BACKGROUND： In patients with depression, as well as in patients with schizophrenia, both mood and working memory performance are often impaired. Both issues can only be addressed and improved with medication to some ...BACKGROUND： In patients with depression, as well as in patients with schizophrenia, both mood and working memory performance are often impaired. Both issues can only be addressed and improved with medication to some extent. OBJECTIVE： This study investigates the mood and the working memory performance in patients with depression or schizophrenia and whether acupuncture can improve these. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS： A pragmatic clinical trial design was used The study was conducted in a psychiatric clinic. Fifty patients with depression and 50 with schizophrenia were randomly divided into an experimental and a waiting-list group. Additionally, 25 healthy control participants were included. Twelve weeks of individualized acupuncture treatment was used as the clinical intervention. MAIN OUTCOME MEASURES： All patients were tested before （T1） and after （T2） acupuncture treatment on a mood scale （Beck Depression Inventory-II, BDI-II）, a simple working memory task （digit span）, and a complex working memory task （letter-number sequencing）; the healthy controls were tested at T1 only. RESULTS： Patients with depression scored worse than the others on the BDI-II, and patients with schizophrenia scored worse than the healthy controls. On the digit span, patients with schizophrenia did not differ from healthy controls whereas they scored worse of all on the letter-number sequencing. With respect to the acupuncture findings, first, the present study showed that the use of acupuncture to treat patients with schizophrenia was both practical and safe. Moreover, acupuncture had a positive effect on the BDI-II for the depression group, but acupuncture had no effect on the digit span and on the letter- number sequencing performance for the two clinical groups. CONCLUSION： The clinical improvement in patients with depression after acupuncture treatment was not accompanied by any significant change in a simple working memory task or in a more complex working memory task; the same was true for the patients with schizophrenia.展开更多
Although liver transplantation(LT) is performed increasingly for patients with end-stage alcoholic liver disease(ALD), the topic remains controversial. Traditionally, the role of an addiction specialist focused on the...Although liver transplantation(LT) is performed increasingly for patients with end-stage alcoholic liver disease(ALD), the topic remains controversial. Traditionally, the role of an addiction specialist focused on the screening and identification of patients with a high risk on relapse in heavy alcohol use. These patients were in many cases subsequently excluded from a further LT procedure.Recently, awareness is growing that not only screening of patients but also offering treatment, helping patients regain and maintain abstinence is essential, opening up a broader role for the addiction specialist(team)within the whole of the transplant procedure. Within this context, high-risk assessment is proposed to be an indication of increasing addiction treatment intensity,instead of being an exclusion criterion. In this review we present an overview regarding the state of the art on alcohol relapse assessment and treatment in patients with alcohol use disorders, both with and without ALD.Screening, treatment and monitoring is suggested as central roles for the addiction specialist(team) integrated within transplant centers.展开更多
Alcohol use disorders represent a heterogeneous spectrum of clinical manifestations that have been defined by the Diagnostic and Statistical Manual of Mental Disorders-5. Excessive alcohol intake can lead to damage of...Alcohol use disorders represent a heterogeneous spectrum of clinical manifestations that have been defined by the Diagnostic and Statistical Manual of Mental Disorders-5. Excessive alcohol intake can lead to damage of various organs, including the liver. Alcoholic liver disease includes different injuries ranging from steatosis to cirrhosis and implicates a diagnostic assessment of the liver disease and of its possible complications. There is growing interest in the possible different tools for assessing previous alcohol consumption and for establishing the severity of liver injury, especially by noninvasive methods.展开更多
AIM: To assess presence and severity of associative stigma in family members of psychotic patients and factors for higher associative stigma.METHODS: Standardized semi-structured interview of 150 family members of psy...AIM: To assess presence and severity of associative stigma in family members of psychotic patients and factors for higher associative stigma.METHODS: Standardized semi-structured interview of 150 family members of psychotic patients receiving full time treatment. This study on associative stigma in family members of psychotic patients was part of a larger research program on the burden of the family, using "Interview for the Burden of the Family" and the chapters stigma, treatment and attribution from the "Family interview Schedule". The respondents were relatives, one per patient, either partner or parent. The patients had been diagnosed with schizophrenia or schizo-affective disorder. All contacts with patients and relatives were in Dutch. Relatives were deemed suitable to participate in this research if they saw the patient at least once a week. Recruitment took place in a standardized way: after obtaining the patient's consent, the relatives were approached to participate. The results were analyzed using SPSS Version 18.0. RESULTS: The prevalence of associative stigma in this sample is 86%. Feelings of depression in the majority of family members are prominent. Twenty-one point three percent experienced guilt more or less frequent, while shame was less pronounced. Also, 18.6% of allrespondents indicated that they tried to hide the illness of their family member for others regularly or more. Three six point seven percent really kept secret about it in certain circumstances and 29.3% made efforts to explain what the situation or psychiatric condition of their family member really is like. Factors with marked significance towards higher associative stigma are a worsened relationship between the patient and the family member, conduct problems to family members, the patients' residence in a residential care setting, and hereditary attributional factors like genetic hereditability and character. The level of associative stigma has significantly been predicted by the burden of aggressive disruptions to family housemates of the psychotic patient.CONCLUSION: Family members of psychotic patients in Flanders experience higher associative stigma compared to previous international research. Disruptive behavior by the patient towards in-housing family members is the most accurate predictor of higher associative stigma.展开更多
Traditional Chinese medicine (TCM) is gaining popularity in the treatment of psychiatric disorders that can be described and treated from either an Eastern or a Western perspective. In Eastern medicine, the disorders ...Traditional Chinese medicine (TCM) is gaining popularity in the treatment of psychiatric disorders that can be described and treated from either an Eastern or a Western perspective. In Eastern medicine, the disorders are described according to five diagnostic methods that are used in TCM: inspection, auscultation, olfaction, inquiry, and palpation, including tongue and pulse diagnosis.展开更多
OBJECTIVE: To investigate the effectiveness of acupuncture in the treatment of chronic schizophrenia and co-morbid sleep disorders.METHODS: A 42-year-old German male outpatient,suffering from long-term schizophrenia a...OBJECTIVE: To investigate the effectiveness of acupuncture in the treatment of chronic schizophrenia and co-morbid sleep disorders.METHODS: A 42-year-old German male outpatient,suffering from long-term schizophrenia and sleep disorders, entered the study. Acupuncture was used as a non-pharmacological intervention. In addition to his ongoing Western Medicine(pharmacological) treatment, the patient received 12 weekly(non-standardized) acupuncture treatments in the clinic. The Traditional Chinese Medicine(TCM) diagnosis, the psychological assessment and the actiwatch data were compared before and after the acupuncture treatment.RESULTS: The TCM diagnosis revealed a Liver Fire pattern before the acupuncture treatment, which was still present, although to a lesser degree, after the treatment. The psychological assessment revealed no change in the positive symptoms, but a small decrease in the negative symptoms and the general psychopathology of the patient. This was further illustrated by the small decrease in the number of depressive symptoms. The subjective sleep disorders improved markedly after acupuncture treatment, but the daytime sleepiness did not. The actiwatch results showed that after acupuncture treatment, the patient was moving less during sleep, but no significant results were found for the other sleep parameters.CONCLUSION: Acupuncture was found to be an effective non-pharmacological add-on method for treating subjective sleep disorders, and, to a lesser degree, objective sleep disorders and the negative symptoms of chronic schizophrenia. Future larger clinical trials with follow-up measurements are needed in order to replicate the present preliminary beneficial acupuncture findings and in order to determine whether the observed effects can be sustained.展开更多
AIM: To study the degree of stigmatization among trainee psychiatrists, individual characteristics potentially leading to higher associative stigma, and coping mechanisms.METHODS: Two hundred and seven trainee psychia...AIM: To study the degree of stigmatization among trainee psychiatrists, individual characteristics potentially leading to higher associative stigma, and coping mechanisms.METHODS: Two hundred and seven trainee psychiatrists in Flanders(Belgium), all member of the Flemish Association of Trainee Psychiatrists, were approached to participate in the survey. A non-demanding questionnaire that was specifically designed for the purpose of the study was sent by mail. The questionnaire consisted of three parts, each emphasizing a different aspect of associative stigma: devaluing and humiliating interactions, the focus on stigma during medical train-ing, and identification with negative stereotypes in the media. Answers were scored on a Likert scale ranging from 0 to 3. The results were analyzed using SPSS Version 18.0. RESULTS: The response rate of the study was 75.1%. The internal consistency of the questionnaire was good, with a Cronbach's α of 0.71. Seventy-five percent of all trainee psychiatrists confirmed hearing denigrating or humiliating remarks about the psychiatric profession more than once. Additionally, more than half of them had had remarks about the incompetence of psychiatrists directed at them. Only 1.3% remembered having stigma as a topic during their psychiatric training. Trainees who had been in training for a longer period of time had experienced a significantly higher level of stigmatization than trainees with fewer years of experience(mean total stigma scores of 16.93 ± SD 7.8 vs 14.45 ± SD 6.1, t =-2.179 and P < 0.05). In addition, senior trainees effectively kept quiet about their profession significantly more often than their junior colleagues(mean item score 0.44 ± SD 0.82 vs 0.13 ± SD 0.48, t = 2.874, P < 0.01). Comparable results were found in trainees working in adult psychiatry as were found in those working in child or youth psychiatry(mean item score 0.38 ± SD 0.77 vs 0.15 ± SD 0.53, t =-2.153, P < 0.05). Biologically oriented trainees were more inclined to give preventive explanations about their profession, which can be seen as a coping mechanism used to deal with this stigma(mean item score 2.05 ± SD 1.05 vs 1.34 ± SD 1.1, t =-3.403, P < 0.01).CONCLUSION: Associative stigma in trainee psychiatrists is underestimated. More attention should be paid to this potentially harmful phenomenon in training.展开更多
Nowadays,several noninvasive neuroimaging techniques,including transcranial magnetic stimulation(TMS),exist.The working mechanism behind TMS is a rapidly changing magnetic field that generates an electric current via ...Nowadays,several noninvasive neuroimaging techniques,including transcranial magnetic stimulation(TMS),exist.The working mechanism behind TMS is a rapidly changing magnetic field that generates an electric current via electromagnetic induction.When the coil is placed on the scalp,the magnetic field generates a physiological reaction in the underlying neural tissue.The TMS-induced change in the participant’s behavior is used by researchers to investigate the causal relations between specific brain areas and cognitive functions such as language.A variant of TMS has been developed,which is called rapid-rate TMS(rTMS).In this review,three databases(Medline,Educational Resources Information Center,and Scopus)were searched for rTMS studies on normal reading and dyslexia with a cut-off date of October 31,2014.rTMS was found to be a valuable tool for investigating questions related to reading research,both on the word and the sentence level.Moreover,it can be successfully used in research on dyslexia.Recently,(high-frequency)rTMS has been used as a“clinical”intervention technique for treating dyslexia and for improving reading performance by exciting underactive reading pathways in the brain.Finally,we end the paper with a discussion of future directions in the field of rTMS research and dyslexia,for instance,the promising prospect of combining TMS with simultaneous electroencephalographic imaging.展开更多
Neuroscience is a relatively new research field that,so far,has resulted in important progress in understanding the physiology,biochemistry,pharmacology,and structure of the vertebrate brain.^([1])Because of this prog...Neuroscience is a relatively new research field that,so far,has resulted in important progress in understanding the physiology,biochemistry,pharmacology,and structure of the vertebrate brain.^([1])Because of this progress,spectacular technological developments,^([2])i.e.positron emission tomography,functional magnetic resonance imaging,transcranial magnetic stimulation(TMS),diffusion tensor imaging,magneto-encephalography,electro-encephalography,etc.,and new treatments based on them,such as high-frequency repetitive TMS(rTMS),^([3])deep brain stimulation.展开更多
Aim:Treatment non-adherence is a common problem in patients suffering from schizophrenia and depression.This study investigated the possible relationships between symptom severity,quality of sleep,and treatment adhere...Aim:Treatment non-adherence is a common problem in patients suffering from schizophrenia and depression.This study investigated the possible relationships between symptom severity,quality of sleep,and treatment adherence.Methods:Thirty outpatients with schizophrenia and 58 outpatients with depression were enrolled in this study.The beck depression Inventory-II,the positive and negative syndrome scale,and the pittsburgh sleep quality index were used to assess symptom severity and quality of sleep,and sleep log data were used to measure treatment adherence.Results:The preliminary results showed no significant relationship between symptom severity and treatment adherence or between quality of sleep and treatment adherence in patients with depression.However,a significant positive relationship was found between negative symptoms and treatment adherence and a significant negative relationship between quality of sleep and treatment adherence in patients with schizophrenia.Conclusion:The present exploratory study revealed a positive relationship between symptom severity and treatment adherence and a negative relationship between quality of sleep and treatment adherence in patients with schizophrenia,but no significant relationships in patients with depression were found.Future studies are needed in order to gain a better understanding of possible risk factors related to treatment non-adherence.展开更多
Schizophrenia is a severe psychiatric disorder that has a worldwide prevalence of 0.5%^([1])and poses a high cost to society.^([2])The disorder is characterized by positive symptoms,such as hallucinations and delusion...Schizophrenia is a severe psychiatric disorder that has a worldwide prevalence of 0.5%^([1])and poses a high cost to society.^([2])The disorder is characterized by positive symptoms,such as hallucinations and delusions,^([3])negative symptoms,such as impaired emotional functioning and behavioral disruptions(e.g.flat affect,difficulty in starting activities and completing them,etc.),^([4])and cognitive symptoms,such as deficits in executive functioning,impaired working memory,and attention problems.展开更多
文摘BACKGROUND： In patients with depression, as well as in patients with schizophrenia, both mood and working memory performance are often impaired. Both issues can only be addressed and improved with medication to some extent. OBJECTIVE： This study investigates the mood and the working memory performance in patients with depression or schizophrenia and whether acupuncture can improve these. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS： A pragmatic clinical trial design was used The study was conducted in a psychiatric clinic. Fifty patients with depression and 50 with schizophrenia were randomly divided into an experimental and a waiting-list group. Additionally, 25 healthy control participants were included. Twelve weeks of individualized acupuncture treatment was used as the clinical intervention. MAIN OUTCOME MEASURES： All patients were tested before （T1） and after （T2） acupuncture treatment on a mood scale （Beck Depression Inventory-II, BDI-II）, a simple working memory task （digit span）, and a complex working memory task （letter-number sequencing）; the healthy controls were tested at T1 only. RESULTS： Patients with depression scored worse than the others on the BDI-II, and patients with schizophrenia scored worse than the healthy controls. On the digit span, patients with schizophrenia did not differ from healthy controls whereas they scored worse of all on the letter-number sequencing. With respect to the acupuncture findings, first, the present study showed that the use of acupuncture to treat patients with schizophrenia was both practical and safe. Moreover, acupuncture had a positive effect on the BDI-II for the depression group, but acupuncture had no effect on the digit span and on the letter- number sequencing performance for the two clinical groups. CONCLUSION： The clinical improvement in patients with depression after acupuncture treatment was not accompanied by any significant change in a simple working memory task or in a more complex working memory task; the same was true for the patients with schizophrenia.
文摘Although liver transplantation(LT) is performed increasingly for patients with end-stage alcoholic liver disease(ALD), the topic remains controversial. Traditionally, the role of an addiction specialist focused on the screening and identification of patients with a high risk on relapse in heavy alcohol use. These patients were in many cases subsequently excluded from a further LT procedure.Recently, awareness is growing that not only screening of patients but also offering treatment, helping patients regain and maintain abstinence is essential, opening up a broader role for the addiction specialist(team)within the whole of the transplant procedure. Within this context, high-risk assessment is proposed to be an indication of increasing addiction treatment intensity,instead of being an exclusion criterion. In this review we present an overview regarding the state of the art on alcohol relapse assessment and treatment in patients with alcohol use disorders, both with and without ALD.Screening, treatment and monitoring is suggested as central roles for the addiction specialist(team) integrated within transplant centers.
文摘Alcohol use disorders represent a heterogeneous spectrum of clinical manifestations that have been defined by the Diagnostic and Statistical Manual of Mental Disorders-5. Excessive alcohol intake can lead to damage of various organs, including the liver. Alcoholic liver disease includes different injuries ranging from steatosis to cirrhosis and implicates a diagnostic assessment of the liver disease and of its possible complications. There is growing interest in the possible different tools for assessing previous alcohol consumption and for establishing the severity of liver injury, especially by noninvasive methods.
文摘AIM: To assess presence and severity of associative stigma in family members of psychotic patients and factors for higher associative stigma.METHODS: Standardized semi-structured interview of 150 family members of psychotic patients receiving full time treatment. This study on associative stigma in family members of psychotic patients was part of a larger research program on the burden of the family, using "Interview for the Burden of the Family" and the chapters stigma, treatment and attribution from the "Family interview Schedule". The respondents were relatives, one per patient, either partner or parent. The patients had been diagnosed with schizophrenia or schizo-affective disorder. All contacts with patients and relatives were in Dutch. Relatives were deemed suitable to participate in this research if they saw the patient at least once a week. Recruitment took place in a standardized way: after obtaining the patient's consent, the relatives were approached to participate. The results were analyzed using SPSS Version 18.0. RESULTS: The prevalence of associative stigma in this sample is 86%. Feelings of depression in the majority of family members are prominent. Twenty-one point three percent experienced guilt more or less frequent, while shame was less pronounced. Also, 18.6% of allrespondents indicated that they tried to hide the illness of their family member for others regularly or more. Three six point seven percent really kept secret about it in certain circumstances and 29.3% made efforts to explain what the situation or psychiatric condition of their family member really is like. Factors with marked significance towards higher associative stigma are a worsened relationship between the patient and the family member, conduct problems to family members, the patients' residence in a residential care setting, and hereditary attributional factors like genetic hereditability and character. The level of associative stigma has significantly been predicted by the burden of aggressive disruptions to family housemates of the psychotic patient.CONCLUSION: Family members of psychotic patients in Flanders experience higher associative stigma compared to previous international research. Disruptive behavior by the patient towards in-housing family members is the most accurate predictor of higher associative stigma.
文摘Traditional Chinese medicine (TCM) is gaining popularity in the treatment of psychiatric disorders that can be described and treated from either an Eastern or a Western perspective. In Eastern medicine, the disorders are described according to five diagnostic methods that are used in TCM: inspection, auscultation, olfaction, inquiry, and palpation, including tongue and pulse diagnosis.
文摘OBJECTIVE: To investigate the effectiveness of acupuncture in the treatment of chronic schizophrenia and co-morbid sleep disorders.METHODS: A 42-year-old German male outpatient,suffering from long-term schizophrenia and sleep disorders, entered the study. Acupuncture was used as a non-pharmacological intervention. In addition to his ongoing Western Medicine(pharmacological) treatment, the patient received 12 weekly(non-standardized) acupuncture treatments in the clinic. The Traditional Chinese Medicine(TCM) diagnosis, the psychological assessment and the actiwatch data were compared before and after the acupuncture treatment.RESULTS: The TCM diagnosis revealed a Liver Fire pattern before the acupuncture treatment, which was still present, although to a lesser degree, after the treatment. The psychological assessment revealed no change in the positive symptoms, but a small decrease in the negative symptoms and the general psychopathology of the patient. This was further illustrated by the small decrease in the number of depressive symptoms. The subjective sleep disorders improved markedly after acupuncture treatment, but the daytime sleepiness did not. The actiwatch results showed that after acupuncture treatment, the patient was moving less during sleep, but no significant results were found for the other sleep parameters.CONCLUSION: Acupuncture was found to be an effective non-pharmacological add-on method for treating subjective sleep disorders, and, to a lesser degree, objective sleep disorders and the negative symptoms of chronic schizophrenia. Future larger clinical trials with follow-up measurements are needed in order to replicate the present preliminary beneficial acupuncture findings and in order to determine whether the observed effects can be sustained.
文摘AIM: To study the degree of stigmatization among trainee psychiatrists, individual characteristics potentially leading to higher associative stigma, and coping mechanisms.METHODS: Two hundred and seven trainee psychiatrists in Flanders(Belgium), all member of the Flemish Association of Trainee Psychiatrists, were approached to participate in the survey. A non-demanding questionnaire that was specifically designed for the purpose of the study was sent by mail. The questionnaire consisted of three parts, each emphasizing a different aspect of associative stigma: devaluing and humiliating interactions, the focus on stigma during medical train-ing, and identification with negative stereotypes in the media. Answers were scored on a Likert scale ranging from 0 to 3. The results were analyzed using SPSS Version 18.0. RESULTS: The response rate of the study was 75.1%. The internal consistency of the questionnaire was good, with a Cronbach's α of 0.71. Seventy-five percent of all trainee psychiatrists confirmed hearing denigrating or humiliating remarks about the psychiatric profession more than once. Additionally, more than half of them had had remarks about the incompetence of psychiatrists directed at them. Only 1.3% remembered having stigma as a topic during their psychiatric training. Trainees who had been in training for a longer period of time had experienced a significantly higher level of stigmatization than trainees with fewer years of experience(mean total stigma scores of 16.93 ± SD 7.8 vs 14.45 ± SD 6.1, t =-2.179 and P < 0.05). In addition, senior trainees effectively kept quiet about their profession significantly more often than their junior colleagues(mean item score 0.44 ± SD 0.82 vs 0.13 ± SD 0.48, t = 2.874, P < 0.01). Comparable results were found in trainees working in adult psychiatry as were found in those working in child or youth psychiatry(mean item score 0.38 ± SD 0.77 vs 0.15 ± SD 0.53, t =-2.153, P < 0.05). Biologically oriented trainees were more inclined to give preventive explanations about their profession, which can be seen as a coping mechanism used to deal with this stigma(mean item score 2.05 ± SD 1.05 vs 1.34 ± SD 1.1, t =-3.403, P < 0.01).CONCLUSION: Associative stigma in trainee psychiatrists is underestimated. More attention should be paid to this potentially harmful phenomenon in training.
文摘Nowadays,several noninvasive neuroimaging techniques,including transcranial magnetic stimulation(TMS),exist.The working mechanism behind TMS is a rapidly changing magnetic field that generates an electric current via electromagnetic induction.When the coil is placed on the scalp,the magnetic field generates a physiological reaction in the underlying neural tissue.The TMS-induced change in the participant’s behavior is used by researchers to investigate the causal relations between specific brain areas and cognitive functions such as language.A variant of TMS has been developed,which is called rapid-rate TMS(rTMS).In this review,three databases(Medline,Educational Resources Information Center,and Scopus)were searched for rTMS studies on normal reading and dyslexia with a cut-off date of October 31,2014.rTMS was found to be a valuable tool for investigating questions related to reading research,both on the word and the sentence level.Moreover,it can be successfully used in research on dyslexia.Recently,(high-frequency)rTMS has been used as a“clinical”intervention technique for treating dyslexia and for improving reading performance by exciting underactive reading pathways in the brain.Finally,we end the paper with a discussion of future directions in the field of rTMS research and dyslexia,for instance,the promising prospect of combining TMS with simultaneous electroencephalographic imaging.
文摘Neuroscience is a relatively new research field that,so far,has resulted in important progress in understanding the physiology,biochemistry,pharmacology,and structure of the vertebrate brain.^([1])Because of this progress,spectacular technological developments,^([2])i.e.positron emission tomography,functional magnetic resonance imaging,transcranial magnetic stimulation(TMS),diffusion tensor imaging,magneto-encephalography,electro-encephalography,etc.,and new treatments based on them,such as high-frequency repetitive TMS(rTMS),^([3])deep brain stimulation.
文摘Aim:Treatment non-adherence is a common problem in patients suffering from schizophrenia and depression.This study investigated the possible relationships between symptom severity,quality of sleep,and treatment adherence.Methods:Thirty outpatients with schizophrenia and 58 outpatients with depression were enrolled in this study.The beck depression Inventory-II,the positive and negative syndrome scale,and the pittsburgh sleep quality index were used to assess symptom severity and quality of sleep,and sleep log data were used to measure treatment adherence.Results:The preliminary results showed no significant relationship between symptom severity and treatment adherence or between quality of sleep and treatment adherence in patients with depression.However,a significant positive relationship was found between negative symptoms and treatment adherence and a significant negative relationship between quality of sleep and treatment adherence in patients with schizophrenia.Conclusion:The present exploratory study revealed a positive relationship between symptom severity and treatment adherence and a negative relationship between quality of sleep and treatment adherence in patients with schizophrenia,but no significant relationships in patients with depression were found.Future studies are needed in order to gain a better understanding of possible risk factors related to treatment non-adherence.
文摘Schizophrenia is a severe psychiatric disorder that has a worldwide prevalence of 0.5%^([1])and poses a high cost to society.^([2])The disorder is characterized by positive symptoms,such as hallucinations and delusions,^([3])negative symptoms,such as impaired emotional functioning and behavioral disruptions(e.g.flat affect,difficulty in starting activities and completing them,etc.),^([4])and cognitive symptoms,such as deficits in executive functioning,impaired working memory,and attention problems.
