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Frank GKW, Shott ME, Pryor T, Swindle S, Stoddard J. Brain reward response in adolescents and young adults with anorexia nervosa is moderated by changes in body weight and sweetness perception. Int J Eat Disord 2022; 55:1799-1810. [PMID: 36135728 DOI: 10.1002/eat.23814] [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: 05/05/2022] [Revised: 08/30/2022] [Accepted: 09/07/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Anorexia nervosa (AN) is a severe psychiatric illness with complex etiology. Recently, we found elevated striatal brain response to sweet taste stimuli in adolescents and young adults with AN. Here, we tested the hypothesis that nutritional rehabilitation normalizes prediction error activation, a measure for dopamine-related reward circuit response, to salient caloric taste stimuli in AN. METHODS A total of 28 individuals with AN (age = 16 ± 2 years; body mass index [BMI] = 16 ± 1) who previously underwent brain imaging while performing a taste prediction error task using sucrose as salient caloric stimulus, participated in a second brain imaging scan (BMI = 18 ± 1) after intensive specialized eating disorder treatment (41 ± 15 days). A total of 31 healthy controls (age = 16 ± 3 years; BMI = 21 ± 2) were also studied on two occasions. RESULTS At baseline, individuals with AN demonstrated an elevated salience response in bilateral caudate head and nucleus accumbens, and right ventral striatum. At the second scan, elevated response was only found in the right nucleus accumbens. A moderator analysis indicated that greater increase in BMI and greater decrease in sweetness perception predicted lesser prediction error response at the second scan in AN. CONCLUSION Consistent with the previously reported monetary stimulus-response, elevated taste prediction error response in AN was largely absent after weight restoration. This study indicates that changes in BMI and sweet taste perception are independent moderators of change of brain salience response in adolescents and young adults with AN. The study points toward dynamic changes in the brain reward circuitry in AN and highlights the importance of nutrition and weight restoration in that process. PUBLIC SIGNIFICANCE STATEMENT AN is a severe psychiatric illness. Biological factors that integrate neurobiology and behavior could become important targets to improve treatment outcome. This study highlights the importance of weight normalization and taste perception the normalization of brain function, and food type or taste-specific interventions could help in the recovery process. Furthermore, the study suggests that food-related and nonfood-related reward processing adapts to illness state in AN.
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Affiliation(s)
- Guido K W Frank
- Department of Psychiatry, University of California San Diego, San Diego, California, USA.,Rady Children's Hospital San Diego, Medical Behavior Unit, San Diego, California, USA
| | - Megan E Shott
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | | | - Skylar Swindle
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | - Joel Stoddard
- Department of Psychiatry, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
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How Can Animal Models Inform the Understanding of Cognitive Inflexibility in Patients with Anorexia Nervosa? J Clin Med 2022; 11:jcm11092594. [PMID: 35566718 PMCID: PMC9105411 DOI: 10.3390/jcm11092594] [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] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/27/2022] [Accepted: 04/30/2022] [Indexed: 02/04/2023] Open
Abstract
Deficits in cognitive flexibility are consistently seen in patients with anorexia nervosa (AN). This type of cognitive impairment is thought to be associated with the persistence of AN because it leads to deeply ingrained patterns of thought and behaviour that are highly resistant to change. Neurobiological drivers of cognitive inflexibility have some commonalities with the abnormal brain functional outcomes described in patients with AN, including disrupted prefrontal cortical function, and dysregulated dopamine and serotonin neurotransmitter systems. The activity-based anorexia (ABA) model recapitulates the key features of AN in human patients, including rapid weight loss caused by self-starvation and hyperactivity, supporting its application in investigating the cognitive and neurobiological causes of pathological weight loss. The aim of this review is to describe the relationship between AN, neural function and cognitive flexibility in human patients, and to highlight how new techniques in behavioural neuroscience can improve the utility of animal models of AN to inform the development of novel therapeutics.
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Zha R, Li P, Liu Y, Alarefi A, Zhang X, Li J. The orbitofrontal cortex represents advantageous choice in the Iowa gambling task. Hum Brain Mapp 2022; 43:3840-3856. [PMID: 35476367 PMCID: PMC9294296 DOI: 10.1002/hbm.25887] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 02/19/2022] [Accepted: 03/18/2022] [Indexed: 01/26/2023] Open
Abstract
A good‐based model, the central neurobiological model of economic decision‐making, proposes that the orbitofrontal cortex (OFC) represents binary choice outcome, that is, the chosen good. A good is defined by a group of determinants characterizing the conditions in which the commodity is offered, including commodity type, cost, risk, time delay, and ambiguity. Previous studies have found that the OFC represents the binary choice outcome in decision‐making tasks involving commodity type, cost, risk, and delay. Real‐life decisions are often complex and involve uncertainty, rewards, and penalties; however, whether the OFC represents binary choice outcomes in a complex decision‐making situation, for example, Iowa gambling task (IGT), remains unclear. Here, we propose that the OFC represents binary choice outcome, that is, advantageous choice versus disadvantageous choice, in the IGT. We propose two hypotheses: first, the activity pattern in the human OFC represents an advantageous choice; and second, choice induces an OFC‐related functional network. Using functional magnetic resonance imaging and advanced machine‐learning tools, we found that the OFC represented an advantageous choice in the IGT. The OFC representation of advantageous choice was related to decision‐making performance. Choice modulated the functional connectivity between the OFC and the superior medial gyrus. In conclusion, the OFC represents an advantageous choice during the IGT. In the framework of a good‐based model, the results extend the role of the OFC to complex decision‐making situation when making a binary choice.
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Affiliation(s)
- Rujing Zha
- Department of Radiology, the First Affiliated Hospital of USTC, Department of Psychology, School of Humanities & Social Science, Division of Life Science and Medicine, University of Science & Technology of China, Hefei, Anhui, China
| | - Peng Li
- Department of Automation, School of Information Science and Technology, University of Science and Technology of China, Hefei, Anhui, China
| | - Ying Liu
- Department of Radiology, the First Affiliated Hospital of USTC, Department of Psychology, School of Humanities & Social Science, Division of Life Science and Medicine, University of Science & Technology of China, Hefei, Anhui, China
| | - Abdulqawi Alarefi
- Department of Radiology, the First Affiliated Hospital of USTC, Department of Psychology, School of Humanities & Social Science, Division of Life Science and Medicine, University of Science & Technology of China, Hefei, Anhui, China
| | - Xiaochu Zhang
- Department of Radiology, the First Affiliated Hospital of USTC, Department of Psychology, School of Humanities & Social Science, Division of Life Science and Medicine, University of Science & Technology of China, Hefei, Anhui, China.,Application Technology Center of Physical Therapy to Brain Disorders, Institute of Advanced Technology, University of Science & Technology of China, Hefei, Anhui, China.,Hefei Medical Research Center on Alcohol Addiction, Affiliated Psychological Hospital of Anhui Medical University, Hefei Fourth People's Hospital, Anhui Mental Health Center, Hefei, Anhui, China.,Biomedical Sciences and Health Laboratory of Anhui Province, University of Science & Technology of China, Hefei, Anhui, China
| | - Jun Li
- Department of Automation, University of Science and Technology of China, Hefei, China
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van Elburg A, Danner UN, Sternheim LC, Lammers M, Elzakkers I. Mental Capacity, Decision-Making and Emotion Dysregulation in Severe Enduring Anorexia Nervosa. Front Psychiatry 2021; 12:545317. [PMID: 33776810 PMCID: PMC7991306 DOI: 10.3389/fpsyt.2021.545317] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 01/28/2021] [Indexed: 12/20/2022] Open
Abstract
Severe and Enduring Anorexia Nervosa (SE-AN) is a chronic eating disorder characterized by long-term starvation and its physical and psychological sequelae, and severe loss of quality of life. Interactions between neurobiological changes caused by starvation, vulnerability (personality) traits, and eating behaviors play a role. Several other factors, such as increased fear and decreased social cognition, have also been found in relation to SE-AN. With this in mind, we aim to add to the understanding of SE-AN by introducing the concept of mental capacity (MC), which refers to the ability to understand and process information-both on a cognitive and an emotional level-and then make a well-informed choice. MC may be an important construct within the context of SE-AN. Furthermore, we will argue how impaired decision-making processes may underlie, fuel, or contribute to limited MC in SE-AN. We will speculate on the importance of dysfunctional emotion processing and anxiety-related processes (e.g., a high intolerance of uncertainty) and their potential interaction with decision-making. Lastly, we will propose how these aspects, which to our knowledge have previously received little attention, may advise research and treatment or help in dealing with the "want but cannot" situation of life-threatening AN.
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Affiliation(s)
- Annemarie van Elburg
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, Netherlands.,Rintveld Center for Eating Disorders, Altrecht Mental Health Institute, Zeist, Netherlands
| | - Unna Nora Danner
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, Netherlands.,Rintveld Center for Eating Disorders, Altrecht Mental Health Institute, Zeist, Netherlands
| | - Lot Catharina Sternheim
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, Netherlands
| | | | - Isis Elzakkers
- Rintveld Center for Eating Disorders, Altrecht Mental Health Institute, Zeist, Netherlands
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Haynos AF, Lavender JM, Nelson J, Crow SJ, Peterson CB. Moving towards specificity: A systematic review of cue features associated with reward and punishment in anorexia nervosa. Clin Psychol Rev 2020; 79:101872. [PMID: 32521390 DOI: 10.1016/j.cpr.2020.101872] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 03/16/2020] [Accepted: 05/24/2020] [Indexed: 12/13/2022]
Abstract
Models of anorexia nervosa (AN) posit that symptoms are maintained through deficient reward and enhanced punishment processing. However, theoretical and empirical inconsistencies highlight the need for a more nuanced conceptualization of this literature. Our goal was to comprehensively review the research on reward and punishment responding in AN from a cue-specific lens to determine which stimuli evoke or discourage reward and punishment responses in this population, and, ultimately, what properties these rewarding and punishing cues might share. A systematic review interrogating reward and punishment responses to specific cues yielded articles (n = 92) that examined responses to disorder relevant (e.g., food) and irrelevant (e.g., money) stimuli across self-report, behavioral, and biological indices. Overall, in most studies individuals with AN exhibited aversive responses to cues signaling higher body weights, social contexts, and monetary losses, and appetitive responses to cues for weight loss behaviors and thinness. Findings were more mixed on responses to palatable food and monetary gains. Results highlight that reward and punishment responding in AN are context specific and may be affected by varied stimulus qualities (e.g., predictability, controllability, delay, effort). Increasing specificity in future research on reward and punishment mechanisms in AN will better inform development of precisely-targeted interventions.
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Affiliation(s)
- Ann F Haynos
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, United States of America.
| | - Jason M Lavender
- Military Cardiovascular Outcomes Research (MiCOR) Program, Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America; The Metis Foundation, San Antonio, TX, United States of America
| | - Jillian Nelson
- Department of Psychology, George Mason University, Fairfax, VA, United States of America
| | - Scott J Crow
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, United States of America; The Emily Program, St. Paul, MN, United States of America
| | - Carol B Peterson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, United States of America; The Emily Program, St. Paul, MN, United States of America
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