Síndromes disexecutivas do desenvolvimento e adquiridas na prática clínica: três relatos de caso

Abstract

Dysexecutive syndromes are often observed in several neuropsychiatric conditions, such as attention deficit hyperactivity disorder (ADHD), traumatic brain injuries (TBI) or schizophrenia, and usually associate with significant impairments, including familial, academic and professional areas. The present paper aims at presenting three cases of executive functions (EFs) deficits where despite having normal IQ, all subjects' exhibit significant functional and social impairment. The first case describes a young woman who suffered a TBI and her complaints relates to difficulties in memory for new material, apathy, less persistency and initiative. The second case is about a middle-age woman facing problems since kindergarten and with unsuccessful treatments and no formal diagnosis. In this case, collateral report suggests the presence of planning difficulties, some antisocial behavior, delay gratification aversion, poor activation and time estimation deficits. The last case refers to a middle-age man, evaluated after a severe TBI following a car accident. He presented some behavioral changes, such as disinhibition, lack of persistency and inattentive deficits that occur in a more severe level than presented during his childhood, despite having normal performance in tests of EFs. The evaluation of (developmental or acquired) EF deficits might be extremely important for providing adequate therapeutic approach in order to decrease related impairments in everyday activities. M, et al. / Rev Psiq Clín. 2010;37(6):285-90 Keywords: Neuropsychology, executive functions, TBI, personality. Borges ResumoSíndromes disexecutivas podem ser observadas em diversas condições neuropsiquiátricas, como transtorno do déficit de atenção e hiperatividade (TDAH), traumatismos cranioencefálicos (TCE) ou esquizofrenia, frequentemente se associando à ampla gama de comprometimento, incluindo ambientes familiar, acadêmico e profissional. O objetivo do presente estudo é apresentar três casos de disfunções executivas, nos quais, embora todos os pacientes tenham QI dentro dos limites da normalidade, existe significativo comprometimento social e ocupacional. O primeiro caso apresenta uma jovem que sofreu TCE, com queixas de dificuldades de memória para material novo, além de apatia e diminuição de iniciativa e persistência. O segundo caso versa sobre uma mulher que apresenta problemas desde a educação infantil, com histórico de tratamentos ineficazes e nenhum diagnóstico formal. Segundo relato de informante colateral, há déficits de planejamento, comportamentos antissociais, aversão a gratificações tardias e dificuldades de ativação. O último caso refere-se a indivíduo do sexo masculino, avaliado depois de grave TCE após acidente de carro. Há relato de mudança de comportamento com desinibição, diminuição da persistência e desatenção, relatadas como mais graves do que as apresentadas durante a infância, apesar de desempenho normal em testes de funções executivas. A avaliação de disfunções executivas (do desenvolvimento ou adquiridas) pode s...

The Iowa Gambling Task (IGT) in Brazil: a systematic review

“…Incorporating a larger neuropsychological test battery into the study of IGT performance in Brazil is also desirable in future studies. Sixteen studies [7][8][9][10][11][13][14][15][19][20][21]30,32,34,35,40 incorporated the CPT-II and found significant associations between the two tasks. This suggests common cognitive constructs involving impulsivity in attentional and motor dimensions in both the IGT and the CPT-II.…”

“…Another neuropsychological instrument frequently associated with the IGT was the WCST, in 12 studies. 8,12,[15][16][17]26,30,32,33,36,37,39 Even though correlations between the two instruments appear to be weak (e.g., perseverative WCST errors vs. performance on the first block of the IGT), investigators 39 have suggested that this relationship remains inconclusive. While the IGT is considered a classical instrument in the evaluation of high emotional influence and the WCST has a higher preponderance of low emotional influence, 26,52 additional work using more tasks of high and low emotional as well as executive influence are needed to confirm this tentative association in the IGT literature.…”

“…Health-related issues were analyzed in 11 publications (31%) 21,23,26,30,[32][33][34][35]37,38,40 and covered a variety of neurological issues. Three studies 23,37,38 focused on stroke and its impact on decision-making, with one study addressing treatment implications.…”

“…Another study 30 addressed three cases of dysexecutive syndrome, two resulting from traumatic brain injury and the other due to developmental problems. Impairments on IGT performance were identified in all three cases.…”