2: Functional Disorders

Question 1

What are somatoform disorders

Answer 1

Group of disorders where individual repeatedly presents to medical care with symptoms, requesting investigations. Is not reassured when investigations are negative or reassurance by doctor there is no physical pathology

Question 2

What are two somatoform disorders

Answer 2

• Somatisation disorder

- Hypochrondial disorder

Question 3

Define somatisation disorder

Answer 3

Multiple, recurrent and frequently changing symptoms persisting beyond 2-years duration.

Question 4

If symptoms of somatisation disorder, but is has persisted less than 2-years what is it called

Answer 4

Undifferentiated somatoform disorder

Question 5

What age group is somatisation disorder more common

Answer 5

under 40

Question 6

Which gender is somatisation disorder more common in

Answer 6

Female

Question 7

What are two risk factors for somatisation disorder

Answer 7

Parental anxiety towards illness

FH

Question 8

How does somatisation disorder present clinically

Answer 8

• Complex medical history
• Often symptoms entail multiple systems (and
  specialities)
• Patient’s life revolves around illness
• Discrepancy between subjective (10/10) and objective assessment (eg. patient laughing with others)

Question 9

What are three differential diagnosis for somatisation disorder

Answer 9

• Hypochondriasis
• Factitious disorder
• Malingering

Question 10

How is hypochondriasis different too somatisation.

Answer 10

Hypochondriasis = individual believes they have a specific disorder. Somatisation disorder = multiple systems

Question 11

What is factitious disorder

Answer 11

Individual invents symptoms to occupy sick role

Question 12

What is malingering

Answer 12

Individual invents symptoms of external gain

Question 13

how should individuals with somatisation disorder be managed

Answer 13

• Avoid over investigation
• Periodic reviews with same practitioner (to avoid over-attendance)
• CBT

Question 14

what is a risk with somatisation disorder

Answer 14

Iatrogenic harm due to over investigation

Question 15

define hypochondriasis

Answer 15

preoccupation with possibility of having one or more progressive physical disorders which persist despite medical investigations and reassurance, with subsequent distress and impaired function

Question 16

which gender is hypochondriasis more common

Answer 16

equal

Question 17

what is a risk factor for hypochondriasis

Answer 17

• Parental or childhood serious illness

- Neglect or emotional abuse

Question 18

how does hypochondriasis present clinically

Answer 18

• Pre-occupation significant serious progressive disorder
• Rumination
• Interprets normal bodily functions as signs of serious illness
• Seeks medical advice but is un-reassured by negative results

Question 19

how should hypochondriasis be managed

Answer 19

• Allow patient to vent anxieties
• Explain results negative test
• TCA
• Behavioural therapy

Question 20

what is dissociative disorder also known as

Answer 20

conversion disorder

Question 21

define dissociative disorder

Answer 21

loss or disturbance of motor, sensory or cognitive functions that initially thought due to physical or neurological cause and later found to be due to psychological causes

Question 22

what was the initial theory behind dissociative disorders

Answer 22

suppression of unacceptable conscious leads to manifestation as physical symptoms

Question 23

what is important to note about dissociative disorders

Answer 23

symptoms are not consciously invented by the individual (different to malingering and factitious disorder)

Question 24

what are common features of dissociative disorders

Answer 24

• Paralysis unilateral face or arm
• Sensory loss
• Patchy amnesia
• Aphonia

Question 25

explain paralysis in functional disorder

Answer 25

Usually flaccid paralysis. | Individual is unable to consciously move limb, however, synergistic movement does occur

Question 26

what sign is visible in functional disorder

Answer 26

Hoover sign

Question 27

what is unique about sensory loss in functional disorders

Answer 27

Fits with individual's anatomical beleifs

Question 28

how are functional disorders usually diagnosed

Answer 28

Clinical - inconsistent nature of signs and symptoms

Question 29

how are functional disorders identified

Answer 29

1. Exclude organic diagnosis 2. Identify positive signs 3. Supportive psychological cause underlying symptoms

Question 30

explain management of functional disorders

Answer 30

- Frame as positive diagnosis: no serious underlying pathology - Discourage use of aids that may reinforce sick role (eg crutch)

Question 31

Define chronic fatigue syndrome

Answer 31

presence of disabling fatigue for 4-months affecting physical and mental function more than 50% time, in absence of any organic pathology

Question 32

What time period is required to diagnose chronic fatigue

Answer 32

4-months

Question 33

In which gender is chronic fatigue more common

Answer 33

Female

Question 34

what is the main symptom of chronic fatigue

Answer 34

Disabling fatigue

Question 35

what are other symptoms of chronic fatigue syndrome

Answer 35

``` Cognitive: impaired short-term memory Flu-like illness Headache Muscle pain Painful lymph node enlargement Nausea Palpitations ```

Question 36

what does NICe recommend in chronic fatigue syndrome

Answer 36

Screen for organic causes

Question 37

what is used to manage CFS

Answer 37

- Pacing - Graded exercise therapy - CBT - amytryptiline

Question 38

what is pacing

Answer 38

organising activities to avoid tiring

Question 39

what is factitious disorder also known as

Answer 39

Munchausens

Question 40

what is Muchausen's disorder

Answer 40

Individuals fabricate symptoms and signs and past medical history, with primary intention of gaining medical attention and treatment