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Feusner JD, Nowacka A, Ly R, Luders E, Kurth F. Corpus callosum morphology and relationships to illness phenotypes in individuals with anorexia nervosa. Sci Rep 2024; 14:11112. [PMID: 38750237 PMCID: PMC11096409 DOI: 10.1038/s41598-024-61841-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 05/10/2024] [Indexed: 05/18/2024] Open
Abstract
Anorexia nervosa is an often-severe psychiatric illness characterized by significantly low body weight, fear of gaining weight, and distorted body image. Multiple neuroimaging studies have shown abnormalities in cortical morphology, mostly associated with the starvation state. Investigations of white matter, while more limited in number, have suggested global and regional volume reductions, as well as abnormal diffusivity in multiple regions including the corpus callosum. Yet, no study has specifically examined thickness of the corpus callosum, a large white matter tract instrumental in the inter-hemispheric integration of sensory, motor, and cognitive information. We analyzed MRI data from 48 adolescents and adults with anorexia nervosa and 50 healthy controls, all girls/women, to compare corpus callosum thickness and examined relationships with body mass index (BMI), illness duration, and eating disorder symptoms (controlling for BMI). There were no significant group differences in corpus callosum thickness. In the anorexia nervosa group, severity of body shape concerns was significantly, positively correlated with callosal thickness in the rostrum, genu, rostral body, isthmus, and splenium. In addition, there were significant positive correlations between eating disorder-related obsessions and compulsions and thickness of the anterior midbody, rostral body, and splenium. There were no significant associations between callosal thickness and BMI or illness duration. In sum, those with AN with worse concerns about bodily appearance and worse eating disorder-related obsessive thought patterns and compulsive behaviours have regionally thicker corpus callosum, independent of current weight status. These findings provide important neurobiological links to key, specific eating disorder behavioural phenotypes.
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Affiliation(s)
- Jamie D Feusner
- Centre for Addiction and Mental Health, 250 College St., Toronto, ON, M5T 1R8, Canada.
- Department of Psychiatry, University of Toronto, Toronto, Canada.
- Department of Women's and Children's Health, Karolinska Hospital, Karolinska Institutet, Stockholm, Sweden.
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA.
| | - Alicja Nowacka
- School of Psychology, University of Auckland, Auckland, New Zealand
| | - Ronald Ly
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Eileen Luders
- School of Psychology, University of Auckland, Auckland, New Zealand
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Laboratory of Neuro Imaging, School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Florian Kurth
- School of Psychology, University of Auckland, Auckland, New Zealand
- Departments of Neuroradiology and Radiology, Jena University Hospital, Jena, Germany
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Lyall AE, Breithaupt L, Ji C, Haidar A, Kotler E, Becker KR, Plessow F, Slattery M, Thomas JJ, Holsen LM, Misra M, Eddy KT, Lawson EA. Lower region-specific gray matter volume in females with atypical anorexia nervosa and anorexia nervosa. Int J Eat Disord 2024; 57:951-966. [PMID: 38366701 PMCID: PMC11018478 DOI: 10.1002/eat.24168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/18/2024]
Abstract
OBJECTIVE Few studies have focused on brain structure in atypical anorexia nervosa (atypical AN). This study investigates differences in gray matter volume (GMV) between females with anorexia nervosa (AN) and atypical AN, and healthy controls (HC). METHOD Structural magnetic resonance imaging data were acquired for 37 AN, 23 atypical AN, and 41 HC female participants. Freesurfer was used to extract GMV, cortical thickness, and surface area for six brain lobes and associated cortical regions of interest (ROI). Primary analyses employed linear mixed-effects models to compare group differences in lobar GMV, followed by secondary analyses on ROIs within significant lobes. We also explored relationships between cortical gray matter and both body mass index (BMI) and symptom severity. RESULTS Our primary analyses revealed significant lower GMV in frontal, temporal and parietal areas (FDR < .05) in AN and atypical AN when compared to HC. Lobar GMV comparisons were non-significant between atypical AN and AN. The parietal lobe exhibited the greatest proportion of affected cortical ROIs in both AN versus HC and atypical AN versus HC. BMI, but not symptom severity, was found to be associated with cortical GMV in the parietal, frontal, temporal, and cingulate lobes. No significant differences were observed in cortical thickness or surface area. DISCUSSION We observed lower GMV in frontal, temporal, and parietal areas, when compared to HC, but no differences between AN and atypical AN. This indicates potentially overlapping structural phenotypes between these disorders and evidence of brain changes among those who are not below the clinical underweight threshold. PUBLIC SIGNIFICANCE Despite individuals with atypical anorexia nervosa presenting above the clinical weight threshold, lower cortical gray matter volume was observed in partial, temporal, and frontal cortices, compared to healthy individuals. No significant differences were found in cortical gray matter volume between anorexia nervosa and atypical anorexia nervosa. This underscores the importance of continuing to assess and target weight gain in clinical care, even for those who are presenting above the low-weight clinical criteria.
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Affiliation(s)
- Amanda E. Lyall
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, MA
- Mass General Brigham Multidisciplinary Eating Disorders Research Collaborative, Mass General Brigham, Boston, MA
| | - Lauren Breithaupt
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, MA
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, MA
- Mass General Brigham Multidisciplinary Eating Disorders Research Collaborative, Mass General Brigham, Boston, MA
| | - Chunni Ji
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, MA
- Mass General Brigham Multidisciplinary Eating Disorders Research Collaborative, Mass General Brigham, Boston, MA
- Division of Women’s Health, Department of Medicine, and Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Anastasia Haidar
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, MA
| | - Elana Kotler
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, MA
| | - Kendra R Becker
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, MA
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, MA
- Mass General Brigham Multidisciplinary Eating Disorders Research Collaborative, Mass General Brigham, Boston, MA
| | - Franziska Plessow
- Neuroendocrine Unit, Massachusetts General Hospital, Harvard Medical School, MA
- Mass General Brigham Multidisciplinary Eating Disorders Research Collaborative, Mass General Brigham, Boston, MA
| | - Meghan Slattery
- Neuroendocrine Unit, Massachusetts General Hospital, Harvard Medical School, MA
| | - Jennifer J. Thomas
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, MA
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, MA
- Mass General Brigham Multidisciplinary Eating Disorders Research Collaborative, Mass General Brigham, Boston, MA
| | - Laura M. Holsen
- Mass General Brigham Multidisciplinary Eating Disorders Research Collaborative, Mass General Brigham, Boston, MA
- Division of Women’s Health, Department of Medicine, and Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Madhusmita Misra
- Division of Pediatric Endocrinology, Massachusetts General Hospital, Harvard Medical School, MA
- Neuroendocrine Unit, Massachusetts General Hospital, Harvard Medical School, MA
- Mass General Brigham Multidisciplinary Eating Disorders Research Collaborative, Mass General Brigham, Boston, MA
| | - Kamryn T. Eddy
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, MA
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, MA
- Mass General Brigham Multidisciplinary Eating Disorders Research Collaborative, Mass General Brigham, Boston, MA
| | - Elizabeth A. Lawson
- Neuroendocrine Unit, Massachusetts General Hospital, Harvard Medical School, MA
- Mass General Brigham Multidisciplinary Eating Disorders Research Collaborative, Mass General Brigham, Boston, MA
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Alzaid H, Simon JJ, Brugnara G, Vollmuth P, Bendszus M, Friederich HC. Hypothalamic subregion alterations in anorexia nervosa and obesity: Association with appetite-regulating hormone levels. Int J Eat Disord 2024; 57:581-592. [PMID: 38243035 DOI: 10.1002/eat.24137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 12/25/2023] [Accepted: 12/27/2023] [Indexed: 01/21/2024]
Abstract
OBJECTIVE Anorexia nervosa (AN) and obesity are weight-related disorders with imbalances in energy homeostasis that may be due to hormonal dysregulation. Given the importance of the hypothalamus in hormonal regulation, we aimed to identify morphometric alterations to hypothalamic subregions linked to these conditions and their connection to appetite-regulating hormones. METHODS Structural magnetic resonance imaging (MRI) was obtained from 78 patients with AN, 27 individuals with obesity and 100 normal-weight healthy controls. Leptin, ghrelin, and insulin blood levels were measured in a subsample of each group. An automated segmentation method was used to segment the hypothalamus and its subregions. Volumes of the hypothalamus and its subregions were compared between groups, and correlational analysis was employed to assess the relationship between morphometric measurements and appetite-regulating hormone levels. RESULTS While accounting for total brain volume, patients with AN displayed a smaller volume in the inferior-tubular subregion (ITS). Conversely, obesity was associated with a larger volume in the anterior-superior, ITS, posterior subregions (PS), and entire hypothalamus. There were no significant volumetric differences between AN subtypes. Leptin correlated positively with PS volume, whereas ghrelin correlated negatively with the whole hypothalamus volume in the entire cohort. However, appetite-regulating hormone levels did not mediate the effects of body mass index on volumetric measures. CONCLUSION Our results indicate the importance of regional structural hypothalamic alterations in AN and obesity, extending beyond global changes to brain volume. Furthermore, these alterations may be linked to changes in hormonal appetite regulation. However, given the small sample size in our correlation analysis, further analyses in a larger sample size are warranted. PUBLIC SIGNIFICANCE Using an automated segmentation method to investigate morphometric alterations of hypothalamic subregions in AN and obesity, this study provides valuable insights into the complex interplay between hypothalamic alterations, hormonal appetite regulation, and body weight, highlighting the need for further research to uncover underlying mechanisms.
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Affiliation(s)
- Haidar Alzaid
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Joe J Simon
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Gianluca Brugnara
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Philipp Vollmuth
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
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Giannakopoulos A, Chrysis D. Reversibility of disturbed pituitary function in pediatric conditions with psychological stressors: implications for clinical practice. Hormones (Athens) 2024:10.1007/s42000-024-00536-z. [PMID: 38421589 DOI: 10.1007/s42000-024-00536-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/13/2024] [Indexed: 03/02/2024]
Abstract
The complex communication network between the central nervous system and the hypothalamic-pituitary axis forms the basis of endocrine functional plasticity, which facilitates adaptation to changing internal and external conditions, but also makes it vulnerable to the negative effects of stressful psychological factors. Herein, clinical conditions such as functional hypothalamic amenorrhea, eating disorders, growth faltering, post-traumatic stress disorder, and pubertal disorders that may emerge during childhood or adolescence, their origin possibly including psychological stressors, are analyzed regarding their genetic susceptibility and reversibility of endocrine function. A discussion on the optimization of therapeutic management defined by managing stress and maximizing the degree and rate of reversibility follows.
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Affiliation(s)
- Aristeidis Giannakopoulos
- Division of Pediatric Endocrinology, Department of Pediatrics, Medical School of Patras, University Hospital, Rio, 26504, Patras, Greece.
| | - Dionisios Chrysis
- Division of Pediatric Endocrinology, Department of Pediatrics, Medical School of Patras, University Hospital, Rio, 26504, Patras, Greece
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Alberts C, Owe-Larsson M, Urbanska EM. New Perspective on Anorexia Nervosa: Tryptophan-Kynurenine Pathway Hypothesis. Nutrients 2023; 15:nu15041030. [PMID: 36839388 PMCID: PMC9967350 DOI: 10.3390/nu15041030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/14/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open
Abstract
Anorexia nervosa (AN), affecting up to 4% of all females and 0.3% of all males globally, remains the neuropsychiatric disorder with the highest mortality rate. However, the response to the current therapeutic options is rarely satisfactory. Considering the devastating prognosis of survival among patients with AN, further research aimed at developing novel, more effective therapies for AN is essential. Brain and serum tryptophan is mostly converted along the kynurenine pathway into multiple neuroactive derivatives, whereas only 1-2% is used for the synthesis of serotonin. This narrative review provides an update on the experimental and clinical research data concerning the metabolism of tryptophan along the kynurenine pathway in anorexia nervosa based on the available literature. We propose that in AN, lower levels of L-kynurenine and kynurenic acid result in diminished stimulation of the aryl hydrocarbon receptor, which could contribute to abnormally low body weight. The impact of L-kynurenine supplementation on anorexia in animal models and the effects of changes in tryptophan and downstream kynurenines on the clinical progression of AN require further investigation. Moreover, prospective clinical studies on larger cohorts of restrictive and binge-eating/purging AN patients and assessing the potential benefit of L-kynurenine as an add-on therapeutic agent, should follow.
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Affiliation(s)
- Charl Alberts
- Department of Experimental and Clinical Pharmacology, Medical University of Lublin, Jaczewskiego 8B, 20-059 Lublin, Poland
| | - Maja Owe-Larsson
- Department of Histology and Embryology, Center of Biostructure Research, Medical University of Warsaw, Chałubińskiego 5, 02-004 Warsaw, Poland
- Laboratory of Center for Preclinical Research, Department of Experimental and Clinical Physiology, Medical University of Warsaw, Banacha 1B, 02-097 Warsaw, Poland
| | - Ewa M. Urbanska
- Laboratory of Cellular and Molecular Pharmacology, Department of Experimental and Clinical Pharmacology, Medical University of Lublin, Jaczewskiego 8B, 20-059 Lublin, Poland
- Correspondence:
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Halls D, Leppanen J, Kerr‐Gaffney J, Simic M, Nicholls D, Mandy W, Williams S, Tchanturia K. Examining the relationship between autistic spectrum disorder characteristics and structural brain differences seen in anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2022; 30:459-473. [PMID: 35570362 PMCID: PMC9546313 DOI: 10.1002/erv.2910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/01/2022] [Accepted: 04/08/2022] [Indexed: 11/16/2022]
Abstract
Cortical differences have been reported in Anorexia Nervosa (AN) compared with healthy controls (HC); however, it is unclear if Autism Spectrum Disorder (ASD) characteristics are related to these cortical differences. The aim of this study was to examine if structural measures were correlated to ASD traits in AN. In total 184 female participants participated in the study; 57 acutely underweight AN participants (AAN), 59 weight-restored participants (WR) and 68 HC. Participants underwent structural magnetic resonance imaging as well as completing the Autism Diagnostic Observation schedule, second edition to examine ASD characteristics. Group differences in curvature, gyrification, surface area, thickness, global grey matter and white matter were measured. Correlation and regression analysis were conducted to examine the relationship between cortical measures and ASD characteristics. Two decreased gyrification clusters in the right post central and supramarginal gyrus and decreased global grey matter were observed in the AAN group compared to HC and WR. No correlations between ASD traits and structural measures existed. Our results suggest structural differences seen in individuals with AN do not appear to be related to ASD characteristics.
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Affiliation(s)
- Daniel Halls
- King's College London (KCL), Institute of PsychiatryPsychology and Neuroscience (IoPPN)Psychological MedicineLondonUK
| | - Jenni Leppanen
- King's College LondonCentre for Neuroimaging SciencesLondonUK
| | - Jess Kerr‐Gaffney
- King's College London (KCL), Institute of PsychiatryPsychology and Neuroscience (IoPPN)Psychological MedicineLondonUK
| | - Mima Simic
- South London and Maudsley NHS Foundation TrustLondonUK
| | | | - William Mandy
- Division of Psychology and Language SciencesUniversity College LondonLondonUK
| | - Steven Williams
- King's College LondonCentre for Neuroimaging SciencesLondonUK
| | - Kate Tchanturia
- King's College London (KCL), Institute of PsychiatryPsychology and Neuroscience (IoPPN)Psychological MedicineLondonUK
- South London and Maudsley NHS Foundation TrustLondonUK
- Psychology DepartmentIllia State UniversityTbilisiGeorgia
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Göller S, Nickel K, Horster I, Endres D, Zeeck A, Domschke K, Lahmann C, Tebartz van Elst L, Maier S, Joos AAB. State or trait: the neurobiology of anorexia nervosa - contributions of a functional magnetic resonance imaging study. J Eat Disord 2022; 10:77. [PMID: 35641995 PMCID: PMC9158182 DOI: 10.1186/s40337-022-00598-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 05/23/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND The understanding of the cerebral neurobiology of anorexia nervosa (AN) with respect to state- versus trait-related abnormalities is limited. There is evidence of restitution of structural brain alterations with clinical remission. However, with regard to functional brain abnormalities, this issue has not yet been clarified. METHODS We compared women with AN (n = 31), well-recovered female participants (REC) (n = 18) and non-patients (NP) (n = 27) cross-sectionally. Functional magnetic resonance imaging was performed to compare neural responses to food versus non-food images. Additionally, affective ratings were assessed. RESULTS Functional responses and affective ratings did not differ between REC and NP, even when applying lenient thresholds for the comparison of neural responses. Comparing REC and AN, the latter showed lower valence and higher arousal ratings for food stimuli, and neural responses differed with lenient thresholds in an occipital region. CONCLUSIONS The data are in line with some previous findings and suggest restitution of cerebral function with clinical recovery. Furthermore, affective ratings did not differ from NP. These results need to be verified in intra-individual longitudinal studies.
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Affiliation(s)
- Selma Göller
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Kathrin Nickel
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Isabelle Horster
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dominique Endres
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Almut Zeeck
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Katharina Domschke
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Center for Basics in Neuromodulation, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Claas Lahmann
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ludger Tebartz van Elst
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Simon Maier
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Andreas A B Joos
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Ortenau Klinikum, Lahr, Academic Teaching Hospital of the University of Freiburg, Lahr, Germany
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Sader M, Williams JHG, Waiter GD. A meta-analytic investigation of grey matter differences in anorexia nervosa and autism spectrum disorder. EUROPEAN EATING DISORDERS REVIEW 2022; 30:560-579. [PMID: 35526083 PMCID: PMC9543727 DOI: 10.1002/erv.2915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 04/21/2022] [Indexed: 11/11/2022]
Abstract
Recent research reports Anorexia Nervosa (AN) to be highly dependent upon neurobiological function. Some behaviours, particularly concerning food selectivity are found in populations with both Autism Spectrum Disorder (ASD) and AN, and there is a proportionally elevated number of anorexic patients exhibiting symptoms of ASD. We performed a systematic review of structural MRI literature with the aim of identifying common structural neural correlates common to both AN and ASD. Across 46 ASD publications, a meta‐analysis of volumetric differences between ASD and healthy controls revealed no consistently affected brain regions. Meta‐analysis of 23 AN publications revealed increased volume within the orbitofrontal cortex and medial temporal lobe, and adult‐only AN literature revealed differences within the genu of the anterior cingulate cortex. The changes are consistent with alterations in flexible reward‐related learning and episodic memory reported in neuropsychological studies. There was no structural overlap between ASD and AN. Findings suggest no consistent neuroanatomical abnormality associated with ASD, and evidence is lacking to suggest that reported behavioural similarities between those with AN and ASD are due to neuroanatomical structural similarities. Findings related to neuroanatomical structure in AN/ASD demonstrate overlap and require revisiting. Meta‐analytic findings show structural increase/decrease versus healthy controls (LPFC/MTL/OFC) in AN, but no clusters found in ASD. The neuroanatomy associated with ASD is inconsistent, but findings in AN reflect condition‐related impairment in executive function and sociocognitive behaviours.
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Affiliation(s)
- Michelle Sader
- Translational Neuroscience, Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK
| | - Justin H G Williams
- Translational Neuroscience, Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK
| | - Gordon D Waiter
- Biomedical Imaging Centre, Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK
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Maier S, Joos A, Tebartz van Elst L, Ebert D, Endres D, Domschke K, Lahmann C, Zeeck A, Runge K, Denzel D, Reisert M, Nickel K. Reduced structural connectivity in the corpus callosum in patients with anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2022; 30:341-352. [DOI: 10.1002/erv.2894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 02/19/2022] [Accepted: 02/21/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Simon Maier
- Department of Psychiatry and Psychotherapy, Medical Center – University of Freiburg, Faculty of Medicine University of Freiburg Freiburg Germany
| | - Andreas Joos
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center – University of Freiburg, Faculty of Medicine University of Freiburg Freiburg Germany
| | - Ludger Tebartz van Elst
- Department of Psychiatry and Psychotherapy, Medical Center – University of Freiburg, Faculty of Medicine University of Freiburg Freiburg Germany
| | - Dieter Ebert
- Department of Psychiatry and Psychotherapy, Medical Center – University of Freiburg, Faculty of Medicine University of Freiburg Freiburg Germany
| | - Dominique Endres
- Department of Psychiatry and Psychotherapy, Medical Center – University of Freiburg, Faculty of Medicine University of Freiburg Freiburg Germany
| | - Katharina Domschke
- Department of Psychiatry and Psychotherapy, Medical Center – University of Freiburg, Faculty of Medicine University of Freiburg Freiburg Germany
- Center for Basics in Neuromodulation, Faculty of Medicine University of Freiburg Freiburg Germany
| | - Claas Lahmann
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center – University of Freiburg, Faculty of Medicine University of Freiburg Freiburg Germany
| | - Almut Zeeck
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center – University of Freiburg, Faculty of Medicine University of Freiburg Freiburg Germany
| | - Kimon Runge
- Department of Psychiatry and Psychotherapy, Medical Center – University of Freiburg, Faculty of Medicine University of Freiburg Freiburg Germany
| | - Dominik Denzel
- Department of Psychiatry and Psychotherapy, Medical Center – University of Freiburg, Faculty of Medicine University of Freiburg Freiburg Germany
| | - Marco Reisert
- Department of Radiology, Medical Physics, Medical Center – University of Freiburg, Faculty of Medicine University of Freiburg Freiburg Germany
| | - Kathrin Nickel
- Department of Psychiatry and Psychotherapy, Medical Center – University of Freiburg, Faculty of Medicine University of Freiburg Freiburg Germany
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Doose A, Hellerhoff I, Tam FI, King JA, Seidel M, Geisler D, Plähn HCI, Roessner V, Akgün K, Ziemssen T, Ehrlich S. Neural and glial damage markers in women after long-term weight-recovery from anorexia nervosa. Psychoneuroendocrinology 2022; 135:105576. [PMID: 34781223 DOI: 10.1016/j.psyneuen.2021.105576] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 10/06/2021] [Accepted: 10/22/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE The acute state of anorexia nervosa (AN) is accompanied by increased peripheral concentrations of brain-derived damage markers indicative of ongoing neural and glial damage processes. Although these findings correspond with well-documented structural brain changes in the disorder, it remains unclear whether abnormal levels of brain-derived damage markers persist after long-term weight-recovery from AN. METHODS To address this question, we used single-molecule array (Simoa) technology to measure serum levels of neurofilament light (NF-L), tau protein and glial fibrillary acidic protein (GFAP) in a group of 55 long-term weight-recovered women with a history of AN (recAN) and 55 age-matched healthy controls. Strict exclusion criteria allowed us to control for confounds present in previous studies including most importantly neurological conditions. RESULTS We found not only no group differences but also statistical evidence for equal damage marker levels between groups using Bayesian hypothesis testing. CONCLUSION These results provide evidence for the absence of neuronal and glial damage processes after long-term weight-recovery from AN. Together, our findings are indicative of complete normalization following long-term weight restoration provide hope that recovery from AN halts neuronal damage processes and support the need to test potential candidates for therapeutic interventions including pharmacological neuroprotection.
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Affiliation(s)
- Arne Doose
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Inger Hellerhoff
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany; Eating Disorder Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Friederike I Tam
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany; Eating Disorder Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Joseph A King
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Maria Seidel
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Daniel Geisler
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Hans Christian I Plähn
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Katja Akgün
- Center of Clinical Neuroscience, Neurological Clinic, University Hospital Carl Gustav Carus, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Tjalf Ziemssen
- Center of Clinical Neuroscience, Neurological Clinic, University Hospital Carl Gustav Carus, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Stefan Ehrlich
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany; Eating Disorder Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.
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11
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Mishima R, Isobe M, Noda T, Tose K, Kawabata M, Noma S, Murai T. Structural brain changes in severe and enduring anorexia nervosa: A multimodal magnetic resonance imaging study of gray matter volume, cortical thickness, and white matter integrity. Psychiatry Res Neuroimaging 2021; 318:111393. [PMID: 34670165 DOI: 10.1016/j.pscychresns.2021.111393] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 09/29/2021] [Accepted: 09/30/2021] [Indexed: 10/20/2022]
Abstract
Whole-brain T1-weighted imaging and diffusion tensor imaging was performed in 35 adult women with anorexia nervosa (AN) and 35 healthy controls. We conducted voxel-based group comparisons for gray matter volume (GMV), cortical thickness (CT), and fractional anisotropy (FA) values, using age and total intracranial volume as nuisance covariates. We then conducted the same group comparisons for these three measures, but this time also controlled for the following global pathological measures: total GMV, mean CT across the whole brain, and mean FA across the entire white matter skeleton. Compared with the healthy controls, AN patients had lower GMV and CT in widespread cortical regions, and smaller FA values in widespread white matter regions. After controlling for global parameters, almost all of the differences between the two groups disappeared, except for higher CT in the medial orbital gyrus and parietal operculum in the AN group. Structural brain changes in AN are likely to be composed of both global and region-specific changes. The former changes are likely to have a dominant impact, while the latter changes might in part explain the disease-specific pathophysiology of AN.
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Affiliation(s)
- Ryo Mishima
- Department of Psychiatry, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaracho, Sakyo-ku, Kyoto, Japan
| | - Masanori Isobe
- Department of Psychiatry, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaracho, Sakyo-ku, Kyoto, Japan.
| | - Tomomi Noda
- Department of Psychiatry, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaracho, Sakyo-ku, Kyoto, Japan
| | - Keima Tose
- Department of Psychiatry, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaracho, Sakyo-ku, Kyoto, Japan
| | - Michiko Kawabata
- Department of Psychiatry, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaracho, Sakyo-ku, Kyoto, Japan
| | - Shun'ichi Noma
- Department of Psychiatry, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaracho, Sakyo-ku, Kyoto, Japan; Noma Kokoro Clinic, 5-322-1 Fukakusa-Sujikaibashi, Fushimi-ku, Kyoto, Japan
| | - Toshiya Murai
- Department of Psychiatry, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaracho, Sakyo-ku, Kyoto, Japan
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12
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Frintrop L, Trinh S, Seitz J, Kipp M. The Role of Glial Cells in Regulating Feeding Behavior: Potential Relevance to Anorexia Nervosa. J Clin Med 2021; 11:jcm11010186. [PMID: 35011927 PMCID: PMC8745326 DOI: 10.3390/jcm11010186] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/17/2021] [Accepted: 12/25/2021] [Indexed: 12/16/2022] Open
Abstract
Eating behavior is controlled by hypothalamic circuits in which agouti-related peptide-expressing neurons when activated in the arcuate nucleus, promote food intake while pro-opiomelanocortin-producing neurons promote satiety. The respective neurotransmitters signal to other parts of the hypothalamus such as the paraventricular nucleus as well as several extra-hypothalamic brain regions to orchestrate eating behavior. This complex process of food intake may be influenced by glia cells, in particular astrocytes and microglia. Recent studies showed that GFAP+ astrocyte cell density is reduced in the central nervous system of an experimental anorexia nervosa model. Anorexia nervosa is an eating disorder that causes, among the well-known somatic symptoms, brain volume loss which was associated with neuropsychological deficits while the underlying pathophysiology is unknown. In this review article, we summarize the findings of glia cells in anorexia nervosa animal models and try to deduce which role glia cells might play in the pathophysiology of eating disorders, including anorexia nervosa. A better understanding of glia cell function in the regulation of food intake and eating behavior might lead to the identification of new drug targets.
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Affiliation(s)
- Linda Frintrop
- Institute of Anatomy, Rostock University Medical Center, 18057 Rostock, Germany;
- Correspondence: ; Tel.: +49-(0)-381-494-8406
| | - Stefanie Trinh
- Institute of Neuroanatomy, RWTH Aachen University, 52074 Aachen, Germany;
| | - Jochen Seitz
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, 52074 Aachen, Germany;
| | - Markus Kipp
- Institute of Anatomy, Rostock University Medical Center, 18057 Rostock, Germany;
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13
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Vidal L, Ortega MA, Alvarez-Mon MA, Álvarez-Mon M, Lahera G. Volumetric Alterations of the Cerebral Cortex in Eating Disorders. J Clin Med 2021; 10:jcm10235480. [PMID: 34884181 PMCID: PMC8658332 DOI: 10.3390/jcm10235480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/10/2021] [Accepted: 11/18/2021] [Indexed: 11/16/2022] Open
Abstract
Eating disorders are relatively frequent psychiatric disorders that can produce serious consequences at the brain level. In an effort to clarify the neurobiological mechanisms of their pathogenesis, some studies have suggested the existence of modifications of the cortical architecture in eating disorders, but it is unknown whether the alterations described are a cause or consequence of eating disorders. The main objective of this systematic review is to collect the evidence available about the volumetric alterations of the cerebral cortex in eating disorders in adults and their apparent relationship with the pathogenesis of the disease. Initially, 91 articles were found by a search that included the terms anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder, gray matter, cortical thickness (CT), and brain volume. To pare down the articles, the following inclusion criteria were applied: (1) cortical thickness and/or gray matter volume (GMV) in patients with anorexia, bulimia nervosa, or binge-eating disorder was the main measure of the study; and (2) the sample was adult patients aged 18–65. The exclusion criteria were as follows: (1) articles that did not analyze cortical thickness or gray matter volume; (2) studies with patients with comorbidities; and (3) studies in patients who did not meet the DSM-IV/DSM-V criteria. In the first phase of selection, we proceeded to read the titles and abstracts as a first screen, thereby excluding 62 studies, followed by a complete critical reading of the 29 remaining articles. In this last phase, nine studies were excluded because they did not specify the eating disorder subtype, they included adolescents, or they did not measure GMV or CT. Finally, after the above systematic selection process, 20 articles were included in this review. Despite the methodological heterogeneity of the studies, there was some agreement between them. They showed an overall reduction in GMV in eating disorders, as well as alterations in certain regions of the cerebral cortex. Some of the most often mentioned cortical areas were the frontal, cingulate, and right orbitofrontal cortices, the precuneus, the right insula, and some temporoparietal gyri in cases of AN, with greater cortical involvement in frontotemporal and medial orbitofrontal regions in BN and binge eating disorder. Likewise, certain cortical regions, such as the left inferior frontal gyrus, the precuneus, the right superior motor area, the cingulate cortex, the insula, and the medial orbitofrontal sulcus, often remained altered after recovery from AN, making them potential cortical areas involved in the etiopathogenesis of AN. A reduction in GMV in specific areas of the CNS can inform us about the neurobiological mechanisms that underlie eating disorders as well as give us a better understanding of their possible consequences at the brain level.
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Affiliation(s)
- Laura Vidal
- Department of Medicine and Medical Specialities, University of Alcala, 28801 Alcalá de Henares, Spain; (L.V.); (M.A.A.-M.); (M.Á.-M.); (G.L.)
| | - Miguel A Ortega
- Department of Medicine and Medical Specialities, University of Alcala, 28801 Alcalá de Henares, Spain; (L.V.); (M.A.A.-M.); (M.Á.-M.); (G.L.)
- Ramón y Cajal Institute of Sanitary Researcsh, 28034 Madrid, Spain
- Cancer Registry and Pathology Department, Hospital Universitario Principe de Asturias, 28806 Alcalá de Henares, Spain
- Correspondence:
| | - Miguel Angel Alvarez-Mon
- Department of Medicine and Medical Specialities, University of Alcala, 28801 Alcalá de Henares, Spain; (L.V.); (M.A.A.-M.); (M.Á.-M.); (G.L.)
- Ramón y Cajal Institute of Sanitary Researcsh, 28034 Madrid, Spain
- Department of Psychiatry and Mental Health, Hospital Universitario Infanta Leonor, 28031 Madrid, Spain
| | - Melchor Álvarez-Mon
- Department of Medicine and Medical Specialities, University of Alcala, 28801 Alcalá de Henares, Spain; (L.V.); (M.A.A.-M.); (M.Á.-M.); (G.L.)
- Ramón y Cajal Institute of Sanitary Researcsh, 28034 Madrid, Spain
- Immune System Diseases-Rheumatology, Oncology Service an Internal Medicine, University Hospital Príncipe de Asturias, 28806 Alcalá de Henares, Spain
| | - Guillermo Lahera
- Department of Medicine and Medical Specialities, University of Alcala, 28801 Alcalá de Henares, Spain; (L.V.); (M.A.A.-M.); (M.Á.-M.); (G.L.)
- Ramón y Cajal Institute of Sanitary Researcsh, 28034 Madrid, Spain
- Psychiatry Service, Center for Biomedical Research in the Mental Health Network, University Hospital Príncipe de Asturias, 28806 Alcalá de Henares, Spain
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14
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Myrvang AD, Vangberg TR, Linnman C, Stedal K, Rø Ø, Endestad T, Rosenvinge JH, Aslaksen PM. Altered functional connectivity in adolescent anorexia nervosa is related to age and cortical thickness. BMC Psychiatry 2021; 21:490. [PMID: 34615497 PMCID: PMC8496064 DOI: 10.1186/s12888-021-03497-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 09/22/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Functional networks develop throughout adolescence when anorexia nervosa (AN) normally debuts. In AN, cerebral structural alterations are found in most brain regions and may be related to the observed functional brain changes. Few studies have investigated the functional networks of the brain in adolescent AN patients.. The aim of this explorative study was to investigate multiple functional networks in adolescent AN patients compared to healthy age-matched controls (HC) and the relationship with age, eating disorder symptoms and structural alterations. METHODS Included were 29 female inpatients with restrictive AN, and 27 HC. All participants were between the ages of 12 to 18 years. Independent component analysis (ICA) identified 21 functional networks that were analyzed with multivariate and univariate analyses of components and group affiliation (AN vs HC). Age, age × group interaction and AN symptoms were included as covariates. Follow-up correlational analyses of selected components and structural measures (cortical thickness and subcortical volume) were carried out. RESULTS Decreased functional connectivity (FC) in AN patients was found in one cortical network, involving mainly the precuneus, and identified as a default mode network (DMN). Cortical thickness in the precuneus was significantly correlated with functional connectivity in this network. Significant group differences were also found in two subcortical networks involving mainly the hippocampus and the amygdala respectively, and a significant interaction effect of age and group was found in both these networks. There were no significant associations between FC and the clinical measures used in the study. CONCLUSION The findings from the present study may imply that functional alterations are related to structural alterations in selected regions and that the restricted food intake in AN patients disrupt normal age-related development of functional networks involving the amygdala and hippocampus.
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Affiliation(s)
- Anna D. Myrvang
- grid.10919.300000000122595234Department of Psychology, Faculty of Health Sciences, UiT The Artic University of Norway, Huginbakken 32, N-9037 Tromsø, Norway
| | - Torgil R. Vangberg
- grid.10919.300000000122595234Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway ,grid.412244.50000 0004 4689 5540PET Center, University Hospital of North Norway, Tromsø, Norway
| | - Clas Linnman
- grid.416228.b0000 0004 0451 8771Spaulding Rehabilitation Hospital, Boston, USA
| | - Kristin Stedal
- grid.55325.340000 0004 0389 8485Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Øyvind Rø
- grid.55325.340000 0004 0389 8485Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway ,grid.5510.10000 0004 1936 8921Institute of clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway
| | - Tor Endestad
- grid.5510.10000 0004 1936 8921Department of psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway ,Helgelandssykehuset, Mosjøen, Norway
| | - Jan H. Rosenvinge
- grid.10919.300000000122595234Department of Psychology, Faculty of Health Sciences, UiT The Artic University of Norway, Huginbakken 32, N-9037 Tromsø, Norway
| | - Per M. Aslaksen
- grid.10919.300000000122595234Department of Psychology, Faculty of Health Sciences, UiT The Artic University of Norway, Huginbakken 32, N-9037 Tromsø, Norway ,grid.412244.50000 0004 4689 5540Regional Center for Eating Disorders, University Hospital of North Norway, Tromsø, Norway
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15
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Su T, Gong J, Tang G, Qiu S, Chen P, Chen G, Wang J, Huang L, Wang Y. Structural and functional brain alterations in anorexia nervosa:A multimodal meta-analysis of neuroimaging studies. Hum Brain Mapp 2021; 42:5154-5169. [PMID: 34296492 PMCID: PMC8449099 DOI: 10.1002/hbm.25602] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/10/2021] [Accepted: 07/12/2021] [Indexed: 12/26/2022] Open
Abstract
Anorexia nervosa (AN) is a complex psychiatric disorder with poorly understood etiology. Numerous voxel‐based morphometry (VBM) and resting‐state functional imaging studies have provided strong evidence of abnormal brain structure and intrinsic and functional activities in AN, but with inconsistent conclusions. Herein, a whole‐brain meta‐analysis was conducted on VBM (660 patients with AN, and 740 controls) and resting‐state functional imaging (425 patients with AN, and 461 controls) studies that measured differences in the gray matter volume (GMV) and intrinsic functional activity between patients with AN and healthy controls (HCs). Overall, patients with AN displayed decreased GMV in the bilateral median cingulate cortex (extending to the bilateral anterior and posterior cingulate cortex), and left middle occipital gyrus (extending to the left inferior parietal lobe). In resting‐state functional imaging studies, patients with AN displayed decreased resting‐state functional activity in the bilateral anterior cingulate cortex and bilateral median cingulate cortex, and increased resting‐state functional activity in the right parahippocampal gyrus. This multimodal meta‐analysis identified reductions of gray matter and functional activity in the anterior and median cingulate in patients with AN, which contributes to further understanding of the pathophysiology of AN.
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Affiliation(s)
- Ting Su
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, China.,Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, China
| | - Jiaying Gong
- Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, China.,Department of Radiology, Six Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Guixian Tang
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, China.,Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, China
| | - Shaojuan Qiu
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Pan Chen
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, China.,Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, China
| | - Guanmao Chen
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, China.,Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, China
| | - Junjing Wang
- Department of Applied Psychology, Guangdong University of Foreign Studies, Guangzhou, China
| | - Li Huang
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Ying Wang
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, China
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16
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Vatheuer CC, Dzionsko I, Maier S, Näher T, van Zutphen L, Sprenger A, Jacob GA, Arntz A, Domes G. Looking at the bigger picture: Cortical volume, thickness and surface area characteristics in borderline personality disorder with and without posttraumatic stress disorder. Psychiatry Res Neuroimaging 2021; 311:111283. [PMID: 33812313 DOI: 10.1016/j.pscychresns.2021.111283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 03/05/2021] [Accepted: 03/19/2021] [Indexed: 11/21/2022]
Abstract
Borderline personality disorder (BPD) is a severe psychiatric disorder accompanied by multiple comorbidities. Neuroimaging studies have identified structural abnormalities in BPD with most findings pointing to gray matter volume reductions in the fronto-limbic network, although results remain inconsistent. Similar alterations were found in posttraumatic stress disorder (PTSD), a common comorbidity of BPD. Only a small number of studies have investigated structural differences in BPD patients regarding comorbid PTSD specifically and studies conducting additional surface analyses are scarce. We investigated structural differences in women with BPD with and without PTSD and non-patient controls. Automated voxel-based and region-based volumetric analyses were applied. Additionally, four surface-based measures were analyzed: cortical thickness, gyrification index, fractal dimension, and sulcus depth. Analyses did not identify cortical volume alterations in the fronto-limbic network. Instead, hypergyrification was detected in the right superior parietal cortex in BPD patients compared to non-patient controls. No distinction was revealed between BPD patients with and without PTSD. These findings underline the importance of a holistic investigation examining volumetric and surface measures as these might enhance the understanding of structural alterations in BPD.
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Affiliation(s)
- C Carolyn Vatheuer
- Department of Biological and Clinical Psychology, University of Trier, Johanniterufer 15, 54290 Trier, Germany
| | - Inga Dzionsko
- Department of Biological and Clinical Psychology, University of Trier, Johanniterufer 15, 54290 Trier, Germany
| | - Simon Maier
- Department of Psychiatry and Psychotherapy, Section for Experimental Neuropsychiatry, Medical Center, University of Freiburg, Freiburg, Germany
| | - Tim Näher
- Department of Biological and Clinical Psychology, University of Trier, Johanniterufer 15, 54290 Trier, Germany
| | - Linda van Zutphen
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | | | - Gitta A Jacob
- Department of Clinical Psychology and Psychotherapy, University of Freiburg, Freiburg, Germany
| | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Gregor Domes
- Department of Biological and Clinical Psychology, University of Trier, Johanniterufer 15, 54290 Trier, Germany; Institute of Psychobiology, University of Trier, Trier, Germany.
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17
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Foerde K, Walsh BT, Dalack M, Daw N, Shohamy D, Steinglass JE. Changes in brain and behavior during food-based decision-making following treatment of anorexia nervosa. J Eat Disord 2021; 9:48. [PMID: 33865441 PMCID: PMC8052661 DOI: 10.1186/s40337-021-00402-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/31/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Anorexia nervosa is a severe illness with a high mortality rate, driven in large part by severe and persistent restriction of food intake. A critical challenge is to identify brain mechanisms associated with maladaptive eating behavior and whether they change with treatment. This study tested whether food choice-related caudate activation in anorexia nervosa changes with treatment. METHODS Healthy women (n = 29) and women hospitalized with anorexia nervosa (n = 24), ages 18 to 40 years, completed a Food Choice Task during fMRI scanning at two timepoints. Among patients, procedures occurred upon hospital admission (Time 1) and again after patients had gained to normal weight (Time 2). Healthy controls were tested twice at an interval group-matched to patients. Choice-related caudate activation was assessed at each timepoint, using parametric analyses in an a priori region of interest. RESULTS Among patients, the proportion of high-fat foods selected did not change over time (p's > 0.47), but decreased neural activity in the caudate after treatment was associated with increased selection of high-fat foods (r23 = - 0.43, p = 0.037). Choice-related caudate activation differed among women with anorexia nervosa vs healthy control women at Time 1 (healthy control: M = 0.15 ± 0.87, anorexia nervosa: M = 0.70 ± 1.1, t51 = - 2.05, p = 0.045), but not at Time 2 (healthy control: M = 0.18 ± 1.0, anorexia nervosa: M = 0.37 ± 0.99, t51 = - 0.694, p = 0.49). CONCLUSIONS Caudate activity was more strongly associated with decisions about food among individuals with anorexia nervosa relative to healthy comparison individuals prior to treatment, and decreases in caudate engagement among individuals with anorexia nervosa undergoing treatment were associated with increases in high-fat food choices. The findings underscore the need for treatment development that more successfully alters both eating behavior and the neural mechanisms that guide it.
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Affiliation(s)
- Karin Foerde
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York, NY, 10032, USA.,Psychiatry Department, Columbia University Irving Medical Center, 1051 Riverside Drive, Unit 98, New York, NY, 10032, USA
| | - B Timothy Walsh
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York, NY, 10032, USA.,Psychiatry Department, Columbia University Irving Medical Center, 1051 Riverside Drive, Unit 98, New York, NY, 10032, USA
| | - Maya Dalack
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York, NY, 10032, USA
| | - Nathaniel Daw
- Princeton Neuroscience Institute, Department of Psychology, Princeton University, Princeton, NJ, 08540, USA
| | - Daphna Shohamy
- Psychology Department and Zuckerman Mind Brain and Behavior Institute, Columbia University, 3227 Broadway, New York, NY, 10027, USA
| | - Joanna E Steinglass
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York, NY, 10032, USA. .,Psychiatry Department, Columbia University Irving Medical Center, 1051 Riverside Drive, Unit 98, New York, NY, 10032, USA.
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18
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Bohon C, Welch H. Quadratic relations of BMI with depression and brain volume in children: Analysis of data from the ABCD study. J Psychiatr Res 2021; 136:421-427. [PMID: 33657461 PMCID: PMC8225589 DOI: 10.1016/j.jpsychires.2021.02.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 02/10/2021] [Accepted: 02/12/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Weight-related health conditions and depression peak during adolescence and show relations with brain structure. Understanding how these conditions relate to each other prior to adolescence may guide research on the co-development of unhealthy weight conditions (both underweight and overweight) and depression, with a potential brain-based link. This study examines the cross-sectional relations between body mass index (BMI), depressive symptoms, and brain volume (total and regional) to determine whether BMI has a linear or quadratic relation with depressive symptoms and brain volume and how depressive symptoms and brain volume are related. METHODS Cross-sectional study using structural magnetic resonance imaging, height and weight to calculate BMI z-scores, and Child Behavior Checklist withdrawn depression scores. Data were from the Adolescent Brain Cognitive Development Study, collected at 21 sites across the United States from 11,875 9- and 10-year-old children recruited as a national sample. Mixed models were used to examine the linear and quadratic effects of BMI z-score on both brain volume (total and regional) and withdrawn depression scores, as well as the relations between brain volume and depression scores. Intracranial volume, age, sex, race, site, and family were included in the models as covariates. RESULTS Overall, BMI z-scores showed a quadratic relation with brain volumes and depressive symptoms. When including intracranial volume as a covariate, regional volumes investigated did not follow the same global pattern of effects except for right hippocampus and left lateral orbitofrontal cortex. Total brain volume was negatively related to depressive symptoms. CONCLUSIONS Links between depressive symptoms and low or high weight could improve our understanding of brain structural differences in depression. These findings also emphasize the importance of including the full spectrum of BMI from underweight to overweight and testing for nonlinear effects in models.
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Affiliation(s)
- Cara Bohon
- Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Stanford University School of Medicine, USA.
| | - Hannah Welch
- Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Stanford University School of Medicine
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19
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Liu X, Li L, Li M, Ren Z, Ma P. Characterizing the subtype of anhedonia in major depressive disorder: A symptom-specific multimodal MRI study. Psychiatry Res Neuroimaging 2021; 308:111239. [PMID: 33453684 DOI: 10.1016/j.pscychresns.2020.111239] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 11/02/2020] [Accepted: 12/18/2020] [Indexed: 01/19/2023]
Abstract
Anhedonia is a core symptom of major depressive disorder (MDD). Two subtypes of anhedonia: anticipatory anhedonia and consummatory anhedonia has been recognized in MDD patients. However, our knowledge regarding the distinction of anticipatory anhedonia and consummatory anhedonia in MDD remains limited. This study aimed to characterize the anticipatory anhedonia and consummatory anhedonia in first-episode, drug-naïve MDD patients. Resting-state functional MRI and T1-structural MRI were acquired for 38 MDD patients and 65 matched healthy controls (HCs). The ALFF and cortical surface indexes were compared between MDD and HCs. Then the correlations between the ALFF and cortical surface indexes alternations and the scores of anticipatory and consummatory pleasure measured by Temporal Experience of Pleasure Scale were evaluated. The elevated ALFF of left dorsal anterior cingulate cortex (dACC) and the reduced cortical thickness (CT) of left rostral ACC and lateral orbitofrontal cortex (lOFC) were respectively correlated with anticipatory anhedonia and consummatory anhedonia in MDD patients. These findings suggested the dissociated pathophysiological basis and imaging characteristics of anticipatory anhedonia and consummatory anhedonia. The ALFF and CT values of ACC and lOFC might serve as the imaging biomarker of the subtypes of anhedonia in early onset of MDD.
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Affiliation(s)
- Xiaodan Liu
- Medical Imaging Center, First affiliated hospital of JINAN University, Guangzhou, 510630, China.
| | - Lingsheng Li
- Medical Imaging Center, First affiliated hospital of JINAN University, Guangzhou, 510630, China
| | - Meng Li
- Medical Imaging Center, First affiliated hospital of JINAN University, Guangzhou, 510630, China
| | - Zepu Ren
- Department of Psychiatry, First affiliated hospital of JINAN University, Guangzhou, China
| | - Ping Ma
- Department of Psychiatry, First affiliated hospital of JINAN University, Guangzhou, China
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20
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de la Cruz F, Schumann A, Suttkus S, Helbing N, Zopf R, Bär KJ. Cortical thinning and associated connectivity changes in patients with anorexia nervosa. Transl Psychiatry 2021; 11:95. [PMID: 33542197 PMCID: PMC7862305 DOI: 10.1038/s41398-021-01237-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 12/12/2020] [Accepted: 12/15/2020] [Indexed: 01/30/2023] Open
Abstract
Structural brain abnormalities are a consistent finding in anorexia nervosa (AN) and proposed as a state biomarker of the disorder. Yet little is known about how regional structural changes affect intrinsic resting-state functional brain connectivity (rsFC). Using a cross-sectional, multimodal imaging approach, we investigated the association between regional cortical thickness abnormalities and rsFC in AN. Twenty-two acute AN patients and twenty-six age- and gender-matched healthy controls underwent a resting-state functional magnetic resonance imaging scan and cognitive tests. We performed group comparisons of whole-brain cortical thickness, seed-based rsFC, and network-based statistical (NBS) analyses. AN patients showed cortical thinning in the precuneus and inferior parietal lobules, regions involved in visuospatial memory and imagery. Cortical thickness in the precuneus correlated with nutritional state and cognitive functions in AN, strengthening the evidence for a critical role of this region in the disorder. Cortical thinning was accompanied by functional connectivity reductions in major brain networks, namely default mode, sensorimotor and visual networks. Similar to the seed-based approach, the NBS analysis revealed a single network of reduced functional connectivity in patients, comprising mainly sensorimotor- occipital regions. Our findings provide evidence that structural and functional brain abnormalities in AN are confined to specific regions and networks involved in visuospatial and somatosensory processing. We show that structural changes of the precuneus are linked to nutritional and functional states in AN, and future longitudinal research should assess how precuneus changes might be related to the evolution of the disorder.
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Affiliation(s)
- Feliberto de la Cruz
- Lab for Autonomic Neuroscience, Imaging and Cognition (LANIC), Department of Psychosomatic Medicine and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Andy Schumann
- Lab for Autonomic Neuroscience, Imaging and Cognition (LANIC), Department of Psychosomatic Medicine and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Stefanie Suttkus
- Lab for Autonomic Neuroscience, Imaging and Cognition (LANIC), Department of Psychosomatic Medicine and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Nadin Helbing
- Lab for Autonomic Neuroscience, Imaging and Cognition (LANIC), Department of Psychosomatic Medicine and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Regine Zopf
- Department of Cognitive Science, Perception in Action Research Centre, Faculty of Medical, Health & Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Karl-Jürgen Bär
- Lab for Autonomic Neuroscience, Imaging and Cognition (LANIC), Department of Psychosomatic Medicine and Psychotherapy, Jena University Hospital, Jena, Germany.
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21
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Myrvang AD, Vangberg TR, Stedal K, Rø Ø, Endestad T, Rosenvinge JH, Aslaksen PM. Cerebral cortical thickness and surface area in adolescent anorexia nervosa: Separate and joint analyses with a permutation-based nonparametric method. Int J Eat Disord 2020; 54:561-568. [PMID: 33350512 DOI: 10.1002/eat.23448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 11/12/2020] [Accepted: 12/07/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Reduction in cerebral volume is often found in underweight patients with anorexia nervosa (AN), but few studies have investigated other morphological measures. Cortical thickness (CTh) and surface area (CSA), often used to produce the measure of cortical volume, are developmentally distinct measures that may be differentially affected in AN, particularly in the developing brain. In the present study, we investigated CTh and CSA both separately and jointly to gain further insight into structural alterations in adolescent AN patients. METHOD Thirty female AN inpatients 12-18 years of age, and 27 age-matched healthy controls (HC) underwent structural magnetic resonance imaging. Group differences in CTh and CSA were investigated separately and jointly with a permutation-based nonparametric combination method (NPC) which may be more sensitive in detecting group differences compared to traditional volumetric methods. RESULTS Results showed significant reduction in in both CTh and CSA in several cortical regions in AN compared to HC and the reduction was related to BMI. Different results for the two morphological measures were found in a small number of cortical regions. The joint NPC analyses showed significant group differences across most of the cortical mantle. DISCUSSION Results from this study give novel insight to areal reduction in adolescent AN patients and indicate that both CTh and CSA reduction is related to BMI. The study is the first to use the NPC method to reveal large structural alterations covering most of the brain in adolescent AN.
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Affiliation(s)
- Anna D Myrvang
- Department of psychology, Faculty of Health Sciences, UiT The Artic University of Norway, Tromsø, Norway
| | - Torgil R Vangberg
- Department of Clinical Medicine, University Hospital of North Norway, Tromsø, Norway
- PET Center, University Hospital of North Norway, Tromsø, Norway
| | - Kristin Stedal
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Øyvind Rø
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Tor Endestad
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | - Jan H Rosenvinge
- Department of psychology, Faculty of Health Sciences, UiT The Artic University of Norway, Tromsø, Norway
| | - Per M Aslaksen
- Department of psychology, Faculty of Health Sciences, UiT The Artic University of Norway, Tromsø, Norway
- Regional Center for Eating Disorders, University Hospital of North Norway, Tromsø, Norway
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22
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Keeler J, Patsalos O, Thuret S, Ehrlich S, Tchanturia K, Himmerich H, Treasure J. Hippocampal volume, function, and related molecular activity in anorexia nervosa: A scoping review. Expert Rev Clin Pharmacol 2020; 13:1367-1387. [PMID: 33176113 DOI: 10.1080/17512433.2020.1850256] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Anorexia nervosa (AN) is a serious and persistent eating disorder, characterized by severe dietary restriction and weight loss, with a third of patients developing a severe-enduring form. The factors contributing to this progression are poorly understood, although there is evidence for impairments in neural structures such as the hippocampus, an area particularly affected by malnutrition and chronic stress. AREAS COVERED This study aimed to map the evidence for alterations in hippocampal volume, function, and related molecular activity in anorexia nervosa. PubMed, PsycINFO, and Web of Science were searched for studies related to hippocampal function and integrity using a range of methodologies, such as neuropsychological paradigms, structural and functional magnetic resonance imaging, and analysis of blood components. EXPERT OPINION Thirty-nine studies were included in this review. The majority were neuroimaging studies, which found hippocampus-specific volumetric and functional impairments. Neuropsychological studies showed evidence for a specific memory and learning impairments. There was some evidence for molecular abnormalities (e.g. cortisol), although these were few studies. Taken together, our review suggests that the hippocampus might be a particular region of interest when considering neurobiological approaches to understanding AN. These findings warrant further investigation and may lead to novel treatment approaches.
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Affiliation(s)
- Johanna Keeler
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology & Neuroscience ,UK
| | - Olivia Patsalos
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology & Neuroscience ,UK
| | - Sandrine Thuret
- Department of Basic and Clinical Neuroscience, King's College London, Institute of Psychiatry, Psychology and Neuroscience , UK
| | - Stefan Ehrlich
- Faculty of Medicine, Technische Universitat Dresden, Division of Psychological and Social Medicine and Developmental Neurosciences , Germany
| | - Kate Tchanturia
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology & Neuroscience ,UK
| | - Hubertus Himmerich
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology & Neuroscience ,UK
| | - Janet Treasure
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology & Neuroscience ,UK
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23
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Bang L, Tamnes CK, Norbom LB, Thomassen RA, Holm JS, Skotte LH, Juliusson PB, Mejlaender-Evjensvold M, Rø Ø. Associations of age, body mass index and biochemical parameters with brain morphology in patients with anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2020; 29:74-85. [PMID: 33125776 DOI: 10.1002/erv.2803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/01/2020] [Accepted: 10/18/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Accumulating evidence shows that patients with anorexia nervosa (AN) have globally reduced brain mass, including lower cortical volume and thickness, which largely normalizes following weight restoration. The underlying mechanisms for these processes are unknown, and how age and severity of emaciation are associated with brain morphology in AN is poorly understood. We investigated associations of age, body mass index (BMI) and biochemical parameters with brain morphology among patients in treatment. METHOD We included 85 patients (94% female) aged 12-48 (mean = 23) years with quality controlled magnetic resonance imaging (MRI) data. T1-weighted MRI images, clinical characteristics and biochemical parameters were retrospectively collected from hospital records. Brain morphology was measured using FreeSurfer, and associations investigated using regression models and correlations. RESULTS Controlling for BMI, age showed significant associations with brain morphology generally concordant with typical brain developmental patterns. Controlling for age, BMI showed significant positive associations with cortical volume and thickness. There were no significant interaction effects between age and BMI. None of the biochemical parameters correlated significantly with brain morphology. CONCLUSION Our findings suggest the presence of typical neurodevelopmental patterns in AN. Importantly, we showed that severity of emaciation is related to brain morphology reductions, underscoring the importance of weight restoration.
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Affiliation(s)
- Lasse Bang
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Christian Krog Tamnes
- PROMENTA Research Center, Department of Psychology, University of Oslo, Oslo, Norway.,NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Linn Bonaventure Norbom
- PROMENTA Research Center, Department of Psychology, University of Oslo, Oslo, Norway.,NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Rut Anne Thomassen
- Department of Paediatric Medicine, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Jill Solberg Holm
- Department of Clinical Neurosciences for Children, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Laila Holgersen Skotte
- Department of Clinical Neurosciences for Children, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Petur Benedikt Juliusson
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Health Registries, Norwegian Institute of Public Health, Bergen, Norway.,Department of Paediatrics, Haukeland University Hospital, Bergen, Norway
| | | | - Øyvind Rø
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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24
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Oliva R, Baiano M, Salvo P, Cereser L, Castiello U, Begliomini C. Metacognition in individuals recovered from anorexia nervosa: a voxel-based morphometry study. Psychiatry Res Neuroimaging 2020; 304:111138. [PMID: 32702602 DOI: 10.1016/j.pscychresns.2020.111138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 07/09/2020] [Accepted: 07/14/2020] [Indexed: 02/07/2023]
Abstract
Recent evidence shows that individuals with Anorexia Nervosa (AN) can be characterized by dysfunctional metacognition as well as reductions of gray matter volumes (GMV) in prefrontal brain regions involved in cognitive processes. However, whether these differences are reversible or stable markers has yet to be understood. Thus, we aimed at characterizing metacognition and brain morphometry in individuals recovered from AN (rec-AN). A combined psychometric-brain morphometry investigation on metacognitive functioning in rec-AN individuals was conducted. Fifteen healthy controls (HC) and fifteen rec-AN women underwent a psychometric assessment for metacognitive functioning and a high-resolution T1-weighted Magnetic Resonance Imaging measurement to assess global and regional brain volumes, using Voxel-Based Morphometry. The two groups did not differ for metacognitive functioning and GMV, while regional GMV reductions were observed in rec-AN compared to HC in the left Inferior Frontal Gyrus (IFG). While changes in metacognitive abilities may not represent a stable trait of AN, regional GMV reductions in brain regions devoted to specific cognitive functions, such as inhibitory/top-down control processes, can act as a neurobiological fingerprint for such condition. These findings can represent a promising hint for future investigations on the maintaining factors of AN.
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Affiliation(s)
- Rossella Oliva
- Department of General Psychology, University of Padova, Italy
| | - Monica Baiano
- Centro Unico Disturbi del Comportamento alimentare, Clinica Psichiatrica, Dipartimento di Salute Mentale - Azienda Sanitaria Universitaria Friuli Centrale, Italy
| | - Pierandrea Salvo
- Eating disorders Centre Portogruaro, AULSS 4 Veneto Orientale, Italy
| | - Lucia Cereser
- Eating disorders Centre Portogruaro, AULSS 4 Veneto Orientale, Italy
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25
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Horster I, Nickel K, Holovics L, Schmidt S, Endres D, Tebartz van Elst L, Zeeck A, Maier S, Joos A. A Neglected Topic in Neuroscience: Replicability of fMRI Results With Specific Reference to ANOREXIA NERVOSA. Front Psychiatry 2020; 11:777. [PMID: 32848943 PMCID: PMC7419696 DOI: 10.3389/fpsyt.2020.00777] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 07/21/2020] [Indexed: 12/21/2022] Open
Abstract
Functional magnetic resonance imaging (fMRI) studies report impaired functional correlates of cognition and emotion in mental disorders. The validity of preexisting studies needs to be confirmed through replication studies, which there is a lack of. So far, most replication studies have been conducted on non-patients (NP) and primarily investigated cognitive and motor tasks. To fill this gap, we conducted the first fMRI replication study to investigate brain function using disease-related food stimuli in patients with anorexia nervosa (AN). Using fMRI, we investigated 31 AN patients and 27 NP for increased amygdala and reduced midcingulate activation when viewing food and non-food stimuli, as reported by the original study (11AN, 11NP; Joos et al., 2011). Similar to the previous study, we observed in the within group comparisons (food>non-food) a frontoinsular activation for both groups. Although in AN the recorded activation clustered more prominently and extended into the cingulate cortex. In the between-group comparisons, the increased amygdala and reduced midcingulate activation could not be replicated. Instead, AN showed a higher activation of the cingulate cortices, the pre-/postcentral gyrus and the inferior parietal lobe. Unlike in the initial study, no significant differences between NP>AN could be observed. The inconsistency of results and the non-replication of the study could have several reasons, such as high inter-individual variance of functional correlates of emotion processing, as well as intra-individual variances and the smaller group size of the initial study. These results underline the importance of replication for assessing the reliability and validity of results from fMRI research.
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Affiliation(s)
- Isabelle Horster
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, University of Freiburg, Freiburg, Germany
| | - Kathrin Nickel
- Department of Psychiatry and Psychotherapy, University Medical Center, University of Freiburg, Freiburg, Germany
| | - Lukas Holovics
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, University of Freiburg, Freiburg, Germany
| | - Stefan Schmidt
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, University of Freiburg, Freiburg, Germany
| | - Dominique Endres
- Department of Psychiatry and Psychotherapy, University Medical Center, University of Freiburg, Freiburg, Germany
| | - Ludger Tebartz van Elst
- Department of Psychiatry and Psychotherapy, University Medical Center, University of Freiburg, Freiburg, Germany
| | - Almut Zeeck
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, University of Freiburg, Freiburg, Germany
| | - Simon Maier
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, University of Freiburg, Freiburg, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center, University of Freiburg, Freiburg, Germany
| | - Andreas Joos
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, University of Freiburg, Freiburg, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Ortenau Klinikum, Offenburg, Germany
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26
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Medical Complications of Anorexia Nervosa. PSYCHOSOMATICS 2020; 61:625-631. [PMID: 32778424 DOI: 10.1016/j.psym.2020.06.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/25/2020] [Accepted: 06/26/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The purpose of this study was to describe the medical complications of anorexia nervosa (AN) to enable a consult-liaison psychiatrist to be familiar with these complications when involved with the care of a hospitalized patient with AN. METHODS Comprehensive PubMed search of English language publications of adult patients with AN was carried out using keywords, phrases, and medical subject headings of anorexia nervosa-medical complications, cardiac, osteoporosis, gastrointestinal, hematological, and endocrine. The database search was restricted by time of publication of studies from 2005 to 2020. RESULTS Every organ system can be adversely affected by AN. Most are fully reversible with time and informed medical care. A multidisciplinary team is needed to optimally care for patients who are hospitalized as a result of the medical complications of their AN. CONCLUSIONS Consult-liaison psychiatrists are asked to help in the care of patients with AN who are admitted to a hospital because of a medical complication of their illness. Being familiar with these complications and their treatments will optimize their hospital stays and the care provided. In addition, involving other relevant ancillary services is an important care consideration.
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27
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Steinglass JE, Glasofer DR, Dalack M, Attia E. Between wellness, relapse, and remission: Stages of illness in anorexia nervosa. Int J Eat Disord 2020; 53:1088-1096. [PMID: 32031292 PMCID: PMC7384605 DOI: 10.1002/eat.23237] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/20/2020] [Accepted: 01/20/2020] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Psychiatric illnesses, like medical illnesses, can sometimes be considered as progressing through stages. Understanding these stages can lead to a better understanding of pathophysiology, and clarification of prognosis and treatment needs. Opinions from experts in the field of anorexia nervosa (AN) were sought to create a model of stages of illness. METHOD The Delphi approach was used to achieve consensus from a panel of 31 individuals from a range of disciplines with expertise in AN. Over three iterative rounds, participants rated agreement with statements about an overall staging framework and definitions of specific stages. RESULTS Agreement was reached about a longitudinal progression including Subsyndromal, Full Syndrome, Persistent Illness, and Partial and Full Remission. The panel achieved consensus in defining Subsyndromal AN as characterized by body image disturbance and mild to moderate restrictive eating. Overall, there was consensus that restrictive eating is central to the behavioral features of all stages of AN, and agreement that its absence is essential to any stage of health. There was little consensus about biological markers, other than body mass index, and no consensus about quality of life indices associated with different stages. DISCUSSION This panel discussion yielded an expert-informed staging model for AN. This model now needs to be tested for its validity. The lack of consensus in several areas highlighted other research questions to address in order to develop an empirically valid and scientifically useful model of the progression of AN.
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Affiliation(s)
- Joanna E. Steinglass
- Department of Psychiatry, Columbia University Irving Medical Center & New York State Psychiatric Institute, New York, New York
| | - Deborah R. Glasofer
- Department of Psychiatry, Columbia University Irving Medical Center & New York State Psychiatric Institute, New York, New York
| | - Maya Dalack
- Department of Psychiatry, Columbia University Irving Medical Center & New York State Psychiatric Institute, New York, New York
| | - Evelyn Attia
- Department of Psychiatry, Columbia University Irving Medical Center & New York State Psychiatric Institute, New York, New York,Weill Cornell Medical Center, Presbyterian Hospital, White Plains, New York
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28
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Kaufmann LK, Hänggi J, Jäncke L, Baur V, Piccirelli M, Kollias S, Schnyder U, Martin-Soelch C, Milos G. Age influences structural brain restoration during weight gain therapy in anorexia nervosa. Transl Psychiatry 2020; 10:126. [PMID: 32366823 PMCID: PMC7198513 DOI: 10.1038/s41398-020-0809-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 04/15/2020] [Accepted: 04/17/2020] [Indexed: 01/22/2023] Open
Abstract
Neuroimaging studies on anorexia nervosa (AN) have consistently reported globally reduced gray matter in patients with acute AN. While first studies on adolescent AN patients provide evidence for the reversibility of these impairments after weight gain, longitudinal studies with detailed regional analysis for adult AN patients are lacking and factors associated with brain restitution are poorly understood. We investigated structural changes in anorexia nervosa using T1-weighted magnetic resonance images with surface-based morphometry. The sample consisted of 26 adult women with severe AN and 30 healthy controls. The longitudinal design comprised three time points, capturing the course of weight-restoration therapy in AN patients at distinct stages of weight gain (BMI ≤ 15.5 kg/m2; 15.5 < BMI < 17.5 kg/m2; BMI ≥ 17.5 kg/m2). Compared to controls, AN patients showed globally decreased cortical thickness and subcortical volumes at baseline. Linear mixed effect models revealed the reversibility of these alterations, with brain restoration being most pronounced during the first half of treatment. The restoration of cortical thickness of AN patients negatively correlated with age, but not duration of illness. After weight restoration, residual group differences of cortical thickness remained in the superior frontal cortex. These findings indicate that structural brain alterations of adult patients with severe AN recuperate independently of the duration of illness during weight-restoration therapy. The temporal pattern of brain restoration suggests a decrease in restoration rate over the course of treatment, with patients' age as a strong predictor of brain restitution, possibly reflecting decreases of brain plasticity as patients grow older.
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Affiliation(s)
- Lisa-Katrin Kaufmann
- Department of Consultation-Liaison Psychiatry and Psychosomatics, University Hospital Zurich, University of Zurich, Zurich, Switzerland. .,Division of Neuropsychology, Department of Psychology, University of Zurich, Zurich, Switzerland. .,Unit of Clinical and Health Psychology, Department of Psychology, University of Fribourg, Fribourg, Switzerland.
| | - Jürgen Hänggi
- grid.7400.30000 0004 1937 0650Division of Neuropsychology, Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Lutz Jäncke
- grid.7400.30000 0004 1937 0650Division of Neuropsychology, Department of Psychology, University of Zurich, Zurich, Switzerland ,grid.7400.30000 0004 1937 0650International Normal Aging and Plasticity Imaging Center (INAPIC), University of Zurich, Zurich, Switzerland ,grid.7400.30000 0004 1937 0650University Research Priority Program (URPP) “Dynamic of Healthy Aging”, University of Zurich, Zurich, Switzerland
| | - Volker Baur
- grid.7400.30000 0004 1937 0650Department of Consultation-Liaison Psychiatry and Psychosomatics, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Marco Piccirelli
- grid.412004.30000 0004 0478 9977Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland
| | - Spyros Kollias
- grid.412004.30000 0004 0478 9977Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland
| | - Ulrich Schnyder
- grid.7400.30000 0004 1937 0650University of Zurich, Zurich, Switzerland
| | - Chantal Martin-Soelch
- grid.8534.a0000 0004 0478 1713Unit of Clinical and Health Psychology, Department of Psychology, University of Fribourg, Fribourg, Switzerland
| | - Gabriella Milos
- grid.7400.30000 0004 1937 0650Department of Consultation-Liaison Psychiatry and Psychosomatics, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Insular Cell Integrity Markers Linked to Weight Concern in Anorexia Nervosa-An MR-Spectroscopy Study. J Clin Med 2020; 9:jcm9051292. [PMID: 32365843 PMCID: PMC7288299 DOI: 10.3390/jcm9051292] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 12/29/2022] Open
Abstract
Objective: An insular involvement in the pathogenesis of anorexia nervosa (AN) has been suggested in many structural and functional neuroimaging studies. This magnetic resonance spectroscopy (MRS) study is the first to investigate metabolic signals in the anterior insular cortex in patients with AN and recovered individuals (REC). Method: The MR spectra of 32 adult women with AN, 21 REC subjects and 33 healthy controls (HC) were quantified for absolute N-acetylaspartate (NAA), glutamate + glutamine (Glx), total choline, myo-inositol, creatine concentrations (mM/L). After adjusting the metabolite concentrations for age and partial gray/white matter volume, group differences were tested using one-way multivariate analyses of variance (MANOVA). Post-hoc analyses of variance were applied to identify those metabolites that showed significant group effects. Correlations were tested for associations with psychometric measures (eating disorder examination), duration of illness, and body mass index. Results: The MANOVA exhibited a significant group effect. The NAA signal was reduced in the AN group compared to the HC group. The REC and the HC groups did not differ in metabolite concentrations. In the AN group, lower NAA and Glx signals were related to increased weight concern. Discussion: We interpret the decreased NAA availability in the anterior insula as a signal of impaired neuronal integrity or density. The association of weight concern, which is a core feature of AN, with decreased NAA and Glx indicates that disturbances of glutamatergic neurotransmission might be related to core psychopathology in AN. The absence of significant metabolic differences between the REC and HC subjects suggests that metabolic alterations in AN represent a state rather than a trait phenomenon.
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30
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Curzio O, Calderoni S, Maestro S, Rossi G, De Pasquale CF, Belmonti V, Apicella F, Muratori F, Retico A. Lower gray matter volumes of frontal lobes and insula in adolescents with anorexia nervosa restricting type: Findings from a Brain Morphometry Study. Eur Psychiatry 2020; 63:e27. [PMID: 32172703 PMCID: PMC7315882 DOI: 10.1192/j.eurpsy.2020.19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Brain atrophy in anorexia nervosa (AN) is one of the most marked structural brain changes observed in mental disorders. In this study, we propose a whole brain analysis approach to characterize global and regional cerebral volumes in adolescents with restricting-type anorexia nervosa (AN-r). METHODS A total of 48 adolescent females (age range 13-18 years) were enrolled in the study (24 right-handed AN-r in the early stages of the illness and treated in the same clinical setting and 24 age-matched healthy controls [HC]). High-resolution T1-weighted magnetic resonance images were acquired. Cerebral volumes, including the total amounts of gray matter (GM), white matter (WM), and cerebrospinal fluid (CSF) were obtained with the Statistical Parametric Mapping software (SPM8); specific cortical regional volumes were computed by applying an atlas-based cortical parcellation to the SPM8 GM segments. Analysis of variance (ANOVA) was performed to identify any significant between-group differences in global and regional brain volumes. RESULTS The analyses revealed reduced total GM volumes (p = 0.02) and increased CSF (p = 0.05) in AN-r, compared with HC. No significant between-group difference was found in WM volumes. At the regional level, significantly lower GM volumes in both frontal lobes (p = 0.006) and in the left insula (p = 0.016) were detected. No significant relationships were found between cerebral volumes and duration of illness, psychiatric comorbidities, psychopharmacological treatment, prepubertal phase, or presence of amenorrhea. CONCLUSIONS The topographic distribution of GM reduction in a homogenous group of AN-r involves regions responsible for the emotional and cognitive deficits associated with the illness. These findings are discussed in relation to the roles of the insular cortex and the frontal lobes.
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Affiliation(s)
- O Curzio
- Institute of Clinical Physiology of the National Research Council (IFC-CNR), Department of Biomedical Sciences, Pisa, Italy
| | - S Calderoni
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,Department of Developmental Neuroscience - IRCCS Fondazione Stella Maris, Pisa, Italy
| | - S Maestro
- Department of Developmental Neuroscience - IRCCS Fondazione Stella Maris, Pisa, Italy
| | - G Rossi
- Institute of Clinical Physiology of the National Research Council (IFC-CNR), Department of Biomedical Sciences, Pisa, Italy.,G. Monasterio Foundation, Tuscany Region (FTGM), Pisa, Italy
| | - C F De Pasquale
- Department of Developmental Neuroscience - IRCCS Fondazione Stella Maris, Pisa, Italy
| | - V Belmonti
- Department of Developmental Neuroscience - IRCCS Fondazione Stella Maris, Pisa, Italy
| | - F Apicella
- Department of Developmental Neuroscience - IRCCS Fondazione Stella Maris, Pisa, Italy
| | - F Muratori
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,Department of Developmental Neuroscience - IRCCS Fondazione Stella Maris, Pisa, Italy
| | - A Retico
- Pisa Division, INFN - National Institute for Nuclear Physics, Pisa, Italy
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Treasure J, Willmott D, Ambwani S, Cardi V, Clark Bryan D, Rowlands K, Schmidt U. Cognitive Interpersonal Model for Anorexia Nervosa Revisited: The Perpetuating Factors that Contribute to the Development of the Severe and Enduring Illness. J Clin Med 2020; 9:E630. [PMID: 32120847 PMCID: PMC7141127 DOI: 10.3390/jcm9030630] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 02/21/2020] [Accepted: 02/25/2020] [Indexed: 02/07/2023] Open
Abstract
The cognitive interpersonal model was outlined initially in 2006 in a paper describing the valued and visible aspects of anorexia nervosa (Schmidt and Treasure, 2006). In 2013, we summarised many of the cognitive and emotional traits underpinning the model (Treasure and Schmidt, 2013). In this paper, we describe in more detail the perpetuating aspects of the model, which include the inter- and intrapersonal related consequences of isolation, depression, and chronic stress that accumulate in the severe and enduring stage of the illness. Since we developed the model, we have been using it to frame research and development at the Maudsley. We have developed and tested interventions for both patients and close others, refining the model through iterative cycles of model/intervention development in line with the Medical Research Council (MRC) framework for complex interventions. For example, we have defined the consequences of living with the illness on close others (including medical professionals) and characterised the intense emotional reactions and behaviours that follow. For the individual with an eating disorder, these counter-reactions can allow the eating disorder to become entrenched. In addition, the consequent chronic stress from starvation and social pain set in motion processes such as depression, neuroprogression, and neuroadaptation. Thus, anorexia nervosa develops a life of its own that is resistant to treatment. In this paper, we describe the underpinnings of the model and how this can be targeted into treatment.
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Affiliation(s)
- Janet Treasure
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, SE5 8AF London, UK; (J.T.); (V.C.); (D.C.B.); (K.R.); (U.S.)
| | - Daniel Willmott
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, SE5 8AF London, UK; (J.T.); (V.C.); (D.C.B.); (K.R.); (U.S.)
| | - Suman Ambwani
- Department of Psychology, Dickinson College, Carlisle, PA17013, USA;
| | - Valentina Cardi
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, SE5 8AF London, UK; (J.T.); (V.C.); (D.C.B.); (K.R.); (U.S.)
| | - Danielle Clark Bryan
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, SE5 8AF London, UK; (J.T.); (V.C.); (D.C.B.); (K.R.); (U.S.)
| | - Katie Rowlands
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, SE5 8AF London, UK; (J.T.); (V.C.); (D.C.B.); (K.R.); (U.S.)
| | - Ulrike Schmidt
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, SE5 8AF London, UK; (J.T.); (V.C.); (D.C.B.); (K.R.); (U.S.)
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Lai J, Xu T, Zhang H, Xi C, Zhou H, Du Y, Jiang J, Wu L, Zhang P, Xu Y, Hu S, Xu D. Fractional amplitude of low frequency fluctuation in drug-naïve first-episode patients with anorexia nervosa: A resting-state fMRI study. Medicine (Baltimore) 2020; 99:e19300. [PMID: 32118747 PMCID: PMC7478752 DOI: 10.1097/md.0000000000019300] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To characterize the fractional amplitude of low-frequency fluctuation (fALFF) in drug-naïve first-episode female patients with anorexia nervosa (AN) using resting-state functional magnetic resonance imaging (rs-fMRI).Whole brain rs-fMRI data were collected from 7 drug-naïve first-episode female patients with DSM-5 AN and 14 age-matched healthy female controls. fALFF values were calculated and compared between the two groups using a two-sample t test. Correlation analysis between the fALFF values in the entire brain and body mass index (BMI) was performed.Compared with the healthy controls, increased fALFF values were observed in the AN patients in their right hippocampus and left superior frontal gyrus, while decreased fALFF values were observed in their left rectus and left middle occipital gyrus. Moreover, low BMI was significantly associated with decreased fALFF in the left inferior frontal gyrus but increased fALFF in the left calcarine. In particular, the z-standardized fALFF (zfALFF) value of the left rectus was positive associated with BMI.Our findings suggest that spontaneous brain activity in the frontal region, hippocampus and rectus, characterized by fALFF values, was altered in drug-naïve, first-episode female patients with AN.
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Affiliation(s)
- Jianbo Lai
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine
- The Key Laboratory of Mental Disorder's Management in Zhejiang Province
- Brain Research Institute of Zhejiang University
| | - Tingting Xu
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine
- Zhejiang University School of Medicine
- Mental Health Centre, Xiaoshan Hospital of Zhejiang Province, Hangzhou
| | - Haorong Zhang
- Shanghai Key Laboratory of Magnetic Resonance Imaging & Institute of Cognitive Neuroscience, East China Normal University, Shanghai, China
| | - Caixi Xi
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine
- Zhejiang University School of Medicine
| | - Hetong Zhou
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine
- The Key Laboratory of Mental Disorder's Management in Zhejiang Province
- Brain Research Institute of Zhejiang University
| | - Yanli Du
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine
- Zhejiang University School of Medicine
| | - Jiajun Jiang
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine
- Zhejiang University School of Medicine
| | - Lingling Wu
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine
- Zhejiang University School of Medicine
| | - Peifen Zhang
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine
- Zhejiang University School of Medicine
| | - Yi Xu
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine
- The Key Laboratory of Mental Disorder's Management in Zhejiang Province
- Brain Research Institute of Zhejiang University
| | - Shaohua Hu
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine
- The Key Laboratory of Mental Disorder's Management in Zhejiang Province
- Brain Research Institute of Zhejiang University
| | - Dongrong Xu
- Molecular Imaging and Neuropathology Division, Department of Psychiatry, Columbia University & New York State Psychiatric Institute, New York, NY 10032
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Scharner S, Stengel A. Alterations of brain structure and functions in anorexia nervosa. CLINICAL NUTRITION EXPERIMENTAL 2019. [DOI: 10.1016/j.yclnex.2019.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Abstract
PURPOSE OF REVIEW Eating disorders are severe psychiatric disorders with a suspected complex biopsychosocial cause. The purpose of this review is to synthesize the recent literature on brain imaging in eating disorders. RECENT FINDINGS Food restriction as well as binge eating and purging behaviors are associated with lower regional brain volumes or cortical thickness, but those changes largely return to normal with normalization of weight and eating behavior. Computational modeling has started to identify patterns of structural and functional imaging data that classify eating disorder subtypes, which could be used in the future, diagnostically and to better understand disorder-specific psychopathology. The prediction error model, a computational approach to assess dopamine-related brain reward function, helped support a brain-based model for anorexia nervosa. In that model, the conscious motivation to restrict conflicts with body signals that stimulate eating. This conflict causes anxiety and drives a vicious cycle of food restriction. SUMMARY Novel brain research supports the notion that eating disorders have distinct neurobiological underpinnings. This new knowledge can be used to describe disease models to patients and develop novel treatments.
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35
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Frank GKW. Editorial to the virtual issue highlighting neuroscience based research in eating disorders to mark the 49th Society for Neuroscience Annual Meeting. Int J Eat Disord 2019; 52:1332-1335. [PMID: 31524987 DOI: 10.1002/eat.23163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 08/19/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVE This virtual issue of the International Journal of Eating Disorders highlights recently published research that is based on neuroscience concepts, to mark the 49th Society for Neuroscience Annual Meeting in Chicago, IL, in November 2019. METHODS AND RESULTS The collection of articles includes research published between 2018 and 2019 that fall within the broader field of clinical neuroscience. Those articles span a broad range of themes, including food intake regulation and reward circuitry, taste perception, decision-making, cognitive and emotional bias, and targeting altered brain circuits using novel therapeutic methods. DISCUSSION The eating disorders field as a whole is increasingly incorporating neuroscience-based concepts when studying those disorders and developing disease models. We hope that this virtual issue will further stimulate discussion and research that is focused on brain circuits and neurobiology to study etiology and pathophysiology of eating disorders to develop more effective treatments.
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Affiliation(s)
- Guido K W Frank
- Department of Psychiatry, University of California, San Diego, Health Sciences, UCSD Eating Disorder Center for Treatment and Research, San Diego, California
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36
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Abstract
PURPOSE OF REVIEW This article reviews new research in the context of existing literature to identify approaches that will advance understanding of the persistence of anorexia nervosa. RECENT FINDINGS Neuroscience research in anorexia nervosa has yielded disparate findings: no definitive neural mechanism underlying illness vulnerability or persistence has been identified and no clear neural target for intervention has emerged. Recent advances using structural and functional neuroimaging research, as well as new techniques for applying and combining these approaches, have led to a refined understanding of changes in neural architecture among individuals who are acutely ill, have undergone renourishment, or are in recovery/remission. In particular, advances have come from the incorporation of computational and translational approaches, as well as efforts to link experimental paradigms with illness-relevant behavior. Recent findings converge to suggest abnormalities in systems involved in reward learning and processing among individuals with anorexia nervosa. SUMMARY Anorexia nervosa is associated with neurobiological abnormalities. Aberrant learning and reward processing may contribute to the persistence of illness. To better utilize new techniques to understand the neural mechanisms of persistent anorexia nervosa, it may help to distinguish stages of illness and to link neurobiology with maladaptive behavior.
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Abstract
Eating disorders are severe psychiatric illnesses with a typical age of onset in adolescence. Brain research in youth and young adults may help us identify specific neurobiology that contributes to onset and maintenance of those disorders. This article provides a state-of-the-art review of our current understanding of the neurobiology of anorexia nervosa and bulimia nervosa. This includes brain structure and function studies to understand food restriction, binge-eating or purging behaviors, cognitive and emotional factors, as well as interoception. Binge-eating disorder and avoidant restrictive food intake disorder are also discussed, but the literature is still very small.
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Gaudio S, Carducci F, Piervincenzi C, Olivo G, Schiöth HB. Altered thalamo–cortical and occipital–parietal– temporal–frontal white matter connections in patients with anorexia and bulimia nervosa: a systematic review of diffusion tensor imaging studies. J Psychiatry Neurosci 2019; 44:324-339. [PMID: 30994310 PMCID: PMC6710091 DOI: 10.1503/jpn.180121] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Anorexia nervosa and bulimia nervosa are complex mental disorders, and their etiology is still not fully understood. This paper reviews the literature on diffusion tensor imaging studies in patients with anorexia nervosa and bulimia nervosa to explore the usefulness of white matter microstructural analysis in understanding the pathophysiology of eating disorders. METHODS We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify diffusion tensor imaging studies that compared patients with an eating disorder to control groups. We searched relevant databases for studies published from database inception to August 2018, using combinations of select keywords. We categorized white matter tracts according to their 3 main classes: projection (i.e., thalamo–cortical), association (i.e., occipital–parietal–temporal–frontal) and commissural (e.g., corpus callosum). RESULTS We included 19 papers that investigated a total of 427 participants with current or previous eating disorders and 444 controls. Overall, the studies used different diffusion tensor imaging approaches and showed widespread white matter abnormalities in patients with eating disorders. Despite differences among the studies, patients with anorexia nervosa showed mainly white matter microstructural abnormalities of thalamo–cortical tracts (i.e., corona radiata, thalamic radiations) and occipital–parietal–temporal–frontal tracts (i.e., left superior longitudinal and inferior fronto-occipital fasciculi). It was less clear whether white matter alterations persist after recovery from anorexia nervosa. Available data on bulimia nervosa were partially similar to those for anorexia nervosa. LIMITATIONS Study sample composition and diffusion tensor imaging analysis techniques were heterogeneous. The number of studies on bulimia nervosa was too limited to be conclusive. CONCLUSION White matter microstructure appears to be affected in anorexia nervosa, and these alterations may play a role in the pathophysiology of this eating disorder. Although we found white matter alterations in bulimia nervosa that were similar to those in anorexia nervosa, white matter changes in bulimia nervosa remain poorly investigated, and these findings were less conclusive. Further studies with longitudinal designs and multi-approach analyses are needed to better understand the role of white matter changes in eating disorders.
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Affiliation(s)
- Santino Gaudio
- From the Department of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden (Gaudio, Olivo, Schiöth); the Centre for Integrated Research, Area of Diagnostic Imaging, Universita Campus Bio-Medico di Roma, Rome, Italy (Gaudio); the Department of Physiology and Pharmacology, Neuroimaging Laboratory, Sapienza University, Rome, Italy (Carducci, Piervincenzi); and the Institute for Translational Medicine and Biotechnology, Sechenov First Moscow State Medical University, Moscow, Russia (Schiöth)
| | - Filippo Carducci
- From the Department of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden (Gaudio, Olivo, Schiöth); the Centre for Integrated Research, Area of Diagnostic Imaging, Universita Campus Bio-Medico di Roma, Rome, Italy (Gaudio); the Department of Physiology and Pharmacology, Neuroimaging Laboratory, Sapienza University, Rome, Italy (Carducci, Piervincenzi); and the Institute for Translational Medicine and Biotechnology, Sechenov First Moscow State Medical University, Moscow, Russia (Schiöth)
| | - Claudia Piervincenzi
- From the Department of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden (Gaudio, Olivo, Schiöth); the Centre for Integrated Research, Area of Diagnostic Imaging, Universita Campus Bio-Medico di Roma, Rome, Italy (Gaudio); the Department of Physiology and Pharmacology, Neuroimaging Laboratory, Sapienza University, Rome, Italy (Carducci, Piervincenzi); and the Institute for Translational Medicine and Biotechnology, Sechenov First Moscow State Medical University, Moscow, Russia (Schiöth)
| | - Gaia Olivo
- From the Department of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden (Gaudio, Olivo, Schiöth); the Centre for Integrated Research, Area of Diagnostic Imaging, Universita Campus Bio-Medico di Roma, Rome, Italy (Gaudio); the Department of Physiology and Pharmacology, Neuroimaging Laboratory, Sapienza University, Rome, Italy (Carducci, Piervincenzi); and the Institute for Translational Medicine and Biotechnology, Sechenov First Moscow State Medical University, Moscow, Russia (Schiöth)
| | - Helgi B. Schiöth
- From the Department of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden (Gaudio, Olivo, Schiöth); the Centre for Integrated Research, Area of Diagnostic Imaging, Universita Campus Bio-Medico di Roma, Rome, Italy (Gaudio); the Department of Physiology and Pharmacology, Neuroimaging Laboratory, Sapienza University, Rome, Italy (Carducci, Piervincenzi); and the Institute for Translational Medicine and Biotechnology, Sechenov First Moscow State Medical University, Moscow, Russia (Schiöth)
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Leppanen J, Sedgewick F, Cardi V, Treasure J, Tchanturia K. Cortical morphometry in anorexia nervosa: An out-of-sample replication study. EUROPEAN EATING DISORDERS REVIEW 2019; 27:507-520. [PMID: 31172616 PMCID: PMC6698193 DOI: 10.1002/erv.2686] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 05/01/2019] [Accepted: 05/09/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND Acute anorexia nervosa (AN) is frequently accompanied by reduced global cortical volume. Investigations of local cortical alterations in AN have revealed widespread reduction in cortical thickness, gyrification, and curvature. The aim of the present study was to combine data from two previous studies to replicate previous findings. METHODOLOGY Magnetic resonance imaging (MRI) images from 46 adult women with AN and 54 age-matched healthy comparison (HC) women were analysed using FreeSurfer. Group differences in cortical volume and local cortical measures, including gyrification, curvature, thickness, and area, were examined controlling for dataset and age. RESULTS The AN group had reduced global cortical volume relative to the HC group. The AN group also had reduction in local cortical gyrification, small localised clusters of reduced cortical thickness, in the occipital and parietal cortices, and surface area in the frontal and temporal cortices. The AN group also had increased cortical thickness in the ACC relative to the HC participants. CONCLUSIONS The present findings replicate and validate previous findings of reduced global cortical volume and local gyrification in acute AN. The findings highlight the need for further investigation of local cortical folding, thickness, and surface area in AN to gain further insight into the biological underpinnings of AN.
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Affiliation(s)
- Jenni Leppanen
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, King's College London, London, UK
| | - Felicity Sedgewick
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, King's College London, London, UK
| | - Valentina Cardi
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, King's College London, London, UK
| | - Janet Treasure
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, King's College London, London, UK.,South London and Maudsley Mental Health NHS Foundation Trust, Section of Eating Disorders, London, UK
| | - Kate Tchanturia
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, King's College London, London, UK.,South London and Maudsley Mental Health NHS Foundation Trust, Section of Eating Disorders, London, UK.,Department of Psychology, Illia State University, Tbilisi, Georgia
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40
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Nickel K, Joos A, Tebartz van Elst L, Holovics L, Endres D, Zeeck A, Maier S. Altered cortical folding and reduced sulcal depth in adults with anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2019; 27:655-670. [DOI: 10.1002/erv.2685] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 03/25/2019] [Accepted: 04/17/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Kathrin Nickel
- Section for Experimental Neuropsychiatry, Department of Psychiatry and PsychotherapyMedical Center – University of Freiburg, Faculty of Medicine, University of Freiburg Freiburg Germany
| | - Andreas Joos
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center – University of FreiburgFaculty of Medicine, University of Freiburg Freiburg Germany
- Psychotherapeutic NeurologyKliniken Schmieder Gailingen Germany
| | - Ludger Tebartz van Elst
- Section for Experimental Neuropsychiatry, Department of Psychiatry and PsychotherapyMedical Center – University of Freiburg, Faculty of Medicine, University of Freiburg Freiburg Germany
| | - Lukas Holovics
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center – University of FreiburgFaculty of Medicine, University of Freiburg Freiburg Germany
| | - Dominique Endres
- Section for Experimental Neuropsychiatry, Department of Psychiatry and PsychotherapyMedical Center – University of Freiburg, Faculty of Medicine, University of Freiburg Freiburg Germany
| | - Almut Zeeck
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center – University of FreiburgFaculty of Medicine, University of Freiburg Freiburg Germany
| | - Simon Maier
- Section for Experimental Neuropsychiatry, Department of Psychiatry and PsychotherapyMedical Center – University of Freiburg, Faculty of Medicine, University of Freiburg Freiburg Germany
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center – University of FreiburgFaculty of Medicine, University of Freiburg Freiburg Germany
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Nickel K, Tebartz van Elst L, Holovics L, Feige B, Glauche V, Fortenbacher T, Endres D, Zeeck A, Tüscher O, Joos A, Maier S. White Matter Abnormalities in the Corpus Callosum in Acute and Recovered Anorexia Nervosa Patients-A Diffusion Tensor Imaging Study. Front Psychiatry 2019; 10:490. [PMID: 31338044 PMCID: PMC6628864 DOI: 10.3389/fpsyt.2019.00490] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 06/21/2019] [Indexed: 12/26/2022] Open
Abstract
Objective: Severe malnutrition in patients with anorexia nervosa (AN) as well as possible trait-related aberrations lead to pronounced structural brain changes whose reversibility after recovery is currently unclear. Previous diffusion tensor imaging (DTI) studies investigating white matter (WM) microstructure alterations in AN are inconsistent. Methods: In this so far largest DTI study in adults, we investigated 33 AN patients, 20 recovered (REC), and 33 healthy women. DTI data were processed using the "DTI and Fiber tools," and the Computational Anatomy Toolbox. WM integrity, both in terms of fractional anisotropy (FA) and mean diffusivity (MD), was assessed. Results: We found a significant FA decrease in the corpus callosum (body) and an MD decrease in the posterior thalamic radiation in the AN group. The REC group displayed FA decrease in the corpus callosum in comparison to HC, whereas there were no MD differences between the REC and HC groups. Conclusion: Despite prolonged restoration of weight in the REC group, no significant regeneration of WM integrity in terms of FA could be observed. Transient changes in MD likely represent a reversible consequence of the acute state of starvation or result from dehydration. Reduction of FA either may be due to WM damage resulting from malnutrition or may be considered a pre-morbid marker.
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Affiliation(s)
- Kathrin Nickel
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ludger Tebartz van Elst
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Lukas Holovics
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bernd Feige
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Volkmar Glauche
- Department of Neurology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tina Fortenbacher
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dominique Endres
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Almut Zeeck
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Oliver Tüscher
- Department of Psychiatry and Psychotherapy, University of Mainz, Mainz, Germany
| | - Andreas Joos
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Psychotherapeutic Neurology, Kliniken Schmieder, Gailingen, Germany
| | - Simon Maier
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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