Associations of executive and functional outcomes with full-score intellectual quotient among ADHD adults.

Associations between executive and functional impairment, intelligence, and attention deficit hyperactivity disorder (ADHD) have been scarcely investigated among adult populations and lead to inconsistent results. This study tested the impact of intellectual level on executive and functional impairment in a clinical sample of adults diagnosed with ADHD. Participants were recruited in a specialized center for the diagnosis and treatment of ADHD (n=66, mean age=27.9 ± 10.8). Measures included intellectual quotient (IQ, Wechsler Adult Intelligence Scale) categorized as ≤110 or >110, the continuous performance test (CPT3TM), grade retention, educational attainment, and having an activity (job or studies). Participants with a higher IQ had significantly better functional outcomes than participants with a standard IQ: higher educational attainment, lower grade retention, and often having an activity. Participants with higher IQ performed significantly better on all CPT variables assessing executive functioning. Intelligence seemed to work as a protective factor for executive and functional outcomes in a clinical population of ADHD adults and might reduce long-lasting detrimental consequences in life.

Does the Continuous Performance Test Predict ADHD Symptoms Severity and ADHD Presentation in Adults?

Objective: Our study aimed to provide empirical evidence on the usefulness of one of the most popular neuropsychological tests, the Continuous Performance Test (CPT), as a marker of ADHD severity and presentations among adults. Method: ADHD participants were recruited in a specialized center for the diagnosis and treatment of adults suffering from ADHD (n = 201). Measures included the CPT3™ and ADHD symptoms using a clinical interview and self-reported measures. Results: Only 51.7% of the participants were classified as likely to have a disorder characterized by attention deficit, such as ADHD, by the CPT. The relationships between CPT variables and ADHD symptoms were small. The classification error was 80.3% for the inattentive presentation and 22.5% for the hyperactive presentation when using the CPT to identify ADHD presentations. Conclusion: There was no evidence of the clinical utility of the CPT to assess or monitor ADHD in adult populations diagnosed and treated for ADHD.

Insight, symptoms and executive functions in schizophrenia.

INTRODUCTION: We investigated the relationship of insight with executive functions and symptoms in a group of stabilised inpatients with schizophrenia. METHODS: Executive functions using an extensive battery constituted of several tests as well as psychopathology were assessed in 38 inpatients with a DSM-IV diagnosis of schizophrenia. Insight was assessed with the Scale to assess Unawareness of Mental Disorder (SUMD). RESULTS: A principal component analysis of the insight dimensions revealed a three-factor model which accounted for 98% of the variance. Of particular interest is the finding that a composite factor that accounted for 74% of the variance covered insight dimensions that represent a higher degree of insight (awareness of mental disorder, its social consequences, and attribution of symptoms). Only an association between letter fluency and this composite factor was found, which was weakly mediated by depressive symptoms. A stepwise multiple regression analysis revealed a relationship between antipsychotic dose and awareness of medication effect. No association of illness duration and insight was found. CONCLUSIONS: The findings of partial association between dimensions of insight and measures of executive function supports the growing evidence that insight is a multidimensional phenomenon. Accordingly, they emphasise that in the framework of therapeutic interventions, enhancement of higher levels of insight needs to take into account that patients suffering from schizophrenia have differential impairment in insight dimensions.

Insight in relation to psychosocial adjustment in schizophrenia.

Insight impairment occurs commonly in patients with schizophrenia, and it can be expected that patients with impaired insight may subsequently have poorer psychosocial adjustment. The aim of the present study was to measure the relationship between insight and psychosocial adjustment in 38 inpatients with a diagnosis of DSM-IV schizophrenia. Insight was assessed using the Scale to Assess Unawareness of Mental Disorder. A comprehensive set of measures was used to assess psychosocial adjustment. No relationship was found between measures of psychosocial adjustment and insight. However, a self-rated measure of psychosocial adjustment was partially related to insight. Our results suggest that patients' insight levels may not be reliable predictors of the patients' level of psychosocial adjustment, and that these findings may need to be considered in continuous care of psychotic patients, in particular when outpatient care needs to be planned.

Dysexecutive syndrome and social adjustment in schizophrenia.

OBJECTIVE: This paper reports on a study designed to (i) assess levels of executive functions among patients suffering from schizophrenia; (ii) investigate associations between measures of executive functions and psychosocial adjustment; and (iii) examine the influence of psychopathology on the relationship between executive functions and psychosocial adjustment. Clear knowledge of executive functions and of their impact on social adjustment in patients with schizophrenia may play a decisive role in preparing and structuring appropriate outpatient care. METHOD: An extensive battery constituted of several tests developed for the assessment of executive functions was used in 38 inpatients with a DSM-IV diagnosis of schizophrenia. Psychosocial adjustment was assessed with a set of commonly used scales. RESULTS: Performance on measures of executive functions was heterogeneous among the patient population, with a subgroup performing within normal scores. A similar pattern was found on measures of psychosocial adjustment. Most of the executive measures were not dependent on demographic or clinical variables. A factorial analysis on measures of psychosocial adjustment yielded a one-factor model which showed inconsistent, and at most, weak to moderate correlations with executive functions. Regression analysis revealed that symptom levels accounted for two-thirds of the variance of psychosocial adjustment, and together with measures of executive functions for 91% of the variance. General and negative symptoms showed strong correlations with psychosocial adjustment. CONCLUSIONS: Our study supports the view that executive function is a heterogeneous construct with several subdimensions. Additionally, it suggests that symptom level has an important role as "rate limiting factor" on psychosocial adjustment and is partially mediated by executive dysfunction. Our results call for careful and detailed assessment in this patient population in order to establish appropriate treatment programmes such as cognitive remediation.