Functional Neurological Disorder Flashcards
What is a functional neurological disorder (FND)?
Neurological symptoms or abnormal motor behaviours which cannot be explained by an organic cause
What is malingering?
Deliberately putting on symptoms to gain benefit e.g. money/housing from their or the state
What is munchausen’s syndrome?
The patient puts on symptoms to put on the sick role. Is common with adults who have spent a lot of time in hospital as a child
What is munchausen’s by proxy?
A caregiver is trying to gain attention through the person they are caring for e.g. parent is causing the symptoms in their child themselves
What is dystonia?
Changes in muscle tone
What are hyperkinetic conditions?
Uncontrolled movements of the limbs
Name the 11 common symptoms of functional neurological disorder?
o Tremor o Dystonia o Hyperkinetic conditions o Gait disorders/disturbance o Paresis o Pain o Loss of sensation o Hypersensitivity o Loss of concentration and memory o Seizures o Blindness/visual disturbance
What is paresis?
Anything from a mild loss of muscle strength to a complete loss of muscles activity
Name 8 pre-disposing factors of FND.
Anxiety, depression, personality disorder, dissociative disorders, obsessive compulsive disorder (OCD), previous history of FND, history of physical or sexual abuse, having a close relative with a functional disorder
What are factors that can trigger FND/what are the precipitating factors?
Physical injury/illness, panic attacks, migraines, infectious diseases/illness, stressful life events (losing a job, death of a loved one, breakdown of a relationship, changing schools (paediatric))
What does psychogenic mean?
It implies there is a primary psychological cause to FND
What does conversion disorder mean?
A term used to describe FND. It requires the identification of a defined psychological trigger
What factors can perpetuate FND? (6)
Non-acceptance of diagnosis Litigation Family dysfunction Financial benefits Provision of aids and equipment Provision of adaptive accommodation
In a patient how would you distinguish between a functional and organic tremor?
Functional tremor: patient will direct attention towards affected limb on examination, will show variable severity depending on attention towards affected limb (i.e. worse on examination, better with cognitive distraction techniques)
Organic tremor: tend not to direct attention to limb upon examination, severity remain unchanged with level of attention towards limb.
What is functional dystonia?
It is fixed abnormal postures of the limbs which are accompanied by severe pain
Often occurs after a peripheral injury
What is functional myoclonus?
Clonus= Greek for repetitive, fast or violent (of the muscle)
What piece of equipment is used to diagnose functional myoclonus?
Electro-physiological tests can be used as a diagnostic tool EEG-EMG back-averaging assess cortical activity prior to
movement (Bereitschaftspotential
What is an EEG?
What is an EMG?
EEG: Electroencephalogram (picks up cortical excitability)
EMG: electromyography (records electrical activity in skeletal muscle)
What are the 3 main clinical features of FND?
Functional myoclonus
Functional dystonia
Gait disturbance
What is ataxia?
A lack of muscle control/co-ordination of voluntary movements
How should FND be diagnosed?
What 3 diagnostic tools help diagnose FND?
FND can be diagnosed without any organic cause after investigation. It should be not diagnosed out of exclusion i.e. it should be a positive diagnosis.
Fahn-Williams criteria - 4-point degree scale of certainty
Shill-Gerber criteria - a development of Fahn-Williams
Electrodiagnostic tests/fMRI
Outline the Shill-Gerber criteria.
Primary criteria:
- Inconsistent with organic disease
- Excessive pain or fatigue
- Previous exposure to disease model
- Potential for secondary gain
Secondary criteria:
- Multiple somatizations (other than pain and fatigue i.e. where they have complaints in 3 or more organs)
- Obvious psychiatric disturbance
Clinically definite = > 3 primary and > 2 secondary
Clinically probable = 2 primary and 2 secondary
Clinically possible = 2 of primary and 1 of secondary or vice versa
Mention 9 symptoms/factors that rule out organic disease and suggest FND .
- False weakness
- False sensory signs
- Inconsistent over time
- Distractibility
- Abrupt onset
- Paroxysmal in nature, or periods of spontaneous remission
- Astasia-abasia (a sudden inability to stand/walk in a normal manner)
- Entrainment of tremor
- Atypical response to pharmacological agent
Outline 3 management therapies for FND
Physiotherapy - management of motor symptoms (gait, weakness), retrain movement patterns, encourage focus away from affected body part
Occupational therapy - regain confidence in ability to perform ADL’s in different environments
Psychology - CBT, stress/anxiety/depression/PTSD management
Describe 4 factors that contribute to good prognostic outcome from FND.
- Symptoms present for < 1 year
- Diagnosis of a psychiatric affective disorder at the onset of symptoms,
- Change in marital status
- Having one isolated symptom
Describe 4 factors that contribute to poor prognostic outcome from FND.
- Financial benefits of condition
- Litigation
- Personality disorders
- Multiple symptoms
How would you set goals for an FND patient and how would you manage a patients behaviour? (4)
Mutually agreed upon SMART goals with patient & next of kin
o Ignore Illness behaviour
If the patient is focusing on their symptoms
o Reward wellness behaviour
Achieving mutually agreed goals
Positive approach to rehabilitation
o Facilitate cognitive re-structuring
Help patients identify and modify negative thoughts by reflecting on their achievements
o Withdrawal of any gains of illness
Room placement, aid prescription, attention/mothering
