functional disorders

Question 1

treatment of functional disorders

Answer 1

screen for depressive/anxiety symptoms
consider antidepressants
psychological - explore illness beliefs, manage emotional symptoms

physiotherapy - prevent deconditioning

Question 2

somatisation

Answer 2

subconscious process by which emotional distress is expressed as physical (somatic) symptoms

we all somatise at times
symptoms are real - not made up or imagined
assoc with excessive use of healthcare
fluctuate in severity/inconsistent with anatomy

Question 3

chronic somatisers

Answer 3

non-cardiac chest pain
chronic fatigue syndrome
irritable bowel syndroms
fibromyalgia
functional neurological symptoms disorder
somatic symptoms disorder

Question 4

aetiology of somatisation

Answer 4

predisposing - childhood illness, lack of parental care, child abuse (pelvic pain), physical fam illness (Hx MI = non-cardiac chest pain)

precipitating - stressful events, psychiatric illness

perpetuating - ambiguous medical advice, fam/spouse collusion, threat of withdrawal of social benefits

Question 5

common somatied symptoms

Answer 5

• Chest/back pain
• Fatigue
• Dizziness
• Headache
• Dysphonia
• Numbness/tingling
• Weakness

Question 6

consequences of chronic somatisation

Answer 6

• Over-investigation / iatrogenic illness – surgery
• Repeated hospitalisations
• Misuse of prescribed drugs – opioids
• Inability to work/invalidism/financial difficulties
• Family/relationship breakdown
• Deterioration in doctor/patient relationships – repeated request for second opinion

Question 7

somatic symptom disorder

Answer 7

 Multiple, distressing, somatic symptoms which result in significant disruption of daily life + functioning

May be limited to only one symptom – commonly pain
Complaints often non-specific – fatigue
Disproportionated + persistent anxiety about seriousness of symptoms
Fear of underlying physical illness/persistent health anxiety
Negative test results only temporarily reassuring

• Poor/unsustained response to treatment
• Intolerant of medication
• Complaints about medical care
• Disinclination/refusal to consider psychological aetiology

Question 8

somatic symptom disorder insight

Answer 8

• Disinclination/refusal to consider psychological aetiology

Question 9

functional neurological disorder (FND)

Answer 9

one or more NEUROLOGICAL symptoms unexplained by an specific disease process affecting the nervous system

Question 10

functional neurological disorder (FND) presentation

Answer 10

weakness or paralysis, gait abnormalities
tremor, abnormal limb posturing

altered/absent skin sensation
visual field abnormalities, double vision
impaired hearing
non-epileptic attack/seizures (NEAD)

Question 10

diagnosis of functional neurological disorder (FND)

Answer 10

essential to demonstrate incompatibility with neurological disease for diagnosis

positive hoover’s sign -> functional weakness of lower limb

Question 11

malingering

Answer 11

fraudulent simulation or exaggeration of symptoms with the intention of financial or other gain

Question 12

Factitious disorder (Munchausen’s syndrome)

Answer 12

occupy sick role, intentional production of physical or psychological symptoms