Functional Disorders

Question 1

Define ‘functional disorder’

Answer 1

Symptoms where you cannot easily associate symptoms with a classically identifiable organic disease process

Question 2

List examples of functional symptoms that could be experienced by the patient

Answer 2

Pain
Altered sensation
Dizziness
Movement disorders
Weakness
Seizures
Cognitive symptoms

Question 3

List examples of common functional diseases

Answer 3

Non-epileptic attacks
Fibromyalgia
Chronic fatigue syndrome
IBS
Pseudo-seizures
Pseudo-dementia

Question 4

According to ICD guidelines. functional disorders can also be described as…

Answer 4

Dissociative disorders
Detachment from reality, which can be in terms of the patient’s own body (depersonalisation) or the world (derealisation)

Question 5

Functional disorders do not respond well to treatment. True/ False?

Answer 5

False
60% of patients do respond well to treatment
30% resolve completely

Question 6

List points in the history that are important to ask about when a functional disorder is suspected

Answer 6

Clear timescale of events
Disability
Dissociation (dizzy, faint)
Other medical experiences
Illness beliefs (what do you think is going on?)

Question 7

What previous medical procedures can increase a person’s risk of functional disorder?

Answer 7

Early age hysterectomy
Appendectomy
Laparoscopy for abdominal pain

Question 8

What previous medical conditions can increase a person’s risk of functional disorder?

Answer 8

Previous functional symptoms
Previous mood or affective disorders
Childhood abuse

Question 9

What signs on examination can suggest functional disorder?

Answer 9

Dragging walk
'Walking on ice'
Power better on bed than walking
Collapsing weakness
Non-dermatomal sensory weakness

Question 10

What is Hoover’s sign?

Answer 10

Weakness of voluntary hip extension with normal involuntary hip extension during contralateral hip flexion against resistance

Question 11

List signs of a non-epileptic attack

Answer 11

Sudden onset oscillating problem with no tonic phase (no exhalation of air from lungs)
Arms above head
Body habitus change (arching of back)
Asymmetrical arms and legs

Question 12

How can u differentiate epilepsy from a non-epileptic attack?

Answer 12

EEG

Question 13

Outline the explanation of functional disorders to the patient

Answer 13

Normalisation (it is common)
Validation (symptoms are genuine)
Reversibility (many make good progress, treatment)
Remove blame (not your fault)

Question 14

List the treatment for functional disorders. What is the standard treatment of choice?

Answer 14

Treat comorbidities
CBT (GOLD STANDARD)
TCADs (imapramine, amitryptiline in comorbid depression/ anxiety/ pain)
Breathing retraining (panic disorder, hyperventilation)