Attention may be compromised in people with PTSD. Several tasks have been developed to assess attention. The most common task is The Stroop Colour Word Test, which presents colour names printed in an ink congruent to the colour name (e.g. blue), or incongruent to the colour name (e.g. blue). Participants are asked to either read the word or name the ink colour. A Stroop interference index is calculated by subtracting response times in the colour-naming condition from those in the incongruent condition. This serves as a measure of the attentional engagement, with more engagement indicating an attentional bias. The emotional Stroop task replaces colour-words with neutral and emotionally loaded stimuli (e.g., the word “violence” painted in blue compared to a neutral word in the same colour). Other tasks include the Continuous Performance Test that uses both visual and auditory stimuli and requires participants to respond to targets and ignore distractors. Also, the Trail Making Test requires participants to connect, in order, letters and/or numbers as quickly as possible.

What is the evidence for attention in people with PTSD?

Moderate to high quality evidence finds medium-sized effects of poorer attention in people with PTSD than in healthy controls (people not exposed to trauma and those without PTSD). Similar findings were apparent in both children and adults. People with PTSD had greater attentional interference with PTSD-relevant stimuli and with emotionally positive stimuli than with emotionally neutral stimuli. In sexual victimisation survivors with or without PSTD, a small effect showed more attentional bias for sexual threat stimuli in those with PTSD.

August 2021

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Aspects of attention can be affected in bipolar disorder. These include selective attention, which is the ability to focus on relevant stimuli and ignore irrelevant stimuli. Sustained attention is the ability to maintain a consistent focus. Selective and sustained attention involve ‘alerting’ (achieving and maintaining an alert state); ‘orienting’ (directing attention); and ‘executive control’ (choosing suitable responses).

Several tasks have been developed to assess attention performance. The most common tasks include the Continuous Performance Test (CPT) that uses both visual and auditory stimuli and requires participants to respond to targets and ignore distractors. The Trail Making Test (TMT), requires participants to connect, in order, letters and/or numbers as quickly as possible. The Stroop Colour Word Test (SCWT), presents colour names printed in an ink congruent to the colour name (e.g. blue), or incongruent to the colour name (e.g. blue). Participants are asked to either read the word or name the ink colour. Any impairment in attention disrupts other cognitive functions. Information processing, for example, requires selective attention to retrieve relevant information, and dismiss irrelevant information. Working memory requires sustained attention in order to maintain concentration on information temporarily being stored. Therefore, tasks that have been developed to measure attention also measure other cognitive constructs.

What is the evidence regarding attention in people with bipolar disorder?

Moderate to high quality evidence suggests a medium-sized effect of poorer attention in people with bipolar disorder compared to controls, with no significant changes over time (3-5 years). The effect was similar in people with bipolar I or bipolar II disorder, in people with first-episode bipolar disorder, and in elderly patients who were matched to controls for age and education. The effect was not significant in children with bipolar disorder who were matched to controls for age (mean age 13 years) and IQ (mean IQ score 104).

High quality evidence suggests a small association between poorer attention and poorer general functioning in people with bipolar disorder.

Moderate quality evidence suggests people with first-episode bipolar disorder showed a medium-sized effect of better performance on some attention tasks (TMT-A and B) compared to people with first-episode schizophrenia. However, high quality evidence showed no differences in attention between people with bipolar disorder and a history of psychotic symptoms and people with bipolar disorder and no history of psychotic symptoms.

Moderate quality evidence found no differences in attention between people with bipolar disorder and people with major depression, in both euthymic and depression phases.

In people of any age with a first-degree relative with bipolar disorder, moderate to high quality evidence found no differences in attention compared to controls, or compared to first-degree relatives of people with schizophrenia. However, in youth aged 10 to 25 years with a first-degree relative with bipolar disorder, there was a small to medium-sized effect of poorer attention compared to controls.

September 2021

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Selective attention is the ability to focus on relevant stimuli and ignore irrelevant stimuli. Sustained attention is the ability to maintain a consistent focus. Several tasks have been developed to assess attention performance. Examples include the Continuous Performance Test (CPT), which uses both visual and auditory stimuli and requires participants to respond to targets and ignore distractors. Other examples include the Trail Making Test (TMT), which requires participants to connect, in order, letters and/or numbers as quickly as possible, and the Wisconsin Card Sorting Test (WCST) that tests the ability to display flexibility during changing schedules. The Stroop Colour Word Test (SCWT) presents the name of a colour printed in an ink congruent to the colour name (e.g. blue), or incongruent to the colour name (e.g. blue), and participants are asked to either read the word or name the ink colour. Attention tasks may also measure other cognitive constructs, such as processing speed and memory.

What is the evidence for attention?

Moderate to high quality evidence shows medium to large effects of poorer performance on various attention and vigilance tasks in people with schizophrenia compared to people without schizophrenia. There are small to medium-sized associations between poorer attention and more severe symptoms, poorer community functioning, and poorer social skills. People taking olanzapine or quetiapine showed medium to large improvements on attention tasks after treatment. People taking haloperidol showed small improvements after treatment, and people taking clozapine or risperidone showed no improvement after treatment.

High quality evidence found people at clinical high risk of psychosis and people at familial high risk for psychosis are similarly impaired on attention tasks. Moderate to high quality evidence shows a medium-sized effect of better attention in people at clinical high-risk than people with first-episode psychosis. Those at risk who converted to psychosis were more impaired on attention tasks than those at risk who did not convert to psychosis.

Compared to people with bipolar disorder, moderate to high quality evidence shows people with schizophrenia have slightly poorer performance on attention tasks. There was also poorer performance on attention tasks in people with schizophrenia who were herpes simplex virus positive or had metabolic syndrome than in people with schizophrenia who were herpes simplex virus negative or did not have metabolic syndrome. There was a small effect of greater impairment in attention in smokers vs. non-smokers with schizophrenia, however people with schizophrenia and a substance use disorder performed better on attention tasks than people with schizophrenia and no substance use disorder.

March 2022

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