[Functional disease pictures without pathologic organ findings--a challenge for the internist]

Many patients suffer from symptoms related to pathomorphologically healthy organs. Typical symptom patterns may be defined as functional disease entities. No demonstrable pathomorphologic alterations mean normal clinical findings, normal results of laboratory tests and function studies, absence of abnormal findings in imaging techniques, and normal results of cytologic or histologic investigations. Symptom patterns of functional diseases are usually impressive and clear, allowing a primary diagnosis, which of cause must be verified by excluding possible differential diagnoses. Early diagnosis has a heavy impact on later course and prognosis. From a certain point of chronicity, functional diseases become more or less refractory to therapy. Neglection of the correct diagnosis may therefore promote chronic disease. The main reason for a misleading diagnosis is the unreadiness of physicians and patients to accept and to face the functional, non-organic nature of symptoms. The main etiologic factor is psychosocial stress in most cases. Treatment is based on four different approaches, which may well be combined with each other: oral communication to clarify and to explain the nature of the disease, changing the all day way of life, supporting drug therapy, and specific psychosomatic treatment.