Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Neuropsychiatric Disorders > Functional Neurological Disorder > Flashcards

Functional Neurological Disorder Flashcards

1
Q

What are functional disorders?

A

Physical symptoms in the absence of physical disease (disorder of function)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Similar symptoms to functional disorders can be induced by….

A

Suggestion, hypnosis, or placebo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Functional symptoms are not ___________ generated.

A

Consciously

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What percent of medicine is functional?

A

30%

Across specialties!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is functional ‘overlay’?

A

When functional symptoms occur ‘on top of’ physical disease.

This is very common
Physical disease is a risk factor for functional disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What might functional overlay help to explain?

A

Placebo effect and the role of expectation

What they expect the symptoms to be and what they expect from a treatment (e.g. immediate effect)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

When are functional disorders typically referred to as ‘Medically Unexplained Symptoms’ and why?

A

By psychologists

Alludes to psychological aetiology but stays open to allow for a etiological exploration with psychological therapies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What did Stone et al (2003) conclude about the naming of functional disorders?

A

‘Functional weakness’ was the best accepted term.

People were also generally accepting of stress as a cause of the problem (‘stress related weakness’)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How are functional disorders classed in the ICD11?

A

Dissociative disorder of movement, sensation, or cognition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the three main categories of ‘unexplained’ symptoms?

A

▪️Functional/MUS/Non-organic etc…
▪️Simulated illness
▪️Genuinely unexplained

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How can functional disorders be further divided into two categories?

A

▪️Multiple systems or symptoms (somatic symptoms disorder/somatisation)
▪️Single system or symptoms (e.g. FND, CFS, IBS, ME etc)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is somatisation disorder?

A

Multiple, recurrent, and frequently changing physical symptoms across different symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

For how long must you experience unexplained symptoms to get a diagnosis of somatisation disorder?

A

2 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the two types of somatisation disorder in the DSM

A
  1. Simple Somatic Symptoms Disorder
  2. Complex Somatic Symptoms Disorder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How is somatisation disorder classed in the ICD?

A

Disorders of Bodily Distress or Bodily Experience

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How does somatisation disorder differ from hypercondriasis?

A

Emphasis is on symptoms, not illness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What factors increase likelihood of somatisation disorder?

A

▪️Female
▪️Family history (although little evidence of heritability)
▪️Parental illness
▪️Childhood abdominal pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How does Complex Somatic Symptom Disorder differ from simple?

A

▪️Chronic (at least 6 months compared to 1)
▪️2 or more of: (instead of 1)
a) high health related anxiety
b) disproportionate and persistent concerns
c) excessive time and energy devoted to concerns

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Does physical/organic disease need to be excluded for diagnosis of somatisation disorder?

A

No!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the two main types of simulated illness?

A

▪️Factitious disorder
▪️Malingering

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is simulated illness?

A

Consciously generated/feigned symptoms for some sort of benefit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is factitious disorder?

A

Consciously generated symptoms, intentially produced to assume “sick role” and gain medical attention

(e.g. Munchausen’s disease)

23
Q

What signs might suggest factitious disorder?

A

▪️Secondary gain
▪️Male with antisocial personality
▪️Drug seeking
▪️Fake identities
▪️False histories

24
Q

What is malingering?

A

Consciously generate, feigned symptoms for benefit other than medical attention/healthcare, typically for financial compensation

(a legal concept)

25
Q

What is a primary gain from symptoms?

A

Positive aspects of the disorder (e.g. escape from stressor, moving mental stress)

Typically associated with functional, not feigned

26
Q

How do you distinguish functional from feigned symptoms?

A

The motivation/gain

Primary gain = typically functional
Secondary gain = feigned

27
Q

What are the problems with distinguishing functional from feigned illness?

A

▪️Often look the same
▪️Difficult to assess intent/motivation at clinic
▪️Likely a spectrum on intent
▪️Patient may be unaware
▪️All patients may elaborate to convince clinicians
▪️Intent can vary over time

28
Q

How does ICD11 description differ from DSM?

A

Less focus in psychological formulation and distinguishing it from organic disease

29
Q

Who is most at risk of FND?

A

▪️Females
▪️Particularly in their early 20s

30
Q

What percentage of neurology outpatients present with FND?

A

12-16%

(30% if include functional overlay)

31
Q

What role did Charcot play in distinguishing functional and organic disorders?

A

Proposed the division between structure and function

32
Q

What is dissociation?

A

The disruption of and/or discontinuity in the normal integration of consciousness/awareness and other psychological and neurological functions, experienced as a sense of disconnection.

33
Q

What are the main categories of dissociation in the DSM V?

A

▪️Trauma and stressor related disorders
▪️Dissociative disorders (uncommon)
▪️Somatic symptom disorders (common)

34
Q

What are the three main types of dissociative disorder in the DSM?

A

▪️Dissociative identity disorder
▪️Dissociative amnesia
▪️Depersonalisation/derealisation disorder

35
Q

What is conversion disorder?

A

Proposed by Freud

Neurological symptoms are the physical manifestations of unresolved psychological turmoil

36
Q

What are the two main components of conversion disorder as proposed by Freud?

A
  1. Central role of psychological stressor that can be repressed from consciousness and revealed by psychoanalysis
  2. Conversion to physical symptoms for either primary (the conversion reduces the stressor) or secondary gain (the physical symptoms reduce the stressor)
37
Q

What are the three key compenents of FND?

A
  1. Neurological symptoms
  2. Not explained by neurological disorder (‘negative’ features)
  3. Not explainable by neurological disorder (‘positive’ signs)

(but can be explained psychologically - associated with stressor)

38
Q

What neurological symptoms can be seen with FND?

A

Any!

▪️Seizures
▪️Weakness
▪️Movement disorders
▪️Sensory symptoms
▪️Cognitive impairment

39
Q

What is a ‘negative’ diagnostic feature of FND?

A

No disease found to explain the symptoms

40
Q

What is a ‘positive’ diagnostic feature of FND?

A

Symptoms which are not explainable by physical diseases

41
Q

What are the three main types of ‘positive’ neurological features?

A

▪️Decreased conscious function compared to unconscious (e.g. Hoover’s sign)
▪️Symptoms at variance with anatomy/physiology (e.g. sensory change)
▪️Other (e.g. collapsing weakness)

42
Q

What is Hoover’s sign in functional weakness?

A

▪️Unable to push heel down on command
▪️BUT when lifting the other leg against resistance, the right hip extends pushing the weak leg down

43
Q

What are convergent/symmetrical platysma contractions indicative of?

A

Functional facial weakness

44
Q

How can you distinguish a functional tremor from an organic tremor?

A

Entrainment - shows loss of agency and the role of attention

45
Q

What did Parees et al (2011) report about functional tremor duration?

A

Both functional and organic patients self-report greater tremor duration through the day than shown by actigraphy

BUT difference is much more pronounced in functional cases

46
Q

What are signs of functional sensory symptoms?

A

Sensory change with non-anatomical distribution

e.g. change at the midline or groin/shoulder crease (sharp change from sensation to loss of)

47
Q

What types of stressful life events are more commonly reported in FND?

A

All types, particularly emotional neglect

48
Q

How does physical illness interact with psychological/functional symptoms?

A

▪️Physical injury often precedes FND onset
▪️Physical disease is a risk factor for FND
▪️Functional overlay is common

49
Q

What are the benefits of showing patients their positive physical signs?

A

▪️Help them to understand why we think it’s FND
▪️Helps show role of attention, belief, expectation etc
▪️Shows reversibility and potential for recovery

50
Q

What model can be used to explain how stressful life events impact later symptom presentation?

A

The diathesis-stress model

51
Q

What is the diathesis stress model?

A

Disorder occurs as a result of an interaction between predispositional biological vulnerability and adverse life events

(Jar analogy - what’s needed to cross the threshold?)

52
Q

What is the Bayesian brain theory?

A

The brain encodes beliefs (probabilistic states) to generate predictions about sensory inputs, using prediction errors to update this

53
Q

How can the Bayesian model of predictive coding be used to understand FND?

A
  1. Symptoms perception begins with prior formation (expectation based on previous experience)
  2. Sensory inputs compared to priors to generate prediction error (PE)
  3. Symptom experience (posteriors) generated to best match prior and PE
  4. Posterior then used to determine new prior
54
Q

What psychiatric disorders are more commonly comorbid with FND?

A

▪️Anxiety disorders
▪️Depression
▪️PTSD (medical trauma?)
▪️Personality disorder
▪️Neurodevelopmental disorders

Neuropsychiatric Disorders (30 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions