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Clinical and Ethical Implications of Impaired Executive Control Functions for Patient Autonomy -- Workman et al. 51 (3): 359 -- Psychiatr Serv

Clinical and Ethical Implications of Impaired Executive Control Functions for Patient Autonomy -- Workman et al. 51 (3): 359 -- Psychiatr Serv

Executive control functions have been defined as "those processes which orchestrate relatively simple ideas, movements, or actions into complex goal-directed behavior"(1). Without them, behaviors important to independent living can be expected to break down into their component parts; patients become overdependent on environmental cues and are easily distracted and perseverative (2,3).

Executive functions have been associated with three prefrontal-subcortical subtypes, the dorsolateral prefrontal, the orbitofrontal, and the anterior cingulate (mesiofrontal) (4,5,6). Damage to the dorsolateral subtype impairs abstraction and hypothesis generation. Orbitofrontal lesions lead to impaired emotional control. Irritability and mood swings in the absence of pervasive mood disorder are common sequelae. Mesiofrontal lesions lead to apathy, indifference, and impairment of goal-directed attention. Patients become passive and disorganized (7,8). In 1994 the American Psychiatric Association added executive control functions to the list of cognitive domains that should be considered when making a diagnosis of dementia (9).

Impairments in executive control functions are not limited to dementia, where they contribute greatly to patient morbidity, caregiver burden, and institutionalization (3,10,11). Nor are they limited to traumatic brain injury of the frontal lobes. Specific systemic illnesses that appear to be related to declines in frontal lobe abilities include hypertension, diabetes, and chronic obstructive pulmonary disease (12). Impaired executive control functions can also be recognized in major depression, Parkinson's disease, subcortical strokes, and psychotic disorders (3,13,14).

That's what I'm looking for. A link between diabetes and ADD.

Individuals with impaired executive control functions often do well on many standard cognitive assessments and function adequately in a structured setting.

Yup. Routine and structure help big time. One guy at the ADD support group I've visited said he was happy in the army. They tell you what to do all the time. I find that disturbing because I'm a very contrarian, independent person. But when I have the freedom I want I don't know what to do with it.
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