Attention Disorders And Their Psychopathology

Several mental disorders, such as schizophrenia, cause serious attentional disturbances.

Attentional capacity is one of the skills that most frequently becomes altered with the presence of psychopathology. Next we will see the various deviations that attention can suffer depending on some of the most common psychological disorders.

Care and its typologies

Although many are the authors who have proposed different definitions of the concept of attention, one of the recent contributions (Rios, 2007) states that attention is a neurocognitive state of readiness, which precedes perceptual capacity and action, and that It is made up of a network of cortical connections that are in charge of orientation, alert and executive control functions.  

More specifically, attention is made up of the following elements: arousal, focal attention, sustained attention, selective attention, alternating attention (change of attention focus based on the information that needs to be processed at all times) and divided attention (ability to attend to two types of stimulation simultaneously).

Attention disorders and psychopathologies

In an attempt to describe the relationship between altered attentional capacity and its presence in certain psychopathologies, Higueras et al. (1996) have differentiated aprosexias, hypoprosexias, pseudoprosexias, paraprosexias and hyperprosexias in their classification. 

This taxonomy orders the categories understanding attention as a one-dimensional variable in which the extremes (aprosexia and hyperprosexia) correspond to a total absence and an increased ability to focus attention and concentration, respectively. Thus, more specifically, each of them are defined as follows:

1. The Aprosexias

The total absence of attention is usually associated with symptoms of intense agitation or stupor, a serious alteration of the level of consciousness in which alertness is highly compromised. This state can be caused by organic factors (diffuse brain dysfunctions, for example) or psychiatric (melancholic, catatonic and related to hysteria).

2. Hypoprosexias 

They are states of decreased attentional capacity of less intensity than aprosexia, and they are divided into subgroups:

a) Distractibility : present in  ADHD or twilight state, a disorder of the narrowing of the field of consciousness.

b) Attentive emotional lability linked to anxiety symptoms.

c) Inhibition of attention attributed to depressive and schizophrenic states.

d) Negligence, an inability to orient oneself after a focal type stroke.

e) Attention fatigue, a state characterized by exhaustion of attention (typical of dementias and the presence of tumors) and the apathy associated with certain personality disorders.

3. Pseudoprosexias

They can be confused with aprosexias in a superficial way because apparently the attentional capacity seems absent due to the patient’s pretense, although it is actually preserved. It is common in states of hysteria or in Gánser syndrome (a type of dissociative disorder) with the aim of attracting the attention of relatives and relatives of the individual.

4. Paraprosexias

It is defined as an altered direction of the attentional focus, related to hypochondriacal behaviors.

5. Hyperprosexias

They consist of an increased and transitory attentional state present in moments of altered consciousness such as hyperlucency or extreme vigilance.

Attention as a cognitive process

Derived from scientific research at the end of the last century, Reed (1988) has related some psychopathologies to the aspect of care, which in each case is more altered. Thus, the following attentional abilities are distinguished.

1. Attention as concentration or sustained attention

It is defined as the maintenance of attention for a long time. This capacity is related to the task of fixing attention and its most frequent alteration occurs in cases of extreme fatigue, sleep disturbance or states of malnutrition.  

In this category there may be phenomena such as mental absence (exclusion of external information that is usually accessible, where attention is decreased for distracting stimuli or not closely related to the thought in question itself and there is also an increase in the threshold necessary to enable attention focus) or time gap (an absence of recording of events while performing an automatic cognitive processing task, such as while driving a vehicle on a regular journey).

2. Attention as selection

It consists of the ability to discriminate relevant information by inhibiting other non-main stimulating elements. That is, the ability to separate the determining stimuli for the task in question from those secondary or irrelevant. 

Given the limited nature of attentional capacity, a common phenomenon in this type of ability is the act of “tuning in”, which consists of following a source of information when different sources compete to attract said attention. 

The alteration of this function is also known as “distractibility” and it can appear in a great variety of psychopathological disorders such as anxiety, manic episodes or twilight symptoms (symptoms similar to epilepsy).

3. Attention as activation or arousal

It is the state of general activation of the organism that allows to be on alert and is related to the attention focus in terms of degree or intensity. This ability is compromised in a state of high stress or anxiety, where there is a greater orientation of attention to threatening stimuli. These deviations are known as the “tunnel vision” phenomenon.

4. Attention as vigilance

It is defined as the state of hypersensitivity or high receptivity to the environment, as well as a type of attention dedication in long-term tasks in which the subject must detect a low-frequency stimulus. In this type of capacity , commission errors (detection of a stimulus when it is not present) and omission (inadequate processing of non-detection of present information) are of special relevance.  

This ability is mainly found altered in schizophrenic subjects, in individuals with high scores in the anxiety trait such as  GAD, or Generalized Anxiety Disorder. Its most frequent manifestations include general hypervigilance (attending to any stimulus irrelevant to the task), specific hypervigilance (selectively attending to stimuli related to threatening information), widening of attention (prior to the detection of stimulation). stressful or narrowing of attention (in the processing of a threatening stimulus, as in paranoid subjects).

5. Attention as an expectation

The ability to anticipate is a characteristic based on previous experience that allows the subject to be more efficient when carrying out a specific task. This ability is altered, for example, in the reaction time of schizophrenic individuals 

According to Shakow’s (1962) research, the latter have a “segmental set” that prevents them from benefiting from preparatory time intervals in tasks that measure reaction time. In contrast, subjects without psychopathology are characterized by having a “general set”, which makes it possible to perceive the stimulating situation globally and allows the individual to respond without taking into account the irrelevant elements of the activity.

In conclusion

As can be seen, the alteration of attentional capacity is present in a high comorbidity with anxiogenic or schizophrenic psychopathology. A cognitive enhancement of this ability can become an important component in the intervention in this type of clinical disorders.

Bibliographic references:

  • García, J. (1997). Psychology of attention. Madrid: Synthesis.
  • Ríos, M., Muñoz, J. and Paúl, N. (2007). Attention disorders after traumatic brain injury: evaluation and rehabilitation. Journal of Neurology, 44, 291-297. 

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