Functional Disorder

Question 1

How to take a history of a patient with a functional symptom/symptoms?

Answer 1

• take time to do history
• clear timescale
• ask about disability, dissociation, other medical experiences,
• history - PMH, previous functional symptoms
• psychiatric history & mood symptoms at the end

Question 2

What is particularly important in a consultation with a patient with functional symptoms?

Answer 2

• Physical exam!!
• elicit functional signs
• inconsistent findings (common in functional symptoms)

Question 3

What is Charcot’s gait?

Answer 3

Dragging one leg but actually pushing themselves with the “weak” leg - this is positive sign for functional

Question 4

What is Hoover’s sign and how do you ellicit it?

Answer 4

Patient presents with weak leg, get patient to lift opposite leg whilst feeling muscles of opposite leg, opposite leg muscles will contract - positive sign of functional disorder

Question 4

What is Hoover’s sign and how do you ellicit it?

Answer 4

Patient presents with weak leg, get patient to lift opposite leg whilst feeling muscles of opposite leg, opposite leg muscles will contract - positive sign of functional disorder

Question 5

What is a classic positive functional seizure sign?

Answer 5

Arching of the back

Question 6

What is the treatment for functional disorders?

Answer 6

Formulation - normalisation, validation, reversibility, remove blame
Treat the treatable e.g. depression,anxiety
CBT standard treatment of choice
tricyclic antidepressants (imipramine, amitriptyline)
breathing retraining