Transnosographic analysis of executive dysfunction – clinical, psychometric and therapeutic dimensions

Abstract

The analysis of executive dysfunction in patients with mental disorders presents clinical and therapeutic importance, based on research that supports the involvement of this component in shaping the symptomatic picture and in determining the recovery prognosis. Although therapeutic approaches that specifically target cognitive impairments (in schizophrenia, vascular depression, ADHD etc.) are not yet used on a large scale, they can be considered augmentation strategies with the potential to improve the patients’ recovery and quality of life. A structured assessment of the executive functioning in clinical setting, using validated psychometric methods, is recommended in order to monitor as completely as possible the patients’ mental status and the adaptive difficulties generated by these cognitive problems. The current analysis will include aspects related to the correlations between executive dysfunction and specific psychiatric symptoms, on the one hand, as well as psychosocial functioning, on the other hand. The study of endophenotypes, which occupy an intermediate position between genotypes and clinical manifestations (phenotypes), can help reduce the heterogeneity of some nosographic categories and can motivate early therapeutic intervention strategies. Another dimension of the present analysis refers to the impact of specific therapies, pharmacological, psychosocial or neurostimulation, on executive dysfunction. This first part of the review presents data on executive dysfunction in schizophrenia, major depressive disorder, vascular depression, bipolar disorder, neurocognitive disorders and eating disorders.