Functional Disorders

Question 1

What are functional symptoms?

Answer 1

Symptoms where one can’t easily associate the symptoms with a classically identifiable organic disease process

Question 2

What are some common functional symptoms?

Answer 2

Pain, altered sensation, dizziness, movement disorders, weakness, seizures, cognitive symptoms

Question 3

How common are functional symptoms?

Answer 3

Physical symptoms like headache and dizziness prompt almost 50% of all primary consultations
About 1/3 of neurological outpatients have no organic pathology

Question 4

What are some functional symptoms seen in neurology and gastroenterology?

Answer 4

Neuro = functional weakness, non-epileptic attacks, hemisensory symptoms
GI = IBS, non-ulcer dyspepsia, chronic abdominal pain

Question 5

What are some functional symptoms seen in cardiology and ENT?

Answer 5

Cardio = atypical chest pain, unexplained palpitations
ENT = functional dyspepsia, globus pharynges

Question 6

What are some unhelpful concepts that surround functional symptoms?

Answer 6

Conversion disorder, somatisation disorder, dissociative motor disorder, hypochondriasis, factitious disorder, malingering

Question 7

What is conversion disorder?

Answer 7

Patients convert mental disorder into physical symptoms = usually weakness, movement disorders, sensory symptoms or non-epileptic attacks

Question 8

What is somatisation disorder?

Answer 8

Patient has lifelong pattern of physical symptoms which aren’t due to disease

Question 9

How well do functional symptoms respond to treatment?

Answer 9

Up to 60% of patients show good response to treatment = up to 30% may resolve completely

Question 10

What are some poor predictors of outcome in functional disorders?

Answer 10

Hopelessness, despair and entrapment

Question 11

What is a predictor for developing a functional disorder in later life?

Answer 11

Childhood abuse = affective disorders increase risk of functional disorders

Question 12

What is the treatment of choice for functional disorders?

Answer 12

CBT is first line

Question 13

What are some other treatments for functional disorder?

Answer 13

Treat comorbid psychiatric illness if present
Tricyclics = useful generally and especially if there is comorbid depression, anxiety or pain
Breathing retraining = panic disorder or hyperventilation