Abstract
This study compared deficits in executive functioning in psychiatric outpatients with anxiety and depression to neurologically impaired patients and a community sample using a cross-sectional design. Anxious, depressed and neurologically impaired patients were compared for executive dysfunction using the revised Dysexecutive Questionnaire. A large sample of 663 community individuals, 39 mood disordered, 121 anxiety disordered and 120 neurologically impaired outpatients participated. Anxious and depressed patients exhibited significantly greater executive dysfunction than neurological patients and healthy controls. Anxiety patients reported the greatest executive dysfunction than all other groups including greater total problems and specific deficits in inhibiting responses and in acting with volition. Problems with inhibition reflect difficulties of anxiety patients in preventing automatic responses. Problems with volition reported by anxiety patients were attributed to comorbid depression, consistent with anxiety patients reporting the highest levels of depressive as well as anxious symptomology. Depressed patients reported greater problems with volition than community members, reflecting problems with planning and motivation. Neurologically impaired individuals reported a comparable level of executive dysfunction to the general community. This was attributed mainly to the poor ability of neurologically impaired individuals to report their own deficits. We discuss the relevance of executive functioning to anxiety and depression, and the implications of using the DEX-R with clinical samples.
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Airaksinen, E., Larsson, M., & Forsell, Y. (2005). Neuropsychological functions in anxiety disorders in population-based samples: evidence of episodic memory dysfunction. Journal of Psychiatric Research, 39(2), 207–214.
American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR. Washington: American Psychiatric Publications.
Baddeley, A. D. (1986). Working memory. Oxford: Clarendon Press.
Bar-Haim, Y., Lamy, D., Pergamin, L., Bakermans-Kranenburg, M. J., & Van Ijzendoorn, M. H. (2007). Threat-related attentional bias in anxious and nonanxious individuals: a meta-analytic study. Psychological Bulletin, 133(1), 1–24.
Beck, A. T., Epstein, N., Brown, G., & Steer, R. A. (1988). An inventory for measuring clinical anxiety: psychometric properties. Journal of Consulting and Clinical Psychology, 56(6), 893–897.
Briggs, S. R., & Cheek, J. M. (1986). The role of factor analysis in the development and evaluation of personality scales. Journal of Personality, 54, 106–148.
Brown, T. A., & Barlow, D. H. (2009). A proposal for a dimensional classification system based on the shared features of the DSM-IV anxiety and mood disorders: implications for assessment and treatment. Psychological Assessment, 21(3), 256–271.
Burgess, P. W., Alderman, N., Wilson, B. A., Evans, J. J., & Emslie, H. (1996). The dysexecutive questionnaire. Behavioural assessment of the dysexecutive syndrome. Bury St. Edmunds: Thames Valley Test Company.
Burgess, P. W., Alderman, N., Evans, J., Emslie, H., & Wilson, B. A. (1998). The ecological validity of tests of executive function. Journal of the International Neuropsychological Society 4(06), 547–558.
Chan, R. C. (2001). Dysexecutive symptoms among a non-clinical sample: a study with the use of the dysexecutive questionnaire. British Journal of Psychology, 92, 551–565.
Christopher, G., & MacDonald, J. (2005). The impact of clinical depression on working memory. Cognitive Neuropsychiatry, 10(5), 379–399.
Cohen, J., & Cohen, P. (Eds.) (1983). Applied multiple regression/correlation analysis for the behavioral sciences. Hillsdale: Erlbaum.
de Zubicaray, G. (2006). Neuroimaging and clinical neuropsychological practice (chapter 4). In P. J. Snyder, P. D. Nussbaum, & D. L. Robins (Eds.), Clinical neuropsychology: A pocket handbook for assessment (pp. 56–74). Washington: American Psychological Association.
Ghika-Schmid, F., & Bogousslavsky, J. (1997). Affective disorders following stroke. European Neurology, 38(2), 75–81.
Henry, G. M., Weingartner, H., & Murphy, D. L. (1973). Influence of affective states and psychoactive drugs on verbal learning and memory. American Journal of Psychiatry, 130(9), 966–971.
Hertel, P. T., & Hardin, T. S. (1990). Remembering with and without awareness in a depressed mood: evidence of deficits in initiative. Journal of Experimental Psychology: General, 119(1), 45–59.
Ladouceur, R., Blais, F., Freeston, M. H., & Dugas, M. J. (1998). Problem solving and problem orientation in generalized anxiety disorder. Journal of Anxiety Disorders, 12(2), 139–152.
Lautenbacher, S., Spernal, J., & Krieg, J. C. (2002). Divided and selective attention in panic disorder. European Archives of Psychiatry and Clinical Neuroscience, 252(5), 210–213.
Lezak, M. D., Howieson, D., & Loring, D. (Eds.) (2004). Neuropsychological assessment (4th Ed.). New York: Oxford University Press.
Lord, F. M. (1969). Statistical adjustments when comparing preexisting groups. Psychological Bulletin, 68(5), 336–337.
Lucas, J. A., & Addeo, R. (2006). Traumatic brain injury and postconcussion syndrome. In P. J. Snyder, P. D. Nussbaum, & D. L. Robins (Eds.), Clinical neuropsychology: A pocket handbook for assessment (pp. 351–380). Washington: American Psychological Association.
Ludewig, S., Ludewig, K., Geyer, M. A., Hell, D., & Vollenweider, F. X. (2002). Prepulse inhibition deficits in patients with panic disorder. Depression and Anxiety, 15(2), 55–60.
MacQueen, G. M., Tipper, S. P., Young, L. T., Joffe, R. T., & Levitt, A. J. (2000). Impaired distractor inhibition on a selective attention task in unmedicated, depressed subjects. Psychological Medicine, 30(03), 557–564.
McGeorge, T. (2006). Neuropsychology of PTSD: biological, cognitive, and clinical perspectives. International Review of Psychiatry, 18(2), 193–193.
Mialet, J. P., Pope, H. G., & Yurgelun-Todd, D. (1996). Impaired attention in depressive states: a non-specific deficit? Psychological Medicine, 26(05), 1009–1020.
Mooney, B., Walmsley, C., & McFarland, K. (2006). Factor analysis of the self-report dysexecutive (DEX-S) questionnaire. Applied Neuropsychology, 13(1), 12–18.
Nitschke, J. B., & Mackiewicz, K. L. (2005). Prefrontal and anterior cingulate contributions to volition in depression. International Review of Neurobiology, 67, 73–94.
Ponsford, J. L., Olver, J. H., & Curran, C. (1995). A profile of outcome: 2 years after traumatic brain injury. Brain Injury, 9(1), 1–10.
Rao, V., & Lyketsos, C. G. (2000). The benefits and risks of ECT for patients with primary dementia who also suffer from depression. International Journal of Geriatric Psychiatry, 15(8), 729–735.
Rozenthal, M., Laks, J., & Engelhardt, E. (2004). Aspectos neuropsicológicos da depressão. Revista de Psiquiatria, 26(2), 204–212.
Saver, J. L., & Damasio, A. R. (1991). Preserved access and processing of social knowledge in a patient with acquired sociopathy due to ventromedial frontal damage. Neuropsychologia, 29(12), 1241–1249.
Shaw, S., Oei, T. P., & Sawang, S. (2015). Psychometric validation of the dysexecutive questionnaire (DEX). Psychological Assessment, 27(1), 138–147.
Stordal, E., Morken, G., Mykletun, A., Neckelmann, D., & Dahl, A. A. (2008). Monthly variation in prevalence rates of comorbid depression and anxiety in the general population at 63–65° north: the HUNT study. Journal of Affective Disorders, 106(3), 273–278.
Wilson, B. A., Alderman, N., Burgess, P. W., Emslie, H., & Evans, J. J. (1996). Behavioural assessment of the dysexecutive syndrome. Bury St Edmunds: Thames Valley Test Company.
Zung, W. W. (1965). A self-rating depression scale. Archives of General Psychiatry, 12(1), 63–70.
Acknowledgments
Dr. Oei is now an Emeritus Professor of UQ and also a visiting Professor of James Cook University, Singapore and Nanjing University, Pr China. We would like to thank the participants, in particular the outpatients who participated in this study.
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Oei, T.P.S., Shaw, S. & Healy, K...L. Executive Function Deficits in Psychiatric Outpatients in Australia. Int J Ment Health Addiction 14, 337–349 (2016). https://doi.org/10.1007/s11469-016-9634-x
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DOI: https://doi.org/10.1007/s11469-016-9634-x