Functional disorders in primary care physician practice

Functional disorders occupy one of the leading places in the clinical practice of doctors of various specialties. As in comorbid conditions, functional disorders can alter each other’s clinical manifestations, and in addition are capable of mimicking various organic pathologies, including acute conditions. Such patients often face many difficulties at the stage of diagnosis and treatment. The lack of specific markers of functional disorders forces the doctor to resort to expensive examination methods, such as magnetic resonance imaging, computed tomography, endoscopic examinations and others. The pathogenesis of functional disorders is considered within the framework of a biopsychosocial model. The development of functional symptoms is influenced by a number of factors such as provoking, predisposing, mediating and supporting. Psychological factors play a leading role in health assessment within the biopsychosocial model, and stress is seen as one of the important triggers associated with the development of multiple chronic diseases and conditions. The cardiovascular system is the primary target of the stress response. Data from epidemiological studies demonstrate an association between stress and the development of myocardial infarction, as well as between stress and acute cerebrovascular accidents. In addition, psychological stress leads to changes in heart rate, heart rate variability, and alters circadian rhythm. Symptomatic therapy for functional disorders of the cardiovascular system helps to alleviate the patient’s condition and has a significant psychotherapeutic effect. Its action is aimed at quick relief of the leading symptom, which prevents the chronization of the process. In patients with functional disorders, it is important to follow the rules for prescribing different groups of drugs, taking into account their clinical effects, interaction characteristics, timing of use and individual sensitivity of patients.