Functional Disorders Flashcards
what are functional symptoms
symptoms where one cannot easily associate the symptoms with a classically identifiable organic disease process
what are common sensory symptoms
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
what are types of neurological functional disorders
functional weakness, non epileptic attacks, hemisensory symptoms
what are types of GI functional disorders
IBS, non ulcer dyspepsia, chronic abdo pain
what are types of gynaecological functional disorders
chronic pelvic pain, PMS
what are types of ENT functional disorders
functional dysphagia, globus pharynges
what are types of cardiology functional disorders
atypical chest pain, unexplained palpitations
what are types of rheumatology functional disorders
fibromyalgia
what are types of infectious disease functional disorders
post viral chronic fatigue syndrome
what are types of immunology/ allergy functional disorders
multiple chemical sensitivity syndrome
what is dissociative disorder
term for a functional disorder
what is dissociation
detachment from reality- can be normal or pathological
what is depersonalisation
a feeling that your body doesn’t quite belong to you or is disconnected from you
what is derealisation
a feeling that you are disconnected from the world around you or spaced out
what are good prognostic indicators for response to treatment
patients view that things are amenable to change
time to presentation (longer lasting illness means more social isolation)
what are poor prognostic factors for functional disorder
hopelessness
despair
entrapment
what can you do to help functional disorders
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
what should you do in exam of functional symptoms
always do exam
elicit functional signs and later explain
inconsistent findings common
what is ‘formulation’ in functional disorders
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
what is the treatment for functional disorders
formulation
CBT
tricyclic antidepreeants (esp if co morbid depression/ anxiety/ pain)
breathing training (panic disorder/ hyperventilation)
