Hatice BAYRAKTAR, EVRİM ÖZKORUMAK KARAGÜZEL, Ahmet TİRYAKİ

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 have been widely studied and shown to be consistently impaired in ADHD. However, there is a lack of knowledge about which executive function deficits are attributable to ADHD and which of them are assosciated with comorbid psychiatric disorders. Thus, the aim of this study was to investigate to what extent the deficits in executive functions are 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 psychiatric patients without ADHD (n=26) and healthy subjects (n=26) matched for age, sex, and duration of education. Adult ADHD Self-Report Scale, Wender Utah Rating Scale for the ADHD and Structured Clinical Interview for DSM-IV Axis I Disorders screened all participants. In addition, Wisconsin Card Sorting Test computer form, Rey Auditory Verbal 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 without ADHD scored significantly lower than healthy controls in terms of planning and problem solving. Conclusions: Our findings suggest that the ADHD, rather than comorbid psychiatric disorders, is the significant underlying cause for executive function deficits in inhibition, attention, set-shifting, verbal learning, and verbal memory. (Anatolian Journal of Psychiatry 2019; 20(1):84-92)

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)

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