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Frank GKW, Reynolds JR, Shott ME, Jappe L, Yang TT, Tregellas JR, O'Reilly RC. Anorexia nervosa and obesity are associated with opposite brain reward response. Neuropsychopharmacology 2012; 37:2031-46. [PMID: 22549118 PMCID: PMC3398719 DOI: 10.1038/npp.2012.51] [Citation(s) in RCA: 197] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Revised: 03/15/2012] [Accepted: 03/16/2012] [Indexed: 12/17/2022]
Abstract
Anorexia nervosa (AN) is a severe psychiatric disorder associated with food avoidance and malnutrition. In this study, we wanted to test whether we would find brain reward alterations in AN, compared with individuals with normal or increased body weight. We studied 21 underweight, restricting-type AN (age M 22.5, SD 5.8 years), 19 obese (age M 27.1, SD 6.7 years), and 23 healthy control women (age M 24.8, SD 5.6 years), using blood oxygen level-dependent functional magnetic resonance brain imaging together with a reward-conditioning task. This paradigm involves learning the association between conditioned visual stimuli and unconditioned taste stimuli, as well as the unexpected violation of those learned associations. The task has been associated with activation of brain dopamine reward circuits, and it allows the comparison of actual brain response with expected brain activation based on established neuronal models. A group-by-task condition analysis (family-wise-error-corrected P<0.05) indicated that the orbitofrontal cortex differentiated all three groups. The dopamine model reward-learning signal distinguished groups in the anteroventral striatum, insula, and prefrontal cortex (P<0.001, 25 voxel cluster threshold), with brain responses that were greater in the AN group, but lesser in the obese group, compared with controls. These results suggest that brain reward circuits are more responsive to food stimuli in AN, but less responsive in obese women. The mechanism for this association is uncertain, but these brain reward response patterns could be biomarkers for the respective weight state.
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Affiliation(s)
- Guido K W Frank
- Department of Psychiatry, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA.
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152
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Szalay C, Aradi M, Schwarcz A, Orsi G, Perlaki G, Németh L, Hanna S, Takács G, Szabó I, Bajnok L, Vereczkei A, Dóczi T, Janszky J, Komoly S, Örs Horváth P, Lénárd L, Karadi Z. Gustatory perception alterations in obesity: an fMRI study. Brain Res 2012; 1473:131-40. [PMID: 22885291 DOI: 10.1016/j.brainres.2012.07.051] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 07/24/2012] [Accepted: 07/25/2012] [Indexed: 12/27/2022]
Abstract
The background of feeding associated and metabolic diseases is not sufficiently understood yet. Since gustatory alterations may be of particular significance in the above illnesses, in the present experiments, cerebral activation was detected by fMRI in twelve obese patients and twelve, age and gender matched healthy subjects. The gustatory stimulus solutions were delivered via intraorally positioned polyvinyl tubes. Each session consisted of three runs. Sucrose was used as a pleasant; quinine HCl as an aversive; and a high-calorie, vanilla flavored nourishment solution as a complex taste of high palatability. In each run, only one taste was used as a stimulus. During all runs, distilled water served as a neutral stimulus. Group analysis was made by using the FSL software package. The taste stimuli elicited characteristic and distinct activity changes of the two groups. In contrast to the controls, in the obese patients, stronger activation was detected in various cortical (anterior cingulate cortex, insular and opercular cortices, orbitofrontal cortex) and subcortical (amygdala, nucleus accumbens, putamen and pallidum) structures in case of all three stimuli. The present examinations elucidated differential activation of various brain structures to pleasant and unpleasant gustatory stimuli in obese patients compared to control subjects. These taste alterations are supposed to be of particular significance in obesity, and our findings may contribute to develop better strategies for prevention and effective therapies in the future.
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Affiliation(s)
- Csaba Szalay
- Institute of Physiology and Neurophysiology Research Group of the Hungarian Academy of Sciences, Pécs University, Medical School, Hungary.
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Olanzapine, but not fluoxetine, treatment increases survival in activity-based anorexia in mice. Neuropsychopharmacology 2012; 37:1620-31. [PMID: 22395732 PMCID: PMC3358753 DOI: 10.1038/npp.2012.7] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Anorexia nervosa (AN) is an eating disorder characterized by extreme hypophagia, hyperactivity, and fear of weight gain. No approved pharmacological treatments exist for AN despite high mortality rates. The activity-based anorexia (ABA) phenomenon models aspects of AN in rodents, including progressive weight loss, reduced food intake, and hyperactivity. First, we optimized the ABA paradigm for mice. We compared mouse strains (Balb/cJ, A/J) for susceptibility with ABA, and evaluated the effects of different food access durations (2, 4, 6, 8, and 10 h) on ABA parameters. Balb/cJ mice exhibited significantly shorter survival time (days until 25% bodyweight loss) in the ABA paradigm compared with A/J mice. Furthermore, 6 h of food access reduced survival in mice housed with wheels without reducing survival in mice housed without wheels. We then evaluated the effects of chronic treatment with fluoxetine (4 weeks) or subchronic treatment with olanzapine (OLZ) (1 week) on ABA in BALB/cJ mice. OLZ (12 mg/kg/day) significantly increased survival and reduced food anticipatory activity (FAA). However, OLZ did not alter food intake or running wheel activity during ad-lib feeding (baseline) or restriction conditions, or in mice housed without wheels. Fluoxetine (18 mg/kg/day) increased food intake and reduced FAA, but did not alter survival. Here, we report for the first time that OLZ, but not fluoxetine, reduces ABA in mice. Our findings indicate further need for clinical investigations into the effects of OLZ, but not selective serotonin reuptake inhibitors, on core features of AN.
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154
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Frank GKW. Advances in the diagnosis of anorexia nervosa and bulimia nervosa using brain imaging. EXPERT OPINION ON MEDICAL DIAGNOSTICS 2012; 6:235-244. [PMID: 22936952 PMCID: PMC3427937 DOI: 10.1517/17530059.2012.673583] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION: Anorexia and bulimia nervosa are severe psychiatric disorders and the availability of brain imaging techniques hold promise that those techniques will be useful in clinical practice. AREAS COVERED: In this review I describe currently available brain imaging techniques and focus on the brain imaging methods functional magnetic resonance imaging (fMRI) and positron emission tomography (PET). Those techniques have helped describe alterations in brain circuitry in AN and BN that related to anxiety and reward processing. Novel computational models help further define brain function in relation to particular neurotransmitters. EXPERT OPINION: Brain imaging techniques are exciting methods to learn about brain function and progress has been made to identify in healthy populations brain circuits that code behaviors. These techniques have been used in AN and BN over the past decade and have improved our understanding of brain function in those disorders. Still, human brain imaging is not at a point yet where it could be used diagnostically. However, with the refinement of imaging hardware as well as improved models that describe brain function we will get closer to our aims to not only better understand the neurobiology of those disorders, but predict illness development, treatment response and long term prognosis.
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Affiliation(s)
- Guido K W Frank
- Departments of Psychiatry and Neuroscience, University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Gary Pavilion A036/B-130, 13123 East 16th Avenue, Aurora, CO 80045, Tel.: 720-777-1909
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155
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Neuronal correlates of appetite regulation in patients with schizophrenia: is there a basis for future appetite dysfunction? Eur Psychiatry 2012; 28:293-301. [PMID: 22542330 DOI: 10.1016/j.eurpsy.2012.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Revised: 01/10/2012] [Accepted: 02/05/2012] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Given the undesired metabolic side effects of atypical antipsychotic medication it is important to understand the neuronal basis related to processing of appetite regulation in patients affected by schizophrenia. METHODS Here we used functional magnetic resonance imaging (fMRI) to assess brain activity in response to food cues and neutral stimuli in twenty patients with schizophrenia and eleven healthy individuals. In addition to clinical and dietary habits assessments, we collected, in patients, measurements of fasting glucose, ghrelin, leptin, insulin, prolactin and lipids blood concentration and we correlated the cerebral activity with clinical and metabolic measures. RESULTS Both groups engaged a common neuronal network while processing food cues, which included the left insula, primary sensorimotor areas, and inferior temporal and parietal cortices. Cerebral responses to appetitive stimuli in thalamus, parahippocampus and middle frontal gyri were specific only to schizophrenic patients, with parahippocampal activity related to hunger state and increasing linearly over time. Antipsychotic medication dosage correlated positively with a cognitive measure reflecting food cravings, whereas the severity of the disease correlated negatively with a cognitive measure indicating dietary restraint in eating habits. These cognitive variables correlated, in turn, with parahippocampal and thalamic neuronal activities, respectively. CONCLUSIONS We identified a specific neural substrate underlying cognitive processing of appetitive stimuli in schizophrenia, which may contribute to appetite dysfunction via perturbations in processing of homeostatic signals in relation to external stimuli. Our results also suggest that both antipsychotic medication and the disease severity per se could amplify these effects, via different mechanisms and neuronal networks.
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156
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Cowdrey FA, Harmer CJ, Park RJ, McCabe C. Neural responses to emotional faces in women recovered from anorexia nervosa. Psychiatry Res 2012; 201:190-5. [PMID: 22464825 DOI: 10.1016/j.pscychresns.2011.08.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Revised: 08/04/2011] [Accepted: 08/19/2011] [Indexed: 10/28/2022]
Abstract
Impairments in emotional processing have been associated with anorexia nervosa. However, it is unknown whether neural and behavioural differences in the processing of emotional stimuli persist following recovery. The aim of this study was to investigate the neural processing of emotional faces in individuals recovered from anorexia nervosa compared with healthy controls. Thirty-two participants (16 recovered anorexia nervosa, 16 healthy controls) underwent a functional magnetic resonance imaging (fMRI) scan. Participants viewed fearful and happy emotional faces and indicated the gender of the face presented. Whole brain analysis revealed no significant differences between the groups to the contrasts of fear versus happy and vice versa. Region of interest analysis demonstrated no significant differences in the neural response to happy or fearful stimuli between the groups in the amygdala or fusiform gyrus. These results suggest that processing of emotional faces may not be aberrant after recovery from anorexia nervosa.
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157
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Brooks SJ, O'Daly O, Uher R, Friederich HC, Giampietro V, Brammer M, Williams SCR, Schiöth HB, Treasure J, Campbell IC. Thinking about eating food activates visual cortex with reduced bilateral cerebellar activation in females with anorexia nervosa: an fMRI study. PLoS One 2012; 7:e34000. [PMID: 22479499 PMCID: PMC3313953 DOI: 10.1371/journal.pone.0034000] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Accepted: 02/24/2012] [Indexed: 01/04/2023] Open
Abstract
Background Women with anorexia nervosa (AN) have aberrant cognitions about food and altered activity in prefrontal cortical and somatosensory regions to food images. However, differential effects on the brain when thinking about eating food between healthy women and those with AN is unknown. Methods Functional magnetic resonance imaging (fMRI) examined neural activation when 42 women thought about eating the food shown in images: 18 with AN (11 RAN, 7 BPAN) and 24 age-matched controls (HC). Results Group contrasts between HC and AN revealed reduced activation in AN in the bilateral cerebellar vermis, and increased activation in the right visual cortex. Preliminary comparisons between AN subtypes and healthy controls suggest differences in cortical and limbic regions. Conclusions These preliminary data suggest that thinking about eating food shown in images increases visual and prefrontal cortical neural responses in females with AN, which may underlie cognitive biases towards food stimuli and ruminations about controlling food intake. Future studies are needed to explicitly test how thinking about eating activates restraint cognitions, specifically in those with restricting vs. binge-purging AN subtypes.
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158
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Oliveira-Maia AJ, de Araujo IE, Monteiro C, Workman V, Galhardo V, Nicolelis MAL. The insular cortex controls food preferences independently of taste receptor signaling. Front Syst Neurosci 2012; 6:5. [PMID: 22403530 PMCID: PMC3290770 DOI: 10.3389/fnsys.2012.00005] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Accepted: 01/30/2012] [Indexed: 11/17/2022] Open
Abstract
The insular cortex (IC) contains the primary sensory cortex for oral chemosensation including gustation, and its integrity is required for appropriate control of feeding behavior. However, it remains unknown whether the role of this brain area in food selection relies on the presence of peripheral taste input. Using multielectrode recordings, we found that the responses of populations of neurons in the IC of freely licking, sweet-blind Trpm5−/− mice are modulated by the rewarding postingestive effects of sucrose. FOS immunoreactivity analyses revealed that these responses are restricted to the dorsal insula. Furthermore, bilateral lesions in this area abolished taste-independent preferences for sucrose that can be conditioned in these Trpm5−/− animals while preserving their ability to detect sucrose. Overall, these findings demonstrate that, even in the absence of peripheral taste input, IC regulates food choices based on postingestive signals.
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Affiliation(s)
- Albino J Oliveira-Maia
- Departamento de Biologia Experimental, Faculdade de Medicina, Universidade do Porto Porto, Portugal
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159
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Keating C, Tilbrook AJ, Rossell SL, Enticott PG, Fitzgerald PB. Reward processing in anorexia nervosa. Neuropsychologia 2012; 50:567-75. [PMID: 22349445 DOI: 10.1016/j.neuropsychologia.2012.01.036] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Revised: 01/18/2012] [Accepted: 01/30/2012] [Indexed: 12/31/2022]
Abstract
Individuals with anorexia nervosa (AN) demonstrate a relentless engagement in behaviors aimed to reduce their weight, which leads to severe underweight status, and occasionally death. Neurobiological abnormalities, as a consequence of starvation are controversial: evidence, however, demonstrates abnormalities in the reward system of patients, and recovered individuals. Despite this, a unifying explanation for reward abnormalities observed in AN and their relevance to symptoms of the illness, remains incompletely understood. Theories explaining reward dysfunction have conventionally focused on anhedonia, describing that patients have an impaired ability to experience reward or pleasure. We review taste reward literature and propose that patients' reduced responses to conventional taste-reward tasks may reflect a fear of weight gain associated with the caloric nature of the tasks, rather than an impaired ability to experience reward. Consistent with this, we propose that patients are capable of 'liking' hedonic taste stimuli (e.g., identifying them), however, they do not 'want' or feel motivated for the stimuli in the same way that healthy controls report. Recent brain imaging data on more complex reward processing tasks provide insights into fronto-striatal neural circuit dysfunction related to altered reward processing in AN that challenges the relevance of anhedonia in explaining reward dysfunction in AN. In this way, altered activity of the anterior cingulate cortex and striatum could explain patients' pathological engagement in behaviors they consider rewarding (e.g., self-starvation) that are otherwise aversive or punishing, to those without the eating disorder. Such evidence for altered patterns of brain activity associated with reward processing tasks in patients and recovered individuals may provide important information about mechanisms underlying symptoms of AN, their future investigation, and the development of treatment approaches.
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Affiliation(s)
- Charlotte Keating
- Monash Alfred Psychiatry Research Centre, Monash University, Central Clinical School, The Alfred, Australia.
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160
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161
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Volkow ND, Wang GJ, Fowler JS, Tomasi D, Baler R. Food and drug reward: overlapping circuits in human obesity and addiction. Curr Top Behav Neurosci 2012; 11:1-24. [PMID: 22016109 DOI: 10.1007/7854_2011_169] [Citation(s) in RCA: 241] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Both drug addiction and obesity can be defined as disorders in which the saliency value of one type of reward (drugs and food, respectively) becomes abnormally enhanced relative to, and at the expense of others. This model is consistent with the fact that both drugs and food have powerful reinforcing effects-partly mediated by dopamine increases in the limbic system-that, under certain circumstances or in vulnerable individuals, could overwhelm the brain's homeostatic control mechanisms. Such parallels have generated significant interest in understanding the shared vulnerabilities and trajectories between addiction and obesity. Now, brain imaging discoveries have started to uncover common features between these two conditions and to delineate some of the overlapping brain circuits whose dysfunctions may explain stereotypic and related behavioral deficits in human subjects. These results suggest that both obese and drug-addicted individuals suffer from impairments in dopaminergic pathways that regulate neuronal systems associated not only with reward sensitivity and incentive motivation, but also with conditioning (memory/learning), impulse control (behavioural inhibition), stress reactivity, and interoceptive awareness. Here, we integrate findings predominantly derived from positron emission tomography that shed light on the role of dopamine in drug addiction and in obesity, and propose an updated working model to help identify treatment strategies that may benefit both of these conditions.
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Affiliation(s)
- N D Volkow
- National Institute on Drug Abuse, 6001 Executive Boulevard 6001, Room 5274, Bethesda, MD, 20892, USA,
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162
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Park RJ, Dunn BD, Barnard PJ. Schematic Models and Modes of Mind in Anorexia Nervosa I: A Novel Process Account. Int J Cogn Ther 2011. [DOI: 10.1521/ijct.2011.4.4.415] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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163
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164
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Rockwell RE, Boutelle K, Trunko ME, Jacobs MJ, Kaye WH. An innovative short-term, intensive, family-based treatment for adolescent anorexia nervosa: case series. EUROPEAN EATING DISORDERS REVIEW 2011; 19:362-7. [PMID: 21308869 DOI: 10.1002/erv.1094] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE In order to improve the dissemination of new expert-based treatments for adolescents with anorexia nervosa, we have developed an innovative 1-week intensive family-based evaluation and treatment programme. Ages of the adolescents in the programme ranged from 10 to 18 years (mean = 15.0, SD = 2.1). We report the outcomes of the first 19 cases. METHOD Data were obtained from a retrospective chart review and a follow-up of cases at 52 to 738 days (mean = 278.4, SD = 193.8) post-treatment. The primary outcome measure was ideal body weight (IBW) percentage. RESULTS At admission, the duration of illness ranged from less than 1 to 8 years (mean 2.1, SD = 1.7). Admission IBW ranged from 69.3 to 99.1% (mean = 84.3%, SD = 8.7). Follow-up IBW ranged from 84.4 to 134.6% (mean = 99.3%, SD = 11.8). All but one patient reported a sustained gain in weight post-treatment (mean = 15.0, SD = 14.5). DISCUSSION These data provide further support for the notion that short-term family-based therapy may be useful for weight restoration and maintenance in some adolescents with anorexia nervosa.
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Affiliation(s)
- Roxanne E Rockwell
- University of California, San Diego, Department of Psychiatry, La Jolla, CA, USA
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165
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Kaye WH, Bailer UF. Understanding the neural circuitry of appetitive regulation in eating disorders. Biol Psychiatry 2011; 70:704-705. [PMID: 21967986 PMCID: PMC5954823 DOI: 10.1016/j.biopsych.2011.08.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Accepted: 08/26/2011] [Indexed: 11/17/2022]
Affiliation(s)
- Walter H Kaye
- Department of Psychiatry, University of California, San Diego, La Jolla, California.
| | - Ursula F Bailer
- Department of Psychiatry, University of California, San Diego, La Jolla, California; Department of Psychiatry and Psychotherapy, Division of Biological Psychiatry, Medical University of Vienna, Vienna, Austria
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166
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Cowdrey FA, Park RJ, Harmer CJ, McCabe C. Increased neural processing of rewarding and aversive food stimuli in recovered anorexia nervosa. Biol Psychiatry 2011; 70:736-743. [PMID: 21714958 DOI: 10.1016/j.biopsych.2011.05.028] [Citation(s) in RCA: 166] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 05/24/2011] [Accepted: 05/24/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Recent evidence has shown that individuals with acute anorexia nervosa and those recovered have aberrant physiological responses to rewarding stimuli. We hypothesized that women recovered from anorexia nervosa would show aberrant neural responses to both rewarding and aversive disorder-relevant stimuli. METHODS Using functional magnetic resonance imaging (fMRI), the neural response to the sight and flavor of chocolate, and their combination, in 15 women recovered from restricting-type anorexia nervosa and 16 healthy control subjects matched for age and body mass index was investigated. The neural response to a control aversive condition, consisting of the sight of moldy strawberries and a corresponding unpleasant taste, was also measured. Participants simultaneously recorded subjective ratings of "pleasantness," "intensity," and "wanting." RESULTS Despite no differences between the groups in subjective ratings, individuals recovered from anorexia nervosa showed increased neural response to the pleasant chocolate taste in the ventral striatum and pleasant chocolate sight in the occipital cortex. The recovered participants also showed increased neural response to the aversive strawberry taste in the insula and putamen and to the aversive strawberry sight in the anterior cingulate cortex and caudate. CONCLUSIONS Individuals recovered from anorexia nervosa have increased neural responses to both rewarding and aversive food stimuli. These findings suggest that even after recovery, women with anorexia nervosa have increased salience attribution to food stimuli. These results aid our neurobiological understanding and support the view that the neural response to reward may constitute a neural biomarker for anorexia nervosa.
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Affiliation(s)
- Felicity A Cowdrey
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom.
| | - Rebecca J Park
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom
| | - Catherine J Harmer
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom
| | - Ciara McCabe
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom
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167
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Rothemund Y, Buchwald C, Georgiewa P, Bohner G, Bauknecht HC, Ballmaier M, Klapp BF, Klingebiel R. Compulsivity predicts fronto striatal activation in severely anorectic individuals. Neuroscience 2011; 197:242-50. [PMID: 21952129 DOI: 10.1016/j.neuroscience.2011.09.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Revised: 09/07/2011] [Accepted: 09/07/2011] [Indexed: 11/17/2022]
Abstract
Anorexia nervosa is a severe illness and shows one of the highest death rates among psychiatric or psychosomatic diseases. However, despite several lines of research, the etiology of this disease is still unknown. One of those features is the rigidity of behaviors, for example, controlling of weight and pursuing of thinness, that often meets the criteria for obsessive-compulsive behavior. In this study, it was investigated whether the clinical feature of compulsivity in anorexia nervosa patients relates to regional brain activation. Using functional magnetic resonance imaging, 12 severely anorectic women were compared to 12 normal-weight female individuals following a cue-reactivity paradigm. Cues comprised food cues of high and low calorie content as well as eating-related utensils. Voxel-based morphometric analysis indicated significantly overall reduced gray matter volume and significantly increased cerebrospinal fluids in anorexia nervosa (AN) patients, which was controlled for in subsequent analyses. Following the high-calorie stimulation, AN patients activated the right caudate body and right precuneus, whereas control subjects did not show significant regional activations. In both other conditions, low-calorie foods and eating utensils, regional brain activations did not survive FDR thresholds. During the high-calorie condition, compulsivity, that is, the subscore "obsessive thoughts," predicted activation of the superior frontal gyrus [Brodmann areas (BA) 10], inferior frontal gyrus, anterior cingulate cortex (BA 32), cingulate gyrus (BA 24), caudate body, cuneus, pre- and postcentral gyrus. The subscore "compulsive acts" correlated with activation of the claustrum during the high-calorie condition and predicted a number of deactivations of frontal and temporal regions. We conclude that in severely anorectic individuals, the degree of compulsivity predicts activation and deactivation of the fronto-striatal pathway.
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Affiliation(s)
- Y Rothemund
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité-University Medicine, Charité Platz 1, 10117 Berlin, Germany.
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Abstract
AIM To assess the prevalence and type of taste disorders in Aboriginal and non-Aboriginal children matched for age, gender and living in the same general and educational environment. METHODS Taste function was assessed in 432 Aboriginal (n = 166) and non-Aboriginal (n = 266) children aged 8-12 years from six public schools in a rural township using a three-choice taste identification test and a cross-sectional design. RESULTS The prevalence of taste disorders was very high and significantly more common in Aboriginal (20/166; 12.0%) than in non-Aboriginal (21/266; 7.9%) children. Forty-one children had quality-specific disorders, of whom 27 (65.9%) had sweet disorders. Children often had more than one quality disorder. CONCLUSION The prevalence of taste disorders in children was high and exceeded the level (4%) designated by the World Health Organisation as requiring immediate action by health authorities. As the cause of the disorders is unknown, there is a need for a wider investigation of the causes and the consequences.
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Affiliation(s)
- D G Laing
- Faculty of Medicine, School of Women's and Children's Health, University of New South Wales and Sydney Children's Hospital, Sydney, Australia.
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169
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Harrison A, Treasure J, Smillie LD. Approach and avoidance motivation in eating disorders. Psychiatry Res 2011; 188:396-401. [PMID: 21645929 DOI: 10.1016/j.psychres.2011.04.022] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Revised: 04/12/2011] [Accepted: 04/20/2011] [Indexed: 10/18/2022]
Abstract
It has been proposed that approach and avoidance processes may be critically involved in the development and maintenance of eating disorders (EDs), including anorexia nervosa (AN) and bulimia nervosa (BN). The Behavioural Inhibition System and Behavioural Activation System Scales (BIS/BAS) and Appetitive Motivation Scale (AMS) questionnaires were administered to 286 participants: 91 healthy controls (HCs), 121 participants with a current ED, either AN (restrictive and binge purge subtypes), or BN and 74 participants recovered from an ED. Individuals with EDs had higher levels of sensitivity to punishment and lower levels of reward reactivity than controls. Individuals in recovery from an ED scored the same as those in the acute group, with the exception of BAS fun seeking, for which they scored significantly higher than those with restricting AN. Discriminant analysis revealed that HCs were maximally separated from those in the acute and recovered ED groups along a dimension reflecting high punishment sensitivity and low reward sensitivity. Classification analysis demonstrated that ED and HC group membership was predicted from reward and punishment sensitivity measures; however recovered participants tended to be misclassified as ED. This study suggests high punishment sensitivity and low reward reactivity/sensitivity might form a personality cluster associated with the risk of developing an ED.
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Affiliation(s)
- Amy Harrison
- Kings College London, Institute of Psychiatry, Section of Eating Disorders, London, UK.
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170
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Kazlouski D, Rollin MD, Tregellas J, Shott ME, Jappe LM, Hagman JO, Pryor T, Yang TT, Frank GK. Altered fimbria-fornix white matter integrity in anorexia nervosa predicts harm avoidance. Psychiatry Res 2011; 192:109-16. [PMID: 21498054 PMCID: PMC3085716 DOI: 10.1016/j.pscychresns.2010.12.006] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Revised: 11/30/2010] [Accepted: 12/09/2010] [Indexed: 01/12/2023]
Abstract
The eating disorder anorexia nervosa (AN) is associated with high anxiety. The brain mechanisms that drive those behaviors are unknown. In this study we wanted to test whether brain white matter (WM) integrity is altered in AN, and related to heightened anxiety. Sixteen adult women with AN (mean age 24 ± 7 years) and 17 healthy control women (CW, mean age 25 ± 4 years) underwent diffusion tensor imaging (DTI) of the brain. The DTI brain images were used to calculate the fractional anisotropy (FA) of WM tracts, which is a measure for WM integrity. AN individuals compared to CW showed clusters of significantly reduced FA (p<0.05, corrected) in the bilateral fimbria-fornix and the fronto-occipital fasciculus, as well as the posterior cingulum WM. In the AN group, Harm Avoidance was predicted by FA in the left and right fimbria-fornix. Those findings were not due to WM volume deficits in AN. This study indicates that WM integrity is abnormal in AN in limbic and association pathways, which could contribute to disturbed feeding, emotion processing and body perception in AN. The prediction of Harm Avoidance in AN by fimbria-fornix WM integrity suggests that this pathway may be mechanistically involved in high anxiety in AN.
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Affiliation(s)
- Demitry Kazlouski
- Department of Psychiatry, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Michael D.H. Rollin
- Department of Psychiatry, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Jason Tregellas
- Department of Psychiatry, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA, Neuroscience Program, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA, Research Service, Denver VA Medical Center, Denver, CO, USA
| | - Megan E. Shott
- Department of Psychiatry, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Leah M. Jappe
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Jennifer O. Hagman
- Department of Psychiatry, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Tamara Pryor
- Eating Disorders Center Denver, Glendale, CO, USA
| | - Tony T. Yang
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Guido K.W. Frank
- Department of Psychiatry, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA, Neuroscience Program, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
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171
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Abstract
PURPOSE OF REVIEW Imaging studies that demonstrate loss of brain substance help explain why people with anorexia nervosa have cognitive deficits and may help to elucidate the cognitive style found in many patients. It is not known whether a neurobiological vulnerability predisposes to anorexia nervosa or if this is associated with maintenance of symptoms once the illness develops. RECENT FINDINGS Evidence emerging from functional neuro-imaging studies raise the possibility of a biological abnormality that may predispose to anorexia nervosa. Studies have found abnormal functioning in the frontal, limbic, occipital, striatal and cerebellar regions that may persist after recovery. However, most recent cross-sectional and prospective studies indicate improved cerebral activity and mixed findings in regards to neurocognitve function with recovery from anorexia nervosa. SUMMARY The elucidation of the neurobiology of anorexia nervosa has benefited from recent advances in neuro-imaging and cognitive neuroscience. Further research is needed to examine the degree to which abnormalities are a consequence of starvation or are caused by a putative anorexia nervosa endophenotype.
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172
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Dalle Grave R. Eating disorders: progress and challenges. Eur J Intern Med 2011; 22:153-60. [PMID: 21402245 DOI: 10.1016/j.ejim.2010.12.010] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2010] [Revised: 12/11/2010] [Accepted: 12/17/2010] [Indexed: 11/23/2022]
Abstract
BACKGROUND Eating disorders are common health problems afflicting mainly female adolescents and young women. They are associated with important physical health and psychosocial morbidity, and carry increased risk of death. Their cause is not yet completely understood and their management is complex, with some patients resisting all available treatments. AIMS OF THIS REVIEW: To provide the readers with an update regarding our knowledge and understanding of eating disorders. METHODS Medline database has been used for searching articles on eating disorders published since 1980. The key words used were eating disorders, anorexia nervosa, bulimia nervosa, bulimia, and binge eating. Professional books published during this period has been also reviewed. CONCLUSIONS In the last 30 years a substantial improvement has been achieved both in the understanding and management of eating disorders, but many problems still need to be resolved. Three principal priorities should be addressed. First, the actual classification of eating disorders should be revised, since about half the cases seen in clinical practice receive a diagnosis of eating disorder not otherwise specified, and it is common to observe a migration between eating disorder diagnoses. Second, the research on pathogenesis should better clarify the exact role of genetic and environmental risk factors, and how they interact and vary across the development and maintenance of eating disorders. Third, there is an urgent need both to disseminate the few evidence-based treatments available, and to develop more potent treatments for all the eating disorder diagnostic categories.
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Affiliation(s)
- Riccardo Dalle Grave
- Department of Eating & Weight Disorder, Villa Garda Hospital, Garda (VR), Italy.
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173
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Anorexia nervosa and the insula. Med Hypotheses 2011; 76:353-7. [DOI: 10.1016/j.mehy.2010.10.038] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Revised: 10/20/2010] [Accepted: 10/22/2010] [Indexed: 11/20/2022]
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174
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Abstract
The aim of this paper is to bring eating back into the centre of the eating disorder discourse. The ability to interrogate and understand the central processes of appetite has increased considerably since the discovery of leptin and the ability to observe brain function with scanning methodologies. This has led to substantial progress in understanding the biological causative and maintaining factors in eating disorders, opening up the possibility of translating the latest findings into new forms of treatment. The biological mechanisms underpinning symptoms evolution and course of illness will first be described, follows by a discussion on integrating the research evidence in fear and feeding into patient care.
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Affiliation(s)
- Janet Treasure
- Section of Eating Disorders, Institute of Psychiatry, King's College London, London, UK
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175
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Abstract
OBJECTIVES This chapter reviews brain imaging findings in anorexia and bulimia nervosa which characterize brain circuitry that may contribute to the pathophysiology of eating disorders (EDs). SUMMARY OF RECENT FINDINGS Recent imaging studies provide evidence of disturbed gustatory processing in EDs which involve the anterior insula as well as striatal regions. These results raise the possibility that individuals with anorexia nervosa have altered appetitive mechanism that may involve sensory, interoceptive, or reward processes. Furthermore, evidence of altered reward mechanisms is supported by studies that suggest that individuals with anorexia nervosa and bulimia nervosa share a trait toward similar anterior ventral striatal pathway dysregulation. This shared trait disturbance of the modulation of reward and emotionality may create a vulnerability for dysregulated appetitive behaviors. However, those with anorexia nervosa may be able to inhibit appetite and have extraordinary self-control because of exaggerated dorsal cognitive circuit function, whereas individuals with bulimia nervosa are vulnerable to overeating when they get hungry, because they have less ability to control their impulses. FUTURE DIRECTIONS Current therapeutic interventions have modest success. Better understanding of neurocircuits that may be related to altered appetite, mood, impulse control, and other symptoms underlying the pathophysiology of EDs might improve psychotherapeutic and drug treatment strategies.
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Affiliation(s)
- Walter H Kaye
- Department of Psychiatry, University of California, San Diego, CA, USA.
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176
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Oberndorfer TA, Kaye WH, Simmons AN, Strigo IA, Matthews SC. Demand-specific alteration of medial prefrontal cortex response during an inhibition task in recovered anorexic women. Int J Eat Disord 2011; 44:1-8. [PMID: 20127942 DOI: 10.1002/eat.20750] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE It is well known that individuals with anorexia nervosa (AN) are inhibited and over-controlled. This study investigated a prefrontal-cingulate network that is involved in inhibitory control. METHOD To avoid the confounds of malnutrition, 12 recovered (RAN) subjects were compared to 12 matched control women (CW) using a validated inhibition task (i.e., a stop signal task) during functional magnetic resonance imaging. RESULTS Consistent with the a priori hypothesis, RAN subjects showed altered task-related activation in the medial prefrontal cortex (mPFC), a critical node of the inhibitory control network. Specifically, whereas RAN and CW showed similar mPFC activity during trials when inhibitory demand was low (i.e., easy trials), RAN relative to CW showed significantly less mPFC activation as inhibition trials became more difficult (i.e., hard trials), suggesting a demand-specific modulation of inhibitory control circuitry in RAN. DISCUSSION These findings support a neural basis for altered impulse control symptoms in AN.
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Affiliation(s)
- Tyson A Oberndorfer
- Department of Psychiatry, University of California-San Diego, La Jolla, CA 92037, USA
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177
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Schmidt U, Oldershaw A, van Elburg A. Translating experimental neuroscience into treatment of eating disorders: two examples. Curr Top Behav Neurosci 2011; 6:253-268. [PMID: 21243480 DOI: 10.1007/7854_2010_76] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Anorexia nervosa (AN) is a serious mental disorder with impaired functioning including not only the cognitive and socio-emotional but also physical domains. Improved treatments, especially for adults with AN, are urgently needed. The insights gained from basic research in experimental animal models and the advent of cognitive neuroscience have produced major advances in our understanding of the condition, but translating these into clinical research or practice remains a challenge. We describe here what the eating disorders field can gain from schizophrenia research in this area. We use the example of socio-emotional impairments in AN to describe the iterative process between basic research and intervention development for neurobiologically informed and based treatments for this condition and briefly touch on some other examples that stem from translational science.
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Affiliation(s)
- Ulrike Schmidt
- Section of Eating Disorders, King's College London, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK.
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178
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Castro-Fornieles J, Caldú X, Andrés-Perpiñá S, Lázaro L, Bargalló N, Falcón C, Plana MT, Junqué C. A cross-sectional and follow-up functional MRI study with a working memory task in adolescent anorexia nervosa. Neuropsychologia 2010; 48:4111-6. [DOI: 10.1016/j.neuropsychologia.2010.10.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Revised: 09/07/2010] [Accepted: 10/01/2010] [Indexed: 10/19/2022]
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179
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Experience with activity based anorexia enhances conditioned taste aversion learning in rats. Physiol Behav 2010; 102:51-7. [PMID: 20946908 DOI: 10.1016/j.physbeh.2010.10.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Revised: 10/05/2010] [Accepted: 10/06/2010] [Indexed: 11/21/2022]
Abstract
Activity based anorexia (ABA) is a model that mimics the self-starvation and hyperactivity features of anorexia nervosa (AN). This study investigated whether a history of ABA will enhance food avoidance learning and retard its extinction in female rats. We compared the acquisition and extinction of a conditioned taste aversion (CTA) in naive (ad lib with no access to RW), ABA, and pair-fed to the food intake of ABA (with access to a locked RW) female Sprague-Dawley rats. The CTA conditioning was conducted after the ABA and pair-fed rats had recovered to their pre-food restriction body weights. For the CTA learning, 0.3M sucrose consumption was followed by low doses LiCl (0.009M or 0.018M at 1.33ml/100g of body weight, IP) injection. The results revealed that the ABA rats acquired an aversion to sucrose significantly sooner than the naive controls. Furthermore, they completely avoided sucrose while the naive and pair-fed controls still sampled it by the end of 10 conditioning trials. When extinction was assessed by 1-bottle and 2-bottle tests, the ABA rats extinguished more slowly than the controls. However, the differences in sucrose aversion extinction between the ABA and control rats were only significant in the 1-bottle test. These data suggest that experience with AN-like behaviors results in an acquired aversion to a preferred food sooner and a longer retention of the negative food associations. These findings have implications for understanding the persistence of aberrant eating behaviors in eating disorders.
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180
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Szalay C, Abrahám I, Papp S, Takács G, Lukáts B, Gáti A, Karádi Z. Taste reactivity deficit in anorexia nervosa. Psychiatry Clin Neurosci 2010; 64:403-7. [PMID: 20546167 DOI: 10.1111/j.1440-1819.2010.02106.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM Anorexia nervosa is a complex psychiatric disorder posing a rapidly increasing burden on modern societies. Our purpose was to clarify perceptual-motivational aspects of gustatory disturbances in the disease. METHODS A taste reactivity test, with the use of all five primary qualities in two concentrations, was performed in restrictive-type anorexic patients, and their hedonic evaluations were compared to those of age-matched healthy control subjects. RESULTS The patients gave significantly lower pleasantness scores for pleasant taste stimuli compared with controls. The differences were the greatest for the lower concentration sucrose, umami and sodium chloride. Ratings given for the aversive taste stimuli were similar in both experimental groups. CONCLUSION Our findings contribute to a better understanding of complex symptoms of anorexia nervosa, and may also help to develop more effective cognitive-behavioral therapies.
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Affiliation(s)
- Csaba Szalay
- Institute of Physiology and Neurophysiology Research Group of the Hungarian Academy of Sciences, Pécs University Medical School, Pécs, Hungary.
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181
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Friederich HC, Brooks S, Uher R, Campbell IC, Giampietro V, Brammer M, Williams SC, Herzog W, Treasure J. Neural correlates of body dissatisfaction in anorexia nervosa. Neuropsychologia 2010; 48:2878-85. [DOI: 10.1016/j.neuropsychologia.2010.04.036] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2009] [Revised: 03/16/2010] [Accepted: 04/11/2010] [Indexed: 10/19/2022]
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182
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Klein DA, Schebendach JE, Gershkovich M, Smith GP, Walsh BT. Modified sham feeding of sweet solutions in women with anorexia nervosa. Physiol Behav 2010; 101:132-40. [PMID: 20438741 DOI: 10.1016/j.physbeh.2010.04.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Revised: 04/26/2010] [Accepted: 04/27/2010] [Indexed: 10/19/2022]
Abstract
Anorexia Nervosa (AN) is a disorder of self-starvation characterized by decreased meal size and food intake. While it is possible that reduced food intake in AN reflects an excess of inhibitory factors, e.g., cognitive inhibition related to fear of weight gain or abnormal postingestive negative feedback, it is also possible that decreased intake reflects diminished orosensory stimulation of food intake. This has been difficult to test directly because the amount of food ingested during a test meal by patients with AN reflects an integration of orosensory excitatory, and cognitive, learned, and postingestive inhibitory controls of eating. To begin to dissociate these controls, we adapted the modified sham feeding technique (MSF) to measure the intake of a series of sweetened solutions in the absence of postingestive stimulation. Subjects with AN (n=24) and normal controls (NC, n=10) were randomly presented with cherry Kool Aid solutions sweetened with five concentrations of aspartame (0, 0.01, 0.03, 0.08 and 0.28%) in a closed opaque container fitted with a straw. They were instructed to sip as much as they wanted of the solution during 15 1-minute trials and to spit the fluid out into another opaque container. Subjects with AN sipped less unsweetened solution than NC (p<0.05). Because this difference appeared to account completely for the smaller intakes of sweetened solutions by AN, responsiveness of intake to sweet taste per se was not different in AN and NC. Since MSF eliminated postingestive and presumably cognitive inhibitory controls, and the orosensory response to sweet taste was not different in AN than NC, we conclude that decreased intake by AN subjects under these conditions reflects the increased inhibition characteristic of this disorder that is presumably learned, with a possible contribution of decreased potency of orosensory stimulation by the sipped solutions.
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Affiliation(s)
- D A Klein
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA.
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183
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Keating C. Theoretical perspective on anorexia nervosa: The conflict of reward. Neurosci Biobehav Rev 2010; 34:73-9. [PMID: 19619579 DOI: 10.1016/j.neubiorev.2009.07.004] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2009] [Revised: 06/24/2009] [Accepted: 07/13/2009] [Indexed: 11/16/2022]
Affiliation(s)
- Charlotte Keating
- Alfred Psychiatry Research Centre, The Alfred and Monash University, Melbourne, Australia.
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184
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van Kuyck K, Gérard N, Van Laere K, Casteels C, Pieters G, Gabriëls L, Nuttin B. Towards a neurocircuitry in anorexia nervosa: evidence from functional neuroimaging studies. J Psychiatr Res 2009; 43:1133-45. [PMID: 19442986 DOI: 10.1016/j.jpsychires.2009.04.005] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2008] [Revised: 04/06/2009] [Accepted: 04/14/2009] [Indexed: 11/19/2022]
Abstract
Functional neuroimaging is widely used to unravel changes in brain functioning in psychiatric disorders. In the current study, we review single-photon emission tomography (SPECT), positron emission tomography (PET) and functional magnetic resonance imaging (fMRI) studies in anorexia nervosa (AN), a difficult-to-treat eating disorder with the highest mortality rate among psychiatric disorders. We discuss the role of the parietal cortex, anterior and subgenual cingulate cortex, frontal cortex and temporal lobe in light of the cardinal symptoms of AN. The insights of the current review may ultimately lead to the development of new treatments.
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Affiliation(s)
- Kris van Kuyck
- Laboratory for Experimental Functional Neurosurgery, Department of Neurosciences, K.U.Leuven Provisorium I, Minderbroedersstraat 17, 3000 Leuven, Belgium.
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185
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Kaye WH, Fudge JL, Paulus M. New insights into symptoms and neurocircuit function of anorexia nervosa. Nat Rev Neurosci 2009; 10:573-84. [PMID: 19603056 DOI: 10.1038/nrn2682] [Citation(s) in RCA: 561] [Impact Index Per Article: 37.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Individuals with anorexia nervosa have a relentless preoccupation with dieting and weight loss that results in severe emaciation and sometimes death. It is controversial whether such symptoms are secondary to psychosocial influences, are a consequence of obsessions and anxiety or reflect a primary disturbance of brain appetitive circuits. New brain imaging technology provides insights into ventral and dorsal neural circuit dysfunction - perhaps related to altered serotonin and dopamine metabolism - that contributes to the puzzling symptoms found in people with eating disorders. For example, altered insula activity could explain interoceptive dysfunction, and altered striatal activity might shed light on altered reward modulation in people with anorexia nervosa.
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Affiliation(s)
- Walter H Kaye
- Eating Disorder Treatment & Research Program, Department of Psychiatry, University of California, San Diego, La Jolla Village Professional Center, 8950 Villa La Jolla Drive, Suite C-207, La Jolla, California 92037, USA.
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186
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Dellava JE, Policastro P, Hoffman DJ. Energy metabolism and body composition in long-term recovery from anorexia nervosa. Int J Eat Disord 2009; 42:415-21. [PMID: 19107831 DOI: 10.1002/eat.20619] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The aim of this study was to determine if energy metabolism and body composition differ between women recovered from anorexia nervosa for 2 or more years (RAN) and control (C) women. METHOD Using a cross-sectional design, 16 RAN and 18 C women were studied. Respiratory quotient (RQ) and resting energy expenditure (REE) were measured using indirect calorimetry and body composition using dual energy X-ray absorptiometry. RESULTS The REE between RAN and C women was not significantly different, even when adjusted for body composition. However, RAN women had a higher rate of fat oxidation (p = .015), controlling for diet and body composition. There were no significant differences between the groups for body composition, percent body fat, or percent truncal fat mass. DISCUSSION Although RAN women have a higher rate of fat oxidation, there were no significant differences in REE or body composition when compared with C women.
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Affiliation(s)
- Jocilyn E Dellava
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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187
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Klump KL, Bulik CM, Kaye WH, Treasure J, Tyson E. Academy for eating disorders position paper: eating disorders are serious mental illnesses. Int J Eat Disord 2009; 42:97-103. [PMID: 18951455 DOI: 10.1002/eat.20589] [Citation(s) in RCA: 276] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Kelly L Klump
- Department of Psychology, Michigan State University, East Lansing, Michigan 48824-1116, USA.
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188
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Van den Eynde F, Treasure J. Neuroimaging in eating disorders and obesity: implications for research. Child Adolesc Psychiatr Clin N Am 2009; 18:95-115. [PMID: 19014860 DOI: 10.1016/j.chc.2008.07.016] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Medicine and psychiatry have benefited from developments in investigational techniques. Neuroimaging is one such domain that has technically progressed enormously in recent years, resulting in, for example, higher temporal and spatial resolution. Neuroimaging techniques have been widely used in a range of psychiatric disorders, providing new insights into neural brain circuits and neuroreceptor functions in vivo. These imaging techniques allow researchers to study not only the configuration of brain structures but also aspects of normal and anomalous human behavior more accurately.
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Affiliation(s)
- Frederique Van den Eynde
- Institute of Psychiatry, Section of Eating Disorders PO59, De Crespigny Park, SE5 8AF, London, UK
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189
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Crow SJ, Mitchell JE, Roerig JD, Steffen K. What potential role is there for medication treatment in anorexia nervosa? Int J Eat Disord 2009; 42:1-8. [PMID: 18683884 DOI: 10.1002/eat.20576] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To review selected issues regarding the development of drug treatments for anorexia nervosa (AN). METHOD The existing pharmacotherapy literature for AN is reviewed, and the theoretical and practical considerations are discussed. RESULTS A very wide variety of drugs have been examined in AN, generally with negative results. There are a number of potential reasons for this finding, including compliance, nutritional deficits, selection of the wrong targets or the wrong outcome measures, use of monotherapy, lack of animal models, or factors intrinsic to AN. CONCLUSION Pharmacotherapy provides little benefit in the treatment of AN at present. Several strategies might lead to the identification of more effective agents, including new measurement strategies, identification of novel pharmacologic targets, and consideration of a clinical trials network.
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Affiliation(s)
- Scott J Crow
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota 55454-1495, USA.
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190
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Aschenbrenner K, Scholze N, Joraschky P, Hummel T. Gustatory and olfactory sensitivity in patients with anorexia and bulimia in the course of treatment. J Psychiatr Res 2008; 43:129-37. [PMID: 18423668 DOI: 10.1016/j.jpsychires.2008.03.003] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2007] [Revised: 02/26/2008] [Accepted: 03/04/2008] [Indexed: 10/22/2022]
Abstract
BACKGROUND The majority of studies on taste and smell in eating disorders have revealed several alterations of olfactory or gustatory functions. Aim of this prospective study was to employ detailed olfactory and gustatory testing in female subjects of three homogenous groups - anorexia nervosa, bulimia nervosa and healthy controls - and to look at the effects of treatment on these measures. METHODS Sixteen hospitalized female patients with anorexia (restricting type, mean age [M]=24.5 years), 24 female patients with bulimia (purging type, M=24.3 years) as well as 23 healthy controls (M=24.5 years) received olfactory ("Sniffin' Sticks") and gustatory testing ("Taste Strips"). Group differences in olfactory and gustatory sensitivity, body mass index (BMI), the Beck depression inventory, the eating attitudes test (EAT), and the influence of therapy on gustatory and olfactory function were investigated. RESULTS (1) Group differences were present for odor discrimination and overall olfactory function with anorexic patients having the lowest scores. (2) Regarding taste function, controls scored higher than patients with anorexia. (3) At admission small but significant correlations were found between overall olfactory function and body weight (r(63)=0.35), BMI (r(63) = 0.37), and EAT score (r(63) = -0.27). Similarly, (4) the taste test score correlated significantly with body weight (r(63)= 0.48), and BMI (r(63) = 0.45). Finally, (5) at discharge overall olfactory and gustatory function were significantly higher compared to admission in anorexic patients. CONCLUSIONS As compared to healthy controls and bulimic patients our results show lowered olfactory and gustatory sensitivities in anorexic patients that improved with increasing BMI and decreasing eating pathology in the course of treatment.
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Affiliation(s)
- Katja Aschenbrenner
- Department for Psychosomatic Medicine, University of Dresden Medical School, Fetscherstrasse 74, 01307 Dresden, Germany.
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191
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Kami YN, Goto TK, Tokumori K, Yoshiura T, Kobayashi K, Nakamura Y, Honda H, Ninomiya Y, Yoshiura K. The development of a novel automated taste stimulus delivery system for fMRI studies on the human cortical segregation of taste. J Neurosci Methods 2008; 172:48-53. [DOI: 10.1016/j.jneumeth.2008.04.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2008] [Revised: 04/01/2008] [Accepted: 04/06/2008] [Indexed: 10/22/2022]
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192
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Lopez C, Tchanturia K, Stahl D, Treasure J. Weak central coherence in eating disorders: a step towards looking for an endophenotype of eating disorders. J Clin Exp Neuropsychol 2008; 31:117-25. [PMID: 18608648 DOI: 10.1080/13803390802036092] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Previous work has found that women with anorexia nervosa and bulimia nervosa have weak coherence. The aim of this study was to examine whether women who had recovered from an eating disorder (ED) also had weak coherence. A total of 42 recovered ED women and 42 healthy women were assessed with a battery of five neuropsychological tests that measure aspects of global or local functioning. The recovered ED group showed superior local processing and poorer global processing than the healthy group. These results are indicative of weak coherence. The finding that weak coherence is a stable characteristic rather than a state effect suggests that it may be an endophenotype for ED.
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Affiliation(s)
- Carolina Lopez
- Division of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK.
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Abstract
Anorexia nervosa (AN) and bulimia nervosa (BN) are related disorders of unknown etiology that most commonly begin during adolescence in women. AN and BN have unique and puzzling symptoms, such as restricted eating or binge-purge behaviors, body image distortions, denial of emaciation, and resistance to treatment. These are often chronic and relapsing disorders, and AN has the highest death rate of any psychiatric disorder. The lack of understanding of the pathogenesis of this illness has hindered the development of effective interventions, particularly for AN. Individuals with AN and BN are consistently characterized by perfectionism, obsessive-compulsiveness, and dysphoric mood. Individuals with AN tend to have high constraint, constriction of affect and emotional expressiveness, ahendonia and asceticism, whereas individuals with BN tend to be more impulsive and sensation seeking. Such symptoms often begin in childhood, before the onset of an eating disorder, and persist after recovery, suggesting they are traits that create a vulnerability for developing an ED. There is growing acknowledgement that neurobiological vulnerabilities make a substantial contribution to the pathogenesis of AN and BN. Considerable evidence suggests that altered brain serotonin (5-HT) function contributes to dysregulation of appetite, mood, and impulse control in AN and BN. Brain imaging studies, using 5-HT specific ligands, show that disturbances of 5-HT function occur when people are ill, and persist after recovery from AN and BN. It is possible that a trait-related disturbance of 5-HT neuronal modulation predates the onset of AN and contributes to premorbid symptoms of anxiety, obsessionality, and inhibition. This dysphoric temperament may involve an inherent dysregulation of emotional and reward pathways which also mediate the hedonic aspects of feeding, thus making these individuals vulnerable to disturbed appetitive behaviors. Restricting food intake may become powerfully reinforcing because it provides a temporary respite from dysphoric mood. Several factors may act on these vulnerabilities to cause AN to start in adolescence. First, puberty-related female gonadal steroids or age-related changes may exacerbate 5-HT dysregulation. Second, stress and/or cultural and societal pressures may contribute by increasing anxious and obsessional temperament. Individuals with AN may discover that reduced dietary intake, by reducing plasma tryptophan availability, is a means by which they can modulate brain 5-HT functional activity and anxious mood. People with AN enter a vicious cycle which accounts for the chronicity of this disorder because caloric restriction results in a brief respite from dysphoric mood. However, malnutrition and weight loss, in turn, produce alterations in many neuropeptides and monoamine function, perhaps in the service of conserving energy, but which also exaggerates dysphoric mood. In summary, this article reviews findings in brain chemistry and neuroimaging that shed new light on understanding the psychopathology of these difficult and frustrating disorders.
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Affiliation(s)
- Walter Kaye
- University of California, San Diego, 8950 Villa La Jolla Drive, Suite C207, La Jolla, CA 92037, United States.
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