Functional Neurological Disorders Flashcards
What is meant by a functional neurological disorder?
No organic disease process can be found to explain the symptoms the patient is experiencing
How is a functional disorder often described to patients to help them understand that there is no organic cause for their condition?
Hardware Vs Software problem
A lot of computers break down but NOT due to direct damage of the hardware
Often it is just the software internally causing the problems.
What symptoms are often experienced in neurological disorders?
Pain Altered Sensation Dizziness Movement Problems Weakness Seizures Cognitive Symptoms
What words were previously used as descriptive terms of “functional” disorders?
Medically Unexplained Psychogenic Somatic Non-epileptic Conversion Pseudo (seizure, dementia)
Why is it not best practice to study the body system specialities in isolation if you suspect a patient has a functional disorder?
You need to look at the bigger picture and physical symptoms as a whole to work out what is actually wrong with the patient
What fraction of Neurology outpatient appointments are held by patients with functional neurological disorders?
1/3
Treatment of patients with functional disorders often requires a lot of the money from the NHS. TRUE/FALSE?
TRUE
(often this may be due to presumption of an underlying cause that cannot be found => many tests have been done to rule various things out)
What medical specialities describe the most patients presenting with functional disorders?
Gastroenterology - IBS, non-ulcer dyspepsia, chronic abdominal pain
Neurology - non-epileptic seizures, weakness
Cardiology - atypical chest pain, palpitations
Why are older descriptions of functional disorders not deemed as useful terminology to help the patient understand?
Conversion disorder implies the change of mental distress into physical illness
Non-organic/psychogenic implies disease is purely psychological => patients have stigma against this
Hysteria - historically used term, but very demeaning to patients
What terms are now used to help explain functional disorders to patients?
Dissociation disorder - detachment from reality (much like when you forget parts of a car journey that you drive)
Depersonalisation = body feels disconnected from you
Derealisation - world seems disconnected from you
Why are neurologists and psychiatrists often unhelpful in functional disorder referral?
Nervous system examination is normal
No major psychiatric disorder is present in many of these patients => are not sever enough to be seen as a psych referral for treatment
What percentage of functional neurological patients respond to treatment and how many actually recover completely?
- 60% respond to treatment
- Up to 30% may resolve completely
What patients are more likely to respond to treatment?
Patients with the view that things may change for better once on treatment
Early presentation = good prognostic indicator
How should we make sure when taking the history that a patient is explaining a functional disorder ?
Take time over history Get a clear timescale Ask about disability Ask about dissociation - “Dizzy” “Faint” Ask about other medical experiences Illness beliefs? Check PMHx for abdominal surgeries etc
What “traps” should we look out for if patients are describing functional disorders?
Benefits
Difficult Job
Compensation claims
Why is a physical examination important even in a functional disorder?
Need to try and elicit functional signs and later explain them to the patient
Explain inconsistent findings - common in functional symptoms
Give examples of inconsistent findings which are common in functional symptoms
Charcots gait (pt walks as if back leg is weak but is using power in “weak” leg to walk forward)
Unergonomic gait - patient grossly struggling to walk
Hoovers sign - contraction of “weak” contralateral leg muscles when trying to raise unaffected leg => no neurological deficit
How should functional disorders be explained to patients to improve compliance to treatment?
- normalisation – we see this often / this is common
- validation – symptoms = genuine/ you are not imagining it
- reversibility – people make good progress, this can be treated
- remove blame – Not your fault
How are functional disorders often treated?
Treat any comorbid psychiatric illness
- CBT
- Tricyclics (useful especially if comorbid depression / anxiety / pain)
- Breathing retraining - panic disorder / hyperventilation
What is the notable difference between a functional and true epileptic seizure?
True epileptic generalised seizure
- Patients usually very matter of fact about their symptoms during a hx taking
- tonic clonic movements, start in one area of body and move throughout
Functional:
- patients unsure of symptoms and look to family members for description
- oscillating movements
- BACK ARCHING
- starts in all areas at same time
- Some patients appear conscious during the seizure (NOT COMMON)
- patients not usually incontinent, and have a lack of injuries unlike epileptic seizures
- lack of trigger/pattern
Non-epileptic attack disorders is highly related to what childhood factors?
Sexual abuse
Childhood Trauma
What is a conversion disorder?
patients present with medically unexplained neurological symptoms
e.g. paralysis from what they suspect is “stroke”
OR loss of sight etc
