Erişkin dikkat eksikliği/hiperaktivite bozukluğunda yürütücü işlevler ve eş tanıların rolü
Dikkat eksikliği hiperaktivite bozukluğunun (DEHB) psikiyatrik eş tanılarla birlikte görülmesi, nöropsikolojik bozulmaların hangi hastalıktan dolayı olduğunun ayırt edilebilmesini güçleştirmektedir. DEHB'de yürütücü işlevlerde bozulmalar olduğu daha önce birçok kez gösterilmiştir. Ancak yürütücü işlevlerdeki bu bozulmaların hangilerinin hastalığın kendisiyle ilişkili olduğu ve psikiyatrik eş tanıların bu bozulmaları nasıl etkilediği konusunda yeterli bilgi yoktur. Bu çalışmanın amacı, yürütücü işlevlerindeki bozulmaların, DEHB olan erişkin hastalarda psikiyatrik eş tanı- lardan bağımsız olarak DEHB'ye ne ölçüde bağlı olduğunu araştırmaktır. Yöntem: Yaş, cinsiyet ve eğitim süresi açısından eşleştirilmiş DEHB tanısı konan psikiyatrik eş tanısı olan erişkin hastalar (n=26), DEHB olmayan psiki- yatrik hastalıkları olan erişkinler (n=26) ve sağlıklı bireyler (n=26) karşılaştırıldı. Tüm hastalar Erişkin DEHB ÖzBildirim Ölçeği, Wender Utah Öz-Bildirim Ölçeği, DSM-IV Yapılandırılmış Klinik Görüşme Formu ile tarandı. Buna ek olarak nöropsikolojik değerlendirme için Wisconsin Kart Eşleme Testi, Rey Sözel İşitsel Öğrenme Testi ve Stroop Renk-KelimeTesti kullanıldı. Bulgular: Erişkin DEHB grubu, DEHB olmayan psikiyatrik bozukluğu olan gruba göre inhibisyon, dikkat, planlama, set-değiştirme, problem çözme, sözel öğrenme ve sözel bellek ölçümlerinde daha düşük puan aldı. DEHB olmayan psikiyatrik hasta grubu planlama ve problem çözme alanlarında sağlıklı kontrollere göre daha düşük puan aldı. Sonuç: Bulgularımız, DEHB’de görülen inhibisyon, dikkat, set-değiştirme, sözel öğren- me ve sözel bellekteki yürütücü işlev bozukluklarının eşlik eden diğer psikiyatrik bozukluklardan çok, DEHB'nin kendisi ile ilişkili olduğunu göstermiştir. (Anadolu Psikiyatri Derg 2019; 20(1):84-92)
Executive functions in adult attention-deficit/hyperactivity disorder and the role of comorbid psychiatric disorders
Objective: Attention-deficit hyperactivity disorder (ADHD) with other psychiatric comorbidities in adulthood is chal-lenging in terms of differentiating the neuropsychological impairments in each disorder. Executive functions havebeen widely studied and shown to be consistently impaired in ADHD. However, there is a lack of knowledge aboutwhich executive function deficits are attributable to ADHD and which of them are assosciated with comorbidpsychiatric disorders. Thus, the aim of this study was to investigate to what extent the deficits in executive functionsare attributable to ADHD rather than comorbid psychiatric diseases among adult patients with ADHD. Methods:Adult patients diagnosed with ADHD and comorbid psychiatric disorders (n=26) were compared with psychiatricpatients without ADHD (n=26) and healthy subjects (n=26) matched for age, sex, and duration of education. AdultADHD Self-Report Scale, Wender Utah Rating Scale for the ADHD and Structured Clinical Interview for DSM-IVAxis I Disorders screened all participants. In addition, Wisconsin Card Sorting Test computer form, Rey AuditoryVerbal Learning Test, and the Stroop Color Word Test were used for neuropsychological assessment. Results:Adults psychiatric patients with ADHD scored lower than those without ADHD in terms of measures of inhibition,attention, planning, set-shifting, problem-solving, verbal learning, and verbal memory. Psychiatric patients withoutADHD scored significantly lower than healthy controls in terms of planning and problem solving. Conclusions: Ourfindings suggest that the ADHD, rather than comorbid psychiatric disorders, is the significant underlying cause forexecutive function deficits in inhibition, attention, set-shifting, verbal learning, and verbal memory. (AnatolianJournal of Psychiatry 2019; 20(1):84-92)
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- American Psychiatric Association. Diagnostic and
Statistical Manual of Mental Disorders, Fourth
Edition. Philadephia: American Psychiatric Asso-
ciation, 2000.
- Biederman J, Petty CR, Evans M, Small J,
Faraone SV. How persistent is ADHD? A con-
trolled 10-year follow-up study of boys with ADHD.
Psychiatry Res 2010; 177:299-304.
- Willcutt EG, Doyle AE, Nigg JT, Faraone SV,
Pennington BF. Validity of the executive function
theory of attention-deficit/hyperactivity disorder: a
meta-analytic review. Biol Psychiatry 2005;
57:1336-1346.
- Frazier TW, Demareem HA, Youngstrom EA.
Meta-analysis of intellectual and neuropsycholo-
gical test performance in attention-deficit/hyper-
activity disorder. Neuropsychology 2004; 18:543-
555.
- Welsh MC, Pennington BF. Assessing frontal lobe
functioning in children: Views from developmental
psychology. Dev Neuropsychol 1988; 4:199-230.
- Hervey AS, Epstein JN, Curry JF. Neuropsycho-
logy of adults with attention-deficit/hyperactivity disorder: a meta-analytic review. Neuropsycho-
logy 2004; 18:485-503.
- Boonstra AM, Oosterlaan J, Sergeant JA,
Buitelaar JK. Executive functioning in adult ADHD:
a meta-analytic review. Psychol Med 2005;
35:1097-1108.
- Woods SP, Lovejoy DW, Ball J. Neuropsycholo-
gical characteristics of adults with ADHD: a com-
prehensive review of initial studies. Clin Neuro-
psychol 2002; 16:12-34.
- Nigg JT, Willcutt EG, Doyle AE, Sonuga-Barke EJ.
Causal heterogeneity in attention-deficit/hyper-
activity disorder: do we need neuropsychologically
impaired subtypes? Biol Psychiatry 2005;
57:1224-1230.
- Cumyn L, French L, Hechtman L. Comorbidity in
adults with attention-deficit hyperactivity disorder.
Can J Psychiatry 2009; 54:673-683.
- Fayyad J, De Graaf R, Kessler R, Alonso J, Ange-
rmeyer M, Demyttenaere K, et al. Cross-national
prevalence and correlates of adult attention–
deficit hyperactivity disorder. Br J Psychiatry
2007; 190: 402-409.
- First MB, Robert L, Spitzer RL, Gibbon M,
Williams JBW. Structured Clinical Interview for
DSM-IV Axis I Disorders (SCID-I). Washington
DC: American Psychiatric Press, 1997.
- Çorapçıoğlu A, Aydemir Ö, Yıldız M, Köroğlu E.
DSM-IV Eksen I Bozuklukları (SCID-I) için Yapı-
landırılmış Klinik Görüşme, Klinik versiyon. Anka-
ra: Hekimler Yayın Birliği, 1999.
- Guy W. ECDEU Assessment Manual for Psycho-
pharmacology (Clinical Global Impressions [CGI])
Rockville, MD: National Institutes of Health, 1976,
p.218-222.
- Kessler RC, Adler L, Ames M, Demler O, Faraone
S, Hiripi E, et al. The World Health Organization
Adult ADHD Self-Report Scale (ASRS): a short
screening scale for use in the general population.
Psychol Med 2005; 35:245-256.
- Kessler RC, Adler LA, Gruber MJ, Sarawate CA,
Spencer T, Van Brunt DL. Validity of the World
Health Organization Adult ADHD Self-Report
Scale (ASRS) Screener in presentative sample of
health plan members. Int J Methods Psychiatr Res
2007; 16:52-65.
- Öncü B, Ölmez ş, şentürk V. Validity and reliability
of the Turkish version of the Wender Utah Rating
Scale for attention-deficit/hyperactivity disorder in
adults. Turk Psikiyatri Derg 2005; 16:252-259.
- Heaton RK, Chelune GJ, Talley JL Kay GG, Curtis
G. Wisconsin Card Sorting Test Manual: Revised
and Expanded. Florida: Psycological Assessment
Resources, 1993.
- Strauss E, Spreen O. A Compendium of Neuro-
psychological Tests: Administration, Norms, and
Commentary. Second ed., Newyork: Oxford Uni-
versity Press, 1998.
- Karakaş S, Eski R, Başar E. Türk kültürü için
standardizasyonu yapılmış nöropsikolojik testler
topluluğu: BİLNOT Bataryası. 32. Ulusal Nöroloji
Kongresi Kitabı, İstanbul: Ufuk Matbaası, 1996
- Stroop JR. Studies of interference in serial verbal
reactions. J Exp Psychol 1935; 18:643-662.
- Karakaş S. BİLNOT Bataryası El Kitabı: Nöropsi-
kolojik Testler için Araştırma ve Geliştirme Çalış-
maları. Ankara: Dizayn Ofset, 2004.
- Rey A. L'Examen Clinique en Psychologie. Paris:
Press Universitaires de France, 1964.
- Genç-Açıkgöz D, Karakaş S. AVLT (İSÖT)'nin
Türk diline uyarlanmasına ilişkin bir çalışma. IX.
Ulusal Psikoloji Kongresi (İstanbul). Türk Psiko-
loglar Derneği, Boğaziçi Üniversitesi, 1996.
- Salomone S, Fleming GR, Bramham J, O’Connell
RG, Robertson IH. Neuropsychological deficits in
adult ADHD: evidence for differential attentional
impairments, deficient executive functions, and
high self-reported functional impairments. J Atten
Disord
2016;
1087054715623045.
https://doi.org/10.1177/1087054715623045
- Seidman LJ, Biederman J, Weber W, Hatch M,
Faraone SV. Neuropsychological function in
adults with attention-deficit/hyperactivity disorder.
Psychiatr Clin North Am 2004; 27:261-282.
- Jenkins M, Cohen R, Malloy P, Salloway S, Gillard
Johnson E, Penn J, et al. Neuropsychological
measures which discriminate among adults with
residual symptoms of attention deficit disorder and
other attentional complaints. Clin Neuropsychol
1998; 12:74-83.
- Schoechlin C, Engel RR. Neuropsychological
performance in adult attention-deficit hyperactivity
disorder: Meta-analysis of empirical data. Arch
Clin Neuropsychol 2005; 20:727-744.
- Holst Y, Thorell LB. Neuropsychological Func-
tioning in Adults With ADHD and Adults With
Other Psychiatric Disorders: The Issue of
Specificity.
J
Atten
Disord
2013:
1087054713506264.
https://doi.org/10.1177/1087054713506264
- Boonstra AM, Kooij JJ, Oosterlaan J, Sergeant
JA, Buitelaar JK. To act or not to act, that’s the
problem: Primarily inhibition difficulties in adult
ADHD. Neuropsychology 2010; 24:209-221.
- Barkley R, Murphy K, Fischer M. ADHD in Adults:
What the Science Says. New York: Guilford
Press, 2008.
- Rohlf H, Jucksch V, Gawrilow C, Huss M, Hein J,
Lehmkuhl U, et al. Set shifting and working
memory in adults with attention-deficit/hyperac-
tivity disorder. J Neural Transm 2012; 119:95-106.
- Seidman LJ, Biederman J, Weber W, Hatch M,
Faraone SV. Neuropsychological function in
adults with attention-deficit hyperactivity disorder.
Biol Psychiatry 1998; 44:260-268.
- Alderson RM, Hudec KL, Patros CH, Kasper LJ.
Working memory deficits in adults with attention-
deficit/hyperactivity disorder (ADHD): An exami-
nation of central executive and storage/rehearsal
processes. J Abnorm Psychol 2013; 122:532-541.
- Nigg JT, Stavro G, Ettenhofer M, Hambrick DZ,
Miller T, Henderson JM. Executive functions and
ADHD in adults: evidence for selective effects on
ADHD symptom domains. J Abnorm Psychol
2005; 114:706-717.
- Taylor CJ, Miller DC. Neuropsychological assess-
ment of attention in ADHD adults. J Atten Disord
1997; 2:77-88.
- Johnson DE, Epstein JN, Waid LR, Latham PK,
Voronin KE, Anton RF. Neuropsychological per-
formance deficits in adults with attention deficit/
hyperactivity disorder. Arch Clin Neuropsychol
2001; 16:587-604.
- Katz LJ, Wood DS, Goldstein G, Auchenbach RC,
Geckle M. The utility of neuropsychological tests
in evaluation of attention-deficit/hyperactivity dis-
order (ADHD) versus depression in adults.
Assessment 1998; 5:45-51.
- Epstein JN, Johnson DE, Varia IM, Conners CK.
Neuropsychological assessment of response inhi-
bition in adults with ADHD. J Clin Exp Neuro-
psychol 2001; 23:362-371.
- Beiderman J, Faraone S, Spencer T, Wilens T,
Norman D, Lapey KA, et al. Patterns of psychiatric
comorbidity, cognition, and psychosocial func-
tioning in adults with attention deficit hyperactivity
disorder. Am J Psychiatry 1993; 150:1792-1798.
- Boonstra AM. Aspects of ADHD in Adults:
Neurocognitive Functioning, Actigraphy, Effects of
Methylphenidate, and Association with Genetic
Polymorphisms. Unpublished Master Thesis,
Radboud Universiteit Nijmegen, 2006.
- Cohen LJ, Hollander E, DeCaria CM, Stein DJ,
Simeon D, Liebowitz MR, et al. Specificity of
neuropsychological impairment in obsessive-
compulsive disorder: a comparison with social
phobic and normal control subjects. J Neuro-
psychiatry Clin Neurosci 1996; 8:82-85.
- Zakzanis K, Leach L, Kaplan E. On the nature and
pattern of neurocognitive function in major de-
pressive disorder. Cogn Behav Neurol 1998;
11:111-119.
- Ottowitz WE, Tondo L, Dougherty DD, Savage
CR. The neural network basis for abnormalities of
attention and executive function in major de-
pressive disorder: implications for application of the medical disease model to psychiatric disor-
ders. Harv Rev Psychiatry 2002; 10:86-99.
- Airaksinen E, Larsson M, Forsell Y. Neuro-
psychological functions in anxiety disorders in
population-based samples: evidence of episodic
memory dysfunction. J Psychiatr Res 2005;
39:207-214.
- Asmundson GJ, Stein MB, Larsen DK, Walker JR.
Neurocognitive function in panic disorder and
social phobia patients. Anxiety 1994; 1:201-207.
- Lucas JA, Telch MJ, Bigler ED. Memory func-
tioning in panic disorder: a neuropsychological
perspective. J Anxiety Disord 1991; 5:1-20.
- Antshel KM, Biederman J, Spencer TJ, Faraone
SV. The neuropsychological profile of comorbid
post-traumatic stress disorder in adult ADHD. J
Atten Disord 2016; 20:1047-1055.
- Schatz DB, Rostain AL. ADHD with comorbid
anxiety a review of the current literature. J Atten
Disord 2006; 10:141-149.
- Abramovitch A, Dar R, Hermesh H, Schweiger A.
Comparative neuropsychology of adult obsessive ‐
compulsive disorder and attention deficit/hyper-
activity disorder: Implications for a novel executive
overload model of OCD. J Neuropsychol 2012;
6:161-191.