Post Psychiatric Cognitive Impairment

In my Practice I see people with anxiety and mood disorders , people with PTSD and chronic pain.  I have noticed over time that these people complain off similar cognitive problems and that these problems seem to be there even after there depression or anxiety disorder has largely resolved.

The typical problems are these:

  • Verbal Memory     – poor memory for instructions. They get the first instruction but miss the rest
  • Visual Memory     –  to a lesser extent there are problems on testing remembering a  number of items randomly placed on a tray then covered up.
  • Attention Span –     difficulty focusing and sustaining attention
  • Executive Function-  difficulty with multi-tasking, problem-solving , and organising.

These problems are often sufficiently severe that they are the main barrier to holding down a job.

There is no strong evidence that medication helps these deficits. On occasions I have found L-Methyl Folate  and Amantadine helpful. Antidepressants don’t seem beneficial.  psychostimulants increase mental processing speed but don’t help these problem areas either.

I think cognitive remediation using iphone and computer games designed to practice each specific difficulty are the best answer. There is a test package called THINC available on the internet which tests people with a past history of depression for cognitive dysfunction.

For sustained attention I recommend an app called IQ2

For executive function I recommend  an app called  Stroop Effect

For Visual Memory I recommend an app called  Visual Memory

If you are bad at face recall try an app called  Spy Coach

I haven’t found a good app for verbal memory as a stand alone item.  There are verbal memory quizzes in packaged products such as luminosity and elevate ( I prefer elevate myself).   One can of course practice with a partner a list of 8 new unrelated words per day with an immediate recall test and a 5min delayed recall test (after a coffee break).

There is also a company called Lash & Assoc who markets computer games for brain injury which are useable . The two useful ones are DASAT ( for executive function/sustained attention) and Abime ( For Visual/Verbal Memory) They cost about $120 each. They are quite enjoyable.

Cognitive remediation takes about three months to bear fruit.

 

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