Functional Neurological Disorders Flashcards
factitious disorder
for medical attention
symptoms are intentionally produced or feigned to assume the sick role
includs munchausens
malingering
for other benefit that is not medical attention
financial gain
avoiding war
what is the male to female ratio of fnd
3:1 female to male
hysteria
hippocrates (460-370 BC)
the idea that the body is affected by the wondering womb
functional disorder
charcot (1825-1893)
brain disorder with normal structure
hyponosis as ,mechanism and treatment
conversion disorder
freud (1856-1939)
Conversion of ‘affect’ (emotion/stress) into physical symptoms- Psychodynamic mechanism: stressor repression
dissociation
janet (1859-1947)
Disconnection between awareness & neurological function- Disorder of attention
primary gain in conversion disorder
the process of conversion itself reduces the stressor
secondary gain in conversion disorder
the resulting physical symptoms reduce the stressor
what is the definition of fnd in dsm and icd
neurological symptoms
not explained by neurological disorder
not explainable by neurological disorder
can be explained psychologically
nor feigning
what are the core fnd symptoms
weakness/ paralysis
movement disorders
seizures/ attacks
sensory dysfunction
define
positive neurological signs
symptoms not explainable by neurological disorder
descrine
positive neurological signs
concious vs unconcious observed as strength/ balance/ vision on examination e.g. positive hoover’s sign or tremor entrainment
symptoms at variance with anatomy/ physiology e.g. changes in sensation or tubular visual field deficit
other positive neurological signs such as give way, collapsing weakness
what are the benefits of showing patients positive neurological signs
shows potential for recovery
confidence in diagnosis and no need for further testing
positive hoover’s sign
pressure is felt under the affected leg when the unaffected leg is lifted
signs of epileptic seizures
eyes remain open
head is fixed or unilateral version
limbs in the same direction
body is straight
no rotation of body movement
evolves uninterrupted
signs suggestive of non epileptic seizures
eyes closed
side to side head movements
out of phase limb movements
arching
intense rotation
fluctuating course of evolution
what are the mechanisms of fnd
freud’s trauma model
biopsychosocial model
bayesian/ computational model
trauma model of fnd
stressful life events such as childhood and adult abuse and neglect
biopsychosocial model of fnd
diathesis stress model
physical and psychological interaction in fnd
physical injury often precedes onset of fnd (risk factor)
functional overlay is common
psychiatric comorbidities in fnd
anxiety panic disorders
depression (secondary)
PTSD
(personality disorders)
(neurodevelopmental disorders)
