This is not an uncommon reason for presenting to a physician; both psychiatrist and primary care physi-cians. Sometimes what is presented as the main complaint is the resultant impairment in functioning: “I am getting very forgetful.” “I am making unusual mistakes at work.” “My grades are going down.” “The teacher says my child is not listening in class.” “My husband (or wife) says I don’t listen, and ask the same questions.” “I am wondering if I am getting Alzheimer’s.”
In medicine, focus is more commonly referred to as “concentration”. It is a thinking process that allows us to register new information or retrieve a stored one.
Impairment in this process therefore results in in-terference in both registration and retrieval-learning and recalling.
Let’s conceptualize concentration in this way: Imagine a virtual tunnel with limited space through which information flows to and from a memory bank in the brain. Any condition which involves partial or permanent blocking of the tunnel could result in impaired ability to recall or retain information. There are several medical conditions, including disease states and altered consciousness, as in intoxicated states that could involve impairment in concentration.
That means, lust like fever, impaired concentration or focus by itself is not a disease. It is a sign of an underlying disease or medical problem.
Like fever, the definitive treatment starts with establishing the medical cause and treating ap-propriately. Just like with fever, in which your physician being aware of other changes such as abnormal cough or frequent urination, may facilitate diagnosis, it is equally important in concentration impairment for your physician to be aware of other changes:
1. What kind of thoughts seem to dominate your mind?
2. Are the thoughts slower or faster than usual?
3. Do the thoughts jump from one idea to another and if so, are they random ideas or all problems exaggerated more than the facts bear out?
4. Does the difficulty in concentration seem to dramatically fluctuate or present all the time?
5. When did it start? Since childhood? During elementary school? Or later in adolescence and adulthood?
6. Are there accompanying changes in your usual mood, pattern or energy level?
7. What medications-prescribed, over the counter or recreational have been used?
All this information is vital in establishing the medi-cal causes of the concentration problems. In anxiety disorders, the thoughts are dominated by problems which the person admits seem more exaggerated in their mind but “can’t help it.” Other changes can be feeling of anxiousness, muscle tension, and sleep impairment.
In depressive disorders the thoughts are dominat-ed by pessimistic thinking, exaggerated self blame and guilt. The person reports feeling slow in their thoughts and mood may be unhappier than used to be and there may be a decline in usual interests. In manic states the thoughts are dominated by multiple plans and ideas, usually unrealistic for the situation and quickly move from one idea to another, often random and unrelated. Other changes can include excessive talking, and can be observed by others to go from topic to topic with-out completing one idea fully.
There is tendency to act more impulsively than usual. Energy level and overall activity also may be elevated. Mood may be uncharacteristically irritable or elated. In attention deficit disorder (ADD) — the symptoms must have been manifest by age 7, (that is by el-ementary school). It is NOT acquired later in life. The thoughts seem to stream from one idea to another rather than the jumpy pattern of a manic state. Distraction is more by external cues in the environment e.g., what is seen or heard around.
The impulsivity does not usually result in drastic consequences, unlike manic states where the impulsive acts can have disastrous consequences such as problems with relationship, legal and financial troubles. In dementia (like Alzheimer’s disease), the recall problem is not from clogging of the “tunnel” but by abnormal changes in the memory bank itself. It often starts after age 50 and is progressive with accompanying decline in one’s independent functioning. It does not “go and come”. As is evident from the above, the complaint of concentration problems requires further medical exploration.
The treatment depends on the medi-cal diagnosis. Taking medication for the wrong disorder could be harmful or worsen your illness e.g. taking ADD medication when you are in a manic or anxiety state could significantly worsen the symptoms and, consequently, your quality of life. Next time you or your loved one experiences problems with concentration, or are concerned that you are more forgetful, go over the other changes and be sure to inform your physician. It could go a long way in ensuring a more accu-rate diagnosis and treatment.
