leg weakness sometimes have a very characteristic way of walking which means that their affected leg “drags” along the ground.
Hoover’s sign - in this test, your affected leg may be weak when you try to push your foot down into the bed. However, when the doctor asks you to push up with your other leg the strength in your affected leg returns.
Describe the presentation of fibromyalgia
Fibromyalgia is a syndrome that consists of the following signs and symptoms:
- Persistent (≥ 3 months) widespread pain (pain/tenderness on both sides of the body, above and below the waist, and includes the axial spine
- Fatigue; disrupted and unrefreshing sleep
- Cognitive difficulties
- Multiple other unexplained symptoms, anxiety and/or depression, and functional impairment of activities of daily living (ADLs)
Describe the typical presentation of chronic fatigue syndrome
CFS is also known as ME, which stands for myalgic encephalomyelitis.
The main symptom of CFS/ME is feeling extremely tired and generally unwell.
Symptoms:
- sleep problems
- muscle or joint pain
- headaches
- a sore throat or sore glands that aren’t swollen
- problems thinking, remembering or concentrating
- flu-like symptoms
- feeling dizzy or sick
- fast or irregular heartbeats (heart palpitations)
Overexcerising makes symptoms worse
Diagnosis is by exclusion
Describe the typical presenting features of non-epileptic attack disorder
- Non epileptic attacks look like epileptic seizures but are not caused by electrical activity in the brain. (EEG normal)
- Most commonly, the attack will mirror a tonic-clonic seizure with obvious convulsion like movements of the arms, legs, head and body.
- May experience an aura
- ome people may fall to the floor, bite their tongue, lose control of their bladder or hurt themselves.
- For other people, the attack appears more like a complex partial seizure: they will go blank or just stare in an unseeing way.
- For many people, once the attack is over they will feel confused and tired and may take some time to fully recover.
Describe the key presenting features of irritable bowel syndrome
The diagnosis of IBS should be considered if the patient has had the following for at least 6 months:
- abdominal pain, and/or
- bloating, and/or
- change in bowel habit
A positive diagnosis of IBS should be made if the patient has abdominal pain relieve
d by defecation or associated with altered bowel frequency stool form, in addition to 2 of the following 4 symptoms:
- altered stool passage (straining, urgency, incomplete evacuation)
- abdominal bloating (more common in women than men), distension, tension or hardness
- symptoms made worse by eating
- passage of mucus
Food, stress and hormones (women) are all factors which can increase chances of IBS
What are the main non-functional disorders ?
- Hypochondrial disorder
- Munchausen’s syndrome also called factitious disorder
- dissociative disorder
- Malingering
- Somatisation disorder
- Conversion disorder
Cmon (eilidh) Heather McLeod Stop Moaning (you) Dick
Descibe hypochondrial disorder (hypochondriacs)
Patient has a persistent belief in the presence of an underlying serious DISEASE, e.g. cancer pt refuses to accept reassurance or negative test results
Describe somatisation disorder
- Patient has multiple physical SYMPTOMS present for at least 2 years (affecting mutiple organ symptoms)
- Patient refuses to accept reassurance or negative test results
Describe conversion disorder
- typically involves loss of motor or sensory function e.g. blindness, paralysis, or other nervous system (neurologic) symptoms that cannot be explained by medical evaluation
- the patient doesn’t consciously feign the symptoms (factitious disorder) or seek material gain (malingering)
Describe dissociative disorder
- dissociation is a process of ‘separating off’ certain memories from normal consciousness
- in contrast to conversion disorder it involves psychiatric symptoms e.g. Amnesia, fugue (a loss of awareness of ones identity), stupor (a state of near unconsciousness)
Describe munchausens syndrome (also called factitious disorder)
the intentional production of physical or psychological symptoms for medical attention
Instead of doing it out of personal gain, they have an ingrained, unreasonable attachment to the notion of being ill or acting as the caretaker of another ill person
Describe malingering
fraudulent simulation or exaggeration of symptoms with the intention of financial or other gain e.g. getting out of a test
