Functional Disorders

Question 1

what are functional symptoms

Answer 1

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

Question 2

what are common sensory symptoms

Answer 2

pain 
altered sensation 
dizziness 
movement disorders 
weakness 
seizures and paralysis 
cognitive symptoms 
sensory symptoms 
bladder/ bowel problems 
fatigue 
speech problems 
dissociation 
muscle cramps and spasm 
tremors

Question 3

what are types of neurological functional disorders

Answer 3

functional weakness, non epileptic attacks, hemisensory symptoms

Question 4

what are types of GI functional disorders

Answer 4

IBS, non ulcer dyspepsia, chronic abdo pain

Question 5

what are types of gynaecological functional disorders

Answer 5

chronic pelvic pain, PMS

Question 6

what are types of ENT functional disorders

Answer 6

functional dysphagia, globus pharynges

Question 7

what are types of cardiology functional disorders

Answer 7

atypical chest pain, unexplained palpitations

Question 8

what are types of rheumatology functional disorders

Answer 8

fibromyalgia

Question 9

what are types of infectious disease functional disorders

Answer 9

post viral chronic fatigue syndrome

Question 10

what are types of immunology/ allergy functional disorders

Answer 10

multiple chemical sensitivity syndrome

Question 11

what is dissociative disorder

Answer 11

term for a functional disorder

Question 12

what is dissociation

Answer 12

detachment from reality- can be normal or pathological

Question 13

what is depersonalisation

Answer 13

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

Question 14

what is derealisation

Answer 14

a feeling that you are disconnected from the world around you or spaced out

Question 15

what are good prognostic indicators for response to treatment

Answer 15

patients view that things are amenable to change

time to presentation (longer lasting illness means more social isolation)

Question 16

what are poor prognostic factors for functional disorder

Answer 16

hopelessness
despair
entrapment

Question 17

what can you do to help functional disorders

Answer 17

take time over history (perception of being listened to and believed) 
get a clear timescale 
ask about disability 
ask about dissociation (dizzy, faint) 
ask about other medical experiences 
illness beliefs? 
PMHx- early age hysterectomy, appendectomy, laparoscopy for abdo pain 
previous functional symptoms 
ask about psychiatric Hx at the end

Question 18

what should you do in exam of functional symptoms

Answer 18

always do exam
elicit functional signs and later explain
inconsistent findings common

Question 19

what is ‘formulation’ in functional disorders

Answer 19

treatment:
Includes normalisation – this is common / we see this often / you are not weird
Includes validation – these symptoms are genuine and you are not imagining it
Includes reversibility – many people make good progress, this can potentially be treated
Remove blame – it’s not your fault that you have these symptoms
But – you will need to put some effort into getting better

Question 20

what is the treatment for functional disorders

Answer 20

formulation
CBT
tricyclic antidepreeants (esp if co morbid depression/ anxiety/ pain)
breathing training (panic disorder/ hyperventilation)