Functional Disorders Flashcards
What is a functional disorder?
Physical symptoms suggesting a physical disorder, but no evidence of organic disease.
Fully accounts for patient’s complaints.
Strong evidence or presumption
Symptoms linked to psychological factors/conflicts
What is dissociation/conversion?
Partial loss of the normal integration between memories of the past, awareness of identity, immediate sensations and control of bodily movements
What happens in dissociative disorders of movement and sensation?
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
What occurs in somatisation?
Multiple, recurrent and frequently changing physical symptoms
Long complicated Hx of contact with medical services
Any body part/system involved
Causes social and family impairment
What happens in somatoform disorders?
Repeated presentation of physical symptoms
Persistent requests for Ix
Despite -ve findings and reassurance
Usually resist attempts to discuss psychological basis
Attention seeking
What are some classic functional disorder system presentations?
Cardiology- Atypical chest pain
Dermatology-Chronic vulval pain
Gynaecology-Chronic pelvic pain
Orthopaedics-Chronic low back pain
What are the overlapping clinical features of FM, CFS and ME?
Chronic physical and mental fatigue with associated somatic features e.g. muscular aches and pains
No identifiable organic pathology
What are the core features of chronic somatisation?
Preoccupation with physical symptoms
Attributed to physical/organic cause
Disinclination to consider psychological/emotional factors
Benign sensations mis-attributed to physical disease e.g. Somatic symptoms of anxiety
Development of inflexible core benefits (pain/cancer)
Persistent requests for medical investigations
Negative results dismissed
Who is more likely to get a functional disorder?
Female more than male 3rd to 6th decade Relatives of patients with FD's AHP staff Patients with learning difficulties
What are some indicators of a poor prognosis in FD’s?
Long duration of symptoms
Motor symptoms
Personality Disorder
What are some predisposing factors to somatoform disorders?
Childhood Experiences
Personality Characterisitcs- Neuroticism, Anxiety, Introspection
Cognitive Styles- Catastrophising, external locus of control
What are perpetuating factors of somatoform disorders a consequence of?
Over investigation
What are some perpetuating factors of somatoform disorders?
Psychiatric illness/important psychosocial issues overlooked
Consolidates patient’s belief in organicity
Risk of iatrogenic illness
75% of treatments (medical & surgical) considered unsuccessful
Secondary Gains- Benefits etc
Intentional elaboration/feigning
Loss of face
What are some precipitating factors of somatoform disorders?
Stressful live events:
Major threats to life e.g. MI, cancer, viral illness
Personal losses e.g. relationship breakdown, bereavement
Psychiatric illness e.g. depression, anxiety
What is seen on imaging in functional hemiparesis?
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
