Functional Disorders

Question 1

Define “medically unexplained symptoms”

Answer 1

Persistent bodily complaints for which adequate examination does not reveal sufficient explanatory structural or other specified pathology

Question 2

Common presentation of medically unexplained symptoms

Answer 2

Generalised pain, fatigue or disturbance of organ systems (e.g. stomach ache, breathlessness) that has been present for over 3 months and is associated with impaired functioning

Question 3

Define somatoform disorder

Answer 3

Describes the presence of physical symptoms that cannot be explained by a medical condition, drug or other mental health disorder

Question 4

Common presenting symptoms in somatoform disorder

Answer 4

GI symptoms

Abdominal pain

Fatigue

Weakness

MSK symptoms

Question 5

Diagnosis criteria for somatoform disorder

Answer 5

Multiple physical symptoms present for at least 2 years

Patient refuses to accept reassurance or negative test results

Question 6

Outline hypochondriasis

Answer 6

Patients have excessive concern that they have a serious illness (such as cancer) despite a lack of evidence

Patients often demand unnecessary tests and investigations, and can be quite debilitated as a result of their constant worrying

Question 7

Outline dissociative disorder

Answer 7

Process of ‘separating off’ certain memories from normal consciousness

In contrast to conversion disorder involves psychiatric symptoms e.g. amnesia, fugue, stupor

Question 8

Management of functional disorders

Answer 8

Sensitive consultation style

Screen for underlying mental health problems e.g. depression and anxiety

Psycho-social support and therapies such as CBT are helpful in reducing symptoms

Extensive investigations unlikely to add to diagnosis and may increase patient’s anxiety