COMMENTARY

Understanding Inattention: Diagnosis and Misdiagnosis

Derick E. Vergne, MD

Disclosures

December 11, 2014

In This Article

Inattention in Depressive States

Major depressive disorder (MDD) or depressed states can bring about the same diagnostic difficulties. MDD presents two types of cognitive dysfunction, namely cognitive biases, which include distorted information processing or attentional allocation toward negative stimuli, as well as cognitive deficits, which include impairments in attention, short-term memory, and executive functioning.[17]

Moreover, neuroimaging studies in depression show that critical appraisal of stimuli is lost to the extent that brain regions dealing with emotion, such as the anterior cingulate, amygdala, striatum, and insula (all of these being evolutionary primitive deep-brain structures) are overactivated at the expense of regions that are geared more toward cognitive appraisal of stimuli, such as the medial, dorsal-medial, and dorsal lateral prefrontal cortex.[13] Such imaging findings are associated with an overall reduction in cognitive control of emotion, difficulties in working memory, and overall executive dysfunction.[13] In other words, attentional and cognitive capabilities become inefficient in that environmental stimuli that may have been neutral in a depression-free state are perceived as threatening and depressogenic. As in anxiety, there is a type of hyperfocus on guilt, shame, loss, etc., at the expense of seeing the "cup half full." This psychological state represents a type of inattention that could be misdiagnosed for the innate inattention found in ADD.

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