1168718 tn?1464983535

Functional Overlay

Hi Guys,
Here we go again, with this darn explanation of my symptons.  I just got the report from my last Neuro appt, and again she said, the "Functional Overlay" makes it hard for her to tell if I have progressed or not. . I am angry about it, but don't really know what to do either.  I have looked up the definition of the phrase, and it seems like they say you are a little LOOPY and making more of the situation ............... I have to confront her again, but this time she is using the phrase from a couple of years ago when the Neuro/opthomologist used it in his report.

Just wondering if anyone else has encountered this, and if so, did they find out what the heck it meant .......

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5265383 tn?1483808356
I had that on my first report with my neuro -- haven't seen it since.  That was my take too -- but there are a few different explanations and most aren't conscious.  In my case I think he meant anxiety was heightening my reactions.  

I'd like to see our neurologists' reactions to getting hit with these random events!

I found this article helpful, candy ...

Especially this line:

"The dynamics of overlay are a combination of anxiety from body-image distortion and depression from decreased efficiency of the body, as well as the resulting psychosocial disruption in a patient's life."

Ummm yep.  I certainly have had that, and it doesn't embarrass me one bit.  I wouldn't worry about it.
This article states that it's not a legitimate psychological diagnosis.

Helpful - 0
987762 tn?1331027953
Did you notice the date of publication was 1979? I do know that back in the early 2000's 'functional overlay' was not in the American Psychiatric association of diagnostic and statistical manual of mental disorders but off the top of my head the latest DSMV-5 does have 'functional' with some disorders reclassified under this......i'll have to get back to you tomorrow with exactly what's what as its late and i can't seem to find where i've put it....

"‘Functional’ embodies real divisions in neurologists' conceptualisation of unexplained symptoms and, perhaps, between those of patients and neurologists: its diversity of meanings allows it to be a common term while meaning different things to different people, or at different times, and thus conceal some of the conflict in a particularly contentious area. This flexibility may help explain the term's longevity."


This was published back in 2012 but it has some interesting points about neurologists use of 'functional' although i do have a few others more informative on the topic but I will have to get back to you with it, sorry.

Helpful - 0
thanks lovie, I'm doing ok with that comment now, for some reason. How are you ??
987762 tn?1331027953
Hey babe, I've finally found what i was looking for last night.......

*'Functional Symptoms in Clinically Definite MS – Pseudo-relapse Syndrome' published in The International MS Journal 2008; 15: 47–51

"Diagnosing such functional symptoms or overlay is much more difficult when there is a diagnosis of definite MS. In the Diagnostic and Statistical Manual
of Mental Disorder, 4th edition (DSM IV), diagnostic criteria for conversion disorders, reference is made to the difficulties that may arise in making a diagnosis when a patient presents with symptoms of probable psychogenic origin with a co-existing physical disorder, or where the symptoms may be an unusual manifestation of a physical disorder.

Thorough history-taking and clinical examination are particularly important in a case of suspected relapse. They can provide a framework for comparison of
clinical status at follow-up visits, as well as potentially lending support to a diagnosis of a pseudo-relapse or functional symptoms.

Careful examination of power in affected muscle groups and observation of gait may show discrepancies in clinical presentation. The abductor sign and Hoover’s sign have been described as being useful in distinguishing organic weakness from non-organic weakness.

To test the abductor sign, the examiner tells the patient to abduct each leg, and opposes this movement with his/her hands placed on the lateral surfaces of the patient’slegs. The leg contralateral to the abducted one shows opposite
actions for organic paresis and non-organic paresis. When the paretic leg is abducted, the sound leg stays fixed in organic paresis, but moves in the
hyperadducting direction in non-organic paresis.

Hoover’s original description indicated that the sign is composed of two separate tests. The first part, examines the complementary opposition of the paretic leg when the sound leg is lifted. This downward pressure is compared against the strength of the hip extensor manually tested beforehand. The paresis was judged to be non-organic if the paretic leg exerted full downward
opposition, stronger than the manually tested strength. The paresis was judged to be organic if the downward pressure was equally weak to the manually tested strength. When the manually tested strength of the hip extensor was full, this test was not diagnostic.

The second part of Hoover’s test examines the complementary opposition of the sound leg when the patient lifts, or attempts to lift the paretic leg. When the sound leg exerts only weak downward pressure and is passively lifted by the examiner’s hand, the paresis is judged to be non-organic. A normally strong downward opposition of the sound leg suggests organic paresis.

Both of these signs rely on the principle of synergistic contraction; however, in a patient with MS these signs may not be reliable due to pre-existing weakness."

"We suggest pseudo-relapse as a distinct entity in patients with definite MS who have confirmatory laboratory evidence. Pseudo-relapse syndrome
describes functional symptoms or emotional overlay inconsistent and separate to the organic physical component of MS.

Several studies have reported high rates of depression in MS with a lifetime prevalence of approximately 50% and an annual prevalence of
20% not uncommon. Depression in itself frequently presents somatically rather than psychologically.

Additionally, there are many sources of stress for patients with MS. These patients are particularly vulnerable to a deteriorating cycle of stressful life
events, illness episodes and disability. Acutely stressful events have been shown in some studies to predict relapse occurrence.

Early involvement of a multidisciplinary team may help minimize psychological distress and break the reciprocal cycle that can lead to accumulation of disability. Psychosocial stressors have been linked to both MS
relapse and functional disorders.

However, causation has not been proved in either scenario and the absence or presence of such stressors should not be used as primary means for distinguishing a clinical relapse, from overlay or functional disorder. Disabling
organic and functional symptoms may co-exist, making both diagnosis and management more difficult.

Recognition and minimization of stressors in any clinical scenario may be useful to help reduce a patient’s distress. Identifying a stressor may not in
itself help in making a diagnosis, but may be highly relevant obstacles to recovery."


.......It doesn't necessarily mean what you probably think it means, depending on the doctor it honestly does vary, so whilst most people assume it only equates to emotional health ie disproportionately believing things are worse than the actually physical evidence, making it up, loopy, attention seeking, emotional conversion, health anxiety etc etc etc

In someone dx with a chronic medical condition, it can also be used when there are additional issues eg muscle weakness from disuse, limiting mobility, compensation techniques used etc or the disease associated mental health issues eg depression, anxiety, low self esteem, negative self image, isolation, family and financial stresses etc is additionally negatively affecting their disease situation.

Most people have heard of the positives of the placebo effect but it can be both negative and positive, if you believe xyz is true strongly enough, the human psyche is capable of unconsciously creating it, as in self fulfilling prophesy...sorry i'm not sure i'm explaining this well enough.....

Unfortunately unless you directly ask your neuro for a clarification of her meaning and ask her what specifically has made her form the function overlay idea, you could have the wrong end of the stick.

I would suggest if she is thinking you are dealing with 'additional' mental health issues that is potentially making you feel your worse off than your clinical signs, i would definitely not advice confronting her, as it wouldn't benefit anyone but suggest you take a step back and consider if there 'could be' any possible truth in additional functional overlay.......regardless of your answer, before you next see your neurologist, if you haven't already I would recommend you consider seeing a psychologist who supports people with MS for their professional opinion on functional overlay, what ever the outcome may be what directs your next move with this particular neurologist.  


PS i hope that makes sense, it's stinking hot over here in oz
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1168718 tn?1464983535
Thank you guys, I will take it to heart , and study it further.  Thanks again,

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