Functional Disorders

Question 1

What are functional symptoms

Answer 1

Symptoms where you cannot easily associate them with a classically identifiable organic disease process
Cannot find a physical cause for them

Question 2

List some common functional symptoms

Answer 2

Pain - cramps etc 
Fatigue
Altered Sensation
Dizziness
Movement Disorders - tremors, spasms etc
Weakness
Seizures
Cognitive Symptoms
Memory problems

Question 3

Where do symptoms arise from

Answer 3

Disease process
Psychological factors
Social/cultural factors
Physiological processes

Question 4

If a patient does not have an underlying disease, is their symptom genuine

Answer 4

YES
Symptoms are subjective
Just because a doctor cannot find a cause it does not mean they aren’t experiencing it

Question 5

How can you manage a functional disorder

Answer 5

Have to do the the
vital investigations to rule out dangerous pathology - don’t over investigate as causes more anxiety
Explanation of the findings to the patient
Try and get them to see that things are able to change - good predictor
Go through each symptoms and LISTEN
Psychological therapy
Antidepressants can be used for comorbid depression and / or anxiety

Question 6

What are poor predictors of recovery from a functional disorder

Answer 6

Hopelessness, despair and entrapment

Question 7

What are good predictors of recovery from a functional disorder

Answer 7

Patients viewing the symptom as amenable to change

Early presentation

Question 8

What aspects of PMH are predictors of developing a functional disorder

Answer 8

Early age hysterectomy, appendicectomy, laparoscopy for abdominal pain
Childhood abuse or illness
Affective disorders
Depressive or anxiety disorders

Question 9

What signs are suggestive of a functional seizure rather than epilepsy

Answer 9

Back arching and rhythmic movements

Question 10

What is Charcot’s gait

Answer 10

A functional movement disorder
The patient will struggle with their gait as if they have a weak leg
Will drag foot behind – actually shows they are pushing off the back foot so it isn’t actually ‘weak’

Question 11

What weakness pattern is diagnostic of a functional disorder

Answer 11

Hemisensory weakness

Question 12

What is involved in the formulation of a functional disorder

Answer 12

Normalisation - this is common
Validation - these symptoms are real
Reversibility - this can be treated
Remove blame

But make them aware that they will need to put effort into getting better

Question 13

List some named conditions that cover medically unexplained symptoms

Answer 13

Non-cardiac chest pain 
IBS 
Chronic fatigue syndrome 
Fibromyalgia 
Chronic headache 
Non-epileptic attack disorders

Question 14

Anxiety disorders and depressive symptoms are commonly co-morbid with functional disorders - true or false

Answer 14

True

Can exacerbate both symptom severity and duration.

Question 15

What is a somatisisation disorder

Answer 15

Symptoms which are entirely unconsciously generated - e.g. not making it up
Multiple recurrent and changing physical symptoms not accounted for by physical pathology. Starts in early life, chronic and fluctuating course.

Question 16

What is hypochondria

Answer 16

Severe and precipitant anxiety about ill health and conviction of disease despite negative medical investigation and reassurance

Question 17

What is the definition of pain disorder

Answer 17

Poorly define but usually chronic pain which cannot be accounted for by any primary physical or mental disorder.

Question 18

What is body dysmorphic disorder

Answer 18

Persistent, inappropriate concern about the appearance of the body or body parts.
May lead to demands for cosmetic and other surgery.

Question 19

What is a factitious disorder

Answer 19

The intentional production of physical pathology or the feigning of symptoms.
Differs from malingering in that it does not apparently bring any external reward such as time off work.
Maunchausen’s syndrome is a rare and extreme form.