1
|
Stern CM, McPherson I, Dreier MJ, Coniglio K, Palmer LP, Gydus J, Graver H, Germine LT, Tabri N, Wang SB, Breithaupt L, Eddy KT, Thomas JJ, Plessow F, Becker KR. Avoidant/restrictive food intake disorder differs from anorexia nervosa in delay discounting. J Eat Disord 2024; 12:19. [PMID: 38287459 PMCID: PMC10823699 DOI: 10.1186/s40337-023-00958-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 12/18/2023] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Avoidant/restrictive food intake disorder (ARFID) and anorexia nervosa (AN) are the two primary restrictive eating disorders; however, they are driven by differing motives for inadequate dietary intake. Despite overlap in restrictive eating behaviors and subsequent malnutrition, it remains unknown if ARFID and AN also share commonalities in their cognitive profiles, with cognitive alterations being a key identifier of AN. Discounting the present value of future outcomes with increasing delay to their expected receipt represents a core cognitive process guiding human decision-making. A hallmark cognitive characteristic of individuals with AN (vs. healthy controls [HC]) is reduced discounting of future outcomes, resulting in reduced impulsivity and higher likelihood of favoring delayed gratification. Whether individuals with ARFID display a similar reduction in delay discounting as those with AN (vs. an opposing bias towards increased delay discounting or no bias) is important in informing transdiagnostic versus disorder-specific cognitive characteristics and optimizing future intervention strategies. METHOD To address this research question, 104 participants (ARFID: n = 57, AN: n = 28, HC: n = 19) completed a computerized Delay Discounting Task. Groups were compared by their delay discounting parameter (ln)k. RESULTS Individuals with ARFID displayed a larger delay discounting parameter than those with AN, indicating steeper delay discounting (M ± SD = -6.10 ± 2.00 vs. -7.26 ± 1.73, p = 0.026 [age-adjusted], Hedges' g = 0.59), with no difference from HC (p = 0.514, Hedges' g = -0.35). CONCLUSION Our findings provide a first indication of distinct cognitive profiles among the two primary restrictive eating disorders. The present results, together with future research spanning additional cognitive domains and including larger and more diverse samples of individuals with ARFID (vs. AN), will contribute to identifying maintenance mechanisms that are unique to each disorder as well as contribute to the optimization and tailoring of treatment strategies across the spectrum of restrictive eating disorders.
Collapse
Affiliation(s)
- Casey M Stern
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA, 02114, USA
| | - Iman McPherson
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, USA
| | - Melissa J Dreier
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA, 02114, USA
- Department of Psychology, Rutgers University, New Brunswick, USA
| | - Kathryn Coniglio
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA, 02114, USA
- Department of Psychology, Rutgers University, New Brunswick, USA
| | - Lilian P Palmer
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA, 02114, USA
| | - Julia Gydus
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, USA
| | - Haley Graver
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA, 02114, USA
| | - Laura T Germine
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, USA
- Department of Psychiatry, Harvard Medical School, Cambridge, USA
| | - Nassim Tabri
- Department of Psychology, Carleton University, Ottawa, Canada
- Mental Health and Well-Being Research and Training Hub, Carleton University, Ottawa, Canada
| | - Shirley B Wang
- Department of Psychology, Harvard University, Cambridge, USA
| | - Lauren Breithaupt
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA, 02114, USA
- Department of Psychiatry, Harvard Medical School, Cambridge, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, USA
| | - Kamryn T Eddy
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA, 02114, USA
- Department of Psychiatry, Harvard Medical School, Cambridge, USA
| | - Jennifer J Thomas
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA, 02114, USA
- Department of Psychiatry, Harvard Medical School, Cambridge, USA
| | - Franziska Plessow
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, USA
- Department of Medicine, Harvard Medical School, Cambridge, USA
| | - Kendra R Becker
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA, 02114, USA.
- Department of Psychiatry, Harvard Medical School, Cambridge, USA.
| |
Collapse
|
2
|
Stedal K, Broomfield C, Hay P, Touyz S, Scherer R. Neuropsychological functioning in adult anorexia nervosa: A meta-analysis. Neurosci Biobehav Rev 2021; 130:214-226. [PMID: 34453951 DOI: 10.1016/j.neubiorev.2021.08.021] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/10/2021] [Accepted: 08/22/2021] [Indexed: 02/07/2023]
Abstract
Several studies have conceptualized neuropsychological dysfunction as part of the core pathology and defining behaviors seen in the eating disorder anorexia nervosa (AN). The aim of the current review was to synthesize the differences in neuropsychological test performance between individuals with AN and healthy controls, quantify and explain their heterogeneity. The search and screening procedures resulted in fifty studies that comprised 186 neuropsychological test results. Utilizing random-effects meta-analyses, the results revealed evidence for significant, moderate underperformance in people with AN in overall neuropsychological functioning (g¯ = -0.43, 95 % CI [-0.50, -0.36]). Weighted mean effect sizes ranged from g¯ = -0.53 for visuospatial abilities to g¯ = -0.10 for planning. Study and participant characteristics, including body mass index (BMI) and age, had significant moderator effects, especially on executive function, memory, and visuospatial abilities. The findings from the current study provide an extensive and comprehensive overview of the possible impairments in neuropsychological functioning in adult patients diagnosed with AN.
Collapse
Affiliation(s)
- Kristin Stedal
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital Ullevål HF, Postboks 4956 Nydalen, 0424, Oslo, Norway.
| | - Catherine Broomfield
- School of Psychology, Faculty of Science, The University of Sydney, NSW, 2006, Australia
| | - Phillipa Hay
- Translational Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Stephen Touyz
- School of Psychology, Faculty of Science, The University of Sydney, NSW, 2006, Australia
| | - Ronny Scherer
- Centre for Educational Measurement at the University of Oslo (CEMO), Faculty of Educational Sciences, University of Oslo, P.O. Box 1161 Blindern, 0318, Oslo, Norway
| |
Collapse
|
3
|
Same room - different windows? A systematic review and meta-analysis of the relationship between self-report and neuropsychological tests of cognitive flexibility in healthy adults. Clin Psychol Rev 2021; 88:102061. [PMID: 34332263 DOI: 10.1016/j.cpr.2021.102061] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 06/01/2021] [Accepted: 06/17/2021] [Indexed: 01/14/2023]
Abstract
Cognitive flexibility can be thought of as the ability to effectively adapt one's cognitive and behavioural strategies in response to changing task or environmental demands. To substantiate the common inference that self-report and neuropsychological tests of cognitive flexibility provide 'different windows into the same room', we undertook a systematic review and meta-analysis to determine whether self-report and neuropsychological tests of cognitive flexibility are related in healthy adults. Ten databases and relevant grey literature were searched from inception. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were adhered to. Twenty-one articles satisfied our inclusion criteria. A multi-level random-effects meta-analysis revealed no relationship (0.05, 95% CI = -0.00 to 0.10). Random-effects meta-analyses raised the possibility that the Cognitive Flexibility Scale and the Trail Making Test - part B (time) may be related (0.19, 95% CI = 0.06 to 0.31). We conclude that the relationship between self-report and neuropsychological tests of cognitive flexibility is not large enough to be considered convincing evidence for the two assessment approaches sharing construct validity. These results have clear implications for assessing and interpreting cognitive flexibility research and clinical practice.
Collapse
|
4
|
Maria AS, Barry C, Ringuenet D, Falissard B, Group T, Berthoz S. Subjective cognitive rigidity and attention to detail: A cross-cultural validation of the Detail and Flexibility Questionnaire (DFlex) in a French clinical sample. J Clin Exp Neuropsychol 2020; 42:1059-1071. [PMID: 33274668 DOI: 10.1080/13803395.2020.1842333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: People diagnosed with Anorexia Nervosa (AN) are at risk for poor cognitive flexibility and excessive attention to detail. These difficulties are traditionally quantified using neuropsychological tests. These tests do not capture the subjective repercussions of these cognitive styles. The Detail and Flexibility Questionnaire (DFlex) has been specifically developed to measure these repercussions. The aim of this study was to evaluate the psychometric properties of the French version of this scale (F-DFlex) and to adapt it if needed. Methods: The instrument factor structure, internal consistency, convergent, and discriminant validity were assessed in a sample of 107 French women AN inpatients. For convergent validity, associations between F-DFlex scores, perceived levels of autistic traits (Autism Quotient questionnaire - AQ) and eating disorders symptomatology (Eating Disorder Examination Questionnaire - EDE-Q), as well as neuropsychological evaluations (Wisconsin Card Sorting Test - WCST, Rey Complex Figure - RCF) were tested. Discriminant validity was assessed by comparing F-DFlex scores of the patients with a chronic versus non-chronic illness. Results: The results of the exploratory factorial analysis led to the removal of four items. Internal consistency indices of this shortened version were good. Correlation coefficients directions and values between F-DFlex factors and relevant AQ Switching and Detail subscores were satisfactory, indicating good convergent validity. F-DFlex Rigidity scores were associated with the WCST percentage of perseverative errors, but the F-DFlex Attention to Detail scores were not associated with the RCF central coherence index. F-DFlex scores were associated with the severity of eating disorders symptomatology independently of BMI, illness duration, or anxiety, and depression. Conclusion: This study indicates good psychometric properties of this new version of the DFlex. The F-DFlex appears as a promising self-report screening tool of important cognitive dimensions for use in clinical management of people diagnosed with AN.
Collapse
Affiliation(s)
- Anne-Solène Maria
- Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM , Villejuif, France
| | - Caroline Barry
- Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM , Villejuif, France
| | - Damien Ringuenet
- Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM , Villejuif, France.,Unité de Traitement des Troubles des Conduites Alimentaires, Département de Psychiatrie et d'Addictologie, Hôpital Paul Brousse , Villejuif, France
| | - Bruno Falissard
- Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM , Villejuif, France
| | | | - Sylvie Berthoz
- Département de Psychiatrie de l'Adolescent et du Jeune Adulte, Institut Mutualiste Montsouris , Paris, France.,Univ. Bordeaux, CNRS, EPHE, INCIA, UMR 5287 , Bordeaux, France
| |
Collapse
|
5
|
Mallorquí-Bagué N, Lozano-Madrid M, Testa G, Vintró-Alcaraz C, Sánchez I, Riesco N, César Perales J, Francisco Navas J, Martínez-Zalacaín I, Megías A, Granero R, Veciana De Las Heras M, Chami R, Jiménez-Murcia S, Fernández-Formoso JA, Treasure J, Fernández-Aranda F. Clinical and Neurophysiological Correlates of Emotion and Food Craving Regulation in Patients with Anorexia Nervosa. J Clin Med 2020; 9:jcm9040960. [PMID: 32244331 PMCID: PMC7230937 DOI: 10.3390/jcm9040960] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 03/26/2020] [Accepted: 03/27/2020] [Indexed: 01/24/2023] Open
Abstract
Background: Difficulties in emotion regulation and craving regulation have been linked to eating symptomatology in patients with anorexia nervosa (AN), contributing to the maintenance of their eating disorder. Methods: To investigate clinical and electrophysiological correlates of these processes, 20 patients with AN and 20 healthy controls (HC) completed a computerized task during EEG recording, where they were instructed to down-regulate negative emotions or food craving. Participants also completed self-report measures of emotional regulation and food addiction. The P300 and Late Positive Potential (LPP) ERPs were analysed. Results: LPP amplitudes were significantly smaller during down-regulation of food craving among both groups. Independent of task condition, individuals with AN showed smaller P300 amplitudes compared to HC. Among HC, the self-reported use of re-appraisal strategies positively correlated with LPP amplitudes during emotional regulation task, while suppressive strategies negatively correlated with LPP amplitudes. The AN group, in comparison to the HC group, exhibited greater food addiction, greater use of maladaptive strategies, and emotional dysregulation. Conclusions: Despite the enhanced self-reported psychopathology among AN, both groups indicated neurophysiological evidence of food craving regulation as evidenced by blunted LPP amplitudes in the relevant task condition. Further research is required to delineate the mechanisms associated with reduced overall P300 amplitudes among individuals with AN.
Collapse
Affiliation(s)
- Nuria Mallorquí-Bagué
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, 08907 Barcelona, Spain; (M.L.-M.); (G.T.); (C.V.-A.); (I.S.); (N.R.); (I.M.-Z.); (S.J.-M.)
- CIBER Fisiopatologia Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029 Madrid, Spain; (R.G.); (J.A.F.-F.)
- Addictive Behavior Unit, Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, 08001 Barcelona, Spain
- Correspondence: (N.M.-B.); (F.F.-A.)
| | - María Lozano-Madrid
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, 08907 Barcelona, Spain; (M.L.-M.); (G.T.); (C.V.-A.); (I.S.); (N.R.); (I.M.-Z.); (S.J.-M.)
- CIBER Fisiopatologia Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029 Madrid, Spain; (R.G.); (J.A.F.-F.)
| | - Giulia Testa
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, 08907 Barcelona, Spain; (M.L.-M.); (G.T.); (C.V.-A.); (I.S.); (N.R.); (I.M.-Z.); (S.J.-M.)
- CIBER Fisiopatologia Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029 Madrid, Spain; (R.G.); (J.A.F.-F.)
| | - Cristina Vintró-Alcaraz
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, 08907 Barcelona, Spain; (M.L.-M.); (G.T.); (C.V.-A.); (I.S.); (N.R.); (I.M.-Z.); (S.J.-M.)
- CIBER Fisiopatologia Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029 Madrid, Spain; (R.G.); (J.A.F.-F.)
| | - Isabel Sánchez
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, 08907 Barcelona, Spain; (M.L.-M.); (G.T.); (C.V.-A.); (I.S.); (N.R.); (I.M.-Z.); (S.J.-M.)
| | - Nadine Riesco
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, 08907 Barcelona, Spain; (M.L.-M.); (G.T.); (C.V.-A.); (I.S.); (N.R.); (I.M.-Z.); (S.J.-M.)
| | - José César Perales
- Department of Experimental Psychology, Mind, Brain, and Behavior Research Centre, University of Granada, 18071 Granada, Spain; (J.C.P.); (A.M.)
| | - Juan Francisco Navas
- Department of Basic Psychology, Autonomous University of Madrid, 28049 Madrid, Spain;
- Universitat Oberta de Catalunya, 08018 Barcelona, Spain
| | - Ignacio Martínez-Zalacaín
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, 08907 Barcelona, Spain; (M.L.-M.); (G.T.); (C.V.-A.); (I.S.); (N.R.); (I.M.-Z.); (S.J.-M.)
- Clinical Sciences Department, School of Medicine, University of Barcelona, 08907 Barcelona, Spain
| | - Alberto Megías
- Department of Experimental Psychology, Mind, Brain, and Behavior Research Centre, University of Granada, 18071 Granada, Spain; (J.C.P.); (A.M.)
| | - Roser Granero
- CIBER Fisiopatologia Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029 Madrid, Spain; (R.G.); (J.A.F.-F.)
- Department of Psychobiology and Methodology, Autonomous University of Barcelona, 08035 Barcelona, Spain
| | | | - Rayane Chami
- Section of Eating Disorders, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London, London SE5 8AF, UK; (R.C.); (J.T.)
| | - Susana Jiménez-Murcia
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, 08907 Barcelona, Spain; (M.L.-M.); (G.T.); (C.V.-A.); (I.S.); (N.R.); (I.M.-Z.); (S.J.-M.)
- CIBER Fisiopatologia Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029 Madrid, Spain; (R.G.); (J.A.F.-F.)
- Clinical Sciences Department, School of Medicine, University of Barcelona, 08907 Barcelona, Spain
| | - José Antonio Fernández-Formoso
- CIBER Fisiopatologia Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029 Madrid, Spain; (R.G.); (J.A.F.-F.)
| | - Janet Treasure
- Section of Eating Disorders, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London, London SE5 8AF, UK; (R.C.); (J.T.)
| | - Fernando Fernández-Aranda
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, 08907 Barcelona, Spain; (M.L.-M.); (G.T.); (C.V.-A.); (I.S.); (N.R.); (I.M.-Z.); (S.J.-M.)
- CIBER Fisiopatologia Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029 Madrid, Spain; (R.G.); (J.A.F.-F.)
- Clinical Sciences Department, School of Medicine, University of Barcelona, 08907 Barcelona, Spain
- Correspondence: (N.M.-B.); (F.F.-A.)
| |
Collapse
|
6
|
Abstract
INTRODUCTION Brain rate is parameter correlated to brain electric and metabolic activity. AIM The aim of this study was to analyze the results obtained for brain rate parameter as an indicator for general mental arousal in anxious patients and to compare them with results of healthy young people matched in age and gender, as well as with anorectic and hyperactive children. MATERIAL AND METHODS The diagnosis for all examinees was made according two statistic manuals (DMSIV- R and ICD-10), medical history, neuropsychological assessment, biochemical analysis and QEEG. In this study we examined the spectra power of the brain waves through quantified EEG (QEEG). The obtained results were exported to brain rate software and then calculated for each region separately. The QEEG spectra power data and the brain rate data were analyzed using Statistica software. RESULTS According to sagittal and lateral topography maximal values of brain rate parameter were obtained in group of healthy individuals and in group of anorectic patients. The lowest results were obtained in group of hyperactive children for all three regions. CONCLUSIONS The general conclusion will be that pathological conditions in childhood, analyzed in this research, can be defined as conditions of hypoarausal and this can be specific sign of brain dysfunction.
Collapse
|
7
|
Kucharska K, Kulakowska D, Starzomska M, Rybakowski F, Biernacka K. The improvement in neurocognitive functioning in anorexia nervosa adolescents throughout the integrative model of psychotherapy including cognitive remediation therapy. BMC Psychiatry 2019; 19:15. [PMID: 30626367 PMCID: PMC6327421 DOI: 10.1186/s12888-018-1984-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 12/11/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Patients with anorexia nervosa (AN) experience difficulties in neurocognitive functioning in the acute phase of illness which might be related to clinical presentation, but also in the apparently remitted state after weight recovery. Among the most commonly reported persistent deficits is cognitive inflexibility, which can be interpreted as a vulnerability trait or a "neuropsychological scar" reflecting the detrimental effect of prolonged semi-starvation in patients with a long duration of illness. Studies of adolescent samples with a relatively short clinical course may enable avoiding the effect of prolonged illness and help to determine whether neuropsychological deficits are trait or state dependent. The aim of this study is to assess cognitive functioning in adolescents with AN before and after the inpatient treatment programme, including cognitive remediation therapy (CRT). METHODS Forty-seven adolescent female inpatients with AN diagnosed according to DSM-5 and fifty healthy female adolescents matched for the education level and age were recruited. The patients underwent a multimodal treatment including a ten-week CRT. The standardized and cross-validated neuropsychological (Trail Making Test - TMT A and B, Color-Word Stroop Task - CWST, Ruff Figural Fluency Test - RFFT) and clinical measurements (Beck Depression Inventory - BDI, Eating Attitude Test - EAT-26, Yale-Brown Obsessive Compulsive Scale - Y-BOCS) were used to assess both clinical (in the acute phase and after partial weight recovery) and control subjects. RESULTS Initially, AN patients performed significantly worse compared to the controls, but afterwards, inpatient treatment improvement was noted on all examined measures. In a few subtests (TMT, CWST) performance of AN patients after the programme was still significantly poorer than in HC. CONCLUSIONS Cognitive inflexibility in adolescent AN patients, as measured with TMT, CWST, and RFFT tends to improve after therapy. Nevertheless, a few neuropsychological subtests which did not show complete normalization may warrant attention in subsequent studies. Further research including control intervention is needed to conclude whether CRT intervention affects the outcome.
Collapse
Affiliation(s)
- K. Kucharska
- 0000 0001 2237 2890grid.418955.4The Specialist Eating Disorder Unit, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - D. Kulakowska
- 0000 0001 2237 2890grid.418955.4The Specialist Eating Disorder Unit, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - M. Starzomska
- 0000 0001 2301 5211grid.440603.5Institute of Psychology, Faculty of Christian Philosophy, Cardinal Stefan Wyszynski University in Warsaw, Warsaw, Poland
| | - F. Rybakowski
- 0000 0001 2205 0971grid.22254.33The Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - K. Biernacka
- 0000 0001 2237 2890grid.418955.4The Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Neurology, 9 Sobieski, 02-957 Warsaw, Poland
| |
Collapse
|
8
|
Milos G, Wolf M, Robetin L, Sprenger M, Monteverde S, Schaer D. [Integrated Complex Treatment for Extreme Anorexia Nervosa; An Interdisciplinary Treatment Concept of the University Hospital Zurich]. PRAXIS 2019; 108:923-930. [PMID: 31662109 DOI: 10.1024/1661-8157/a003356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Integrated Complex Treatment for Extreme Anorexia Nervosa; An Interdisciplinary Treatment Concept of the University Hospital Zurich Abstract. The serious physical mental and psychosocial morbidity due to anorexia nervosa is often perceived by sufferers as less serious than from their environment. Doctors and other healthcare professionals are therefore confronted with the difficulty that urgent medical treatment is considered as unnecessary or even threatening by those affected. Although patients with anorexia nervosa usually wish to improve their condition, they are usually only able to tolerate treatment aimed at normalizing eating behavior and gaining weight in response to high external pressure. In view of this situation, an interdisciplinary team with experience in these treatments is required to treat these patients. Close cooperation is necessary to ensure a supporting treatment framework.
Collapse
Affiliation(s)
- Gabriella Milos
- Universitätsspital Zürich, Klinik für Konsiliarpsychiatrie und Psychosomatik, Zentrum für Essstörungen, Zürich
| | - Maria Wolf
- Universitätsspital Zürich, Klinik für Konsiliarpsychiatrie und Psychosomatik, Zentrum für Essstörungen, Zürich
- Universitätsspital Zürich, Klinik und Poliklinik für Innere Medizin, Zürich
| | - Lara Robetin
- Universitätsspital Zürich, Klinik und Poliklinik für Innere Medizin, Zürich
| | - Melanie Sprenger
- Universitätsspital Zürich, Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, Ernährungsberatung, Zürich
| | | | - Dominik Schaer
- Universitätsspital Zürich, Klinik und Poliklinik für Innere Medizin, Zürich
| |
Collapse
|
9
|
Grau A, Magallón-Neri E, Faus G, Feixas G. Cognitive impairment in eating disorder patients of short and long-term duration: a case-control study. Neuropsychiatr Dis Treat 2019; 15:1329-1341. [PMID: 31190837 PMCID: PMC6535667 DOI: 10.2147/ndt.s199927] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 03/11/2019] [Indexed: 11/23/2022] Open
Abstract
Introduction: Several studies have noted the potentially negative effect of eating disorders (ED) on cognitive performance. Objective: To compare the impact of the duration of abnormal eating behaviors on cognitive performance in a sample of people with short- and long-term eating disorders and in two control groups matched for age. Method: The neuropsychological performance of 82 women diagnosed with an eating disorder were compared with two control groups from the community of 66 healthy women. Time of duration of the disorder was less than two years in half of the clinical sample, and more than 10 years in the other half. The following instruments were used to measure neuropsychological performance: the Matrix Test, the Stroop task, the Trail-Making Test, the Tower of London Test, the Posner Spatial Task, the Rey's Complex Figure, the Wechsler Vocabulary Test, and the Hayling Completion Test. Results: It showed that persons with long-term ED presented more impaired neuropsychological profiles, but not in all areas. In contrast, the short-term ED group presented similar profiles to the control groups. Discussion: This study highlights the positive association between cognitive impairment and time of evolution of ED, above all in perceptual measures and non-verbal memory. Considering the effect of the evolution of ED cognitive performance (especially in long-term patients) may further our understanding of the development of the disorder and the factors that may favor its persistence.
Collapse
Affiliation(s)
- Antoni Grau
- ITA Mental Health Specialist, Madrid, Spain.,ITA Foundation, Barcelona, Spain
| | - Ernesto Magallón-Neri
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Barcelona, Spain.,Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Gustavo Faus
- ITA Mental Health Specialist, Madrid, Spain.,ITA Foundation, Barcelona, Spain
| | - Guillem Feixas
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Barcelona, Spain.,Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| |
Collapse
|
10
|
Johnson S, Williamson P, Wade TD. A systematic review and meta-analysis of cognitive processing deficits associated with body dysmorphic disorder. Behav Res Ther 2018; 107:83-94. [PMID: 29935380 DOI: 10.1016/j.brat.2018.05.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 05/16/2018] [Accepted: 05/29/2018] [Indexed: 10/16/2022]
Abstract
This systematic review and meta-analysis examined the evidence supporting the association between body dysmorphic disorder (BDD) symptomology and four types of cognitive processing abnormalities: local processing, selective attention, interpretive biases, and memory deficits. Twenty-three studies met inclusion requirements that examined differences in performance on cognitive tasks between BDD and control groups across the four categories. Multilevel modelling was used to calculate an overall effect size for each cognitive category. BDD and control groups differed significantly on measures of selective attention (g = 0.60, 95% CI = 0.26: 0.93), interpretive biases (g = 0.30, 95% CI = . 07: 0.54), and memory deficits (g=.56, 95% CI = 0.26: 0.87). Differences between the BDD and control groups on measures of local processing did not reach significance. These findings support the hypothesis that people with BDD may selectively attend to perceived threats or to disorder-related stimuli, misinterpret ambiguous stimuli as threatening, overvalue the importance of attractiveness, and have inaccurate coding and recall for facial or bodily stimuli. Recommendations for future research of these specific cognitive deficits in BDD include introducing the use of Modified Dot Probe Paradigms and new treatment targets that can be used as adjuncts to current treatment modalities.
Collapse
Affiliation(s)
- Shevaugn Johnson
- School of Psychology, Flinders University, PO Box 2100, Adelaide, SA, 5001, Australia.
| | - Paul Williamson
- School of Psychology, Flinders University, PO Box 2100, Adelaide, SA, 5001, Australia
| | - Tracey D Wade
- School of Psychology, Flinders University, PO Box 2100, Adelaide, SA, 5001, Australia
| |
Collapse
|
11
|
Allom V, Mullan B, Smith E, Hay P, Raman J. Breaking bad habits by improving executive function in individuals with obesity. BMC Public Health 2018; 18:505. [PMID: 29661241 PMCID: PMC5902887 DOI: 10.1186/s12889-018-5392-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 04/03/2018] [Indexed: 01/01/2023] Open
Abstract
Background Two primary factors that contribute to obesity are unhealthy eating and sedentary behavior. These behaviors are particularly difficult to change in the long-term because they are often enacted habitually. Cognitive Remediation Therapy has been modified and applied to the treatment of obesity (CRT-O) with preliminary results of a randomized controlled trial demonstrating significant weight loss and improvements in executive function. The objective of this study was to conduct a secondary data analysis of the CRT-O trial to evaluate whether CRT-O reduces unhealthy habits that contribute to obesity via improvements in executive function. Method Eighty participants with obesity were randomized to CRT-O or control. Measures of executive function (Wisconsin Card Sort Task and Trail Making Task) and unhealthy eating and sedentary behavior habits were administered at baseline, post-intervention and at 3 month follow-up. Results Participants receiving CRT-O demonstrated improvements in both measures of executive function and reductions in both unhealthy habit outcomes compared to control. Mediation analyses revealed that change in one element of executive function performance (Wisconsin Card Sort Task perseverance errors) mediated the effect of CRT-O on changes in both habit outcomes. Conclusion These results suggest that the effectiveness of CRT-O may result from the disruption of unhealthy habits made possible by improvements in executive function. In particular, it appears that cognitive flexibility, as measured by the Wisconsin Card Sort task, is a key mechanism in this process. Improving cognitive flexibility may enable individuals to capitalise on interruptions in unhealthy habits by adjusting their behavior in line with their weight loss goals rather than persisting with an unhealthy choice. Trial registration The RCT was registered with the Australian New Zealand Registry of Clinical Trials (trial id: ACTRN12613000537752).
Collapse
Affiliation(s)
- Vanessa Allom
- Health Psychology and Behavioral Medicine Research Group, School of Psychology and Speech Pathology, Curtin University, Perth, Australia
| | - Barbara Mullan
- Health Psychology and Behavioral Medicine Research Group, School of Psychology and Speech Pathology, Curtin University, Perth, Australia
| | - Evelyn Smith
- Eating disorders and Obesity Psychology Research Clinic (EDOC), School of Social Sciences and Psychology, Western Sydney University, Penrith, NSW, 2751, Australia. .,Clinical and Health Psychology Research Initiative, School of Social Sciences and Psychology, Western Sydney University, Sydney, Australia.
| | - Phillipa Hay
- School of Medicine, Western Sydney University, Sydney, Australia
| | - Jayanthi Raman
- Clinical Psychology, Graduate School of Health, University of Technology Sydney (UTS), Sydney, Australia
| |
Collapse
|
12
|
Abstract
Anorexia nervosa is a disorder of feeding behavior associated with distortion of body image, mood disturbance and a wide variety of hormonal and metabolic abnormalities. It is supposed that the disease could be the consequence of a combination of cultural-social, psychological and biological factors. Our study confirmed that anorexia mentalis is a serious, life threatening disorder which in our country appears earlier than it was expected and that is strongly related to environmental factors (family, school, fashion, society). We showed that specific personality traits are characteristic for both, young patients and mothers. Sublimation of emotional stress by exceptional performances, accompanied by food restrictive consumption together with hypersensitivity, oppositional behavior and aggression are specific for this disorder. High levels of self-imposed standards increase the risk for psychological distress, especially for eating disorder symptomatology. Both genders could be involved as patients. Boys must be especially followed for possible psychiatric manifestation. We confirmed that the biofeedback as additional therapeutic modality is very useful.
Collapse
|
13
|
Hirst RB, Beard CL, Colby KA, Quittner Z, Mills BM, Lavender JM. Anorexia nervosa and bulimia nervosa: A meta-analysis of executive functioning. Neurosci Biobehav Rev 2017; 83:678-690. [PMID: 28851577 DOI: 10.1016/j.neubiorev.2017.08.011] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 05/28/2017] [Accepted: 08/16/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Research investigating the link between eating disorder (ED) diagnosis and executive dysfunction has had conflicting results, yet no meta-analyses have examined the overall association of ED pathology with executive functioning (EF). METHOD Effect sizes were extracted from 32 studies comparing ED groups (27 of anorexia nervosa, 9 of bulimia nervosa) with controls to determine the grand mean effect on EF. Analyses included effects for individual EF measures, as well as an age-based subgroup analysis. RESULTS There was a medium effect of ED diagnosis on executive functioning, with bulimia nervosa demonstrating a larger effect (Hedges's g=-0.70) than anorexia nervosa (g=-0.41). Within anorexia nervosa studies, subgroup analyses were conducted for age and diagnostic subtype. The effect of anorexia nervosa on EF was largest in adults; however, subgroup differences for age were not significant. CONCLUSIONS Anorexia and bulimia nervosa are associated with EF deficits, which are particularly notable for individuals with bulimia nervosa. The present analysis includes recommendations for future studies regarding study design and EF measurement.
Collapse
Affiliation(s)
- Rayna B Hirst
- Palo Alto University, 1791 Arastradero Road, Palo Alto, CA 94304, United States.
| | - Charlotte L Beard
- Palo Alto University, 1791 Arastradero Road, Palo Alto, CA 94304, United States.
| | - Katrina A Colby
- Palo Alto University, 1791 Arastradero Road, Palo Alto, CA 94304, United States.
| | - Zoe Quittner
- Palo Alto University, 1791 Arastradero Road, Palo Alto, CA 94304, United States.
| | - Brent M Mills
- Palo Alto University, 1791 Arastradero Road, Palo Alto, CA 94304, United States.
| | - Jason M Lavender
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States.
| |
Collapse
|
14
|
Kesby A, Maguire S, Brownlow R, Grisham JR. Intolerance of Uncertainty in eating disorders: An update on the field. Clin Psychol Rev 2017; 56:94-105. [PMID: 28710918 DOI: 10.1016/j.cpr.2017.07.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Revised: 07/03/2017] [Accepted: 07/04/2017] [Indexed: 01/12/2023]
Abstract
Pathological fear and anxiety regarding food, eating, weight and body shape are at the core of eating disorder (ED) psychopathology. To manage anxiety, patients develop complicated repertoires of ritualistic and repetitive behaviours, which can lead to total functional impairment. Yet the cognitive processes underlying anxiety, fear, and anxiety-driven behaviours in EDs remain poorly understood. Intolerance of Uncertainty (IU) is defined as a tendency to react negatively on an emotional, cognitive, and behavioural level to uncertain situations and events. There is substantial evidence that IU is a transdiagnostic process that contributes to the maintenance of anxiety disorders; however, IU may also be relevant to the understanding and treatment of EDs. The current review summarises the growing literature examining IU in relation to ED symptoms, including restriction, bingeing, purging, ritualised behaviours, reassurance-seeking and body checking. Extending from the obsessive-compulsive disorder (OCD) and anxiety disorder literature, we propose that IU provides a novel theoretical and clinical framework from which to understand the anxiety, fixation with rules and rituals, and the cognitively rigid profile that is characteristic of ED presentations. We conclude with suggestions for future research, and discuss IU as a potential treatment target for core features of EDs and comorbid symptoms.
Collapse
Affiliation(s)
- Alice Kesby
- School of Psychology, UNSW Australia, Sydney, NSW, Australia.
| | - Sarah Maguire
- Boden Institute, University of Sydney, Sydney, NSW, Australia
| | - Rachel Brownlow
- Boden Institute, University of Sydney, Sydney, NSW, Australia
| | | |
Collapse
|
15
|
Ambrosecchia M, Ardizzi M, Russo E, Ditaranto F, Speciale M, Vinai P, Todisco P, Maestro S, Gallese V. Interoception and Autonomic Correlates during Social Interactions. Implications for Anorexia. Front Hum Neurosci 2017; 11:219. [PMID: 28567008 PMCID: PMC5434670 DOI: 10.3389/fnhum.2017.00219] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 04/18/2017] [Indexed: 01/01/2023] Open
Abstract
The aim of this study is to investigate the bodily-self in Restrictive Anorexia, focusing on two basic aspects related to the bodily self: autonomic strategies in social behavior, in which others' social desirability features, and social cues (e.g., gaze) are modulated, and interoception (i.e., the sensitivity to stimuli originating inside the body). Furthermore, since previous studies carried out on healthy individuals found that interoception seems to contribute to the autonomic regulation of social behavior, as measured by Respiratory Sinus Arrhythmia (RSA), we aimed to explore this link in anorexia patients, whose ability to perceive their bodily signal seems to be impaired. To this purpose, we compared a group of anorexia patients (ANg; restrictive type) with a group of Healthy Controls (HCg) for RSA responses during both a resting state and a social proxemics task, for their explicit judgments of comfort in social distances during a behavioral proxemics task, and for their Interoceptive Accuracy (IA). The results showed that ANg displayed significantly lower social disposition and a flattened autonomic reactivity during the proxemics task, irrespective of the presence of others' socially desirable features or social cues. Moreover, unlike HCg, the autonomic arousal of ANg did not guide behavioral judgments of social distances. Finally, IA was strictly related to social disposition in both groups, but with opposite trends in ANg. We conclude that autonomic imbalance and its altered relationship with interoception might have a crucial role in anorexia disturbances.
Collapse
Affiliation(s)
- Marianna Ambrosecchia
- Department of Medicine and Surgery, Unit of Neuroscience, University of ParmaParma, Italy
| | - Martina Ardizzi
- Department of Medicine and Surgery, Unit of Neuroscience, University of ParmaParma, Italy
| | - Elisa Russo
- Casa di Cura, Villa MargheritaVicenza, Italy
| | - Francesca Ditaranto
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Fondazione Stella MarisPisa, Italy
| | | | | | | | - Sandra Maestro
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Fondazione Stella MarisPisa, Italy
| | - Vittorio Gallese
- Department of Medicine and Surgery, Unit of Neuroscience, University of ParmaParma, Italy
- Institute of Philosophy, School of Advanced Study, University of LondonLondon, UK
| |
Collapse
|
16
|
Mishra A, Anand M, Umesh S. Neurobiology of eating disorders - an overview. Asian J Psychiatr 2017; 25:91-100. [PMID: 28262179 DOI: 10.1016/j.ajp.2016.10.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 09/03/2016] [Accepted: 10/09/2016] [Indexed: 12/12/2022]
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
| |
Collapse
|
17
|
Smith E, Whittingham C. Cognitive remediation therapy plus behavioural weight loss compared to behavioural weight loss alone for obesity: study protocol for a randomised controlled trial. Trials 2017; 18:42. [PMID: 28126015 PMCID: PMC5270361 DOI: 10.1186/s13063-017-1778-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 12/30/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Current research indicates that obese individuals have cognitive deficits in executive function, leading to difficulties with planning, impulse control and decision-making. High levels of inflammation have been proposed to contribute to executive function deficits in individuals with obesity. METHODS/DESIGN One hundred and seventy-six obese participants will be randomly assigned to one of two groups: (1) behavioural weight loss alone (BWL) group = 8 sessions of individual BWL sessions plus 12 group BWL sessions or (2) Cognitive Remediation Therapy for Obesity (CRT-O) plus BWL group (CRT-O + BWL) = 8 sessions of individual CRT-O plus 12 group BWL sessions. The study is double blind - participants will only be told that two weight-loss treatments are being compared and research assistants conducting outcome assessments will not know participants' group allocation. Blood tests will be conducted to measure inflammatory markers. Measurement points will be at baseline, post treatment and 1-year follow-up. The primary outcomes will be differences between treatment groups in percentage weight loss, executive function, binge eating and an examination of whether changes in executive function predict changes in weight and binge eating. Secondary outcome measures will examine changes on inflammation, quality of life, and grazing behaviour and whether these predict changes in executive function and weight. DISCUSSION If CRT-O + BWL is more effective in assisting people to lose weight long term than BWL alone it should significantly improve treatment outcomes. This study expands upon our recent trial which showed that CRT-O enhanced executive function and weight loss in obese adults. The current study is strengthened by several factors: it is double-blind, it uses an active control, has a larger sample size, and measures inflammation to examine the mechanisms. TRIAL REGISTRATION The RCT is registered with the Australian New Zealand Registry of Clinical Trial, trial identifier: ACTRN12616000658415 . Registered on 20 May 2016.
Collapse
Affiliation(s)
- Evelyn Smith
- Eating Disorders and Obesity Psychology Research Clinic, School of Social Sciences and Psychology, Western Sydney University, Locked Bag 1747, Penrith 2751, Sydney, NSW Australia
- Clinical and Health Psychology Research Initiative, School of Social Sciences and Psychology, Western Sydney University, Locked Bag 1747, Penrith 2751, Sydney, NSW Australia
| | - Charlotte Whittingham
- Eating Disorders and Obesity Psychology Research Clinic, School of Social Sciences and Psychology, Western Sydney University, Locked Bag 1747, Penrith 2751, Sydney, NSW Australia
- Clinical and Health Psychology Research Initiative, School of Social Sciences and Psychology, Western Sydney University, Locked Bag 1747, Penrith 2751, Sydney, NSW Australia
| |
Collapse
|
18
|
Overlapping neurocognitive inefficiencies in anorexia nervosa: a preliminary investigation of women with both poor set-shifting and weak central coherence. Eat Weight Disord 2016; 21:725-729. [PMID: 27435812 DOI: 10.1007/s40519-016-0302-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 07/07/2016] [Indexed: 10/21/2022] Open
|
19
|
Peterson CM, Tissot AM, Matthews A, Hillman JB, Peugh JL, Rawers E, Tong J, Mitan L. Impact of short-term refeeding on appetite and meal experiences in new onset adolescent eating disorders. Appetite 2016; 105:298-305. [PMID: 27263068 DOI: 10.1016/j.appet.2016.05.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 05/02/2016] [Accepted: 05/31/2016] [Indexed: 10/21/2022]
Abstract
Restrictive eating disorders (ED) are increasing and represent a serious risk to the health of adolescent females. Restrictive ED in youth are often treated through aggressive short-term refeeding. Although evidence supports that this intervention is the "gold standard" for improving ED outcomes in youth, little research has specifically probed appetite and meal-related responses to this type of intensive, short-term refeeding in newly diagnosed individuals. Information about appetite and meal-related dysfunction could provide valuable insights regarding treatment-interfering features of ED in both acute inpatient and longer-term outpatient treatment. The purpose of this study was to evaluate the hunger, fullness, olfactory, and gustatory responses of adolescents with newly-diagnosed restrictive ED and to probe how and when these responses are altered by refeeding. Using a quasi-experimental ecologically valid methodology, this study described and compared profiles of hunger, fullness, olfactory, and gustatory responses in adolescent females (n = 15) with newly diagnosed restrictive ED at hospital admission (i.e., severe malnutrition) and after medical refeeding, in comparison to healthy controls (n = 15). Results showed that newly diagnosed (i.e., malnourished) adolescents with ED showed significantly different meal-related experiences than controls. Refeeding improved some of these differences, but not all. Following refeeding, females with ED continued to show lower hunger, greater fullness, and lower pleasantness of smell ratings compared to controls. Unpleasantness of taste ratings maladaptively increased, such that females who were re-fed reported more aversive scents than pre-treatment. Profiles of meal-related responses were also identified and compared between groups. The applicability of these findings are discussed within the context of critical periods of change during refeeding treatment and potentially promising intervention targets that might enhance treatment outcomes for adolescents with newly onset, restrictive ED.
Collapse
Affiliation(s)
- Claire M Peterson
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | | | - Abigail Matthews
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - James L Peugh
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Emily Rawers
- University of Cincinnati, College of Medicine, Cincinnati, OH, USA
| | | | - Laurie Mitan
- Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| |
Collapse
|
20
|
Interacting Neural Processes of Feeding, Hyperactivity, Stress, Reward, and the Utility of the Activity-Based Anorexia Model of Anorexia Nervosa. Harv Rev Psychiatry 2016; 24:416-436. [PMID: 27824637 PMCID: PMC5485261 DOI: 10.1097/hrp.0000000000000111] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Anorexia nervosa (AN) is a psychiatric illness with minimal effective treatments and a very high rate of mortality. Understanding the neurobiological underpinnings of the disease is imperative for improving outcomes and can be aided by the study of animal models. The activity-based anorexia rodent model (ABA) is the current best parallel for the study of AN. This review describes the basic neurobiology of feeding and hyperactivity seen in both ABA and AN, and compiles the research on the role that stress-response and reward pathways play in modulating the homeostatic drive to eat and to expend energy, which become dysfunctional in ABA and AN.
Collapse
|
21
|
Abbate-Daga G, Buzzichelli S, Marzola E, Aloi M, Amianto F, Fassino S. Does depression matter in neuropsychological performances in anorexia nervosa? A descriptive review. Int J Eat Disord 2015; 48:736-45. [PMID: 26032280 DOI: 10.1002/eat.22399] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 12/16/2014] [Accepted: 02/12/2015] [Indexed: 01/12/2023]
Abstract
OBJECTIVE This review aims to examine the impact of depressive symptoms on the assessment of cognitive flexibility, central coherence, and decision-making in individuals with anorexia nervosa (AN). METHOD An online search was carried out using PubMed and PsycInfo. Articles were selected for review if they were published in English between 1990 and 2014 and used the Wisconsin Card Sorting Test, the Trail Making Task parts A and B, the Brixton Test, the Rey-Osterrieth Complex Figure Test, and/or the Iowa Gambling Task. RESULTS Sixty-two studies were included. Thirty (48%) of the studies statistically assessed the association between depression and neurocognition in AN versus healthy controls. Where significant correlations were found, it became clear that the more serious the depression, the greater the neuropsychological impairment. Only six (10%) studies examined whether increased depressive symptoms were able to eliminate the differences between individuals with AN and healthy controls, and one study found that depressive symptoms did eliminate group differences in cognitive flexibility and decision-making. DISCUSSION Only a subgroup of articles on neuropsychology in AN adjusted for depression. However, given the role of depression that some articles suggest, future studies should pay closer attention to the evaluation of this potential confounder.
Collapse
Affiliation(s)
- Giovanni Abbate-Daga
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Sara Buzzichelli
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Enrica Marzola
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Matteo Aloi
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy.,Ambulatory for Clinical Research and Treatment of Eating Disorders, Department of Health Sciences, University "Magna Graecia", Catanzaro, Italy
| | - Federico Amianto
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Secondo Fassino
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| |
Collapse
|
22
|
Heled E, Hoofien D, Bachar E, Ebstein RP. Verbal Versus Figural Fluency Tests in Currently Ill and Weight Restored Anorexia Nervosa Patients. EUROPEAN EATING DISORDERS REVIEW 2015. [PMID: 26206112 DOI: 10.1002/erv.2387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Fluency tests allow domain-specific assessment of verbal and non-verbal executive functions (EF) comparison and also enable utilizing of both quantitative and qualitative scoring methods. Thirty-five currently ill anorexia nervosa patients (PANs), 33 weight-restored patients (WRAN) and 47 healthy controls (HCs) were administered the word fluency test and the five-point test. Results show that WRANs tended to perseverate more than HCs in the verbal-fluency test. In addition, PANs produced significantly less correct figures and perseverated more than HCs and WRANs; HCs used more strategy methods than PANs and WRANs. Additionally, a positive correlation was found in the HC group between the total number of words in the verbal phonemic test and the number of designs produced and the number of correct designs. No such correlations were found in both anorexia groups. In conclusion, there is a differentiation between verbal and non-verbal EF in PANs and WRANs, showing a deficiency in the non-verbal domain. These findings may contribute to our understanding of the cognitive nature of the disorder.
Collapse
Affiliation(s)
- Eyal Heled
- Day Rehabilitation Unit, Sheba Medical Center, Ramat Gan, Israel.,Department of Psychology, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Dan Hoofien
- Department of Psychology, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Eytan Bachar
- Department of Psychology, Hebrew University of Jerusalem, Jerusalem, Israel.,Department of Psychiatry, Hadassah University Medical Center, Jerusalem, Israel
| | - Richard P Ebstein
- Department of Psychology, National University of Singapore, Singapore
| |
Collapse
|
23
|
von Hausswolff-Juhlin Y, Brooks SJ, Larsson M. The neurobiology of eating disorders--a clinical perspective. Acta Psychiatr Scand 2015; 131:244-55. [PMID: 25223374 DOI: 10.1111/acps.12335] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/18/2014] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To provide a neurobiological basis of eating disorders for clinicians and to enlighten how comparing neurobiology and eating disorders with neurobiology of other psychiatric illnesses can improve treatment protocols. METHOD A selective review on the neurobiology of eating disorders. The article focuses on clinical research on humans with consideration of the anatomical, neural, and molecular basis of eating disorders. RESULTS The neurobiology of people with eating disorders is altered. Many of the neurobiological regions, receptors, and chemical substrates that are affected in other mental illnesses also play an important role in eating disorders. More knowledge about the neurobiological overlap between eating disorders and other psychiatric populations will help when developing treatment protocols not the least regarding that comorbidity is common in patients with EDs. CONCLUSION Knowledge about the underlying neurobiology of eating disorders will improve treatment intervention and will benefit from comparisons with other mental illnesses and their treatments.
Collapse
Affiliation(s)
- Y von Hausswolff-Juhlin
- Center for Psychiatry Research, Karolinska Institute, Stockholm, Sweden; Stockholm Centre for Eating Disorders, Stockholm, Sweden
| | | | | |
Collapse
|
24
|
King JA, Geisler D, Ritschel F, Boehm I, Seidel M, Roschinski B, Soltwedel L, Zwipp J, Pfuhl G, Marxen M, Roessner V, Ehrlich S. Global cortical thinning in acute anorexia nervosa normalizes following long-term weight restoration. Biol Psychiatry 2015; 77:624-32. [PMID: 25433902 DOI: 10.1016/j.biopsych.2014.09.005] [Citation(s) in RCA: 120] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 09/11/2014] [Accepted: 09/11/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Anorexia nervosa (AN) is a serious eating disorder characterized by self-starvation, extreme weight loss, and alterations in brain structure. Structural magnetic resonance imaging studies have documented brain volume reductions in acute AN, but it is unclear whether they are 1) regionally specific, or 2) reversible following weight restoration. Here, we measured cortical thickness (CT) for the first time in AN. METHODS Structural magnetic resonance imaging data were acquired from adolescent and young adult female patients with acute AN (n = 40), recovered patients following long-term weight restoration (n = 34), and an equal number of age-matched healthy control subjects. Group differences in CT were tested with well-validated procedures implemented in FreeSurfer. The mediating role of clinical variables including body mass index and drive for thinness were explored. For completeness, we also used FreeSurfer's subcortical segmentation stream to test group differences in volumes of select gray matter regions of interest. RESULTS Vertex-wise analyses revealed significant thinning of over 85% of the cortical surface in patients with acute AN and CT normalization in recovered patients following long-term weight restoration, although normal age-related trajectories were absent in the disorder. This pattern of results was largely mirrored in subcortical volumes. We also observed a strong negative correlation between CT and drive for thinness in extrastriate regions involved in body perception. CONCLUSIONS Structural brain anomalies in AN as expressed in CT and subcortical volume are primarily the consequence of malnutrition and unlikely to reflect premorbid trait markers or permanent scars, but longitudinal data are needed.
Collapse
Affiliation(s)
- Joseph A King
- Department of Child and Adolescent Psychiatry, Eating Disorder Services and Research Center, Technische Universität Dresden, Faculty of Medicine, University Hospital C. G. Carus, Dresden
| | - Daniel Geisler
- Department of Child and Adolescent Psychiatry, Eating Disorder Services and Research Center, Technische Universität Dresden, Faculty of Medicine, University Hospital C. G. Carus, Dresden
| | - Franziska Ritschel
- Department of Child and Adolescent Psychiatry, Eating Disorder Services and Research Center, Technische Universität Dresden, Faculty of Medicine, University Hospital C. G. Carus, Dresden
| | - Ilka Boehm
- Department of Child and Adolescent Psychiatry, Eating Disorder Services and Research Center, Technische Universität Dresden, Faculty of Medicine, University Hospital C. G. Carus, Dresden
| | - Maria Seidel
- Department of Child and Adolescent Psychiatry, Eating Disorder Services and Research Center, Technische Universität Dresden, Faculty of Medicine, University Hospital C. G. Carus, Dresden
| | - Benjamin Roschinski
- Department of Child and Adolescent Psychiatry, Eating Disorder Services and Research Center, Technische Universität Dresden, Faculty of Medicine, University Hospital C. G. Carus, Dresden
| | - Laura Soltwedel
- Department of Child and Adolescent Psychiatry, Eating Disorder Services and Research Center, Technische Universität Dresden, Faculty of Medicine, University Hospital C. G. Carus, Dresden
| | - Johannes Zwipp
- Department of Child and Adolescent Psychiatry, Eating Disorder Services and Research Center, Technische Universität Dresden, Faculty of Medicine, University Hospital C. G. Carus, Dresden
| | - Gerit Pfuhl
- Department of Child and Adolescent Psychiatry, Eating Disorder Services and Research Center, Technische Universität Dresden, Faculty of Medicine, University Hospital C. G. Carus, Dresden; Department of Psychology, University of Tromsø, Tromsø, Norway
| | - Michael Marxen
- Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Faculty of Medicine, University Hospital C. G. Carus, Dresden, Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry, Eating Disorder Services and Research Center, Technische Universität Dresden, Faculty of Medicine, University Hospital C. G. Carus, Dresden
| | - Stefan Ehrlich
- Department of Child and Adolescent Psychiatry, Eating Disorder Services and Research Center, Technische Universität Dresden, Faculty of Medicine, University Hospital C. G. Carus, Dresden; Massachusetts General Hospital/Massachusetts Institute of Technology /Harvard Medical School Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown; Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts.
| |
Collapse
|
25
|
Body checking as a behavioral link: a preliminary study assessing inhibition and its association to idiosyncratic body checking in anorexia nervosa. Eat Behav 2014; 15:591-4. [PMID: 25218356 DOI: 10.1016/j.eatbeh.2014.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 05/28/2014] [Accepted: 08/13/2014] [Indexed: 11/20/2022]
Abstract
Body checking (BC) is a behavioral feature of anorexia nervosa (AN), which is also present in obsessive-compulsive (OC) disorders. This study assessed whether increased body checking in AN patients correlated with deficits in cognitive inhibition. A battery of neuropsychological tests (the Ravello Profile), OC disorder measures, and the Body Checking Questionnaire (BCQ) were administered to nine adolescent females being treated for AN at an in-patient hospital in Scotland, UK. Neuropsychological measures were assessed using composite variables. Body Checking prevalence was split into high and low category to compare across groups. A negative relationship between cognitive inhibition and idiosyncratic body checking was evident. Clinically, increased body-checking symptoms were related to OC symptoms. These findings provide preliminary evidence that idiosyncratic body checking in AN patients may indicate a similar neuropsychological profile found in those with checking behaviors in OCD patients.
Collapse
|
26
|
Raman J, Hay P, Smith E. Manualised Cognitive Remediation Therapy for adult obesity: study protocol for a randomised controlled trial. Trials 2014; 15:426. [PMID: 25370364 PMCID: PMC4230366 DOI: 10.1186/1745-6215-15-426] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 10/15/2014] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Research has shown that obese individuals have cognitive deficiencies in executive function, leading to poor planning and impulse control, and decision-making difficulties. An intervention that could help reduce these deficits and in turn help weight loss maintenance is Cognitive Remediation Therapy for Obesity (CRT-O). We aim to examine the efficacy of manualised CRT-O, which is intended to improve executive function, enhance reflective practice and help weight loss maintenance. METHODS/DESIGN A randomised controlled trial (registered with the Australian New Zealand Clinical Trials Registry) will be conducted. First, 90 obese adults (body mass index >30 kg/m2) in the community will receive three weekly sessions of a group Behaviour Weight Loss Treatment (BWLT), and then will be randomised either to receive CRT-O or to enter a no-treatment control group. CRT-O training will comprise twice-weekly sessions of 45 minutes over a 4 to 6 week period, for a total of eight sessions. Measurement points will be at baseline, post CRT-O (or 4 to 6 weeks after BWLT for the no-treatment control), 3 months post treatment and 1 year post treatment. The primary outcome will be executive function and secondary outcome measures will include participants' body mass index, hip to waist ratio, eating behaviours and quality of life. DISCUSSION This is the first study of its kind to examine the efficacy of Cognitive Remediation Therapy for obese adults through a randomised controlled trial. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry number: 12613000537752. Date of registration: 14 May 2013.
Collapse
Affiliation(s)
| | - Phillipa Hay
- Centre for Health Research, School of Medicine, University of Western Sydney, Locked Bag 1747, Penrith, NSW 2751, Australia.
| | | |
Collapse
|
27
|
Bodell LP, Keel PK, Brumm MC, Akubuiro A, Caballero J, Tranel D, Hodis B, McCormick LM. Longitudinal examination of decision-making performance in anorexia nervosa: before and after weight restoration. J Psychiatr Res 2014; 56:150-7. [PMID: 24939417 PMCID: PMC4127974 DOI: 10.1016/j.jpsychires.2014.05.015] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 04/21/2014] [Accepted: 05/20/2014] [Indexed: 01/30/2023]
Abstract
BACKGROUND This study aimed to extend previous work on decision-making deficits in anorexia nervosa (AN) by using a longitudinal design to examine decision-making before and after weight restoration. METHODS Participants were 22 women with AN and 20 healthy comparison participants who completed the Iowa Gambling Task (IGT). Decision-making was assessed both before and after weight restoration in a subset of 14 AN patients. Self-report and interview assessments were used to measure psychological correlates of decision-making performance including depression, anxiety, and eating disorder symptoms, and magnetic resonance imaging (MRI) scans were conducted to explore associations between brain volume in the orbitofrontal cortex (OFC) and decision-making in individuals with AN. RESULTS Currently ill AN patients performed worse on the IGT compared to the control group. Although decision-making performance did not improve significantly with weight restoration in the full AN sample, AN patients who were poor performers at baseline did improve task performance with weight-restoration. When actively ill, lower body mass index (BMI) and decreased left medial OFC volume were significantly associated with worse IGT performance, and these associations were no longer significant after weight restoration. CONCLUSIONS Findings suggest that decision-making deficits in AN in the acute phase of illness are associated with low weight and decreased left medial OFC volume, but increases in brain volume and BMI may not have been sufficient to improve decision-making in all patients. Findings contribute to a model for understanding how some patients may sustain self-starvation, and future work should examine whether decision-making deficits predict relapse.
Collapse
Affiliation(s)
- Lindsay P Bodell
- Florida State University, Department of Psychology, United States.
| | - Pamela K Keel
- Florida State University, Department of Psychology, United States
| | - Michael C Brumm
- University of Iowa Carver College of Medicine, Department of Psychiatry, United States
| | - Ashley Akubuiro
- University of Iowa, Department of Neuroscience, United States
| | | | - Daniel Tranel
- University of Iowa Carver College of Medicine, Division of Behavioral Neurology and Cognitive Neuroscience, United States; University of Iowa, Department of Psychology, United States
| | - Brendan Hodis
- University of Iowa Carver College of Medicine, United States
| | - Laurie M McCormick
- University of Iowa Carver College of Medicine, Department of Psychiatry, United States; University of the Virgin Islands, United States; Roy Lester Schneider Hospital, United States.
| |
Collapse
|
28
|
Richmond RC, Skugarevsky O, Yang S, Kramer MS, Wade KH, Patel R, Bogdanovich N, Vilchuck K, Sergeichick N, Smith GD, Oken E, Martin RM. The association of early childhood cognitive development and behavioural difficulties with pre-adolescent problematic eating attitudes. PLoS One 2014; 9:e104132. [PMID: 25102171 PMCID: PMC4125275 DOI: 10.1371/journal.pone.0104132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 07/11/2014] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Few studies have prospectively investigated associations of child cognitive ability and behavioural difficulties with later eating attitudes. We investigated associations of intelligence quotient (IQ), academic performance and behavioural difficulties at 6.5 years with eating attitudes five years later. METHODS We conducted an observational cohort study nested within the Promotion of Breastfeeding Intervention Trial, Belarus. Of 17,046 infants enrolled at birth, 13,751 (80.7%) completed the Children's Eating Attitude Test (ChEAT) at 11.5 years, most with information on IQ (n = 12,667), academic performance (n = 9,954) and behavioural difficulties (n = 11,098) at 6.5 years. The main outcome was a ChEAT score ≥ 85th percentile, indicative of problematic eating attitudes. RESULTS Boys with higher IQ at 6.5 years reported fewer problematic eating attitudes, as assessed by ChEAT scores ≥ 85th percentile, at 11.5 years (OR per SD increase in full-scale IQ = 0.87; 0.79, 0.94). No such association was observed in girls (1.01; 0.93, 1.10) (p for sex-interaction = 0.016). In both boys and girls, teacher-assessed academic performance in non-verbal subjects was inversely associated with high ChEAT scores five years later (OR per unit increase in mathematics ability = 0.88; 0.82, 0.94; and OR per unit increase in ability for other non-verbal subjects = 0.86; 0.79, 0.94). Behavioural difficulties were positively associated with high ChEAT scores five years later (OR per SD increase in teacher-assessed rating = 1.13; 1.07, 1.19). CONCLUSION Lower IQ, worse non-verbal academic performance and behavioural problems at early school age are positively associated with risk of problematic eating attitudes in early adolescence.
Collapse
Affiliation(s)
- Rebecca C. Richmond
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
- MRC Integrative Epidemiology Unit (IEU), University of Bristol, Bristol, United Kingdom
| | - Oleg Skugarevsky
- Psychiatry and Medical Psychology Department, Belarussian State Medical University, Minsk, Belarus
| | - Seungmi Yang
- Departments of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Canada
| | - Michael S. Kramer
- Departments of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Canada
| | - Kaitlin H. Wade
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
- MRC Integrative Epidemiology Unit (IEU), University of Bristol, Bristol, United Kingdom
| | - Rita Patel
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Natalia Bogdanovich
- The National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus
| | - Konstantin Vilchuck
- The National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus
| | - Natalia Sergeichick
- The National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus
| | - George Davey Smith
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
- MRC Integrative Epidemiology Unit (IEU), University of Bristol, Bristol, United Kingdom
| | - Emily Oken
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and the Harvard Pilgrim Health Care Institute, Boston, Massachusetts, United States of America
| | - Richard M. Martin
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
- MRC Integrative Epidemiology Unit (IEU), University of Bristol, Bristol, United Kingdom
- National Institute of Health Research (NIHR) Bristol Biomedical Research Unit in Nutrition, University Hospitals Bristol NHS Trust and University of Bristol, Bristol, United Kingdom
| |
Collapse
|
29
|
Harney MB, Bardone-Cone AM. The Influence of Body Dissatisfaction on Set Shifting Ability. COGNITIVE THERAPY AND RESEARCH 2014. [DOI: 10.1007/s10608-014-9612-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
30
|
Weider S, Indredavik MS, Lydersen S, Hestad K. Intellectual function in patients with anorexia nervosa and bulimia nervosa. EUROPEAN EATING DISORDERS REVIEW 2014; 22:15-24. [PMID: 24185818 DOI: 10.1002/erv.2260] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 08/29/2013] [Accepted: 09/02/2013] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This study aimed to examine cognitive function in individuals with anorexia nervosa (AN) and bulimia nervosa (BN) on the basis of IQ measures, indexes and subtests of the Wechsler Adult Intelligence Scale – Third Edition (WAIS-III). METHODS A total of 41 patients with AN, 40 patients with BN and 40 healthy controls (HC), matched for sex, age and education, were recruited consecutively to complete the WAIS-III. RESULTS The AN group showed a significantly lower performance than the HC group on most global measures and on eight of the 13 administered subtests. Minor differences in verbal function were detected between the BN group and the HC group. CONCLUSION The patients with eating disorders showed normal intellectual functions compared with the normative population. However, the AN group displayed a consistently lower performance than the matched HC group, which performed above normative means. The BN group performed at a level between that of the AN and HC groups.
Collapse
|
31
|
Lindner SE, Fichter MM, Quadflieg N. Set-Shifting and its Relation to Clinical and Personality Variables in Full Recovery of Anorexia Nervosa. EUROPEAN EATING DISORDERS REVIEW 2014; 22:252-9. [DOI: 10.1002/erv.2293] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
| | - Manfred M. Fichter
- Department of Psychiatry; University of Munich (LMU); Munich Germany
- Schoen Hospital Roseneck for Behavioral Medicine; Prien Germany
| | - Norbert Quadflieg
- Department of Psychiatry; University of Munich (LMU); Munich Germany
| |
Collapse
|
32
|
Asch M, Esteves J, De Hautecloque D, Bargiacchi A, Le Heuzey MF, Mouren MC, Doyen C. [Cognitive remediation therapy for children and adolescents with anorexia nervosa in France: an exploratory study]. Encephale 2014; 40:240-6. [PMID: 24636282 DOI: 10.1016/j.encep.2013.10.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 10/10/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Cognitive remediation therapy (CRT) seems to be increasingly interesting in the treatment of anorexia nervosa for adult patients. We attempted to apply this support to a group of young inpatients, initially to assess its feasibility and acceptability, and then to improve its content for therapeutic application and future research. METHODS Ten 12- to 17-year-old inpatients with primary DSM-IV diagnosis of anorexia nervosa participated in a 10-week intervention program with a one-hour group session of CRT per week. All 10 patients were assessed before the intervention and those who completed the 10 sessions were assessed after. Assessment included a clinical examination by a psychiatrist, a battery of clinical inventories, and set-shifting tests. Moreover, each patient wrote a letter providing feedback on the intervention for subsequent analysis. RESULTS Only two patients completed all 10 sessions, the other eight who were discharged from the hospital in the meantime could not attend the sessions for practical reasons. After the 10 sessions, an improvement in BMI and in measured levels of some psychopathological symptoms was observed in our two patients. Most neuropsychological task performances were improved after cognitive remediation. Feedback from the 10 patients was generally positive. CONCLUSION AND IMPLICATIONS FOR PRACTICE This preliminary investigation suggests that cognitive remediation therapy is acceptable and feasible in this population. Replication of these findings requires a larger sample, improvement of the trial design, more sensitive measures, and another training format to avoid loss of so many participants.
Collapse
Affiliation(s)
- M Asch
- Service de psychiatrie de l'enfant et de l'adolescent, hôpital Robert-Debré, 48, boulevard Serrurier, 75019 Paris, France.
| | - J Esteves
- Service de psychiatrie de l'enfant et de l'adolescent, hôpital Robert-Debré, 48, boulevard Serrurier, 75019 Paris, France
| | - D De Hautecloque
- Service de psychiatrie de l'enfant et de l'adolescent, hôpital Robert-Debré, 48, boulevard Serrurier, 75019 Paris, France
| | - A Bargiacchi
- Service de psychiatrie de l'enfant et de l'adolescent, hôpital Robert-Debré, 48, boulevard Serrurier, 75019 Paris, France
| | - M-F Le Heuzey
- Service de psychiatrie de l'enfant et de l'adolescent, hôpital Robert-Debré, 48, boulevard Serrurier, 75019 Paris, France
| | - M-C Mouren
- Service de psychiatrie de l'enfant et de l'adolescent, hôpital Robert-Debré, 48, boulevard Serrurier, 75019 Paris, France
| | - C Doyen
- Service de psychiatrie de l'enfant et de l'adolescent, hôpital Sainte Anne, Paris, France
| |
Collapse
|
33
|
Benau EM, Orloff NC, Janke EA, Serpell L, Timko CA. A systematic review of the effects of experimental fasting on cognition. Appetite 2014; 77:52-61. [PMID: 24583414 DOI: 10.1016/j.appet.2014.02.014] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Revised: 01/14/2014] [Accepted: 02/17/2014] [Indexed: 11/27/2022]
Abstract
Numerous investigations have been conducted on the impact of short-term fasting on cognition in healthy individuals. Some studies have suggested that fasting is associated with executive function deficits; however, findings have been inconsistent. The lack of consensus regarding the impact of short-term fasting in healthy controls has impeded investigation of the impact of starvation or malnutrition in clinical groups, such as anorexia nervosa (AN). One method of disentangling these effects is to examine acute episodes of starvation experimentally. The present review systematically investigated the impact of short-term fasting on cognition. Studies investigating attentional bias to food-related stimuli were excluded so as to focus on general cognition. Ten articles were included in the review. The combined results are equivocal: several studies report no observable differences as a result of fasting and others show specific deficits on tasks designed to test psychomotor speed, executive function, and mental rotation. This inconsistent profile of fasting in healthy individuals demonstrates the complexity of the role of short-term fasting in cognition; the variety of tasks used, composition of the sample, and type and duration of fasting across studies may also have contributed to the inconsistent profile. Additional focused studies on neuropsychological profiles of healthy individuals are warranted in order to better develop an understanding of the role of hunger in cognition.
Collapse
Affiliation(s)
- Erik M Benau
- Department of Behavioral and Social Sciences, University of the Sciences, 600 S. 43rd St., Philadelphia, PA 19107, USA
| | - Natalia C Orloff
- Department of Behavioral and Social Sciences, University of the Sciences, 600 S. 43rd St., Philadelphia, PA 19107, USA
| | - E Amy Janke
- Department of Behavioral and Social Sciences, University of the Sciences, 600 S. 43rd St., Philadelphia, PA 19107, USA
| | - Lucy Serpell
- Division of Psychology and Language Sciences, University College London, 1-19 Torrington Place, London WC1E 7HB, UK; North East London Foundation Trust, Trust Head Office, Goodmayes Hospital, Barley Lane, Ilford Essex IG3 8XJ, UK
| | - C Alix Timko
- Department of Behavioral and Social Sciences, University of the Sciences, 600 S. 43rd St., Philadelphia, PA 19107, USA.
| |
Collapse
|
34
|
Heled E, Hoofien D, Bachner-Melman R, Bachar E, Ebstein RP. The sorting test of the D-KEFS in current and weight restored anorexia nervosa patients. Int J Eat Disord 2014; 47:92-8. [PMID: 24166931 DOI: 10.1002/eat.22203] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/09/2013] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Efforts have been made to characterize executive functions (EF) in anorexia nervosa (AN) both in the acute stage of the illness and after weight gain, yet many questions remain. The question of verbal versus visuo-perceptual stimuli in this regard has not been adequately addressed. The aim of this study is to further examine EF in women with past and present AN and to compare their performances in verbal and visual modalities with women who have never suffered from an eating disorder. METHOD Thirty-five underweight AN patients, 33 weight-restored patients symptom-free for at least 2 years, and 48 healthy female controls completed the Delis-Kaplan Executive Function System Sorting Test, so as to evaluate their EF. RESULTS No differences were observed between the scores of women with current and past AN. Both groups scored lower than controls on most test variables. However, while in the visuo-perceptual domain the performance of the AN groups was worse than that of controls, in the verbal domain they performed similarly to them. DISCUSSION Women with a past or present diagnosis of AN show difficulties in visuo-perceptual EF, whereas verbal EF seem to be preserved. There may be a dissociation between verbal and visuo-perceptual EF that persists after weight restoration.
Collapse
Affiliation(s)
- Eyal Heled
- Day Treatment Rehabilitation Unit, Sheba Medical Center, Ramat Gan, Israel; Department of Psychology, Hebrew University, Jerusalem, Israel
| | | | | | | | | |
Collapse
|
35
|
Dahlgren CL, Lask B, Landrø NI, Rø Ø. Patient and Parental Self-reports of Executive Functioning in a Sample of Young Female Adolescents with Anorexia Nervosa Before and After Cognitive Remediation Therapy. EUROPEAN EATING DISORDERS REVIEW 2013; 22:45-52. [DOI: 10.1002/erv.2265] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 09/03/2013] [Accepted: 09/23/2013] [Indexed: 11/07/2022]
Affiliation(s)
- Camilla Lindvall Dahlgren
- Regional Department for Eating Disorders, Division of Mental Health and Addiction; Oslo University Hospital Ullevål HF; Oslo Norway
| | - Bryan Lask
- Regional Department for Eating Disorders, Division of Mental Health and Addiction; Oslo University Hospital Ullevål HF; Oslo Norway
- Feeding and Eating Disorders Service, Department of Child and Adolescent Mental Health; Great Ormond Street Hospital for Children, NHS Trust; London UK
- Care UK; London UK
| | - Nils Inge Landrø
- Clinical Neuroscience Research Group, Department of Psychology; University of Oslo; Oslo Norway
| | - Øyvind Rø
- Regional Department for Eating Disorders, Division of Mental Health and Addiction; Oslo University Hospital Ullevål HF; Oslo Norway
| |
Collapse
|
36
|
Dahlgren CL, Lask B, Landrø NI, Rø Ø. Neuropsychological functioning in adolescents with anorexia nervosa before and after cognitive remediation therapy: a feasibility trial. Int J Eat Disord 2013; 46:576-81. [PMID: 23828636 DOI: 10.1002/eat.22155] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/24/2013] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To investigate neuropsychological functioning in adolescents with anorexia nervosa (AN) before and after receiving cognitive remediation therapy (CRT). METHOD Twenty young females with AN participated in an individually-delivered CRT treatment program. Neuropsychological and psychiatric assessments were administered before and after treatment. Weight, depression, anxiety, duration of illness, and level of eating disorder psychopathology were considered as covariates in statistical analyses. RESULTS Significant changes in weight, depression, visio-spatial memory, perceptual disembedding abilities, and verbal fluency were observed. Changes in weight had a significant effect on improvements in visuo-spatial memory and verbal fluency. Results also revealed a significant effect of depressive symptoms on perceptual disembedding abilities. DISCUSSION The results suggest improvements on a number of neuropsychological functions during the course of CRT. Future studies should explore the use of additional assessment instruments, and include control groups to assess the effectiveness of the intervention.
Collapse
Affiliation(s)
- Camilla Lindvall Dahlgren
- Division of Mental Health and Addiction, Regional Department for Eating Disorders, Oslo University Hospital Ullevål HF, Norway
| | | | | | | |
Collapse
|
37
|
Oltra-Cucarella J, Espert R, Rojo L, Jacas C, Guillén V, Moreno S. Neuropsychological Impairments in Anorexia Nervosa: A Spanish Sample Pilot Study. APPLIED NEUROPSYCHOLOGY-ADULT 2013; 21:161-75. [DOI: 10.1080/09084282.2013.782030] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
| | - Raul Espert
- a Unit of Neuropsychology , Hospital Clínico Universitario , Valencia , Spain
| | - Luís Rojo
- b Unit of Infant/Juvenile Psychiatry and Eating Disorders , Hospital Universitari y Politècnic La Fe , Valencia , Spain
| | - Carlos Jacas
- c Unit of Neuropsychology, Department of Psychiatry , Hospital Universitario Vall d'Hebrón , Barcelona , Spain
| | - Verónica Guillén
- d Faculty of Psychology , University of Valencia, and Unit of Eating Disorders, PREVI Center of Psychology , Valencia , Spain
| | - Sergio Moreno
- a Unit of Neuropsychology , Hospital Clínico Universitario , Valencia , Spain
| |
Collapse
|
38
|
Galimberti E, Fadda E, Cavallini MC, Martoni RM, Erzegovesi S, Bellodi L. Executive functioning in anorexia nervosa patients and their unaffected relatives. Psychiatry Res 2013; 208:238-44. [PMID: 23122554 DOI: 10.1016/j.psychres.2012.10.001] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2012] [Revised: 10/01/2012] [Accepted: 10/03/2012] [Indexed: 11/26/2022]
Abstract
Formal genetic studies suggested a substantial genetic influence for anorexia nervosa (AN), but currently results are inconsistent. The use of the neurocognitive endophenotype approach may facilitate our understanding of the AN pathophysiology. We investigated decision-making, set-shifting and planning in AN patients (n=29) and their unaffected relatives (n=29) compared to healthy probands (n=29) and their relatives (n=29). The Iowa Gambling Task (IGT), the Tower of Hanoi (ToH) and the Wisconsin Card Sorting Test (WCST) were administered. Concordance rates and heritability indices were also calculated in probands/relatives. Impaired performance on the IGT and the WCST were found in both AN probands and their relatives, although planning appeared to be preserved. The IGT heritability index suggested the presence of genetic effects that influence this measure. No evidence for genetic effects was found for the WCST. The results suggest the presence of a shared dysfunctional executive profile in women with AN and their unaffected relatives, characterized by deficient decision-making and set-shifting. Concordance analysis strongly suggests that these impairments aggregate in AN families, supporting the hypothesis that they may constitute biological markers for AN. Decision-making impairment presents a moderate heritability, suggesting that decision-making may be a candidate endophenotype for AN.
Collapse
Affiliation(s)
- Elisa Galimberti
- Experimental Neurology Institute, INSPE, Vita-Salute San Raffaele University, Milan, Italy.
| | | | | | | | | | | |
Collapse
|
39
|
Baron-Cohen S, Jaffa T, Davies S, Auyeung B, Allison C, Wheelwright S. Do girls with anorexia nervosa have elevated autistic traits? Mol Autism 2013; 4:24. [PMID: 23915495 PMCID: PMC3735388 DOI: 10.1186/2040-2392-4-24] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Accepted: 06/20/2013] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Patients with anorexia may have elevated autistic traits. In this study, we tested test whether patients with anorexia nervosa (anorexia) have an elevated score on a dimensional measure of autistic traits, the Autism Spectrum Quotient (AQ), as well as on trait measures relevant to the autism spectrum: the Empathy Quotient (EQ), and the Systemizing Quotient (SQ). METHODS Two groups were tested: (1) female adolescents with anorexia: n = 66, aged 12 to 18 years; and (2) female adolescents without anorexia: n =1,609, aged 12 to 18 years. Both groups were tested using the AQ, EQ, and SQ, via the parent-report adolescent versions for patients aged 12 to 15 years old, and the self-report adult versions for patients aged over 16 years. RESULTS As predicted, the patients with anorexia had a higher AQ and SQ. Their EQ score was reduced, but only for the parent-report version in the younger age group. Using EQ-SQ scores to calculate 'cognitive types', patients with anorexia were more likely to show the Type S profile (systemizing (S) better than empathy (E)), compared with typical females. CONCLUSIONS Females with anorexia have elevated autistic traits. Clinicians should consider if a focus on autistic traits might be helpful in the assessment and treatment of anorexia. Future research needs to establish if these results reflect traits or states associated with anorexia.
Collapse
Affiliation(s)
- Simon Baron-Cohen
- Autism Research Centre, Department of Psychiatry, Cambridge University, 18B Trumpington Rd, Cambridge CB2 8AH, UK
- CLASS Clinic, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Tony Jaffa
- Phoenix Centre, Ida Darwin, Fulbourn, Cambridge, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Sarah Davies
- Phoenix Centre, Ida Darwin, Fulbourn, Cambridge, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Bonnie Auyeung
- Autism Research Centre, Department of Psychiatry, Cambridge University, 18B Trumpington Rd, Cambridge CB2 8AH, UK
| | - Carrie Allison
- Autism Research Centre, Department of Psychiatry, Cambridge University, 18B Trumpington Rd, Cambridge CB2 8AH, UK
| | - Sally Wheelwright
- Autism Research Centre, Department of Psychiatry, Cambridge University, 18B Trumpington Rd, Cambridge CB2 8AH, UK
| |
Collapse
|
40
|
Sato Y, Saito N, Utsumi A, Aizawa E, Shoji T, Izumiyama M, Mushiake H, Hongo M, Fukudo S. Neural basis of impaired cognitive flexibility in patients with anorexia nervosa. PLoS One 2013; 8:e61108. [PMID: 23675408 PMCID: PMC3651087 DOI: 10.1371/journal.pone.0061108] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Accepted: 03/05/2013] [Indexed: 02/07/2023] Open
Abstract
Background Impaired cognitive flexibility in anorexia nervosa (AN) causes clinical problems and makes the disease hard to treat, but its neural basis has yet to be fully elucidated. The purpose of this study was to evaluate the brain activity of individuals with AN while performing a task requiring cognitive flexibility on the Wisconsin Card Sorting Test (WCST), which is one of the most frequently used neurocognitive measures of cognitive flexibility and problem-solving ability. Methods Participants were 15 female AN patients and 15 age- and intelligence quotient-matched healthy control women. Participants completed the WCST while their brain activity was measured by functional magnetic resonance imaging during the task. Brain activation in response to set shifting error feedback and the correlation between such brain activity and set shifting performance were analyzed. Results The correct rate on the WCST was significantly poorer for AN patients than for controls. Patients showed poorer activity in the right ventrolateral prefrontal cortex and bilateral parahippocampal cortex on set shifting than controls. Controls showed a positive correlation between correct rate and ventrolateral prefrontal activity in response to set shifting whereas patients did not. Conclusion These findings suggest dysfunction of the ventrolateral prefrontal cortex and parahippocampal cortex as a cause of impaired cognitive flexibility in AN patients.
Collapse
Affiliation(s)
- Yasuhiro Sato
- Department of Psychosomatic Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Naohiro Saito
- Department of Clinical Neuroscience, Yamagata University Graduate School of Medical Science, Yamagata City, Yamagata, Japan
| | | | - Emiko Aizawa
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Tomotaka Shoji
- Department of Psychosomatic Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan
| | | | - Hajime Mushiake
- Department of Physiology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Michio Hongo
- Kurokawa Hospital, Taiwa-cho, Miyagi, Japan
- Department of Comprehensive Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Shin Fukudo
- Department of Psychosomatic Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan
- Department of Behavioral Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
- * E-mail:
| |
Collapse
|
41
|
Tantillo M, Sanftner J, Hauenstein E. Restoring connection in the face of disconnection: an integrative approach to understanding and treating anorexia nervosa. ACTA ACUST UNITED AC 2013. [DOI: 10.1080/21662630.2013.742980] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
42
|
Calderoni S, Muratori F, Leggero C, Narzisi A, Apicella F, Balottin U, Carigi T, Maestro S, Fabbro F, Urgesi C. Neuropsychological functioning in children and adolescents with restrictive-type anorexia nervosa: An in-depth investigation with NEPSY–II. J Clin Exp Neuropsychol 2013; 35:167-79. [DOI: 10.1080/13803395.2012.760536] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
43
|
Abstract
Eating disorders are considered psychiatric pathologies that are characterized by pathological worry related to body shape and weight. The lack of progress in treatment development, at least in part, reflects the fact that little is known about the pathophysiologic mechanisms that account for the development and persistence of eating disorders. The possibility that patients with eating disorders have a dysfunction of the central nervous system has been previously explored; several studies assessing the relationship between cognitive processing and certain eating behaviors have been conducted. These studies aim to achieve a better understanding of the pathophysiology of such diseases. The aim of this study was to review the current state of neuropsychological studies focused on eating disorders. This was done by means of a search process covering three relevant electronic databases, as well as an additional search on references included in the analyzed papers; we also mention other published reviews obtained by handsearching.
Collapse
|
44
|
Fagundo AB, de la Torre R, Jiménez-Murcia S, Agüera Z, Granero R, Tárrega S, Botella C, Baños R, Fernández-Real JM, Rodríguez R, Forcano L, Frühbeck G, Gómez-Ambrosi J, Tinahones FJ, Fernández-García JC, Casanueva FF, Fernández-Aranda F. Executive functions profile in extreme eating/weight conditions: from anorexia nervosa to obesity. PLoS One 2012; 7:e43382. [PMID: 22927962 PMCID: PMC3424186 DOI: 10.1371/journal.pone.0043382] [Citation(s) in RCA: 157] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Accepted: 07/23/2012] [Indexed: 12/31/2022] Open
Abstract
Background Extreme weight conditions (EWC) groups along a continuum may share some biological risk factors and intermediate neurocognitive phenotypes. A core cognitive trait in EWC appears to be executive dysfunction, with a focus on decision making, response inhibition and cognitive flexibility. Differences between individuals in these areas are likely to contribute to the differences in vulnerability to EWC. The aim of the study was to investigate whether there is a common pattern of executive dysfunction in EWC while comparing anorexia nervosa patients (AN), obese subjects (OB) and healthy eating/weight controls (HC). Methods Thirty five AN patients, fifty two OB and one hundred thirty seven HC were compared using the Wisconsin Card Sorting Test (WCST); Stroop Color and Word Test (SCWT); and Iowa Gambling Task (IGT). All participants were female, aged between 18 and 60 years. Results There was a significant difference in IGT score (F(1.79); p<.001), with AN and OB groups showing the poorest performance compared to HC. On the WCST, AN and OB made significantly more errors than controls (F(25.73); p<.001), and had significantly fewer correct responses (F(2.71); p<.001). Post hoc analysis revealed that the two clinical groups were not significantly different from each other. Finally, OB showed a significant reduced performance in the inhibition response measured with the Stroop test (F(5.11); p<.001) compared with both AN and HC. Conclusions These findings suggest that EWC subjects (namely AN and OB) have similar dysfunctional executive profile that may play a role in the development and maintenance of such disorders.
Collapse
Affiliation(s)
- Ana B. Fagundo
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Rafael de la Torre
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Spain
- Human Pharmacology and Clinical Neurosciences Research Group, Neuroscience Research Program, IMIM-Hospital del Mar Research Institute, Parc de Salut Mar, Barcelona, Spain
| | - Susana Jiménez-Murcia
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, Spain
| | - Zaida Agüera
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Spain
| | - Roser Granero
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Spain
- Laboratori d’Estadística Aplicada, Departament de Psicobiologia i Metodologia, Universitat Autònoma de Barcelona, Spain
| | - Salomé Tárrega
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Spain
- Laboratori d’Estadística Aplicada, Departament de Psicobiologia i Metodologia, Universitat Autònoma de Barcelona, Spain
| | - Cristina Botella
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Spain
- Department of Basic Psychology, Clinic and Psychobiology, University Jaume I, Castellón, Spain
| | - Rosa Baños
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Spain
- Department of Pyschological, Personality, Evaluation and Treatment, University of Valencia, Spain
| | - Jose M. Fernández-Real
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Spain
- Service of Diabetes, Endocrinology and Nutrition, Institut d’Investigació Biomèdica de Girona (IdlBGi) Hospital Dr Josep Trueta, Girona, Spain
| | - Roser Rodríguez
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Spain
- Service of Diabetes, Endocrinology and Nutrition, Institut d’Investigació Biomèdica de Girona (IdlBGi) Hospital Dr Josep Trueta, Girona, Spain
| | - Laura Forcano
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Spain
| | - Gema Frühbeck
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Spain
- Department of Endocrinology, University of Navarra, Pamplona, Spain
| | - Javier Gómez-Ambrosi
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Spain
- Department of Endocrinology, University of Navarra, Pamplona, Spain
| | - Francisco J. Tinahones
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Spain
- Service of Diabetes, Endocrinology and Nutrition, Hospital Clínico Universitario Virgen de Victoria, Málaga, Spain
| | - Jose C. Fernández-García
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Spain
- Service of Diabetes, Endocrinology and Nutrition, Hospital Clínico Universitario Virgen de Victoria, Málaga, Spain
| | - Felipe F. Casanueva
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Spain
- Endocrine Division, Complejo Hospitalario U. de Santiago, Santiago de Compostela University, Spain
| | - Fernando Fernández-Aranda
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, Spain
- * E-mail:
| |
Collapse
|
45
|
Danner UN, Sanders N, Smeets PAM, van Meer F, Adan RAH, Hoek HW, van Elburg AA. Neuropsychological weaknesses in anorexia nervosa: set-shifting, central coherence, and decision making in currently ill and recovered women. Int J Eat Disord 2012; 45:685-94. [PMID: 22331528 DOI: 10.1002/eat.22007] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/31/2011] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The purpose of this study is to examine set-shifting, central coherence, and decision making in women currently ill with anorexia nervosa (AN), women recovered from AN, and healthy control women. We aim to test whether these neuropsychological weaknesses persist after recovery, and explore relations between the impairments RESULTS Compared to control women, ill and recovered women showed poor set-shifting and decision making. There were strong correlations between set-shifting and central coherence in the ill and recovered women. Decision making did not correlate with the other measures. DISCUSSION The present findings suggest that impaired set-shifting and decision making are stable traits in women with AN. Because individual differences within these groups were large, a rigid thinking style is only present in a (sub)population of ill and recovered women. Decision-making performance is not related to a rigid thinking style, but further research in this area is warranted.
Collapse
Affiliation(s)
- Unna N Danner
- Altrecht Eating Disorders Rintveld, Altrecht Mental Health Institute, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
46
|
Galimberti E, Martoni RM, Cavallini MC, Erzegovesi S, Bellodi L. Motor inhibition and cognitive flexibility in eating disorder subtypes. Prog Neuropsychopharmacol Biol Psychiatry 2012; 36:307-12. [PMID: 22079108 DOI: 10.1016/j.pnpbp.2011.10.017] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2011] [Revised: 10/20/2011] [Accepted: 10/26/2011] [Indexed: 01/24/2023]
Abstract
Anorexia Nervosa (AN) and Bulimia Nervosa (BN) are complex Eating Disorders (EDs). Even if are considered two different diagnostic categories, they share clinical relevant characteristics. The evaluation of neurocognitive functions, using standardized neuropsychological assessment, could be a interesting approach to better understand differences and similarities between diagnostic categories and clinical subtypes in EDs thus improving our knowledge of the pathophisiology of EDs spectrum. This study explored cognitive flexibility and motor inhibition in patients with AN considering both Restricter and Binge/Purge subtypes, patients with BN and healthy comparisons subjects (HC). Intra-Extra Dimentional Set shifting Test and Stop Signal Task, selected from CANTAB battery, were administered to analyzed set-shifting and motor inhibition respectively. AN patients showed a deficient motor inhibition compared to HC, while no evidence for impaired motor inhibition was found in BN patients; a significant relationship between commission errors in the Stop Signal Task and attentional impulsiveness was found. Moreover, no difference in set-shifting abilities was found comparing all clinician groups and HC. So our results indicated no cognitive impairment in these two cognitive functions in BN patients, while AN and BN showed different performances in motor inhibition. A similar cognitive profile was found in other obsessive compulsive spectrum disorders. Finally, the paper suggests a new interactive approach for the study of cognitive profile in psychiatric disorders; it might be more useful since it is more closely related to the executive functions complexity.
Collapse
Affiliation(s)
- Elisa Galimberti
- Experimental Neurology Institute, INSPE, Vita-Salute San Raffaele University, Italy.
| | | | | | | | | |
Collapse
|
47
|
Blazevic S, Colic L, Culig L, Hranilovic D. Anxiety-like behavior and cognitive flexibility in adult rats perinatally exposed to increased serotonin concentrations. Behav Brain Res 2012; 230:175-81. [PMID: 22342491 DOI: 10.1016/j.bbr.2012.02.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 01/27/2012] [Accepted: 02/01/2012] [Indexed: 12/27/2022]
Abstract
Serotonin (5-hydroxytryptamine, 5HT) is a biologically active amine that regulates the development of 5HT neurons and target tissues during neurogenesis, while later it assumes the function of a neurotransmitter. Serotonin mediates many essential behaviors common to all mammals, and is held responsible for anxiety-like behavior and cognitive rigidity. Proper serotonin levels, controlled through 5HT synthesis and metabolism, are crucial for normal brain development. In this study we investigated anxiety-like behavior and cognitive flexibility in adult animals after exposing their developing brains to increased 5HT concentrations. Wistar rats were treated subcutaneously from gestational day 12 to post-natal day 21 with the immediate 5HT precursor 5-hydroxytryptophan (5HTP, 25mg/kg), a non-selective MAO inhibitor tranylcypromine (TCP, 2mg/kg), or saline. After reaching adulthood, animals were tested for anxiety-like behavior (exploratory behavior, thigmotactic behavior, social contact, and reaction to stressful stimulus) and cognitive flexibility (ability for reversal learning). Results of the behavioral studies corresponded with our previous neurochemical findings. Treatment with 5HTP, which has induced mild reduction in cortical 5HT concentrations, caused reduction in only one aspect of anxiety-like behavior (increased exploratory activity). Treatment with TCP, which lead to drastic reduction in 5HT concentration/function, resulted in a highly anxiolytic phenotype (reduced thigmotaxis, reaction to stress, and social anxiety) with improved cognitive flexibility. Although further neurochemical, anatomical and gene-expression studies are needed to elucidate the mechanisms underlying the observed behavior, we hope that our results will contribute to the understanding of the role of serotonin in anxiety-like behavior and cognitive rigidity.
Collapse
Affiliation(s)
- Sofia Blazevic
- Department of Animal Physiology, Faculty of Science, University of Zagreb, Rooseveltov trg 6, HR-10 000 Zagreb, Croatia
| | | | | | | |
Collapse
|
48
|
Tchanturia K, Davies H, Roberts M, Harrison A, Nakazato M, Schmidt U, Treasure J, Morris R. Poor cognitive flexibility in eating disorders: examining the evidence using the Wisconsin Card Sorting Task. PLoS One 2012; 7:e28331. [PMID: 22253689 PMCID: PMC3257222 DOI: 10.1371/journal.pone.0028331] [Citation(s) in RCA: 269] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Accepted: 11/06/2011] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND People with eating disorders (ED) frequently present with inflexible behaviours, including eating related issues which contribute to the maintenance of the illness. Small scale studies point to difficulties with cognitive set-shifting as a basis. Using larger scale studies will lend robustness to these data. METHODOLOGY/PRINCIPAL FINDINGS 542 participants were included in the dataset as follows: Anorexia Nervosa (AN) n = 171; Bulimia Nervosa (BN) n = 82; Recovered AN n = 90; Healthy controls (HC): n = 199. All completed the Wisconsin Card Sorting Task (WCST), an assessment that integrates multiple measurement of several executive processes concerned with problem solving and cognitive flexibility. The AN and BN groups performed poorly in most domains of the WCST. Recovered AN participants showed a better performance than currently ill participants; however, the number of preservative errors was higher than for HC participants. CONCLUSIONS/SIGNIFICANCE There is a growing interest in the diagnostic and treatment implications of cognitive flexibility in eating disorders. This large dataset supports previous smaller scale studies and a systematic review which indicate poor cognitive flexibility in people with ED.
Collapse
Affiliation(s)
- Kate Tchanturia
- Division of Psychological Medicine, Institute of Psychiatry, King's College London (KCL), London, United Kingdom.
| | | | | | | | | | | | | | | |
Collapse
|
49
|
Andrés-Perpiña S, Lozano-Serra E, Puig O, Lera-Miguel S, Lázaro L, Castro-Fornieles J. Clinical and biological correlates of adolescent anorexia nervosa with impaired cognitive profile. Eur Child Adolesc Psychiatry 2011; 20:541-9. [PMID: 21984403 DOI: 10.1007/s00787-011-0216-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Accepted: 09/07/2011] [Indexed: 11/28/2022]
Abstract
Some neuropsychological studies of anorexia nervosa (AN) have yielded conflicting results, and it has been established that not all adult patients with AN are cognitively impaired. The objective of this study is to determine the percentage of adolescents with AN who present worse cognitive functioning according to neuropsychological criteria of cognitive impairment, and to study their clinical characteristics. Thirty-seven adolescents (11-18 years) with a diagnosis of AN in an acute state of the illness and with low body mass index (BMI) were compared with 41 healthy subjects of the same sex and similar age and intelligence using a comprehensive neuropsychological battery. Overall, AN patients took longer to copy Rey's Figure than the control group (p = 0.001). Thirty per cent of patients showed impaired neuropsychological functioning (defined as scoring two standard deviations lower than the average or lower than their intelligence level in two tasks) with worse performance on visuo-spatial tasks. This subgroup of patients presented lower BMI (p = 0.023) and higher trait anxiety (p = 0.028). The performance of adolescents in an acute state of AN was similar to that of the healthy control group, with the exception of lower time to completion in copying a complex figure. However, cognitive performance varied in these patients, being clearly impaired in one-third of the sample. The cognitive impairment subgroup showed lower BMI and higher anxiety. Longitudinal follow-up studies are necessary to assess the stability of this profile after longer treatment periods.
Collapse
|
50
|
Brooks SJ, Barker GJ, O'Daly OG, Brammer M, Williams SCR, Benedict C, Schiöth HB, Treasure J, Campbell IC. Restraint of appetite and reduced regional brain volumes in anorexia nervosa: a voxel-based morphometric study. BMC Psychiatry 2011; 11:179. [PMID: 22093442 PMCID: PMC3278387 DOI: 10.1186/1471-244x-11-179] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Accepted: 11/17/2011] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Previous Magnetic Resonance Imaging (MRI) studies of people with anorexia nervosa (AN) have shown differences in brain structure. This study aimed to provide preliminary extensions of this data by examining how different levels of appetitive restraint impact on brain volume. METHODS Voxel based morphometry (VBM), corrected for total intracranial volume, age, BMI, years of education in 14 women with AN (8 RAN and 6 BPAN) and 21 women (HC) was performed. Correlations between brain volume and dietary restraint were done using Statistical Package for the Social Sciences (SPSS). RESULTS Increased right dorsolateral prefrontal cortex (DLPFC) and reduced right anterior insular cortex, bilateral parahippocampal gyrus, left fusiform gyrus, left cerebellum and right posterior cingulate volumes in AN compared to HC. RAN compared to BPAN had reduced left orbitofrontal cortex, right anterior insular cortex, bilateral parahippocampal gyrus and left cerebellum. Age negatively correlated with right DLPFC volume in HC but not in AN; dietary restraint and BMI predicted 57% of variance in right DLPFC volume in AN. CONCLUSIONS In AN, brain volume differences were found in appetitive, somatosensory and top-down control brain regions. Differences in regional GMV may be linked to levels of appetitive restraint, but whether they are state or trait is unclear. Nevertheless, these discrete brain volume differences provide candidate brain regions for further structural and functional study in people with eating disorders.
Collapse
Affiliation(s)
- Samantha J Brooks
- Section of Eating Disorders, Institute of Psychiatry, King's College London, London, SE5 8AF UK.
| | - Gareth J Barker
- Centre for Neuroimaging Sciences, Institute of Psychiatry, King's College London, London, SE5 8AF, UK
| | - Owen G O'Daly
- Centre for Neuroimaging Sciences, Institute of Psychiatry, King's College London, London, SE5 8AF, UK
| | - Michael Brammer
- Centre for Neuroimaging Sciences, Institute of Psychiatry, King's College London, London, SE5 8AF, UK
| | - Steven CR Williams
- Centre for Neuroimaging Sciences, Institute of Psychiatry, King's College London, London, SE5 8AF, UK
| | | | - Helgi B Schiöth
- Uppsala University, Department of Neuroscience, 75124 Uppsala Sweden
| | - Janet Treasure
- Section of Eating Disorders, Institute of Psychiatry, King's College London, London, SE5 8AF UK
| | - Iain C Campbell
- Section of Eating Disorders, Institute of Psychiatry, King's College London, London, SE5 8AF UK
| |
Collapse
|