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Phonological working memory is adversely affected in adults with anorexia nervosa: a systematic literature review. Eat Weight Disord 2022; 27:1931-1952. [PMID: 35133643 PMCID: PMC9287223 DOI: 10.1007/s40519-022-01370-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 01/18/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Cognitive restraint has potentiating and deleterious effects on working memory (WM) in anorexia nervosa (AN). Conflicting evidence may be due to heterogeneity of tasks examining different WM components (e.g., verbal/auditory versus visuospatial), and differences in adolescent versus adult AN. Additionally, differential cognitive profiles of restricting versus binge/purging subtypes, comorbid psychiatric disorders and psychotropic medication use may confound findings. METHODS To address these conflicts, 25 studies, published between 2016 and 2021, investigating WM in children, adolescents and adults with AN were systematically reviewed using PRISMA guidelines. RESULTS In 71% of WM tasks, no difference in performance between AN patients and age-matched controls was reported, while 29% of WM tasks showed worse performance. Adults with AN displayed deficits in 44% of the verbal/auditory tasks, while performance remained unaffected in 86% of visuospatial tasks. CONCLUSION Examining age groups and WM subsystems separately revealed novel findings of differentially affected WM components in AN. Comorbidities and psychotropic medications were common among AN participants and should be regarded as critical confounding factors for WM measures. Future studies examining different components of WM, acknowledging these confounding factors, may reveal specific deficits in AN to aid treatment improvement strategies. LEVEL OF EVIDENCE I, systematic review.
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2
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Thomas KS, Birch RE, Jones CRG, Vanderwert RE. Neural Correlates of Executive Functioning in Anorexia Nervosa and Obsessive-Compulsive Disorder. Front Hum Neurosci 2022; 16:841633. [PMID: 35693540 PMCID: PMC9179647 DOI: 10.3389/fnhum.2022.841633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
Anorexia nervosa (AN) and obsessive-compulsive disorder (OCD) are commonly reported to co-occur and present with overlapping symptomatology. Executive functioning difficulties have been implicated in both mental health conditions. However, studies directly comparing these functions in AN and OCD are extremely limited. This review provides a synthesis of behavioral and neuroimaging research examining executive functioning in AN and OCD to bridge this gap in knowledge. We outline the similarities and differences in behavioral and neuroimaging findings between AN and OCD, focusing on set shifting, working memory, response inhibition, and response monitoring. This review aims to facilitate understanding of transdiagnostic correlates of executive functioning and highlights important considerations for future research. We also discuss the importance of examining both behavioral and neural markers when studying transdiagnostic correlates of executive functions.
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Affiliation(s)
- Kai S. Thomas
- School of Psychology, Cardiff University, Cardiff, United Kingdom
- Cardiff University Centre for Human Developmental Science, School of Psychology, Cardiff University, Cardiff, United Kingdom
| | | | - Catherine R. G. Jones
- School of Psychology, Cardiff University, Cardiff, United Kingdom
- Cardiff University Centre for Human Developmental Science, School of Psychology, Cardiff University, Cardiff, United Kingdom
| | - Ross E. Vanderwert
- School of Psychology, Cardiff University, Cardiff, United Kingdom
- Cardiff University Centre for Human Developmental Science, School of Psychology, Cardiff University, Cardiff, United Kingdom
- Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University, Cardiff, United Kingdom
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3
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Ghiotto C, Silva C, Charvin I, Atzori P, Givaudan M, Da Fonseca D, Bat-Pitault F. Comparing executive functions profiles in anorexia nervosa and autism spectrum disorder in adolescence. EUROPEAN EATING DISORDERS REVIEW 2022; 30:474-485. [PMID: 35411575 PMCID: PMC9540333 DOI: 10.1002/erv.2904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 03/22/2022] [Accepted: 03/31/2022] [Indexed: 11/25/2022]
Abstract
Objective Executive functions (EFs) inefficiencies in anorexia nervosa (AN), especially in set‐shifting and central coherence, suggest a link between AN and autism spectrum disorders (ASDs). This study aimed at comparing EF profiles in AN and ASD, and investigating clinical variables associated with the identified EF difficulties. Method One hundred and sixty‐two adolescents with AN or ASD completed self‐report questionnaires assessing depression, anxiety and autism symptoms. Parents completed the behaviour rating of executive functions parent‐form (BRIEF‐P). Besides comparing EFs in AN and ASD, we also analysed clinical variables scoring below and above the mean age score across the all sample. We additionally examined the relationship between clinical variables and the BRIEF‐P indexes in AN. Results Participants with ASD had greater EF difficulties than participants with AN on all BRIEF‐P scales. In the whole sample, higher autistic features were related to poorer EF. In AN, lower body mass index and particularly higher autism‐spectrum quotient (BRI: Beta = 0.55; p < 0.001 and GEC: Beta = 0.50; p < 0.001) were most strongly associated with poorer EF. Conclusion Although participants with ASD showed greater difficulties, autistic traits were related to alter EFs in AN. Exploring further this dimension can undeniably allow better adaptive cognitive remediation programs. Participants with autism spectrum disorder (ASD) had greater executive function (EF) difficulties than participants with anorexia nervosa (AN) on all behaviour rating of executive functions parent‐form scales In AN, lower body mass index and particularly higher autism‐spectrum quotient were most strongly associated with poorer EF Our study highlights the importance of autistic features in the alteration of EF in AN
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Affiliation(s)
- Clément Ghiotto
- Child and Adolescent Psychiatry Unit, Salvator University Hospital, Public Assistance-Marseille Hospitals, Aix-Marseille University, Marseille, France
| | - Catarina Silva
- Child and Adolescent Psychiatry Unit, Salvator University Hospital, Public Assistance-Marseille Hospitals, Aix-Marseille University, Marseille, France.,Institute of Neuroscience Timone, CNRS, Aix-Marseille University, Marseille, France
| | - Isabelle Charvin
- Child and Adolescent Psychiatry Unit, Salvator University Hospital, Public Assistance-Marseille Hospitals, Aix-Marseille University, Marseille, France
| | - Paola Atzori
- Child and Adolescent Psychiatry Unit, Salvator University Hospital, Public Assistance-Marseille Hospitals, Aix-Marseille University, Marseille, France
| | - Marion Givaudan
- Child and Adolescent Psychiatry Unit, Salvator University Hospital, Public Assistance-Marseille Hospitals, Aix-Marseille University, Marseille, France
| | - David Da Fonseca
- Child and Adolescent Psychiatry Unit, Salvator University Hospital, Public Assistance-Marseille Hospitals, Aix-Marseille University, Marseille, France.,Institute of Neuroscience Timone, CNRS, Aix-Marseille University, Marseille, France
| | - Flora Bat-Pitault
- Child and Adolescent Psychiatry Unit, Salvator University Hospital, Public Assistance-Marseille Hospitals, Aix-Marseille University, Marseille, France.,Institute of Neuroscience Timone, CNRS, Aix-Marseille University, Marseille, France
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4
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Alfano V, Mele G, Cotugno A, Longarzo M. Multimodal neuroimaging in anorexia nervosa. J Neurosci Res 2020; 98:2178-2207. [PMID: 32770570 DOI: 10.1002/jnr.24674] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 02/26/2020] [Accepted: 05/25/2020] [Indexed: 12/13/2022]
Abstract
Anorexia nervosa (AN) is a severe and complex psychiatric disorder characterized by intense fear about weight gain and finalized to food-related control behaviors. Growing interest has been demonstrated about neurobiological processes subtend to AN physiopathology. The present review aimed to collect neurostructural and neurofunctional available data from 2010 to 2019. Results have been organized according to the neuroimaging technique employed, also including a specific section on electroencephalographic results, mostly neglected in previous reviews. Diffuse cerebral vulnerability has been demonstrated and the contribution of several structures has been identified. Insula, cingulate cortex, parietal and frontal areas are primarily involved both by structural and functional perspectives. Moreover, consistent alterations in white matter integrity and brain electrical activity have been reported. Neuroimaging findings give a substantial contribution to AN pathophysiological description, also in order to understand altered but reversible processes in the passage from acute illness phase to disorder's remission, useful also for defining therapy.
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5
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Leppanen J, Sedgewick F, Cardi V, Treasure J, Tchanturia K. Cortical morphometry in anorexia nervosa: An out-of-sample replication study. EUROPEAN EATING DISORDERS REVIEW 2019; 27:507-520. [PMID: 31172616 PMCID: PMC6698193 DOI: 10.1002/erv.2686] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 05/01/2019] [Accepted: 05/09/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND Acute anorexia nervosa (AN) is frequently accompanied by reduced global cortical volume. Investigations of local cortical alterations in AN have revealed widespread reduction in cortical thickness, gyrification, and curvature. The aim of the present study was to combine data from two previous studies to replicate previous findings. METHODOLOGY Magnetic resonance imaging (MRI) images from 46 adult women with AN and 54 age-matched healthy comparison (HC) women were analysed using FreeSurfer. Group differences in cortical volume and local cortical measures, including gyrification, curvature, thickness, and area, were examined controlling for dataset and age. RESULTS The AN group had reduced global cortical volume relative to the HC group. The AN group also had reduction in local cortical gyrification, small localised clusters of reduced cortical thickness, in the occipital and parietal cortices, and surface area in the frontal and temporal cortices. The AN group also had increased cortical thickness in the ACC relative to the HC participants. CONCLUSIONS The present findings replicate and validate previous findings of reduced global cortical volume and local gyrification in acute AN. The findings highlight the need for further investigation of local cortical folding, thickness, and surface area in AN to gain further insight into the biological underpinnings of AN.
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Affiliation(s)
- Jenni Leppanen
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, King's College London, London, UK
| | - Felicity Sedgewick
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, King's College London, London, UK
| | - Valentina Cardi
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, King's College London, London, UK
| | - Janet Treasure
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, King's College London, London, UK.,South London and Maudsley Mental Health NHS Foundation Trust, Section of Eating Disorders, London, UK
| | - Kate Tchanturia
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, King's College London, London, UK.,South London and Maudsley Mental Health NHS Foundation Trust, Section of Eating Disorders, London, UK.,Department of Psychology, Illia State University, Tbilisi, Georgia
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6
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Steward T, Menchón JM, Jiménez-Murcia S, Soriano-Mas C, Fernández-Aranda F. Neural Network Alterations Across Eating Disorders: A Narrative Review of fMRI Studies. Curr Neuropharmacol 2018; 16:1150-1163. [PMID: 29046154 PMCID: PMC6187750 DOI: 10.2174/1570159x15666171017111532] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 08/18/2017] [Accepted: 10/10/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Functional magnetic resonance imaging (fMRI) has provided insight on how neural abnormalities are related to the symptomatology of the eating disorders (EDs): anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). More specifically, an increasingly growing number of brain imaging studies has shed light on how functionally connected brain networks contribute not only to disturbed eating behavior, but also to transdiagnostic alterations in body/interoceptive perception, reward processing and executive functioning. METHODS This narrative review aims to summarize recent advances in fMRI studies of patients with EDs by highlighting studies investigating network alterations that are shared across EDs. RESULTS AND CONCLUSION Findings on reward processing in both AN and BN patients point to the presence of altered sensitivity to salient food stimuli in striatal regions and to the possibility of hypothalamic inputs being overridden by top-down emotional-cognitive control regions. Additionally, innovative new lines of research suggest that increased activations in fronto-striatal circuits are strongly associated with the maintenance of restrictive eating habits in AN patients. Although significantly fewer studies have been carried out in patients with BN and BED, aberrant neural responses to both food cues and anticipated food receipt appear to occur in these populations. These altered responses, coupled with diminished recruitment of prefrontal cognitive control circuitry, are believed to contribute to the binge eating of palatable foods. Results from functional network connectivity studies are diverse, but findings tend to converge on indicating disrupted resting-state connectivity in executive networks, the default-mode network and the salience network across EDs.
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Affiliation(s)
| | | | | | - Carles Soriano-Mas
- Address correspondence to these authors at the Department of Psychiatry, Bellvitge University Hospital-IDIBELL, CIBEROBN and CIBERSAM, c/ Feixa Llarga s/n, 08907 L’Hospitalet de Llobregat Barcelona, Spain; Tel: +34 93 260 79 88; Fax: +34 93 260 76 58; E-mails: &
| | - Fernando Fernández-Aranda
- Address correspondence to these authors at the Department of Psychiatry, Bellvitge University Hospital-IDIBELL, CIBEROBN and CIBERSAM, c/ Feixa Llarga s/n, 08907 L’Hospitalet de Llobregat Barcelona, Spain; Tel: +34 93 260 79 88; Fax: +34 93 260 76 58; E-mails: &
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Brooks SJ, Funk SG, Young SY, Schiöth HB. The Role of Working Memory for Cognitive Control in Anorexia Nervosa versus Substance Use Disorder. Front Psychol 2017; 8:1651. [PMID: 29018381 PMCID: PMC5615794 DOI: 10.3389/fpsyg.2017.01651] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 09/07/2017] [Indexed: 01/20/2023] Open
Abstract
Prefrontal cortex executive functions, such as working memory (WM) interact with limbic processes to foster impulse control. Such an interaction is referred to in a growing body of publications by terms such as cognitive control, cognitive inhibition, affect regulation, self-regulation, top-down control, and cognitive–emotion interaction. The rising trend of research into cognitive control of impulsivity, using various related terms reflects the importance of research into impulse control, as failure to employ cognitions optimally may eventually result in mental disorder. Against this background, we take a novel approach using an impulse control spectrum model – where anorexia nervosa (AN) and substance use disorder (SUD) are at opposite extremes – to examine the role of WM for cognitive control. With this aim, we first summarize WM processes in the healthy brain in order to frame a systematic review of the neuropsychological, neural and genetic findings of AN and SUD. In our systematic review of WM/cognitive control, we found n = 15 studies of AN with a total of n = 582 AN and n = 365 HC participants; and n = 93 studies of SUD with n = 9106 SUD and n = 3028 HC participants. In particular, we consider how WM load/capacity may support the neural process of excessive epistemic foraging (cognitive sampling of the environment to test predictions about the world) in AN that reduces distraction from salient stimuli. We also consider the link between WM and cognitive control in people with SUD who are prone to ‘jumping to conclusions’ and reduced epistemic foraging. Finally, in light of our review, we consider WM training as a novel research tool and an adjunct to enhance treatment that improves cognitive control of impulsivity.
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Affiliation(s)
- Samantha J Brooks
- Functional Pharmacology, Department of Neuroscience, Uppsala UniversityUppsala, Sweden.,Department of Psychiatry and Mental Health, University of Cape TownCape Town, South Africa
| | - Sabina G Funk
- Department of Psychiatry and Mental Health, University of Cape TownCape Town, South Africa
| | - Susanne Y Young
- Department of Psychiatry, Stellenbosch UniversityBellville, South Africa
| | - Helgi B Schiöth
- Functional Pharmacology, Department of Neuroscience, Uppsala UniversityUppsala, Sweden
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8
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Terhoeven V, Kallen U, Ingenerf K, Aschenbrenner S, Weisbrod M, Herzog W, Brockmeyer T, Friederich HC, Nikendei C. Meaningful Memory in Acute Anorexia Nervosa Patients-Comparing Recall, Learning, and Recognition of Semantically Related and Semantically Unrelated Word Stimuli. EUROPEAN EATING DISORDERS REVIEW 2016; 25:89-97. [PMID: 28032373 DOI: 10.1002/erv.2496] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 10/17/2016] [Accepted: 11/14/2016] [Indexed: 11/10/2022]
Abstract
OBJECTIVE It is unclear whether observed memory impairment in anorexia nervosa (AN) depends on the semantic structure (categorized words) of material to be encoded. We aimed to investigate the processing of semantically related information in AN. METHOD Memory performance was assessed in a recall, learning, and recognition test in 27 adult women with AN (19 restricting, 8 binge-eating/purging subtype; average disease duration: 9.32 years) and 30 healthy controls using an extended version of the Rey Auditory Verbal Learning Test, applying semantically related and unrelated word stimuli. RESULTS Short-term memory (immediate recall, learning), regardless of semantics of the words, was significantly worse in AN patients, whereas long-term memory (delayed recall, recognition) did not differ between AN patients and controls. DISCUSSION Semantics of stimuli do not have a better effect on memory recall in AN compared to CO. Impaired short-term versus long-term memory is discussed in relation to dysfunctional working memory in AN. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.
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Affiliation(s)
- Valentin Terhoeven
- Department of General Internal and Psychosomatic Medicine, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Ursula Kallen
- Department of General Internal and Psychosomatic Medicine, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany.,Department of Psychiatry and Psychotherapy Bethel, Evangelisches Krankenhaus Bielefeld, Bielefeld, Germany
| | - Katrin Ingenerf
- Department of General Internal and Psychosomatic Medicine, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Steffen Aschenbrenner
- Department of General Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Matthias Weisbrod
- Department of General Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany.,Department of Psychiatry and Psychotherapy, SRH Klinikum Karlsbad-Langensteinbach, Karlsbad-Langensteinbach, Germany
| | - Wolfgang Herzog
- Department of General Internal and Psychosomatic Medicine, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Timo Brockmeyer
- Department of General Internal and Psychosomatic Medicine, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal and Psychosomatic Medicine, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany.,Clinical Institute of Psychosomatic Medicine and Psychotherapy, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Christoph Nikendei
- Department of General Internal and Psychosomatic Medicine, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
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9
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Evidence for Thalamocortical Circuit Abnormalities and Associated Cognitive Dysfunctions in Underweight Individuals with Anorexia Nervosa. Neuropsychopharmacology 2016; 41:1560-8. [PMID: 26462619 PMCID: PMC4832017 DOI: 10.1038/npp.2015.314] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 09/29/2015] [Accepted: 09/29/2015] [Indexed: 11/09/2022]
Abstract
Anorexia nervosa (AN) is characterized by extremely low body weight resulting from pathological food restriction, and carries a mortality rate among the highest of any psychiatric illness. AN, particularly during the acute, underweight state of the illness, has been associated with abnormalities across a range of brain regions, including the frontal cortex and basal ganglia. Few studies of AN have investigated the thalamus, a key mediator of information flow through frontal-basal ganglia circuit loops. We examined both thalamic surface morphology using anatomical MRI and thalamo-frontal functional connectivity using resting-state functional MRI. Individuals with AN (n=28) showed localized inward deformations of the thalamus relative to healthy controls (HC, n=22), and abnormal functional connectivity between the thalamus and the dorsolateral and anterior prefrontal cortices. Alterations in thalamo-frontal connectivity were associated with deficits in performance on tasks probing cognitive control (Stroop task) and working memory (Letter-Number Sequencing (LNS) task). Our findings suggest that abnormalities in thalamo-frontal circuits may have a role in mediating aspects of cognitive dysfunction in underweight individuals with AN.
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10
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Abstract
Studies published between the beginning of 2013 and May 2015 on the neuropsychological functioning of patients with anorexia nervosa compared with healthy participants framed in the context of the Research Domain Criteria matrix identifies evidence for functional differences in three domains: Negative Valance Systems-negative attentional biases and lack of neural responsivity to hunger; Cognitive Systems-limited congruence between clinical and cognitive performance, poorer non-verbal than verbal performance, altered attentional styles to disorder related stimuli, perceptual processing impairment in discriminating body images, weaknesses in central coherence, set shifting weaknesses at low weight status, decision-making weaknesses, and greater neural resources required for working memory; Systems for Social Processes-patients appear to have a different attentional response to faces, and perception and understanding of self and others. Hence, there is evidence to suggest that patients with anorexia nervosa have a specific neuropsychological performance style across tasks in three domains of functioning. Some current controversies and areas for future development are identified.
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Affiliation(s)
- Marie-Claire Reville
- Feeding and Eating Disorders Service, Department of Child and Adolescent Mental Health, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK.
- College of Life and Environmental Sciences, University of Exeter, Exeter, UK.
| | - Lorna O'Connor
- College of Life and Environmental Sciences, University of Exeter, Exeter, UK
- Department of Psychology, University of Bath, Bath, UK
| | - Ian Frampton
- Feeding and Eating Disorders Service, Department of Child and Adolescent Mental Health, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK
- College of Life and Environmental Sciences, University of Exeter, Exeter, UK
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Brooks SJ. A debate on working memory and cognitive control: can we learn about the treatment of substance use disorders from the neural correlates of anorexia nervosa? BMC Psychiatry 2016; 16:10. [PMID: 26772802 PMCID: PMC4715338 DOI: 10.1186/s12888-016-0714-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 01/12/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Anorexia Nervosa (AN) is a debilitating, sometimes fatal eating disorder (ED) whereby restraint of appetite and emotion is concomitant with an inflexible, attention-to-detail perfectionist cognitive style and obsessive-compulsive behaviour. Intriguingly, people with AN are less likely to engage in substance use, whereas those who suffer from an ED with a bingeing component are more vulnerable to substance use disorder (SUD). DISCUSSION This insight into a beneficial consequence of appetite control in those with AN, which is shrouded by the many other unhealthy, excessive and deficit symptoms, may provide some clues as to how the brain could be trained to exert better, sustained control over appetitive and impulsive processes. Structural and functional brain imaging studies implicate the executive control network (ECN) and the salience network (SN) in the neuropathology of AN and SUD. Additionally, excessive employment of working memory (WM), alongside more prominent cognitive deficits may be utilised to cope with the experience of negative emotions and may account for aberrant brain function. WM enables mental rehearsal of cognitive strategies while regulating, restricting or avoiding neural responses associated with the SN. Therefore, high versus low WM capacity may be one of the factors that unites common cognitive and behavioural symptoms in those suffering from AN and SUD respectively. Furthermore, emerging evidence suggests that by evoking neural plasticity in the ECN and SN with WM training, improvements in neurocognitive function and cognitive control can be achieved. Thus, considering the neurocognitive processes of excessive appetite control and how it links to WM in AN may aid the application of adjunctive treatment for SUD.
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Affiliation(s)
- Samantha J. Brooks
- UCT Department of Psychiatry and Mental Health, Groote Schuur Hospital, Anzio Road, Observatory Cape Town, South Africa
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12
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Fuglset TS, Landrø NI, Reas DL, Rø Ø. Functional brain alterations in anorexia nervosa: a scoping review. J Eat Disord 2016; 4:32. [PMID: 27933159 PMCID: PMC5125031 DOI: 10.1186/s40337-016-0118-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 08/30/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neuroimaging allows for the identification of brain abnormalities and alterations that are associated with anorexia nervosa (AN). We performed a scoping review to map out the extent and nature of recent research activity on functional magnetic resonance imaging (fMRI) in individuals diagnosed with, or recovered from, AN (AN-REC). MAIN TEXT A literature search of PubMed, Psychinfo and Embase was conducted using the search terms "anorexia nervosa" AND "functional magnetic resonance imaging." We included fMRI studies that involved a comparison between individuals with AN or AN-REC and healthy controls published in English language between 2010 and 2015. A total of 49 papers were included, regardless of the experimental stimuli or paradigm. CONCLUSIONS Findings varied considerably across studies, reflecting methodological differences in study design, such as sample differences and experimental paradigms. Collectively, studies published during the past five years suggest altered activation in regions related to the fronto-striato and the limbic circuits, which are theorized to have an important role in the pathophysiology of AN.
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Affiliation(s)
- Tone Seim Fuglset
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Nils Inge Landrø
- Department of Psychology, Clinical Neuroscience Research Group, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | - Deborah Lynn Reas
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Ullevål, Oslo, Norway ; Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | - Øyvind Rø
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Ullevål, Oslo, Norway ; Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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13
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Ehrlich S, Geisler D, Ritschel F, King JA, Seidel M, Boehm I, Breier M, Clas S, Weiss J, Marxen M, Smolka MN, Roessner V, Kroemer NB. Elevated cognitive control over reward processing in recovered female patients with anorexia nervosa. J Psychiatry Neurosci 2015; 40:307-15. [PMID: 26107161 PMCID: PMC4543093 DOI: 10.1503/jpn.140249] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Individuals with anorexia nervosa are thought to exert excessive self-control to inhibit primary drives. METHODS This study used functional MRI (fMRI) to interrogate interactions between the neural correlates of cognitive control and motivational processes in the brain reward system during the anticipation of monetary reward and reward-related feedback. In order to avoid confounding effects of undernutrition, we studied female participants recovered from anorexia nervosa and closely matched healthy female controls. The fMRI analysis (including node-to-node functional connectivity) followed a region of interest approach based on models of the brain reward system and cognitive control regions implicated in anorexia nervosa: the ventral striatum, medial orbitofrontal cortex (mOFC) and dorsolateral prefrontal cortex (DLPFC). RESULTS We included 30 recovered patients and 30 controls in our study. There were no behavioural differences and no differences in hemodynamic responses of the ventral striatum and the mOFC in the 2 phases of the task. However, relative to controls, recovered patients showed elevated DLPFC activity during the anticipation phase, failed to deactivate this region during the feedback phase and displayed greater functional coupling between the DLPFC and mOFC. Recovered patients also had stronger associations than controls between anticipation-related DLPFC responses and instrumental responding. LIMITATIONS The results we obtained using monetary stimuli might not generalize to other forms of reward. CONCLUSION Unaltered neural responses in ventral limbic reward networks but increased recruitment of and connectivity with lateral-frontal brain circuitry in recovered patients suggests an elevated degree of selfregulatory processes in response to rewarding stimuli. An imbalance between brain systems subserving bottom-up and top-down processes may be a trait marker of the disorder.
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Affiliation(s)
- Stefan Ehrlich
- Correspondence to: S. Ehrlich, Technische Universität Dresden, Faculty of Medicine, University Hospital C. G. Carus, Dresden, Department of Child and Adolescent Psychiatry, Translational Developmental Neuroscience Section, Fetscherstraße 74, 01307 Dresden, Germany;
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14
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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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Israel M, Klein M, Pruessner J, Thaler L, Spilka M, Efanov S, Ouellette AS, Berlim M, Ali N, Beaudry T, Van den Eynde F, Walker CD, Steiger H. n-back task performance and corresponding brain-activation patterns in women with restrictive and bulimic eating-disorder variants: preliminary findings. Psychiatry Res 2015; 232:84-91. [PMID: 25707581 DOI: 10.1016/j.pscychresns.2015.01.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Revised: 09/28/2014] [Accepted: 01/27/2015] [Indexed: 01/08/2023]
Abstract
Eating disorder (ED) variants characterized by "binge-eating/purging" symptoms differ from "restricting-only" variants along diverse clinical dimensions, but few studies have compared people with these different eating-disorder phenotypes on measures of neurocognitive function and brain activation. We tested the performances of 19 women with "restricting-only" eating syndromes and 27 with "binge-eating/purging" variants on a modified n-back task, and used functional magnetic resonance imaging (fMRI) to examine task-induced brain activations in frontal regions of interest. When compared with "binge-eating/purging" participants, "restricting-only" participants showed superior performance. Furthermore, in an intermediate-demand condition, "binge-eating/purging" participants showed significantly less event-related activation than did "restricting-only" participants in a right posterior prefrontal region spanning Brodmann areas 6-8-a region that has been linked to planning of motor responses, working memory for sequential information, and management of uncertainty. Our findings suggest that working memory is poorer in eating-disordered individuals with binge-eating/purging behaviors than in those who solely restrict food intake, and that observed performance differences coincide with interpretable group-based activation differences in a frontal region thought to subserve planning and decision making.
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Affiliation(s)
- Mimi Israel
- Eating Disorders Program, Douglas University Institute, Montreal, Quebec, Canada; McGill University, Psychiatry Department, Montreal, Quebec, Canada; Research Centre, Douglas University Institute, Montreal, Quebec, Canada.
| | - Michael Klein
- McGill University, Department of Psychology, Montreal, Quebec, Canada; Montreal Neurological Institute, Cognitive Neuroscience Unit, Montreal, Quebec, Canada
| | - Jens Pruessner
- McGill University, Psychiatry Department, Montreal, Quebec, Canada; Research Centre, Douglas University Institute, Montreal, Quebec, Canada
| | - Lea Thaler
- Eating Disorders Program, Douglas University Institute, Montreal, Quebec, Canada; McGill University, Psychiatry Department, Montreal, Quebec, Canada; Research Centre, Douglas University Institute, Montreal, Quebec, Canada
| | - Michael Spilka
- Eating Disorders Program, Douglas University Institute, Montreal, Quebec, Canada; Research Centre, Douglas University Institute, Montreal, Quebec, Canada
| | - Simona Efanov
- Eating Disorders Program, Douglas University Institute, Montreal, Quebec, Canada; Research Centre, Douglas University Institute, Montreal, Quebec, Canada
| | - Anne-Sophie Ouellette
- Eating Disorders Program, Douglas University Institute, Montreal, Quebec, Canada; Research Centre, Douglas University Institute, Montreal, Quebec, Canada
| | - Marcelo Berlim
- Eating Disorders Program, Douglas University Institute, Montreal, Quebec, Canada; McGill University, Psychiatry Department, Montreal, Quebec, Canada; Research Centre, Douglas University Institute, Montreal, Quebec, Canada
| | - Nida Ali
- McGill University, Psychiatry Department, Montreal, Quebec, Canada; Research Centre, Douglas University Institute, Montreal, Quebec, Canada
| | - Thomas Beaudry
- McGill University, Psychiatry Department, Montreal, Quebec, Canada; Research Centre, Douglas University Institute, Montreal, Quebec, Canada
| | - Frederique Van den Eynde
- Eating Disorders Program, Douglas University Institute, Montreal, Quebec, Canada; McGill University, Psychiatry Department, Montreal, Quebec, Canada; Research Centre, Douglas University Institute, Montreal, Quebec, Canada
| | - Claire-Dominique Walker
- McGill University, Psychiatry Department, Montreal, Quebec, Canada; Research Centre, Douglas University Institute, Montreal, Quebec, Canada
| | - Howard Steiger
- Eating Disorders Program, Douglas University Institute, Montreal, Quebec, Canada; McGill University, Psychiatry Department, Montreal, Quebec, Canada; Research Centre, Douglas University Institute, Montreal, Quebec, Canada
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16
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Tchanturia K, Doris E, Mountford V, Fleming C. Cognitive Remediation and Emotion Skills Training (CREST) for anorexia nervosa in individual format: self-reported outcomes. BMC Psychiatry 2015; 15:53. [PMID: 25884480 PMCID: PMC4377046 DOI: 10.1186/s12888-015-0434-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 03/09/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate self-reported outcomes after a brief course of skills-based individual therapy for inpatients with anorexia nervosa (AN). METHODS In this case series study 37 adults with AN participated in cognitive remediation and emotion skills training (CREST) sessions, and completed social anhedonia, alexithymia and motivational measures before and after the intervention. RESULTS The CREST primary outcome measures were total scores on the Revised Social Anhedonia Scale (RSAS), which decreased significantly (p = 0.03) with an effect size of 0.31, and the Toronto Alexithymia Scale (TAS), which also decreased significantly (p = 0.05) with an effect size of 0.35. The secondary outcome measures focused on motivation: perceived 'importance to change' and 'ability to change'; the second of which increased significantly (p < 0.001) with a medium effect size (d = 0.71). CONCLUSIONS The individual format of CREST led to a decrease in patients' self-reported social anhedonia, an improvement in the ability to label their emotions, and increased confidence in their ability to change. Considering the limited number of individual sessions, this is a promising preliminary finding which warrants further research.
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Affiliation(s)
- Kate Tchanturia
- King's College London, Division of Psychological Medicine, Institute of Psychiatry, SE5 8AF, London, UK. .,Eating Disorders Unit, South London and Maudsley NHS Foundation Trust, London, UK. .,Illia State University, Tbilisi, Georgia.
| | - Eli Doris
- King's College London, Division of Psychological Medicine, Institute of Psychiatry, SE5 8AF, London, UK. .,Eating Disorders Unit, South London and Maudsley NHS Foundation Trust, London, UK.
| | - Vicki Mountford
- Eating Disorders Unit, South London and Maudsley NHS Foundation Trust, London, UK.
| | - Caroline Fleming
- Eating Disorders Unit, South London and Maudsley NHS Foundation Trust, London, UK.
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Brooks SJ, Solstrand Dahlberg L, Swenne I, Aronsson M, Zarei S, Lundberg L, Jacobsson JA, Rask-Andersen M, Salonen-Ros H, Rosling A, Larsson EM, Schiöth HB. Obsessive-compulsivity and working memory are associated with differential prefrontal cortex and insula activation in adolescents with a recent diagnosis of an eating disorder. Psychiatry Res 2014; 224:246-53. [PMID: 25456522 DOI: 10.1016/j.pscychresns.2014.10.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 09/19/2014] [Accepted: 10/02/2014] [Indexed: 12/14/2022]
Abstract
The role of rumination at the beginning of eating disorder (ED) is not well understood. We hypothesised that impulsivity, rumination and restriction could be associated with neural activity in response to food stimuli in young individuals with eating disorders (ED). We measured neural responses with functional magnetic resonance imaging (fMRI), tested working memory (WM) and administered the eating disorders examination questionnaire (EDE-Q), Barratt impulsivity scale (BIS-11) and obsessive-compulsive inventory (OCI-R) in 15 adolescent females with eating disorder not otherwise specified (EDNOS) (mean age 15 years) and 20 age-matched healthy control females. We found that EDNOS subjects had significantly higher scores on the BIS 11, EDE-Q and OCI-R scales. Significantly increased neural responses to food images in the EDNOS group were observed in the prefrontal circuitry. OCI-R scores in the EDNOS group also significantly correlated with activity in the prefrontal circuitry and the cerebellum. Significantly slower WM responses negatively correlated with bilateral superior frontal gyrus activity in the EDNOS group. We conclude that ruminations, linked to WM, are present in adolescent females newly diagnosed with EDNOS. These may be risk factors for the development of an eating disorder and may be detectable before disease onset.
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Affiliation(s)
- Samantha J Brooks
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden; Deptartment of Psychiatry and Mental Health, University of Cape Town, Cape Town, Western Cape, South Africa.
| | | | - Ingemar Swenne
- Department of Women׳s and Children׳s Health, Uppsala University, Uppsala, Sweden
| | - Marianne Aronsson
- Department of Women׳s and Children׳s Health, Uppsala University, Uppsala, Sweden
| | - Sanaz Zarei
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden
| | - Lina Lundberg
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden
| | - Josefin A Jacobsson
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden
| | - Mathias Rask-Andersen
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden
| | - Helena Salonen-Ros
- Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Sweden
| | - Agneta Rosling
- Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Sweden
| | | | - Helgi B Schiöth
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden
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18
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Kjaersdam Telléus G, Jepsen JR, Bentz M, Christiansen E, Jensen SOW, Fagerlund B, Thomsen PH. Cognitive profile of children and adolescents with anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2014; 23:34-42. [PMID: 25504443 PMCID: PMC4309487 DOI: 10.1002/erv.2337] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 11/11/2014] [Accepted: 11/12/2014] [Indexed: 12/21/2022]
Abstract
Objective Few studies of cognitive functioning in children and adolescents with anorexia nervosa (AN) have been conducted. The aim of this study was to examine the neurocognitive and intelligence profile of this clinical group. Method The study was a matched case–control (N = 188), multi-centre study including children and adolescents with AN (N = 94) and healthy control participants (N = 94). Results The results suggest that Full Scale Intelligence Quotient (Wechsler Intelligence Scale for Children-III/Wechsler Adult Intelligence Scale-III) in this patient group is close to the normal population mean of 100. Individuals with AN exhibited significantly worse performance in nonverbal intelligence functions (i.e. Wechsler Intelligence Scale for Children-III/Wechsler Adult Intelligence Scale-III, Perceptual Organization Index) and in verbal memory (Test of Memory and Learning—Second Edition, Memory for Stories) and motor speed (Cambridge Neuropsychological Test Automated Battery, Simple and Choice Reaction Time) compared with healthy control participants. No significant difference in set-shifting ability (Cambridge Neuropsychological Test Automated Battery, Intra-Extra Dimensional Set Shift and Trail Making Test B) was found. Conclusions Inefficiency in nonverbal intelligence functions and in specific cognitive functions was found in this study of children and adolescents with AN. © 2014 The Authors. European Eating Disorders Review published by John Wiley & Sons, Ltd.
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Affiliation(s)
- Gry Kjaersdam Telléus
- Unit for Psychiatric Research, Aalborg University Hospital, Aalborg, Denmark; Section of Eating Disorders, Unit for Child and Adolescent Psychiatry, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark
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Suda M, Brooks SJ, Giampietro V, Uher R, Mataix-Cols D, Brammer MJ, Williams SCR, Treasure J, Campbell IC. Provocation of symmetry/ordering symptoms in Anorexia nervosa: a functional neuroimaging study. PLoS One 2014; 9:e97998. [PMID: 24844926 PMCID: PMC4028263 DOI: 10.1371/journal.pone.0097998] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 04/24/2014] [Indexed: 12/13/2022] Open
Abstract
Anorexia nervosa (AN), obsessive–compulsive disorder (OCD), and obsessive–compulsive personality disorder (OCPD) are often co-morbid; however, the aetiology of such co-morbidity has not been well investigated. This study examined brain activation in women with AN and in healthy control (HC) women during the provocation of symmetry/ordering-related anxiety. During provocation, patients with AN showed more anxiety compared to HCs, which was correlated with the severity of symmetry/ordering symptoms. Activation in the right parietal lobe and right prefrontal cortex (rPFC) in response to provocation was reduced in the AN group compared with the HC group. The reduced right parietal activation observed in the AN group is consistent with parietal lobe involvement in visuospatial cognition and with studies of OCD reporting an association between structural abnormalities in this region and the severity of ‘ordering’ symptoms. Reduced rPFC activation in response to symmetry/ordering provocation has similarities with some, but not all, data collected from patients with AN who were exposed to images of food and bodies. Furthermore, the combination of data from the AN and HC groups showed that rPFC activation during symptom provocation was inversely correlated with the severity of symmetry/ordering symptoms. These data suggest that individuals with AN have a diminished ability to cognitively deal with illness-associated symptoms of provocation. Furthermore, our data also suggest that symptom provocation can progressively overload attempts by the rPFC to exert cognitive control. These findings are discussed in the context of the current neurobiological models of AN.
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Affiliation(s)
- Masashi Suda
- Section of Eating Disorders, Institute of Psychiatry, King's College London, London, United Kingdom
- * E-mail:
| | | | - Vincent Giampietro
- Centre for Neuroimaging Studies, Institute of Psychiatry, King's College London, London, United Kingdom
| | - Rudolf Uher
- Section of Eating Disorders, Institute of Psychiatry, King's College London, London, United Kingdom
| | - David Mataix-Cols
- Departments of Psychosis Studies and Psychology, Institute of Psychiatry, King's College London, London, United Kingdom
| | - Michael J. Brammer
- Centre for Neuroimaging Studies, Institute of Psychiatry, King's College London, London, United Kingdom
| | - Steven C. R. Williams
- Centre for Neuroimaging Studies, Institute of Psychiatry, King's College London, London, United Kingdom
| | - Janet Treasure
- Section of Eating Disorders, Institute of Psychiatry, King's College London, London, United Kingdom
| | - Iain C. Campbell
- Section of Eating Disorders, Institute of Psychiatry, King's College London, London, United Kingdom
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Tchanturia K, Doris E, Fleming C. Effectiveness of Cognitive Remediation and Emotion Skills Training (CREST) for Anorexia Nervosa in Group Format: A Naturalistic Pilot Study. EUROPEAN EATING DISORDERS REVIEW 2014; 22:200-5. [DOI: 10.1002/erv.2287] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 01/24/2014] [Accepted: 02/11/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Kate Tchanturia
- King's College London; Division of Psychological Medicine, Institute of Psychiatry; London UK
- Eating Disorders Unit; South London and Maudsley NHS Foundation Trust; London UK
- Illia State University Tbilisi; Georgia
| | - Eli Doris
- Eating Disorders Unit; South London and Maudsley NHS Foundation Trust; London UK
| | - Caroline Fleming
- Eating Disorders Unit; South London and Maudsley NHS Foundation Trust; London UK
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Abstract
OBJECTIVE Recent advances in neuroimaging techniques have enabled a better understanding of the neurobiological underpinnings of anorexia nervosa (AN). The aim of this paper was to summarise our current understanding of the neurobiology of AN. METHODS The literature was searched using the electronic databases PubMed and Google Scholar, and by additional hand searches through reference lists and specialist eating disorders journals. Relevant studies were included if they were written in English, only used human participants, had a specific AN group, used clinical populations of AN, group comparisons were reported for AN compared to healthy controls and not merely AN compared to other eating disorders or other psychiatric groups, and were not case studies. RESULTS The systematic review summarises a number of structural and functional brain differences which are reported in individuals with AN, including differences in neurotransmitter function, regional cerebral blood flow, glucose metabolism, volumetrics and the blood oxygen level dependent response. CONCLUSION Several structural and functional differences have been reported in AN, some of which reverse and others which persist following weight restoration. These findings have important implications for our understanding of the neurobiological underpinnings of AN, and further research in this field may provide new direction for the development of more effective treatments.
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Affiliation(s)
- Andrea Phillipou
- 1Department of Optometry and Vision Sciences, The University of Melbourne, Melbourne, Australia
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Funciones ejecutivas y sintomatología asociada con los trastornos de la conducta alimentaria. REVISTA LATINOAMERICANA DE PSICOLOGIA 2014. [DOI: 10.1016/s0120-0534(14)70022-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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23
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Brockmeyer T, Ingenerf K, Walther S, Wild B, Hartmann M, Herzog W, Bents H, Friederich HC. Training cognitive flexibility in patients with anorexia nervosa: a pilot randomized controlled trial of cognitive remediation therapy. Int J Eat Disord 2014; 47:24-31. [PMID: 24166941 DOI: 10.1002/eat.22206] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 09/04/2013] [Accepted: 09/14/2013] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Inefficient cognitive flexibility is considered a neurocognitive trait marker involved in the development and maintenance of anorexia nervosa (AN). Cognitive Remediation Therapy (CRT) is a specific treatment targeting this cognitive style. The aim of this study was to investigate the feasibility and efficacy (by estimating the effect size) of specifically tailored CRT for AN, compared to non-specific cognitive training. METHOD A prospective, randomized controlled, superiority pilot trial was conducted. Forty women with AN receiving treatment as usual (TAU) were randomized to receive either CRT or non-specific neurocognitive therapy (NNT) as an add-on. Both conditions comprised 30 sessions of computer-assisted (21 sessions) and face-to-face (9 sessions) training over a 3-week period. CRT focused specifically on cognitive flexibility. NNT was comprised of tasks designed to improve attention and memory. The primary outcome was performance on a neuropsychological post-treatment assessment of cognitive set-shifting. RESULTS Data available from 25 treatment completers were analyzed. Participants in the CRT condition outperformed participants in the NNT condition in cognitive set-shifting at the end of the treatment (p = 0.027; between-groups effect size d = 0.62). Participants in both conditions showed high treatment acceptance. DISCUSSION This study confirms the feasibility of CRT for AN, and provides a first estimate of the effect size that can be achieved using CRT for AN. Furthermore, the present findings corroborate that neurocognitive training for AN should be tailored to the specific cognitive inefficiencies of this patient group.
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Affiliation(s)
- Timo Brockmeyer
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
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