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
