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Marcolini F, Ravaglia A, Tempia Valenta S, Bosco G, Marconi G, De Ronchi D, Atti AR. Severe enduring anorexia nervosa (SE-AN) treatment options and their effectiveness: a review of literature. J Eat Disord 2024; 12:48. [PMID: 38654374 DOI: 10.1186/s40337-024-01006-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 04/16/2024] [Indexed: 04/25/2024] Open
Abstract
INTRODUCTION For nearly 20% of patients diagnosed with Anorexia Nervosa (AN), the eating disorder (ED) is prolonged and becomes long-lasting. It has been reported that patients diagnosed with Severe Enduring Anorexia Nervosa (SE-AN) have worse ED symptoms, higher rates of lifetime hospitalization, and lower psychosocial well-being compared to patients with shorter disease duration. OBJECTIVES This review aims to describe the treatments proposed to date and their effectiveness on SE-AN-related outcomes. METHODS We conducted a PubMed search for studies addressing the issue of treatment approach to SE-AN adults, that were published between 2003 and 2023, peer-reviewed, written in the English language, and available in full-text. Next, we inductively created relevant macro-themes by synthesizing the data from the included articles. RESULTS Of 251 PubMed studies, 25 articles were considered for data extraction, all published between 2003 and 2022. We identified three macro-themes. The first macro-theme, "Psychotherapy", mostly takes into consideration treatment effectiveness of cognitive behavioral therapy (CBT). Various reports determined its greater effectiveness compared to Specialist Supportive Clinical Management (SSCM), and one study proved that outpatient CBT is a valid alternative to hospitalization. The second one involves "Pharmacological Treatments". Research on dronabinol, a synthetic orexigenic cannabinoid, antipsychotics (in particular, olanzapine and haloperidol), and ketamine showed some mixed results regarding the often-complementary areas of weight gain and improvement in ED-related symptoms. Regarding the third macro-theme, "Brain Stimulation Therapies," such as Repetitive Transcranial Magnetic Stimulation (rTMS) and Deep Brain Stimulation (DBS), we found promising results in improving ED-related psychological traits (such as mood and anxiety), affective regulation, and quality of life. However, we have observed divergent results regarding outcome measures such as BMI and weight gain. CONCLUSIONS SE-AN patients are predicted to encounter both medical complications and psychological distress of increasing severity that will inevitably affect their quality of life; to our knowledge, research evidence on treatment options for SE-AN remains limited, and the methodological quality of studies is generally low. These findings denote the need to focus future research efforts on effective treatment strategies specific to long-lasting EDs.
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Affiliation(s)
- Federica Marcolini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Viale Pepoli 5, 40123, Bologna, Italy.
| | - Alessandro Ravaglia
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Viale Pepoli 5, 40123, Bologna, Italy
| | - Silvia Tempia Valenta
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Viale Pepoli 5, 40123, Bologna, Italy
| | - Giovanna Bosco
- Department of Clinical Nutrition, AUSL Bologna, Bologna, Italy
| | - Giorgia Marconi
- U.O. Cure Primarie, AUSL Area Vasta Romagna, Ambito di Rimini, Rimini, Italy
| | - Diana De Ronchi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Viale Pepoli 5, 40123, Bologna, Italy
| | - Anna Rita Atti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Viale Pepoli 5, 40123, Bologna, Italy
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Schroeder PA, Collantoni E, Meregalli V, Rabarbari E, Simonazzi C, Svaldi J, Cardi V. Persistent avoidance of virtual food in anorexia nervosa-restrictive type: Results from motion tracking in a virtual stopping task. Int J Eat Disord 2024; 57:624-634. [PMID: 38263753 DOI: 10.1002/eat.24143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 01/05/2024] [Accepted: 01/08/2024] [Indexed: 01/25/2024]
Abstract
OBJECTIVE Food avoidance is central to patients with anorexia nervosa-restrictive type (AN-R). Competing accounts in experimental psychopathology research suggest that food avoidance may result from automatic, habitual responses or from elevated inhibitory control abilities. This study investigated behavioral trajectories of food avoidance in a novel virtual reality stopping task. METHOD Sixty patients with AN-R and 29 healthy controls with normal weight were investigated using a novel, kinematic task in virtual reality. We recorded spatial displacement in stop- and go-trials to virtual food and control objects. Inhibitory control abilities were operationalized by the VR task in stopping performance (i.e., interrupted movement in stop-trials), whereas we also measured habitual avoidance of virtual food across both go- and stop-trials (i.e., delayed movement relative to nonfood objects). RESULTS In patients with AN-R, hand displacements were shorter to food versus nonfood across stop- and go-trials, reflected in a Stimulus × Group interaction. Healthy controls showed no differences. Importantly, the food-specific effect in AN-R was identical across stop- and go-trials, indicating habitual food avoidance. Moreover, stop error rates (i.e., stop-trials with response) were lower in patients with AN-R. DISCUSSION The findings suggest food-specific habitual avoidance and heightened generalized inhibitory control in AN-R. The continuously delayed displacements during active hand movements across stop- and go-trials indicated the persistence of patients' avoidance of food. PUBLIC SIGNIFICANCE Experimental research investigates the mechanisms underlying mental disorders such as anorexia nervosa. In this study, we measured interrupted hand movements in response to food pictures or neutral pictures (shoes) in patients with anorexia nervosa and healthy controls. A virtual reality scenario was used. Findings indicated that patients were slower at approaching food, interrupted or not. Key mechanisms of food avoidance can be translated into habit-based treatment options in future research.
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Affiliation(s)
- Philipp A Schroeder
- Department of Psychology, Clinical Psychology & Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Enrico Collantoni
- Department of Neuroscience, University of Padova, Padova, Italy
- Department of General Psychology, University of Padova, Padova, Italy
| | - Valentina Meregalli
- Department of Neuroscience, University of Padova, Padova, Italy
- Department of General Psychology, University of Padova, Padova, Italy
| | - Elisa Rabarbari
- Department of General Psychology, University of Padova, Padova, Italy
| | | | - Jennifer Svaldi
- Department of Psychology, Clinical Psychology & Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Valentina Cardi
- Department of General Psychology, University of Padova, Padova, Italy
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, London, UK
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Hjerresen TS, Bentz M, Nejad AB, Raffin E, Andersen KW, Hulme OJ, Siebner HR, Plessen KJ. Performing well but not appreciating it - A trait feature of anorexia nervosa. JCPP Adv 2024; 4:e12194. [PMID: 38486955 PMCID: PMC10933629 DOI: 10.1002/jcv2.12194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 07/28/2023] [Indexed: 03/17/2024] Open
Abstract
Background Despite advances in the etiology of anorexia nervosa (AN), a large subgroup of individuals does not profit optimally from treatment. Perfectionism has been found to be a risk factor predicting the onset, severity, and duration of AN episodes. To date, perfectionism has been studied predominantly by the use of self-report questionnaires, a useful approach that may, however, be impacted by demand characteristics, or other distortions of introspective or metacognitive access. Methods Here we circumvent these problems via a behavioral paradigm in which participants perform a modified Go/NoGo task, whilst self-evaluating their performance. We compared a group of 33 adolescent females during their first episode of AN (age = 16.0) with 29 female controls (age = 16.2), and 23 adolescent girls recovered from AN (age = 18.3) with 23 female controls (age = 18.5). The controls were closely matched by intelligence quotient and age to the two clinical groups. Results First-episode AN and control participants performed equally well on the task (reaction time and errors of commission), whereas the recovered group displayed significantly faster reaction times but incurred the same error rate. Despite performing at least as good as and predominantly better than control groups, both clinical groups evaluated their performances more negatively than controls. Conclusion We offer a novel behavioral method for measuring perfectionism independent of self-report, and we provide tentative evidence that this behavioral manifestation of perfectionism is evident during first-episode AN and persists even after recovery.
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Affiliation(s)
- Tine Schuppli Hjerresen
- Child and Adolescent Mental Health CenterCopenhagen University Hospital ‐ Mental Health Services CPHCopenhagenDenmark
- Danish Research Centre for Magnetic ResonanceCentre for Functional and Diagnostic Imaging and ResearchCopenhagen University Hospital ‐ Amager and HvidovreCopenhagenDenmark
- Department of Clinical MedicineFaculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Mette Bentz
- Child and Adolescent Mental Health CenterCopenhagen University Hospital ‐ Mental Health Services CPHCopenhagenDenmark
| | | | - Estelle Raffin
- Danish Research Centre for Magnetic ResonanceCentre for Functional and Diagnostic Imaging and ResearchCopenhagen University Hospital ‐ Amager and HvidovreCopenhagenDenmark
- Defitech Chair of Clinical NeuroengineeringNeuro‐X Institute and Brain Mind Institute (BMI)Swiss Federal Institute of Technology (EPFL)GenevaSwitzerland
| | - Kasper Winther Andersen
- Danish Research Centre for Magnetic ResonanceCentre for Functional and Diagnostic Imaging and ResearchCopenhagen University Hospital ‐ Amager and HvidovreCopenhagenDenmark
| | - Oliver James Hulme
- Danish Research Centre for Magnetic ResonanceCentre for Functional and Diagnostic Imaging and ResearchCopenhagen University Hospital ‐ Amager and HvidovreCopenhagenDenmark
- London Mathematical LaboratoryLondonUK
- Department of PsychologyUniversity of CopenhagenCopenhagenDenmark
| | - Hartwig Roman Siebner
- Danish Research Centre for Magnetic ResonanceCentre for Functional and Diagnostic Imaging and ResearchCopenhagen University Hospital ‐ Amager and HvidovreCopenhagenDenmark
- Department of Clinical MedicineFaculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
- Department of NeurologyCopenhagen University Hospital Bispebjerg and FrederiksbergCopenhagenDenmark
| | - Kerstin Jessica Plessen
- Child and Adolescent Mental Health CenterCopenhagen University Hospital ‐ Mental Health Services CPHCopenhagenDenmark
- Division of Child and Adolescent PsychiatryDepartment of PsychiatryUniversity Hospital LausanneLausanneSwitzerland
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4
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Bernardoni F, King JA, Hellerhoff I, Schoemann M, Seidel M, Geisler D, Boehm I, Pauligk S, Doose A, Steding J, Gramatke K, Roessner V, Scherbaum S, Ehrlich S. Mouse-cursor trajectories reveal reduced contextual influence on decision conflict during delay discounting in anorexia nervosa. Int J Eat Disord 2023; 56:1898-1908. [PMID: 37415568 DOI: 10.1002/eat.24019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 06/05/2023] [Accepted: 06/26/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVE The capacity of individuals with anorexia nervosa (AN) to forgo immediate food rewards in their long-term pursuit of thinness is thought to reflect elevated self-control and/or abnormal reward sensitivity. Prior research attempted to capture an increased tendency to delay gratification in AN using delay-discounting tasks that assess how rapidly the subjective value of rewards decreases as a function of time until receipt. However, significant effects were mostly subtle or absent. Here, we tested whether the process leading to such decisions might be altered in AN. METHOD We recorded mouse-cursor movement trajectories leading to the final choice in a computerized delay-discounting task (238 trials) in 55 acutely underweight females with AN and pairwise age-matched female healthy controls (HC). We tested for group differences in deviations from a direct choice path, a measure of conflict strength in decision making, and whether group moderated the effect of several predictors of conflict strength (e.g., choice difficulty, consistency). We also explored reaction times and changes in trajectory directions (X-flips). RESULTS No group differences in delay-discounting parameters or movement trajectories were detected. However, the effect of the aforementioned predictors on deviations (and to a lesser extent reaction times) was reduced in AN. DISCUSSION These findings suggest that while delay discounting and conflict strength in decision making are generally unaltered in AN, conflict strength was more stable across different decisions in the disorder. This might enable individuals with AN to pursue (maladaptive) long-term body-weight goals, because particularly conflicting choices may not be experienced as such. PUBLIC SIGNIFICANCE The deviations from a direct path of mouse-cursor movements during a computerized delay-discounting task varied less in people with anorexia nervosa. Assuming such deviations measure decision conflict, we speculate that this increased stability might help people with anorexia nervosa achieve their long-term weight goals, as for them the struggle with the decision to eat high-calorie meals when hungry will be milder, so they would be more likely to skip them.
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Affiliation(s)
- Fabio Bernardoni
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Joseph A King
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Inger Hellerhoff
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Dresden, Germany
- Eating Disorder Treatment and Research Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Martin Schoemann
- Department of Psychology, Faculty of Natural sciences, TU Dresden, Dresden, Germany
| | - Maria Seidel
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Daniel Geisler
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Ilka Boehm
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Sophie Pauligk
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Arne Doose
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Julius Steding
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Katrin Gramatke
- Eating Disorder Treatment and Research Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, University Hospital C. G. Carus, Technische Universität Dresden, Dresden, Germany
| | - Stefan Scherbaum
- Eating Disorder Treatment and Research Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Stefan Ehrlich
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Dresden, Germany
- Eating Disorder Treatment and Research Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
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5
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Zhong S, Su T, Gong J, Huang L, Wang Y. Brain functional alterations in patients with anorexia nervosa: A meta-analysis of task-based functional MRI studies. Psychiatry Res 2023; 327:115358. [PMID: 37544086 DOI: 10.1016/j.psychres.2023.115358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 07/16/2023] [Accepted: 07/21/2023] [Indexed: 08/08/2023]
Abstract
The goal of this study was to discern the neural activation patterns associated with anorexia nervosa (AN) in response to tasks related to body-, food-, emotional-, cognitive-, and reward- processing. A meta-analysis was performed on task-based fMRI studies, revealing that patients with AN showed increased activity in the left superior temporal gyrus and bilaterally in the ACC during a reward-related task. During cognitive-related tasks, patients with AN also showed increased activity in the left superior parietal gyrus, right middle temporal gyrus, but decreased activity in the MCC. Additionally, patients with AN showed increased activity bilaterally in the cerebellum, MCC, and decreased activity bilaterally in the bilateral precuneus/PCC, right middle temporal gyrus, left ACC when they viewed food images. During emotion-related tasks, patients with AN showed increased activity in the left cerebellum, but decreased activity bilaterally in the striatum, right mPFC, and right superior parietal gyrus. Patients with AN also showed increased activity in the right striatum and decreased activity in the right inferior temporal gyrus and bilaterally in the mPFC during body-related tasks. The present meta-analysis provides a comprehensive overview of the patterns of brain activity evoked by task stimuli, thereby augmenting the current comprehension of the pathophysiology in AN.
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Affiliation(s)
- Shuming Zhong
- Department of Psychiatry, First Affiliated Hospital, Jinan University, Guangzhou 510630, China
| | - Ting Su
- Medical Imaging Center, First Affiliated Hospital, Jinan University, Guangzhou 510630, China
| | - Jiaying Gong
- Institute of Molecular and Functional Imaging, Jinan University, Guangzhou 510630, China; Department of Radiology, Six Affiliated Hospital of Sun Yat-sen University, Guangzhou 510655, China
| | - Li Huang
- Medical Imaging Center, First Affiliated Hospital, Jinan University, Guangzhou 510630, China
| | - Ying Wang
- Medical Imaging Center, First Affiliated Hospital, Jinan University, Guangzhou 510630, China; Institute of Molecular and Functional Imaging, Jinan University, Guangzhou 510630, China.
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Berner LA, Harlé KM, Simmons AN, Yu A, Paulus MP, Bischoff-Grethe A, Wierenga CE, Bailer UF, Kaye WH. State-specific alterations in the neural computations underlying inhibitory control in women remitted from bulimia nervosa. Mol Psychiatry 2023; 28:3055-3062. [PMID: 37106117 PMCID: PMC10133909 DOI: 10.1038/s41380-023-02063-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 03/20/2023] [Accepted: 03/28/2023] [Indexed: 04/29/2023]
Abstract
The neurocomputational processes underlying bulimia nervosa and its primary symptoms, out-of-control overeating and purging, are poorly understood. Research suggests that the brains of healthy individuals form a dynamic internal model to predict whether control is needed in each moment. This study tested the hypothesis that this computational process of inhibitory control is abnormally affected by metabolic state (being fasted or fed) in bulimia nervosa. A Bayesian ideal observer model was fit to behavioral data acquired from 22 women remitted from bulimia nervosa and 20 group-matched controls who completed a stop-signal task during two counterbalanced functional MRI sessions, one after a 16 h fast and one after a meal. This model estimates participants' trial-by-trial updating of the probability of a stop signal based on their experienced trial history. Neural analyses focused on control-related Bayesian prediction errors, which quantify the direction and degree of "surprise" an individual experiences on any given trial. Regardless of group, metabolic state did not affect behavioral performance on the task. However, metabolic state modulated group differences in neural activation. In the fed state, women remitted from bulimia nervosa had attenuated prediction-error-dependent activation in the left dorsal caudate. This fed-state activation was lower among women with more frequent past binge eating and self-induced vomiting. When they are in a fed state, individuals with bulimia nervosa may not effectively process unexpected information needed to engage inhibitory control. This may explain the difficulties these individuals have stopping eating after it begins.
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Affiliation(s)
- Laura A Berner
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Katia M Harlé
- Department of Psychiatry, University of California, San Diego, CA, USA
- VA San Diego Healthcare System, San Diego, CA, USA
| | - Alan N Simmons
- Department of Psychiatry, University of California, San Diego, CA, USA
- VA San Diego Healthcare System, San Diego, CA, USA
| | - Angela Yu
- Department of Psychiatry, University of California, San Diego, CA, USA
- Centre for Cognitive Science & Hessian AI Center, Technical University of Darmstadt, Darmstadt, Germany
| | - Martin P Paulus
- Department of Psychiatry, University of California, San Diego, CA, USA
- Laureate Institute for Brain Research, Tulsa, OK, USA
| | | | - Christina E Wierenga
- Department of Psychiatry, University of California, San Diego, CA, USA
- VA San Diego Healthcare System, San Diego, CA, USA
| | - Ursula F Bailer
- Department of Psychiatry, University of California, San Diego, CA, USA
- Department of Psychiatry and Psychotherapy, Division of Biological Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Walter H Kaye
- Department of Psychiatry, University of California, San Diego, CA, USA
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7
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Fürtjes S, Seidel M, Diestel S, Wolff M, King JA, Hellerhoff I, Bernadoni F, Gramatke K, Goschke T, Roessner V, Ehrlich S. Real-Life Self-Control Conflicts in Anorexia Nervosa: An Ecological Momentary Assessment Investigation. Eur Psychiatry 2022; 65:e39. [PMID: 35707860 PMCID: PMC9280923 DOI: 10.1192/j.eurpsy.2022.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Individuals with anorexia nervosa (AN) are often thought to show heightened self-control and increased ability to inhibit desires. In addition to inhibitory self-control, antecedent-focused strategies (e.g., cognitive reconstrual—the re-evaluation of tempting situations) might contribute to disorder maintenance and enable disorder-typical, maladaptive behaviors. Methods Over a period of 14 days, 40 acutely underweight young female patients with anorexia nervosa (AN) and 40 healthy control (HC) participants reported their affect and behavior in self-control situations via ecological momentary assessment during inpatient treatment (AN) and everyday life (HC). Data were analyzed via hierarchical analyses (linear and logistic modeling). Results Conflict strength had a significantly lower impact on self-control success in AN compared to HC. While AN and HC did not generally differ in the number or strength of self-control conflicts or in the percentage of self-control success, AN reported self-controlled behavior to be less dependent on conflict strength. Conclusions While patients with AN were not generally more successful at self-control, they appeared to resolve self-control conflicts more effectively. These findings suggest that the magnitude of self-control conflicts has comparatively little impact on individuals with AN, possibly due to the use of antecedent-focused strategies. If confirmed, cognitive-behavioral therapy might focus on and help patients to exploit these alternative self-control strategies in the battle against their illness.
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Affiliation(s)
- Sophia Fürtjes
- 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
| | - Stefan Diestel
- Schumpeter School of Business and Economics, Faculty of Economy, University of Wuppertal, Wuppertal, Germany
| | - Max Wolff
- MIND Foundation, Berlin, Germany.,Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Berlin, 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
| | - 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
| | - Fabio Bernadoni
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Katrin Gramatke
- Eating Disorder Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Thomas Goschke
- Department of Psychology, Technische Universität Dresden, Dresden, Germany
| | - Veit Roessner
- Eating Disorder Research and Treatment Center, Department of Child and Adolescent Psychiatry, 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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Thomas KS, Birch RE, Jones CRG, Vanderwert RE. Neural Correlates of Executive Functioning in Anorexia Nervosa and Obsessive-Compulsive Disorder. Front Hum Neurosci 2022; 16:841633. [PMID: 35693540 PMCID: PMC9179647 DOI: 10.3389/fnhum.2022.841633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
Anorexia nervosa (AN) and obsessive-compulsive disorder (OCD) are commonly reported to co-occur and present with overlapping symptomatology. Executive functioning difficulties have been implicated in both mental health conditions. However, studies directly comparing these functions in AN and OCD are extremely limited. This review provides a synthesis of behavioral and neuroimaging research examining executive functioning in AN and OCD to bridge this gap in knowledge. We outline the similarities and differences in behavioral and neuroimaging findings between AN and OCD, focusing on set shifting, working memory, response inhibition, and response monitoring. This review aims to facilitate understanding of transdiagnostic correlates of executive functioning and highlights important considerations for future research. We also discuss the importance of examining both behavioral and neural markers when studying transdiagnostic correlates of executive functions.
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Affiliation(s)
- Kai S. Thomas
- School of Psychology, Cardiff University, Cardiff, United Kingdom
- Cardiff University Centre for Human Developmental Science, School of Psychology, Cardiff University, Cardiff, United Kingdom
| | | | - Catherine R. G. Jones
- School of Psychology, Cardiff University, Cardiff, United Kingdom
- Cardiff University Centre for Human Developmental Science, School of Psychology, Cardiff University, Cardiff, United Kingdom
| | - Ross E. Vanderwert
- School of Psychology, Cardiff University, Cardiff, United Kingdom
- Cardiff University Centre for Human Developmental Science, School of Psychology, Cardiff University, Cardiff, United Kingdom
- Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University, Cardiff, United Kingdom
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9
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Bulik CM, Coleman JRI, Hardaway JA, Breithaupt L, Watson HJ, Bryant CD, Breen G. Genetics and neurobiology of eating disorders. Nat Neurosci 2022; 25:543-54. [PMID: 35524137 DOI: 10.1038/s41593-022-01071-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 04/01/2022] [Indexed: 12/14/2022]
Abstract
Eating disorders (anorexia nervosa, bulimia nervosa and binge-eating disorder) are a heterogeneous class of complex illnesses marked by weight and appetite dysregulation coupled with distinctive behavioral and psychological features. Our understanding of their genetics and neurobiology is evolving thanks to global cooperation on genome-wide association studies, neuroimaging, and animal models. Until now, however, these approaches have advanced the field in parallel, with inadequate cross-talk. This review covers overlapping advances in these key domains and encourages greater integration of hypotheses and findings to create a more unified science of eating disorders. We highlight ongoing and future work designed to identify implicated biological pathways that will inform staging models based on biology as well as targeted prevention and tailored intervention, and will galvanize interest in the development of pharmacologic agents that target the core biology of the illnesses, for which we currently have few effective pharmacotherapeutics.
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Foldi CJ, Morris MJ, Oldfield BJ. Executive function in obesity and anorexia nervosa: Opposite ends of a spectrum of disordered feeding behaviour? Prog Neuropsychopharmacol Biol Psychiatry 2021; 111:110395. [PMID: 34217755 DOI: 10.1016/j.pnpbp.2021.110395] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/26/2021] [Accepted: 06/29/2021] [Indexed: 02/02/2023]
Abstract
Higher-order executive functions such as decision-making, cognitive flexibility and behavioural control are critical to adaptive success in all aspects of life, including the maintenance of a healthy body weight by regulating food intake. Performance on tasks designed to assess these aspects of cognition is impaired in individuals with obesity and anorexia nervosa (AN); conditions at either end of a spectrum of body weight disturbance. While the conceptualisation of obesity and AN as mirror images of each other makes some sense from a metabolic point of view, whether or not these conditions also reflect opposing states of executive function is less clear. Here, we review evidence from neurocognitive and neuroimaging studies to compare the direction and extent of executive dysfunction in subjects with obesity and AN and how these are underpinned by changes in structure and function of subregions of the prefrontal cortex (PFC). Both conditions of extreme body weight disturbance are associated with impaired decision-making and cognitive inflexibility, however, impulsive behaviour presents in opposing directions; obesity being associated with reduced behavioural control and AN being associated with elevated control over behaviour with respect to food and feeding. Accordingly, the subregions of the PFC that guide inhibitory control and valuation of action outcomes (dorsolateral prefrontal cortex and orbitofrontal cortex) show opposite patterns of activation in subjects with obesity compared to those with AN, whereas the subregions implicated in cognitive and behavioural flexibility (ventromedial prefrontal cortex and anterior cingulate cortex) show alterations in the same direction in both conditions but with differential extent of dysfunction. We synthesise these findings in the context of the utility of animal models of obesity and AN to interrogate the detail of the neurobiological contributions to cognition in patient populations and the utility of such detail to inform future treatment strategies that specifically target executive dysfunction.
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Affiliation(s)
- Claire J Foldi
- Department of Physiology, Monash University, 26 Innovation Walk, Clayton 3800, Australia; Monash Biomedicine Discovery Institute, 23 Innovation Walk, Clayton 3800, Australia.
| | - Margaret J Morris
- School of Medical Sciences, UNSW Sydney, High Street, Randwick 2052, Australia
| | - Brian J Oldfield
- Department of Physiology, Monash University, 26 Innovation Walk, Clayton 3800, Australia; Monash Biomedicine Discovery Institute, 23 Innovation Walk, Clayton 3800, Australia
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11
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Suttkus S, Schumann A, De la Cruz F, Bär KJ. Attenuated neuronal and autonomic responses during error processing in anorexia nervosa. Brain Behav 2021; 11:e2235. [PMID: 34318622 PMCID: PMC8413769 DOI: 10.1002/brb3.2235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/03/2021] [Accepted: 05/23/2021] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Anorexia nervosa (AN) is a severe psychiatric illness with alarming mortality rates. Nevertheless, despite former and recent research results, the etiology of AN is still poorly understood. Of particular interest is that, despite exaggerated response control and increased perfectionism scores, patients with AN seem not to perform better that those unaffected in tasks that require inhibitory control. One reason might be aberrant processing of errors. The objective of our study was thus to obtain further insight into the pathopsychology of AN. We were particularly interested in neuronal and autonomic responses during error processing and their association with behavior. METHODS We analyzed 16 acute patients suffering from restrictive type AN and 21 healthy controls using functional magnetic resonance imaging (fMRI) with simultaneous physiological recordings during a Go/Nogo response inhibition task. Data were corrected for noise due to cardiac and respiratory influence. RESULTS Patients and controls had similarly successful response inhibition in Nogo trials. However, in failed Nogo trials, controls had significantly greater skin conductance responses (SCR) than in correct Nogo trials. Patients did not exhibit elevated SCR to errors. Furthermore, we found significantly increased neuronal responses, especially in the amygdala and hippocampus, in controls compared to patients during error trials. We also found significant positive correlations in controls but not in patients between Nogo performance and activation in the salience network core regions after errors. CONCLUSION Acute restrictive type AN patients seem to lack neuronal and autonomic responses to errors that might impede a flexible behavior adaption.
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Affiliation(s)
- Stefanie Suttkus
- Lab for Autonomic Neuroscience, Imaging and Cognition (LANIC), Department of Psychosomatic Medicine and Psychotherapy, Jena University, Jena, Germany
| | - Andy Schumann
- Lab for Autonomic Neuroscience, Imaging and Cognition (LANIC), Department of Psychosomatic Medicine and Psychotherapy, Jena University, Jena, Germany
| | - Feliberto De la Cruz
- Lab for Autonomic Neuroscience, Imaging and Cognition (LANIC), Department of Psychosomatic Medicine and Psychotherapy, Jena University, Jena, Germany
| | - Karl-Jürgen Bär
- Lab for Autonomic Neuroscience, Imaging and Cognition (LANIC), Department of Psychosomatic Medicine and Psychotherapy, Jena University, Jena, Germany
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12
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Tenconi E, Collantoni E, Meregalli V, Bonello E, Zanetti T, Veronese A, Meneguzzo P, Favaro A. Clinical and Cognitive Functioning Changes After Partial Hospitalization in Patients With Anorexia Nervosa. Front Psychiatry 2021; 12:653506. [PMID: 33959056 PMCID: PMC8093567 DOI: 10.3389/fpsyt.2021.653506] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 03/19/2021] [Indexed: 12/21/2022] Open
Abstract
Introduction: Anorexia nervosa is usually associated with emotional and cognitive difficulties. Little knowledge is available about the changes in cognitive functioning in patients undergoing treatments. The aim of the present study was to longitudinally assess the impact of partial hospitalization on clinical and cognitive functioning in anorexia nervosa. Materials and Methods: 56 women with anorexia nervosa according to DSM-5 criteria and 58 healthy women were enrolled in the study. At baseline, all participants underwent clinical, diagnostic and neuropsychological assessment (T0). Patients were also assessed at the end of the treatment program (T1; n = 56). Results: BMI improved significantly throughout treatment. At baseline, patients showed significantly poorer executive abilities and less specific autobiographical memory. After the day-hospital program, decision-making abilities improved significantly. Response to treatment was predicted by BMI at admission and duration of illness, but neuropsychological performance did not contribute to the prediction model. Discussion: Cognitive difficulties, mostly regarding executive functions, resulted differently affected by clinical improvement. In particular, while cognitive monitoring and cognitive inhibition appear to be mostly stable trait-like characteristics, decision-making is both more state-dependent and sensitive to clinical status. None of the cognitive variables added information about the response to day hospital treatment; patients with short duration of illness and a rapidly decreasing BMI would benefit more from intensive interventions than less "acute" patients. These observations, if confirmed by future studies, have important clinical implications in order to understand the impact of malnutrition on cognitive functioning and to provide individualized effective treatment for patients with anorexia nervosa.
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Affiliation(s)
- Elena Tenconi
- Department of Neuroscience, University of Padova, Padua, Italy
- Padova Neuroscience Center, University of Padova, Padua, Italy
| | | | - Valentina Meregalli
- Department of Neuroscience, University of Padova, Padua, Italy
- Padova Neuroscience Center, University of Padova, Padua, Italy
| | - Elisa Bonello
- Department of Neuroscience, University of Padova, Padua, Italy
| | - Tatiana Zanetti
- Department of Neuroscience, University of Padova, Padua, Italy
| | - Angela Veronese
- Department of Neuroscience, University of Padova, Padua, Italy
| | - Paolo Meneguzzo
- Department of Neuroscience, University of Padova, Padua, Italy
| | - Angela Favaro
- Department of Neuroscience, University of Padova, Padua, Italy
- Padova Neuroscience Center, University of Padova, Padua, Italy
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13
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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14
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Wonderlich JA, Bershad M, Steinglass JE. Exploring Neural Mechanisms Related to Cognitive Control, Reward, and Affect in Eating Disorders: A Narrative Review of FMRI Studies. Neuropsychiatr Dis Treat 2021; 17:2053-2062. [PMID: 34188475 PMCID: PMC8232881 DOI: 10.2147/ndt.s282554] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/04/2021] [Indexed: 12/23/2022] Open
Abstract
Studies using functional magnetic resonance imaging (fMRI) have contributed to our understanding of possible neural abnormalities among individuals with eating disorders. Many of these studies have focused on three domains: 1) cognitive control, 2) reward processing, and 3) affective processing. This review attempts to summarize the recent fMRI findings across these domains among the most well-characterized eating disorders: anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). Though the literature is a bit murky, a few major themes have emerged. Cognitive control systems are affected among individuals across eating disorder diagnoses, but effects seem least pronounced in AN. Specifically, individuals with all eating disorders appear to show decreased prefrontal activation during cognitive control, but there is less evidence in AN linking decreased prefrontal activation with behavior. There is some evidence that the reinforcing value of food is reduced in AN, but individuals with BN and BED show hyperactivation to rewarding food-related stimuli, suggesting the reinforcing value of food may be enhanced. However, more complex reward processing paradigms show that individuals with BN and BED exhibit hypoactivation to reward anticipation and provide mixed results with regards to reward receipt. There are fewer neuroimaging findings related to affective processing, yet behavioral findings suggest affective processing is important in understanding eating disorders. Though the extant literature is complicated, these studies represent a foundation from which to build and provide insight into potential neurobiological mechanisms that may contribute to the pathophysiology of eating disorders.
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Affiliation(s)
- Joseph A Wonderlich
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA.,Department of Psychiatry, New York State Psychiatric Institute, New York, NY, USA
| | - Mariya Bershad
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA.,Department of Psychiatry, New York State Psychiatric Institute, New York, NY, USA
| | - Joanna E Steinglass
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA.,Department of Psychiatry, New York State Psychiatric Institute, New York, NY, USA
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15
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Reyes-Ortega P, Ragu Varman D, Rodríguez VM, Reyes-Haro D. Anorexia induces a microglial associated pro-inflammatory environment and correlates with neurodegeneration in the prefrontal cortex of young female rats. Behav Brain Res 2020; 392:112606. [PMID: 32387351 DOI: 10.1016/j.bbr.2020.112606] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 02/12/2020] [Accepted: 02/27/2020] [Indexed: 01/13/2023]
Abstract
Dehydration-Induced Anorexia (DIA) is a murine model that reproduces weight loss and avoidance of food, despite its availability. The prefrontal cortex (PFC) integrates sensory inputs and updates associative learning to promote (hunger) or inhibit (satiety) food-seeking behavior. In this study we tested if anorexia induces a pro-inflammatory environment associated with microglia in the medial prefrontal cortex (mPFC) and orbitofrontal cortex (OFC), specific subregions of the PFC involved in appetite. Our results showed that anorexia increased microglial density, promoted a de-ramified morphology and augmented the de-ramified/ramified ratio in the mPFC and OFC but not in the motor cortex. Anorexia also increased the expression of the pro-inflammatory cytokines TNF-α, IL-6 and IL-1β. This pro-inflammatory environment associated with microglia activation correlates with neuronal damage as revealed by Fluoro Jade C (FJC) and NeuN immunolabeling. We conclude that anorexia triggers a pro-inflammatory environment associated with microglia that correlates with neurodegeneration in the mPFC and OFC.
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Affiliation(s)
- Pamela Reyes-Ortega
- Departamento de Neurobiología Celular y Molecular. Instituto de Neurobiología. Universidad Nacional Autónoma de México, Campus Juriquilla. Boulevard Juriquilla #3001. Juriquilla, Querétaro; CP 76230, México
| | - Durairaj Ragu Varman
- Departamento de Neurobiología Celular y Molecular. Instituto de Neurobiología. Universidad Nacional Autónoma de México, Campus Juriquilla. Boulevard Juriquilla #3001. Juriquilla, Querétaro; CP 76230, México; Department of Pharmacology and Toxicology, Virginia Commonwealth University, Richmond, VA 23298, USA
| | - Verónica M Rodríguez
- Departamento de Neurobiología Conductual y Cognitiva. Instituto de Neurobiología. Universidad Nacional Autónoma de México, Campus Juriquilla. Boulevard Juriquilla #3001. Juriquilla, Querétaro; CP 76230, México
| | - Daniel Reyes-Haro
- Departamento de Neurobiología Celular y Molecular. Instituto de Neurobiología. Universidad Nacional Autónoma de México, Campus Juriquilla. Boulevard Juriquilla #3001. Juriquilla, Querétaro; CP 76230, México.
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16
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King JA, Bernardoni F, Geisler D, Ritschel F, Doose A, Pauligk S, Pásztor K, Weidner K, Roessner V, Smolka MN, Ehrlich S. Intact value-based decision-making during intertemporal choice in women with remitted anorexia nervosa? An fMRI study. J Psychiatry Neurosci 2020; 45:108-116. [PMID: 31595737 PMCID: PMC7828910 DOI: 10.1503/jpn.180252] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Extreme restrictive food choice in anorexia nervosa is thought to reflect excessive self-control and/or abnormal reward sensitivity. Studies using intertemporal choice paradigms have suggested an increased capacity to delay reward in anorexia nervosa, and this may explain an unusual ability to resist immediate temptation and override hunger in the long-term pursuit of thinness. It remains unclear, however, whether altered delay discounting in anorexia nervosa constitutes a state effect of acute illness or a trait marker observable after recovery. METHODS We repeated the analysis from our previous fMRI investigation of intertemporal choice in acutely underweight patients with anorexia nervosa in a sample of weight-recovered women with anorexia nervosa (n = 36) and age-matched healthy controls (n = 36) who participated in the same study protocol. Follow-up analyses explored functional connectivity separately in both the weight-recovered/healthy controls sample and the acute/healthy controls sample. RESULTS In contrast to our previous findings in acutely underweight patients with anorexia nervosa, we found no differences between weight-recovered patients with anorexia nervosa and healthy controls at either behavioural or neural levels. New analysis of data from the acute/healthy controls sample sample revealed increased coupling between dorsal anterior cingulate cortex and posterior brain regions as a function of decision difficulty, supporting the hypothesis of altered neural efficiency in the underweight state. LIMITATIONS This was a cross-sectional study, and the results may be task-specific. CONCLUSION Although our results underlined previous demonstrations of divergent temporal reward discounting in acutely underweight patients with anorexia nervosa, we found no evidence of alteration in patients with weight-recovered anorexia nervosa. Together, these findings suggest that impaired valuebased decision-making may not constitute a defining trait variable or “scar” of the disorder.
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Affiliation(s)
- Joseph A. King
- From the Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (King, Bernardoni, Geisler, Ritschel, Doose, Pauligk, Pásztor, Ehrlich); the Translational Developmental Neuroscience Section, Eating Disorder Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Ritschel, Roessner, Ehrlich); the Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Weidner); and the Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany (Smolka)
| | - Fabio Bernardoni
- From the Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (King, Bernardoni, Geisler, Ritschel, Doose, Pauligk, Pásztor, Ehrlich); the Translational Developmental Neuroscience Section, Eating Disorder Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Ritschel, Roessner, Ehrlich); the Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Weidner); and the Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany (Smolka)
| | - Daniel Geisler
- From the Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (King, Bernardoni, Geisler, Ritschel, Doose, Pauligk, Pásztor, Ehrlich); the Translational Developmental Neuroscience Section, Eating Disorder Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Ritschel, Roessner, Ehrlich); the Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Weidner); and the Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany (Smolka)
| | - Franziska Ritschel
- From the Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (King, Bernardoni, Geisler, Ritschel, Doose, Pauligk, Pásztor, Ehrlich); the Translational Developmental Neuroscience Section, Eating Disorder Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Ritschel, Roessner, Ehrlich); the Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Weidner); and the Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany (Smolka)
| | - Arne Doose
- From the Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (King, Bernardoni, Geisler, Ritschel, Doose, Pauligk, Pásztor, Ehrlich); the Translational Developmental Neuroscience Section, Eating Disorder Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Ritschel, Roessner, Ehrlich); the Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Weidner); and the Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany (Smolka)
| | - Sophie Pauligk
- From the Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (King, Bernardoni, Geisler, Ritschel, Doose, Pauligk, Pásztor, Ehrlich); the Translational Developmental Neuroscience Section, Eating Disorder Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Ritschel, Roessner, Ehrlich); the Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Weidner); and the Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany (Smolka)
| | - Konrad Pásztor
- From the Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (King, Bernardoni, Geisler, Ritschel, Doose, Pauligk, Pásztor, Ehrlich); the Translational Developmental Neuroscience Section, Eating Disorder Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Ritschel, Roessner, Ehrlich); the Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Weidner); and the Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany (Smolka)
| | - Kerstin Weidner
- From the Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (King, Bernardoni, Geisler, Ritschel, Doose, Pauligk, Pásztor, Ehrlich); the Translational Developmental Neuroscience Section, Eating Disorder Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Ritschel, Roessner, Ehrlich); the Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Weidner); and the Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany (Smolka)
| | - Veit Roessner
- From the Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (King, Bernardoni, Geisler, Ritschel, Doose, Pauligk, Pásztor, Ehrlich); the Translational Developmental Neuroscience Section, Eating Disorder Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Ritschel, Roessner, Ehrlich); the Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Weidner); and the Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany (Smolka)
| | - Michael N. Smolka
- From the Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (King, Bernardoni, Geisler, Ritschel, Doose, Pauligk, Pásztor, Ehrlich); the Translational Developmental Neuroscience Section, Eating Disorder Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Ritschel, Roessner, Ehrlich); the Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Weidner); and the Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany (Smolka)
| | - Stefan Ehrlich
- From the Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (King, Bernardoni, Geisler, Ritschel, Doose, Pauligk, Pásztor, Ehrlich); the Translational Developmental Neuroscience Section, Eating Disorder Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Ritschel, Roessner, Ehrlich); the Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Weidner); and the Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany (Smolka)
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Yue L, Tang Y, Kang Q, Wang Q, Wang J, Chen J. Deficits in response inhibition on varied levels of demand load in anorexia nervosa: an event-related potentials study. Eat Weight Disord 2020; 25:231-40. [PMID: 30168032 DOI: 10.1007/s40519-018-0558-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 07/30/2018] [Indexed: 10/28/2022] Open
Abstract
PURPOSE The aim of the present study was to investigate the executive function of inhibitory control in anorexia nervosa (AN), which is considered as an underlying pathophysiology of restricting eating. METHODS In this work, we examined the function of response inhibition in 27 unmedicated AN patients and 30 healthy controls (HC) using stop-signal tasks with different demand loads. Two event-related potentials (ERP) during the stop-signal tasks, N2 and P300, were compared between the AN and HC groups. RESULTS We found attenuated P300 amplitudes and delayed N2 latencies in AN patients across all three demand loads compared to HCs. We also found significant interaction between group and level of demand load. N2 latencies were prolonged when the inhibitory demand was lower in the AN group, whereas no differences in N2 latencies were found across different demand loads in HCs. CONCLUSIONS Taken together, altered P300 amplitudes and N2 latencies may be associated with impaired response inhibition in AN patients. In particular, alterations of fronto-central N2 activations were demand-related, which might contribute to an aberrant inhibitory control process in AN. LEVEL OF EVIDENCE Level II, controlled trial without randomization.
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18
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Seidel M, Borchardt V, Geisler D, King JA, Boehm I, Pauligk S, Bernardoni F, Biemann R, Roessner V, Walter M, Ehrlich S. Abnormal Spontaneous Regional Brain Activity in Young Patients With Anorexia Nervosa. J Am Acad Child Adolesc Psychiatry 2019; 58:1104-1114. [PMID: 30768380 DOI: 10.1016/j.jaac.2019.01.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 01/18/2019] [Accepted: 02/11/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Functional magnetic resonance imaging (fMRI) studies have repeatedly shown alterations in patients with anorexia nervosa (AN). These alterations might be driven by baseline signal characteristics such as the (fractional) amplitude of low frequency fluctuations (fALFF/ALFF), as well as regional signal consistency (ie, regional homogeneity [ReHo]) within circumscribed brain regions. Previous studies have also demonstrated gray matter (pseudo-) atrophy in underweight individuals with AN. Here we study fALFF/ALFF and ReHo in predominantly adolescent patients with AN, while taking gray matter changes into consideration. METHOD Resting state fMRI data were acquired from a sample of 148 female volunteers: 74 underweight patients with AN and 74 age-matched female healthy controls (HC). RESULTS Group differences for fALFF and ReHo measures were found in several AN-relevant brain regions, including networks related to cognitive control, habit formation, and the ventral visual stream. Furthermore, the magnitude of correlation between gray matter volume/thickness and fALFF and ReHo were reduced in AN compared to HC. CONCLUSION Abnormal local resting state characteristics in AN-related brain-networks as well as reduced structure-function relationships may help to explain previously reported task-related and classical resting state neural alterations in underweight AN. Patients with AN may serve as a valuable population for investigating dynamic changes in the relationships between brain structure and function.
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Affiliation(s)
- Maria Seidel
- Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Viola Borchardt
- Clinical Affective Neuroimaging Laboratory, Magdeburg, Germany, and the Leibniz Institute for Neurobiology, Magdeburg, Germany
| | - Daniel Geisler
- Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Joseph A King
- Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Ilka Boehm
- Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Sophie Pauligk
- Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Fabio Bernardoni
- Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Ronald Biemann
- Institute of Clinical Chemistry and Pathobiochemistry, Otto-von-Guericke University, Magdeburg, Germany
| | - Veit Roessner
- Translational Developmental Neuroscience Section, Eating Disorder Research and Treatment Center, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Martin Walter
- Clinical Affective Neuroimaging Laboratory, Magdeburg, Germany, and the Leibniz Institute for Neurobiology, Magdeburg, Germany; Clinic for Psychiatry and Psychotherapy, Eberhard-Karls University, Tuebingen, Germany
| | - Stefan Ehrlich
- Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany; Translational Developmental Neuroscience Section, Eating Disorder Research and Treatment Center, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.
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Bartholdy S, O'Daly OG, Campbell IC, Banaschewski T, Barker G, Bokde ALW, Bromberg U, Büchel C, Quinlan EB, Desrivières S, Flor H, Frouin V, Garavan H, Gowland P, Heinz A, Ittermann B, Martinot JL, Paillère Martinot ML, Nees F, Orfanos DP, Poustka L, Hohmann S, Fröhner JH, Smolka MN, Walter H, Whelan R, Schumann G, Schmidt U, Artiges E, Schneider S, Bach C, Paus T, Barbot A, Gareth Barker, Bokde A, Vetter N, Büchel C, Cattrell A, Constant P, Gowland P, Crombag H, Czech K, Dalley J, Decideur B, Spranger T, Ripley T, Heym N, Flor H, Sommer W, Fuchs B, Gallinat J, Spanagel R, Kaviani M, Heinrichs B, Andreas Heinz, Subramaniam N, Jia T, Ihlenfeld A, Ireland J, Ittermann B, Conrod P, Banaschewski T, Jones J, Klaassen A, Lalanne C, Lanzerath D, Lawrence C, Lemaitre H, Desrivieres S, Mallik C, Karl Mann, Mar A, Martinez-Medina L, Jean-Luc Martinot, Mennigen E, Mesquita de Carvahlo F, Schwartz Y, Bruehl R, Müller K, Nees F, Nymberg C, Lathrop M, Trevor Robbins, Pausova Z, Jani Pentilla, Biondo F, Jean-Baptiste Poline, Hohmann S, Poustka L, Millenet S, Michael Smolka, Fröhner J, Struve M, Steve Williams, Hübner T, Bromberg U, Aydin S, Rogers J, Romanowski A, Schmäl C, Schmidt D, Ripke S, Arroyo M, Schubert F, Pena-Oliver Y, Fauth-Bühler M, Mignon X, Whelan R, Speiser C, Fadai T, Dai Stephens, Ströhle A, Paillere ML, Strache N, Theobald D, Jurk S, Vulser H, Miranda R, Yacubian J, Frouin V, Genauck A, Parchetka C, Gemmeke I, Kruschwitz J, Weiß K, Walter H, Feng J, Papadopoulos D, Filippi I, Ing A, Ruggeri B, Xu B, Macare C, Chu C, Hanratty E, Burke Quinlan E, Robert G, Schumann G, Yu T, Ziesch V, Stedman A. Neural Correlates of Failed Inhibitory Control as an Early Marker of Disordered Eating in Adolescents. Biol Psychiatry 2019; 85:956-965. [PMID: 31122340 DOI: 10.1016/j.biopsych.2019.01.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 01/23/2019] [Accepted: 01/24/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Binge eating and other forms of disordered eating behavior (DEB) are associated with failed inhibitory control. This study investigated the neural correlates of failed inhibitory control as a potential biomarker for DEB. METHODS The study used prospective longitudinal data from the European IMAGEN study adolescent cohort. Participants completed baseline assessments (questionnaires and a brain scan [functional magnetic resonance imaging]) at 14 years of age and a follow-up assessment (questionnaires) at 16 years of age. Self-reported binge eating and/or purging were used to indicate presence of DEB. Neural correlates of failed inhibition were assessed using the stop signal task. Participants were categorized as healthy control subjects (reported no DEB at both time points), maintainers (reported DEB at both time points), recoverers (reported DEB at baseline only), and developers (reported DEB at follow-up only). Forty-three individuals per group with complete scanning data were matched on gender, age, puberty, and intelligence (N = 172). RESULTS At baseline, despite similar task performance, incorrectly responding to stop signals (failed inhibitory control) was associated with greater recruitment of the medial prefrontal cortex and anterior cingulate cortex in the developers compared with healthy control subjects and recoverers. CONCLUSIONS Greater recruitment of the medial prefrontal and anterior cingulate regions during failed inhibition accords with abnormal evaluation of errors contributing to DEB development. As this precedes symptom onset and is evident despite normal task performance, neural responses during failed inhibition may be a useful biomarker of vulnerability for DEB. This study highlights the potential value of prospective neuroimaging studies for identifying markers of illness before the emergence of behavior changes.
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Affiliation(s)
- Savani Bartholdy
- Section of Eating Disorders, Department of Psychological Medicine, London, United Kingdom.
| | - Owen G O'Daly
- Centre for Neuroimaging Sciences, London, United Kingdom
| | - Iain C Campbell
- Section of Eating Disorders, Department of Psychological Medicine, London, United Kingdom
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Gareth Barker
- Centre for Neuroimaging Sciences, London, United Kingdom
| | - Arun L W Bokde
- Discipline of Psychiatry, School of Medicine and Trinity College Institute of Neuroscience, Dublin, Ireland
| | - Uli Bromberg
- University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | | | - Erin Burke Quinlan
- Medical Research Council Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Sylvane Desrivières
- Medical Research Council Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Herta Flor
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany
| | - Vincent Frouin
- Neurospin, Commissariat à l'énergie atomique et aux énergies alternatives, Université Paris-Saclay, Gif-sur-Yvette, Paris, France
| | - Hugh Garavan
- Departments of Psychiatry and Psychology, University of Vermont, Burlington, Vermont
| | - Penny Gowland
- Sir Peter Mansfield Imaging Centre School of Physics and Astronomy, University of Nottingham, Nottingham, United Kingdom
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Bernd Ittermann
- Physikalisch-Technische Bundesanstalt, Braunschweig, Germany
| | - Jean-Luc Martinot
- Institut National de la Santé et de la Recherche Médicale, INSERM Unit 1000 "Neuroimaging & Psychiatry," University Paris Sud - Paris Saclay, University Paris Descartes, Paris, France
| | - Marie-Laure Paillère Martinot
- Institut National de la Santé et de la Recherche Médicale, INSERM Unit 1000 "Neuroimaging & Psychiatry," University Paris Sud - Paris Saclay, University Paris Descartes, Paris, France; Department of Adolescent Psychopathology and Medicine, Maison de Solenn, Cochin Hospital, Public Assistance Hospitals of Paris, Paris, France
| | - Frauke Nees
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Dimitri Papadopoulos Orfanos
- Neurospin, Commissariat à l'énergie atomique et aux énergies alternatives, Université Paris-Saclay, Gif-sur-Yvette, Paris, France
| | - Luise Poustka
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Centre Göttingen, Göttingen, Germany; Clinic for Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Sarah Hohmann
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Juliane H Fröhner
- Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany
| | - Michael N Smolka
- Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany
| | - Henrik Walter
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Robert Whelan
- School of Psychology and Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Gunter Schumann
- Medical Research Council Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Ulrike Schmidt
- Section of Eating Disorders, Department of Psychological Medicine, London, United Kingdom; South London & Maudsley National Health Service Foundation Trust, London, United Kingdom
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Lamanna J, Sulpizio S, Ferro M, Martoni R, Abutalebi J, Malgaroli A. Behavioral assessment of activity-based-anorexia: how cognition can become the drive wheel. Physiol Behav 2019; 202:1-7. [DOI: 10.1016/j.physbeh.2019.01.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 01/17/2019] [Accepted: 01/19/2019] [Indexed: 12/19/2022]
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Abstract
Anorexia nervosa and bulimia nervosa are characterized by severely restricted intake, binge eating, and compensatory behaviors like self-induced vomiting. The neurobiological underpinnings of these maladaptive behaviors are poorly understood, but the application of cognitive neuroscience and neuroimaging to eating disorders has begun to elucidate their pathophysiology. Specifically, this review focuses on 3 areas that suggest paths forward: reward, cognitive and behavioral control, and decision making. Understanding the brain-based mechanisms that promote and maintain these often chronic symptoms could guide the development of new and more effective treatments.
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22
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Murray SB, Strober M, Craske MG, Griffiths S, Levinson CA, Strigo IA. Fear as a translational mechanism in the psychopathology of anorexia nervosa. Neurosci Biobehav Rev 2018; 95:383-395. [DOI: 10.1016/j.neubiorev.2018.10.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 10/11/2018] [Accepted: 10/22/2018] [Indexed: 12/30/2022]
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Rachid F. Repetitive transcranial magnetic stimulation in the treatment of eating disorders: A review of safety and efficacy. Psychiatry Res 2018; 269:145-156. [PMID: 30149272 DOI: 10.1016/j.psychres.2018.08.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 07/05/2018] [Accepted: 08/09/2018] [Indexed: 02/07/2023]
Abstract
Eating disorders are a significant public health concern accounting for significant morbidity and mortality. Therapeutic approaches are available to treat eating disorders but less than half of the patients recover. Therapeutic alternatives are needed such as repetitive transcranial magnetic stimulation. I reviewed studies that evaluated the safety and efficacy of this technique for the treatment of eating disorders. The electronic literature on repetitive transcranial magnetic stimulation, theta burst and deep transcranial magnetic stimulation in the treatment of eating disorders was retrieved. The findings were quite heterogeneous in results with some studies showing relatively positive results with reduction of both craving and eating behaviors with active stimulation versus sham. Repetitive transcranial magnetic stimulation was safe. Research in this field was limited by the small number of studies and sample sizes, diversity of stimulation parameters, questionable placebo conditions, the lack of a sham-controlled design and the use of subjective scales lacking in sensitivity. The evidence supporting rTMS for eating disorders is somewhat promising. Future studies on high frequency rTMS of the LDLPFC/DMPFC with increased statistical power, rigorous randomization, outcome measures and optimal parameters are needed to confirm the short- and long-term safety and efficacy of rTMS for the treatment of eating disorders.
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Affiliation(s)
- Fady Rachid
- 7, place de la Fusterie, 1204 Geneva, Switzerland.
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24
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Nickel K, Joos A, Tebartz van Elst L, Matthis J, Holovics L, Endres D, Zeeck A, Hartmann A, Tüscher O, Maier S. Recovery of cortical volume and thickness after remission from acute anorexia nervosa. Int J Eat Disord 2018; 51:1056-1069. [PMID: 30212599 DOI: 10.1002/eat.22918] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 06/07/2018] [Accepted: 06/08/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Reduced grey (GM) and white matter (WM) volumes and increased cerebrospinal fluid (CSF) have been frequently reported in anorexia nervosa (AN), but studies focusing on cortical thickness (CT) are scarce and findings inconsistent. We conducted the first study in AN that analyzed both parameters in the same study to gain novel and comprehensive insight. METHOD Voxel-based morphometry (VBM) analysis was performed on T1-weighted magnetic resonance images from 34 predominantly adult women with acute AN, 24 REC participants, and 41 healthy controls (HC). Global brain segment volumes (GM, WM, and CSF), regional GM volume, and cortical thickness measures were obtained from the same study sample. We further focused on recovery by including a REC group. RESULTS The GM and WM volumes were decreased, and correspondingly, the CSF volume increased in the AN in comparison to the HC and REC groups. No significant volume differences between the REC and HC groups could be observed. AN patients showed reduced regional GM volumes in the right hippocampus and the left middle and right inferior frontal gyrus. Cortical thinning occurred in the AN group, which was particularly robust in fronto-parietal areas. The REC and HC groups failed to show any regional GM or cortical thickness differences. DISCUSSION AN is accompanied by severe loss of brain volume and cortical thickness as assessed by complementary investigation tools. However, these changes seem to be largely reversible, which should be encouraging for therapists and patients. The underlying neurobiological mechanisms remain unclear and should be assessed in further studies.
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Affiliation(s)
- Kathrin Nickel
- Faculty of Medicine, Department of Psychiatry and Psychotherapy, Section for Experimental Neuropsychiatry, Medical Center, University of Freiburg, Freiburg, Germany
| | - Andreas Joos
- Faculty of Medicine, Department of Psychosomatic Medicine and Psychotherapy, Medical Center, University of Freiburg, Freiburg, Germany
| | - Ludger Tebartz van Elst
- Faculty of Medicine, Department of Psychiatry and Psychotherapy, Section for Experimental Neuropsychiatry, Medical Center, University of Freiburg, Freiburg, Germany
| | - Jamila Matthis
- Faculty of Medicine, Department of Psychiatry and Psychotherapy, Section for Experimental Neuropsychiatry, Medical Center, University of Freiburg, Freiburg, Germany.,Faculty of Medicine, Department of Psychosomatic Medicine and Psychotherapy, Medical Center, University of Freiburg, Freiburg, Germany
| | - Lukas Holovics
- Faculty of Medicine, Department of Psychosomatic Medicine and Psychotherapy, Medical Center, University of Freiburg, Freiburg, Germany
| | - Dominique Endres
- Faculty of Medicine, Department of Psychiatry and Psychotherapy, Section for Experimental Neuropsychiatry, Medical Center, University of Freiburg, Freiburg, Germany
| | - Almut Zeeck
- Faculty of Medicine, Department of Psychosomatic Medicine and Psychotherapy, Medical Center, University of Freiburg, Freiburg, Germany
| | - Armin Hartmann
- Faculty of Medicine, Department of Psychosomatic Medicine and Psychotherapy, Medical Center, University of Freiburg, Freiburg, Germany
| | - Oliver Tüscher
- Faculty of Medicine, Department of Psychiatry and Psychotherapy, Medical Center, University of Mainz, Mainz, Germany
| | - Simon Maier
- Faculty of Medicine, Department of Psychiatry and Psychotherapy, Section for Experimental Neuropsychiatry, Medical Center, University of Freiburg, Freiburg, Germany.,Faculty of Medicine, Department of Psychosomatic Medicine and Psychotherapy, Medical Center, University of Freiburg, Freiburg, Germany
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25
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Lavagnino L, Mwangi B, Cao B, Shott ME, Soares JC, Frank GK. Cortical thickness patterns as state biomarker of anorexia nervosa. Int J Eat Disord 2018; 51:241-249. [PMID: 29412456 PMCID: PMC5843530 DOI: 10.1002/eat.22828] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 01/08/2018] [Accepted: 01/08/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Only few studies have investigated cortical thickness in anorexia nervosa (AN), and it is unclear whether patterns of altered cortical thickness can be identified as biomarkers for AN. METHOD Cortical thickness was measured in 19 adult women with restricting-type AN, 24 individuals recovered from restricting-type AN (REC-AN) and 24 healthy controls. Those individuals with current or recovered from AN had previously shown altered regional cortical volumes across orbitofrontal cortex and insula. A linear relevance vector machine-learning algorithm estimated patterns of regional thickness across 24 subdivisions of those regions. RESULTS Region-based analysis showed higher cortical thickness in AN and REC-AN, compared to controls, in the right medial orbital (olfactory) sulcus, and greater cortical thickness for short insular gyri in REC-AN versus controls bilaterally. The machine-learning algorithm identified a pattern of relatively higher right orbital, right insular and left middle frontal cortical thickness, but lower left orbital, right middle and inferior frontal, and bilateral superior frontal cortical thickness specific to AN versus controls (74% specificity and 74% sensitivity, χ2 p < .004); predicted probabilities differed significantly between AN and controls (p < .023). No pattern significantly distinguished the REC-AN group from controls. CONCLUSIONS Higher cortical thickness in medial orbitofrontal cortex and insula probably contributes to higher gray matter volume in AN in those regions. The machine-learning algorithm identified a mixed pattern of mostly higher orbital and insular, but relatively lower superior frontal cortical thickness in individuals with current AN. These novel results suggest that regional cortical thickness patterns could be state markers for AN.
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Affiliation(s)
- Luca Lavagnino
- University of Texas Health Sciences Center at Houston, Department of Psychiatry and Behavioral Sciences, Houston, Texas, USA
| | - Benson Mwangi
- University of Texas Health Sciences Center at Houston, Department of Psychiatry and Behavioral Sciences, Houston, Texas, USA
| | - Bo Cao
- University of Texas Health Sciences Center at Houston, Department of Psychiatry and Behavioral Sciences, Houston, Texas, USA
| | - Megan E. Shott
- Departments of Psychiatry and Neuroscience, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jair C. Soares
- University of Texas Health Sciences Center at Houston, Department of Psychiatry and Behavioral Sciences, Houston, Texas, USA
| | - Guido K.W. Frank
- Departments of Psychiatry and Neuroscience, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Seidel M, King JA, Ritschel F, Boehm I, Geisler D, Bernardoni F, Holzapfel L, Diestel S, Diers K, Strobel A, Goschke T, Walter H, Roessner V, Ehrlich S. The real-life costs of emotion regulation in anorexia nervosa: a combined ecological momentary assessment and fMRI study. Transl Psychiatry 2018; 8:28. [PMID: 29362440 DOI: 10.1038/s41398-017-0004-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 06/29/2017] [Accepted: 07/14/2017] [Indexed: 11/17/2022] Open
Abstract
Regulation of emotions is necessary for successful attainment of short-term and long-term goals. However, over-regulation may also have its costs. In anorexia nervosa (AN), forgoing food intake despite emaciation and endocrine signals that promote eating is an example of "too much" self-control. Here we investigated whether voluntary emotion regulation in AN patients comes with associated disorder-relevant costs. Thirty-five patients with acute AN and thirty-five age-matched healthy controls (HCs) performed an established emotion regulation paradigm during functional magnetic resonance imaging after an overnight fast. The task required reducing emotions induced by positively valenced pictures via distancing. We calculated a neural regulation score from responses recorded in a reward-related brain region of interest (ventral striatum; VS) by subtracting activation measured on "positive distance" trials from that elicited under the "positive watch" (baseline) condition. Complementing the imaging data, we used ecological momentary assessment (EMA) to probe disorder-related rumination and affect six times/day for 2 weeks following the scanning session. The neural regulation score indicating reduced VS activation during emotion regulation was used as a predictor in hierarchical linear models with EMA measures as outcomes. No group differences in neural activity were found for the main contrasts of the task. However, regulation of VS activity was associated with increased body-related rumination and increased negative affect in AN, but not in HC. In line with this finding, correlational analysis with longitudinal BMI measurements revealed a link between greater VS regulation and poorer treatment outcome after 60 and 90 days. Together, these results identify a neural correlate of altered emotion regulation in AN, which seems to be detrimental to psychological well-being and may interfere with recovery.
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Abstract
Neuromodulation can affect the functioning of the central nervous system (CNS), and emotional/eating behavior is an exciting facet of that functioning. Therefore, it would be possible to offer an alternative (or complement) treatment to psychotropic medications and different psychological and nutritional approaches to both eating disorders (EDs) and obesity. Although there are a number of publications in these areas, a systematic review has not been conducted to date. Abstracts, letters, conference reports, dissertations, and reviews were excluded. Clinical trials and controlled human clinical trials were filtered and included in this study. Articles included were based on the population suffering from anorexia nervosa, bulimia nervosa, binge ED, overweight, and obesity. No restrictions were placed on the sample size. Only trials investigating the effect of neuromodulation by means of deep brain stimulation (DBS), transcranial direct current stimulation (tDCS), and transcranial magnetic stimulation (TMS) were included. The following databases were used to conduct the search: MEDLINE/ PubMed, PsycINFO, PsycArticles, and Cochrane (Search Trials, CENTRAL). Study selection was performed following the PRISMA process (PRISMA 2009 Checklist). The total number of participants in all the trials was 562 (DBS, 25; tDCS, 138; TMS, 399; range, 3-90; median, 23.5). As a result, 50% of the studies had samples of between 14 and 38 participants. Neuro-modulation in ED seems to have certain clinical potential, and therefore, this is a promising area for further research. Developments in ED neuromodulation will be linked to neuroimaging to identify potential stimulation targets and possible biomarkers of treatment response. To date, TMS and/or direct current stimulation (DCS) is not the first-line treatment yet, but it could become a preferred option of treatment in the future. Further studies should avoid small sample sizes and the use of different methodologies. Currently, neuromodulation techniques are in the experimental phase, and they are not an evidence-based treatment for ED.
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Affiliation(s)
- Ignacio Jáuregui-Lobera
- Department of Molecular Biology and Biochemical Engineering, University of Pablo de Olavide of Seville, Seville, Spain,
| | - José V Martínez-Quiñones
- Department of Neurosurgery, Mutua de Accidentes de Zaragoza (Servicio de Neurocirugía), Zaragoza, Spain
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28
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Martin Monzon B, Henderson LA, Madden S, Macefield VG, Touyz S, Kohn MR, Clarke S, Foroughi N, Hay P. Grey matter volume in adolescents with anorexia nervosa and associated eating disorder symptoms. Eur J Neurosci 2017; 46:2297-2307. [PMID: 28833732 DOI: 10.1111/ejn.13659] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 07/26/2017] [Accepted: 08/09/2017] [Indexed: 01/01/2023]
Abstract
Anorexia nervosa (AN) is a mental health disorder of complex aetiology. Previous neuroimaging studies have found consistent global reductions in global grey matter volume of underweight girls with AN; however, differences in regional grey matter volumes are less consistent. The aims of this study were to investigate grey matter regional volumes of adolescent girls with AN before and after weight recovery and the relationship of any changes with clinical characteristics. We collected high-resolution T1-weighted images from 26 underweight girls with AN before weight gain and 20 healthy control volunteers. Clinical features were assessed using the Eating Disorder Examination Questionnaire. AN subjects displayed reduced grey matter volumes in the insula, amygdala, prefrontal, hippocampal and cingulate cortices and the precuneus, relative to healthy controls. In a subset of 10 AN subjects who were followed after weight recovery, grey matter volumes increased to near-control levels in the orbito- and medial prefrontal, insular, left hippocampal and mid- and posterior cingulate cortices and precuneus. The recovery of the right anterior thalamus and the left orbitofrontal cortex was correlated with improvements in eating concerns and shape concerns, respectively. However, large parts of the anterior cingulate cortex, caudate nuclei and right hippocampus did not display any grey matter recovery following a short-term of treatment. These results show that in adolescents with AN, some brain regions display marked recovery in grey matter volume following weight recovery, whereas others do not, considering grey mater recovery possibly linked to symptom improvement.
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Affiliation(s)
- Beatriz Martin Monzon
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, Sydney, NSW, 2751, Australia
| | - Luke A Henderson
- Department of Anatomy and Histology, University of Sydney, Sydney, NSW, Australia
| | - Sloane Madden
- School of Medicine, University of Sydney, Sydney, NSW, Australia
| | | | - Stephen Touyz
- Clinical Psychology Unit, School of Psychology, University of Sydney, Sydney, NSW, Australia
| | - Michael R Kohn
- Centre for Research into Adolescents' Health (CRASH), Millennium Institute, University of Sydney, Sydney, NSW, Australia
| | - Simon Clarke
- Centre for Research into Adolescents' Health (CRASH), Millennium Institute, University of Sydney, Sydney, NSW, Australia
| | - Nasim Foroughi
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, Sydney, NSW, 2751, Australia
| | - Phillipa Hay
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, Sydney, NSW, 2751, Australia
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Wierenga CE, Bischoff-Grethe A, Rasmusson G, Bailer UF, Berner LA, Liu TT, Kaye WH. Aberrant Cerebral Blood Flow in Response to Hunger and Satiety in Women Remitted from Anorexia Nervosa. Front Nutr 2017; 4:32. [PMID: 28770207 PMCID: PMC5515860 DOI: 10.3389/fnut.2017.00032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 07/03/2017] [Indexed: 12/20/2022] Open
Abstract
The etiology of pathological eating in anorexia nervosa (AN) remains poorly understood. Cerebral blood flow (CBF) is an indirect marker of neuronal function. In healthy adults, fasting increases CBF, reflecting increased delivery of oxygen and glucose to support brain metabolism. This study investigated whether women remitted from restricting-type AN (RAN) have altered CBF in response to hunger that may indicate homeostatic dysregulation contributing to their ability to restrict food. We compared resting CBF measured with pulsed arterial spin labeling in 21 RAN and 16 healthy comparison women (CW) when hungry (after a 16-h fast) and after a meal. Only remitted subjects were examined to avoid the confounding effects of malnutrition on brain function. Compared to CW, RAN demonstrated a reduced difference in the Hungry − Fed CBF contrast in the right ventral striatum, right subgenual anterior cingulate cortex (pcorr < 0.05) and left posterior insula (punc < 0.05); RAN had decreased CBF when hungry versus fed, whereas CW had increased CBF when hungry versus fed. Moreover, decreased CBF when hungry in the left insula was associated with greater hunger ratings on the fasted day for RAN. This represents the first study to show that women remitted from AN have aberrant resting neurovascular function in homeostatic neural circuitry in response to hunger. Regions involved in homeostatic regulation showed group differences in the Hungry − Fed contrast, suggesting altered cellular energy metabolism in this circuitry that may reduce motivation to eat.
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Affiliation(s)
- Christina E Wierenga
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States
| | - Amanda Bischoff-Grethe
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States
| | - Grace Rasmusson
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States
| | - Ursula F Bailer
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States.,Division of Biological Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Laura A Berner
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States
| | - Thomas T Liu
- Department of Radiology, University of California San Diego, La Jolla, CA, United States
| | - Walter H Kaye
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States
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30
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Ritschel F, Geisler D, King JA, Bernardoni F, Seidel M, Boehm I, Vettermann R, Biemann R, Roessner V, Smolka MN, Ehrlich S. Neural correlates of altered feedback learning in women recovered from anorexia nervosa. Sci Rep 2017; 7:5421. [PMID: 28710363 DOI: 10.1038/s41598-017-04761-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 05/19/2017] [Indexed: 12/19/2022] Open
Abstract
Anorexia nervosa (AN) is associated with exaggerated self-control and altered reward-based decision making, but the underlying neural mechanisms are poorly understood. Consistent with the notion of excessive cognitive control, we recently found increased dorsal anterior cingulate cortex (dACC) activation in acutely ill patients (acAN) on lose-shift trials in a probabilistic reversal learning (PRL) task. However, undernutrition may modulate brain function. In attempt to disentangle trait from state factors, the current fMRI study investigated cognitive control in recovered patients (recAN). Thirty-one recAN and 31 healthy controls (HC) completed a PRL task during fMRI. Based on previous findings, we focused on hemodynamic responses during lose-shift behaviour and conducted supplementary functional connectivity analysis. RecAN showed elevated lose-shift behaviour relative to HC. On the neural level, recAN showed normal dACC responses, but increased activation in fronto-parietal control regions. A trend for increased coupling between frontal and parietal regions of interest was also evident in recAN. The current findings in recAN differ from those in our previous study in acAN. While aberrant dACC response to negative feedback may be a correlate of the underweight state in acAN, impaired behavioural adaptation and elevated activation of cognitive control regions in recAN is suggestive of altered neural efficiency.
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Affiliation(s)
- Anand Mishra
- Central Institute of Psychiatry, Ranchi, Jharkhand, India.
| | - Manu Anand
- Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | - Shreekantiah Umesh
- K.S. Mani Centre for Cognitive Neurosciences, Central Institute of Psychiatry, Ranchi, Jharkhand, India
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32
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Schultz CC, Wagner G, de la Cruz F, Berger S, Reichenbach JR, Sauer H, Bär KJ. Evidence for alterations of cortical folding in anorexia nervosa. Eur Arch Psychiatry Clin Neurosci 2017; 267:41-49. [PMID: 26678081 DOI: 10.1007/s00406-015-0666-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 12/06/2015] [Indexed: 12/13/2022]
Abstract
Anorexia nervosa (AN) is highly heritable, and the perspective on the etiology of AN has changed from a behavioral to a neurobiological and neurodevelopmental view. However, cortical folding as an important marker for deviations in brain development has yet rarely been explored in AN. Hence, in order to determine potential cortical folding alterations, we investigated fine-grained cortical folding in a cohort of 26 patients with AN, of whom 6 patients were recovered regarding their weight at the time point of MRI measurement. MRI-derived cortical folding was computed and compared between patients and healthy controls at about 150,000 points per hemisphere using a surface-based technique (FreeSurfer). Patients with AN exhibited highly significant increased cortical folding in a right dorsolateral prefrontal cortex region (DLPFC). Furthermore, a statistical trend in the same direction was found in the right visual cortex. We did not find a correlation of local cortical folding and current symptoms of the disease. In conclusion, our analyses provide first evidence that altered DLPFC cortical folding plays a role in the etiology of AN. The absence of correlations with clinical parameters implicates a relatively independence of cortical folding alterations from the current symptomatology and might thus be regarded as a trait characteristic of the disease potentially related to other neurobiological features of AN.
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Affiliation(s)
- C Christoph Schultz
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, 07740, Jena, Germany.
| | - Gerd Wagner
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, 07740, Jena, Germany.,Psychiatric Brain & Body Research Group Jena, Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Feliberto de la Cruz
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, 07740, Jena, Germany.,Psychiatric Brain & Body Research Group Jena, Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Sandy Berger
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, 07740, Jena, Germany.,Psychiatric Brain & Body Research Group Jena, Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Jürgen R Reichenbach
- Medical Physics Group, Institute for Diagnostic and Interventional Radiology, Jena University Hospital, Jena, Germany
| | - Heinrich Sauer
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, 07740, Jena, Germany
| | - Karl J Bär
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, 07740, Jena, Germany.,Psychiatric Brain & Body Research Group Jena, Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
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Abstract
BACKGROUND Anorexia nervosa is a severe, biologically based brain disorder with significant medical complications. It is critical that new, effective treatments are developed to interrupt the persistent course of the illness due to the medical and psychological sequelae. Several psychosocial, behavioral and pharmacologic interventions have been investigated in adult anorexia nervosa; however, evidence shows that their impact is weak and treatment effects are generally small. METHOD This paper describes a new neurobiological anorexia nervosa model that shifts focus from solely external influences, such as social and family, to include internal influences that integrate genetic and neurobiological contributions, across the age span. The model serves as a theoretical structure for a new, five-day treatment, outlined in this paper, targeting anorexia nervosa temperament, which integrates neurobiological dimensions into evidence-based treatment interventions. The treatment is in two phases. Phase I is a five day, 40 hour treatment for anorexia nervosa adults. Phase II is the follow-up and is currently being developed. RESULTS Preliminary qualitative acceptability data on 37 adults with anorexia nervosa and 60 supports (e.g., spouses, parents, aunts, friends, partners, children of anorexia nervosa adults) are promising from Phase I. Clients with anorexia nervosa and their supports report that learning neurobiological facts improved their understanding of the illness and helped equip them with better tools to manage anorexia nervosa traits and symptoms. In addition, nutritional knowledge changed significantly. CONCLUSIONS This is the first neurobiologically based, five-day treatment for adults with anorexia nervosa and their supports. It is a new model that outlines underlying genetic and neurobiological contributions to anorexia nervosa that serves as a foundation to treat both traits and symptoms. Preliminary qualitative findings are promising, with both clients and supports reporting that the neurobiological treatment approach helped them better understand the illness, while better conceptualizing how to respond to their traits and manage their symptoms. Data in Phase I shows promise as a neurobiologically based intervention for anorexia nervosa, and it serves as a foundation for the development of Phase II. Evidence of ongoing program efficacy will be described as data are reported on Phase II. TRIAL REGISTRATION NCT NCT02852538 Registered 1 August 2016.
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Affiliation(s)
- Laura Hill
- The Center for Balanced Living, 8001 Ravines Edge Court, Suite 201, Columbus, OH 43235 USA
| | | | | | - Walter H. Kaye
- Department of Psychiatry, University of California San Diego, San Diego, CA USA
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Bartholdy S, Campbell IC, Schmidt U, O’Daly OG. Proactive inhibition: An element of inhibitory control in eating disorders. Neurosci Biobehav Rev 2016; 71:1-6. [DOI: 10.1016/j.neubiorev.2016.08.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 07/19/2016] [Accepted: 08/05/2016] [Indexed: 12/01/2022]
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King JA, Geisler D, Bernardoni F, Ritschel F, Böhm I, Seidel M, Mennigen E, Ripke S, Smolka MN, Roessner V, Ehrlich S. Altered Neural Efficiency of Decision Making During Temporal Reward Discounting in Anorexia Nervosa. J Am Acad Child Adolesc Psychiatry 2016; 55:972-979. [PMID: 27806865 DOI: 10.1016/j.jaac.2016.08.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 07/08/2016] [Accepted: 08/30/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The ability of individuals with anorexia nervosa (AN) to resist hunger and restrict caloric intake is often believed to reflect an unusual amount of self-control. However, the underlying neural substrate is poorly understood, especially in adolescent patients. METHOD Functional magnetic resonance imaging was used during an intertemporal choice task to probe the hemodynamic correlates of a common measurement of self-control-delayed (monetary) reward discounting-in a sample of acutely ill, predominately adolescent female patients with AN (n = 31) and age-matched healthy controls (n = 31). RESULTS Delayed discounting rates did not differ between the groups, but decision making was consistently faster in the AN group. Although no group differences in the neural correlates of reward valuation were evident, activation associated with decision making was decreased in the AN group, most notably in the lateral prefrontal and posterior parietal regions implicated in executive control. Follow-up analysis of difficult decisions showed decreased activation in the AN group in a region of the dorsal anterior cingulate cortex. CONCLUSION Decreased activation in frontoparietal regions involved in decision making, but faster and more consistent choice behavior, suggests that the altered efficiency of neural resource allocation might underlie an increased level of self-control in AN. This pattern of neural activation and behavior might reflect an ingrained "habit" to sustain high-level proactive (anticipatory) cognitive control in AN, which in turn might compromise reactive control mechanisms needed to adapt to changing cognitive demands, such as when difficult decisions must be made.
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Affiliation(s)
- Joseph A King
- Eating Disorders Research and Treatment Center, TU Dresden, Faculty of Medicine, Dresden, Germany
| | - Daniel Geisler
- Eating Disorders Research and Treatment Center, TU Dresden, Faculty of Medicine, Dresden, Germany
| | - Fabio Bernardoni
- Eating Disorders Research and Treatment Center, TU Dresden, Faculty of Medicine, Dresden, Germany
| | - Franziska Ritschel
- Eating Disorders Research and Treatment Center, TU Dresden, Faculty of Medicine, Dresden, Germany
| | - Ilka Böhm
- Eating Disorders Research and Treatment Center, TU Dresden, Faculty of Medicine, Dresden, Germany
| | - Maria Seidel
- Eating Disorders Research and Treatment Center, TU Dresden, Faculty of Medicine, Dresden, Germany
| | | | | | | | - Veit Roessner
- Eating Disorders Research and Treatment Center, TU Dresden, Faculty of Medicine, Dresden, Germany
| | - Stefan Ehrlich
- Eating Disorders Research and Treatment Center, TU Dresden, Faculty of Medicine, Dresden, Germany.
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36
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Sultson H, van Meer F, Sanders N, van Elburg AA, Danner UN, Hoek HW, Adan RAH, Smeets PAM. Associations between neural correlates of visual stimulus processing and set-shifting in ill and recovered women with anorexia nervosa. Psychiatry Res Neuroimaging 2016; 255:35-42. [PMID: 27518327 DOI: 10.1016/j.pscychresns.2016.07.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Revised: 04/27/2016] [Accepted: 07/07/2016] [Indexed: 11/18/2022]
Abstract
Women ill with anorexia nervosa (AN) have been shown to exhibit altered cognitive functioning, particularly poor set-shifting (SS). In this study, we investigated whether brain activation in frontal and parietal regions during visual stimulus processing correlates with SS ability. Women currently ill with AN (AN; N=14), recovered women (REC; N=14) and healthy controls (HC; N=15), viewed alternating blocks of food and non-food pictures during functional magnetic resonance imaging (fMRI). The Berg's Card Sorting Task was completed outside the scanner to measure SS. A priori regions of interest (ROIs) were defined in frontal and parietal regions. The activation during visual stimulus processing in several ROIs correlated positively with poor SS ability in REC, particularly in the left dorsal anterior cingulate cortex (dACC). The correlations with poor SS ability were opposite in AN patients, particularly in the right dACC. These findings underscore that addressing heightened levels of cognitive control associated with higher frontal activation could reduce cognitive inflexibility in recovered women. In AN, greater activation in frontal and parietal regions might be necessary to perform at normal levels during various tasks. Thus, weight restoration could be necessary for AN patients prior to addressing cognitive inflexibility.
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Affiliation(s)
- Hedvig Sultson
- Image Sciences Institute, University Medical Center Utrecht, Heidelberglaan 100, Q02.4.45, 3584 CX Utrecht, The Netherlands
| | - Floor van Meer
- Image Sciences Institute, University Medical Center Utrecht, Heidelberglaan 100, Q02.4.45, 3584 CX Utrecht, The Netherlands
| | - Nicole Sanders
- Altrecht Eating Disorders Rintveld, Altrecht Mental Health Institute, Zeist, The Netherlands; Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Annemarie A van Elburg
- Altrecht Eating Disorders Rintveld, Altrecht Mental Health Institute, Zeist, The Netherlands; Faculty of Social Sciences, Utrecht University, Utrecht, The Netherlands
| | - Unna N Danner
- Altrecht Eating Disorders Rintveld, Altrecht Mental Health Institute, Zeist, The Netherlands
| | - Hans W Hoek
- Altrecht Eating Disorders Rintveld, Altrecht Mental Health Institute, Zeist, The Netherlands; Parnassia Psychiatric Institute, The Hague, The Netherlands; Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands
| | - Roger A H Adan
- Altrecht Eating Disorders Rintveld, Altrecht Mental Health Institute, Zeist, The Netherlands; Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Paul A M Smeets
- Image Sciences Institute, University Medical Center Utrecht, Heidelberglaan 100, Q02.4.45, 3584 CX Utrecht, The Netherlands; Division of Human Nutrition, Wageningen University & Research Center, Wageningen, The Netherlands.
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37
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McAdams CJ, Jeon-Slaughter H, Evans S, Lohrenz T, Montague PR, Krawczyk DC. Neural differences in self-perception during illness and after weight-recovery in anorexia nervosa. Soc Cogn Affect Neurosci 2016; 11:1823-1831. [PMID: 27354739 PMCID: PMC5091684 DOI: 10.1093/scan/nsw092] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 06/22/2016] [Indexed: 02/06/2023] Open
Abstract
Anorexia nervosa (AN) is a severe mental illness characterized by problems with self-perception. Whole-brain neural activations in healthy women, women with AN and women in long-term weight recovery following AN were compared using two functional magnetic resonance imaging tasks probing different aspects of self-perception. The Social Identity-V2 task involved consideration about oneself and others using socially descriptive adjectives. Both the ill and weight-recovered women with AN engaged medial prefrontal cortex less than healthy women for self-relevant cognitions, a potential biological trait difference. Weight-recovered women also activated the inferior frontal gyri and dorsal anterior cingulate more for direct self-evaluations than for reflected self-evaluations, unlike both other groups, suggesting that recovery may include compensatory neural changes related to social perspectives. The Faces task compared viewing oneself to a stranger. Participants with AN showed elevated activity in the bilateral fusiform gyri for self-images, unlike the weight-recovered and healthy women, suggesting cognitive distortions about physical appearance are a state rather than trait problem in this disease. Because both ill and recovered women showed neural differences related to social self-perception, but only recovered women differed when considering social perspectives, these neurocognitive targets may be particularly important for treatment.
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Affiliation(s)
- Carrie J McAdams
- Department of Psychiatry, University of Texas at Southwestern Medical School, Dallas, TX 75390, USA .,Psychiatry, Texas Health Presbyterian Hospital of Dallas, Dallas, TX 75321, USA
| | - Haekyung Jeon-Slaughter
- Department of Psychiatry, University of Texas at Southwestern Medical School, Dallas, TX 75390, USA
| | - Siobahn Evans
- Department of Psychiatry, University of Texas at Southwestern Medical School, Dallas, TX 75390, USA
| | - Terry Lohrenz
- Virginia Tech Carilion Research Institute, Virginia Tech, Roanoke, VA 24016, USA
| | - P Read Montague
- Virginia Tech Carilion Research Institute, Virginia Tech, Roanoke, VA 24016, USA.,Computational Psychiatry Unit, Virginia Tech, Roanoke, VA 24016, USA.,Wellcome Trust Centre for Neuroimaging, University College London, 12 Queen Square, London, WCIN 3BG, UK.,Department of Physics, Virginia Tech, Blacksburg, VA 24061, USA
| | - Daniel C Krawczyk
- Department of Psychiatry, University of Texas at Southwestern Medical School, Dallas, TX 75390, USA.,Center for Brain Health, University of Texas at Dallas, Dallas, TX 75390, USA
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38
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Ely AV, Wierenga CE, Kaye WH. Anxiety Impacts Cognitive Inhibition in Remitted Anorexia Nervosa. Eur Eat Disorders Rev 2016; 24:347-51. [DOI: 10.1002/erv.2451] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 02/26/2016] [Accepted: 03/23/2016] [Indexed: 12/31/2022]
Affiliation(s)
- Alice V. Ely
- Department of Psychiatry; University of California San Diego; San Diego CA USA
| | | | - Walter H. Kaye
- Department of Psychiatry; University of California San Diego; San Diego CA USA
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Brockmeyer T, Walther S, Ingenerf K, Wild B, Hartmann M, Weisbrod M, Weber MA, Eckhardt-Henn A, Herzog W, Friederich HC. Brain effects of computer-assisted cognitive remediation therapy in anorexia nervosa: A pilot fMRI study. Psychiatry Res Neuroimaging 2016; 249:52-56. [PMID: 27000307 DOI: 10.1016/j.pscychresns.2016.02.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 01/07/2016] [Accepted: 02/20/2016] [Indexed: 10/22/2022]
Abstract
Poor cognitive-behavioral flexibility is considered a trait marker in anorexia nervosa (AN) that can be improved by cognitive remediation therapy (CRT). The present pilot study aimed at identifying changes in brain function potentially associated with CRT in AN. Data was obtained from a randomized, controlled trial. Twenty-four patients were assessed before and after 30 sessions of either CRT or a non-specific neurocognitive therapy. Voxel-wise analysis of whole brain functional magnetic resonance imaging was applied. Brain activation was measured during response inhibition and task switching. Although results did not reach significance, we found tentative support for CRT-related increases in brain activation in the dorsal putamen during task switching and in the dorsolateral prefrontal, sensorimotor and temporal cortex during response inhibition. These pilot findings provide viable pathways for future research on brain changes underlying CRT in AN.
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Affiliation(s)
- Timo Brockmeyer
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany.
| | - Stephan Walther
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Katrin Ingenerf
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Beate Wild
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Mechthild Hartmann
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Matthias Weisbrod
- Section of Experimental Psychopathology and Neurophysiology, University Hospital Heidelberg, Heidelberg, Germany; Department of Psychiatry, SRH Hospital Karlsbad-Langensteinbach, Karlsbad, Germany
| | - Marc-André Weber
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Wolfgang Herzog
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany; Department of Psychosomatic Medicine and Psychotherapy, LVR-clinics, University Duisburg-Essen, Essen, Germany
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McClelland J, Kekic M, Bozhilova N, Nestler S, Dew T, Van den Eynde F, David AS, Rubia K, Campbell IC, Schmidt U. A Randomised Controlled Trial of Neuronavigated Repetitive Transcranial Magnetic Stimulation (rTMS) in Anorexia Nervosa. PLoS One 2016; 11:e0148606. [PMID: 27008620 PMCID: PMC4805273 DOI: 10.1371/journal.pone.0148606] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 01/19/2016] [Indexed: 12/22/2022] Open
Abstract
Background Anorexia nervosa (AN) is associated with morbid fear of fatness, extreme food restriction and altered self-regulation. Neuroimaging data implicate fronto-striatal circuitry, including the dorsolateral prefrontal cortex (DLPFC). Methods In this double-blind parallel group study, we investigated the effects of one session of sham-controlled high-frequency repetitive transcranial magnetic stimulation (rTMS) to the left DLPFC (l-DLPFC) in 60 individuals with AN. A food exposure task was administered before and after the procedure to elicit AN-related symptoms. Outcomes The primary outcome measure was ‘core AN symptoms’, a variable which combined several subjective AN-related experiences. The effects of rTMS on other measures of psychopathology (e.g. mood), temporal discounting (TD; intertemporal choice behaviour) and on salivary cortisol concentrations were also investigated. Safety, tolerability and acceptability were assessed. Results Fourty-nine participants completed the study. Whilst there were no interaction effects of rTMS on core AN symptoms, there was a trend for group differences (p = 0.056): after controlling for pre-rTMS scores, individuals who received real rTMS had reduced symptoms post-rTMS and at 24-hour follow-up, relative to those who received sham stimulation. Other psychopathology was not altered differentially following real/sham rTMS. In relation to TD, there was an interaction trend (p = 0.060): real versus sham rTMS resulted in reduced rates of TD (more reflective choice behaviour). Salivary cortisol concentrations were unchanged by stimulation. rTMS was safe, well–tolerated and was considered an acceptable intervention. Conclusions This study provides modest evidence that rTMS to the l-DLPFC transiently reduces core symptoms of AN and encourages prudent decision making. Importantly, individuals with AN considered rTMS to be a viable treatment option. These findings require replication in multiple-session studies to evaluate therapeutic efficacy. Trial Registration www.Controlled-Trials.comISRCTN22851337
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Affiliation(s)
- Jessica McClelland
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- * E-mail:
| | - Maria Kekic
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Natali Bozhilova
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Steffen Nestler
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Tracy Dew
- Department of Clinical Biochemistry, King’s College Hospital, London, United Kingdom
| | - Frederique Van den Eynde
- Neuromodulation Research Clinic, Douglas Mental Health University Institute, Montréal, Québec, Canada
| | - Anthony S. David
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Katya Rubia
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Iain C. Campbell
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Ulrike Schmidt
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
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Bang L, Rø Ø, Endestad T. Amygdala alterations during an emotional conflict task in women recovered from anorexia nervosa. Psychiatry Res Neuroimaging 2016; 248:126-133. [PMID: 26778366 DOI: 10.1016/j.pscychresns.2015.12.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 12/22/2015] [Accepted: 12/28/2015] [Indexed: 11/17/2022]
Abstract
The pathophysiology of anorexia nervosa (AN) is not completely understood, but research suggests that alterations in brain circuits related to cognitive control and emotion are central. The aim of this study was to explore neural responses to an emotional conflict task in women recovered from AN. Functional magnetic resonance imaging was used to measure neural responses to an emotional conflict task in 22 women recovered from AN and 21 age-matched healthy controls. The task involved categorizing affective faces while ignoring affective words. Face and word stimuli were either congruent (non-conflict) or incongruent (conflict). Brain responses to emotional conflict did not differ between groups. However, in response to emotional non-conflict, women recovered from AN relative to healthy controls showed significantly less activation in the bilateral amygdala. Specifically, while emotional non-conflict evoked significant activations of the amygdala in healthy controls, recovered AN women did not show such activations. Similar significant group differences were also observed in the hippocampus and basal ganglia. These results suggest that women recovered from AN are characterized by alterations within emotion-related brain circuits. Recovered women's absence of amygdala and hippocampus activation during non-conflict trials possibly reflects an impaired ability to process emotional significant stimuli.
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Affiliation(s)
- Lasse Bang
- 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; Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Tor Endestad
- Institute of Psychology, University of Oslo, Oslo, Norway
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Bartholdy S, Dalton B, O'Daly OG, Campbell IC, Schmidt U. A systematic review of the relationship between eating, weight and inhibitory control using the stop signal task. Neurosci Biobehav Rev 2016; 64:35-62. [PMID: 26900651 DOI: 10.1016/j.neubiorev.2016.02.010] [Citation(s) in RCA: 145] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 01/26/2016] [Accepted: 02/13/2016] [Indexed: 11/24/2022]
Abstract
Altered inhibitory control (response inhibition, reward-based inhibition, cognitive inhibition, reversal learning) has been implicated in eating disorders (EDs) and obesity. It is unclear, however, how different types of inhibitory control contribute to eating and weight-control behaviours. This review evaluates the relationship between one aspect of inhibitory control (a reactive component of motor response inhibition measured by the stop signal task) and eating/weight in clinical and non-clinical populations. Sixty-two studies from 58 journal articles were included. Restrained eaters had diminished reactive inhibitory control compared to unrestrained eaters, and showed greatest benefit to their eating behaviour from manipulations of inhibitory control. Obese individuals may show less reactive inhibitory control but only in the context of food-specific inhibition or after executive resources are depleted. Of the limited studies in EDs, the majority found no impairment in reactive inhibitory control, although findings are inconsistent. Thus, altered reactive inhibitory control is related to some maladaptive eating behaviours, and hence may provide a therapeutic target for behavioural manipulations and/or neuromodulation. However, other types of inhibitory control may also contribute. Methodological and theoretical considerations are discussed.
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Dunlop KA, Woodside B, Downar J. Targeting Neural Endophenotypes of Eating Disorders with Non-invasive Brain Stimulation. Front Neurosci 2016; 10:30. [PMID: 26909013 PMCID: PMC4754427 DOI: 10.3389/fnins.2016.00030] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 01/25/2016] [Indexed: 12/14/2022] Open
Abstract
The term "eating disorders" (ED) encompasses a wide variety of disordered eating and compensatory behaviors, and so the term is associated with considerable clinical and phenotypic heterogeneity. This heterogeneity makes optimizing treatment techniques difficult. One class of treatments is non-invasive brain stimulation (NIBS). NIBS, including repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), are accessible forms of neuromodulation that alter the cortical excitability of a target brain region. It is crucial for NIBS to be successful that the target is well selected for the patient population in question. Targets may best be selected by stepping back from conventional DSM-5 diagnostic criteria to identify neural substrates of more basic phenotypes, including behavior related to rewards and punishment, cognitive control, and social processes. These phenotypic dimensions have been recently laid out by the Research Domain Criteria (RDoC) initiative. Consequently, this review is intended to identify potential dimensions as outlined by the RDoC and the underlying behavioral and neurobiological targets associated with ED. This review will also identify candidate targets for NIBS based on these dimensions and review the available literature on rTMS and tDCS in ED. This review systematically reviews abnormal neural circuitry in ED within the RDoC framework, and also systematically reviews the available literature investigating NIBS as a treatment for ED.
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Affiliation(s)
- Katharine A. Dunlop
- Institute of Medical Sciences, University of TorontoToronto, ON, Canada
- MRI-Guided rTMS Clinic, University Health NetworkToronto, ON, Canada
| | - Blake Woodside
- Institute of Medical Sciences, University of TorontoToronto, ON, Canada
- Department of Psychiatry, University Health NetworkToronto, ON, Canada
- Department of Psychiatry, University of TorontoToronto, ON, Canada
- Eating Disorders Program, University Health NetworkToronto, ON, Canada
| | - Jonathan Downar
- Institute of Medical Sciences, University of TorontoToronto, ON, Canada
- MRI-Guided rTMS Clinic, University Health NetworkToronto, ON, Canada
- Department of Psychiatry, University Health NetworkToronto, ON, Canada
- Department of Psychiatry, University of TorontoToronto, ON, Canada
- Toronto Western Research Institute, University Health NetworkToronto, ON, Canada
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Collantoni E, Michelon S, Tenconi E, Degortes D, Titton F, Manara R, Clementi M, Pinato C, Forzan M, Cassina M, Santonastaso P, Favaro A. Functional connectivity correlates of response inhibition impairment in anorexia nervosa. Psychiatry Res Neuroimaging 2016; 247:9-16. [PMID: 26655584 DOI: 10.1016/j.pscychresns.2015.11.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Revised: 10/12/2015] [Accepted: 11/30/2015] [Indexed: 01/12/2023]
Abstract
Anorexia nervosa (AN) is a disorder characterized by high levels of cognitive control and behavioral perseveration. The present study aims at exploring inhibitory control abilities and their functional connectivity correlates in patients with AN. Inhibitory control - an executive function that allows the realization of adaptive behavior according to environmental contingencies - has been assessed by means of the Stop-Signal paradigm. The study involved 155 patients with lifetime AN and 102 healthy women. A subsample underwent resting-state functional magnetic resonance imaging and was genotyped for COMT and 5-HTTLPR polymorphisms. AN patients showed an impaired response inhibition and a disruption of the functional connectivity of the ventral attention circuit, a neural network implicated in behavioral response when a stimulus occurs unexpected. The 5-HTTLPR genotype appears to significantly interact with the functional connectivity of ventral attention network in explaining task performance in both patients and controls, suggesting a role of the serotoninergic system in mechanisms of response selection. The disruption of the ventral attention network in patients with AN suggests lower efficiency of bottom-up signal filtering, which might be involved in difficulties to adapt behavioral responses to environmental needs. Our findings deserve further research to confirm their scientific and therapeutic implications.
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Affiliation(s)
- Enrico Collantoni
- Psychiatric Clinic, Department of Neurosciences, University of Padova, Via Giustiniani 3, 35128 Padova, Italy
| | - Silvia Michelon
- Psychiatric Clinic, Department of Neurosciences, University of Padova, Via Giustiniani 3, 35128 Padova, Italy
| | - Elena Tenconi
- Psychiatric Clinic, Department of Neurosciences, University of Padova, Via Giustiniani 3, 35128 Padova, Italy
| | - Daniela Degortes
- Psychiatric Clinic, Department of Neurosciences, University of Padova, Via Giustiniani 3, 35128 Padova, Italy
| | - Francesca Titton
- Psychiatric Clinic, Department of Neurosciences, University of Padova, Via Giustiniani 3, 35128 Padova, Italy
| | - Renzo Manara
- Department of Medicine and Surgery, University of Salerno, Italy; IRCCS Istituto San Camillo, Venezia, Italy
| | - Maurizio Clementi
- Clinical Genetics Unit, Department of Woman and Child Health, University of Padova, Italy
| | - Claudia Pinato
- Clinical Genetics Unit, Department of Woman and Child Health, University of Padova, Italy
| | - Monica Forzan
- Clinical Genetics Unit, Department of Woman and Child Health, University of Padova, Italy
| | - Matteo Cassina
- Clinical Genetics Unit, Department of Woman and Child Health, University of Padova, Italy
| | - Paolo Santonastaso
- Psychiatric Clinic, Department of Neurosciences, University of Padova, Via Giustiniani 3, 35128 Padova, Italy
| | - Angela Favaro
- Psychiatric Clinic, Department of Neurosciences, University of Padova, Via Giustiniani 3, 35128 Padova, Italy.
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Abstract
BACKGROUND Neuroimaging allows for the identification of brain abnormalities and alterations that are associated with anorexia nervosa (AN). We performed a scoping review to map out the extent and nature of recent research activity on functional magnetic resonance imaging (fMRI) in individuals diagnosed with, or recovered from, AN (AN-REC). MAIN TEXT A literature search of PubMed, Psychinfo and Embase was conducted using the search terms "anorexia nervosa" AND "functional magnetic resonance imaging." We included fMRI studies that involved a comparison between individuals with AN or AN-REC and healthy controls published in English language between 2010 and 2015. A total of 49 papers were included, regardless of the experimental stimuli or paradigm. CONCLUSIONS Findings varied considerably across studies, reflecting methodological differences in study design, such as sample differences and experimental paradigms. Collectively, studies published during the past five years suggest altered activation in regions related to the fronto-striato and the limbic circuits, which are theorized to have an important role in the pathophysiology of AN.
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Affiliation(s)
- Tone Seim Fuglset
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Nils Inge Landrø
- Department of Psychology, Clinical Neuroscience Research Group, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | - Deborah Lynn Reas
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Ullevål, Oslo, Norway ; Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | - Øyvind Rø
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Ullevål, Oslo, Norway ; Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Mcclelland J, Kekic M, Campbell IC, Schmidt U. Repetitive Transcranial Magnetic Stimulation (rTMS) Treatment in Enduring Anorexia Nervosa: A Case Series: Transcranial magnetic stimulation in anorexia. Eur Eat Disorders Rev 2016; 24:157-63. [DOI: 10.1002/erv.2414] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 10/06/2015] [Accepted: 10/07/2015] [Indexed: 11/07/2022]
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Ehrlich S, Geisler D, Ritschel F, King JA, Seidel M, Boehm I, Breier M, Clas S, Weiss J, Marxen M, Smolka MN, Roessner V, Kroemer NB. Elevated cognitive control over reward processing in recovered female patients with anorexia nervosa. J Psychiatry Neurosci 2015; 40:307-15. [PMID: 26107161 PMCID: PMC4543093 DOI: 10.1503/jpn.140249] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Individuals with anorexia nervosa are thought to exert excessive self-control to inhibit primary drives. METHODS This study used functional MRI (fMRI) to interrogate interactions between the neural correlates of cognitive control and motivational processes in the brain reward system during the anticipation of monetary reward and reward-related feedback. In order to avoid confounding effects of undernutrition, we studied female participants recovered from anorexia nervosa and closely matched healthy female controls. The fMRI analysis (including node-to-node functional connectivity) followed a region of interest approach based on models of the brain reward system and cognitive control regions implicated in anorexia nervosa: the ventral striatum, medial orbitofrontal cortex (mOFC) and dorsolateral prefrontal cortex (DLPFC). RESULTS We included 30 recovered patients and 30 controls in our study. There were no behavioural differences and no differences in hemodynamic responses of the ventral striatum and the mOFC in the 2 phases of the task. However, relative to controls, recovered patients showed elevated DLPFC activity during the anticipation phase, failed to deactivate this region during the feedback phase and displayed greater functional coupling between the DLPFC and mOFC. Recovered patients also had stronger associations than controls between anticipation-related DLPFC responses and instrumental responding. LIMITATIONS The results we obtained using monetary stimuli might not generalize to other forms of reward. CONCLUSION Unaltered neural responses in ventral limbic reward networks but increased recruitment of and connectivity with lateral-frontal brain circuitry in recovered patients suggests an elevated degree of selfregulatory processes in response to rewarding stimuli. An imbalance between brain systems subserving bottom-up and top-down processes may be a trait marker of the disorder.
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Affiliation(s)
- Stefan Ehrlich
- Correspondence to: S. Ehrlich, Technische Universität Dresden, Faculty of Medicine, University Hospital C. G. Carus, Dresden, Department of Child and Adolescent Psychiatry, Translational Developmental Neuroscience Section, Fetscherstraße 74, 01307 Dresden, Germany;
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Abstract
Eating disorders are complex and serious psychiatric illnesses whose etiology includes psychological, biological, and social factors. Treatment of eating disorders is challenging as there are few evidence-based treatments and limited understanding of the mechanisms that result in sustained recovery. In the last 20 years, we have begun to identify neural pathways that are altered in eating disorders. Consideration of how these pathways may contribute to an eating disorder can provide an understanding of expected responses to treatments. Eating disorder behaviors include restrictive eating, compulsive overeating, and purging behaviors after eating. Eating disorders are associated with changes in many neural systems. In this targeted review, we focus on three cognitive processes associated with neurocircuitry differences in subjects with eating disorders such as reward, decision-making, and social behavior. We briefly examine how each of these systems function in healthy people, using Neurosynth meta-analysis to identify key regions commonly implicated in these circuits. We review the evidence for disruptions of these regions and systems in eating disorders. Finally, we describe psychiatric and psychological treatments that are likely to function by impacting these regions.
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Affiliation(s)
- Carrie J McAdams
- University of Texas at Southwestern Medical Center, Dallas, TX, USA; Department of Psychiatry, Texas Health Presbyterian Hospital of Dallas, Dallas, TX, USA
| | - Whitney Smith
- University of Texas at Southwestern Medical Center, Dallas, TX, USA
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49
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Fujisawa TX, Yatsuga C, Mabe H, Yamada E, Masuda M, Tomoda A. Anorexia Nervosa during Adolescence Is Associated with Decreased Gray Matter Volume in the Inferior Frontal Gyrus. PLoS One 2015; 10:e0128548. [PMID: 26067825 PMCID: PMC4465897 DOI: 10.1371/journal.pone.0128548] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 04/28/2015] [Indexed: 11/18/2022] Open
Abstract
Anorexia nervosa (AN) is an eating disorder characterized by the relentless pursuit to lose weight, mostly through self-starvation, and a distorted body image. AN tends to begin during adolescence among women. However, the underlying neural mechanisms related to AN remain unclear. Using voxel-based morphometry based on magnetic resonance imaging scans, we investigated whether the presence of AN was associated with discernible changes in brain morphology. Participants were 20 un-medicated, right-handed patients with early-onset AN and 14 healthy control subjects. Group differences in gray matter volume (GMV) were assessed using high-resolution, T1-weighted, volumetric magnetic resonance imaging datasets (3T Trio scanner; Siemens AG) and analyzed after controlling for age and total GMV, which was decreased in the bilateral inferior frontal gyrus (IFG) (left IFG: FWE corrected, p < 0.05; right IFG: uncorrected, p < 0.05) of patients with AN. The GMV in the bilateral IFG correlated significantly with current age (left IFG: r = -.481, p < .05; right IFG: r = -.601, p < .01) and was limited to the AN group. We speculate that decreased IFG volume might lead to deficits in executive functioning or inhibitory control within neural reward systems. Precocious or unbalanced neurological trimming within this particular region might be an important factor for the pathogenesis of AN onset.
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Affiliation(s)
- Takashi X. Fujisawa
- Research Center for Child Mental Development, University of Fukui, Fukui, Japan
- Department of Child Development, United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University and University of Fukui, Fukui, Japan
| | - Chiho Yatsuga
- Research Center for Child Mental Development, University of Fukui, Fukui, Japan
- Department of Child Development, United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University and University of Fukui, Fukui, Japan
| | - Hiroyo Mabe
- Department of Child Development, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Eiji Yamada
- Department of Child Development, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Masato Masuda
- Department of Child Development, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Akemi Tomoda
- Research Center for Child Mental Development, University of Fukui, Fukui, Japan
- Department of Child Development, United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University and University of Fukui, Fukui, Japan
- * E-mail:
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Abstract
The Research Domain Criteria (RDoC) project was initiated by the National Institute of Mental Health as a heuristic for addressing the limitations of categorical, symptom-based psychiatric diagnoses. RDoC is conceptualized as a matrix, with the rows representing dimensional constructs or domains implicated in the expression of psychiatric symptoms and the columns representing units of analysis that can be used to assess dimensional constructs (i.e., genes, molecules, cells, circuits, physiology, behavior, and self-reports). Few studies in eating disorders have adopted an RDoC framework, but accumulating data provide support for the relevance of RDoC dimensions to eating disorder symptoms. Herein, we review findings from RDoC-informed studies across the five domains of functioning included in the RDoC matrix-negative valence systems, positive valence systems, cognitive systems, systems for social processes, and arousal and regulatory systems-and describe directions for future research utilizing RDoC to enhance study design and treatment development in eating disorders.
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Affiliation(s)
- Jennifer E Wildes
- Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic of UPMC, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA,
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