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Wierenga CE, Bischoff-Grethe A, Melrose AJ, Irvine Z, Torres L, Bailer UF, Simmons A, Fudge JL, McClure SM, Ely A, Kaye WH. Hunger does not motivate reward in women remitted from anorexia nervosa. Biol Psychiatry 2015; 77:642-52. [PMID: 25481622 PMCID: PMC4359668 DOI: 10.1016/j.biopsych.2014.09.024] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 09/05/2014] [Accepted: 09/23/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Hunger enhances sensitivity to reward, yet individuals with anorexia nervosa (AN) are not motivated to eat when starved. This study investigated brain response to rewards during hunger and satiated states to examine whether diminished response to reward could underlie food restriction in AN. METHODS Using a delay discounting monetary decision task known to discriminate brain regions contributing to processing of immediate rewards and cognitive control important for decision making regarding future rewards, we compared 23 women remitted from AN (RAN group; to reduce the confounding effects of starvation) with 17 healthy comparison women (CW group). Monetary rewards were used because the rewarding value of food may be confounded by anxiety in AN. RESULTS Interactions of Group (RAN, CW) × Visit (hunger, satiety) revealed that, for the CW group, hunger significantly increased activation in reward salience circuitry (ventral striatum, dorsal caudate, anterior cingulate cortex) during processing of immediate reward, whereas satiety increased activation in cognitive control circuitry (ventrolateral prefrontal cortex, insula) during decision making. In contrast, brain response in reward and cognitive neurocircuitry did not differ during hunger and satiety in the RAN group. A main effect of group revealed elevated response in the middle frontal gyrus for the RAN group compared with the CW group. CONCLUSIONS Women remitted from AN failed to increase activation of reward valuation circuitry when hungry and showed elevated response in cognitive control circuitry independent of metabolic state. Decreased sensitivity to the motivational drive of hunger may explain the ability of individuals with AN to restrict food when emaciated. Difficulties in valuating emotional salience may contribute to inabilities to appreciate the risks inherent in this disorder.
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Affiliation(s)
| | | | - A. James Melrose
- University of California San Diego, Department of Psychiatry, San Diego CA USA
| | - Zoe Irvine
- University of California San Diego, Department of Psychiatry, San Diego CA USA
| | - Laura Torres
- University of California San Diego, Department of Psychiatry, San Diego CA USA
| | - Ursula F. Bailer
- University of California San Diego, Department of Psychiatry, San Diego CA USA
| | - Alan Simmons
- University of California San Diego, Department of Psychiatry, San Diego CA USA
| | - Julie L. Fudge
- University of Rochester Medical Center, Department of Psychiatry and Neurobiology and Anatomy, Rochester NY USA
| | | | - Alice Ely
- University of California San Diego, Department of Psychiatry, San Diego CA USA
| | - Walter H. Kaye
- University of California San Diego, Department of Psychiatry, San Diego CA USA
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Dawson L, Rhodes P, Touyz S. Defining recovery from anorexia nervosa: a Delphi study to determine expert practitioners’ views. ACTA ACUST UNITED AC 2015. [DOI: 10.1080/21662630.2015.1009145] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Wierenga CE, Ely A, Bischoff-Grethe A, Bailer UF, Simmons AN, Kaye WH. Are Extremes of Consumption in Eating Disorders Related to an Altered Balance between Reward and Inhibition? Front Behav Neurosci 2014; 8:410. [PMID: 25538579 PMCID: PMC4260511 DOI: 10.3389/fnbeh.2014.00410] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 11/11/2014] [Indexed: 01/31/2023] Open
Abstract
The primary defining characteristic of a diagnosis of an eating disorder (ED) is the "disturbance of eating or eating-related behavior that results in the altered consumption or absorption of food" (DSM V; American Psychiatric Association, 2013). There is a spectrum, ranging from those who severely restrict eating and become emaciated on one end to those who binge and overconsume, usually accompanied by some form of compensatory behaviors, on the other. How can we understand reasons for such extremes of food consummatory behaviors? Recent work on obesity and substance use disorders has identified behaviors and neural pathways that play a powerful role in human consummatory behaviors. That is, corticostriatal limbic and dorsal cognitive neural circuitry can make drugs and food rewarding, but also engage self-control mechanisms that may inhibit their use. Importantly, there is considerable evidence that alterations of these systems also occur in ED. This paper explores the hypothesis that an altered balance of reward and inhibition contributes to altered extremes of response to salient stimuli, such as food. We will review recent studies that show altered sensitivity to reward and punishment in ED, with evidence of altered activity in corticostriatal and insula processes with respect to monetary gains or losses, and tastes of palatable foods. We will also discuss evidence for a spectrum of extremes of inhibition and dysregulation behaviors in ED supported by studies suggesting that this is related to top-down self-control mechanisms. The lack of a mechanistic understanding of ED has thwarted efforts for evidence-based approaches to develop interventions. Understanding how ED behavior is encoded in neural circuits would provide a foundation for developing more specific and effective treatment approaches.
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Affiliation(s)
- Christina E. Wierenga
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Alice Ely
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | | | - Ursula F. Bailer
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Department of Psychiatry and Psychotherapy, Division of Biological Psychiatry, Austria Medical University of Vienna, Vienna, Austria
| | - Alan N. Simmons
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Walter H. Kaye
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
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Merlotti E, Mucci A, Volpe U, Montefusco V, Monteleone P, Bucci P, Galderisi S. Impulsiveness in patients with bulimia nervosa: electrophysiological evidence of reduced inhibitory control. Neuropsychobiology 2014; 68:116-23. [PMID: 23881271 DOI: 10.1159/000352016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Accepted: 05/06/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Bulimia nervosa (BN) is associated with a deficit of self-regulatory control and impulsivity. The present study aimed to clarify whether an impaired inhibitory control due to hyperarousal underlies impulsivity in BN subjects. METHODS Event-related potentials (ERPs) were recorded in 17 female patients with BN and 17 healthy controls during a three-tone oddball task. ERP components related to inhibition of irrelevant distractor stimuli, as well as effortful processing, were analyzed. Standardized low-resolution electromagnetic tomography (sLORETA) was used to assess ERP source activity. RESULTS Compared to healthy controls, BN patients showed reduced amplitude and shorter latency of the N200 (N2), increased amplitude and shorter latency of the target slow wave (SW), and higher amplitude of the P300 for distractor stimuli (P3a) and for targets (P3b). sLORETA showed the following: (1) higher activity of the P3a generators in the left parietal cortex, bilateral precuneus and right frontal and anterior cingulate for distractor stimuli and (2) lower activity of the SW generators in the left medial frontal gyrus, bilateral superior frontal, anterior cingulate and cuneus for target stimuli. The reduction of the N2 latency was associated with the Barratt scores for impulsiveness. CONCLUSIONS The observed electrophysiological abnormalities suggest a condition of hyperarousal, with impaired suppression of irrelevant stimuli due to abnormal cortical activation and reduced signal-to-noise ratio. Our findings point to functional abnormalities within a neural system that subserves attention and self-regulatory control, which may contribute to impulsive behaviors in BN.
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Boehm I, Geisler D, King JA, Ritschel F, Seidel M, Deza Araujo Y, Petermann J, Lohmeier H, Weiss J, Walter M, Roessner V, Ehrlich S. Increased resting state functional connectivity in the fronto-parietal and default mode network in anorexia nervosa. Front Behav Neurosci 2014; 8:346. [PMID: 25324749 PMCID: PMC4183185 DOI: 10.3389/fnbeh.2014.00346] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Accepted: 09/13/2014] [Indexed: 11/13/2022] Open
Abstract
The etiology of anorexia nervosa (AN) is poorly understood. Results from functional brain imaging studies investigating the neural profile of AN using cognitive and emotional task paradigms are difficult to reconcile. Task-related imaging studies often require a high level of compliance and can only partially explore the distributed nature and complexity of brain function. In this study, resting state functional connectivity imaging was used to investigate well-characterized brain networks potentially relevant to understand the neural mechanisms underlying the symptomatology and etiology of AN. Resting state functional magnetic resonance imaging data was obtained from 35 unmedicated female acute AN patients and 35 closely matched healthy controls female participants (HC) and decomposed using spatial group independent component analyses (ICA). Using validated templates, we identified components covering the fronto-parietal “control” network, the default mode network (DMN), the salience network, the visual and the sensory-motor network. Group comparison revealed an increased functional connectivity between the angular gyrus and the other parts of the fronto-parietal network in patients with AN in comparison to HC. Connectivity of the angular gyrus was positively associated with self-reported persistence in HC. In the DMN, AN patients also showed an increased functional connectivity strength in the anterior insula in comparison to HC. Anterior insula connectivity was associated with self-reported problems with interoceptive awareness. This study, with one of the largest sample to date, shows that acute AN is associated with abnormal brain connectivity in two major resting state networks (RSN). The finding of an increased functional connectivity in the fronto-parietal network adds novel support for the notion of AN as a disorder of excessive cognitive control, whereas the elevated functional connectivity of the anterior insula with the DMN may reflect the high levels of self- and body-focused ruminations when AN patients are at rest.
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Affiliation(s)
- Ilka Boehm
- Department of Child and Adolescent Psychiatry, Translational Developmental Neuroscience Section, Eating Disorder Services and Research Center, Faculty of Medicine, University Hospital C. G. Carus, Technische Universität Dresden Dresden, Germany
| | - Daniel Geisler
- Department of Child and Adolescent Psychiatry, Translational Developmental Neuroscience Section, Eating Disorder Services and Research Center, Faculty of Medicine, University Hospital C. G. Carus, Technische Universität Dresden Dresden, Germany
| | - Joseph A King
- Department of Child and Adolescent Psychiatry, Translational Developmental Neuroscience Section, Eating Disorder Services and Research Center, Faculty of Medicine, University Hospital C. G. Carus, Technische Universität Dresden Dresden, Germany
| | - Franziska Ritschel
- Department of Child and Adolescent Psychiatry, Translational Developmental Neuroscience Section, Eating Disorder Services and Research Center, Faculty of Medicine, University Hospital C. G. Carus, Technische Universität Dresden Dresden, Germany
| | - Maria Seidel
- Department of Child and Adolescent Psychiatry, Translational Developmental Neuroscience Section, Eating Disorder Services and Research Center, Faculty of Medicine, University Hospital C. G. Carus, Technische Universität Dresden Dresden, Germany
| | - Yacila Deza Araujo
- Department of Child and Adolescent Psychiatry, Translational Developmental Neuroscience Section, Eating Disorder Services and Research Center, Faculty of Medicine, University Hospital C. G. Carus, Technische Universität Dresden Dresden, Germany
| | - Juliane Petermann
- Department of Child and Adolescent Psychiatry, Translational Developmental Neuroscience Section, Eating Disorder Services and Research Center, Faculty of Medicine, University Hospital C. G. Carus, Technische Universität Dresden Dresden, Germany
| | - Heidi Lohmeier
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, University Hospital C. G. Carus, Technische Universität Dresden Dresden, Germany
| | - Jessika Weiss
- Department of Child and Adolescent Psychiatry, Translational Developmental Neuroscience Section, Eating Disorder Services and Research Center, Faculty of Medicine, University Hospital C. G. Carus, Technische Universität Dresden Dresden, Germany
| | - Martin Walter
- Department of Psychiatry, Otto-von-Guericke University Magdeburg, Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry, Translational Developmental Neuroscience Section, Eating Disorder Services and Research Center, Faculty of Medicine, University Hospital C. G. Carus, Technische Universität Dresden Dresden, Germany
| | - Stefan Ehrlich
- Department of Child and Adolescent Psychiatry, Translational Developmental Neuroscience Section, Eating Disorder Services and Research Center, Faculty of Medicine, University Hospital C. G. Carus, Technische Universität Dresden Dresden, Germany ; MGH/MIT/HMS Martinos Center for Biomedical Imaging, Massachusetts General Hospital Charlestown, MA, USA ; Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital Boston, MA, USA
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Bolton HM, Burgess PW, Gilbert SJ, Serpell L. Increased set shifting costs in fasted healthy volunteers. PLoS One 2014; 9:e101946. [PMID: 25025179 PMCID: PMC4099008 DOI: 10.1371/journal.pone.0101946] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 06/13/2014] [Indexed: 02/06/2023] Open
Abstract
We investigated the impact of temporary food restriction on a set shifting task requiring participants to judge clusters of pictures against a frequently changing rule. 60 healthy female participants underwent two testing sessions: once after fasting for 16 hours and once in a satiated state. Participants also completed a battery of questionnaires (Hospital Anxiety and Depression Scale [HADS]; Persistence, Perseveration and Perfectionism Questionnaire [PPPQ-22]; and Eating Disorders Examination Questionnaire [EDE-Q6]). Set shifting costs were significantly increased after fasting; this effect was independent of self-reported mood and perseveration. Furthermore, higher levels of weight concern predicted a general performance decrement under conditions of fasting. We conclude that relatively short periods of fasting can lead to set shifting impairments. This finding may have relevance to studies of development, individual differences, and the interpretation of psychometric tests. It also could have implications for understanding the etiology and maintenance of eating disorders, in which impaired set shifting has been implicated.
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Affiliation(s)
- Heather M. Bolton
- Division of Psychology and Language Sciences, University College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, United Kingdom
| | - Paul W. Burgess
- Division of Psychology and Language Sciences, University College London, London, United Kingdom
| | - Sam J. Gilbert
- Division of Psychology and Language Sciences, University College London, London, United Kingdom
| | - Lucy Serpell
- Division of Psychology and Language Sciences, University College London, London, United Kingdom
- North East London NHS Foundation Trust, Porters Avenue Health Centre, Dagenham, Essex, United Kingdom
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Kullmann S, Giel KE, Teufel M, Thiel A, Zipfel S, Preissl H. Aberrant network integrity of the inferior frontal cortex in women with anorexia nervosa. NEUROIMAGE-CLINICAL 2014; 4:615-22. [PMID: 24936412 PMCID: PMC4053633 DOI: 10.1016/j.nicl.2014.04.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 04/02/2014] [Accepted: 04/05/2014] [Indexed: 12/30/2022]
Abstract
Neuroimaging studies investigating the neural profile of anorexia nervosa (AN) have revealed a predominant imbalance between the reward and inhibition systems of the brain, which are also hallmark characteristics of the disorder. However, little is known whether these changes can also be determined independent of task condition, using resting-state functional magnetic resonance imaging, in currently ill AN patients. Therefore the aim of our study was to investigate resting-state connectivity in AN patients (n = 12) compared to healthy athlete (n = 12) and non-athlete (n = 14) controls. For this purpose, we used degree centrality to investigate functional connectivity of the whole-brain network and then Granger causality to analyze effective connectivity (EC), to understand directional aspects of potential alterations. We were able to show that the bilateral inferior frontal gyrus (IFG) is a region of special functional importance within the whole-brain network, in AN patients, revealing reduced functional connectivity compared to both healthy control groups. Furthermore, we found decreased EC from the right IFG to the midcingulum and increased EC from the bilateral orbitofrontal gyrus to the right IFG. For the left IFG, we only observed increased EC from the bilateral insula to the left IFG. These results suggest that AN patients have reduced connectivity within the cognitive control system of the brain and increased connectivity within regions important for salience processing. Due to its fundamental role in inhibitory behavior, including motor response, altered integrity of the inferior frontal cortex could contribute to hyperactivity in AN. We evaluate resting-state functional (FC) and effective (EC) connectivity. We compare anorexia nervosa (AN) patients with healthy controls. AN patients show reduced FC in the inferior frontal gyrus (IFG). AN patients show reduced EC from the IFG and increased EC to the IFG. Altered FC patterns correlate with physical activity.
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Affiliation(s)
- Stephanie Kullmann
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany ; German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany ; Institute of Medical Psychology and Behavioral Neurobiology, Eberhard Karls University, Tübingen, Germany ; fMEG Center, University of Tübingen, Tübingen, Germany
| | - Katrin E Giel
- Institute of Medical Psychology and Behavioral Neurobiology, Eberhard Karls University, Tübingen, Germany
| | - Martin Teufel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital, Tübingen, Germany
| | - Ansgar Thiel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital, Tübingen, Germany
| | - Stephan Zipfel
- Institute of Sport Science, University Tübingen, Tübingen, Germany
| | - Hubert Preissl
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany ; German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany ; Institute of Medical Psychology and Behavioral Neurobiology, Eberhard Karls University, Tübingen, Germany ; fMEG Center, University of Tübingen, Tübingen, Germany
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Wierenga C, Bischoff-Grethe A, Melrose AJ, Grenesko-Stevens E, Irvine Z, Wagner A, Simmons A, Matthews S, Yau WYW, Fennema-Notestine C, Kaye WH. Altered BOLD response during inhibitory and error processing in adolescents with anorexia nervosa. PLoS One 2014; 9:e92017. [PMID: 24651705 PMCID: PMC3961291 DOI: 10.1371/journal.pone.0092017] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 02/18/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Individuals with anorexia nervosa (AN) are often cognitively rigid and behaviorally over-controlled. We previously showed that adult females recovered from AN relative to healthy comparison females had less prefrontal activation during an inhibition task, which suggested a functional brain correlate of altered inhibitory processing in individuals recovered from AN. However, the degree to which these functional brain alterations are related to disease state and whether error processing is altered in AN individuals is unknown. METHODOLOGY/PRINCIPAL FINDINGS In the current study, ill adolescent AN females (n = 11) and matched healthy comparison adolescents (CA) with no history of an eating disorder (n = 12) performed a validated stop signal task (SST) during functional magnetic resonance imaging (fMRI) to explore differences in error and inhibitory processing. The groups did not differ on sociodemographic variables or on SST performance. During inhibitory processing, a significant group x difficulty (hard, easy) interaction was detected in the right dorsal anterior cingulate cortex (ACC), right middle frontal gyrus (MFG), and left posterior cingulate cortex (PCC), which was characterized by less activation in AN compared to CA participants during hard trials. During error processing, a significant group x accuracy (successful inhibit, failed inhibit) interaction in bilateral MFG and right PCC was observed, which was characterized by less activation in AN compared to CA participants during error (i.e., failed inhibit) trials. CONCLUSION/SIGNIFICANCE Consistent with our prior findings in recovered AN, ill AN adolescents, relative to CA, showed less inhibition-related activation within the dorsal ACC, MFG and PCC as inhibitory demand increased. In addition, ill AN adolescents, relative to CA, also showed reduced activation to errors in the bilateral MFG and left PCC. These findings suggest that altered prefrontal and cingulate activation during inhibitory and error processing may represent a behavioral characteristic in AN that is independent of the state of recovery.
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Affiliation(s)
- Christina Wierenga
- Department of Psychiatry, University of California San Diego, La Jolla, California, United States of America
| | - Amanda Bischoff-Grethe
- Department of Psychiatry, University of California San Diego, La Jolla, California, United States of America
| | - A. James Melrose
- Department of Psychiatry, University of California San Diego, La Jolla, California, United States of America
| | - Emily Grenesko-Stevens
- Department of Psychiatry, University of California San Diego, La Jolla, California, United States of America
| | - Zoë Irvine
- Department of Psychiatry, University of California San Diego, La Jolla, California, United States of America
| | - Angela Wagner
- Department of Psychiatry, University of California San Diego, La Jolla, California, United States of America
| | - Alan Simmons
- Department of Psychiatry, University of California San Diego, La Jolla, California, United States of America
- Veterans Affairs San Diego Healthcare System, San Diego, California, United States of America
| | - Scott Matthews
- Department of Psychiatry, University of California San Diego, La Jolla, California, United States of America
- Veterans Affairs San Diego Healthcare System, San Diego, California, United States of America
| | - Wai-Ying Wendy Yau
- Department of Psychiatry, University of California San Diego, La Jolla, California, United States of America
| | - Christine Fennema-Notestine
- Department of Psychiatry, University of California San Diego, La Jolla, California, United States of America
- Department of Radiology, University of California San Diego, La Jolla, California, United States of America
| | - Walter H. Kaye
- Department of Psychiatry, University of California San Diego, La Jolla, California, United States of America
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Abstract
OBJECTIVE Recent advances in neuroimaging techniques have enabled a better understanding of the neurobiological underpinnings of anorexia nervosa (AN). The aim of this paper was to summarise our current understanding of the neurobiology of AN. METHODS The literature was searched using the electronic databases PubMed and Google Scholar, and by additional hand searches through reference lists and specialist eating disorders journals. Relevant studies were included if they were written in English, only used human participants, had a specific AN group, used clinical populations of AN, group comparisons were reported for AN compared to healthy controls and not merely AN compared to other eating disorders or other psychiatric groups, and were not case studies. RESULTS The systematic review summarises a number of structural and functional brain differences which are reported in individuals with AN, including differences in neurotransmitter function, regional cerebral blood flow, glucose metabolism, volumetrics and the blood oxygen level dependent response. CONCLUSION Several structural and functional differences have been reported in AN, some of which reverse and others which persist following weight restoration. These findings have important implications for our understanding of the neurobiological underpinnings of AN, and further research in this field may provide new direction for the development of more effective treatments.
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Affiliation(s)
- Andrea Phillipou
- 1Department of Optometry and Vision Sciences, The University of Melbourne, Melbourne, Australia
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Yaseen ZS, Kopeykina I, Gutkovich Z, Bassirnia A, Cohen LJ, Galynker II. Predictive validity of the Suicide Trigger Scale (STS-3) for post-discharge suicide attempt in high-risk psychiatric inpatients. PLoS One 2014; 9:e86768. [PMID: 24466229 PMCID: PMC3897755 DOI: 10.1371/journal.pone.0086768] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 12/17/2013] [Indexed: 11/19/2022] Open
Abstract
Background The greatly increased risk of suicide after psychiatric hospitalization is a critical problem, yet we are unable to identify individuals who would attempt suicide upon discharge. The Suicide Trigger Scale v.3 (STS-3), was designed to measure the construct of an affective ‘suicide trigger state’ hypothesized to precede a suicide attempt (SA). This study aims to test the predictive validity of the STS-3 for post-discharge SA on a high-risk psychiatric-inpatient sample. Methods The STS-3, and a psychological test battery measuring suicidality, mood, impulsivity, trauma history, and attachment style were administered to 161 adult psychiatric patients hospitalized following suicidal ideation (SI) or SA. Receiver Operator Characteristic and logistic regression analyses were used to assess prediction of SA in the 6-month period following discharge from hospitalization. Results STS-3 scores for the patients who made post-discharge SA followed a bimodal distribution skewed to high and low scores, thus a distance from median transform was applied to the scores. The transformed score was a significant predictor of post-discharge SA (AUC 0.731), and a subset of six STS-3 scale items was identified that produced improved prediction of post-discharge SA (AUC 0.814). Scores on C-SSRS and BSS were not predictive. Patients with ultra-high (90th percentile) STS-3 scores differed significantly from ultra-low (10th percentile) scorers on measures of affective intensity, depression, impulsiveness, abuse history, and attachment security. Conclusion STS-3 transformed scores at admission to the psychiatric hospital predict suicide attempts following discharge among the high-risk group of suicidal inpatients. Patients with high transformed scores appear to comprise two clinically distinct groups; an impulsive, affectively intense, fearfully attached group with high raw STS-3 scores and a low-impulsivity, low affect and low trauma-reporting group with low raw STS-3 scores. These groups may correspond to low-plan and planned suicide attempts, respectively, but this remains to be established by future research.
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Affiliation(s)
- Zimri S. Yaseen
- Beth Israel Medical Center, New York, New York, United States of America
- * E-mail:
| | - Irina Kopeykina
- Beth Israel Medical Center, New York, New York, United States of America
| | - Zinoviy Gutkovich
- St. Luke's Roosevelt Hospital, New York, New York, United States of America
| | - Anahita Bassirnia
- Beth Israel Medical Center, New York, New York, United States of America
| | - Lisa J. Cohen
- Beth Israel Medical Center, New York, New York, United States of America
| | - Igor I. Galynker
- Beth Israel Medical Center, New York, New York, United States of America
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Abstract
PURPOSE OF REVIEW To systematize new neurobiological findings on the cause and treatment of eating disorders. RECENT FINDINGS The conceptual framework of the cause of eating disorders has undergone great changes in the past decades. Recently, the National Institute of Mental Health proposed a new set of criteria for research purposes--the Research Domain Criteria (RDoC). We aim to structure this study as much as possible using these constructs across biological units of analysis, summarizing new findings. Brain imaging techniques have become sophisticated in identifying brain circuits related to illness behaviour and to fundamental traits such as reward and social processing. Genetic studies have moved from candidate gene studies onto genome-wide association studies; however, the field needs to cooperate to collect larger samples in order to benefit from this approach. Hormonal changes as the results of starvation or as underlying factors for behavioural changes still receive attention in both animal and human studies. Advances made in neuropsychology show problems in cognition (set shifting and central coherence) and in other RDoC domains. Some of these findings have been translated into treatment. SUMMARY New biological models are being developed which explain causal and maintaining factors. The RDoC construct may be used to systematize these findings.
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Friederich HC, Wu M, Simon JJ, Herzog W. Neurocircuit function in eating disorders. Int J Eat Disord 2013; 46:425-32. [PMID: 23658085 DOI: 10.1002/eat.22099] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/12/2012] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Eating disorders are serious psychosomatic disorders with high morbidity and lifetime mortality. Inadequate response to current therapeutic interventions constitutes a challenging clinical problem. A better understanding of the underlying neurobiological mechanisms could improve psychotherapeutic and drug treatment strategies. METHOD A review highlighting the current state of brain imaging in eating disorders related to the anxiety and pathological fear learning model of anorexia nervosa (AN) and the impulsivity model of binge eating in bulimia nervosa (BN). RESULTS Available neuroimaging studies in patients with acute AN primarily suggest a hyper-responsive emotional and fear network to food, but not necessarily to eating disorder-unrelated, salient stimuli. Furthermore, patients with AN show decreased activation in the ventral fronto-striatal circuits during the performance of a cognitive flexibility task. Results in patients with BN primarily suggest a hypo-responsive reward system to food stimuli, especially to taste reward. Additionally, patients with BN exhibit impaired brain activation in the inhibitory control network during the performance of general response-inhibition tasks. DISCUSSION Anxiety and pathological fear learning may lead to conditioned neural stimulus-response patterns to food stimuli and increased cognitive rigidity, which could account for the phobic avoidance of food intake in patients with acute AN. However, further neurobiological studies are required to investigate pathological fear learning in patients with AN. Patients with BN may binge eat to compensate for a hypo-responsive reward system. The impaired brain activation in the inhibitory control network may facilitate the loss of control over food intake in patients with BN.
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Affiliation(s)
- Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, Medical University of Heidelberg, Heidelberg, Germany.
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Kullmann S, Giel KE, Hu X, Bischoff SC, Teufel M, Thiel A, Zipfel S, Preissl H. Impaired inhibitory control in anorexia nervosa elicited by physical activity stimuli. Soc Cogn Affect Neurosci 2013; 9:917-23. [PMID: 23677490 DOI: 10.1093/scan/nst070] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Besides food restriction, hyperactivity is considered a key behavioral trait of anorexia nervosa (AN), playing a major role in the pathogenesis and progression of the disorder. However, the underlying neurophysiology remains poorly understood. We used functional magnetic resonance imaging during two affective go/no-go tasks to probe inhibitory control in response to stimuli depicting physical activity vs inactivity and food vs non-food in AN patients compared with 26 healthy athlete and non-athlete controls. We hypothesized that neural correlates of behavioral inhibition are biased by the emotional information of the stimuli in AN patients, leading to a differential neural inhibitory pattern during the two tasks. Indeed, we found reduced response inhibition for food and non-food images in the putamen, while stimuli depicting physical activity resulted in an exaggerated response of the prefrontal cortex (PFC) and cerebellum in AN patients. However, both AN patients and athletes revealed an increased response in the somatosensory cortex to physical activity stimuli. These results suggest that physical activity stimuli might place an increased demand on the inhibitory control system in AN patients. The resulting hyperactivity of the PFC and cerebellum may lead to altered executive function and motor control, sustaining increased physical activity in AN patients.
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Affiliation(s)
- Stephanie Kullmann
- fMEG Center, University of Tübingen, 72076 Tübingen, Germany, Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, 72076 Tübingen, Germany, German Center for Diabetes Research, 85764 Neuherberg, Germany, Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, 72076 Tübingen, Germany, Department of Psychiatry, University of Bonn, 53105 Bonn, Germany, Institute of Nutritional Medicine, University Hohenheim, 70599 Stuttgart, Germany, and Institute of Sport Science, University Tübingen, 72076 Tübingen, GermanyfMEG Center, University of Tübingen, 72076 Tübingen, Germany, Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, 72076 Tübingen, Germany, German Center for Diabetes Research, 85764 Neuherberg, Germany, Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, 72076 Tübingen, Germany, Department of Psychiatry, University of Bonn, 53105 Bonn, Germany, Institute of Nutritional Medicine, University Hohenheim, 70599 Stuttgart, Germany, and Institute of Sport Science, University Tübingen, 72076 Tübingen, GermanyfMEG Center, University of Tübingen, 72076 Tübingen, Germany, Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, 72076 Tübingen, Germany, German Center for Diabetes Research, 85764 Neuherberg, Germany, Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, 72076 Tübingen, Germany, Department of Psychiatry, University of Bonn, 53105 Bonn, Germany, Institute of Nutritional Medicine, University Hohenheim, 70599 Stuttgart, Germany, and Institute of Sport Science, University Tübingen, 72076 Tübingen, Germany
| | - Katrin E Giel
- fMEG Center, University of Tübingen, 72076 Tübingen, Germany, Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, 72076 Tübingen, Germany, German Center for Diabetes Research, 85764 Neuherberg, Germany, Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, 72076 Tübingen, Germany, Department of Psychiatry, University of Bonn, 53105 Bonn, Germany, Institute of Nutritional Medicine, University Hohenheim, 70599 Stuttgart, Germany, and Institute of Sport Science, University Tübingen, 72076 Tübingen, Germany
| | - Xiaochen Hu
- fMEG Center, University of Tübingen, 72076 Tübingen, Germany, Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, 72076 Tübingen, Germany, German Center for Diabetes Research, 85764 Neuherberg, Germany, Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, 72076 Tübingen, Germany, Department of Psychiatry, University of Bonn, 53105 Bonn, Germany, Institute of Nutritional Medicine, University Hohenheim, 70599 Stuttgart, Germany, and Institute of Sport Science, University Tübingen, 72076 Tübingen, Germany
| | - Stephan C Bischoff
- fMEG Center, University of Tübingen, 72076 Tübingen, Germany, Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, 72076 Tübingen, Germany, German Center for Diabetes Research, 85764 Neuherberg, Germany, Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, 72076 Tübingen, Germany, Department of Psychiatry, University of Bonn, 53105 Bonn, Germany, Institute of Nutritional Medicine, University Hohenheim, 70599 Stuttgart, Germany, and Institute of Sport Science, University Tübingen, 72076 Tübingen, Germany
| | - Martin Teufel
- fMEG Center, University of Tübingen, 72076 Tübingen, Germany, Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, 72076 Tübingen, Germany, German Center for Diabetes Research, 85764 Neuherberg, Germany, Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, 72076 Tübingen, Germany, Department of Psychiatry, University of Bonn, 53105 Bonn, Germany, Institute of Nutritional Medicine, University Hohenheim, 70599 Stuttgart, Germany, and Institute of Sport Science, University Tübingen, 72076 Tübingen, Germany
| | - Ansgar Thiel
- fMEG Center, University of Tübingen, 72076 Tübingen, Germany, Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, 72076 Tübingen, Germany, German Center for Diabetes Research, 85764 Neuherberg, Germany, Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, 72076 Tübingen, Germany, Department of Psychiatry, University of Bonn, 53105 Bonn, Germany, Institute of Nutritional Medicine, University Hohenheim, 70599 Stuttgart, Germany, and Institute of Sport Science, University Tübingen, 72076 Tübingen, Germany
| | - Stephan Zipfel
- fMEG Center, University of Tübingen, 72076 Tübingen, Germany, Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, 72076 Tübingen, Germany, German Center for Diabetes Research, 85764 Neuherberg, Germany, Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, 72076 Tübingen, Germany, Department of Psychiatry, University of Bonn, 53105 Bonn, Germany, Institute of Nutritional Medicine, University Hohenheim, 70599 Stuttgart, Germany, and Institute of Sport Science, University Tübingen, 72076 Tübingen, Germany
| | - Hubert Preissl
- fMEG Center, University of Tübingen, 72076 Tübingen, Germany, Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, 72076 Tübingen, Germany, German Center for Diabetes Research, 85764 Neuherberg, Germany, Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, 72076 Tübingen, Germany, Department of Psychiatry, University of Bonn, 53105 Bonn, Germany, Institute of Nutritional Medicine, University Hohenheim, 70599 Stuttgart, Germany, and Institute of Sport Science, University Tübingen, 72076 Tübingen, GermanyfMEG Center, University of Tübingen, 72076 Tübingen, Germany, Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, 72076 Tübingen, Germany, German Center for Diabetes Research, 85764 Neuherberg, Germany, Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, 72076 Tübingen, Germany, Department of Psychiatry, University of Bonn, 53105 Bonn, Germany, Institute of Nutritional Medicine, University Hohenheim, 70599 Stuttgart, Germany, and Institute of Sport Science, University Tübingen, 72076 Tübingen, GermanyfMEG Center, University of Tübingen, 72076 Tübingen, Germany, Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, 72076 Tübingen, Germany, German Center for Diabetes Research, 85764 Neuherberg, Germany, Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, 72076 Tübingen, Germany, Department of Psychiatry, University of Bonn, 53105 Bonn, Germany, Institute of Nutritional Medicine, University Hohenheim, 70599 Stuttgart, Germany, and Institute of Sport Science, University Tübingen, 72076 Tübingen, Germany
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64
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Sato Y, Saito N, Utsumi A, Aizawa E, Shoji T, Izumiyama M, Mushiake H, Hongo M, Fukudo S. Neural basis of impaired cognitive flexibility in patients with anorexia nervosa. PLoS One 2013; 8:e61108. [PMID: 23675408 PMCID: PMC3651087 DOI: 10.1371/journal.pone.0061108] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Accepted: 03/05/2013] [Indexed: 02/07/2023] Open
Abstract
Background Impaired cognitive flexibility in anorexia nervosa (AN) causes clinical problems and makes the disease hard to treat, but its neural basis has yet to be fully elucidated. The purpose of this study was to evaluate the brain activity of individuals with AN while performing a task requiring cognitive flexibility on the Wisconsin Card Sorting Test (WCST), which is one of the most frequently used neurocognitive measures of cognitive flexibility and problem-solving ability. Methods Participants were 15 female AN patients and 15 age- and intelligence quotient-matched healthy control women. Participants completed the WCST while their brain activity was measured by functional magnetic resonance imaging during the task. Brain activation in response to set shifting error feedback and the correlation between such brain activity and set shifting performance were analyzed. Results The correct rate on the WCST was significantly poorer for AN patients than for controls. Patients showed poorer activity in the right ventrolateral prefrontal cortex and bilateral parahippocampal cortex on set shifting than controls. Controls showed a positive correlation between correct rate and ventrolateral prefrontal activity in response to set shifting whereas patients did not. Conclusion These findings suggest dysfunction of the ventrolateral prefrontal cortex and parahippocampal cortex as a cause of impaired cognitive flexibility in AN patients.
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Affiliation(s)
- Yasuhiro Sato
- Department of Psychosomatic Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Naohiro Saito
- Department of Clinical Neuroscience, Yamagata University Graduate School of Medical Science, Yamagata City, Yamagata, Japan
| | | | - Emiko Aizawa
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Tomotaka Shoji
- Department of Psychosomatic Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan
| | | | - Hajime Mushiake
- Department of Physiology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Michio Hongo
- Kurokawa Hospital, Taiwa-cho, Miyagi, Japan
- Department of Comprehensive Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Shin Fukudo
- Department of Psychosomatic Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan
- Department of Behavioral Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
- * E-mail:
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65
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Stefano GB, Ptáček R, Kuželová H, Mantione KJ, Raboch J, Papezova H, Kream RM. Convergent dysregulation of frontal cortical cognitive and reward systems in eating disorders. Med Sci Monit 2013; 19:353-8. [PMID: 23660852 PMCID: PMC3659002 DOI: 10.12659/msm.889133] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
A substantive literature has drawn a compelling case for the functional involvement of mesolimbic/prefrontal cortical neural reward systems in normative control of eating and in the etiology and persistence of severe eating disorders that affect diverse human populations. Presently, we provide a short review that develops an equally compelling case for the importance of dysregulated frontal cortical cognitive neural networks acting in concert with regional reward systems in the regulation of complex eating behaviors and in the presentation of complex pathophysiological symptoms associated with major eating disorders. Our goal is to highlight working models of major eating disorders that incorporate complementary approaches to elucidate functionally interactive neural circuits defined by their regulatory neurochemical phenotypes. Importantly, we also review evidence-based linkages between widely studied psychiatric and neurodegenerative syndromes (e.g., autism spectrum disorders and Parkinson’s disease) and co-morbid eating disorders to elucidate basic mechanisms involving dopaminergic transmission and its regulation by endogenously expressed morphine in these same cortical regions.
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Affiliation(s)
- George B Stefano
- Center for Molecular and Cognitive Neuroscience, 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.
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66
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Kaye WH, Wierenga CE, Bailer UF, Simmons AN, Wagner A, Bischoff-Grethe A. Does a shared neurobiology for foods and drugs of abuse contribute to extremes of food ingestion in anorexia and bulimia nervosa? Biol Psychiatry 2013; 73:836-42. [PMID: 23380716 PMCID: PMC3755487 DOI: 10.1016/j.biopsych.2013.01.002] [Citation(s) in RCA: 123] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 12/12/2012] [Accepted: 01/04/2013] [Indexed: 01/08/2023]
Abstract
Is starvation in anorexia nervosa (AN) or overeating in bulimia nervosa (BN) a form of addiction? Alternatively, why are individuals with BN more vulnerable and individuals with AN protected from substance abuse? Such questions have been generated by recent studies suggesting that there are overlapping neural circuits for foods and drugs of abuse. To determine whether a shared neurobiology contributes to eating disorders and substance abuse, this review focused on imaging studies that investigated response to tastes of food and tasks designed to characterize reward and behavioral inhibition in AN and BN. BN and those with substance abuse disorders may share dopamine D2 receptor-related vulnerabilities, and opposite findings may contribute to "protection" from substance abuse in AN. Moreover, imaging studies provide insights into executive corticostriatal processes related to extraordinary inhibition and self-control in AN and diminished inhibitory self-control in BN that may influence the rewarding aspect of palatable foods and likely other consummatory behaviors. AN and BN tend to have premorbid traits, such as perfectionism and anxiety that make them vulnerable to using extremes of food ingestion, which serve to reduce negative mood states. Dysregulation within and/or between limbic and executive corticostriatal circuits contributes to such symptoms. Limited data support the hypothesis that reward and inhibitory processes may contribute to symptoms in eating disorders and addictive disorders, but little is known about the molecular biology of such mechanisms in terms of shared or independent processes.
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Affiliation(s)
- Walter H Kaye
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.
| | | | - Ursula F Bailer
- University of California San Diego, Department of Psychiatry, La Jolla CA,Medical University of Vienna, Department of Psychiatry and Psychotherapy, Division of Biological Psychiatry, Vienna, Austria
| | - Alan N Simmons
- University of California San Diego, Department of Psychiatry, La Jolla CA,Veterans Affairs San Diego Healthcare System, Psychiatry Service, San Diego CA,Veterans Affairs San Diego Healthcare System, Research Service, San Diego CA
| | - Angela Wagner
- University of California San Diego, Department of Psychiatry, La Jolla CA
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67
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Calderoni S, Muratori F, Leggero C, Narzisi A, Apicella F, Balottin U, Carigi T, Maestro S, Fabbro F, Urgesi C. Neuropsychological functioning in children and adolescents with restrictive-type anorexia nervosa: An in-depth investigation with NEPSY–II. J Clin Exp Neuropsychol 2013; 35:167-79. [DOI: 10.1080/13803395.2012.760536] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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68
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Kaye WH, Wierenga CE, Bailer UF, Simmons AN, Bischoff-Grethe A. Nothing tastes as good as skinny feels: the neurobiology of anorexia nervosa. Trends Neurosci 2013; 36:110-20. [PMID: 23333342 PMCID: PMC3880159 DOI: 10.1016/j.tins.2013.01.003] [Citation(s) in RCA: 310] [Impact Index Per Article: 28.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Accepted: 01/07/2013] [Indexed: 01/30/2023]
Abstract
Individuals with anorexia nervosa (AN) engage in relentless restrictive eating and often become severely emaciated. Because there are no proven treatments, AN has high rates of relapse, chronicity, and death. Those with AN tend to have childhood temperament and personality traits, such as anxiety, obsessions, and perfectionism, which may reflect neurobiological risk factors for developing AN. Restricted eating may be a means of reducing negative mood caused by skewed interactions between serotonin aversive or inhibitory and dopamine reward systems. Brain imaging studies suggest that altered eating is a consequence of dysregulated reward and/or awareness of homeostatic needs, perhaps related to enhanced executive ability to inhibit incentive motivational drives. An understanding of the neurobiology of this disorder is likely to be important for developing more effective treatments.
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Affiliation(s)
- Walter H Kaye
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.
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69
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Strigo IA, Matthews SC, Simmons AN, Oberndorfer T, Klabunde M, Reinhardt LE, Kaye WH. Altered insula activation during pain anticipation in individuals recovered from anorexia nervosa: evidence of interoceptive dysregulation. Int J Eat Disord 2013; 46:23-33. [PMID: 22836447 PMCID: PMC3507323 DOI: 10.1002/eat.22045] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2012] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Recent evidence raises the possibility that symptoms of anorexia nervosa (AN) could be related to impaired interoception. Pain is an interoceptive process with well-characterized neuroanatomical pathways that may overlap to a large degree with neural systems that may be dysregulated in individuals with AN, such as the insula. METHOD Functional magnetic resonance imaging (fMRI) was used to assess neural substrates of pain anticipation and processing in 10 healthy control women (CW) and 12 individuals recovered from AN (REC AN) in order to avoid the confounding effects of malnutrition. Painful heat stimuli were applied while different colors signaled the intensity of the upcoming stimuli. RESULTS REC AN compared with CW showed greater activation within right anterior insula (rAI), dorsolateral prefrontal cortex (dlPFC) and cingulate during pain anticipation, and greater activation within dlPFC and decreased activation within posterior insula during painful stimulation. Greater anticipatory rAI activation correlated positively with alexithymic feelings in REC AN participants. DISCUSSION REC AN showed a mismatch between anticipation and objective responses, suggesting altered integration and, possibly, disconnection between reported and actual interoceptive state. Alexithymia assessment provided additional evidence of an altered ability to accurately perceive bodily signals in women recovered from AN.
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Affiliation(s)
- Irina A. Strigo
- Department of Psychiatry, University of California, San Diego, La Jolla, CA,Research Service, VA San Diego Healthcare System, San Diego, CA,VA Center of Excellence for Stress and Mental Health(CESAMH), San Diego, CA,BioCircuits Institute (BCI), La Jolla, CA 92037
| | - Scott C. Matthews
- Department of Psychiatry, University of California, San Diego, La Jolla, CA,Research Service, VA San Diego Healthcare System, San Diego, CA,VA Center of Excellence for Stress and Mental Health(CESAMH), San Diego, CA
| | - Alan N. Simmons
- Department of Psychiatry, University of California, San Diego, La Jolla, CA,Research Service, VA San Diego Healthcare System, San Diego, CA,Psychiatry Service, VA San Diego Healthcare System, San Diego, CA,VA Center of Excellence for Stress and Mental Health(CESAMH), San Diego, CA
| | - Tyson Oberndorfer
- Department of Psychiatry, University of California, San Diego, La Jolla, CA
| | - Megan Klabunde
- Department of Child and Adolescent Psychiatry, Stanford University, Stanford, CA
| | | | - Walter H. Kaye
- Department of Psychiatry, University of California, San Diego, La Jolla, CA
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70
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Frank GK, Kaye WH. Current status of functional imaging in eating disorders. Int J Eat Disord 2012; 45:723-36. [PMID: 22532388 PMCID: PMC3872533 DOI: 10.1002/eat.22016] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/11/2012] [Indexed: 11/11/2022]
Abstract
Eating Disorders are complex psychiatric problems that involve biologic and psychological factors. Brain imaging studies provide insights about how functionally connected brain networks may contribute to disturbed eating behavior, resulting in food refusal and altered body weight, but also body preoccupations and heightened anxiety. In this article, we review the current state of brain imaging in eating disorders, and how such techniques may help identify pathways that could be important in the treatment of those often detrimental disorders.
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Affiliation(s)
- Guido K.W. Frank
- University of Colorado Denver, Departments of Child & Adolescent Psychiatry and Neuroscience, Aurora CO
| | - Walter H. Kaye
- University of California San Diego, Department of Psychiatry, La Jolla CA
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71
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Stein D, Gross-Isseroff R, Besserglick R, Ziv A, Mayer G, Yaroslavsky A, Toledano A, Voet H, Weizman A, Hermesh H. Olfactory function and alternation learning in eating disorders. Eur Neuropsychopharmacol 2012; 22:615-24. [PMID: 22858418 DOI: 10.1016/j.euroneuro.2011.12.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Revised: 11/13/2011] [Accepted: 12/03/2011] [Indexed: 10/28/2022]
Abstract
Orbitofrontal dysfunction is a prominent feature of obsessive compulsive disorder (OCD). In the present study we assessed orbitofrontal functioning in eating disorders (EDs) which share many features with OCD. For this purpose we studied female adolescent inpatients with anorexia nervosa restricting type (n=40), anorexia nervosa binge/purge type (n=23), a normal weight group including patients with either bulimia nervosa or eating disorder not otherwise specified-purging type (n=33), and 20 non-ED control females. Patients were assessed at admission, and when achieving weight restoration and symptom stabilization at discharge, for depression, non-ED, and ED-related OC symptoms. Orbitofrontal functioning was assessed with an alternation learning task, and with a battery assessing olfactory threshold and discrimination. Control females were assessed once. ED patients of all subtypes performed better on olfactory threshold and discrimination, but not on alternation learning, in comparison to healthy controls. More favorable orbitofrontal functioning was associated with greater ED-related obsessionality. No changes were found in olfactory threshold and discrimination between acutely-ill and symptomatically-stabilized patients. The improvement shown in alternation learning from admission to discharge was suggested to reflect a learning effect rather than being an actual change. Our findings suggest that the better orbitofrontal functioning of ED patients in comparison to healthy controls may represent a core feature of the ED that is independent of malnutrition and deranged eating behaviors, but is associated with ED-related obsessionality.
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Affiliation(s)
- Daniel Stein
- Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer, Israel
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72
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Stedal K, Rose M, Frampton I, Landrø NI, Lask B. The neuropsychological profile of children, adolescents, and young adults with anorexia nervosa. Arch Clin Neuropsychol 2012; 27:329-37. [PMID: 22414676 DOI: 10.1093/arclin/acs032] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
The neuropsychological profile of a sample of 155 patients with a clinical diagnosis of anorexia nervosa was assessed using a test battery specifically developed for such patients. The current findings suggest that the patients display a common neuropsychological profile including both strengths and weaknesses when compared with published norms. The patients displayed good verbal fluency skills, but performed poorly on tests of visuospatial memory, associated with relatively weak central coherence. They were within the average range on the assessment of executive functioning except for one measure of set-shifting. This study provides a valuable point of reference for clinicians when considering treatment options.
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Affiliation(s)
- Kristin Stedal
- Regional Eating Disorders Service, Oslo University Hospital Ullevål, Norway.
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73
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Weise CM, Thiyyagura P, Reiman EM, Chen K, Krakoff J. Postprandial plasma PYY concentrations are associated with increased regional gray matter volume and rCBF declines in caudate nuclei--a combined MRI and H2(15)O PET study. Neuroimage 2011; 60:592-600. [PMID: 22206963 DOI: 10.1016/j.neuroimage.2011.12.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Revised: 11/28/2011] [Accepted: 12/13/2011] [Indexed: 01/01/2023] Open
Abstract
The anorexigenic gastrointestinal hormone Peptide YY plays an important role in the communication between the gastrointestinal tract and the central nervous system. PYY has been shown to modulate brain activity in regions implicated in reward and food related behavior. Its effects on brain structure however, remain unknown. Voxel-based morphometry was used to investigate the relationship between fasting and postprandial plasma PYY concentrations and regional gray matter volume (GMV). For this analysis twenty adult, non diabetic Caucasians were included (18F/2M, age 31±9 y, percentage of body fat [PFAT] 32±8%) who had volumetric brain magnetic resonance images and underwent H(2)(15)O positron emission tomographic (PET) measurements of regional cerebral blood flow (rCBF), a marker of local neuronal activity, and measurements of plasma total PYY, prior to (fasting) and following a satiating liquid meal. Voxel-wise analysis revealed a regional positive association between postprandial PYY and gray matter volume bilaterally in the caudate nuclei. These associations remained significant (p<0.05) after small volume correction for multiple comparisons. Based on these findings we investigated whether postprandial PYY is associated with PET measured rCBF of the caudate nucleus. We found a significant negative association between average postprandial caudate rCBF and postprandial plasma PYY concentrations (r=-0.60, p<0.02, age, sex and PFAT adjusted). Average postprandial caudate rCBF was also negatively associated with rCBF in the right medial orbitofrontal cortex and the right hippocampal formation (p<0.05, corrected for multiple comparisons). Total PYY is positively associated with gray matter but negatively with postprandial activity in the caudate nuclei while caudate activity is negatively associated with rCBF in prefrontal and paralimbic regions implicated in reward behavior. Thus, PYY may act centrally to modulate eating behavior via striatal networks.
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Affiliation(s)
- Christopher M Weise
- Obesity and Diabetes Clinical Research Section, NIDDK-NIH, DHHS, Phoenix, AZ 85016, USA.
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Abstract
Neuroimaging techniques have been useful tools for accurate investigation of brain structure and function in eating disorders. Computed tomography, magnetic resonance imaging, positron emission tomography, single photon emission computed tomography, magnetic resonance spectroscopy, and voxel-based morphometry have been the most relevant technologies in this regard. The purpose of this review is to update the existing data on neuroimaging in eating disorders. The main brain changes seem to be reversible to some extent after adequate weight restoration. Brain changes in bulimia nervosa seem to be less pronounced than in anorexia nervosa and are mainly due to chronic dietary restrictions. Different subtypes of eating disorders might be correlated with specific brain functional changes. Moreover, anorectic patients who binge/purge may have different functional brain changes compared with those who do not binge/purge. Functional changes in the brain might have prognostic value, and different changes with receptors may be persistent after respect to the binding potential of 5-HT(1A), 5-HT(2A), and D(2)/D(3) recovering from an eating disorder.
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