Functional Disorders

Question 1

Describe a functional disorder.

Answer 1

Troublesome physical symptoms which after investigation are not fully explained by a physical disease process or injury

The symptoms are real and not imagined.
Consequently, it is likely that brain activity involved in producing the symptoms is triggered by emotional change

Symptoms where one cannot easily associate the symptoms with a classically identifiable organic disease

Question 2

List common symptoms of functional disorders.

Answer 2

• Pain
• Altered sensation
• Dizziness
• Movement disorders
• Weakness
• Seizures
• Cognitive symptoms

Question 3

Symptoms like fatigue are the patients ___________ experiences

Answer 3

SUBJECTIVE

Question 4

Neurology functional somatic symptoms

Answer 4

Functional weakness, non-epileptic attacks, hemisensory symptoms

Question 5

GI functional somatic symptoms

Answer 5

IBS, non-ulcer dyspepsia, chronic abdominal pain

Question 6

Gynaecology functional somatic symptoms

Answer 6

Chronic pelvic pain, premenstrual syndrome

Question 7

ENT functional somatic symptoms

Answer 7

Functional dysphonia, globus pharynges

Question 8

Cardiology functional somatic symptoms

Answer 8

Atypical chest pain, unexplained palpitations

Question 9

Rheumatology functional somatic symptoms

Answer 9

Fibromyalgia

Question 10

Infectious disease functional somatic symptoms

Answer 10

(post-viral) chronic fatigue syndrome

Question 11

Immunology/allergy functional somatic symptoms

Answer 11

Multiple chemical sensitivity syndrome

Question 12

What is dissociative disorder?

Answer 12

Is how the symptoms are described in the Internal Classification of Disease

Question 13

Name 3 main categories of dissociative disorder and explain each of these.

Answer 13

Dissociation – detachment from reality

Depersonalization – a feeling that your body doesn’t quite belong to you or is disconnected from you

Derealization- a feeling that you are disconnected from the world around you or ‘spaced out’

Question 14

What should always be asked about when taking a history from someone with a suspected functional disorder?

Answer 14

Ask about disability
Ask about dissociation
Ask about other medical experiences
Illness beliefs?
Past medical history – early age hysterectomy, appendicectomy,
Previous functional symptoms
Ask about psychiatric history and mood symptoms

Question 15

________ ____ is a predictor, evidence of affective disorders increases risk of functional symptoms

Answer 15

Childhood abuse

Question 16

What type of findings during examination are typical for a functional disorder?

Answer 16

Inconsistent i.e none

Question 17

_________ ____ is often a sign of a functional disorder

Answer 17

Uneconomic gait

Question 18

What is hoover’s sign?

Answer 18

It is a maneuver aimed to separate organic from non-organic paresis of the leg

Basically used when a patient complains of ‘unilateral leg weakness’

Question 19

Explain how hoovers sign is looked for.

Answer 19

Put hand under the thigh of the ‘weak’ leg, ask the patient to lift the opposite leg and the muscles of the weak leg WILL contract if it is a non-organic paresis

1. Lay pt on bed
2. Put hand under heal of weak leg and ask pt to push down on your hand
3. The pt won’t push your hand down because hand is ‘weak’
4. Ask pt to raise normal leg and use other hand to push against - resist their movement
5. Heal of affected leg will push down on your hand

Question 20

Outline the 5 steps of formulation.

Answer 20

Normalization – normal, common and seen before
Validation – symptoms are genuine and you are not imaging it
Reversibility – may people make good progress, it can be treated
Blame – it is not your fault you have these symptoms
But – you need to put some effort into getting better

Question 21

Outline the treatment of functional disorders.

Answer 21

Formulation
Treat the treatable
CBT 
Tricyclic antidepressants 
Breathing retaining – panic disorders/hyperventilation