10 replies to this topic

[penisbreath]

hi,

the psychiatric i'm seeing ran me through a series of neurocognitive computer tests, totaling about 45 minutes in total. unfortunately, i don't have the name of the program on hand, but basically it consisted of 5 games, assessing logic skills, processing speed, response inhibition, problem solving skills under pressure etc.

i'm curious how accurate such a program might be in detecting impairments in a more phenomenological sense? i've repeatedly complained to my psychiatrist that i am struggling tremendously - i have difficulty reading, thinking in the abstract, concentrating, almost *no* decision-making skills. i feel like i lack any flexible attention; it's almost impossible to engage with life and my surroundings. the decline in my abilities has been completely heartbreaking.

but amazingly i tested above average in every domain in this computer test, which according to my psych means i am perfectly fine and should be able to return to college. i'm questioning just how thorough such testing might be, and am considering whether i should see my doctor about referring me for neuropsychological testing?

or is it as simple as depression/anxiety being the culprit here? i really don't understand. i tried SSRI's previously when my primary dx. was anxiety and they significantly worsened my focus, but in the case of depression would they at least bring me back to some kind of functional baseline?

i keep 'superficially' busy (i exercise, try see friends, eat well, work part-time) and have so for the last year, but the life i'm leading is completely humiliating and i'm not sure how much longer it's worth living like this.

[TophetLOL]

A 45 min neurocognitive test is worthless, even the better cognitive tests used in clinical trials are very self limiting due to there simplicity in only being able to measure lower order thinking. With no healthy control score to measure against your "sick" score it reduces the test down to nothing but pseudoscience. Most of psychology is nothing more then philosophy hiding behind the illusion of the natural sciences.

[penisbreath]

A 45 min neurocognitive test is worthless, even the better cognitive tests used in clinical trials are very self limiting due to there simplicity in only being able to measure lower order thinking. With no healthy control score to measure against your "sick" score it reduces the test down to nothing but pseudoscience. Most of psychology is nothing more then philosophy hiding behind the illusion of the natural sciences.

thanks for your response. if the test was worthless, then i'm out of pocket $100US. i should add that my psychiatrist is far from a quack; he's well respected, and i don't doubt the validity of the test. but like you say, it seems to basically measure the barest of functioning, and i dont think even assessed working memory, which is what feels impaired in my case. unfortunately, the test results are being used to 'prove' to me that there's no impairment as far as my mental energy, ability to think and reason go.

do you think neuropsychological testing might reveal more?

[chrono]

These kinds of tests are absolutely ridiculous, in my opinion. There may be some kind of correlation between test performance and attention in certain groups (especially hyperactive children), but using these for higher-functioning adults is just pseudoscience, as tophet said. Attentional difficulties can be linked intimately with other neuropsychological factors (especially motivation) which the test can't measure in any way. And even if it does measure the exact factors which are relevant in attentional disorders (which is highly problematic), a test administered in a doctor's office is not an accurate predictor of how those elements will play out day after day as you're attending class and doing homework. Especially one which is only 45 minutes long.

It sounds to me like the test was a better measure of fluid intelligence than anything else. I'd be curious to know which one it was. I always score in the top couple percent on things like this, yet have crippling attentional problems which make it nearly impossible for me to attend school without some kind of medication.

A good psychiatrist will take into account how mental problems are manifesting in your life, and not use an intelligence test of questionable applicability as the sole diagnostic tool. If your psych is telling you you're perfectly fine when you're saying things like "I don't know how much longer it's worth living like this," they've failed. Period. Freaking ridiculous. Find a better one.

Edited by chrono, 20 June 2010 - 10:42 PM.

[penisbreath]

These kinds of tests are absolutely ridiculous, in my opinion. There may be some kind of correlation between test performance and attention in certain groups (especially hyperactive children), but using these for higher-functioning adults is just pseudoscience, as tophet said. Attentional difficulties can be linked intimately with other neuropsychological factors (especially motivation) which the test can't measure in any way. And even if it does measure the exact factors which are relevant in attentional disorders (which is highly problematic), a test administered in a doctor's office is not an accurate predictor of how those elements will play out day after day as you're attending class and doing homework. Especially one which is only 45 minutes long.

It sounds to me like the test was a better measure of fluid intelligence than anything else. I'd be curious to know which one it was. I always score in the top couple percent on things like this, yet have crippling attentional problems which make it nearly impossible for me to attend school without some kind of medication.

A good psychiatrist will take into account how mental problems are manifesting in your life, and not use an intelligence test of questionable applicability as the sole diagnostic tool. If your psych is telling you you're perfectly fine when you're saying things like "I don't know how much longer it's worth living like this," they've failed. Period. Freaking ridiculous. Find a better one.

sorry, i don't know the name of the test. but i'm on lumosity at least once a day out of boredom's sake, and likewise score pretty well, even though, as i say, those tests can barely capture the phenomenological pain of motivational and attentional problems.

my psychiatrist feels like most of my difficulties are confidence-based, which is simply not true. i mean, i've barely been able to read a book for over a year because of this dense fog i live in each and everyday. i get confused by simple things like movie plot-lines. i've been reading up on depersonalization (which a psychologist i saw for over a year dx'd me with) and a lot of my cognitive difficulties seem to correlate; they found that DP patients had significant working memory problems and performed really poorly on the Stroop Test from what i recall.
the only thing that really helps me break out of the confusion are nicotine lozenges (can't get an Rx for stims), which i've been using sparingly when desperate.

like i say, my psych is highly competent, so it makes me *doubt* myself - i feel like i'm the only one who can be at fault here. but i donno ..

chrono, do you think neuropsychological testing will be a similar dead-end? or might it give me a better picture at what might not be functioning correctly?

[chrono]

To be honest, I'm not sure precisely what you mean by neuropsychological testing. Guess I was lucky enough to have a psychiatrist who was willing to listen to me and see how I responded to a couple of medications, rather than just scoring me on a couple of tests.

Your problems (whatever they are) are obviously severe, so I think by saying your only problem is that you lack confidence, your psych demonstrated how competent he is. In my experience, sometimes the most ostensibly qualified doctors are the ones who are most unable to deal with difficult cases fluidly. A doctor's job is to diagnose a problem they can only observe briefly in an artificial environment. Even with presented with symptoms that are physically demonstrable, the best doctors can form different theories which fit the data. This is compounded with psychological problems.

If anything, you may not be confident enough in yourself and what you experience to demand good treatment. I've spent years in this kind of situation with various psychological and physical problems, so I know how frustrating and demoralizing self-doubt can be. I was only ever able to make progress when I tried a different doctor.

Depersonalization and adult ADD are both problems which are very subjective, and IMO, very hard to quantify with a test. Which seems to be this doctor's only approach. As imprecise as diagnosis through medication can be, it sounds like it could be beneficial in your case. There's lots of things a reasonable doctor should be willing to try for the kind of problems that you have, that don't have the kind of taboo and difficulties attached which psychostims do.

And I haven't read much about DP, but nicotine increases dopamine (among other things). This is highly implicated in attentional difficulties. You could do a little searching here, and see how you react to a few other things which affect dopamine. Tyrosine is a real basic one.

[penisbreath]

To be honest, I'm not sure precisely what you mean by neuropsychological testing. Guess I was lucky enough to have a psychiatrist who was willing to listen to me and see how I responded to a couple of medications, rather than just scoring me on a couple of tests.

um .. basically, it's a highly-detailed cognitive assessment. it runs about 6-8 hours, and i've heard can be useful in detecting problems like ADD. the only problem is the prohibitive cost (you're paying a psychologist by the hour, so it can easily end up costing 700-1000$ US). like you say, there is no single *test* for ADD, but it would be nice to at least have some tangible verification of my short-term memory problems, though the risk is that everything might look 'okay' on paper a la my last test. the problem is i work better under pressure and a test is obviously a pressured environment which can't account for day-to-day difficulties.

the neuropsychologist i e-mailed however said that certain disorders (like depression vs. ADD) do tend to produce stereotypical patterns.

i guess i'm just curious to hear from anyone who's had it done and can tell me whether it might be more accurate in detecting impairments.

If anything, you may not be confident enough in yourself and what you experience to demand good treatment. I've spent years in this kind of situation with various psychological and physical problems, so I know how frustrating and demoralizing self-doubt can be. I was only ever able to make progress when I tried a different doctor.

yes, that is basically the case. i was born gifted and was rather high-functioning at one point, but i can't set aside the notion that i'm just .. well "a bag of dirt." i don't mean to indulge in self-pity, but the end result of that belief is that i just can't assert myself in front of doctors, and will bow to their authority. i am lucky enough to have a GP with a heart of gold who has said that he would be happy to refer me to someone else if i continue to struggle.

Depersonalization and adult ADD are both problems which are very subjective, and IMO, very hard to quantify with a test. Which seems to be this doctor's only approach. As imprecise as diagnosis through medication can be, it sounds like it could be beneficial in your case. There's lots of things a reasonable doctor should be willing to try for the kind of problems that you have, that don't have the kind of taboo and difficulties attached which psychostims do.

And I haven't read much about DP, but nicotine increases dopamine (among other things). This is highly implicated in attentional difficulties. You could do a little searching here, and see how you react to a few other things which affect dopamine. Tyrosine is a real basic one.

what complicates things is that i suffer from OCD. and i *know* that OCD can certainly produce ADD symptoms. but the OCD did not emerge until i was 19, and prior to that, i suffered from really stereotypical ADD symptoms: requiring massive stimulation and task-complexity to get things done, a poor attention span (i've never been able to read for more than 45 minutes at a time), doing everything at the last minute, anhedonia and inability to enjoy leisure activities, etc. etc. if anything, the OCD felt like a coping mechanism: it pushed me into such an anxious state (correlating with the demands of college) that i actually became more productive until i finally burnt out.

of course depression can also produce attentional problems, which is why i've wondered if the fact that i respond well to stimulant-like stuff is meaningless .. i.e. would any depressed person experience more mental energy on stims? that said, i have found that ritalin (which i got off a friend) had the effect of bringing me out of my coma (albeit with a lot of anxiety). same with nicotine, as i've mentioned. even memantine helped clear my head, though i ended up going a little high on the dose, i think, which made me depressed (i've mail-ordered some so i can experiment with a lower dose).

my feeling is that i should maybe see an attention specialist who deals with the spectrum of afflictions (ADD, OCD, etc.), though my first inclination was to get this neuropsych testing done (hence the thread). the neuropsych said she could also refer me to someone appropriate based on my results ...

[chrono]

That longer test probably has more of a chance of detecting problems in attention, working memory, etc., and correcting for the "adrenaline rush" effect of taking a short test you're very worked up about. But still, if you're very gifted, I think there's a good chance you'll be on the high end of certain trends they use as predictors. And judging from your examples, I would hazard a guess that (like me) you have inattentive ADD. Based on the continued prevalence of the hyperactive type in literature, of which inattentive is considered a "subtype" even though it has some radically different characteristics, I have a feeling that parts of the test/trends might be more biased toward ADHD.

And if there are comorbid factors like depression/anxiety/OCD at work, will this type of test show it? I guess it's possible, but I have a hard time picturing how that would go down. At the very least, I'd ask some more pointed questions about exactly what range of conditions this battery supposedly diagnoses.

In your place, assuming money is a factor, I would be thinking that $1000 could get me 5 hour-long consults with other psychiatrists. It seems to me that, at best, the test will demonstrate more concretely that you have attentional problems, and make it easier for you to get medication/treatment without so much runaround. That might be very valuable. But if you describe that you present with essentially all the classic symptoms of severe inattentive ADD, I don't think a diagnosis should be all that difficult for a good doctor. And if there are other factors like depression/OCD/DP involved, I think these are even harder to "test" for than deficits in attention, and would probably be easier to diagnose by having a few conversations with a wide-spectrum specialist, like you said. At a certain point in such a process, it might be more useful to see how you respond to a certain pharmaceutical treatment course, rather than trying to pin down the exact nature of a complex problem before any kind of solution is attempted.

At worst, I think a test like this might give you misplaced confidence in an incomplete or incorrect picture, and you'd be several thousand dollars and a lot of time down the road before you knew it. If you have a sympathetic GP, giving someone else a try first might be a cheaper option, might render such an expensive test entirely unnecessary, and wouldn't preclude that possibility if it became apparent you couldn't work with this new doctor, either.

[penisbreath]

That longer test probably has more of a chance of detecting problems in attention, working memory, etc., and correcting for the "adrenaline rush" effect of taking a short test you're very worked up about. But still, if you're very gifted, I think there's a good chance you'll be on the high end of certain trends they use as predictors.

I don't mean to make out like I'm some failed genius or anything, and I really don't know how gifted I am. But the neuropsychologist did echo your sentiments - that a certain intelligence quotient could skew the test results.

And judging from your examples, I would hazard a guess that (like me) you have inattentive ADD. Based on the continued prevalence of the hyperactive type in literature, of which inattentive is considered a "subtype" even though it has some radically different characteristics, I have a feeling that parts of the test/trends might be more biased toward ADHD.

I feel like I do have iADD, but worry it may just be a useful self-deception on my part in order to add some coherence to my past, and account for certain weaknesses and failings. I always picture iADD being associated with a certain slothfulness, academic difficulties, etc. I was actually okay throughout most of high school, despite difficulties in certain subjects, and did have a lot of natural motivation to succeed (albeit lacking the patientce to really follow through on ideas I had). Have you, like me, found your motivation etc. getting worse over time?

And if there are comorbid factors like depression/anxiety/OCD at work, will this type of test show it? I guess it's possible, but I have a hard time picturing how that would go down. At the very least, I'd ask some more pointed questions about exactly what range of conditions this battery supposedly diagnoses.

hmm, I'm not so sure about that

In your place, assuming money is a factor, I would be thinking that $1000 could get me 5 hour-long consults with other psychiatrists. It seems to me that, at best, the test will demonstrate more concretely that you have attentional problems, and make it easier for you to get medication/treatment without so much runaround. That might be very valuable. But if you describe that you present with essentially all the classic symptoms of severe inattentive ADD, I don't think a diagnosis should be all that difficult for a good doctor. And if there are other factors like depression/OCD/DP involved, I think these are even harder to "test" for than deficits in attention, and would probably be easier to diagnose by having a few conversations with a wide-spectrum specialist, like you said. At a certain point in such a process, it might be more useful to see how you respond to a certain pharmaceutical treatment course, rather than trying to pin down the exact nature of a complex problem before any kind of solution is attempted.

At worst, I think a test like this might give you misplaced confidence in an incomplete or incorrect picture, and you'd be several thousand dollars and a lot of time down the road before you knew it. If you have a sympathetic GP, giving someone else a try first might be a cheaper option, might render such an expensive test entirely unnecessary, and wouldn't preclude that possibility if it became apparent you couldn't work with this new doctor, either.

Thanks so much for your thoughtful response. I think I will take you up on your advice and seek an opinion from another specialist first. I guess part of my motivation in seeking out neuropsych testing is also proving it to *myself*; like I say, an ADD label is a convenient way to account for certain difficulties in my past, and I worry I may be selectively remember certain details and lying to myself. It's really difficult to put myself into my head state during high school, given how long it's been.

[chrono]

I always picture iADD being associated with a certain slothfulness, academic difficulties, etc. I was actually okay throughout most of high school, despite difficulties in certain subjects, and did have a lot of natural motivation to succeed (albeit lacking the patientce to really follow through on ideas I had). Have you, like me, found your motivation etc. getting worse over time?

Most definitely. For the first 2.5 years of high school, I was first in my class without even trying. Had a lot of natural motivation to learn, without really having to feel like I was working "toward" something by doing well in school. My motivation got incredibly bad my last year of high school, perhaps because of the realization that most of the work I was doing wasn't actually learning, and the learning I was doing wasn't really that satisfying. Still graduated 11th in my class, but senior year I got a couple of Fs thoughout the year because it suddenly didn't make sense for me to do the work.

I failed lots of classes when I tried going to college. Again, all the work was well within my capabilities (or at least, attainable with a reasonable amount of effort), but I had a huge amount of difficulty making myself do it, because none of it seemed relevant to me. Lots of nights staying up until dawn doing homework that should have been really quick, because forcing myself to concentrate on it was like holding my breath underwater.

In the last five years or so I've learned so much; in many ways, more than I would have if I'd been a successful college student and upshifted smartly into a conventional career. I have the rare ability to be interested in a huge number of subjects, and to delve into them very deeply simply out of curiosity. I rarely watch TV, and am not satisfied unless I'm learning something. In other words, I'm one of the least "lazy" and most self-directed people I know.

But this is mostly because of certain adaptations I've made. Some incredibly basic things are still so hard for me. Things that aren't self-directed, are menial or tedious, take an unreasonable amount of struggling. I'll put off a simple half-hour task for weeks, that will make a big difference in my life, and allow me to do things I really want to, because I'm never in the right frame of mind to concentrate on it effectively.

I have some real problems concentrating, as well...I have a hard time reading for more than a certain amount of time (seemingly modulated by how excited/interested I am by the material, but also pertaining to purely recreational reading), before I start to realize my eyes are following the lines, but I was thinking of something completely different and can't remember the last paragraph. Inability to attend feeds into inability to get motivated, and vice-versa. But I've found that attentional problems can be ameliorated by a variety of strategies (time structuring, some nootropics), but motivational troubles are much harder to compensate for...because on a very fundamental level it irrationally doesn't make sense to me to do certain things.

I guess part of my motivation in seeking out neuropsych testing is also proving it to *myself*; like I say, an ADD label is a convenient way to account for certain difficulties in my past, and I worry I may be selectively remember certain details and lying to myself. It's really difficult to put myself into my head state during high school, given how long it's been.

I know what you mean. I've been dealing with this for like 8 years now, and in writing this I have to suppress that little voice that keeps saying "you're just making excuses for yourself." I got diagnosed with ADD more or less by accident, as I was seeing a psychiatrist for some anxiety issues during a long and somewhat tragic period in my early 20s. It never occurred to me at the time that I might have ADD, because I don't fit the popular conception in many ways, and so many of these things were so...effortless for me when I was a teenager.

Even now, I'm not apt to tell people I have ADD, except in this kind of context. Not because I'm ashamed, but because having to listen to those "but you don't seem like..." and "you just need to try harder..." clichés echo my own cycles of self-doubt, and after a certain point it's not useful to agonize over any more. Some kind of brain scan that would give me a certificate saying "YOU HAVE ADD" would make a lot of this easier, but in a way I'm glad I don't identify with a disorder as strongly as I might. Looking at it as a set of thought/behavioral structures that require certain practices to utilize effectively helps me keep things in perspective.

Sorry for the long post...just wanted to let you know how my stuff went, because it sounds like you're dealing with some of the same obstacles. Not that I'm trying to definitely diagnose you with ADD based on your short description (although it's pretty indicative). It really sounds like you're thinking along the right lines, and pursuing some good options. Just have more confidence in yourself, and if you're sure something is happening a certain way in your mind, don't let a doctor tell you otherwise unless they have a compelling reason why you're wrong.

[penisbreath]

Most definitely. For the first 2.5 years of high school, I was first in my class without even trying. Had a lot of natural motivation to learn, without really having to feel like I was working "toward" something by doing well in school. My motivation got incredibly bad my last year of high school, perhaps because of the realization that most of the work I was doing wasn't actually learning, and the learning I was doing wasn't really that satisfying. Still graduated 11th in my class, but senior year I got a couple of Fs thoughout the year because it suddenly didn't make sense for me to do the work.

yeah I never went through that 'questioning' phase. I was placed into a competitive academic environment (my high school streamed students according to their grades), so I became really short-sighted and grade obsessed; our purpose was less to learn and more to compete.

I failed lots of classes when I tried going to college. Again, all the work was well within my capabilities (or at least, attainable with a reasonable amount of effort), but I had a huge amount of difficulty making myself do it, because none of it seemed relevant to me. Lots of nights staying up until dawn doing homework that should have been really quick, because forcing myself to concentrate on it was like holding my breath underwater.

I imagine I would have failed if I'd chosen subjects which actually required consistent attendance and studying. Instead, I went into the arts, which meant I could doodle through/barely attend lectures and still get by on my essays, which I wrote using library material.

In the last five years or so I've learned so much; in many ways, more than I would have if I'd been a successful college student and upshifted smartly into a conventional career. I have the rare ability to be interested in a huge number of subjects, and to delve into them very deeply simply out of curiosity. I rarely watch TV, and am not satisfied unless I'm learning something. In other words, I'm one of the least "lazy" and most self-directed people I know.

Hmm, I'm sorta similar. I found that because I couldn't really enjoy stuff, I would have to 'frame' it as having some purpose, so I found myself devoting a lot of time to 'learning' about pop culture by experiencing it. But it's difficult to really break through that core anhedonia, in my opinion.

I have some real problems concentrating, as well...I have a hard time reading for more than a certain amount of time (seemingly modulated by how excited/interested I am by the material, but also pertaining to purely recreational reading), before I start to realize my eyes are following the lines, but I was thinking of something completely different and can't remember the last paragraph. Inability to attend feeds into inability to get motivated, and vice-versa. But I've found that attentional problems can be ameliorated by a variety of strategies (time structuring, some nootropics), but motivational troubles are much harder to compensate for...because on a very fundamental level it irrationally doesn't make sense to me to do certain things.

As much as it sucks, it's reassuring to hear that you also have difficulty with sustained reading. I've always been incredibly jealous of people who finish books in an afternoon, etc. Something like that has always been completely unimaginable to me.

I know what you mean. I've been dealing with this for like 8 years now, and in writing this I have to suppress that little voice that keeps saying "you're just making excuses for yourself." I got diagnosed with ADD more or less by accident, as I was seeing a psychiatrist for some anxiety issues during a long and somewhat tragic period in my early 20s. It never occurred to me at the time that I might have ADD, because I don't fit the popular conception in many ways, and so many of these things were so...effortless for me when I was a teenager.

Even now, I'm not apt to tell people I have ADD, except in this kind of context. Not because I'm ashamed, but because having to listen to those "but you don't seem like..." and "you just need to try harder..." clichés echo my own cycles of self-doubt, and after a certain point it's not useful to agonize over any more. Some kind of brain scan that would give me a certificate saying "YOU HAVE ADD" would make a lot of this easier, but in a way I'm glad I don't identify with a disorder as strongly as I might. Looking at it as a set of thought/behavioral structures that require certain practices to utilize effectively helps me keep things in perspective.

Sorry for the long post...just wanted to let you know how my stuff went, because it sounds like you're dealing with some of the same obstacles. Not that I'm trying to definitely diagnose you with ADD based on your short description (although it's pretty indicative). It really sounds like you're thinking along the right lines, and pursuing some good options. Just have more confidence in yourself, and if you're sure something is happening a certain way in your mind, don't let a doctor tell you otherwise unless they have a compelling reason why you're wrong.

Thanks. I appreciate your confidence. It's a pity that the co-morbid OCD complicates things, but hopefully I can find a suitable treatment plan.