Functional Disorders Flashcards
What are functional symptoms?
Symptoms where you cannot easily associate it with a classically identifiable organic disease
Common functional symptoms?
Pain Altered sensation Dizziness Movement disorders Weakness Seizures and paralysis Cognitive/ memory symptoms Muscle cramps and spasms Dissociation Bladder and bowel problems Fatigue Speech issues
What do functional symptoms arise from?
Disease
Psychological factors
Social/ cultural factors
Physiological processes
Functional symptoms in neurology
Functional weakness
Non-epileptic attacks
Hemisensory symptoms
Functional symptoms in gastroenterology
IBS
Non-ulcer dyspepsia
Chronic abdominal pain
Functional symptoms in gynaecology
Chronic pelvic pain
Premenstrual syndrome
Functional symptoms in ENT
Functional dysphonia
Globus pharynges
Functional symptoms in cardiology
Atypical chest pain
Unexplained palpitations
Functional symptoms in rheumatology
Fibromyalgia
Functional symptoms in infectious diseases
Post viral chronic fatigue syndrome
Functional symptoms in immunology/ allergy
Multiple chemical sensitivity syndrome
How are functional diseases described in ICD-10?
Dissociative disorders
What is dissociation?
Detachment from reality
What is depersonalisation?
Feeling that your body doesn’t quite belong to you or is diconced
Who is likely to respond to treatment in those with functional disorders?
Secondary gain is unhelpful
Patients view that things are amenable to change
Time of presentation
Hopelessness, despair and entrapment are all POOR predictors
What is a common sign seen in functional disorders?
Hoover’s sign
Formulation in functional disorders?
Thoughts Mood Physiology Behaviour Social factors
What is encompassed in the thought process in functional disorders?
Psychological problems are not relevant
Condition is purley medical
Symptoms indicate harm
Rest causes less symptoms that activity and therefore must be better to rest
How can thought be treated in functional disorders?
Acceptance of reality of symptoms, explanation of diagnosis and benefits of activity
What mood disorders tend to be present in functional disorders?
Depression and anxiety
How can mood disorders be treated in functional disorders?
ADs discussing the potential relevance of emotional symptoms
What physiological issues can be seen in functional disorders?
Physiological concomitants of anxiety and depression; poor sleep, concentration etc
Physiological results of inactivity/ deconditioning; reduced exercise tolerance, muscle atrophy, CNS effects
How can physiological issues be treated in functional disorders?
ADs
Behaviorual change
What behavioural issues tend to be present in functional disorders?
Avoidance of normal work and family activities
Searching for medical diagnosis and postponing treatment until is found
Poor sleep routine
How can behavioural issues be treated in functional disorders?
Gradual increase in exercise
Agreement about further medical referrals
Advice about sleep routine
What social factors are implicated in functional disorders?
Belief of others; if you don’t have a medical reason for tiredness you must be lazy or mentally ill
Social pressures/ benefits; physical illnesses are a more legitimate reason to be off work/ benefits
What is the treatment for social factors in functional disorders?
Ask patient to question information received from other sources
Liaise with employer
What does formulation in functional disorders involve?
Includes normalisation
Includes validation
Includes reversibility
Removes blame
Treatment of functional disorders?
Formulation
Treat the treatable
CBT
TCAs; useful if co-morbid depression, anxiety or pain
Breathing retraining; if panic disorder or hyperventilation
