How can Continuous Performance Test help to assess inattention when mood and ADHD symptoms coexist?

Depression and attention-deficit/hyperactivity disorder (ADHD) are prevalent, and often comorbid, disorders, with varying severity levels among patients. Inattention is a symptom present in both disorders, which often makes their differential diagnosis difficult in clinical practice (depression only versus comorbidity). This study aimed to investigate the influence of depressive symptoms on attention performance using one of the most common tasks in clinical practice, the continuous performance test (CPT). Ninety-three college students (60 men, 33 women) with a mean age of 24 years old were investigated with self-reports and semi-structured interviews for ADHD; the Beck Depression Inventory (BDI) was used for depression ratings. Attention measures were derived from the CPT. There was no correlation between depression and ADHD symptoms; in addition, depression was not correlated with any of the CPT scores; ADHD symptomatology was the only predictor of changes in those CPT variables (commission and omission errors and d prime). ADHD-associated impairment on the CPT was not augmented by the presence of depressive symptoms, making neuropsychological results on this test helpful for the differential diagnosis. When attention deficits are observed in individuals with mild or moderate depression, they are most likely not attributed to depression.

Síndromes disexecutivas do desenvolvimento e adquiridas na prática clínica: três relatos de caso / Developmental and acquired dysexecutive syndromes in clinical practice: three case-reports

Síndromes disexecutivas podem ser observadas em diversas condições neuropsiquiátricas, como transtorno do déficit de atenção e hiperatividade (TDAH), traumatismos cranioencefálicos (TCE) ou esquizofrenia, frequentemente se associando à ampla gama de comprometimento, incluindo ambientes familiar, acadêmico e profissional. O objetivo do presente estudo é apresentar três casos de disfunções executivas, nos quais, embora todos os pacientes tenham QI dentro dos limites da normalidade, existe significativo comprometimento social e ocupacional. O primeiro caso apresenta uma jovem que sofreu TCE, com queixas de dificuldades de memória para material novo, além de apatia e diminuição de iniciativa e persistência. O segundo caso versa sobre uma mulher que apresenta problemas desde a educação infantil, com histórico de tratamentos ineficazes e nenhum diagnóstico formal. Segundo relato de informante colateral, há déficits de planejamento, comportamentos antissociais, aversão a gratificações tardias e dificuldades de ativação. O último caso refere-se a indivíduo do sexo masculino, avaliado depois de grave TCE após acidente de carro. Há relato de mudança de comportamento com desinibição, diminuição da persistência e desatenção, relatadas como mais graves do que as apresentadas durante a infância, apesar de desempenho normal em testes de funções executivas. A avaliação de disfunções executivas (do desenvolvimento ou adquiridas) pode ser de extrema importância para servir como base de tratamento visando à diminuição de comprometimento nas atividades cotidianas.

Dysexecutive syndromes are often observed in several neuropsychiatric conditions, such as attention deficit hyperactivity disorder (ADHD), traumatic brain injuries (TBI) or schizophrenia, and usually associate with significant impairments, including familial, academic and professional areas. The present paper aims at presenting three cases of executive functions (EFs) deficits where despite having normal IQ, all subjects' exhibit significant functional and social impairment. The first case describes a young woman who suffered a TBI and her complaints relates to difficulties in memory for new material, apathy, less persistency and initiative. The second case is about a middle-age woman facing problems since kindergarten and with unsuccessful treatments and no formal diagnosis. In this case, collateral report suggests the presence of planning difficulties, some antisocial behavior, delay gratification aversion, poor activation and time estimation deficits. The last case refers to a middle-age man, evaluated after a severe TBI following a car accident. He presented some behavioral changes, such as disinhibition, lack of persistency and inattentive deficits that occur in a more severe level than presented during his childhood, despite having normal performance in tests of EFs. The evaluation of (developmental or acquired) EF deficits might be extremely important for providing adequate therapeutic approach in order to decrease related impairments in everyday activities.