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Haywood D, Baughman FD, Dauer E, Haywood J, Rossell S, Hart NH. It's about time: mitigating cancer-related cognitive impairments through findings from computational models of the Wisconsin Card Sorting Task. BMC Cancer 2024; 24:798. [PMID: 38965483 PMCID: PMC11223404 DOI: 10.1186/s12885-024-12545-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 06/20/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND Many cancer survivors experience cancer-related cognitive impairment (CRCI), often with significant negative consequences across various life domains. Emerging evidence suggests that allowing additional time to process information before acting may be a useful strategy for those with CRCI to mitigate some of its impacts. The Wisconsin Card Sorting Task (WCST), a measure of general cognition, has shown that for some cancer survivors, longer task completion time facilitates similar task performance outcomes to control populations concerning perseveration errors; a key performance metric of the WCST. However, assessing if this strategy may be useful, as well as determining for whom it may be useful, with regard to strengths and weaknesses among select cognitive domains, is challenging due to factors such as the problem of task impurity. Accordingly, this study provides an initial computational and experimental assessment of whether additional time to process information before acting is a useful strategy for those with CRCI. METHODS We simulated individual cognitive differences observed in humans by varying contributions of executive functioning components (updating, shifting, inhibition) to yield 48 distinct computational models of the WCST. Our main manipulation was then to provide these models with more or less time (at three levels of 20, 40 and 60 cycles) before models executed an action to sort a given card. We compared the number of perseveration errors on the WCST produced by the computational models. Additionally, we determined models that simulated the performance of cancer survivors on the WCST by comparing the number of perseveration errors produced by the models to human data. RESULTS Additional processing time resulted in the models producing significantly fewer perseveration errors, supporting our hypothesis. In addition, 8 unique models simulated the performance of cancer survivors on the WCST. Additional time appeared to have a positive influence on performance primarily by mitigating the impacts of severe inhibition impairments. For more severe global executive function impairments, a substantial amount of additional time was required to mitigate the impacts of the impairments. For the most severe impairments, additional time was unable to adequately mitigate the impact on performance. CONCLUSION Additional processing time may be a useful strategy to rectify perseveration errors among cancer survivors with CRCI. Our findings have implications for the development of practical strategies, such as workload and deadline management in occupational settings, which may mitigate the negative effects of CRCI.
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Affiliation(s)
- Darren Haywood
- Human Performance Research Centre, INSIGHT Research Institute, Faculty of Health, University of Technology Sydney (UTS), Moore Park, Sydney, NSW, 2030, Australia.
- Department of Mental Health, St. Vincent's Hospital Melbourne, Fitzroy, VIC, Australia.
- Department of Psychiatry, Melbourne Medical School, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, Australia.
- School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia.
| | - Frank D Baughman
- School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
| | - Evan Dauer
- Human Performance Research Centre, INSIGHT Research Institute, Faculty of Health, University of Technology Sydney (UTS), Moore Park, Sydney, NSW, 2030, Australia
- Department of Mental Health, St. Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Jennifer Haywood
- School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
| | - Susan Rossell
- Department of Mental Health, St. Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
- Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Nicolas H Hart
- Human Performance Research Centre, INSIGHT Research Institute, Faculty of Health, University of Technology Sydney (UTS), Moore Park, Sydney, NSW, 2030, Australia
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- Exercise Medicine Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
- Cancer and Palliative Care Outcomes Centre, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Institute for Health Research, University of Notre Dame Australia, Perth, WA, Australia
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Terhoeven V, Faschingbauer S, Huber J, Simon JJ, Herzog W, Friederich HC, Nikendei C. Autobiographical memory following weight gain in adult patients with Anorexia Nervosa: A longitudinal study. EUROPEAN EATING DISORDERS REVIEW 2024; 32:809-823. [PMID: 38558236 DOI: 10.1002/erv.3091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 03/10/2024] [Accepted: 03/14/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Patients with anorexia nervosa (AN) show overgeneralization of memory (OGM) when generating autobiographical episodes related to food and body shape. These memories are central for the construction of a coherent self-concept, interpersonal relationships, and problem-solving abilities. The current study aims to investigate changes in autobiographical memory following weight gain. METHODS OGM was assessed with an adapted version of the Autobiographical Memory Test including food-, body-, depression-related, and neutral cues. N = 41 female patients with AN (28 restricting-, 13 binge-eating/purging-subtype; mean disease duration: 4.5 years; mean BMI: 14.5 kg/m2) and N = 27 healthy controls (HC) were included at baseline. After inpatient treatment (mean duration: 11 weeks), 24 patients with AN and 24 age-matched HC were reassessed. Group differences were assessed using independent samples t-tests for cross-sectional comparisons and repeated measures ANOVAs for longitudinal data. RESULTS At baseline, patients with AN generated significantly fewer specific memories than HC, independent of word category (F(1.66) = 27.167, p < 0.001). During inpatient stay, the average weight gain of patients with AN was 3.1 body mass index points. At follow-up, patients with AN showed a significant improvement in the number of specific memories for both depression-related and neutral cues, but not for food- and body-related cues. CONCLUSIONS Generalised OGM (i.e., independent of word category) in patients with AN before weight restoration may be a general incapacity to recall autobiographical memory. After weight gain, the previously well-studied pattern of eating disorder-related OGM emerges. The clinical relevance of the continuing disorder-related OGM in patients with AN after weight gain is discussed.
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Affiliation(s)
- Valentin Terhoeven
- Department for General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Sandra Faschingbauer
- Department for General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Julia Huber
- Institute of Medical Psychology, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
| | - Joe J Simon
- Department for General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Wolfgang Herzog
- Department for General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department for General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Christoph Nikendei
- Department for General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
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Heled E, Ben-Baruch Polevoi B, Kushnir T, Gur E, Brener-Yaacobi R. Disentangling cognitive flexibility: a model-based assessment of women with anorexia nervosa. Eat Disord 2024:1-16. [PMID: 38937994 DOI: 10.1080/10640266.2024.2353427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Abstract
Cognitive flexibility (CF) has been proposed as a potential trait marker in anorexia nervosa (AN), although findings have been inconsistent. To address this inconsistency, we applied a model that distinguishes between three subtypes of CF: task switching, switching sets, and stimulus-response mapping, which we then assessed using a paradigm-based task battery. The aim of the study was to investigate how AN is associated with these three CF subtypes. Thirty-three women with AN and 37 age- and education-matched controls performed a battery of computerized cognitive tasks to assess the three CF subtypes. Compared to the control group, individuals with AN exhibited poorer performance on the task switching and switching sets subtypes, as measured by response time switch cost, but not on the stimulus-response mapping subtype. No differences were found between the groups in response accuracy. Furthermore, switching sets as compared to the task switching and stimulus-response mapping subtypes was found to better explain the differences between the groups. These findings indicate a domain-specific impairment in CF among patients with AN, reflecting deficits observed in subtypes related to the disorder's characteristics, particularly that associated with visual perception. Therefore, CF impairment in AN should not be viewed dichotomously, but rather as a relative impairment that varies depending on the specific CF subtype.
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Affiliation(s)
- Eyal Heled
- Department of Psychology, Ariel University, Ariel, Israel
- Department of Neurological Rehabilitation, Sheba Medical Center, Ramat-Gan, Israel
| | | | - Talma Kushnir
- Department of Psychology, Ariel University, Ariel, Israel
- Adelson School of Medicine, Ariel University, Ariel, Israel
| | - Eytan Gur
- The Adults Eating Disorders Department, Sheba Medical Center, Ramat-Gan, Israel
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4
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Norton B, Sheen J, Burns L, Enticott PG, Fuller-Tyszkiewicz M, Kirkovski M. Overlap of eating disorders and neurodivergence: the role of inhibitory control. BMC Psychiatry 2024; 24:454. [PMID: 38890597 PMCID: PMC11186180 DOI: 10.1186/s12888-024-05837-6] [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: 01/09/2024] [Accepted: 05/10/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Difficulties with inhibitory control have been identified in eating disorders (EDs) and neurodevelopmental disorders (NDs; including attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder), and there appear to be parallels between the expression of these impairments. It is theorised that impairments in inhibitory control within NDs may represent a unique vulnerability for eating disorders (EDs), and this same mechanism may contribute to poorer treatment outcomes. This review seeks to determine the state of the literature concerning the role of inhibitory control in the overlap of EDs and neurodivergence. METHOD A scoping review was conducted to summarise extant research, and to identify gaps in the existing knowledge base. Scopus, Medline, PsycInfo, Embase, and ProQuest were systematically searched. Studies were included if the study measured traits of ADHD or autism, and symptoms of ED, and required participants to complete a performance task measure of inhibitory control. Where studies included a cohort with both an ND and ED, these results had to be reported separately from cohorts with a singular diagnosis. Studies were required to be published in English, within the last 10 years. RESULTS No studies explored the relationship between autism and EDs using behavioural measures of inhibitory control. Four studies exploring the relationship between ADHD and EDs using behavioural measures of inhibitory control met selection criteria. These studies showed a multifaceted relationship between these conditions, with differences emerging between domains of inhibitory control. ADHD symptoms predicted poorer performance on measures of response inhibition in a non-clinical sample; this was not replicated in clinical samples, nor was there a significant association with EDs. Both ADHD and ED symptoms are associated with poor performance on attentional control measures; where these diagnoses were combined, performance was worse than for those with a singular diagnosis of ADHD. This was not replicated when compared to those with only ED diagnoses. CONCLUSION Impairments in attentional control may represent a unique vulnerability for the development of an ED and contribute to poor treatment outcomes. Further research is needed to explore the role of inhibitory control in EDs, ADHD and autism, including the use of both self-report and behavioural measures to capture the domains of inhibitory control.
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Affiliation(s)
- Bethany Norton
- School of Psychology, Deakin University, Geelong, Australia.
| | - Jade Sheen
- School of Psychology, Deakin University, Geelong, Australia
| | - Lewis Burns
- School of Psychology, Deakin University, Geelong, Australia
| | | | | | - Melissa Kirkovski
- School of Psychology, Deakin University, Geelong, Australia.
- Institute for Health and Sport, Victoria University, Melbourne, VIC, Australia.
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5
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Blanchette-Sarrasin A, Saj A. [Effects of non-invasive neuromodulation on the cognitive profile of people with anorexia nervosa: A scoping review]. L'ENCEPHALE 2024; 50:339-347. [PMID: 38087685 DOI: 10.1016/j.encep.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/13/2023] [Accepted: 11/02/2023] [Indexed: 05/31/2024]
Abstract
BACKGROUND The use of non-invasive neuromodulation is emerging in the treatment of anorexia nervosa. Despite promising results, further research is needed to improve our understanding of these techniques and to adapt interventions to this population. As anorexia nervosa is associated with several cognitive difficulties and cerebral anomalies, the aim of the present study was to summarize the available data on the effects of non-invasive neuromodulation on the neuropsychological profile of people with anorexia nervosa. METHOD A scoping review was conducted by searching in PsycINFO, PubMed and CINAHL databases to systematically identify relevant studies published between 1994 and 2023 on the treatment of anorexia nervosa with repetitive transcranial magnetic stimulation, transcranial direct current stimulation or neurofeedback electroencephalogram. RESULTS Seventeen articles were included, including 12 on repetitive transcranial magnetic stimulation, four on transcranial direct current stimulation and one on neurofeedback electroencephalogram. Of these, only three studies included a neuropsychological measure to assess the impact of neuromodulation on participants' cognitive functions. CONCLUSIONS Including detailed neuropsychological measures in clinical trials of non-invasive neuromodulation is highly recommended and appears essential to improve our understanding of these techniques and optimize their efficacy in the treatment of anorexia nervosa.
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Affiliation(s)
| | - Arnaud Saj
- Département de psychologie, Université de Montréal, Montréal, Québec, H3T 1J4, Canada; Centre de recherche interdisciplinaire en réadaptation (CRIR), Institut Nazareth et Louis-Braille du CISSS de la Montérégie-Centre, Longueuil, QC J4K 5G4, Canada; Centre interdisciplinaire de recherche sur le cerveau et l'apprentissage (CIRCA), Université de Montréal, Montréal, Québec, Canada; Laboratory for Behavioral Neurology and Imaging of Cognition, Neuroscience Department, University of Geneva, 1211 Geneva, Suisse; Département des neurosciences cliniques, Université de Genève, 1205 Genève, Suisse
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Richson BN, Abber SR, Wierenga CE. Conceptualizing avoidant/restrictive food intake disorder via an executive functioning lens. Int J Eat Disord 2024. [PMID: 38804560 DOI: 10.1002/eat.24233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 05/14/2024] [Accepted: 05/15/2024] [Indexed: 05/29/2024]
Abstract
Avoidant/restrictive food intake disorder (ARFID) is a heterogeneous disorder wherein restrictive eating is primarily attributed to non-shape/weight-based reasons (e.g., sensory sensitivity) that empirical research continues to explore. Mounting evidence suggests that ARFID often presents alongside neurodevelopmental diagnoses (NDs) or divergent neurodevelopment broadly. Executive functioning (EF) differences often characterize divergent neurodevelopmental trajectories. Additionally, restrictive eating in anorexia nervosa has been conceptualized as related to EF factors (e.g., set shifting). Given the neurodevelopmental phenotype that may be associated with ARFID and the role of EF in anorexia nervosa, this paper proposes EF as a potentially important, yet understudied factor in ARFID pathology. We posit that various observed ARFID behavioral/cognitive tendencies can be conceptualized in relation to EF differences. We contextualize commonly observed ARFID presentations within "core" EF components (i.e., cognitive flexibility, working memory, inhibitory control), leading to hypotheses about EF in ARFID. Finally, we offer additional considerations/directions for future research on EF in ARFID. Increased research on EF in ARFID is needed to consider this potential common factor in the etiology and maintenance of this heterogeneous disorder. We aim to promote further consideration of EF in ARFID etiology, maintenance, and treatment-outcome research. PUBLIC SIGNIFICANCE: This article proposes that aspects of executive functioning (EF) may play a role in the onset and maintenance of avoidant/restrictive food intake disorder (ARFID), although this notion is largely untested by existing research. Further research on the role of EF in ARFID may assist with refining models and treatments for this heterogeneous disorder.
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Affiliation(s)
- Brianne N Richson
- Sanford Center for Biobehavioral Research, Sanford Research, Fargo, North Dakota, USA
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, USA
| | - Sophie R Abber
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| | - Christina E Wierenga
- Department of Psychiatry, University of California San Diego Eating Disorders Center for Treatment and Research, San Diego, California, USA
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He Q, Zheng H, Zhang J, Yue L, Kang Q, Lian C, Guo L, Chen Y, Hu Y, Wang Y, Peng S, Wang Z, Liu Q, Chen J. Association between the frontoparietal network, clinical symptoms and treatment response in individuals with untreated anorexia nervosa. Gen Psychiatr 2024; 37:e101389. [PMID: 38808176 PMCID: PMC11131127 DOI: 10.1136/gpsych-2023-101389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 04/12/2024] [Indexed: 05/30/2024] Open
Abstract
Background Anorexia nervosa (AN) has been characterised as a psychiatric disorder associated with increased control. Currently, it remains difficult to predict treatment response in patients with AN. Their cognitive abilities are known to be resistant to treatment. It has been established that the frontoparietal control network (FPCN) is the direct counterpart of the executive control network. Therefore, the resting-state brain activity of the FPCN may serve as a biomarker to predict treatment response in AN. Aims The study aimed to investigate the association between resting-state functional connectivity (RSFC) of the FPCN, clinical symptoms and treatment response in patients with AN. Methods In this case-control study, 79 female patients with AN and no prior treatment from the Shanghai Mental Health Center and 40 matched healthy controls (HCs) were recruited from January 2015 to March 2022. All participants completed the Questionnaire Version of the Eating Disorder Examination (version 6.0) to assess the severity of their eating disorder symptoms. Additionally, RSFC data were obtained from all participants at baseline by functional magnetic resonance imaging. Patients with AN underwent routine outpatient treatment at the 4th and 12th week, during which time their clinical symptoms were evaluated using the same measures as at baseline. Results Among the 79 patients, 40 completed the 4-week follow-up and 35 completed the 12-week follow-up. The RSFC from the right posterior parietal cortex (PPC) and dorsolateral prefrontal cortex (dlPFC) increased in 79 patients with AN vs 40 HCs after controlling for depression and anxiety symptoms. By multiple linear regression, the RSFC of the PPC to the inferior frontal gyrus was found to be a significant factor for self-reported eating disorder symptoms at baseline and the treatment response to cognitive preoccupations about eating and body image, after controlling for age, age of onset and body mass index. The RSFC in the dlPFC to the middle temporal gyrus and the superior frontal gyrus may be significant factors in the treatment response to binge eating and loss of control/overeating in patients with AN. Conclusions Alterations in RSFC in the FPCN appear to affect self-reported eating disorder symptoms and treatment response in patients with AN. Our findings offer new insight into the pathogenesis of AN and could promote early prevention and treatment.
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Affiliation(s)
- Qianqian He
- Department of Clinical Psychology, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Clinical Psychology, Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China
| | - Hui Zheng
- Shanghai Key Laboratory of Psychotic Disorders, Brain Health Institute, National Center for Mental Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jialin Zhang
- State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Ling Yue
- Department of Clinical Psychology, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qing Kang
- Department of Clinical Psychology, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Cheng Lian
- Department of Clinical Psychology, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lei Guo
- Department of Clinical Psychology, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Chen
- Department of Clinical Psychology, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yanran Hu
- Department of Clinical Psychology, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuping Wang
- Department of Clinical Psychology, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Sufang Peng
- Department of Clinical Psychology, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhen Wang
- Department of Clinical Psychology, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiang Liu
- Department of Clinical Psychology, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jue Chen
- Department of Clinical Psychology, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Feusner JD, Nowacka A, Ly R, Luders E, Kurth F. Corpus callosum morphology and relationships to illness phenotypes in individuals with anorexia nervosa. Sci Rep 2024; 14:11112. [PMID: 38750237 PMCID: PMC11096409 DOI: 10.1038/s41598-024-61841-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 05/10/2024] [Indexed: 05/18/2024] Open
Abstract
Anorexia nervosa is an often-severe psychiatric illness characterized by significantly low body weight, fear of gaining weight, and distorted body image. Multiple neuroimaging studies have shown abnormalities in cortical morphology, mostly associated with the starvation state. Investigations of white matter, while more limited in number, have suggested global and regional volume reductions, as well as abnormal diffusivity in multiple regions including the corpus callosum. Yet, no study has specifically examined thickness of the corpus callosum, a large white matter tract instrumental in the inter-hemispheric integration of sensory, motor, and cognitive information. We analyzed MRI data from 48 adolescents and adults with anorexia nervosa and 50 healthy controls, all girls/women, to compare corpus callosum thickness and examined relationships with body mass index (BMI), illness duration, and eating disorder symptoms (controlling for BMI). There were no significant group differences in corpus callosum thickness. In the anorexia nervosa group, severity of body shape concerns was significantly, positively correlated with callosal thickness in the rostrum, genu, rostral body, isthmus, and splenium. In addition, there were significant positive correlations between eating disorder-related obsessions and compulsions and thickness of the anterior midbody, rostral body, and splenium. There were no significant associations between callosal thickness and BMI or illness duration. In sum, those with AN with worse concerns about bodily appearance and worse eating disorder-related obsessive thought patterns and compulsive behaviours have regionally thicker corpus callosum, independent of current weight status. These findings provide important neurobiological links to key, specific eating disorder behavioural phenotypes.
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Affiliation(s)
- Jamie D Feusner
- Centre for Addiction and Mental Health, 250 College St., Toronto, ON, M5T 1R8, Canada.
- Department of Psychiatry, University of Toronto, Toronto, Canada.
- Department of Women's and Children's Health, Karolinska Hospital, Karolinska Institutet, Stockholm, Sweden.
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA.
| | - Alicja Nowacka
- School of Psychology, University of Auckland, Auckland, New Zealand
| | - Ronald Ly
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Eileen Luders
- School of Psychology, University of Auckland, Auckland, New Zealand
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Laboratory of Neuro Imaging, School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Florian Kurth
- School of Psychology, University of Auckland, Auckland, New Zealand
- Departments of Neuroradiology and Radiology, Jena University Hospital, Jena, Germany
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Bevilacqua A, Santini F, La Porta D, Cimino S. Association of serotonin receptor gene polymorphisms with anorexia nervosa: a systematic review and meta-analysis. Eat Weight Disord 2024; 29:31. [PMID: 38668826 PMCID: PMC11052845 DOI: 10.1007/s40519-024-01659-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 04/13/2024] [Indexed: 04/29/2024] Open
Abstract
PURPOSE Several studies have investigated the association between anorexia nervosa and polymorphisms of genes regulating serotonin neurotransmission, with a focus on the rs6311 polymorphism of 5-HTR2A. However, inconsistent results of these studies and conflicting conclusions of existing meta-analyses complicate the understanding of a possible association. We have updated these results and evaluated the involvement of other serotonin receptor gene polymorphisms in anorexia nervosa. METHODS Adhering to PRISMA guidelines, we have searched studies on anorexia nervosa and serotonin-regulating genes published from 1997 to 2022, selected those concerning receptor genes and meta-analyzed the results from twenty candidate gene studies on the 5-HTR2A rs6311 polymorphism and the 5-HTR2C rs6318 polymorphism. RESULTS Present analyses reveal an association for the 5-HTR2A rs6311 polymorphism, with G and A alleles, across eighteen studies (2049 patients, 2877 controls; A vs. G allele, Odds Ratio = 1.24; 95% Confidence Interval = 1.06-1.47; p = 0.009). However, after geographic subgrouping, an association emerged only in a Southern European area, involving five studies (722 patients, 773 controls; A vs. G allele, Odds Ratio = 1.82; 95% Confidence Interval = 1.41-2.37; p < 0.00001). No association was observed for the 5-HTR2C rs6318 polymorphism across three studies. CONCLUSIONS To date, the involvement in the pathophysiology of anorexia nervosa of the 5-HTR2A rs6311 polymorphism appears limited to a specific genetic and/or environmental context, while that of the 5-HTR2C rs6318 polymorphism seems excluded. Genome-wide association studies and epigenetic studies will likely offer deeper insights of genetic and environmental factors possibly contributing to the disorder. LEVEL OF EVIDENCE III Evidence obtained from well-designed cohort or case-control analytic studies. Clinical trial registration PROSPERO registration number: CRD42021246122.
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Affiliation(s)
- Arturo Bevilacqua
- Department of Dynamic, Clinical Psychology and Health Studies, Sapienza University of Rome, Via Dei Marsi 78, 00185, Rome, Italy.
- Systems Biology Group Lab and The Experts Group on Inositols in Basic and Clinical Research (EGOI), Research Center in Neurobiology Daniel Bovet (CRiN), Rome, Italy.
| | - Francesca Santini
- Department of Psychology of Development and Socialization Processes, Sapienza University of Rome, Via Dei Marsi 78, 00185, Rome, Italy
| | - Daniela La Porta
- Department of Psychology, Sapienza University of Rome, Via Dei Marsi 78, 00185, Rome, Italy
| | - Silvia Cimino
- Department of Dynamic, Clinical Psychology and Health Studies, Sapienza University of Rome, Via Dei Marsi 78, 00185, Rome, Italy
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Brooks SJ, Dahl K, Dudley-Jones R, Schiöth HB. A neuroinflammatory compulsivity model of anorexia nervosa (NICAN). Neurosci Biobehav Rev 2024; 159:105580. [PMID: 38417395 DOI: 10.1016/j.neubiorev.2024.105580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 01/31/2024] [Accepted: 02/09/2024] [Indexed: 03/01/2024]
Affiliation(s)
- S J Brooks
- Department of Surgical Sciences, Uppsala University, Sweden; School of Psychology, Liverpool John Moores University, UK; Neuroscience Research Laboratory (NeuRL), Department of Psychology, School of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa.
| | - K Dahl
- Department of Surgical Sciences, Uppsala University, Sweden
| | - R Dudley-Jones
- School of Psychology, Liverpool John Moores University, UK
| | - H B Schiöth
- Department of Surgical Sciences, Uppsala University, Sweden
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Himmerich H, Treasure J. Anorexia nervosa: diagnostic, therapeutic, and risk biomarkers in clinical practice. Trends Mol Med 2024; 30:350-360. [PMID: 38331700 DOI: 10.1016/j.molmed.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/22/2023] [Accepted: 01/12/2024] [Indexed: 02/10/2024]
Abstract
In anorexia nervosa (AN), measurable biological parameters can inform the process of treating patients. Such biomarkers include established laboratory parameters as well as a range of potential future biomarkers, including genetic, metabolomic, microbiomic, endocrine, immunological, hematological, electrophysiological, and neuroimaging parameters. In this opinion article we discuss how these biomarkers can support diagnosic and therapeutic processes at specific steps during the AN treatment cycle, that is, the diagnosis, diagnostic specification, risk management, choice of therapy, therapy monitoring, and treatment review. History-taking, physical and neuropsychological examination, clinical observation, and judgment about treatment success by the patient, their carers, and members of the multidisciplinary team are essential to interpret laboratory and imaging data appropriately and to assess the full clinical picture.
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Affiliation(s)
- Hubertus Himmerich
- Centre for Research in Eating and Weight Disorders (CREW), Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
| | - Janet Treasure
- Centre for Research in Eating and Weight Disorders (CREW), Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK.
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12
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Keeler JL, Bahnsen K, Wronski ML, Bernardoni F, Tam F, Arold D, King JA, Kolb T, Poitz DM, Roessner V, Treasure J, Himmerich H, Ehrlich S. Longitudinal changes in brain-derived neurotrophic factor (BDNF) but not cytokines contribute to hippocampal recovery in anorexia nervosa above increases in body mass index. Psychol Med 2024:1-12. [PMID: 38450444 DOI: 10.1017/s0033291724000394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
BACKGROUND Physical sequelae of anorexia nervosa (AN) include a marked reduction in whole brain volume and subcortical structures such as the hippocampus. Previous research has indicated aberrant levels of inflammatory markers and growth factors in AN, which in other populations have been shown to influence hippocampal integrity. METHODS Here we investigated the influence of concentrations of two pro-inflammatory cytokines (tumor necrosis factor-alpha [TNF-α] and interleukin-6 [IL-6]) and brain-derived neurotrophic factor (BDNF) on the whole hippocampal volume, as well as the volumes of three regions (the hippocampal body, head, and tail) and 18 subfields bilaterally. Investigations occurred both cross-sectionally between acutely underweight adolescent/young adult females with AN (acAN; n = 82) and people recovered from AN (recAN; n = 20), each independently pairwise age-matched with healthy controls (HC), and longitudinally in acAN after partial renourishment (n = 58). Hippocampal subfield volumes were quantified using FreeSurfer. Concentrations of molecular factors were analyzed in linear models with hippocampal (subfield) volumes as the dependent variable. RESULTS Cross-sectionally, there was no evidence for an association between IL-6, TNF-α, or BDNF and between-group differences in hippocampal subfield volumes. Longitudinally, increasing concentrations of BDNF were positively associated with longitudinal increases in bilateral global hippocampal volumes after controlling for age, age2, estimated total intracranial volume, and increases in body mass index (BMI). CONCLUSIONS These findings suggest that increases in BDNF may contribute to global hippocampal recovery over and above increases in BMI during renourishment. Investigations into treatments targeted toward increasing BDNF in AN may be warranted.
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Affiliation(s)
- Johanna Louise Keeler
- Centre for Research in Eating and Weight Disorders (CREW), Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Klaas Bahnsen
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Marie-Louis Wronski
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Dresden, Germany
- Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Fabio Bernardoni
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Friederike Tam
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Dresden, Germany
- Eating Disorder Treatment and Research Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Dominic Arold
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Joseph A King
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Theresa Kolb
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - David M Poitz
- Institute for Clinical Chemistry and Laboratory Medicine, TU Dresden, Dresden, Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Janet Treasure
- Centre for Research in Eating and Weight Disorders (CREW), Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Hubertus Himmerich
- Centre for Research in Eating and Weight Disorders (CREW), Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Stefan Ehrlich
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Dresden, Germany
- Eating Disorder Treatment and Research Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Dresden, Germany
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Forester G, Johnson JS, Reilly EE, Lloyd EC, Johnson E, Schaefer LM. Back to the future: Progressing memory research in eating disorders. Int J Eat Disord 2023; 56:2032-2048. [PMID: 37594119 PMCID: PMC10843822 DOI: 10.1002/eat.24045] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/17/2023] [Accepted: 08/02/2023] [Indexed: 08/19/2023]
Abstract
OBJECTIVE Human behaviors, thoughts, and emotions are guided by memories of the past. Thus, there can be little doubt that memory plays a fundamental role in the behaviors (e.g., binging), thoughts (e.g., body-image concerns), and emotions (e.g., guilt) that characterize eating disorders (EDs). Although a growing body of research has begun to investigate the role of memory in EDs, this literature is limited in numerous ways and has yet to be integrated into an overarching framework. METHODS In the present article, we provide an operational framework for characterizing different domains of memory, briefly review existing ED memory research within this framework, and highlight crucial gaps in the literature. RESULTS We distinguish between three domains of memory-episodic, procedural, and working-which differ based on functional attributes and underlying neural systems. Most recent ED memory research has focused on procedural memory broadly defined (e.g., reinforcement learning), and findings within all three memory domains are highly mixed. Further, few studies have attempted to assess these different domains simultaneously, though most behavior is achieved through coordination and competition between memory systems. We, therefore, offer recommendations for how to move ED research forward within each domain of memory and how to study the interactions between memory systems, using illustrative examples from other areas of basic and clinical research. DISCUSSION A stronger and more integrated understanding of the mechanisms that connect memory of past experiences to present ED behavior may yield more comprehensive theoretical models of EDs that guide novel treatment approaches. PUBLIC SIGNIFICANCE Memories of previous eating-related experiences may contribute to the onset and maintenance of eating disorders (EDs). However, research on the role of memory in EDs is limited, and distinct domains of ED memory research are rarely connected. We, therefore, offer a framework for organizing, progressing, and integrating ED memory research, to provide a better foundation for improving ED treatment and intervention going forward.
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Affiliation(s)
- Glen Forester
- Center for Biobehavioral Research, Sanford Research, Fargo, North Dakota, USA
| | - Jeffrey S. Johnson
- Center for Biobehavioral Research, Sanford Research, Fargo, North Dakota, USA
- Department of Psychology, North Dakota State University, Fargo, North Dakota, USA
| | - Erin E. Reilly
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
| | - E. Caitlin Lloyd
- Columbia University Irving Medical Center, New York, New York, USA
- New York State Psychiatric Institute, New York, New York, USA
| | - Emily Johnson
- Department of Psychology, North Dakota State University, Fargo, North Dakota, USA
| | - Lauren M. Schaefer
- Center for Biobehavioral Research, Sanford Research, Fargo, North Dakota, USA
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota, USA
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14
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Hemmingsen SD, Lichtenstein MB, Sjögren M, Gudex C, Larsen PV, Støving RK. Cognitive performance in hospitalized patients with severe or extreme anorexia nervosa. Eat Weight Disord 2023; 28:86. [PMID: 37864583 PMCID: PMC10590307 DOI: 10.1007/s40519-023-01585-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 06/29/2023] [Indexed: 10/23/2023] Open
Abstract
PURPOSE Severe malnourishment may reduce cognitive performance in anorexia nervosa (AN). We studied cognitive functioning during intensive nutritional and medical stabilization in patients with severe or extreme AN and investigated associations between weight gain and cognitive improvement. METHODS A few days after admission to a specialized hospital unit, 33 patients with severe or extreme AN, aged 16-42 years, completed assessments of memory, cognitive flexibility, processing speed, and attention. Mean hospitalization was 6 weeks. Patients completed the same assessments at discharge (n = 22) following somatic stabilization and follow-up up to 6 months after discharge (n = 18). RESULTS The patients displayed normal cognitive performance at admission compared to normative data. During nutritional stabilization, body weight increased (mean: 11.3%; range 2.6-22.2%) and memory, attention, and processing speed improved (p values: ≤ 0.0002). No relationship between weight gain and cognitive improvement was observed at discharge or follow-up. CONCLUSIONS Cognitive performance at hospital admission was normal in patients with severe or extreme AN and improved during treatment although without association to weight gain. Based on these results, which are in line with previous studies, patients with severe or extreme AN need not be excluded from cognitively demanding tasks, possibly including psychotherapy. As patients may have other symptoms that interfere with psychotherapy, future research could investigate cognitive functioning in everyday life in patients with severe AN. TRIAL REGISTRATION NUMBER The study is registered at clinicaltrials.gov (NCT02502617). LEVEL OF EVIDENCE Level III, cohort study.
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Affiliation(s)
- Simone Daugaard Hemmingsen
- Centre for Eating Disorders, Odense University Hospital, Odense, Denmark.
- Research Unit for Medical Endocrinology, Odense University Hospital, Odense, Denmark.
- Research Unit, Child and Adolescent Psychiatry, Mental Health Services in the Region of Southern Denmark, Odense, Denmark.
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
- Open Patient Data Explorative Network (OPEN), Odense, Denmark.
| | - Mia Beck Lichtenstein
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Centre for Digital Psychiatry, Region of Southern Denmark, Odense, Denmark
| | - Magnus Sjögren
- Institute for Clinical Science, Department of Psychiatry, Umeå University, Umeå, Sweden
| | - Claire Gudex
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Open Patient Data Explorative Network (OPEN), Odense, Denmark
| | - Pia Veldt Larsen
- Mental Health Services in the Region of Southern Denmark, Vejle, Denmark
| | - René Klinkby Støving
- Centre for Eating Disorders, Odense University Hospital, Odense, Denmark
- Research Unit for Medical Endocrinology, Odense University Hospital, Odense, Denmark
- Research Unit, Child and Adolescent Psychiatry, Mental Health Services in the Region of Southern Denmark, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Open Patient Data Explorative Network (OPEN), Odense, Denmark
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15
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Lie SØ, Wisting L, Stedal K, Rø Ø, Friborg O. Stressful life events and resilience in individuals with and without a history of eating disorders: a latent class analysis. J Eat Disord 2023; 11:184. [PMID: 37845712 PMCID: PMC10577902 DOI: 10.1186/s40337-023-00907-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 10/04/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Eating disorders (EDs) are associated with a range of stressful life events, but few have investigated protective factors that may affect these associations. The current study used mixture modelling to describe typologies in life stress exposure and availability of protective resources in individuals with and without eating disorders (EDs). METHODS A case - control sample (n = 916) completed measures of stressful life events, resilience protective factors, emotion regulation, and symptoms of EDs, depression and anxiety. We conducted latent class analyses to identify subgroups of stress exposure and profile analyses of emotional regulation and resilience. The resulting two latent variables were combined to explore effects on ED status and symptomatology, depression, and anxiety as distal outcome variables. RESULTS We identified four classes of stressful life events (generally low, some abuse/bullying, sexual/emotional assaults, and high adversity). For protective resources, we identified six profiles that ranged from low to higher levels of protection with variations in social/family resources. The latent protection variable contributed more strongly to the distal outcomes than the latent stress variable, but did not moderate the latent stress and distal outcome variable relationships. Profiles characterized by lower protective resources included higher proportions of individuals with a lifetime ED, and were associated with higher scores on all symptom measures. CONCLUSIONS Intra- and interpersonal protective resources were strongly associated with lifetime EDs and current mental health symptom burden after accounting for stressful event exposure, suggesting protective factors may be useful to target in the clinical treatment of patients with ED.
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Affiliation(s)
- Selma Øverland Lie
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4956, 0424, Nydalen, Oslo, Norway.
| | - Line Wisting
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4956, 0424, Nydalen, Oslo, Norway
| | - Kristin Stedal
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4956, 0424, Nydalen, Oslo, Norway
| | - Øyvind Rø
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4956, 0424, Nydalen, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Oddgeir Friborg
- Faculty of Health Sciences Department of Psychology, UiT - The Arctic University of Norway, Tromsø, Norway
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16
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Keeler JL, Kan C, Treasure J, Himmerich H. Novel treatments for anorexia nervosa: Insights from neuroplasticity research. EUROPEAN EATING DISORDERS REVIEW 2023. [PMID: 37823233 DOI: 10.1002/erv.3039] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/29/2023] [Accepted: 10/01/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVE Treatment for anorexia nervosa (AN) remains challenging; there are no approved psychopharmacological interventions and psychotherapeutic strategies have variable efficacy. The investigation of evidence-based treatments has so far been compounded by an underdeveloped understanding into the neurobiological changes associated with the acute stages of AN. There is converging evidence of deficiencies in neuroplasticity in AN. METHOD This paper provides an overview of neuroimaging, neuropsychological, molecular and qualitative findings relating to neuroplasticity in AN, translating these findings to the identification of novel biological and psychotherapeutic strategies. RESULTS Novel psychopharmacological approaches that may ameliorate deficiencies in neuroplasticity include medications such as ketamine, psilocybin and human recombinant leptin. Anti-inflammatory medications and brain-derived neurotrophic factor mimetics may emerge as potential treatments following further research. Psychotherapeutic strategies that may target neuroplastic deficiencies, as well as having wider effects on identity, include imagery rescripting, memory specificity training, cognitive remediation therapy, exposure therapies, narrative therapies, cultural interventions (e.g. music and arts therapies) and yoga/mindfulness-based interventions. CONCLUSIONS Treatments specifically targeted towards mitigating the neurobiological sequalae of AN are warranted, and emerging neurobiological and neuropsychological research utilising longitudinal designs and large sample sizes, as well as initial feasibility studies, are necessitated to bolster translational efforts.
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Affiliation(s)
- Johanna Louise Keeler
- King's College London, Centre for Research in Eating and Weight Disorders (CREW), Institute of Psychiatry, Psychology & Neuroscience, Department of Psychological Medicine, London, UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Kent, UK
| | - Carol Kan
- Vincent Square Eating Disorder Service, London, UK
| | - Janet Treasure
- King's College London, Centre for Research in Eating and Weight Disorders (CREW), Institute of Psychiatry, Psychology & Neuroscience, Department of Psychological Medicine, London, UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Kent, UK
| | - Hubertus Himmerich
- King's College London, Centre for Research in Eating and Weight Disorders (CREW), Institute of Psychiatry, Psychology & Neuroscience, Department of Psychological Medicine, London, UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Kent, UK
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17
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Dann KM, Veldre A, Miles S, Sumner P, Hay P, Touyz S. Measuring cognitive flexibility in anorexia nervosa: Wisconsin Card Sorting Test versus cued task-switching. Eat Weight Disord 2023; 28:60. [PMID: 37463996 DOI: 10.1007/s40519-023-01589-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 07/10/2023] [Indexed: 07/20/2023] Open
Abstract
PURPOSE The Wisconsin Card Sorting Test (WCST) is the most common measure of cognitive flexibility in anorexia nervosa (AN), but task-switching paradigms are beginning to be utilized. The current study directly compared performance on a cued task-switching measure and the WCST to evaluate their association in participants with a lifetime diagnosis of AN, and to assess which measure is more strongly associated with clinical symptoms. METHODS Forty-five women with a lifetime diagnosis of AN completed the WCST, cued color-shape task-switching paradigm, Anti-saccade Keyboard Task, Running Memory Span, Eating Disorder Examination Questionnaire, Depression Anxiety Stress Scales short form and Eating Disorder Flexibility Index. RESULTS There was no evidence of a significant association between WCST perseverative errors and cued task-switching switch costs. Results suggest lower working memory capacity is a determinant of higher perseverative error rate. When controlling for mood variables, neither cognitive flexibility measure was a significant independent predictor of symptom severity. CONCLUSIONS Results provide support for previous suggestions that WCST perseverative errors could occur due to difficulties with working memory, sensitivity to feedback, and issues with concept formation. Cued task-switching paradigms may provide a useful measure of cognitive flexibility for future eating disorders research by reducing task-specific confounds. LEVEL OF EVIDENCE Level III Case-control analytic study.
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Affiliation(s)
- Kelly M Dann
- School of Psychology, The University of Sydney, Brennan MacCallum Building (A18), Sydney, NSW, 2006, Australia.
- Faculty of Medicine and Health, InsideOut Institute for Eating Disorders, The University of Sydney and Sydney Local Area Health District, Sydney, Australia.
| | - Aaron Veldre
- School of Psychology, The University of Sydney, Brennan MacCallum Building (A18), Sydney, NSW, 2006, Australia
- School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Stephanie Miles
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Philip Sumner
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University and Mental Health Services SWSLHD, Campbelltown, Australia
| | - Stephen Touyz
- Faculty of Medicine and Health, InsideOut Institute for Eating Disorders, The University of Sydney and Sydney Local Area Health District, Sydney, Australia
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Fietz J, Pöhlchen D, Brückl TM, Brem AK, Padberg F, Czisch M, Sämann PG, Spoormaker VI. Data-Driven Pupil Response Profiles as Transdiagnostic Readouts for the Detection of Neurocognitive Functioning in Affective and Anxiety Disorders. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2023:S2451-9022(23)00149-0. [PMID: 37348604 DOI: 10.1016/j.bpsc.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 05/22/2023] [Accepted: 06/12/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Neurocognitive functioning is a relevant transdiagnostic dimension in psychiatry. As pupil size dynamics track cognitive load during a working memory task, we aimed to explore if this parameter allows identification of psychophysiological subtypes in healthy participants and patients with affective and anxiety disorders. METHODS Our sample consisted of 226 participants who completed the n-back task during simultaneous functional magnetic resonance imaging and pupillometry measurements. We used latent class growth modeling to identify clusters based on pupil size in response to cognitive load. In a second step, these clusters were compared on affective and anxiety symptom levels, performance in neurocognitive tests, and functional magnetic resonance imaging activity. RESULTS The clustering analysis resulted in two distinct pupil response profiles: one with a stepwise increasing pupil size with increasing cognitive load (reactive group) and one with a constant pupil size across conditions (nonreactive group). A larger increase in pupil size was significantly associated with better performance in neurocognitive tests in executive functioning and sustained attention. Statistical maps of parametric modulation of pupil size during the n-back task showed the frontoparietal network in the positive contrast and the default mode network in the negative contrast. The pupil response profile of the reactive group was associated with more thalamic activity, likely reflecting better arousal upregulation and less deactivation of the limbic system. CONCLUSIONS Pupil measurements have the potential to serve as a highly sensitive psychophysiological readout for detection of neurocognitive deficits in the core domain of executive functioning, adding to the development of valid transdiagnostic constructs in psychiatry.
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Affiliation(s)
- Julia Fietz
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany; International Max Planck Research School for Translational Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
| | - Dorothee Pöhlchen
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany; International Max Planck Research School for Translational Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
| | - Tanja M Brückl
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
| | - Anna-Katharine Brem
- University Hospital of Old Age Psychiatry, University of Bern, Bern, Switzerland; Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | | | | | - Victor I Spoormaker
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany.
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19
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Hemmingsen SD, Daugaard N, Sjögren M, Lichtenstein MB, Gudex C, Piil F, Støving RK. Cognitive Flexibility in Hospitalized Patients with Severe or Extreme Anorexia Nervosa: A Case-Control Study. J Pers Med 2023; 13:1000. [PMID: 37373990 DOI: 10.3390/jpm13061000] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/08/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
OBJECTIVE To investigate whether cognitive inflexibility could be identified using the Wisconsin Card Sorting Test (WCST) in patients with severe and extreme anorexia nervosa (AN) compared to healthy control participants (HCs). METHOD We used the WCST to assess 34 patients with AN (mean age: 25.9 years, mean body mass index (BMI): 13.2 kg/m2) 3-7 days after admission to a specialized nutrition unit and 34 HCs. The Beck Depression Inventory II and the Eating Disorder Inventory 3 were distributed. RESULTS The patients displayed more perseveration than HCs controlled for age and years of education, with moderate effect sizes (perseverative responses (%): adjusted difference = -7.74, 95% CI: -14.29-(-1.20), p-value: 0.021; perseverative errors (%): adjusted difference = -6.01, 95% CI: -11.06-(-0.96), p-value: 0.020). There were no significant relationships between perseveration and depression, eating disorder symptoms, illness duration, or BMI. DISCUSSION Patients with severe and extreme AN demonstrated lower cognitive flexibility compared to HCs. Performance was not related to psychopathology or BMI. Patients with severe and extreme anorexia nervosa may not differ from less severe patients in cognitive flexibility performance. As this study exclusively focused on patients suffering from severe and extreme AN, potential correlations might be masked by a floor effect.
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Affiliation(s)
- Simone Daugaard Hemmingsen
- Centre for Eating Disorders, Odense University Hospital, 5000 Odense, Denmark
- Research Unit for Medical Endocrinology, Odense University Hospital, 5000 Odense, Denmark
- Research Unit, Child and Adolescent Psychiatry, Mental Health Services in the Region of Southern Denmark, 5000 Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark
- Open Patient Data Explorative Network (OPEN), 5000 Odense, Denmark
| | - Nicolaj Daugaard
- Department of Molecular Medicine, University of Southern Denmark, 5000 Odense, Denmark
| | - Magnus Sjögren
- Institute for Clinical Science, Department of Psychiatry, Umeå University, 901 87 Umeå, Sweden
| | - Mia Beck Lichtenstein
- Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark
- Centre for Digital Psychiatry, Region of Southern Denmark, 5000 Odense, Denmark
| | - Claire Gudex
- Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark
- Open Patient Data Explorative Network (OPEN), 5000 Odense, Denmark
| | - Frederikke Piil
- Centre for Eating Disorders, Odense University Hospital, 5000 Odense, Denmark
- Research Unit for Medical Endocrinology, Odense University Hospital, 5000 Odense, Denmark
- Research Unit, Child and Adolescent Psychiatry, Mental Health Services in the Region of Southern Denmark, 5000 Odense, Denmark
| | - René Klinkby Støving
- Centre for Eating Disorders, Odense University Hospital, 5000 Odense, Denmark
- Research Unit for Medical Endocrinology, Odense University Hospital, 5000 Odense, Denmark
- Research Unit, Child and Adolescent Psychiatry, Mental Health Services in the Region of Southern Denmark, 5000 Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark
- Open Patient Data Explorative Network (OPEN), 5000 Odense, Denmark
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20
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Elwyn R, Mitchell J, Kohn MR, Driver C, Hay P, Lagopoulos J, Hermens DF. Novel ketamine and zinc treatment for anorexia nervosa and the potential beneficial interactions with the gut microbiome. Neurosci Biobehav Rev 2023; 148:105122. [PMID: 36907256 DOI: 10.1016/j.neubiorev.2023.105122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 03/04/2023] [Accepted: 03/07/2023] [Indexed: 03/13/2023]
Abstract
Anorexia nervosa (AN) is a severe illness with diverse aetiological and maintaining contributors including neurobiological, metabolic, psychological, and social determining factors. In addition to nutritional recovery, multiple psychological and pharmacological therapies and brain-based stimulations have been explored; however, existing treatments have limited efficacy. This paper outlines a neurobiological model of glutamatergic and γ-aminobutyric acid (GABA)-ergic dysfunction, exacerbated by chronic gut microbiome dysbiosis and zinc depletion at a brain and gut level. The gut microbiome is established early in development, and early exposure to stress and adversity contribute to gut microbial disturbance in AN, early dysregulation to glutamatergic and GABAergic networks, interoceptive impairment, and inhibited caloric harvest from food (e.g., zinc malabsorption, competition for zinc ions between gut bacteria and host). Zinc is a key part of glutamatergic and GABAergic networks, and also affects leptin and gut microbial function; systems dysregulated in AN. Low doses of ketamine in conjunction with zinc, could provide an efficacious combination to act on NMDA receptors and normalise glutamatergic, GABAergic and gut function in AN.
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Affiliation(s)
- Rosiel Elwyn
- Thompson Institute, University of the Sunshine Coast, Birtinya, QLD, Australia; SouthWest Sydney Local Health District, Liverpool Hospital, Liverpool, NSW, Australia.
| | - Jules Mitchell
- Thompson Institute, University of the Sunshine Coast, Birtinya, QLD, Australia; SouthWest Sydney Local Health District, Liverpool Hospital, Liverpool, NSW, Australia
| | - Michael R Kohn
- AYA Medicine Westmead Hospital, CRASH (Centre for Research into Adolescent's Health) Western Sydney Local Health District, Sydney University, Australia; SouthWest Sydney Local Health District, Liverpool Hospital, Liverpool, NSW, Australia
| | - Christina Driver
- Thompson Institute, University of the Sunshine Coast, Birtinya, QLD, Australia; SouthWest Sydney Local Health District, Liverpool Hospital, Liverpool, NSW, Australia
| | - Phillipa Hay
- Translational Health Research Institute (THRI) School of Medicine, Western Sydney University, Campbelltown, NSW, Australia; SouthWest Sydney Local Health District, Liverpool Hospital, Liverpool, NSW, Australia
| | - Jim Lagopoulos
- Thompson Institute, University of the Sunshine Coast, Birtinya, QLD, Australia; SouthWest Sydney Local Health District, Liverpool Hospital, Liverpool, NSW, Australia
| | - Daniel F Hermens
- Thompson Institute, University of the Sunshine Coast, Birtinya, QLD, Australia; SouthWest Sydney Local Health District, Liverpool Hospital, Liverpool, NSW, Australia
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21
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Terhoeven V, Faschingbauer S, Huber J, Herzog W, Friederich HC, Simon JJ, Nikendei C. Verbal memory following weight gain in adult patients with anorexia nervosa: A longitudinal study. EUROPEAN EATING DISORDERS REVIEW 2023; 31:271-284. [PMID: 36397677 DOI: 10.1002/erv.2956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 10/19/2022] [Accepted: 10/27/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Patients with Anorexia Nervosa (AN) show a moderate deficit in overall neuropsychological functioning. Since previous studies on memory performance mainly employed cross-sectional designs, the present study aims to investigate changes in verbal memory following weight-gain. METHODS Verbal memory was assessed with the Wechsler Memory Scale-Revised (WMS-R; 'logical memory'-story-recall-subtest) and the California Verbal Learning Test-II (CVLT-II; 'verbal learning'). Included were 31 female patients with AN (18 restricting-, 13 purging-subtype; average disease duration: 5.1 years; average baseline BMI: 14.4 kg/m2 ) and 24 medication-free normal-weight healthy women adjusted for age at baseline (T0). In a post-treatment assessment of approx. 6 weeks with weight increase (T1), 18 patients with AN and 20 healthy women were assessed again. Group differences in verbal memory (i.e., WMS-R, CVLT-II) were assessed for the baseline comparisons with a multivariate ANOVA and longitudinal data were analysed with repeated measures (RM) ANOVAs. RESULTS At baseline, patients with AN as compared to healthy women displayed deficits in logical memory. In the follow-up assessment, patients with AN improved their logical memory significantly compared to healthy controls (p < 0.006). Furthermore, groups did not differ in verbal learning neither before nor after inpatient treatment. CONCLUSIONS Enhanced logical memory in patients with AN following weight-gain is probably due to the impaired memory as compared to healthy controls at T0. A survivorship bias could explain the improved memory performance in longitudinal data in contrast to cross-sectional studies. Patients with AN with poorer memory performance before inpatient treatment are at higher risk to drop out and need support.
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Affiliation(s)
- Valentin Terhoeven
- Department for General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Sandra Faschingbauer
- Department for General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Julia Huber
- Institute of Medical Psychology, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
| | - Wolfgang Herzog
- Department for General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department for General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Joe J Simon
- Department for General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Christoph Nikendei
- Department for General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
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22
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Collantoni E, Meregalli V, Manara R, Meneguzzo P, Tenconi E, Favaro A. Volume and complexity of the thalamus in Anorexia Nervosa: An exploratory evaluation. EUROPEAN EATING DISORDERS REVIEW 2023; 31:349-359. [PMID: 36573401 DOI: 10.1002/erv.2965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/30/2022] [Accepted: 12/13/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Recent neuroscientific findings have highlighted the role of the thalamus in several cognitive functions, ranging from perception to cognitive flexibility, memory, and body representation. Since some of these functions may be involved in the pathophysiology of Anorexia Nervosa (AN), this study aims at exploring thalamic structure in different phases of the disorder. METHOD The sample included 38 patients with acute AN, 20 patients who fully recovered from AN (recAN), and 38 healthy controls (HC), all female. All participants underwent high-resolution MRI. The volumes of the whole thalamus and 25 thalamic nuclei were extracted using an automated segmentation algorithm, and thalamic fractal dimension was estimated using the calcFD toolbox. RESULTS Patients with acute AN, compared to HC, displayed reduced thalamic volume and complexity both at the whole level and at the level of specific nuclei. In patients recAN, instead, alterations were observed only at the level of the right laterodorsal and central lateral nuclei. CONCLUSIONS In the acute phase of the disorder patients with AN present a widespread reduction in thalamic volume and complexity. However, these alterations seem to normalise almost completely following weight restoration, thus suggesting the involvement of malnutrition-related mechanisms.
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Affiliation(s)
- Enrico Collantoni
- Department of Neurosciences, University of Padua, Padova, Italy.,Padua Neuroscience Center, University of Padua, Padova, Italy
| | - Valentina Meregalli
- Department of Neurosciences, University of Padua, Padova, Italy.,Padua Neuroscience Center, University of Padua, Padova, Italy
| | - Renzo Manara
- Department of Neurosciences, University of Padua, Padova, Italy
| | - Paolo Meneguzzo
- Department of Neurosciences, University of Padua, Padova, Italy.,Padua Neuroscience Center, University of Padua, Padova, Italy
| | - Elena Tenconi
- Department of Neurosciences, University of Padua, Padova, Italy.,Padua Neuroscience Center, University of Padua, Padova, Italy
| | - Angela Favaro
- Department of Neurosciences, University of Padua, Padova, Italy.,Padua Neuroscience Center, University of Padua, Padova, Italy
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23
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Diaz-Marsa M, Pemau A, de la Torre-Luque A, Vaz-Leal F, Rojo-Moreno L, Beato-Fernandez L, Graell M, Carrasco-Diaz A, Carrasco JL. Executive dysfunction in eating disorders: Relationship with clinical features. Prog Neuropsychopharmacol Biol Psychiatry 2023; 120:110649. [PMID: 36181959 DOI: 10.1016/j.pnpbp.2022.110649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 09/09/2022] [Accepted: 09/25/2022] [Indexed: 10/14/2022]
Abstract
UNLABELLED Eating disorders (ED) are severe mental disorders that may result in significant functional impairment and disability. Neuropsychological studies have consistently found impaired executive function (EF) among ED patients. EF is particularly involved in fundamental skills of daily living and in behavioral and emotional regulation. In this study, impairment of executive functioning is investigated in patients with eating disorders and the associations with clinical features and clinical subtypes are analyzed. METHOD 75 female patients (m = 22.01 years, sd = 9.15) with eating disorder (43 restrictive anorexia, 30 binge-eating anorexia and 13 bulimia nervosa) and 37 healthy controls (m = 18.54 years, sd = 4.21) were included in the study. An extensive assessment of executive function domains (verbal fluency, set shifting, attention span, selective attention, working memory, inhibitory control and processing speed) was carried out in both groups. Clinical scales for food intake restriction, binge-eating/purging, depression, anxiety and impulsivity were also administered and correlated with scores on executive function tests. RESULTS Patients with an ED had significantly lower scores than healthy controls in performance of several executive function tests, particularly in set shifting, interference control and processing speed (p < .01, in all three domains). Executive function impairment was related to anxious, depressive and eating disorder symptoms (p < .05), regardless of clinical subtype. CONCLUSIONS Executive function impairment in eating disorders is associated with greater ED symptomatic severity and might involve a negative treatment outcome. Therefore, cognitive remediation techniques should probably be considered in a number of severe patients with ED.
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Affiliation(s)
- Marina Diaz-Marsa
- Centre for Biomedical Research in Mental Health (CIBERSAM), Spain; School of Medicine, Universidad Complutense de Madrid, Spain; Hospital Clínico San Carlos, Spain
| | - Andres Pemau
- Faculty of Psychology, Universidad Complutense de Madrid, Spain.
| | - Alejandro de la Torre-Luque
- Centre for Biomedical Research in Mental Health (CIBERSAM), Spain; School of Medicine, Universidad Complutense de Madrid, Spain
| | | | | | | | - Montserrat Graell
- Centre for Biomedical Research in Mental Health (CIBERSAM), Spain; Hospital Universitario Niño Jesus, Spain
| | | | - Jose Luis Carrasco
- Centre for Biomedical Research in Mental Health (CIBERSAM), Spain; School of Medicine, Universidad Complutense de Madrid, Spain; Hospital Clínico San Carlos, Spain
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24
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Keeler JL, Konyn CY, Treasure J, Cardi V, Himmerich H, Tchanturia K, Mycroft H. "Your mind doesn't have room for anything else": a qualitative study of perceptions of cognitive functioning during and after recovery from anorexia nervosa. J Eat Disord 2022; 10:201. [PMID: 36575533 PMCID: PMC9793561 DOI: 10.1186/s40337-022-00723-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 12/14/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Past research has indicated the presence of cognitive difficulties in individuals with anorexia nervosa (AN), although it is unclear how these are experienced in real life. Moreover, it is unclear how and whether the experience of cognitive difficulties changes in nature and intensity over the course of the illness and following recovery. METHODS Twenty-one female participants (AN = 11; recovered AN = 10) participated in online semi-structured interviews, utilising open-ended questions and exploring topics relating to their experiences of their cognitive function, changes over time and their perspectives on the future. Reflexive thematic analysis was conducted on the resulting transcripts. RESULTS Six themes were identified, centred around the effects of the illness on mental and physical function, cognition, adaptation to living with the illness, similarities between AN and other psychopathology, tentative optimism for the future and recovery as a representation of liberation. Whilst respondents with AN appeared to perform remarkably well in their professional and educational lives, the cognitive difficulties were described as significantly impacting their ability to engage in life, particularly in the context of leisure and socialising. Respondents recovered from AN noted the importance of developing a non-AN identity as well as better emotion-regulation skills as central to recovery. CONCLUSIONS Whilst people with AN may be able to adapt their lives to the demands of the illness, they report significant cognitive difficulties that interfere with their engagement in many aspects of daily life. This should be considered by professionals working in the clinical management of AN. Treatments focused on ameliorating cognitive difficulties, and promoting emotional regulation and identity in AN are warranted.
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Affiliation(s)
- Johanna Louise Keeler
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 103 Denmark Hill, Section of Eating Disorders, London, SE5 8AF, UK.
| | - Carol Yael Konyn
- Department of Social, Genetic & Developmental Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AF, UK
| | - Janet Treasure
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 103 Denmark Hill, Section of Eating Disorders, London, SE5 8AF, UK.,Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust, Monks Orchard Road, Beckenham, Kent, BR3 3BX, UK
| | - Valentina Cardi
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 103 Denmark Hill, Section of Eating Disorders, London, SE5 8AF, UK.,Department of General Psychology, University of Padova, Padua, Italy
| | - Hubertus Himmerich
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 103 Denmark Hill, Section of Eating Disorders, London, SE5 8AF, UK.,Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust, Monks Orchard Road, Beckenham, Kent, BR3 3BX, UK
| | - Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 103 Denmark Hill, Section of Eating Disorders, London, SE5 8AF, UK.,Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust, Monks Orchard Road, Beckenham, Kent, BR3 3BX, UK.,Illia State University, Tbilisi, Georgia.,Psychological Set Research and Correction Center, Tbilisi State Medical University, Tbilisi, Georgia
| | - Hazel Mycroft
- School of Psychology, University of Exeter, Exeter, Devon, UK
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25
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Keeler JL, Peters-Gill G, Treasure J, Himmerich H, Tchanturia K, Cardi V. Difficulties in retrieving specific details of autobiographical memories and imagining positive future events in individuals with acute but not remitted anorexia nervosa. J Eat Disord 2022; 10:172. [PMID: 36401319 PMCID: PMC9675114 DOI: 10.1186/s40337-022-00684-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 10/31/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The factors that contribute to the maintenance of anorexia nervosa (AN) are not fully understood, although it is generally accepted that depression is a core feature and contributes to poor prognosis. Individuals with depression tend to have difficulties in producing specific details of autobiographical memories and future episodes. Our aim was to investigate autobiographical memory and episodic future thinking (EFT) in individuals with AN (n = 46), people recovered from AN (recAN; n = 40), and non-affected controls (n = 35). METHOD Using a remotely administered computerised version of the autobiographical memory test and episodic future thinking task, we measured six aspects of memory retrieval and EFT generation: specificity, detailedness, difficulty in remembering/imagining, positivity, vividness and realism. Memory and EFT cue valence was manipulated; cues were either positive, neutral, or disorder-related/negative. As the production of EFTs is theoretically linked to the ability to retrieve autobiographical memories, the relationship between autobiographical memory specificity and EFT specificity was explored. To investigate whether autobiographical memory and EFT performance were independent of performance on other forms of cognition, working memory, verbal fluency and cognitive flexibility were measured. RESULTS People with AN had difficulties retrieving specific details of autobiographical memories and rated autobiographical memories as less positive overall, and less vivid when primed by positive cues. People with a lifetime diagnosis (currently ill or recovered) reported greater difficulty in retrieving memories. The AN group generated less positive EFTs, particularly to positive and neutral cues. Comorbid depressive symptoms had some contribution to the observed findings. Lastly, in all groups autobiographical memory specificity predicted EFT specificity. DISCUSSION Problems with retrieving specific details of autobiographical memories and simulating positive EFTs may be a state feature of AN. Treatments targeted at alleviating depressive symptoms, as well those targeted towards facilitating memory retrieval or reconsolidation, and the construction of positive EFTs, may contribute to hope for recovery and strengthen the sense of self beyond the disorder.
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Affiliation(s)
- Johanna Louise Keeler
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 103 Denmark Hill, London, SE5 8AF, UK.
| | | | - Janet Treasure
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 103 Denmark Hill, London, SE5 8AF, UK.,South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, BR3 3BX, UK
| | - Hubertus Himmerich
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 103 Denmark Hill, London, SE5 8AF, UK.,South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, BR3 3BX, UK
| | - Kate Tchanturia
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 103 Denmark Hill, London, SE5 8AF, UK.,South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, BR3 3BX, UK.,Illia State University, Tbilisi, Georgia.,Psychological Set Research and Correction Center, Tbilisi State Medical University, Tbilisi, Georgia
| | - Valentina Cardi
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 103 Denmark Hill, London, SE5 8AF, UK.,Department of General Psychology, University of Padova, Padua, Italy
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26
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Dann KM, Veldre A, Hay P, Touyz S, Andrews S. Assessing cognitive flexibility in anorexia nervosa using eye tracking: A registered report. Int J Eat Disord 2022; 55:1411-1417. [PMID: 35841161 PMCID: PMC9796072 DOI: 10.1002/eat.23779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 07/01/2022] [Accepted: 07/01/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Cognitive flexibility research in anorexia nervosa (AN) has primarily focused on group differences between clinical and control participants, but research in the general population utilizing the mixed pro- anti-saccade flexibility task has demonstrated individual differences in trait anxiety are a determinant of switching performance, and switching impairments are more pronounced for keypress than saccadic (eye-movement) responses. The aim of the current research is to explore trait anxiety and differences in saccadic and keypress responding as potential determinants of performance on flexibility tasks in AN. METHOD We will compare performance on the mixed pro- anti-saccade paradigm between female adult participants with a current diagnosis of AN and matched control participants, observing both saccadic and keypress responses while controlling for trait anxiety (State - Trait Anxiety Inventory) and spatial working memory (Corsi Block Tapping Test). Associations with eating disorder-related symptoms (Eating Disorder Examination Questionnaire), flexibility in everyday life (Eating Disorder Flexibility Index), and the Clinical Perfectionism Questionnaire will also be assessed. RESULTS Data which controls for individual differences in trait anxiety and assesses flexibility at both the task- and response-set level may be used to more accurately understand differences in performance on cognitive flexibility tasks by participants with AN. DISCUSSION Clarifying the effects of trait anxiety on flexibility, and differences between task- and response-set switching may advance our understanding of how cognitive flexibility relates to flexibility in everyday life and improve translation to therapeutic approaches. PUBLIC SIGNIFICANCE STATEMENT This research will compare performance on a flexibility task between participants with anorexia nervosa (AN) and controls while observing their eye-movements to examine whether trait anxiety and type of response (eye-movement and keypress) are associated with performance. This data may improve our understanding of why participants with AN perform more poorly on cognitive flexibility tasks, and how poor cognitive flexibility relates to eating disorder-related issues with flexibility in everyday life.
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Affiliation(s)
- Kelly M. Dann
- School of PsychologyThe University of SydneySydneyAustralia
| | - Aaron Veldre
- School of PsychologyThe University of SydneySydneyAustralia
| | - Phillipa Hay
- Translational Health Research Institute (THRI), School of MedicineWestern Sydney UniversitySydneyAustralia
| | - Stephen Touyz
- InsideOut InstituteThe University of SydneySydneyAustralia
| | - Sally Andrews
- School of PsychologyThe University of SydneySydneyAustralia
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27
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Keeler JL, Robinson L, Keeler-Schäffeler R, Dalton B, Treasure J, Himmerich H. Growth factors in anorexia nervosa: a systematic review and meta-analysis of cross-sectional and longitudinal data. World J Biol Psychiatry 2022; 23:582-600. [PMID: 34875968 DOI: 10.1080/15622975.2021.2015432] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Growth factors are signalling molecules that play roles in the survival, proliferation, migration, and differentiation of cells. Studies have found alterations in specific growth factors in anorexia nervosa (AN). METHODS This systematic review and meta-analysis examined articles from three databases, measuring growth factors in AN cross-sectionally and longitudinally, and in recovered AN (rec-AN) cross-sectionally. Random-effects meta-analyses were conducted for brain-derived neurotrophic factor (BDNF) and insulin growth factor-I (IGF-1) for cross-sectional and longitudinal studies. RESULTS A total of 82 studies were included: 56 cross-sectional (BDNF: n = 15; IGF-1: n = 41) and 24 longitudinal (BDNF: n = 5; IGF-1: n = 19) were meta-analysed and 20 studies were narratively synthesised. In cross-sectional analyses, BDNF and IGF-1 were lower in AN compared to controls, and BDNF was marginally greater in rec-AN compared to controls. In longitudinal meta-analyses, BDNF and IGF-1 increased from baseline to follow-up. Cross-sectional subgroup analyses revealed no differences in BDNF between controls and AN binge-eating/purging subtypes. CONCLUSIONS It is likely that the low BDNF and IGF-1 levels found in AN are consequences of starvation, which are reversible with weight restoration. The increase in BDNF and IGF-1 during therapeutic weight restoration might improve neuroplasticity, which is the basis of learning, and thus psychotherapeutic success.
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Affiliation(s)
- Johanna Louise Keeler
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Lauren Robinson
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Bethan Dalton
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Janet Treasure
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Hubertus Himmerich
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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28
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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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29
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Évaluer un programme de remédiation cognitive dans l’anorexie : nouveaux outils. Encephale 2022; 49:317-320. [DOI: 10.1016/j.encep.2022.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 01/17/2022] [Accepted: 01/18/2022] [Indexed: 11/15/2022]
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30
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Stedal K, Scherer R, Touyz S, Hay P, Broomfield C. Research Review: Neuropsychological functioning in young anorexia nervosa: A meta-analysis. J Child Psychol Psychiatry 2022; 63:616-625. [PMID: 34970745 DOI: 10.1111/jcpp.13562] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/26/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Cognitive inflexibility and compulsive behaviours are commonly observed in patients with anorexia nervosa (AN) and are often considered to be caused by impairments in executive functioning and visuospatial processing. Despite an increasing number of young individuals presenting with AN, there is a lack of meta-analytic evidence on the neuropsychological functioning in this population. Our primary aim was to review and synthesize the differences in neuropsychological test performance between young people with AN and healthy controls, and to explore potential moderators. METHODS A database search following PRISMA guidelines of MEDLINE, PsycINFO, ISI Web of Science and Epistemonikos was conducted. Hedges' g served as an effect size indicating the standardized mean differences. We utilized mixed-effects meta-regression and machine learning meta-analyses to identify relevant moderators. RESULTS Sixteen studies met the inclusion criteria with a total of 1333 participants (665 with AN) and 59 effect sizes. Random-effects meta-analyses demonstrated a small and insignificant difference between young individuals with AN and controls ( g¯ = -0.144, 95% CI [-0.328, 0.041]) in overall neuropsychological functioning. However, the difference was significant for the cognitive domains of memory, working memory and visuospatial abilities. Moderator and machine-learning analyses revealed a stronger negative effect in older participants and moderator effects of country and assessment quality. CONCLUSIONS Our findings highlight the significant impact of age on neuropsychological test performance in patients with AN. There is a need for a more widespread inclusion of potentially confounding variables in primary studies as well as instruments specifically targeted at younger populations.
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Affiliation(s)
- Kristin Stedal
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital Oslo Ullevål, Oslo, Norway
| | - Ronny Scherer
- Faculty of Educational Sciences, Centre for Educational Measurement at the University of Oslo (CEMO), University of Oslo, Oslo, Norway
| | - Stephen Touyz
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
| | - Phillipa Hay
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Catherine Broomfield
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
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31
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Romigi A, Mercuri NB, Caccamo M, Testa F, Vitrani G, Tripaldi MC, Centonze D, Jacoangeli F. Subjective sleep disorders and daytime sleepiness in patients with restrictive type anorexia nervosa and effects on quality of life: a case-control study. Sleep Biol Rhythms 2022; 20:181-189. [PMID: 38469262 PMCID: PMC10899920 DOI: 10.1007/s41105-021-00352-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 10/26/2021] [Indexed: 12/26/2022]
Abstract
To evaluate sleep disorders and daytime drowsiness in a cohort of patients affected by anorexia nervosa and their impact on health-related quality of life. We evaluated patients affected by restricting-type of anorexia nervosa (AN-R) and healthy controls by the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale, Beck Depression Index. We also used the Short-Form Health Survey (SF-36) questionnaire to assess the quality of life in both AN-R and controls. Twenty-eight out of 34 AN-R patients (82.3%) in contrast with ten out of 34 healthy subjects (29.4%) had a pathological PSQI score compared to HC (p < 0.0001). The overall PSQI score (p < 0.001), sleep quality (p < 0.001), sleep duration (p = 0.02), sleep efficiency (p = 0.002), sleep disturbances (p = 0.03) and daytime dysfunction (p = 0.004) were significantly higher in AN-R than in controls. SF36 showed significantly reduced scores of standardized physical components (p = 0.01) and standardized mental components (p < 0.001), physical function (p < 0.001), physical role (p < 0.001) and general health (p < 0.001), vitality (p < 0.001), social functioning (p < 0.001) emotional role (p = 0.001) and mental health (p < 0.001) in AN-R. We found a significant correlation between the PSQI score and both the physical role (r = - 0.35, p = 0.03) and level of education (r = 0.38, p = 0.02). Our data showed reduced overall sleep quality without excessive daytime sleepiness in AN-R. Sleep quality correlated significantly with quality of life (physical role) and level of education.
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Affiliation(s)
- Andrea Romigi
- Sleep Medicine Center, IRCCS Neuromed, Via Atinense 18, Pozzilli, IS Italy
| | - Nicola B. Mercuri
- Department of System Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Marco Caccamo
- Sleep Medicine Center, IRCCS Neuromed, Via Atinense 18, Pozzilli, IS Italy
| | - Federica Testa
- Sleep Medicine Center, IRCCS Neuromed, Via Atinense 18, Pozzilli, IS Italy
| | - Giuseppe Vitrani
- Sleep Medicine Center, IRCCS Neuromed, Via Atinense 18, Pozzilli, IS Italy
| | - Maria Carmela Tripaldi
- Clinical Nutrition and Eating Disorders Unit, Department of System Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Diego Centonze
- Sleep Medicine Center, IRCCS Neuromed, Via Atinense 18, Pozzilli, IS Italy
| | - Fabrizio Jacoangeli
- Clinical Nutrition and Eating Disorders Unit, Department of System Medicine, University of Rome Tor Vergata, Rome, Italy
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Haynos AF, Widge AS, Anderson LM, Redish AD. Beyond Description and Deficits: How Computational Psychiatry Can Enhance an Understanding of Decision-Making in Anorexia Nervosa. Curr Psychiatry Rep 2022; 24:77-87. [PMID: 35076888 PMCID: PMC8934594 DOI: 10.1007/s11920-022-01320-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2021] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW Despite decades of research, knowledge of the mechanisms maintaining anorexia nervosa (AN) remains incomplete and clearly effective treatments elusive. Novel theoretical frameworks are needed to advance mechanistic and treatment research for this disorder. Here, we argue the utility of engaging a novel lens that differs from existing perspectives in psychiatry. Specifically, we argue the necessity of expanding beyond two historically common perspectives: (1) the descriptive perspective: the tendency to define mechanisms on the basis of surface characteristics and (2) the deficit perspective: the tendency to search for mechanisms associated with under-functioning of decision-making abilities and related circuity, rather than problems of over-functioning, in psychiatric disorders. RECENT FINDINGS Computational psychiatry can provide a novel framework for understanding AN because this approach emphasizes the role of computational misalignments (rather than absolute deficits or excesses) between decision-making strategies and environmental demands as the key factors promoting psychiatric illnesses. Informed by this approach, we argue that AN can be understood as a disorder of excess goal pursuit, maintained by over-engagement, rather than disengagement, of executive functioning strategies and circuits. Emerging evidence suggests that this same computational imbalance may constitute an under-investigated phenotype presenting transdiagnostically across psychiatric disorders. A variety of computational models can be used to further elucidate excess goal pursuit in AN. Most traditional psychiatric treatments do not target excess goal pursuit or associated neurocognitive mechanisms. Thus, targeting at the level of computational dysfunction may provide a new avenue for enhancing treatment for AN and related disorders.
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Affiliation(s)
- Ann F. Haynos
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, 2450 Riverside Ave, Minneapolis, MN F 253, USA
| | - Alik S. Widge
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, 2450 Riverside Ave, Minneapolis, MN F 253, USA
| | - Lisa M. Anderson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, 2450 Riverside Ave, Minneapolis, MN F 253, USA
| | - A. David Redish
- Department of Neuroscience, University of Minnesota, 6-145 Jackson Hall 321 Church St. SE, Minneapolis, MN 55455, USA
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