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Gura-Solomon M, Brener Yacobi R, Kushnir T, Heled E. Cognitive flexibility in women who recovered from anorexia nervosa - a model-based approach. J Psychiatr Res 2024; 171:38-42. [PMID: 38241968 DOI: 10.1016/j.jpsychires.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 12/13/2023] [Accepted: 01/05/2024] [Indexed: 01/21/2024]
Abstract
Research findings on cognitive flexibility (CF) functioning in women who recovered from anorexia nervosa (RAN) were found to be inconsistent. This was attributed to the multiple definitions of CF and the diverse measuring tools used to assess it. Applying a deductive approach to explore CF function may address these inconsistencies; thus, we used a model that divides CF into three subtypes, namely, stimulus-response mapping, switching sets and task switching. Additionally, we explored the association between CF subtypes and the disorder's clinical measures to assess the relation of CF to recovery. Forty-three RAN and 54 healthy controls performed tasks designed to assess CF subtypes based on the model's division, and the RAN group completed the Eating Disorder Examination Questionnaire. The results showed that the RAN group performed significantly worse than controls only in the stimulus-response mapping subtype. Additionally, there were no correlations between CF subtypes and clinical symptoms or the disorder measures - current and nadir body mass index, age of onset, time since recovery, and disorder duration. In conclusion, the study revealed CF impairment after recovery from AN, specifically in stimulus-response mapping. The variability in performance of the CF subtypes supports the application of a theory-driven perspective viewing CF as a modular ability in RAN. Additionally, CF is unrelated to clinical measures post-recovery and thus may not be used as a criterion for evaluating recovery.
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Affiliation(s)
| | | | - Talma Kushnir
- Department of Psychology, Ariel University, Israel; Adelson School of Medicine, Ariel University, Israel
| | - Eyal Heled
- Department of Psychology, Ariel University, Israel; Neurological Rehabilitation Department, Sheba Medical Center, Israel.
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Miranda-Olivos R, Testa G, Lucas I, Sánchez I, Sánchez-González J, Granero R, Jiménez-Murcia S, Fernández-Aranda F. Clinical factors predicting impaired executive functions in eating disorders: The role of illness duration. J Psychiatr Res 2021; 144:87-95. [PMID: 34601380 DOI: 10.1016/j.jpsychires.2021.09.042] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 09/08/2021] [Accepted: 09/22/2021] [Indexed: 01/30/2023]
Abstract
Poor performance in executive functions is observed in individuals with eating disorders (EDs). These impairments have usually been associated with the presence of comorbid psychopathology or with higher severity of EDs. However, few studies have explored the interaction between illness duration and deficits in executive functions. The present study investigates the association between ED duration and performance in decision-making, inhibitory control, and cognitive flexibility in the anorexia nervosa restrictive subtype (AN-R), bulimic/purging subtype (AN-BP), and binge spectrum disorders (BSDs) (namely, bulimia nervosa and binge eating disorder) among 116 women with EDs compared with 123 women healthy controls (HCs). Using cumulative survival analysis, we estimated the risk of deficits related to illness duration. Predictors of executive dysfunctions were assessed by regression analysis, including as potential predictors illness duration, severity of general psychopathology, and ED symptomatology. Results showed poor decision-making and cognitive flexibility in participants with EDs compared with HCs. ED duration was associated with poor inhibitory control in the AN-BP group and poor cognitive flexibility in the BSD group. The illness duration increased the risk of presenting early deficits in executive function. In decision-making and inhibitory control, the AN-R group showed the earliest deficits, whereas in cognitive flexibility it was the BSD group. ED duration predicted impaired cognitive flexibility in the BSD group and impaired inhibitory control in the AN-BP group, whereas the severity of general psychopathological symptoms was a predictor of impaired cognitive flexibility in individuals with AN-R. These results highlight the relevance of illness duration in executive dysfunctions in EDs.
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Affiliation(s)
- Romina Miranda-Olivos
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain; Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain; Psychiatry and Mental Health Group, Neuroscience Program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Giulia Testa
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain; Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain; Psychiatry and Mental Health Group, Neuroscience Program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Ignacio Lucas
- Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain; Psychiatry and Mental Health Group, Neuroscience Program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Isabel Sánchez
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain; Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain; Psychiatry and Mental Health Group, Neuroscience Program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Jessica Sánchez-González
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain; Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Roser Granero
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain; Departament de Psicobiologia i Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Susana Jiménez-Murcia
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain; Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain; Psychiatry and Mental Health Group, Neuroscience Program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Spain; Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Fernando Fernández-Aranda
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain; Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain; Psychiatry and Mental Health Group, Neuroscience Program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Spain; Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.
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3
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Brassard SL, Balodis IM. A review of effort-based decision-making in eating and weight disorders. Prog Neuropsychopharmacol Biol Psychiatry 2021; 110:110333. [PMID: 33905755 DOI: 10.1016/j.pnpbp.2021.110333] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 03/19/2021] [Accepted: 04/21/2021] [Indexed: 12/26/2022]
Abstract
Effort-based decision-making provides a framework to understand the mental computations estimating the amount of work ("effort") required to obtain a reward. The aim of the current review is to systematically synthesize the available literature on effort-based decision-making across the spectrum of eating and weight disorders. More specifically, the current review summarises the literature examining whether 1) individuals with eating disorders and overweight/obesity are willing to expend more effort for rewards compared to healthy controls, 2) if particular components of effort-based decision-making (i.e. risk, discounting) relate to specific binge eating conditions, and 3) how individual differences in effort and reward -processing measures relate to eating pathology and treatment measures. A total of 96 studies were included in our review, following PRISMA guidelines. The review suggests that individuals with binge eating behaviours 1) are more likely to expend greater effort for food rewards, but not monetary rewards, 2) demonstrate greater decision-making impairments under risk and uncertainty, 3) prefer sooner rather than delayed rewards for both food and money, and 4) demonstrate increased implicit 'wanting' for high fat sweet foods. Finally, individual differences in effort and reward -processing measures relating to eating pathology and treatment measures are also discussed.
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Affiliation(s)
- Sarah L Brassard
- Department of Neuroscience, McMaster University, Canada; Peter Boris Center for Addictions Research, St. Joseph's Healthcare Hamilton, Canada
| | - Iris M Balodis
- Department of Neuroscience, McMaster University, Canada; Peter Boris Center for Addictions Research, St. Joseph's Healthcare Hamilton, Canada; Department of Psychiatry and Behavioural Neuroscience, McMaster University, Canada.
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Ciberti A, Cavalletti M, Palagini L, Mariani MG, Dell'Osso L, Mauri M, Maglio A, Mucci F, Marazziti D, Miniati M. Decision-Making, Impulsiveness and Temperamental Traits in Eating Disorders. CLINICAL NEUROPSYCHIATRY 2020; 17:199-208. [PMID: 34908995 PMCID: PMC8629064 DOI: 10.36131/cnfioritieditore20200401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To explore decision-making, impulsiveness and temperamental traits in patients suffering from eating disorders (EDs), as compared with healthy controls (HC). METHOD Fifty-one patients affected by ED (fourteen with anorexia restricting subtype, AN-R; fourteen with bulimia, BN; thirteen with anorexia bingeing/purging subtype, AN-BP; ten with binge-eating disorder, BED) and twenty-eight HC. The patients, recruited at the Section of Psychiatry of the University of Pisa (Italy, were evaluated with a battery of neuropsychological questionnaires, including the IOWA Gambling Task (IGT), the Barratt Impulsiveness Scale (BIS-11), the Temperament and Character Inventory (TCI), the Frontal Assessment Battery (FAB) and the Hamilton Depression Rating Scale (HAM-D). RESULTS The results indicated that AN-R, AN-BP and BN patients showed poorer IGT performances than HC (p < .05), while BED performances were similar to those of HC. IGT scores suggested the existence of similarities in decision-making performances of AN-BP and BN patients, as they performed differently from HC starting from block 3 (F(16.2)=1.7). In addition, differences between AN-BP/BN and AN-R patients were detected, given that they performed differently starting from block 4. As far as BIS-11 is concerned, AN-BP and BN patients reached the highest BIS total scores, when compared with the other groups. Further, they shared similar temperamental and impulsiveness profiles, as demonstrated by their BIS-11 'motor impulsiveness' scores, and by their TCI 'novelty seeking', 'reward dependence' and 'persistence' dimensions. The post-hoc analyses revealed that both AN groups (namely, AN-R and AN-BP) scored significantly lower than HC on the FAB. No patients fulfilled the criteria for the diagnosis of a current major depression. CONCLUSIONS Decision-making deficits are common in EDs. In AN-R these seem related to cognitive styles, while in AN-BP and BN patients with temperament features and impulsiveness traits.
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Affiliation(s)
- Agnese Ciberti
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | | | - Laura Palagini
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | | | - Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Mauro Mauri
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Alessandra Maglio
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Federico Mucci
- Department of Clinical and Experimental Medicine, University of Pisa, Italy.,Department of Biotechnology, Chemistry and Pharmacy, University of Siena, Italy
| | - Donatella Marazziti
- Department of Clinical and Experimental Medicine, University of Pisa, Italy.,Saint Camillus International University of Health and Medical Sciences, Rome, Italy.,Brain Research Foundation, Lucca, Italy
| | - Mario Miniati
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
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5
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A further assessment of decision-making in anorexia nervosa. Eur Psychiatry 2020; 30:121-7. [DOI: 10.1016/j.eurpsy.2014.08.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 05/20/2014] [Accepted: 08/18/2014] [Indexed: 11/20/2022] Open
Abstract
AbstractObjective:Anorexia nervosa (AN) may be associated with impaired decision-making. Cognitive processes underlying this impairment remain unclear, mainly because previous assessments of this complex cognitive function were completed with a single test. Furthermore, clinical features such as mood status may impact this association. We aim to further explore the hypothesis of altered decision-making in AN.Method:Sixty-three adult women with AN and 49 female controls completed a clinical assessment and were assessed by three tasks related to decision-making [Iowa Gambling Task (IGT), Balloon Analogue Risk Task (BART), Probabilistic Reversal Learning Task (PRLT)].Results:People with AN had poorer performance on the IGT and made less risky choices on the BART, whereas performances were not different on PRLT. Notably, AN patients with a current major depressive disorder showed similar performance to those with no current major depressive disorder.Conclusion:These results tend to confirm an impaired decision making-process in people with AN and suggest that various cognitive processes such as inhibition to risk-taking or intolerance of uncertainty may underlie this condition Furthermore, these impairments seem unrelated to the potential co-occurent major depressive disorders.
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King JA, Bernardoni F, Geisler D, Ritschel F, Doose A, Pauligk S, Pásztor K, Weidner K, Roessner V, Smolka MN, Ehrlich S. Intact value-based decision-making during intertemporal choice in women with remitted anorexia nervosa? An fMRI study. J Psychiatry Neurosci 2020; 45:108-116. [PMID: 31595737 PMCID: PMC7828910 DOI: 10.1503/jpn.180252] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Extreme restrictive food choice in anorexia nervosa is thought to reflect excessive self-control and/or abnormal reward sensitivity. Studies using intertemporal choice paradigms have suggested an increased capacity to delay reward in anorexia nervosa, and this may explain an unusual ability to resist immediate temptation and override hunger in the long-term pursuit of thinness. It remains unclear, however, whether altered delay discounting in anorexia nervosa constitutes a state effect of acute illness or a trait marker observable after recovery. METHODS We repeated the analysis from our previous fMRI investigation of intertemporal choice in acutely underweight patients with anorexia nervosa in a sample of weight-recovered women with anorexia nervosa (n = 36) and age-matched healthy controls (n = 36) who participated in the same study protocol. Follow-up analyses explored functional connectivity separately in both the weight-recovered/healthy controls sample and the acute/healthy controls sample. RESULTS In contrast to our previous findings in acutely underweight patients with anorexia nervosa, we found no differences between weight-recovered patients with anorexia nervosa and healthy controls at either behavioural or neural levels. New analysis of data from the acute/healthy controls sample sample revealed increased coupling between dorsal anterior cingulate cortex and posterior brain regions as a function of decision difficulty, supporting the hypothesis of altered neural efficiency in the underweight state. LIMITATIONS This was a cross-sectional study, and the results may be task-specific. CONCLUSION Although our results underlined previous demonstrations of divergent temporal reward discounting in acutely underweight patients with anorexia nervosa, we found no evidence of alteration in patients with weight-recovered anorexia nervosa. Together, these findings suggest that impaired valuebased decision-making may not constitute a defining trait variable or “scar” of the disorder.
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Affiliation(s)
- Joseph A. King
- From the Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (King, Bernardoni, Geisler, Ritschel, Doose, Pauligk, Pásztor, Ehrlich); the Translational Developmental Neuroscience Section, Eating Disorder Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Ritschel, Roessner, Ehrlich); the Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Weidner); and the Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany (Smolka)
| | - Fabio Bernardoni
- From the Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (King, Bernardoni, Geisler, Ritschel, Doose, Pauligk, Pásztor, Ehrlich); the Translational Developmental Neuroscience Section, Eating Disorder Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Ritschel, Roessner, Ehrlich); the Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Weidner); and the Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany (Smolka)
| | - Daniel Geisler
- From the Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (King, Bernardoni, Geisler, Ritschel, Doose, Pauligk, Pásztor, Ehrlich); the Translational Developmental Neuroscience Section, Eating Disorder Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Ritschel, Roessner, Ehrlich); the Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Weidner); and the Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany (Smolka)
| | - Franziska Ritschel
- From the Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (King, Bernardoni, Geisler, Ritschel, Doose, Pauligk, Pásztor, Ehrlich); the Translational Developmental Neuroscience Section, Eating Disorder Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Ritschel, Roessner, Ehrlich); the Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Weidner); and the Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany (Smolka)
| | - Arne Doose
- From the Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (King, Bernardoni, Geisler, Ritschel, Doose, Pauligk, Pásztor, Ehrlich); the Translational Developmental Neuroscience Section, Eating Disorder Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Ritschel, Roessner, Ehrlich); the Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Weidner); and the Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany (Smolka)
| | - Sophie Pauligk
- From the Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (King, Bernardoni, Geisler, Ritschel, Doose, Pauligk, Pásztor, Ehrlich); the Translational Developmental Neuroscience Section, Eating Disorder Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Ritschel, Roessner, Ehrlich); the Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Weidner); and the Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany (Smolka)
| | - Konrad Pásztor
- From the Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (King, Bernardoni, Geisler, Ritschel, Doose, Pauligk, Pásztor, Ehrlich); the Translational Developmental Neuroscience Section, Eating Disorder Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Ritschel, Roessner, Ehrlich); the Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Weidner); and the Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany (Smolka)
| | - Kerstin Weidner
- From the Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (King, Bernardoni, Geisler, Ritschel, Doose, Pauligk, Pásztor, Ehrlich); the Translational Developmental Neuroscience Section, Eating Disorder Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Ritschel, Roessner, Ehrlich); the Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Weidner); and the Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany (Smolka)
| | - Veit Roessner
- From the Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (King, Bernardoni, Geisler, Ritschel, Doose, Pauligk, Pásztor, Ehrlich); the Translational Developmental Neuroscience Section, Eating Disorder Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Ritschel, Roessner, Ehrlich); the Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Weidner); and the Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany (Smolka)
| | - Michael N. Smolka
- From the Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (King, Bernardoni, Geisler, Ritschel, Doose, Pauligk, Pásztor, Ehrlich); the Translational Developmental Neuroscience Section, Eating Disorder Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Ritschel, Roessner, Ehrlich); the Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Weidner); and the Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany (Smolka)
| | - Stefan Ehrlich
- From the Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (King, Bernardoni, Geisler, Ritschel, Doose, Pauligk, Pásztor, Ehrlich); the Translational Developmental Neuroscience Section, Eating Disorder Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Ritschel, Roessner, Ehrlich); the Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Weidner); and the Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany (Smolka)
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7
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Verharen JPH, Danner UN, Schröder S, Aarts E, van Elburg AA, Adan RAH. Insensitivity to Losses: A Core Feature in Patients With Anorexia Nervosa? BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2019; 4:995-1003. [PMID: 31262707 DOI: 10.1016/j.bpsc.2019.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 05/02/2019] [Accepted: 05/02/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Patients with anorexia nervosa (AN) demonstrate aberrations in choice behavior, including impairments in laboratory measures of decision making. Although a wealth of studies suggest that these aberrations arise from alterations in value processing, it remains unclear by which core component of value processing this is mediated. METHODS We fit trial-by-trial data of patients with AN (n = 60 first cohort, n = 216 second cohort) and healthy control participants (n = 55) performing the Iowa Gambling Task to a computational model based on prospect utility theory. We determined, per participant, the best-fit model parameters and compared these between the groups. RESULTS Analyses revealed a decreased estimate of model parameter λ in patients with AN, indicative of an attenuation of loss-aversive behavior in the Iowa Gambling Task. In comparison, measures of reward sensitivity, value-based learning, and exploration versus exploitation were unaltered in patients with AN. A measurement in a second independent cohort replicated the finding that loss aversion, typically observed in healthy individuals, is reduced in patients with AN. CONCLUSIONS We show that patients with AN, in contrast to healthy control participants, demonstrate reduced loss-aversive behavior. This finding provides important fundamental insights into the decision-making capacity of patients with AN, suggesting alterations in the mechanisms involved in value processing related to negative feedback.
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Affiliation(s)
- Jeroen P H Verharen
- Brain Center Rudolf Magnus, Department of Translational Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Unna N Danner
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands; Altrecht Eating Disorders Rintveld, Zeist, The Netherlands
| | | | - Emmeke Aarts
- Department of Methodology and Statistics, Utrecht University, Utrecht, The Netherlands
| | - Annemarie A van Elburg
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands; Altrecht Eating Disorders Rintveld, Zeist, The Netherlands
| | - Roger A H Adan
- Brain Center Rudolf Magnus, Department of Translational Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands; Altrecht Eating Disorders Rintveld, Zeist, The Netherlands; Institute of Physiology and Neuroscience, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
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8
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Fuglset TS. Set-shifting, central coherence and decision-making in individuals recovered from anorexia nervosa: a systematic review. J Eat Disord 2019; 7:22. [PMID: 31249687 PMCID: PMC6585061 DOI: 10.1186/s40337-019-0251-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 05/22/2019] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The aim of this study was to review the existing literature and evaluate whether deficits in set-shifting, central coherence and decision-making persist in individuals recovered from anorexia nervosa (AN-REC). METHOD A systematic review approach was used. Literature was identified via searches in PubMed, PsychInfo and Embase database. The main search resulted in 158 articles. After exclusion of 135 articles, 23 articles were included in the review. RESULTS The majority of studies on set-shifting showed that set-shifting difficulties persist after recovery. Central coherence might also be trait related, however findings are inconsistent. Few studies have investigated decision-making in AN-REC, however those studies that do exist suggest that decision-making is not impaired in AN-REC. CONCLUSIONS Novel treatment strategies based on neuroscience research are emerging, focusing on targeting the underlying mechanisms of the illness, including neuropsychological functioning. Whether these functions are trait or state related could have implications for how they are targeted in treatment.
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Affiliation(s)
- Tone Seim Fuglset
- Division of Mental Health and Addiction, Møre and Romsdal Hospital Trust, Parkvegen 84, 6412 Molde, Norway
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9
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Giannunzio V, Degortes D, Tenconi E, Collantoni E, Solmi M, Santonastaso P, Favaro A. Decision-making impairment in anorexia nervosa: New insights into the role of age and decision-making style. EUROPEAN EATING DISORDERS REVIEW 2018; 26:302-314. [PMID: 29665149 DOI: 10.1002/erv.2595] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 02/04/2018] [Accepted: 03/08/2018] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Patients with anorexia nervosa (AN) often report difficulties in decision making, which may interfere with treatment. The aim of this study was to investigate decision making in a large sample of adolescent and adult patients with AN, by using the Iowa gambling task. METHOD Participants were 611 female individuals (310 patients and 301 controls) who underwent neuropsychological and clinical assessment. RESULTS Significantly poorer decision-making performance was observed in adult patients, whereas no difference emerged between affected and nonaffected adolescents. Both adolescent and adult patients were characterized by trends for higher levels of attention to losses in comparison with healthy controls. Although healthy adult women exhibited better decision-making performance than healthy adolescents, in AN, there was no improvement of decision making with age. A cluster analysis identified 2 different styles of decision making in both patients and controls: a conservative style and an impulsive style. DISCUSSION Our study provides evidence of dysfunctional decision making in adult patients with AN and reveals an association between poor decision making and excessive punishment sensitivity in AN. The clinical and scientific implications of these findings merit further exploration.
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Affiliation(s)
- Valeria Giannunzio
- Department of Neurosciences, Padua Neuroscience Center, University of Padova, Italy
| | - Daniela Degortes
- Department of Neurosciences, Padua Neuroscience Center, University of Padova, Italy
| | - Elena Tenconi
- Department of Neurosciences, Padua Neuroscience Center, University of Padova, Italy
| | - Enrico Collantoni
- Department of Neurosciences, Padua Neuroscience Center, University of Padova, Italy
| | - Marco Solmi
- Department of Neurosciences, Padua Neuroscience Center, University of Padova, Italy
| | - Paolo Santonastaso
- Department of Neurosciences, Padua Neuroscience Center, University of Padova, Italy
| | - Angela Favaro
- Department of Neurosciences, Padua Neuroscience Center, University of Padova, Italy
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10
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An ecological approach to the behavioral assessment of executive functions in anorexia nervosa. Psychiatry Res 2018; 259:283-288. [PMID: 29091830 DOI: 10.1016/j.psychres.2017.10.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 09/23/2017] [Accepted: 10/21/2017] [Indexed: 11/21/2022]
Abstract
The use of ecological tests to assess executive functions (EFs) in patients with anorexia nervosa (AN) has not examined extensively. The objective of this study was to analyze and compare the performance of patients with AN and healthy controls (HCs) on standard versus ecologically valid tests on EFs. Sixty-two females aged between 16 and 42 who were diagnosed with AN and 70 matched HCs completed 2 neuropsychological test batteries: standard tests (WCST, TMT, Stroop, ToL, fluency test) and the Behavioral Assessment of Dysexecutive Syndrome (BADS). On the standard tests, patients with AN produced more perseverative response and were slower than HCs in the TMT; in contrast, they scored as well as HCs on tasks that assessed categorization, interference in color naming, planning and semantic fluency. Conversely, there were differences in the ecological tests with patients with AN systematically slower in the resolution of complex tasks. Results demonstrated the power of ecological tests in capturing selective impairments in multifaceted and unstructured tests. Patients with AN experienced systematic deceleration in the resolution of ecological tasks. Also, the increased time needed to solve the tasks, was not reflected in overall improvement in performance. This evidence is further discussed with respect to central coherence.
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11
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Lang K, Roberts M, Harrison A, Lopez C, Goddard E, Khondoker M, Treasure J, Tchanturia K. Central Coherence in Eating Disorders: A Synthesis of Studies Using the Rey Osterrieth Complex Figure Test. PLoS One 2016; 11:e0165467. [PMID: 27806073 PMCID: PMC5091879 DOI: 10.1371/journal.pone.0165467] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 10/12/2016] [Indexed: 11/19/2022] Open
Abstract
Background Large variability in tests and differences in scoring systems used to study central coherence in eating disorders may lead to different interpretations, inconsistent findings and between study discrepancies. This study aimed to address inconsistencies by collating data from several studies from the same research group that used the Rey Osterrieth Complex Figure Test (Rey Figure) in order to produce norms to provide benchmark data for future studies. Method Data was collated from 984 participants in total. Anorexia Nervosa, Bulimia Nervosa, recovered Anorexia Nervosa, unaffected family members and healthy controls were compared using the Rey Figure. Results Poor global processing was observed across all current eating disorder sub-groups and in unaffected relatives. There was no difference in performance between recovered AN and HC groups. Conclusions This is the largest dataset reported in the literature and supports previous studies implicating poor global processing across eating disorders using the Rey Figure. It provides robust normative data useful for future studies.
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Affiliation(s)
- Katie Lang
- King’s College London (KCL), Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
| | - Marion Roberts
- King’s College London (KCL), Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
| | - Amy Harrison
- Regents School of Psychotherapy & Psychology, Faculty of Humanities, Arts & Social Sciences, Regent’s University, London, United Kingdom
| | - Carolina Lopez
- King’s College London (KCL), Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
- Department of Pediatrics and Child Surgery East, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Elizabeth Goddard
- King’s College London (KCL), Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
| | - Mizan Khondoker
- King’s College London (KCL), Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
| | - Janet Treasure
- King’s College London (KCL), Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
| | - Kate Tchanturia
- King’s College London (KCL), Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
- Illia State University, Department of Psychology, Tbilisi, Georgia
- * E-mail:
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12
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Steward T, Mestre-Bach G, Agüera Z, Granero R, Martín-Romera V, Sánchez I, Riesco N, Tolosa-Sola I, Fernández-Formoso JA, Fernández-García JC, Tinahones FJ, Casanueva FF, Baños RM, Botella C, Crujeiras AB, de la Torre R, Fernández-Real JM, Frühbeck G, Ortega FJ, Rodríguez A, Jiménez-Murcia S, Menchón JM, Fernández-Aranda F. Enduring Changes in Decision Making in Patients with Full Remission from Anorexia Nervosa. EUROPEAN EATING DISORDERS REVIEW 2016; 24:523-527. [DOI: 10.1002/erv.2472] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 07/25/2016] [Accepted: 07/29/2016] [Indexed: 12/15/2022]
Affiliation(s)
- Trevor Steward
- Department of Psychiatry; Bellvitge University Hospital-IDIBELL; Barcelona Spain
- CIBER Fisiopatologia Obesidad y Nutrición (CIBEROBN), Instituto Salud Carlos III; Barcelona Spain
| | - Gemma Mestre-Bach
- Department of Psychiatry; Bellvitge University Hospital-IDIBELL; Barcelona Spain
- CIBER Fisiopatologia Obesidad y Nutrición (CIBEROBN), Instituto Salud Carlos III; Barcelona Spain
| | - Zaida Agüera
- Department of Psychiatry; Bellvitge University Hospital-IDIBELL; Barcelona Spain
- CIBER Fisiopatologia Obesidad y Nutrición (CIBEROBN), Instituto Salud Carlos III; Barcelona Spain
| | - Roser Granero
- CIBER Fisiopatologia Obesidad y Nutrición (CIBEROBN), Instituto Salud Carlos III; Barcelona Spain
- Departament de Psicobiologia i Metodologia de les Ciències de la Salut; Universitat Autònoma de Barcelona; Barcelona Spain
| | | | - Isabel Sánchez
- Department of Psychiatry; Bellvitge University Hospital-IDIBELL; Barcelona Spain
- CIBER Fisiopatologia Obesidad y Nutrición (CIBEROBN), Instituto Salud Carlos III; Barcelona Spain
| | - Nadine Riesco
- Department of Psychiatry; Bellvitge University Hospital-IDIBELL; Barcelona Spain
- CIBER Fisiopatologia Obesidad y Nutrición (CIBEROBN), Instituto Salud Carlos III; Barcelona Spain
| | - Iris Tolosa-Sola
- Department of Psychiatry; Bellvitge University Hospital-IDIBELL; Barcelona Spain
| | - Jose A Fernández-Formoso
- CIBER Fisiopatologia Obesidad y Nutrición (CIBEROBN), Instituto Salud Carlos III; Barcelona Spain
| | - Jose C. Fernández-García
- CIBER Fisiopatologia Obesidad y Nutrición (CIBEROBN), Instituto Salud Carlos III; Barcelona Spain
- Department of Diabetes, Endocrinology and Nutrition; Hospital Clínico Universitario Virgen de Victoria; Málaga Spain
| | - Francisco J Tinahones
- CIBER Fisiopatologia Obesidad y Nutrición (CIBEROBN), Instituto Salud Carlos III; Barcelona Spain
- Department of Diabetes, Endocrinology and Nutrition; Hospital Clínico Universitario Virgen de Victoria; Málaga Spain
| | - Felipe F Casanueva
- CIBER Fisiopatologia Obesidad y Nutrición (CIBEROBN), Instituto Salud Carlos III; Barcelona Spain
- Department of Medicine, Endocrinology Division; Santiago de Compostela University, Complejo Hospitalario Universitario; Santiago de Compostela Spain
| | - Rosa M. Baños
- CIBER Fisiopatologia Obesidad y Nutrición (CIBEROBN), Instituto Salud Carlos III; Barcelona Spain
- Department of Psychological; Personality, Evaluation and Treatment of the University of Valencia; Valencia Spain
| | - Cristina Botella
- CIBER Fisiopatologia Obesidad y Nutrición (CIBEROBN), Instituto Salud Carlos III; Barcelona Spain
- Department of Basic Psychology; Clinic and Psychobiology of the University Jaume I; Castelló Spain
| | - Ana B Crujeiras
- CIBER Fisiopatologia Obesidad y Nutrición (CIBEROBN), Instituto Salud Carlos III; Barcelona Spain
- Department of Medicine, Endocrinology Division; Santiago de Compostela University, Complejo Hospitalario Universitario; Santiago de Compostela Spain
| | - Rafael de la Torre
- CIBER Fisiopatologia Obesidad y Nutrición (CIBEROBN), Instituto Salud Carlos III; Barcelona Spain
- Integrated Pharmacology and Systems Neurosciences Research Group, Neuroscience Research Program Organization IMIM (Hospital del Mar Medical Research Institute); Barcelona Spain
- Department of Health and Experimental Sciences; Universitat Pompeu Fabra; Barcelona Spain
| | - Jose M Fernández-Real
- CIBER Fisiopatologia Obesidad y Nutrición (CIBEROBN), Instituto Salud Carlos III; Barcelona Spain
- Department of Diabetes, Endocrinology and Nutrition; Institu d'Investigació, Biomèdica de Girona (IdIBGi), Hospital Dr Josep Trueta; Girona Spain
| | - Gema Frühbeck
- CIBER Fisiopatologia Obesidad y Nutrición (CIBEROBN), Instituto Salud Carlos III; Barcelona Spain
- Metabolic Research Laboratory; Clínica Universidad de Navarra, University of Navarra-IdiSNA; Pamplona Spain
| | - Francisco J. Ortega
- CIBER Fisiopatologia Obesidad y Nutrición (CIBEROBN), Instituto Salud Carlos III; Barcelona Spain
- Department of Diabetes, Endocrinology and Nutrition; Institu d'Investigació, Biomèdica de Girona (IdIBGi), Hospital Dr Josep Trueta; Girona Spain
| | - Amaia Rodríguez
- CIBER Fisiopatologia Obesidad y Nutrición (CIBEROBN), Instituto Salud Carlos III; Barcelona Spain
- Metabolic Research Laboratory; Clínica Universidad de Navarra, University of Navarra-IdiSNA; Pamplona Spain
| | - Susana Jiménez-Murcia
- Department of Psychiatry; Bellvitge University Hospital-IDIBELL; Barcelona Spain
- CIBER Fisiopatologia Obesidad y Nutrición (CIBEROBN), Instituto Salud Carlos III; Barcelona Spain
- Department of Clinical Sciences, School of Medicine; University of Barcelona; Spain
| | - Jose M. Menchón
- Department of Psychiatry; Bellvitge University Hospital-IDIBELL; Barcelona Spain
- Department of Clinical Sciences, School of Medicine; University of Barcelona; Spain
- CIBER Salud Mental (CIBERSAM), Instituto Salud Carlos III; Barcelona Spain
| | - Fernando Fernández-Aranda
- Department of Psychiatry; Bellvitge University Hospital-IDIBELL; Barcelona Spain
- CIBER Fisiopatologia Obesidad y Nutrición (CIBEROBN), Instituto Salud Carlos III; Barcelona Spain
- Department of Clinical Sciences, School of Medicine; University of Barcelona; Spain
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Danner UN, Sternheim L, Bijsterbosch JM, Dingemans AE, Evers C, van Elburg AA. Influence of negative affect on decision making in women with restrictive and binge-purge type anorexia nervosa. Psychiatry Res 2016; 239:39-46. [PMID: 27137960 DOI: 10.1016/j.psychres.2016.02.054] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 02/16/2016] [Accepted: 02/22/2016] [Indexed: 01/26/2023]
Abstract
The present study aims to examine the influence of negative affect on decision making in women with anorexia nervosa (AN) compared to healthy control women and, secondly, to assess differences between the restrictive (ANR) and binge-purge (ANBP) subtypes. One hundred four women (32 with ANR, 32 with ANBP, and 40 healthy controls) participated. All women were asked to watch either a negative or a control film fragment, both followed by the Bechara Gambling Task (BGT). Before and after the fragments negative affect was measured. Additionally, relevant characteristics (e.g., overall depressive symptoms) were assessed. Differences in negative affect did not influence decision making performance. Independent of affective state, decision making was found to be impaired in women with ANBP (no learning effect on the BGT), but not in women with ANR. These findings highlight the importance of considering different AN subtypes when examining decision making processes. However, the role of negative affect on decision making remains uncertain. Since other affect related factors such as affect dysregulation may also play a role, future studies on decision making in AN should take the role of affect into account.
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Affiliation(s)
- Unna N Danner
- Altrecht Eating Disorders Rintveld, Altrecht Mental Health Institute, The Netherlands; Utrecht Research Group Eating disorders, The Netherlands
| | - Lot Sternheim
- Altrecht Eating Disorders Rintveld, Altrecht Mental Health Institute, The Netherlands; Utrecht Research Group Eating disorders, The Netherlands; Department of Clinical and Health Psychology, Utrecht University, The Netherlands
| | - Jojanneke M Bijsterbosch
- Altrecht Eating Disorders Rintveld, Altrecht Mental Health Institute, The Netherlands; Utrecht Research Group Eating disorders, The Netherlands
| | | | - Catharine Evers
- Department of Clinical and Health Psychology, Utrecht University, The Netherlands
| | - Annemarie A van Elburg
- Altrecht Eating Disorders Rintveld, Altrecht Mental Health Institute, The Netherlands; Utrecht Research Group Eating disorders, The Netherlands; Department of Clinical and Health Psychology, Utrecht University, The Netherlands
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14
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Ely AV, Wierenga CE, Kaye WH. Anxiety Impacts Cognitive Inhibition in Remitted Anorexia Nervosa. EUROPEAN EATING DISORDERS REVIEW 2016; 24:347-51. [DOI: 10.1002/erv.2451] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 02/26/2016] [Accepted: 03/23/2016] [Indexed: 12/31/2022]
Affiliation(s)
- Alice V. Ely
- Department of Psychiatry; University of California San Diego; San Diego CA USA
| | | | - Walter H. Kaye
- Department of Psychiatry; University of California San Diego; San Diego CA USA
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15
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Tenconi E, Degortes D, Clementi M, Collantoni E, Pinato C, Forzan M, Cassina M, Santonastaso P, Favaro A. Clinical and genetic correlates of decision making in anorexia nervosa. J Clin Exp Neuropsychol 2015; 38:327-37. [DOI: 10.1080/13803395.2015.1112878] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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16
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Guillaume S, Gorwood P, Jollant F, Van den Eynde F, Courtet P, Richard-Devantoy S. Impaired decision-making in symptomatic anorexia and bulimia nervosa patients: a meta-analysis. Psychol Med 2015; 45:3377-3391. [PMID: 26497047 DOI: 10.1017/s003329171500152x] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Impaired decision-making is a potential neurocognitive phenotype of eating disorders. It is therefore important to disentangle the decision-making deficits associated with the eating disorder subtypes and determine whether this putative impairment is a state or trait marker of the disease or more related to starvation. We systematically reviewed the literature on decision-making in eating disorders and conducted a meta-analysis to explore its role in anorexia nervosa (AN), bulimia nervosa (BN) and binge-eating disorder (BED). METHOD A search of the Medline and EMBASE databases and article references was performed. A total of 23 studies (2044 participants) met the selection criteria. When the Iowa gambling task (IGT) was used in at least three of the studies, a meta-analysis was run. RESULTS IGT performance was significantly worse in patients with an eating disorder diagnosis (AN, BN or BED) compared with healthy controls, indicating that eating disorders have a negative effect on decision-making. Hedges' g effect sizes were moderate to large (-0.72 in AN, -0.62 in BN, and -1.26 in BED). Recovered AN patients had IGT scores similar to those of healthy controls. Restrictive AN patients had significantly lower IGT net scores than purging AN patients, and both AN subtypes had worse performances than healthy controls. Age and body mass index did not explain results. CONCLUSIONS Decision-making was significantly altered in patients with eating disorders. Poor decision-making was more pronounced during the acute phase than in the recovered state of AN. Nutritional status during the acute phase of the disease did not seem to influence decision-making skills.
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Affiliation(s)
- S Guillaume
- Université Montpellier I & CHU Montpellier & Inserm,U1061,Montpellier,France
| | - P Gorwood
- CMME (Groupe Hospitalier Sainte-Anne),Université Paris Descartes,Paris,France
| | - F Jollant
- Department of Psychiatry & Douglas Mental Health University Institute,McGill Group for Suicide Studies,McGill University,Montréal (Québec),Canada
| | - F Van den Eynde
- Department of Psychiatry & Douglas Mental Health University Institute,McGill University,Montréal (Québec),Canada
| | - P Courtet
- Université Montpellier I & CHU Montpellier & Inserm,U1061,Montpellier,France
| | - S Richard-Devantoy
- Department of Psychiatry & Douglas Mental Health University Institute,McGill Group for Suicide Studies,McGill University,Montréal (Québec),Canada
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17
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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.
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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
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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.
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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
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Heled E, Hoofien D, Bachar E, Cooper-Kazaz R, Gur E, Ebstein RP. Employing executive functions of perceptual and memory abilities in underweight and weight-restored anorexia nervosa patients. Eat Weight Disord 2014; 19:479-87. [PMID: 24859670 DOI: 10.1007/s40519-014-0119-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Accepted: 03/21/2014] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Executive functions (EF) have been widely investigated in anorexia nervosa (AN) revealing difficulties in various aspects. We aimed at testing the effects of EF on stimuli perception and its representations in memory. METHODS Thirty AN underweight patients, 30 weight-restored AN patients, and 44 control participants, were recruited. Various EF were assessed using the Rey-Osterrieth Complex Figure Test, analyzed with the Boston Qualitative Scoring System. RESULTS No differences were found in visuo-constructional measures in either AN groups compared to controls on the copy and memory stages. However, both groups performed significantly worse than controls on most EF variables in the copy stage, while in the immediate and delayed memory stages the difference was less substantial. CONCLUSIONS Difficulties in EF among AN patients, current and weight restored, are more pronounced in the perceptual module and less so when employed through memory retrieval. The pattern, which is apparent after weight gain, suggests that there is no ameliorative effect on these difficulties.
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Affiliation(s)
- Eyal Heled
- Day Treatment Rehabilitation Unit, Sheba Medical Center, Ramat Gan, Israel,
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20
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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.
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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.
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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
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22
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Adamowicz JL, Caikauskaite I, Friedberg F. Defining recovery in chronic fatigue syndrome: a critical review. Qual Life Res 2014; 23:2407-16. [PMID: 24791749 DOI: 10.1007/s11136-014-0705-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2014] [Indexed: 11/27/2022]
Abstract
PURPOSE In chronic fatigue syndrome (CFS), the lack of consensus on how recovery should be defined or interpreted has generated controversy and confusion. The purpose of this paper was to systematically review, compare, and evaluate the definitions of recovery reported in the CFS literature and to make recommendations about the scope of recovery assessments. METHODS A search was done using the MEDLINE, PubMed, PsycINFO, CINAHL, and Cochrane databases for peer review papers that contained the search terms "chronic fatigue syndrome" and "recovery," "reversal," "remission," and/or "treatment response." RESULTS From the 22 extracted studies, recovery was operationally defined by reference with one or more of these domains: (1) pre-morbid functioning; (2) both fatigue and function; (3) fatigue (or related symptoms) alone; (4) function alone; and/or (5) brief global assessment. Almost all of the studies measuring recovery in CFS did so differently. The brief global assessment was the most common outcome measure used to define recovery. Estimates of recovery ranged from 0 to 66 % in intervention studies and 2.6 to 62 % in naturalistic studies. CONCLUSIONS Given that the term "recovery" was often based on limited assessments and less than full restoration of health, other more precise and accurate labels (e.g., clinically significant improvement) may be more appropriate and informative. In keeping with common understandings of the term recovery, we recommend a consistent definition that captures a broad-based return to health with assessments of both fatigue and function as well as the patient's perceptions of his/her recovery status.
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Affiliation(s)
- Jenna L Adamowicz
- Department of Psychiatry and Behavioral Sciences, Stony Brook University, Putnam Hall/South Campus, Stony Brook, NY, 11794-8790, USA,
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23
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Psychopathological and personality traits underlie decision making in recent onset medication naïve anorexia nervosa: a pilot study. Psychiatry Res 2014; 216:89-96. [PMID: 24512735 DOI: 10.1016/j.psychres.2013.12.052] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 12/21/2013] [Accepted: 12/29/2013] [Indexed: 01/08/2023]
Abstract
The Iowa Gambling Task (IGT) analyzes the ability of participants to sacrifice immediate rewards in view of a long term gain. Anorexia Nervosa (AN) in addition to weight loss and body image disturbances is also characterized by the tendency to make decisions that may result in long-term negative outcomes. Studies that analyzed IGT performance in patients with AN were not consistent with each other. Fifteen adolescents with AN and 15 matched controls carried out IGT after being clinically and neuropsychologically evaluated. An interesting generalized estimating equation approach showed that four independent clinical variables, and not the group, explained IGT performances, such as blocks repetition, anxiety, psychogenic eating disorders and self transcendence. The impairment of decision making is not related to the diagnosis of AN, but it is driven by high levels of anxiety and self transcendence. Instead, some psychogenic eating disorders traits, related to illness severity, positively affected IGT performance in the whole sample. IGT impairment in AN found by prior studies could be related to these clinical features which are not always taken into account.
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24
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Implicit affective associations predict snack choice for those with low, but not high levels of eating disorder symptomatology. Appetite 2014; 77:122-30. [PMID: 24630936 DOI: 10.1016/j.appet.2014.03.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 01/30/2014] [Accepted: 03/03/2014] [Indexed: 11/22/2022]
Abstract
The central purpose of the current study was to examine whether eating disorder symptomatology moderates the extent to which implicitly and explicitly measured affective associations with fruits, or the feelings individuals associate with them, predict food choice. Participants (N = 107) completed both implicit and explicit measures of affective associations with fruits, a self-report of eating disorder symptomatology. In a subsequent snack selection task, they selected either a granola bar or fruit as a measure of their food choice behavior. Logistic regression analyses revealed that eating disorder symptomatology moderated the relation of implicit affective associations on behavior, OR = 0.27, p = .024, 95% CI (0.085, 0.84). A test of the simple effects indicated that implicit affective associations predicted snack choice at or below mean symptomatology levels [OR = 2.073, p = .02, 95% CI (1.12, 3.84)], but not at high levels [OR = 0.56, p = .28, 95% CI (0.18, 1.74)]. The effects of explicit measures on eating behavior were not moderated by eating disorder symptomatology (ps > .05). These findings advance our understanding of both the relation of implicit affective associations on behavior, as well as the ways in which eating disorder symptomatology may impact the decision-making process, thereby perpetuating disorder-related eating behavior. As such, they have implications for both health decision-making theory, as well as for the study and treatment of eating disorders.
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25
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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.
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Affiliation(s)
- Eyal Heled
- Day Treatment Rehabilitation Unit, Sheba Medical Center, Ramat Gan, Israel; Department of Psychology, Hebrew University, Jerusalem, Israel
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26
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Kappel V, van Noort B, Ritschel F, Seidel M, Ehrlich S. [Anorexia nervosa - from a neuroscience perspective]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2013; 42:39-48; quiz 49-50. [PMID: 24365962 DOI: 10.1024/1422-4917/a000268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Anorexia nervosa is a frequent disorder especially among adolescent girls and young women, with high morbidity, mortality, and relapse rates. To date, no single therapeutic approach has proved to be superior to others (Herpertz et al., 2011). It remains unclear how its etiology and pathology are encoded within cognitive, neural, and endocrinological processes that modulate important mechanisms in appetitive processing and weight regulation. Yet, several trait characteristics have been identified in AN which might reflect predisposing factors. Further, altered levels of neuropeptides and hormones that regulate appetite and feeding behavior have been found during both the acute and the recovered state, pointing to dysfunctional mechanisms in AN that persist even after malnutrition has ceased. Researchers are also hoping that brain imaging techniques will allow for a more detailed investigation of the neural basis of reward and punishment sensitivity that appears to be altered in AN. The integration and extension of recent findings in these areas will hopefully provide a more comprehensive understanding of the disorder and hence enable the development of more effective treatments.
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Affiliation(s)
- Viola Kappel
- Charité-Universitätsmedizin Berlin, Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters
| | - Betteke van Noort
- Charité-Universitätsmedizin Berlin, Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters
| | - Franziska Ritschel
- Technische Universität Dresden, Universitätsklinikum Carl Gustav Carus Dresden, Klinik und Poliklinik für Kinder- und Jugendpsychiatrie und -psychotherapie
| | - Maria Seidel
- Technische Universität Dresden, Universitätsklinikum Carl Gustav Carus Dresden, Klinik und Poliklinik für Kinder- und Jugendpsychiatrie und -psychotherapie
| | - Stefan Ehrlich
- Technische Universität Dresden, Universitätsklinikum Carl Gustav Carus Dresden, Klinik und Poliklinik für Kinder- und Jugendpsychiatrie und -psychotherapie Massachusetts General Hospital, Harvard Medical School, Athinoula A. Martinos Center for Biomedical Imaging, Psychiatric Neuroimaging Research Program
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27
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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.
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Affiliation(s)
- Elisa Galimberti
- Experimental Neurology Institute, INSPE, Vita-Salute San Raffaele University, Milan, Italy.
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28
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Garrido I, Subirá S. Decision-making and impulsivity in eating disorder patients. Psychiatry Res 2013; 207:107-12. [PMID: 23122556 DOI: 10.1016/j.psychres.2012.10.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Revised: 10/03/2012] [Accepted: 10/07/2012] [Indexed: 12/12/2022]
Abstract
Impairment in decision-making can be related to some pathological behaviors in eating disorders. This ability was assessed in 71 eating disorder patients (27 restricting type patients and 44 binge/purging type patients) and compared with 38 healthy controls using the Iowa Gambling Task. This task simulates real-life decision-making by assessing the ability to sacrifice immediate rewards in favor of long term gains. Furthermore, some studies have demonstrated a relationship between impulsivity and decision-making, so in our study the Barratt Impulsiveness Scale was also used. Eating disorder patients, both the restricting and the binge/purging groups, performed poorly in the Iowa Gambling Task compared to controls, confirming a deficit in decision-making in these patients. The restricting group showed poorer IGT performance than the binge/purging group. Interestingly, impulsivity was negatively correlated with decision-making, but only in the binge/purging group. In conclusion, our results confirm a specific deficit in eating disorder patients which may be related to their pathological eating behavior, and suggest that this impairment might be explained by different mechanisms in restricting and binge/purging disorders.
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Affiliation(s)
- Ignasi Garrido
- Eating Disorders Unit, Department of Psychiatry, Hospital Universitari Mútua de Terrassa, Plaça Dr. Robert, 5, 08221 Terrassa, Barcelona, Spain.
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29
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Lindner SE, Fichter MM, Quadflieg N. Central coherence in full recovery of anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2012; 21:115-20. [PMID: 23169674 DOI: 10.1002/erv.2213] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE This study examined central coherence as a possible endophenotype in a large sample of women recovered from anorexia nervosa (rec AN). Recovery was defined by considering physiological, behavioural and psychological variables. METHOD A total of 100 rec AN women and 100 healthy women completed the Rey Complex Figure Test, a measure for visual-spatial central coherence. The participants were matched 1:1 for age and educational level. RESULTS Compared with the healthy control group, the rec AN group showed better accuracy in the copy condition. There was a trend for a local strategy in the rec AN group compared with a global strategy in the healthy control group. CONCLUSIONS This sample of rec AN women showed no inefficiencies in global processing but a superior local processing after full recovery from AN.
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Affiliation(s)
- Susanne E Lindner
- Department of Psychiatry, University of Munich (LMU), Munich, Germany
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