Functional Disorders

Question 1

definition of functional disorder

Answer 1

troublesome physical symptoms which after a investigation are not explained by a physical disease process or injury. (hardware vs software)

Question 2

patient need not have a ‘genuine’ disease to experience a …

Answer 2

‘genuine’ symptom

Question 3

Dissociation is…

Answer 3

Detachment from reality

Question 4

Depersonalisation is ..

Answer 4

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

Question 5

Derealisation is …

Answer 5

a feeling you are disconnected from the world around you ‘spaced out’

Question 6

What percentage of patient’s with functional symptoms show good response to treatment?

Answer 6

60%

Question 7

Common functional symptoms:

Answer 7

Neurological
skin sensations
chest pain
IBS and other GI problems
Dizziness
ENT
Sexual

Question 8

No changes in reflexes
collapsing weakness
hoover's sign
dragging walk
power better on bed than when walking

Answer 8

Functional weakness

Question 9

tiredness, low mood, lack of concentration, poor memory, muscular pain, poor sleep

Answer 9

Chronic Fatigue Syndrome (fibromyalgia)

Question 10

10% have epilepsy, more common in women
90% report previous traumatic experiences
comorbid with depression, anxiety, PTSD

Answer 10

Non-epileptic attack disorder

Question 11

Functional GI problem

Answer 11

IBS

Question 12

How to remove stigma (formulation):

Answer 12

• Normalise (common)
• Validate (symptoms are genuine)
• Reversibility (can be treated)
• Remove blame (not your fault)
• BUT takes effort to get better

Question 13

How to treat:

Answer 13

• Formulation
• Treat the co-morbid psychiatric illness
• CBT = standard treatment
• TCAs (amitryptilline) - useful with co-morbid depression/anxiety/pain.
• Breathing retraining (panic disorder/ hyperventilation)

Question 14

Examples of disorders that are not functional:

Answer 14

• hypochondriasis
• factitious disorder
• malingering