1
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Blanchette-Sarrasin A, Saj A. [Effects of non-invasive neuromodulation on the cognitive profile of people with anorexia nervosa: A scoping review]. L'ENCEPHALE 2024; 50:339-347. [PMID: 38087685 DOI: 10.1016/j.encep.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/13/2023] [Accepted: 11/02/2023] [Indexed: 05/31/2024]
Abstract
BACKGROUND The use of non-invasive neuromodulation is emerging in the treatment of anorexia nervosa. Despite promising results, further research is needed to improve our understanding of these techniques and to adapt interventions to this population. As anorexia nervosa is associated with several cognitive difficulties and cerebral anomalies, the aim of the present study was to summarize the available data on the effects of non-invasive neuromodulation on the neuropsychological profile of people with anorexia nervosa. METHOD A scoping review was conducted by searching in PsycINFO, PubMed and CINAHL databases to systematically identify relevant studies published between 1994 and 2023 on the treatment of anorexia nervosa with repetitive transcranial magnetic stimulation, transcranial direct current stimulation or neurofeedback electroencephalogram. RESULTS Seventeen articles were included, including 12 on repetitive transcranial magnetic stimulation, four on transcranial direct current stimulation and one on neurofeedback electroencephalogram. Of these, only three studies included a neuropsychological measure to assess the impact of neuromodulation on participants' cognitive functions. CONCLUSIONS Including detailed neuropsychological measures in clinical trials of non-invasive neuromodulation is highly recommended and appears essential to improve our understanding of these techniques and optimize their efficacy in the treatment of anorexia nervosa.
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Affiliation(s)
| | - Arnaud Saj
- Département de psychologie, Université de Montréal, Montréal, Québec, H3T 1J4, Canada; Centre de recherche interdisciplinaire en réadaptation (CRIR), Institut Nazareth et Louis-Braille du CISSS de la Montérégie-Centre, Longueuil, QC J4K 5G4, Canada; Centre interdisciplinaire de recherche sur le cerveau et l'apprentissage (CIRCA), Université de Montréal, Montréal, Québec, Canada; Laboratory for Behavioral Neurology and Imaging of Cognition, Neuroscience Department, University of Geneva, 1211 Geneva, Suisse; Département des neurosciences cliniques, Université de Genève, 1205 Genève, Suisse
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2
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Harper JA, Palka JM, McAdams CJ. Interpersonal attribution bias and social evaluation in adolescent eating disorders. EUROPEAN EATING DISORDERS REVIEW 2023; 31:258-270. [PMID: 36349493 PMCID: PMC9898092 DOI: 10.1002/erv.2954] [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: 05/08/2022] [Revised: 09/19/2022] [Accepted: 10/16/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Improved understanding of adolescent eating disorders (EDs), including identification and refinement of treatment and recovery targets, may help improve clinical outcomes. Interpersonal function is a proposed risk and maintenance factor that may be particularly relevant given the significance of adolescence for both psychosocial development and ED onset. This study examined self-referential thinking in adolescents with EDs compared to healthy adolescents. METHOD Twenty-nine adolescents with EDs and 31 healthy controls completed a self-report measure of interpersonal attributions as well as a verbal appraisal task that required conducting direct and indirect evaluations about oneself and direct evaluations about others. RESULTS The ED group had a more negative self-attribution bias than the control group (p = 0.006) even when controlling for depression severity. Additionally, the ED group exhibited less positive direct self (p < 0.001), direct social (p = 0.015), and social reflected self-appraisals (p = 0.011) than the healthy cohort. After including depression as a covariate in the verbal appraisal model, the model was no longer significant, suggesting group differences related to social appraisals may be mediated by depression. CONCLUSIONS Adolescents with EDs have more negative interpersonal beliefs than comparison adolescents. Future studies are needed to determine how the constructs identified here relate to clinical course.
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Affiliation(s)
- Jessica A. Harper
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
- Children’s Medical Center, Dallas, Texas, USA
| | - Jayme M. Palka
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
| | - Carrie J. McAdams
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
- Children’s Medical Center, Dallas, Texas, USA
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3
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Collantoni E, Meregalli V, Manara R, Meneguzzo P, Tenconi E, Favaro A. Volume and complexity of the thalamus in Anorexia Nervosa: An exploratory evaluation. EUROPEAN EATING DISORDERS REVIEW 2023; 31:349-359. [PMID: 36573401 DOI: 10.1002/erv.2965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/30/2022] [Accepted: 12/13/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Recent neuroscientific findings have highlighted the role of the thalamus in several cognitive functions, ranging from perception to cognitive flexibility, memory, and body representation. Since some of these functions may be involved in the pathophysiology of Anorexia Nervosa (AN), this study aims at exploring thalamic structure in different phases of the disorder. METHOD The sample included 38 patients with acute AN, 20 patients who fully recovered from AN (recAN), and 38 healthy controls (HC), all female. All participants underwent high-resolution MRI. The volumes of the whole thalamus and 25 thalamic nuclei were extracted using an automated segmentation algorithm, and thalamic fractal dimension was estimated using the calcFD toolbox. RESULTS Patients with acute AN, compared to HC, displayed reduced thalamic volume and complexity both at the whole level and at the level of specific nuclei. In patients recAN, instead, alterations were observed only at the level of the right laterodorsal and central lateral nuclei. CONCLUSIONS In the acute phase of the disorder patients with AN present a widespread reduction in thalamic volume and complexity. However, these alterations seem to normalise almost completely following weight restoration, thus suggesting the involvement of malnutrition-related mechanisms.
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Affiliation(s)
- Enrico Collantoni
- Department of Neurosciences, University of Padua, Padova, Italy.,Padua Neuroscience Center, University of Padua, Padova, Italy
| | - Valentina Meregalli
- Department of Neurosciences, University of Padua, Padova, Italy.,Padua Neuroscience Center, University of Padua, Padova, Italy
| | - Renzo Manara
- Department of Neurosciences, University of Padua, Padova, Italy
| | - Paolo Meneguzzo
- Department of Neurosciences, University of Padua, Padova, Italy.,Padua Neuroscience Center, University of Padua, Padova, Italy
| | - Elena Tenconi
- Department of Neurosciences, University of Padua, Padova, Italy.,Padua Neuroscience Center, University of Padua, Padova, Italy
| | - Angela Favaro
- Department of Neurosciences, University of Padua, Padova, Italy.,Padua Neuroscience Center, University of Padua, Padova, Italy
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4
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Orloff NC, McGinley K, Lenz K, Mack AS, Timko CA. Adaptations of cognitive remediation therapy for adolescents with anorexia nervosa for delivery via telehealth. Int J Eat Disord 2023; 56:72-79. [PMID: 36401578 PMCID: PMC10207383 DOI: 10.1002/eat.23850] [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: 06/05/2022] [Revised: 11/01/2022] [Accepted: 11/01/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The COVID-19 pandemic hastened a transition to treatment delivery via telehealth. While barriers still exist, the increased uptake of telehealth has the potential to increase access to mental health treatment for all diagnoses, including eating disorders. Delivery of evidence-based treatment as well as adjunctive treatments, including those that are hard to find in-person, have been modified to virtual format to increase accessibility and allow for continuity of care for adolescents with anorexia nervosa. METHOD We describe how to modify and deliver Cognitive Remediation Therapy for youth with anorexia nervosa (CRT-AN) via a telehealth platform. Preliminary and practical guidance for best practice for both group and individual delivery is established. RESULTS With minimal modifications, CRT-AN can be delivered via telehealth for both individual and group delivery. More disengagement in group delivery was noted; however, overall application of the treatment via a remote platform was observed. DISCUSSION As more treatment moves to a telehealth format, highlighting how an adjunctive treatment like CRT-AN can combined with other treatments in a telehealth format has the potential to increase research in its implementation and furthermore increase its dissemination. PUBLIC SIGNIFICANCE Cognitive Remediation Therapy for Anorexia Nervosa (CRT-AN) requires significant manipulation of materials and supplementary human guidance. Suggestions for how to modify CRT-AN for remote delivery via telehealth are provided. Modifications grew out of immediate changes made during the beginning of the COVID-19 pandemic and can be used to inform changes therapists and programs can make to continue to or begin to use CRT-AN in a remote fashion.
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Affiliation(s)
- Natalia C Orloff
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kate McGinley
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Private Practice, Cape May Court House, Cape May County, New Jersey, USA
| | - Katrina Lenz
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Amy S Mack
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - C Alix Timko
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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5
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Phonological working memory is adversely affected in adults with anorexia nervosa: a systematic literature review. Eat Weight Disord 2022; 27:1931-1952. [PMID: 35133643 PMCID: PMC9287223 DOI: 10.1007/s40519-022-01370-1] [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: 10/29/2021] [Accepted: 01/18/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Cognitive restraint has potentiating and deleterious effects on working memory (WM) in anorexia nervosa (AN). Conflicting evidence may be due to heterogeneity of tasks examining different WM components (e.g., verbal/auditory versus visuospatial), and differences in adolescent versus adult AN. Additionally, differential cognitive profiles of restricting versus binge/purging subtypes, comorbid psychiatric disorders and psychotropic medication use may confound findings. METHODS To address these conflicts, 25 studies, published between 2016 and 2021, investigating WM in children, adolescents and adults with AN were systematically reviewed using PRISMA guidelines. RESULTS In 71% of WM tasks, no difference in performance between AN patients and age-matched controls was reported, while 29% of WM tasks showed worse performance. Adults with AN displayed deficits in 44% of the verbal/auditory tasks, while performance remained unaffected in 86% of visuospatial tasks. CONCLUSION Examining age groups and WM subsystems separately revealed novel findings of differentially affected WM components in AN. Comorbidities and psychotropic medications were common among AN participants and should be regarded as critical confounding factors for WM measures. Future studies examining different components of WM, acknowledging these confounding factors, may reveal specific deficits in AN to aid treatment improvement strategies. LEVEL OF EVIDENCE I, systematic review.
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6
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Stedal K, Scherer R, Touyz S, Hay P, Broomfield C. Research Review: Neuropsychological functioning in young anorexia nervosa: A meta-analysis. J Child Psychol Psychiatry 2022; 63:616-625. [PMID: 34970745 DOI: 10.1111/jcpp.13562] [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] [Accepted: 11/26/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Cognitive inflexibility and compulsive behaviours are commonly observed in patients with anorexia nervosa (AN) and are often considered to be caused by impairments in executive functioning and visuospatial processing. Despite an increasing number of young individuals presenting with AN, there is a lack of meta-analytic evidence on the neuropsychological functioning in this population. Our primary aim was to review and synthesize the differences in neuropsychological test performance between young people with AN and healthy controls, and to explore potential moderators. METHODS A database search following PRISMA guidelines of MEDLINE, PsycINFO, ISI Web of Science and Epistemonikos was conducted. Hedges' g served as an effect size indicating the standardized mean differences. We utilized mixed-effects meta-regression and machine learning meta-analyses to identify relevant moderators. RESULTS Sixteen studies met the inclusion criteria with a total of 1333 participants (665 with AN) and 59 effect sizes. Random-effects meta-analyses demonstrated a small and insignificant difference between young individuals with AN and controls ( g¯ = -0.144, 95% CI [-0.328, 0.041]) in overall neuropsychological functioning. However, the difference was significant for the cognitive domains of memory, working memory and visuospatial abilities. Moderator and machine-learning analyses revealed a stronger negative effect in older participants and moderator effects of country and assessment quality. CONCLUSIONS Our findings highlight the significant impact of age on neuropsychological test performance in patients with AN. There is a need for a more widespread inclusion of potentially confounding variables in primary studies as well as instruments specifically targeted at younger populations.
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Affiliation(s)
- Kristin Stedal
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital Oslo Ullevål, Oslo, Norway
| | - Ronny Scherer
- Faculty of Educational Sciences, Centre for Educational Measurement at the University of Oslo (CEMO), University of Oslo, Oslo, Norway
| | - Stephen Touyz
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
| | - Phillipa Hay
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Catherine Broomfield
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
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7
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Hamatani S, Matsumoto K, Takahashi J, Shiko Y, Ozawa Y, Niitsu T, Hirano Y, Shimizu E. Feasibility of guided internet-based cognitive behavioral therapy for patients with anorexia nervosa. Internet Interv 2022; 27:100504. [PMID: 35257002 PMCID: PMC8897312 DOI: 10.1016/j.invent.2022.100504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 02/03/2022] [Accepted: 02/09/2022] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE The objective of the present study was to investigate the feasibility of guided internet cognitive behavioral therapy (ICBT) for anorexia nervosa. METHODS We conducted a prospective single-arm study between January 2020 and March 2021. The intervention was built using videos, web programs, and chat tools. The intervention program was largely based on metacognitive training. Participants performed the self-help program once a week for 12 consecutive weeks. The primary outcome was the global Eating Disorder Examination Questionnaire (EDE-Q) score. Secondary outcomes included clinical symptoms of eating disorders, metacognitive function, body mass index, depression, and generalized anxiety. The main statistical analysis examined whether the EDE-Q score and other outcomes at the end of the intervention differed from the baseline. RESULTS Fourteen participants underwent the trial treatment, and 13 completed the intervention. There was a significant reduction in the global EDE-Q score from 3.48 (SD = 1.4) to 2.54 (SD = 1.5, p = 0.02, Cohen's d = 0.75) from baseline to post-intervention. Some EDE-Q subscales and body checking questionnaire scale demonstrated statistically significant improvements, with moderate to large effect sizes. Although there was no significant improvement in body mass index, metacognitive function, or depressive symptoms, there was a significant improvement in the severity of generalized anxiety (M = -4.0, p = 0.01, Cohen's d = 0.95). No adverse events were observed. DISCUSSION Our findings suggest that guided ICBT for anorexia nervosa is well accepted by female patients and practical as a telemedicine approach that improves symptoms. In the future, tightly controlled randomized controlled trials should be conducted for efficacy verification.
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Affiliation(s)
- Sayo Hamatani
- Research Center for Child Mental Development, Chiba University, Japan
- Learning and Behavior Science, Linköping University, Sweden
- Research Center for Child Mental Development, University of Fukui, Japan
- Corresponding author at: Research Center for Child Mental Development, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui 910-1193, Japan.
| | - Kazuki Matsumoto
- Research Center for Child Mental Development, Chiba University, Japan
- Laboratory of Neuropsychology, Kanazawa University, Japan
| | - Jumpei Takahashi
- Department of Child Psychiatry, Chiba University Hospital, Japan
| | - Yuki Shiko
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, Japan
| | - Yoshihito Ozawa
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, Japan
| | - Tomihisa Niitsu
- Department of Psychiatry, Graduate School of Medicine, Chiba University, Japan
| | - Yoshiyuki Hirano
- Research Center for Child Mental Development, Chiba University, Japan
| | - Eiji Shimizu
- Research Center for Child Mental Development, Chiba University, Japan
- Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University, Japan
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8
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Mendoza CJ, Palka JM, Pelfrey SE, Hunt BJ, Krawczyk DC, McAdams CJ. Neural processes related to negative self-concept in adult and adolescent anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2022; 30:23-35. [PMID: 34655143 PMCID: PMC9233497 DOI: 10.1002/erv.2867] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/04/2021] [Accepted: 10/01/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Negative self-concept is characteristic of anorexia nervosa (AN), but the neural processes mediating this component of AN is unknown. These studies investigated how valence and social perspectives impact neural processing in both adults and adolescents with AN. METHOD In an fMRI task, participants evaluated positive and negative adjectives from three social perspectives. Two studies were completed, one in 59 women (healthy, with AN, recovered from AN) and one in 42 adolescents (healthy, with AN). Neural regions of interest (ROIs) related to valence were identified and activations compared across groups and social perspectives. RESULTS Behaviourally, both adult and adolescent cohorts with AN were less positive during self-evaluations. In the adult study, neural differences related to clinical group and condition were observed in ROIs more responsive to positive social stimuli (medial prefrontal cortex, precuneus, left temporoparietal junction) but not in ROIs more responsive to negative social stimuli. No neural differences in relation to clinical group were observed in the adolescents. CONCLUSIONS Behavioural differences related to negative self-concept are present in both adolescents and adults with AN, and neural differences, selective for positive social stimuli, were also observed in adults. AN may interfere with neurodevelopmental processes involved in positive self-concept.
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Affiliation(s)
- Carlisdania J. Mendoza
- Department of Psychiatry, University of Texas at Southwestern Medical Center, Dallas, TX
| | - Jayme M. Palka
- Department of Psychiatry, University of Texas at Southwestern Medical Center, Dallas, TX
| | - Sarah E. Pelfrey
- Department of Psychiatry, University of Texas at Southwestern Medical Center, Dallas, TX
| | - Bethany J. Hunt
- Department of Psychiatry, University of Texas at Southwestern Medical Center, Dallas, TX
| | - Daniel C. Krawczyk
- Department of Psychiatry, University of Texas at Southwestern Medical Center, Dallas, TX,Center for Brain Health, University of Texas at Dallas, Dallas, TX
| | - Carrie J. McAdams
- Department of Psychiatry, University of Texas at Southwestern Medical Center, Dallas, TX,Psychiatry, Children’s Medical Center, Dallas, TX;,Corresponding author: Carrie McAdams MD PhD, 6363 Forest Park Rd. BL6.204, Dallas, TX 75390-8828, Phone: 214-648-4145, Fax: 214-648-5321,
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9
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Stedal K, Broomfield C, Hay P, Touyz S, Scherer R. Neuropsychological functioning in adult anorexia nervosa: A meta-analysis. Neurosci Biobehav Rev 2021; 130:214-226. [PMID: 34453951 DOI: 10.1016/j.neubiorev.2021.08.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/10/2021] [Accepted: 08/22/2021] [Indexed: 02/07/2023]
Abstract
Several studies have conceptualized neuropsychological dysfunction as part of the core pathology and defining behaviors seen in the eating disorder anorexia nervosa (AN). The aim of the current review was to synthesize the differences in neuropsychological test performance between individuals with AN and healthy controls, quantify and explain their heterogeneity. The search and screening procedures resulted in fifty studies that comprised 186 neuropsychological test results. Utilizing random-effects meta-analyses, the results revealed evidence for significant, moderate underperformance in people with AN in overall neuropsychological functioning (g¯ = -0.43, 95 % CI [-0.50, -0.36]). Weighted mean effect sizes ranged from g¯ = -0.53 for visuospatial abilities to g¯ = -0.10 for planning. Study and participant characteristics, including body mass index (BMI) and age, had significant moderator effects, especially on executive function, memory, and visuospatial abilities. The findings from the current study provide an extensive and comprehensive overview of the possible impairments in neuropsychological functioning in adult patients diagnosed with AN.
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Affiliation(s)
- Kristin Stedal
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital Ullevål HF, Postboks 4956 Nydalen, 0424, Oslo, Norway.
| | - Catherine Broomfield
- School of Psychology, Faculty of Science, The University of Sydney, NSW, 2006, Australia
| | - Phillipa Hay
- Translational Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Stephen Touyz
- School of Psychology, Faculty of Science, The University of Sydney, NSW, 2006, Australia
| | - Ronny Scherer
- Centre for Educational Measurement at the University of Oslo (CEMO), Faculty of Educational Sciences, University of Oslo, P.O. Box 1161 Blindern, 0318, Oslo, Norway
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10
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Meneguzzo P, Tenconi E, Todisco P, Favaro A. Cognitive remediation therapy for anorexia nervosa as a rolling group intervention: Data from a longitudinal study in an eating disorders specialized inpatient unit. EUROPEAN EATING DISORDERS REVIEW 2021; 29:770-782. [PMID: 34118097 PMCID: PMC8453548 DOI: 10.1002/erv.2848] [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: 05/14/2021] [Accepted: 05/21/2021] [Indexed: 12/12/2022]
Abstract
Objective Cognitive remediation therapy (CRT) has been proposed as an add‐on treatment approach that could increase the engagement in treatment of anorexia nervosa (AN) patients and reduce maintaining factors, but prior studies have evaluated CRT in individual and group settings, difficult protocols for rehabilitation settings. Our aim is to evaluate the CRT rolling protocol implementation in an inpatient specialised unit. Methods A historical longitudinal controlled study was designed to include 31 AN patients for the CRT program, and 28 AN patients treated as usual. The CRT rolling group was implemented in a multidisciplinary inpatient rehabilitation ward with both adolescent and adult patients and an 8‐weeks protocol. To evaluate the treatment implementation effect, different self‐administered questionnaires were used. Results The study found greater improvements of the CRT group in clinical symptomatology (p = 0.039), flexibility (p = 0.003), self‐confidence about the ability to change (p < 0.001), and less short‐term focus (p < 0.001), with no differences between restrictive and binge‐purging patients. Conclusion This study demonstrates that CRT rolling group protocol is feasible in an inpatient treatment setting and may improve a rehabilitation program's outcome. Our results have shown how CRT can influence cognitive styles considered AN maintenance factors, positively affecting both restrictive and binge‐purge type. Cognitive remediation therapy (CRT) could be implemented in an inpatient setting with a rolling protocol CRT improves flexibility, drive to change, and therapy engagement No differences between restrictive or binge/purge subgroups Both adolescent and adult patients improved their cognitive styles
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Affiliation(s)
- Paolo Meneguzzo
- Department of Neuroscience, University of Padova, Padova, Italy.,Eating Disorders Unit, Casa di Cura 'Villa Margherita', Arcugnano, Vicenza, Italy
| | - Elena Tenconi
- Department of Neuroscience, University of Padova, Padova, Italy.,Padova Neuroscience Center, University of Padova, Padova, Italy
| | - Patrizia Todisco
- Eating Disorders Unit, Casa di Cura 'Villa Margherita', Arcugnano, Vicenza, Italy
| | - Angela Favaro
- Department of Neuroscience, University of Padova, Padova, Italy.,Padova Neuroscience Center, University of Padova, Padova, Italy
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11
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Cholet J, Rousselet M, Donnio Y, Burlot M, Pere M, Lambert S, Rocher B, Chirio-Espitalier M, Eyzop E, Grall-Bronnec M. Evaluation of cognitive impairment in a French sample of patients with restrictive anorexia nervosa: two distinct profiles emerged with differences in impaired functions and psychopathological symptoms. Eat Weight Disord 2021; 26:1559-1570. [PMID: 32767255 PMCID: PMC8128741 DOI: 10.1007/s40519-020-00981-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 07/31/2020] [Indexed: 12/13/2022] Open
Abstract
PURPOSE The cognitive profiles of patients suffering from anorexia nervosa (AN) are currently explored as potential facilitating and/or maintenance factors. Specific data in restrictive AN (AN-R) remain contradictory. This study focused on women with AN-R to evaluate their cognitive functions to develop a more specific cognitive remediation program. METHODS Female patients older than 15 years who were suffering from AN-R were recruited in a specialized unit for eating disorder management. Female healthy control (HC) participants were recruited who were matched with AN patients on age. All participants completed a cognitive evaluation (premorbid intelligence quotient (IQ), planning, information processing speed, cognitive flexibility) and a clinical evaluation (impulsivity, anxiety, depression). RESULTS A total of 122 participants were included. Patients suffering from AN-R had significant impairment in information processing speed and planning. Patients exhibited significantly better cognitive flexibility than did the HC group when adjustments were made for other cognitive functions and impulsivity. Two distinct subgroups of patients were identified. The first subgroup had more marked cognitive impairment and fewer psychopathological symptoms than did the second subgroup of patients and the HC group. CONCLUSION Our results highlight cognitive impairment in patients with AN who had normal premorbid IQ. Two distinct profiles emerge. In clinical practice, these results open up perspectives for the development of more specific cognitive remediation programs (one specific program for cold cognitions and another specific program targeting emotions and hot cognitions). These results warrant confirmation by larger studies with a more specific evaluation of the impact of emotional status. Trial registration NTC02381639, Date of registration. March 6, 2015.
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Affiliation(s)
- J Cholet
- Clinical Investigation Unit BALANCED "BehaviorAL AddictioNs and ComplEx Mood Disorders", Addictology and Psychiatry Department, University Hospital of Nantes, 85 Rue Saint Jacques, 44093, Nantes Cedex 1, France
| | - M Rousselet
- Clinical Investigation Unit BALANCED "BehaviorAL AddictioNs and ComplEx Mood Disorders", Addictology and Psychiatry Department, University Hospital of Nantes, 85 Rue Saint Jacques, 44093, Nantes Cedex 1, France. .,U1246 SPHERE "methodS in Patient-Centered Outcomes and HEalth ResEarch", INSERM, University of Nantes and Tours, 22 Boulevard Benoni-Goullin, 44200, Nantes, France.
| | - Y Donnio
- Clinical Investigation Unit BALANCED "BehaviorAL AddictioNs and ComplEx Mood Disorders", Addictology and Psychiatry Department, University Hospital of Nantes, 85 Rue Saint Jacques, 44093, Nantes Cedex 1, France
| | - M Burlot
- Clinical Investigation Unit BALANCED "BehaviorAL AddictioNs and ComplEx Mood Disorders", Addictology and Psychiatry Department, University Hospital of Nantes, 85 Rue Saint Jacques, 44093, Nantes Cedex 1, France
| | - M Pere
- Biostatistics Unit, Research Board, Nantes University Hospital, 5 Allées de l'île Gloriette, 44093, Nantes Cedex 1, France
| | - S Lambert
- Clinical Investigation Unit BALANCED "BehaviorAL AddictioNs and ComplEx Mood Disorders", Addictology and Psychiatry Department, University Hospital of Nantes, 85 Rue Saint Jacques, 44093, Nantes Cedex 1, France
| | - B Rocher
- Clinical Investigation Unit BALANCED "BehaviorAL AddictioNs and ComplEx Mood Disorders", Addictology and Psychiatry Department, University Hospital of Nantes, 85 Rue Saint Jacques, 44093, Nantes Cedex 1, France
| | - M Chirio-Espitalier
- Reference Centre for Therapeutic Education and Cognitive Remediation Care (CReSERC), Psychiatry and Mental Health Department, University Hospital of Nantes, 85 Rue Saint Jacques, 44093, Nantes Cedex 1, France
| | - E Eyzop
- Clinical Investigation Unit BALANCED "BehaviorAL AddictioNs and ComplEx Mood Disorders", Addictology and Psychiatry Department, University Hospital of Nantes, 85 Rue Saint Jacques, 44093, Nantes Cedex 1, France
| | - M Grall-Bronnec
- Clinical Investigation Unit BALANCED "BehaviorAL AddictioNs and ComplEx Mood Disorders", Addictology and Psychiatry Department, University Hospital of Nantes, 85 Rue Saint Jacques, 44093, Nantes Cedex 1, France.,U1246 SPHERE "methodS in Patient-Centered Outcomes and HEalth ResEarch", INSERM, University of Nantes and Tours, 22 Boulevard Benoni-Goullin, 44200, Nantes, France
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12
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Duriez P, Kaya Lefèvre H, Di Lodovico L, Viltart O, Gorwood P. Increased cognitive flexibility mediates the improvement of eating disorders symptoms, depressive symptoms and level of daily life functioning in patients with anorexia nervosa treated in specialised centres. EUROPEAN EATING DISORDERS REVIEW 2021; 29:600-610. [PMID: 33851482 DOI: 10.1002/erv.2829] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/15/2021] [Accepted: 02/23/2021] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Poor cognitive flexibility has been highlighted in patients with anorexia nervosa (AN), contributing to the development and maintenance of symptoms. The aim of the present study is to investigate how enhanced cognitive flexibility is involved in treatment outcomes in patients with AN. METHOD One hundred thirty female out-patients treated for AN have been assessed at baseline and after 4 months of treatment. Path analyses were used to investigate the mediating role of cognitive flexibility, measured through the Brixton test, on a wide range of outcomes: body mass index, eating disorder symptoms, daily life functioning, anxiety, depression, emotions, self-rated silhouette. RESULTS Cognitive flexibility was improved during treatment, and enhanced cognitive flexibility explains a significant part of level of the improvement in daily life functioning (26%), reduction of eating disorder symptoms (18%) and reduction of depressive symptoms (17%). Others outcomes were also improved, but these improvements were not mediated by cognitive flexibility. CONCLUSIONS Results suggest that enhancing cognitive flexibility could help reduce rigid cognitive and behavioural patterns involved in AN, thus improving everyday functioning and clinical severity. Further studies combining different types of cognitive flexibility evaluation as well as neuroimaging may be necessary to better establish which of its aspects are involved in patients' improvement.
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Affiliation(s)
- Philibert Duriez
- GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, CMME, Paris, France.,Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Université de Paris, Paris, France
| | - Héline Kaya Lefèvre
- GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, CMME, Paris, France.,Université de Paris, LPPS, Boulogne-Billancourt, France
| | - Laura Di Lodovico
- GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, CMME, Paris, France.,Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Université de Paris, Paris, France
| | - Odile Viltart
- Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Université de Paris, Paris, France.,Cité scientifique, SN4, Université de Lille, Villeneuve d'Ascq, France
| | - Philip Gorwood
- GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, CMME, Paris, France.,Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Université de Paris, Paris, France
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13
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Hunt BJ, Smith Hagan W, Pelfrey S, Mericle S, Harper JA, Palka JM, McAdams C. Pilot data from the Self-Blame and Perspective-Taking Intervention for eating disorders. JOURNAL OF BEHAVIORAL AND COGNITIVE THERAPY 2021; 31:57-66. [PMID: 34124699 PMCID: PMC8195261 DOI: 10.1016/j.jbct.2020.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Eating disorders (EDs) are characterized by altered eating behaviors and valuation of self-image, as well as difficulty establishing supportive social relationships. This pilot study evaluated feasibility, acceptability, and clinical responses to a novel and brief group-therapy intervention for EDs, the Self-Blame and Perspective-Taking Intervention (SBPI). The SBPI consisted of four sessions of experiential art therapy activities in conjunction with psychoeducation targeting interpersonal attributions and mentalization. Twenty-four outpatient, treatment-seeking women with EDs participated in the SBPI, with 87.5% completing the intervention and 94% rating their participation positively. ED symptoms, depression, anxiety, self-attribution bias, and self-esteem were assessed before (T1) and after participation (N = 20 at T2; N = 18 at T3). Separate repeated measures MANOVAs were performed to assess these clinical and self-concept variables. Relative to baseline, participants demonstrated significant improvements in two all self-concept measures: self-attribution bias, trait self-esteem and state self-esteem at T2. ED, depression, and anxiety symptoms were significantly decreased at both T2 (1-4 weeks post) and T3 (3-5 months post). The SBPI altered self-concept targets acutely and led to sustained clinical improvements. Future work is needed to evaluate how self-concept and social constructs are related to clinical symptom expression in EDs.
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Affiliation(s)
- Bethany J Hunt
- Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, USA 75390-9070
| | - Whitney Smith Hagan
- Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, USA 75390-9070
| | - Sarah Pelfrey
- Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, USA 75390-9070
| | - Susan Mericle
- Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, USA 75390-9070
| | - Jessica A Harper
- Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, USA 75390-9070
| | - Jayme M Palka
- Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, USA 75390-9070
| | - Carrie McAdams
- Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, USA 75390-9070
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14
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Quiles Marcos Y, León Zarceño E, López López JA. Effectiveness of exercise‐based interventions in patients with anorexia nervosa: A systematic review. EUROPEAN EATING DISORDERS REVIEW 2020. [DOI: 10.1002/erv.2789] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Yolanda Quiles Marcos
- Department of Behavioral Sciences and Health Miguel Hernández University Elche Spain
| | - Eva León Zarceño
- Department of Behavioral Sciences and Health Miguel Hernández University Elche Spain
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15
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Rylander M, Taylor G, Bennett S, Pierce C, Keniston A, Mehler PS. Evaluation of cognitive function in patients with severe anorexia nervosa before and after medical stabilization. J Eat Disord 2020; 8:35. [PMID: 32760588 PMCID: PMC7393847 DOI: 10.1186/s40337-020-00312-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/01/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The purpose of this study was to quantify cognitive deficits in severe anorexia nervosa (AN) before and after medical stabilization. METHODS This was a prospective study of 40 females between the ages of 18 and 50 admitted to a medical stabilization unit with severe AN (%IBW < 70). The primary outcome of the study was change in test scores on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) at baseline and after medical stabilization. RESULTS There were no statistically significant differences in baseline RBANS scores between AN patients overall and controls (p = 0.0940). There was a statistically significant change in RBANS from baseline 94.1 + 12.7 to medical stabilization 97.1 + 10.6 (p = 0.0173), although notably both mean values fell within the average range. There were no significant differences in baseline RBANS scores between controls and AN-BP patients (p = 0.3320) but significant differences were found between controls and AN-R patients (p = 0.0434). CONCLUSIONS No baseline deficits in cognition were found in this sample of women with severe AN.
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Affiliation(s)
- Melanie Rylander
- Departments of Internal Medicine and Psychiatry, Denver Health Medical Center, University of Colorado School of Medicine, 777 Bannock St, Denver, CO 80204 USA
| | - Gillian Taylor
- Department of Psychiatry, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO 80204 USA
| | - Susan Bennett
- Department of Psychiatry, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO 80204 USA
| | - Christopher Pierce
- Department of Psychiatry, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO 80204 USA
| | - Angela Keniston
- Department of Internal Medicine, University of Colorado School of Medicine, Denver, CO 80204 USA
| | - Philip S. Mehler
- ACUTE Center for Eating Disorders, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO 80204 USA
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16
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Collu R, Post JM, Scherma M, Giunti E, Fratta W, Lutz B, Fadda P, Bindila L. Altered brain levels of arachidonic acid-derived inflammatory eicosanoids in a rodent model of anorexia nervosa. Biochim Biophys Acta Mol Cell Biol Lipids 2019; 1865:158578. [PMID: 31778792 DOI: 10.1016/j.bbalip.2019.158578] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 11/13/2019] [Accepted: 11/15/2019] [Indexed: 12/20/2022]
Abstract
Increasing evidence underline the role of inflammation in the behavioral, emotional and cognitive dysregulations displayed in anorexia nervosa (AN). Among the inflammatory mediators acting at both peripheral and central levels, growing attention receives a class of lipids derived from arachidonic acid (AA), called eicosanoids (eiCs), which exert a complex, multifaceted role in a wide range of neuroinflammatory processes, peripheral inflammation, and generally in immune system function. To date, little is known about their possible involvement in the neurobiological underpinnings of AN. The present study evaluated whether the activity-based model of AN (ABA) may alter AA-metabolic pathways by changing the levels of AA-derived eiCs in specific brain areas implicated in the development of the typical anorexic-like phenotype, i.e. in prefrontal cortex, cerebral cortex, nucleus accumbens, caudate putamen, amygdala, hippocampus, hypothalamus and cerebellum. Our results point to brain region-specific alterations of the cyclooxygenase (COX), lipoxygenase (LOX) and cytochrome P450 epoxygenase (CYP) metabolic pathways rendering altered levels of AA-derived eiCs (i.e. prostaglandins, thromboxanes and hydroxyeicosatetraenoic acids) in response to induction of and recovery from the ABA condition. These changes, supported by altered messenger RNA (mRNA) levels of genes coding for enzymes involved in eiCs-related methabolic pathways (i.e., PLA2, COX-2, 5-LOX and 15-LOX), underlie a widespread brain dysregulation of pro- and anti-inflammatory eiC-mediated processes in the ABA model of AN. These data suggest the importance of eiCs signaling within corticolimbic areas in regulating key neurobehavioral functions and highlight eiCs as biomarker candidates for monitoring the onset and development of AN, and/or as possible targets for pharmacological management.
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Affiliation(s)
- Roberto Collu
- Department of Biomedical Sciences, Division of Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy
| | - Julia Maria Post
- Institute of Physiological Chemistry, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Maria Scherma
- Department of Biomedical Sciences, Division of Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy
| | - Elisa Giunti
- Department of Biomedical Sciences, Division of Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy
| | - Walter Fratta
- Department of Biomedical Sciences, Division of Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy; Centre of Excellence "Neurobiology of Addiction", University of Cagliari, Cagliari, Italy
| | - Beat Lutz
- Institute of Physiological Chemistry, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Paola Fadda
- Department of Biomedical Sciences, Division of Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy; Centre of Excellence "Neurobiology of Addiction", University of Cagliari, Cagliari, Italy; CNR Institute of Neuroscience - Cagliari, National Research Council, Cagliari, Italy; National Neuroscience Institute, Italy.
| | - Laura Bindila
- Institute of Physiological Chemistry, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
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17
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Tomba E, Tecuta L, Crocetti E, Squarcio F, Tomei G. Residual eating disorder symptoms and clinical features in remitted and recovered eating disorder patients: A systematic review with meta-analysis. Int J Eat Disord 2019; 52:759-776. [PMID: 31169332 DOI: 10.1002/eat.23095] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 04/29/2019] [Accepted: 05/03/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE In psychiatry, the presence of residual symptoms after treatment is linked to the definitions of remission and recovery. To identify the presence of residual eating disorder (ED) symptoms and associated non-ED clinical features in remitted and recovered EDs, the current systematic review with meta-analysis was performed. METHOD A systematic review was conducted on residual ED symptoms and non-ED clinical features including comorbid psychopathology, neurophysiological functioning, cognitive functioning, and quality of life in ED patients considered remitted or recovered. To examine residual ED symptoms, meta-analyses were performed while considering age, study quality, remission, and recovery criteria strictness as moderators. Sensitivity, publication bias, and heterogeneity analyses were also conducted. RESULTS The 64 studies selected for the systematic review underscored the presence of residual ED symptoms in anorexia nervosa (AN) and bulimia nervosa (BN), and impairments and deficits in the additional features examined. From the 64 studies, 31 were selected regarding residual ED symptoms in AN for meta-analysis. Large effect sizes indicated that remitted/recovered AN patients reported significantly lower body mass index (Hedges' g = -0.62[-0.77, -0.46]) and significantly greater symptomatology in terms of ED examination-questionnaire (Hedges'g = 0.86 [0.48,1.23]) and ED inventory (Hedges' g = 0.94[0.64,1.24]) than healthy controls, independently of remission and recovery criteria strictness, age, and study quality. DISCUSSION The presence of residual ED symptoms in AN is quantitatively supported, whereas the presence of residual ED symptoms in BN should be further investigated. Data on binge-eating disorder are missing. Future research should use consistent, multicomponent, and standardized comparable indicators of recovery.
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Affiliation(s)
- Elena Tomba
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Lucia Tecuta
- Department of Psychology, University of Bologna, Bologna, Italy
| | | | - Fabio Squarcio
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Giuliano Tomei
- Oxford Health NHS Foundation Trust, Department of Psychiatry, University of Oxford, Oxford, UK
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18
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Stedal K, Ely AV, Kurniadi N, Lopez E, Kaye WH, Wierenga CE. A process approach to verbal memory assessment: Exploratory evidence of inefficient learning in women remitted from anorexia nervosa. J Clin Exp Neuropsychol 2019; 41:653-663. [PMID: 31060425 DOI: 10.1080/13803395.2019.1610160] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Anorexia nervosa (AN) is associated with deficits in set-shifting and cognitive flexibility, yet less is known about the persistence of these deficits after recovery and how they might contribute to reported difficulties organizing and learning new information. To address this question, the current study applied a process-focused approach, that accounts for errors and strategies by which a score is achieved, to investigate the relationship between verbal memory and executive function in women remitted from AN. Method: Twenty-six women remitted from anorexia nervosa (RAN) and 25 control women (CW) aged 19-45 completed the California Verbal Learning Test, Second edition (CVLT-II) and the Wisconsin Card Sorting Test (WCST). Groups were compared on overall achievement scores, and on repetition, intrusion, and perseverative errors on both tests. Associations between learning and memory performance and WCST errors were also examined. Results: RAN and CW groups did not differ on overall CVLT-II learning and memory performance or errors on the WCST, though the RAN group trended towards greater WCST non-perseverative and total errors. On the CVLT-II, the RAN group made significantly more repetition errors than CW (p = 0.010), and within-trial perseveration (WTP) errors (p = 0.044). For the CW group, CVLT-II learning and memory performance were negatively associated with errors on the WCST, whereas among RAN, primarily delayed memory was negatively correlated with WCST errors. Notably, for RAN, greater WCST perseverative responses were correlated with greater CVLT-II repetition and WTP errors, showing the convergence of perseverative responding across tasks. Conclusions: Despite similar overall learning and memory performance, difficulties with executive control seem to persist even after symptom remission in patients with AN. Results indicate an inefficient learning process in the cognitive phenotype of AN and support the use of process approaches to refine neuropsychological assessment of AN by accounting for strategy use.
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Affiliation(s)
- Kristin Stedal
- a Regional Department for Eating Disorders, Division of Mental Health and Addiction , Oslo University Hospital , Oslo , Norway
| | - Alice V Ely
- b Department of Heart and Vascular Care , Christiana Care Health System , Newark , DE , USA
| | - Natalie Kurniadi
- c Department of Clinical Psychology , Alliant International University , San Diego , CA , USA
| | - Emily Lopez
- d Department of Psychiatry , University of California San Diego , La Jolla , CA , USA
| | - Walter H Kaye
- d Department of Psychiatry , University of California San Diego , La Jolla , CA , USA
| | - Christina E Wierenga
- d Department of Psychiatry , University of California San Diego , La Jolla , CA , USA
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19
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Brodrick B, Harper JA, Van Enkevort E, McAdams CJ. Treatment Utilization and Medical Problems in a Community Sample of Adult Women With Anorexia Nervosa. Front Psychol 2019; 10:981. [PMID: 31130898 PMCID: PMC6509221 DOI: 10.3389/fpsyg.2019.00981] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 04/12/2019] [Indexed: 11/13/2022] Open
Abstract
Anorexia nervosa (AN) has a prolonged course of illness, making both defining recovery and determining optimal outpatient treatments difficult. Here, we report the types of treatments utilized in a naturalistic sample of adult women with AN in Texas. Participants were recruited from earlier studies of women with AN (n = 28) and in weight recovery following AN (n = 18). Participants provided information about both their illness and treatments during their most severe period as well as during the 2–6 years following original assessments. Based upon their baseline and follow-up clinical status participants were classified as remaining ill (AN-CC, n = 17), newly in recovery (AN-CR, n = 11), and sustained weight-recovery (AN-WR, n = 18). Utilization of health care institutions and providers were compared across groups. There were no differences in groups related to symptoms or treatments utilized during the severe-period. During the follow-up period, intensive outpatient programs were utilized significantly more by the AN-CC group than the other groups, and dietitians were seen significantly less by the AN-WR group. Medical complications related to the ED were significantly more common in the AN-CC group. All groups maintained similar levels of contact with outpatient psychiatrists, therapists, and primary care physicians. Current treatments remain ineffective for a subset of AN participants. Future prospective studies assessing medical health and comorbidities in AN may provide additional insights into disease severity and predictors of clinical outcome.
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Affiliation(s)
- Brooks Brodrick
- Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, TX, United States.,Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, United States.,Parkland Health and Hospital System Dallas, TX, United States
| | - Jessica A Harper
- Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Erin Van Enkevort
- Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Carrie J McAdams
- Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, United States.,Psychiatry, Children's Medical Center Dallas, Dallas, TX, United States
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20
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Abstract
PURPOSE OF REVIEW This review delineates issues in the conceptualization and operationalization of eating disorder recovery, highlights recent findings about recovery (since 2016), and proposes future directions. RECENT FINDINGS A longstanding problem in the field is that there are almost as many different definitions of recovery in eating disorders as there are studies on the topic. Yet, there has been a general shift to accepting that psychological/cognitive symptoms are important to recovery in addition to physical and behavioral indices. Further, several operationalizations of recovery have been proposed over the past two decades, and some efforts to validate operationalizations exist. However, this work has had limited impact and uptake, such that the field is suffering from "broken record syndrome," where calls are made for universal definitions time and time again. It is critical that proposed operationalizations be compared empirically to help arrive at a consensus definition and that institutional/organizational support help facilitate this. Themes in recent recovery research include identifying predictors, examining biological/neuropsychological factors, and considering severe and enduring anorexia nervosa. From qualitative research, those who have experienced eating disorders highlight recovery as a journey, as well as factors such as hope, self-acceptance, and benefiting from support from others as integral to the process of recovery. The field urgently needs to implement a universal definition of recovery that is backed by evidence, that can parsimoniously be implemented in clinical practice, and that will lead to greater harmonization of scientific findings.
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21
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Oldershaw A, Lavender T, Schmidt U. Are socio-emotional and neurocognitive functioning predictors of therapeutic outcomes for adults with anorexia nervosa? EUROPEAN EATING DISORDERS REVIEW 2018; 26:346-359. [PMID: 29744972 DOI: 10.1002/erv.2602] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 04/08/2018] [Accepted: 04/10/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Emotional, social, and neurocognitive factors are theorised to maintain anorexia nervosa (AN). Yet whether they predict outcomes or relate to clinical change remains unclear. METHODS Seventy-one consecutive adult outpatient eating disorder service referrals presenting with AN, who participated in a randomised controlled trial comparing 2 psychotherapies, were assessed for emotional processing, social cognition, and neurocognition pretherapy and posttherapy. Intention-to-treat analysis employed maximum-likelihood methods to model missing data. Baseline self-reported emotional processing, social cognitive, or neurocognitive task performance was entered into forward stepwise regression models with posttreatment clinical outcomes (weight, eating disorder psychopathology, psychosocial functioning) as dependent variables. Correlation analyses examined relationships between clinical and self-report/task score change. RESULTS Self-reported emotional avoidance (behavioural/cognitive avoidance, low acceptance) and submissive behaviour predicted clinical outcomes. Social cognitive (emotion recognition, emotional theory of mind) and neurocognitive performance (set-shifting, detail focus) had limited predictive ability. CONCLUSIONS Emotional avoidance and submissiveness may represent maintenance factors for AN.
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Affiliation(s)
- Anna Oldershaw
- Salomons Centre for Applied Psychology, Canterbury Christ Church University, Tunbridge Wells, UK.,Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Tony Lavender
- Salomons Centre for Applied Psychology, Canterbury Christ Church University, Tunbridge Wells, UK
| | - Ulrike Schmidt
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Eating Disorders Unit, South London and Maudsley NHS Foundation Trust, London, UK
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22
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McAdams CJ, Harper JA, Van Enkevort E. Mentalization and the left inferior frontal gyrus and insula. EUROPEAN EATING DISORDERS REVIEW 2018; 26:265-271. [PMID: 29464819 DOI: 10.1002/erv.2580] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 06/05/2017] [Accepted: 01/15/2018] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To determine if an interpersonal attribution bias associated with self-perception, the externalizing bias, was related to neural activations during mentalization. METHODS A functional magnetic resonance imaging task involving verbal appraisals measured neural activations when thinking about oneself and others in 59 adults, including healthy women as well as women with and recovered from anorexia nervosa. Whole-brain regressions correlated brain function during mentalization with the externalizing bias measured using the Internal, Personal, and Situational Attributions Questionnaire. RESULTS Women with anorexia nervosa had a lower externalizing bias, demonstrating a tendency to self-attribute more negative than positive social interactions, unlike the other groups. The externalizing bias was correlated with activation of the left inferior frontal gyrus and posterior insula, when comparing thinking about others evaluating oneself with direct self-evaluation. DISCUSSION Externalizing biases may provide an office-based assay reflecting neurocognitive disturbances in social self-perception that are common during anorexia nervosa.
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Affiliation(s)
- Carrie J McAdams
- Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Psychiatry, Children's Medical Center, Dallas, TX, USA.,Psychiatry, Texas Health Presbyterian Hospital of Dallas, Dallas, TX, USA
| | - Jessica A Harper
- Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Erin Van Enkevort
- Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
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