Functional Neurological symptoms Flashcards
What are functional disorders?
- definition?
- what process id involved in these disorders?
Symptoms unexplained by conventional physical disease process
distressing/disabling
-troublesome physical symptoms which after investigation are not fully explained by a physical disease process or injury.
symptoms are real not imagined, likely that brain activity involved in producing the symptoms is triggered by emotional change
-Somatisation
Dissociation disorders
- what is it?
- types?
-partial loss of the normal integration between memories of the past, awareness of identity, immediate sensations and control of bodily movements
Dissociative amnesia
Dissociative fugue Dissociative stupor
Trance and possession disorders
Dissociative disorders of movement and sensation
Describe Dissociative disorders of movement and sensation?
-presentation?
motor disorders, sensory loss and/or convulsions
-presents as having a physical disorder but this doesn’t explain the symptoms
Can represent the patients concept of physical disorder
usually helps patient pt escape conflict or express dependency
somatisation
- what is it?
- presentation?
multiple, recurrent and frequently changing physical symptoms
Long and complicated Hx of contact with medical services
any part of body involved
cause impairment on social and family functioning
-repated presentation of physical symptoms and persistent requests for inv inspire of repeated investigations and reassurance the symptoms have no physical basis
usually resist attempts to discuss psychological basis
How would these disorders present in the following specialties?
- GI
- Neuro
- Rheumatology
- IBS, dysphagia
- Non epileptic attack disorder, weakness +/- sensory disturbance
-fibromyalgia
Chronic fatigue syndrome
CFS/fibromyalgia
-what are they?
representations of a spectrum disorder characterised by fatigue and MSK discomfort, psychologically driven
features of chronic somatisation? (7)
preoccupied with physical symptoms
attributed to physical/organic cause
disinclination to consider psychological/emotional factors
Benign sensations misattributed to physical disease
development of inflexible core benefits
persistent requests for medical investigations
Neg results dismissed
what are the risk factors? (5)
What factors predispose?
female 30-60 yrs relative with functional disorder allied health service staff patients with learning difficulties
-childhood experiences (family illness, abuse, neglect, hospital) personality characteristics (anxiety, neuroticism) Cognitive styles (catastrophising)
- Precipitating factors?
- perpetuating factors?
-major threats to health e.g. MI, Ca, viral illness
Personal loss
Psychiatric illness
-over investigation means psych illness overlooked & consolidates beliefs
risk of iatrogenic illness
Secondary gain (benefits, exemption from work, manipulating others)
intentional elaboration/feigning
What abnormalities are seen on imaging?
inc activity of rCBF bilateral in frontal and parietal cortex in resting state when stimulated bilaterally when recovered
Deficit:
reduced rCBP to contralateral thalamus and basal ganglia
hypoactivatiqn resolved with recovery
Examination findings?
see inconsistency
hoovers sign (push down with R heel has no effect ut R hip extends when patient asked to lift L leg) discrepancies in leg power
external inconsistency-tubular defect inconsistent with law of optics
non anatomical signs
Non epileptic attack disorder
-risk factors?
-women
prev abuse
depression, anxiety, PTSD
treatment options?
positive Dx and rehabilitation
treatment of anxiety/depression/post traumatic stress disorder
psychological therapies
Laxatives/antispasmodics
antidepressant Tx
-disengages somatisation wiring
symptomatic improevemt
