Functional Disorders Flashcards
What are functional symptoms
Symptoms where you cannot easily associate them with a classically identifiable organic disease process
Cannot find a physical cause for them
List some common functional symptoms
Pain - cramps etc Fatigue Altered Sensation Dizziness Movement Disorders - tremors, spasms etc Weakness Seizures Cognitive Symptoms Memory problems
Where do symptoms arise from
Disease process
Psychological factors
Social/cultural factors
Physiological processes
If a patient does not have an underlying disease, is their symptom genuine
YES
Symptoms are subjective
Just because a doctor cannot find a cause it does not mean they aren’t experiencing it
How can you manage a functional disorder
Have to do the the
vital investigations to rule out dangerous pathology - don’t over investigate as causes more anxiety
Explanation of the findings to the patient
Try and get them to see that things are able to change - good predictor
Go through each symptoms and LISTEN
Psychological therapy
Antidepressants can be used for comorbid depression and / or anxiety
What are poor predictors of recovery from a functional disorder
Hopelessness, despair and entrapment
What are good predictors of recovery from a functional disorder
Patients viewing the symptom as amenable to change
Early presentation
What aspects of PMH are predictors of developing a functional disorder
Early age hysterectomy, appendicectomy, laparoscopy for abdominal pain
Childhood abuse or illness
Affective disorders
Depressive or anxiety disorders
What signs are suggestive of a functional seizure rather than epilepsy
Back arching and rhythmic movements
What is Charcot’s gait
A functional movement disorder
The patient will struggle with their gait as if they have a weak leg
Will drag foot behind – actually shows they are pushing off the back foot so it isn’t actually ‘weak’
What weakness pattern is diagnostic of a functional disorder
Hemisensory weakness
What is involved in the formulation of a functional disorder
Normalisation - this is common
Validation - these symptoms are real
Reversibility - this can be treated
Remove blame
But make them aware that they will need to put effort into getting better
List some named conditions that cover medically unexplained symptoms
Non-cardiac chest pain IBS Chronic fatigue syndrome Fibromyalgia Chronic headache Non-epileptic attack disorders
Anxiety disorders and depressive symptoms are commonly co-morbid with functional disorders - true or false
True
Can exacerbate both symptom severity and duration.
What is a somatisisation disorder
Symptoms which are entirely unconsciously generated - e.g. not making it up
Multiple recurrent and changing physical symptoms not accounted for by physical pathology. Starts in early life, chronic and fluctuating course.
What is hypochondria
Severe and precipitant anxiety about ill health and conviction of disease despite negative medical investigation and reassurance
What is the definition of pain disorder
Poorly define but usually chronic pain which cannot be accounted for by any primary physical or mental disorder.
What is body dysmorphic disorder
Persistent, inappropriate concern about the appearance of the body or body parts.
May lead to demands for cosmetic and other surgery.
What is a factitious disorder
The intentional production of physical pathology or the feigning of symptoms.
Differs from malingering in that it does not apparently bring any external reward such as time off work.
Maunchausen’s syndrome is a rare and extreme form.
