Functional Disorders

Question 1

What are functional symptoms?

Answer 1

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

Question 2

Common functional symptoms?

Answer 2

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

Question 3

What do functional symptoms arise from?

Answer 3

Disease
Psychological factors
Social/ cultural factors
Physiological processes

Question 4

Functional symptoms in neurology

Answer 4

Functional weakness
Non-epileptic attacks
Hemisensory symptoms

Question 5

Functional symptoms in gastroenterology

Answer 5

IBS
Non-ulcer dyspepsia
Chronic abdominal pain

Question 6

Functional symptoms in gynaecology

Answer 6

Chronic pelvic pain

Premenstrual syndrome

Question 7

Functional symptoms in ENT

Answer 7

Functional dysphonia

Globus pharynges

Question 8

Functional symptoms in cardiology

Answer 8

Atypical chest pain

Unexplained palpitations

Question 9

Functional symptoms in rheumatology

Answer 9

Fibromyalgia

Question 10

Functional symptoms in infectious diseases

Answer 10

Post viral chronic fatigue syndrome

Question 11

Functional symptoms in immunology/ allergy

Answer 11

Multiple chemical sensitivity syndrome

Question 12

How are functional diseases described in ICD-10?

Answer 12

Dissociative disorders

Question 13

What is dissociation?

Answer 13

Detachment from reality

Question 14

What is depersonalisation?

Answer 14

Feeling that your body doesn’t quite belong to you or is diconced

Question 15

Who is likely to respond to treatment in those with functional disorders?

Answer 15

Secondary gain is unhelpful
Patients view that things are amenable to change
Time of presentation
Hopelessness, despair and entrapment are all POOR predictors

Question 16

What is a common sign seen in functional disorders?

Answer 16

Hoover’s sign

Question 17

Formulation in functional disorders?

Answer 17

Thoughts
Mood
Physiology
Behaviour
Social factors

Question 18

What is encompassed in the thought process in functional disorders?

Answer 18

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

Question 19

How can thought be treated in functional disorders?

Answer 19

Acceptance of reality of symptoms, explanation of diagnosis and benefits of activity

Question 20

What mood disorders tend to be present in functional disorders?

Answer 20

Depression and anxiety

Question 21

How can mood disorders be treated in functional disorders?

Answer 21

ADs discussing the potential relevance of emotional symptoms

Question 22

What physiological issues can be seen in functional disorders?

Answer 22

Physiological concomitants of anxiety and depression; poor sleep, concentration etc
Physiological results of inactivity/ deconditioning; reduced exercise tolerance, muscle atrophy, CNS effects

Question 23

How can physiological issues be treated in functional disorders?

Answer 23

ADs

Behaviorual change

Question 24

What behavioural issues tend to be present in functional disorders?

Answer 24

Avoidance of normal work and family activities
Searching for medical diagnosis and postponing treatment until is found
Poor sleep routine

Question 25

How can behavioural issues be treated in functional disorders?

Answer 25

Gradual increase in exercise
Agreement about further medical referrals
Advice about sleep routine

Question 26

What social factors are implicated in functional disorders?

Answer 26

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

Question 27

What is the treatment for social factors in functional disorders?

Answer 27

Ask patient to question information received from other sources
Liaise with employer

Question 28

What does formulation in functional disorders involve?

Answer 28

Includes normalisation
Includes validation
Includes reversibility
Removes blame

Question 29

Treatment of functional disorders?

Answer 29

Formulation
Treat the treatable
CBT
TCAs; useful if co-morbid depression, anxiety or pain
Breathing retraining; if panic disorder or hyperventilation