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Ko CH, Lu YC, Lee CH, Liao YC. The influence of adverse childhood experiences and depression on addiction severity among methamphetamine users: exploring the role of perseveration. Front Psychiatry 2024; 15:1382646. [PMID: 38807693 PMCID: PMC11130423 DOI: 10.3389/fpsyt.2024.1382646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 04/25/2024] [Indexed: 05/30/2024] Open
Abstract
Aims This investigation aimed to clarify the intricate relationship among depression, cognitive function, adverse childhood experiences (ACEs), and their combined influence on methamphetamine use disorder (MUD). Methods Utilizing a battery of psychological tests, this study ascertained the impact of ACEs on the condition of 76 people with MUD who meet the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria, aged 42.17 on average. The Iowa Gambling Task (IGT), Conners' Continuous Performance-II (CPT-II), the self-report Severity of Dependence Scale (SDS), and the Beck Depression Inventory-II (BDI-II) were used for these evaluations. Individuals involved in the study were categorized into two discrete cohorts, mild (ME) and severe (SE), based on the extent of their ACEs exposure. This study employed the PROCESS regression, the independent t-test andχ2 tests for the analysis. Results The findings revealed notable discrepancies in the psychological consequences between the two groups with different degrees of ACEs; however, no substantial differences were observed in the demographic parameters. The SE group exhibited elevated BDI-II scores, more evident indications of MUD, and a higher degree of CPT-II cognitive perseveration. The PROCESS model revealed that cognitive perseveration moderated the impact of depression on ACEs and subjective MUD severity, explaining 20.2% of the variance. The ACEs and depression predicted 28.6% of the variance in MUD symptoms. However, no statistically significant differences were detected between the two groups regarding the parameters in the IGT-2 assessment. Conclusions These results indicate that the interaction between cognitive and depressive factors mediates the effect of ACEs on subjective MUD severity but not on MUD symptoms. The ACEs significant impact on mental health severity perception is explained by cognitive and depressive factors. This implies that MUD treatment and rehabilitation should address cognitive dysfunction and developmental trauma.
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Affiliation(s)
- Cheng-Hung Ko
- Department of Addiction and Forensic Psychiatry, Jianan Psychiatric Center, Ministry of Health and Welfare (MOHW), Tainan, Taiwan
| | - Yung-Chin Lu
- Department of Clinical Psychology, Jianan Psychiatric Center, Ministry of Health and Welfare, Tainan, Taiwan
| | - Chun-Hung Lee
- Department of Addiction and Forensic Psychiatry, Jianan Psychiatric Center, Ministry of Health and Welfare (MOHW), Tainan, Taiwan
- Department of Addiction Psychiatry, Taoyuan Psychiatric Center, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Yu-Chi Liao
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan
- Center for Prevention and Treatment of Internet Addiction, Asia University, Taichung, Taiwan
- Clinical Psychology Center, Asia University Hospital, Taichung, Taiwan
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Howlett CA, Miles S, Berryman C, Phillipou A, Moseley GL. Conflation between self-report and neurocognitive assessments of cognitive flexibility: a critical review of the Jingle Fallacy. AUSTRALIAN JOURNAL OF PSYCHOLOGY 2023. [DOI: 10.1080/00049530.2023.2174684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Affiliation(s)
- Caitlin A. Howlett
- Innovation, Implementation & Clinical Translation (IIMPACT) in Health, University of South Australia, Kaurna Country, Adelaide, Australia
| | - Stephanie Miles
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Carolyn Berryman
- Innovation, Implementation & Clinical Translation (IIMPACT) in Health, University of South Australia, Kaurna Country, Adelaide, Australia
- Brain Stimulation, Imaging and Cognition Research Group, School of Medicine, The University of Adelaide, Adelaide, Australia
| | - Andrea Phillipou
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
- Department of Mental Health, St Vincent’s Hospital, Melbourne, Australia
- Department of Psychiatry, The University of Melbourne, Melbourne, Australia
- Department of Mental Health, Austin Health, Melbourne, Australia
| | - G. Lorimer Moseley
- Innovation, Implementation & Clinical Translation (IIMPACT) in Health, University of South Australia, Kaurna Country, Adelaide, Australia
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Costache AD, Ignat BE, Grosu C, Mastaleru A, Abdulan I, Oancea A, Roca M, Leon MM, Badescu MC, Luca S, Jigoranu AR, Chetran A, Mitu O, Costache II, Mitu F. Inflammatory Pathways in Overweight and Obese Persons as a Potential Mechanism for Cognitive Impairment and Earlier Onset Alzeihmer's Dementia in the General Population: A Narrative Review. Biomedicines 2023; 11:3233. [PMID: 38137454 PMCID: PMC10741501 DOI: 10.3390/biomedicines11123233] [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: 10/23/2023] [Revised: 11/29/2023] [Accepted: 12/04/2023] [Indexed: 12/24/2023] Open
Abstract
The overweight status or obesity can be confirmed through classical methods such as the body mass index (BMI) and the waist-to-hip ratio (WHR). Apart from metabolic issues such as atherosclerosis, liver steatosis, or diabetes mellitus, long-term obesity or overweight status can pose a risk for cardiovascular and neurovascular complications. While some acute adverse events like coronary syndromes of strokes are well-documented to be linked to an increased body mass, there are also chronic processes that, due to their silent onset and evolution, are underdiagnosed and not as thoroughly studied. Through this review, we aimed to collect all relevant data with regard to the long-term impact of obesity on cognitive function in all ages and its correlation with an earlier onset of dementia such as Alzheimer's disease (AD). The exact mechanisms through which a decline in cognitive functions occurs in overweight or obese persons are still being discussed. A combination of factors has been acknowledged as potential triggers, such as a sedentary lifestyle and stress, as well as a genetic predisposition, for example, the apolipoprotein E (ApoE) alleles in AD. Most research highlights the impact of vascular dysfunction and systemic inflammation on the nervous system in patients with obesity and the subsequent neurological changes. Obesity during the early to mid-ages leads to an earlier onset of cognitive dysfunction in various forms. Also, lifestyle intervention can reverse cognitive dysfunction, especially dieting, to encourage weight loss.
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Affiliation(s)
- Alexandru Dan Costache
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.D.C.); (A.M.); (I.A.); (A.O.); (M.R.); (M.M.L.); (M.C.B.); (S.L.); (A.R.J.); (A.C.); (O.M.); (I.I.C.); (F.M.)
- Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Bogdan Emilian Ignat
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.D.C.); (A.M.); (I.A.); (A.O.); (M.R.); (M.M.L.); (M.C.B.); (S.L.); (A.R.J.); (A.C.); (O.M.); (I.I.C.); (F.M.)
- Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Cristina Grosu
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.D.C.); (A.M.); (I.A.); (A.O.); (M.R.); (M.M.L.); (M.C.B.); (S.L.); (A.R.J.); (A.C.); (O.M.); (I.I.C.); (F.M.)
- Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Alexandra Mastaleru
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.D.C.); (A.M.); (I.A.); (A.O.); (M.R.); (M.M.L.); (M.C.B.); (S.L.); (A.R.J.); (A.C.); (O.M.); (I.I.C.); (F.M.)
- Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Irina Abdulan
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.D.C.); (A.M.); (I.A.); (A.O.); (M.R.); (M.M.L.); (M.C.B.); (S.L.); (A.R.J.); (A.C.); (O.M.); (I.I.C.); (F.M.)
- Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Andra Oancea
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.D.C.); (A.M.); (I.A.); (A.O.); (M.R.); (M.M.L.); (M.C.B.); (S.L.); (A.R.J.); (A.C.); (O.M.); (I.I.C.); (F.M.)
- Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Mihai Roca
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.D.C.); (A.M.); (I.A.); (A.O.); (M.R.); (M.M.L.); (M.C.B.); (S.L.); (A.R.J.); (A.C.); (O.M.); (I.I.C.); (F.M.)
- Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Maria Magdalena Leon
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.D.C.); (A.M.); (I.A.); (A.O.); (M.R.); (M.M.L.); (M.C.B.); (S.L.); (A.R.J.); (A.C.); (O.M.); (I.I.C.); (F.M.)
- Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Minerva Codruta Badescu
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.D.C.); (A.M.); (I.A.); (A.O.); (M.R.); (M.M.L.); (M.C.B.); (S.L.); (A.R.J.); (A.C.); (O.M.); (I.I.C.); (F.M.)
- “St. Spiridon” Emergency County Hospital, 700111 Iasi, Romania
| | - Stefana Luca
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.D.C.); (A.M.); (I.A.); (A.O.); (M.R.); (M.M.L.); (M.C.B.); (S.L.); (A.R.J.); (A.C.); (O.M.); (I.I.C.); (F.M.)
- “St. Spiridon” Emergency County Hospital, 700111 Iasi, Romania
| | - Alexandru Raul Jigoranu
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.D.C.); (A.M.); (I.A.); (A.O.); (M.R.); (M.M.L.); (M.C.B.); (S.L.); (A.R.J.); (A.C.); (O.M.); (I.I.C.); (F.M.)
- “St. Spiridon” Emergency County Hospital, 700111 Iasi, Romania
| | - Adriana Chetran
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.D.C.); (A.M.); (I.A.); (A.O.); (M.R.); (M.M.L.); (M.C.B.); (S.L.); (A.R.J.); (A.C.); (O.M.); (I.I.C.); (F.M.)
- “St. Spiridon” Emergency County Hospital, 700111 Iasi, Romania
| | - Ovidiu Mitu
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.D.C.); (A.M.); (I.A.); (A.O.); (M.R.); (M.M.L.); (M.C.B.); (S.L.); (A.R.J.); (A.C.); (O.M.); (I.I.C.); (F.M.)
- “St. Spiridon” Emergency County Hospital, 700111 Iasi, Romania
| | - Irina Iuliana Costache
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.D.C.); (A.M.); (I.A.); (A.O.); (M.R.); (M.M.L.); (M.C.B.); (S.L.); (A.R.J.); (A.C.); (O.M.); (I.I.C.); (F.M.)
- “St. Spiridon” Emergency County Hospital, 700111 Iasi, Romania
| | - Florin Mitu
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.D.C.); (A.M.); (I.A.); (A.O.); (M.R.); (M.M.L.); (M.C.B.); (S.L.); (A.R.J.); (A.C.); (O.M.); (I.I.C.); (F.M.)
- Clinical Rehabilitation Hospital, 700661 Iasi, Romania
- Romanian Academy of Medical Sciences, 927180 Bucharest, Romania
- Romanian Academy of Scientists, 050044 Bucharest, Romania
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Mora-Maltas B, Lucas I, Granero R, Vintró-Alcaraz C, Miranda-Olivos R, Baenas I, Sánchez I, Jiménez-Del Toro J, Sánchez-González J, Krug I, Tapia J, Jiménez-Murcia S, Fernández-Aranda F. Cognitive flexibility and DSM-5 severity criteria for eating disorders: assessing drive for thinness and duration of illness as alternative severity variables. J Eat Disord 2023; 11:155. [PMID: 37697328 PMCID: PMC10496406 DOI: 10.1186/s40337-023-00875-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 08/22/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND The severity criteria for eating disorders (EDs) proposed in the DSM-5 have been established without sufficient empirical support. Drive for thinness (DT) and duration of illness have been proposed as two alternative severity measures, however their empirical evidence is also limited. To date, no research has assessed the validity of current eating disorder (ED) severity criteria regarding cognitive flexibility factors. Cognitive flexibility is often impaired in EDs, becoming a possible severity symptom. The current study assessed for the first time (1) whether the severity indexes for EDs proposed in the DSM-5 were associated with deficits in cognitive flexibility and, (2) whether drive for thinness and illness duration, acted as an alternative, more meaningful severity indices for deficiencies in cognitive flexibility. METHODS Participants were 161 patients diagnosed with an ED, who were categorized according to DSM-5 severity categories, DT and duration of illness. Discriminative capacity of each classification was assessed for cognitive flexibility measured by Wisconsin card sorting test (WCST). RESULTS The findings for the DSM-5 classification comprised: (a) In the anorexia nervosa (AN) group, patients with moderate severity showed better scores in WCST than patients with mild and severe/extreme severity. Also, patients with moderate severity showed lower percentage of cognitive flexibility deficits than the other two severity categories; (b) For the binge spectrum disorders (BSD) group, the patients with mild severity showed a higher percentage of cognitive flexibility deficits than did the moderate and severe/extreme categories. When assessing the alternative severity index of DT, no differences were found in cognitive flexibility in any of the groups. Regarding illness duration, in the AN group the task performance of the patients with longer illness duration was worse than the performance of the short duration group and, in the BSD group, patients with longer duration also showed more deficits in cognitive flexibility than the patients with shorter duration of illness. CONCLUSIONS Our findings point out the limitations of the DSM-5 severity criteria to categorize cognitive flexibility in EDs and support illness duration as an alternative severity approach for EDs.
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Affiliation(s)
- Bernat Mora-Maltas
- Clinical Psychology Unit, University Hospital Bellvitge and CIBERobn, Feixa Llarga s/n 08907 L'Hospitalet del Llobregat, Barcelona, Spain
- Psychoneurobiology of Eating and Addictive Behaviours Group, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Ignacio Lucas
- Clinical Psychology Unit, University Hospital Bellvitge and CIBERobn, Feixa Llarga s/n 08907 L'Hospitalet del Llobregat, Barcelona, Spain
- Psychoneurobiology of Eating and Addictive Behaviours Group, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Barcelona, Spain
| | - Roser Granero
- Psychoneurobiology of Eating and Addictive Behaviours Group, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Barcelona, Spain
- Departament de Psicobiologia i Metodologia, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristina Vintró-Alcaraz
- Clinical Psychology Unit, University Hospital Bellvitge and CIBERobn, Feixa Llarga s/n 08907 L'Hospitalet del Llobregat, Barcelona, Spain
- Psychoneurobiology of Eating and Addictive Behaviours Group, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Barcelona, Spain
| | - Romina Miranda-Olivos
- Clinical Psychology Unit, University Hospital Bellvitge and CIBERobn, Feixa Llarga s/n 08907 L'Hospitalet del Llobregat, Barcelona, Spain
- Psychoneurobiology of Eating and Addictive Behaviours Group, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Barcelona, Spain
| | - Isabel Baenas
- Clinical Psychology Unit, University Hospital Bellvitge and CIBERobn, Feixa Llarga s/n 08907 L'Hospitalet del Llobregat, Barcelona, Spain
- Psychoneurobiology of Eating and Addictive Behaviours Group, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Barcelona, Spain
| | - Isabel Sánchez
- Clinical Psychology Unit, University Hospital Bellvitge and CIBERobn, Feixa Llarga s/n 08907 L'Hospitalet del Llobregat, Barcelona, Spain
- Psychoneurobiology of Eating and Addictive Behaviours Group, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Barcelona, Spain
| | - Jessica Jiménez-Del Toro
- Clinical Psychology Unit, University Hospital Bellvitge and CIBERobn, Feixa Llarga s/n 08907 L'Hospitalet del Llobregat, Barcelona, Spain
- Psychoneurobiology of Eating and Addictive Behaviours Group, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Jéssica Sánchez-González
- Clinical Psychology Unit, University Hospital Bellvitge and CIBERobn, Feixa Llarga s/n 08907 L'Hospitalet del Llobregat, Barcelona, Spain
- Psychoneurobiology of Eating and Addictive Behaviours Group, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Isabel Krug
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - Javier Tapia
- Clinical Psychology Unit, University Hospital Bellvitge and CIBERobn, Feixa Llarga s/n 08907 L'Hospitalet del Llobregat, Barcelona, Spain
- Gerencia Territorial Metropolitana Sud. Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Susana Jiménez-Murcia
- Clinical Psychology Unit, University Hospital Bellvitge and CIBERobn, Feixa Llarga s/n 08907 L'Hospitalet del Llobregat, Barcelona, Spain
- Psychoneurobiology of Eating and Addictive Behaviours Group, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Fernando Fernández-Aranda
- Clinical Psychology Unit, University Hospital Bellvitge and CIBERobn, Feixa Llarga s/n 08907 L'Hospitalet del Llobregat, Barcelona, Spain.
- Psychoneurobiology of Eating and Addictive Behaviours Group, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Barcelona, Spain.
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.
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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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Mallorquí-Bagué N, Lozano-Madrid M, Granero R, Mestre-Bach G, Vintró-Alcaraz C, Sánchez I, Jiménez-Murcia S, Fernández-Aranda F. Cognitive and clinical gender‐related differences among binge‐spectrum eating disorders: Analysis of therapy response predictors. EUROPEAN EATING DISORDERS REVIEW 2022; 31:377-389. [PMID: 36482806 DOI: 10.1002/erv.2961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 11/18/2022] [Accepted: 11/23/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This study assessed gender-related differences in executive functions (decision-making, inhibitory control and cognitive flexibility), personality traits and psychopathological symptoms in binge-spectrum eating disorders (EDs). Secondly, we aimed to separately explore the predictive value of gender and executive functions in treatment outcome. METHOD A battery of self-reported and neurocognitive measures were answered by a sample of 85 patients (64 females) diagnosed with a binge-spectrum ED (41 BN; 44 binge eating disorder). RESULTS Data showed gender-related differences in executive functioning, displaying women lower inhibitory control and lower cognitive flexibility than men. Regarding personality traits and psychopathology symptoms, women presented higher reward dependence and cooperativeness, as well as more drive for thinness, body dissatisfaction, bulimia, and somatisation symptoms than men. Finally, worse executive functioning, particularly having lower ability in concept formation seems to predict worse treatment outcomes and dropout in these patients. CONCLUSIONS We described gender specific neuropsychological, personality and psychopathological impairments in patients with binge-spectrum EDs. Moreover, difficulties in executive functioning might have an impact on treatment response, since patients with a lower ability in concept formation are less likely to benefit from treatment. The present results can help improving current treatment approaches by tackling gender and individual differences.
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Affiliation(s)
- Núria Mallorquí-Bagué
- Department of Psychiatry, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Spain
- Ciber Fisiopatologia Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain
- Department of Psychology, University of Girona, Girona, Spain
| | - María Lozano-Madrid
- Ciber Fisiopatologia Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Roser Granero
- Ciber Fisiopatologia Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain
- Departament de Psicobiologia i Metodologia, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Cristina Vintró-Alcaraz
- Ciber Fisiopatologia Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Isabel Sánchez
- Ciber Fisiopatologia Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Susana Jiménez-Murcia
- Ciber Fisiopatologia Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Fernando Fernández-Aranda
- Ciber Fisiopatologia Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
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Miles S, Nedeljkovic M, Sumner P, Phillipou A. Understanding self-report and neurocognitive assessments of cognitive flexibility in people with and without lifetime anorexia nervosa. Cogn Neuropsychiatry 2022; 27:325-341. [PMID: 35142252 DOI: 10.1080/13546805.2022.2038554] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objective: Anorexia nervosa (AN) is a serious eating disorder associated with several cognitive difficulties including poor cognitive flexibility (i.e. difficulties in effectively adapting to changes in the environment and/or changing task demands). AN research has primarily assessed cognitive flexibility using neurocognitive tests, and little is known about the differences or similarities between self-report and neurocognitive assessments of cognitive flexibility. This study investigated the relationship between self-report and neurocognitive assessments of cognitive flexibility in people with no history of an eating disorder (n = 207) and people with a self-reported lifetime diagnosis of AN (n = 19).Methods: Participants completed self-report and neurocognitive assessments of cognitive flexibility through an online study.Results: No significant correlations were found between self-report and neurocognitive assessments of cognitive flexibility for either group of the sample, suggesting that these assessments may evaluate different aspects of cognitive flexibility. Further, negative mood and self-reported eating disorder symptoms were found to significantly relate to self-reported cognitive flexibility, but were not associated with performance on neurocognitive tests of cognitive flexibility.Conclusions: To provide a comprehensive understanding of perceived and objective cognitive flexibility in AN, future research and clinical assessments should include both self-report and neurocognitive assessments.
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Affiliation(s)
- Stephanie Miles
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Maja Nedeljkovic
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Philip Sumner
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Andrea Phillipou
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia.,Department of Mental Health, St Vincent's Hospital, Melbourne, Australia.,Department of Psychiatry, The University of Melbourne, Melbourne, Australia.,Department of Mental Health, Austin Health, Melbourne, Australia
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8
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Miranda-Olivos R, Testa G, Lucas I, Sánchez I, Sánchez-González J, Granero R, Jiménez-Murcia S, Fernández-Aranda F. Clinical factors predicting impaired executive functions in eating disorders: The role of illness duration. J Psychiatr Res 2021; 144:87-95. [PMID: 34601380 DOI: 10.1016/j.jpsychires.2021.09.042] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 09/08/2021] [Accepted: 09/22/2021] [Indexed: 01/30/2023]
Abstract
Poor performance in executive functions is observed in individuals with eating disorders (EDs). These impairments have usually been associated with the presence of comorbid psychopathology or with higher severity of EDs. However, few studies have explored the interaction between illness duration and deficits in executive functions. The present study investigates the association between ED duration and performance in decision-making, inhibitory control, and cognitive flexibility in the anorexia nervosa restrictive subtype (AN-R), bulimic/purging subtype (AN-BP), and binge spectrum disorders (BSDs) (namely, bulimia nervosa and binge eating disorder) among 116 women with EDs compared with 123 women healthy controls (HCs). Using cumulative survival analysis, we estimated the risk of deficits related to illness duration. Predictors of executive dysfunctions were assessed by regression analysis, including as potential predictors illness duration, severity of general psychopathology, and ED symptomatology. Results showed poor decision-making and cognitive flexibility in participants with EDs compared with HCs. ED duration was associated with poor inhibitory control in the AN-BP group and poor cognitive flexibility in the BSD group. The illness duration increased the risk of presenting early deficits in executive function. In decision-making and inhibitory control, the AN-R group showed the earliest deficits, whereas in cognitive flexibility it was the BSD group. ED duration predicted impaired cognitive flexibility in the BSD group and impaired inhibitory control in the AN-BP group, whereas the severity of general psychopathological symptoms was a predictor of impaired cognitive flexibility in individuals with AN-R. These results highlight the relevance of illness duration in executive dysfunctions in EDs.
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Affiliation(s)
- Romina Miranda-Olivos
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain; Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain; Psychiatry and Mental Health Group, Neuroscience Program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Giulia Testa
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain; Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain; Psychiatry and Mental Health Group, Neuroscience Program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Ignacio Lucas
- Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain; Psychiatry and Mental Health Group, Neuroscience Program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Isabel Sánchez
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain; Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain; Psychiatry and Mental Health Group, Neuroscience Program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Jessica Sánchez-González
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain; Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Roser Granero
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain; Departament de Psicobiologia i Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Susana Jiménez-Murcia
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain; Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain; Psychiatry and Mental Health Group, Neuroscience Program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Spain; Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Fernando Fernández-Aranda
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain; Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain; Psychiatry and Mental Health Group, Neuroscience Program, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Spain; Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.
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9
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McCarthy M, Zhang L, Monacelli G, Ward T. Using Methods From Computational Decision-making to Predict Nonadherence to Fitness Goals: Protocol for an Observational Study. JMIR Res Protoc 2021; 10:e29758. [PMID: 34842557 PMCID: PMC8665389 DOI: 10.2196/29758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 09/24/2021] [Accepted: 10/03/2021] [Indexed: 11/21/2022] Open
Abstract
Background Can methods from computational models of decision-making be used to build a predictive model to identify individuals most likely to be nonadherent to personal fitness goals? Such a model may have significant value in the global battle against obesity. Despite growing awareness of the impact of physical inactivity on human health, sedentary behavior is increasingly linked to premature death in the developed world. The annual impact of sedentary behavior is significant, causing an estimated 2 million deaths. From a global perspective, sedentary behavior is one of the 10 leading causes of mortality and morbidity. Annually, considerable funding and countless public health initiatives are applied to promote physical fitness, with little impact on sustained behavioral change. Predictive models developed from multimodal methodologies combining data from decision-making tasks with contextual insights and objective physical activity data could be used to identify those most likely to abandon their fitness goals. This has the potential to enable development of more targeted support to ensure that those who embark on fitness programs are successful. Objective The aim of this study is to determine whether it is possible to use decision-making tasks such as the Iowa Gambling Task to help determine those most likely to abandon their fitness goals. Predictive models built using methods from computational models of decision-making, combining objective data from a fitness tracker with personality traits and modeling from decision-making games delivered via a mobile app, will be used to ascertain whether a predictive algorithm can identify digital personae most likely to be nonadherent to self-determined exercise goals. If it is possible to phenotype these individuals, it may be possible to tailor initiatives to support these individuals to continue exercising. Methods This is a siteless study design based on a bring your own device model. A total of 200 healthy adults who are novice exercisers and own a Fitbit (Fitbit Inc) physical activity tracker will be recruited via social media for this study. Participants will provide consent via the study app, which they will download from the Google Play store (Alphabet Inc) or Apple App Store (Apple Inc). They will also provide consent to share their Fitbit data. Necessary demographic information concerning age and sex will be collected as part of the recruitment process. Over 12 months, the scheduled study assessments will be pushed to the subjects to complete. The Iowa Gambling Task will be administered via a web app shared via a URL. Results Ethics approval was received from Dublin City University in December 2020. At manuscript submission, study recruitment was pending. The expected results will be published in 2022. Conclusions It is hoped that the study results will support the development of a predictive model and the study design will inform future research approaches. Trial Registration ClinicalTrials.gov NCT04783298; https://clinicaltrials.gov/ct2/show/NCT04783298
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Affiliation(s)
- Marie McCarthy
- Insight Centre For Data Analytics, Dublin City University, Dublin, Ireland
| | - Lili Zhang
- Insight Centre For Data Analytics, Dublin City University, Dublin, Ireland
| | - Greta Monacelli
- Insight Centre For Data Analytics, Dublin City University, Dublin, Ireland
| | - Tomas Ward
- Insight Centre For Data Analytics, Dublin City University, Dublin, Ireland
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10
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Brassard SL, Balodis IM. A review of effort-based decision-making in eating and weight disorders. Prog Neuropsychopharmacol Biol Psychiatry 2021; 110:110333. [PMID: 33905755 DOI: 10.1016/j.pnpbp.2021.110333] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 03/19/2021] [Accepted: 04/21/2021] [Indexed: 12/26/2022]
Abstract
Effort-based decision-making provides a framework to understand the mental computations estimating the amount of work ("effort") required to obtain a reward. The aim of the current review is to systematically synthesize the available literature on effort-based decision-making across the spectrum of eating and weight disorders. More specifically, the current review summarises the literature examining whether 1) individuals with eating disorders and overweight/obesity are willing to expend more effort for rewards compared to healthy controls, 2) if particular components of effort-based decision-making (i.e. risk, discounting) relate to specific binge eating conditions, and 3) how individual differences in effort and reward -processing measures relate to eating pathology and treatment measures. A total of 96 studies were included in our review, following PRISMA guidelines. The review suggests that individuals with binge eating behaviours 1) are more likely to expend greater effort for food rewards, but not monetary rewards, 2) demonstrate greater decision-making impairments under risk and uncertainty, 3) prefer sooner rather than delayed rewards for both food and money, and 4) demonstrate increased implicit 'wanting' for high fat sweet foods. Finally, individual differences in effort and reward -processing measures relating to eating pathology and treatment measures are also discussed.
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Affiliation(s)
- Sarah L Brassard
- Department of Neuroscience, McMaster University, Canada; Peter Boris Center for Addictions Research, St. Joseph's Healthcare Hamilton, Canada
| | - Iris M Balodis
- Department of Neuroscience, McMaster University, Canada; Peter Boris Center for Addictions Research, St. Joseph's Healthcare Hamilton, Canada; Department of Psychiatry and Behavioural Neuroscience, McMaster University, Canada.
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11
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Seidel M, Brooker H, Lauenborg K, Wesnes K, Sjögren M. Cognitive Function in Adults with Enduring Anorexia Nervosa. Nutrients 2021; 13:nu13030859. [PMID: 33808018 PMCID: PMC7998517 DOI: 10.3390/nu13030859] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/26/2021] [Accepted: 02/28/2021] [Indexed: 12/12/2022] Open
Abstract
Anorexia Nervosa (AN) is a severe and often enduring disorder characterized by restriction of food intake, low body weight, fear of weight gain, and distorted body image. Investigations on cognition performance in AN patients have yielded conflicting results. Using an established and sensitive computerized cognitive test battery, we aimed to assess core aspects of cognitive function, including attention span, information processing, reasoning, working and episodic memory, in AN patients and controls. Patients were recruited from the Danish Prospective Longitudinal all-comer inclusion study in Eating Disorders (PROLED). Included were 26 individuals with AN and 36 healthy volunteers (HV). All were tested with CogTrack (an online cognitive assessment system) at baseline, and AN patients were tested again at a follow-up time point after weight increase (n = 13). At baseline, AN patients showed faster reaction times in the attention tasks, as well as increased accuracy in grammatical reasoning compared to HV. There were no differences in cognitive function between AN patients and HV in the other cognitive domains measured (sustained attention, working and episodic memory, speed of retrieval, and speed of grammatical reasoning). No differences were visible in the AN sample between baseline and follow-up. Performance did not correlate with any clinical variables in the AN sample. These findings supplement results from other studies suggesting increased concentration and reasoning accuracy in patients suffering from AN, who showed increased performance in cognitive tasks despite their illness.
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Affiliation(s)
- Maria Seidel
- Department of Psychological Medicine and Developmental Neuroscience, Medical Faculty, TU Dresden, 01069 Dresden, Germany
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute Stockholm, 17165 Stockholm, Sweden
- Correspondence: ; Tel.: +49 351 4582671
| | - Helen Brooker
- Department of Psychology, Northumbria University, Newcastle NE1 8ST, UK;
| | - Kamilla Lauenborg
- Institute for Clinical Medicine Copenhagen University, 2200 Copenhagen, Denmark; (K.L.); (M.S.)
| | - Keith Wesnes
- Medical School, Exeter University Medical School, Exeter EX1 2HZ, UK;
- Wesnes Cognition Ltd., Streatley RG8 9RD, UK
- Centre for Human Psychopharmacology, Swinburne University, Melbourne 3122, Australia
| | - Magnus Sjögren
- Institute for Clinical Medicine Copenhagen University, 2200 Copenhagen, Denmark; (K.L.); (M.S.)
- Psychiatric Center Ballerup, 2750 Ballerup, Denmark
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12
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Keegan E, Tchanturia K, Wade TD. Central coherence and set-shifting between nonunderweight eating disorders and anorexia nervosa: A systematic review and meta-analysis. Int J Eat Disord 2021; 54:229-243. [PMID: 33305366 DOI: 10.1002/eat.23430] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/20/2020] [Accepted: 11/22/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This systematic review and meta-analysis compared previously documented inefficiencies in central coherence and set-shifting between people with nonunderweight eating disorders (bulimia nervosa and binge-eating disorder) and people with anorexia nervosa. METHOD We performed random-effects meta-analyses on 16 studies (1,112 participants) for central coherence and 38 studies (3,505 participants) for set-shifting. Random effects meta-regressions were used to test whether the effect sizes for people with nonunderweight eating disorders were significantly different from the effect sizes for people with anorexia nervosa. RESULTS People with anorexia nervosa (Hedge's g = -0.53, 95% CIs: -0.80, -0.27, p < .001) and bulimia nervosa (Hedge's g = -0.70, 95% CIs: -1.14, -0.25, p = .002), but not binge-eating disorder, had significantly poorer central coherence than healthy controls. Similarly, people with anorexia nervosa (Hedge's g = -0.38, 95% CIs: -0.50, -0.26, p < .001) and bulimia nervosa (Hedge's g = -0.55, 95% CIs: -0.81, -0.29, p < .001), but not binge-eating disorder, had significantly poorer set-shifting than healthy controls. The effect sizes for people with nonunderweight eating disorders did not significantly differ from those for people with anorexia nervosa. DISCUSSION Our meta-analysis was underpowered to make definitive judgments about people with binge-eating disorder. However, we found that people with bulimia nervosa clearly have central coherence and set-shifting inefficiencies which do not significantly differ from those observed in people with anorexia nervosa. Clinically, this suggests that people with bulimia nervosa might benefit from adjunctive approaches to address these inefficiencies, such as cognitive remediation therapy.
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Affiliation(s)
- Ella Keegan
- Blackbird Initiative, Órama Research Institute, Flinders University, Adelaide, Australia
| | | | - Tracey D Wade
- Blackbird Initiative, Órama Research Institute, Flinders University, Adelaide, Australia
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13
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Miles S, Gnatt I, Phillipou A, Nedeljkovic M. Cognitive flexibility in acute anorexia nervosa and after recovery: A systematic review. Clin Psychol Rev 2020; 81:101905. [PMID: 32891022 DOI: 10.1016/j.cpr.2020.101905] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 08/05/2020] [Accepted: 08/10/2020] [Indexed: 02/06/2023]
Abstract
Difficulties in cognitive flexibility-the ability to adapt effectively to changes in the environment and/or changing task demands-have been reported in anorexia nervosa (AN). However, findings are inconsistent across studies and it remains unclear which specific aspects of cognitive flexibility patients with AN may struggle with. This systematic review aimed to synthesise existing research on cognitive flexibility in AN and clarify differences between patients with acute AN, patients who are weight-restored and patients who are fully recovered from AN. Electronic databases were searched through to January 2020. 3,310 papers were screened and 70 papers were included in the final review. Although adults with acute AN performed worse in perceptual flexibility tasks and self-report measures compared to HCs, they did not exhibit deficits across all domains of cognitive flexibility. Adolescents with acute AN did not differ to HCs in performance on neurocognitive tasks despite self-reporting poorer cognitive flexibility. Overall, significant differences in cognitive flexibility between acute and recovered participants was not evident, though, the findings are limited by a modest number of studies. Recovered participants performed poorer than HCs in some neurocognitive measures, however, results were inconsistent across studies. These results have implications for the assessment of cognitive flexibility in AN and targeted treatment approaches.
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Affiliation(s)
- Stephanie Miles
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia.
| | - Inge Gnatt
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Andrea Phillipou
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia; Department of Mental Health, St Vincent's Hospital, Melbourne, Australia; Department of Psychiatry, The University of Melbourne, Melbourne, Australia; Department of Mental Health, Austin Health, Melbourne, Australia
| | - Maja Nedeljkovic
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
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14
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Martínez-García C, Parra-Martínez C, Parra ÁT, Martínez-García TE, Alameda-Bailén JR. Iowa Gambling Task and Distortion in Perception of Body Image Among Adolescent Women With Eating Disorders. Front Psychol 2020; 11:2223. [PMID: 32982892 PMCID: PMC7488598 DOI: 10.3389/fpsyg.2020.02223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 08/10/2020] [Indexed: 11/13/2022] Open
Abstract
The Iowa gambling task (IGT) is an instrument for the neuropsychological evaluation of cognitive and emotional decision making (DM) processes that was created to test the somatic marker hypothesis (SMH) described by Damasio in 1994. It was initially applied to patients with frontal lobe lesions due to its association with executive functions but was subsequently used on patients with a variety of disorders. Although the DM process is inherently perceptual, few studies have applied the IGT to examine DM processes in patients with eating disorders (EDs), and even fewer have associated the IGT to the perceptual distortion of body image (PDBI) in this population. People diagnosed with ED exhibit heightened control over their somatic responses-for example, they can delay digestion for hours-and DM may be affected in this condition. This study compares the performance of two samples of adolescent women-hospitalized patients with ED, and healthy controls with similar demographic characteristics-on the IGT using body image as a possible factor in the SMH. Seventy-four women with a mean age of 14.97 years (SD = 2.347) participated. To analyze their body self-image, we used the figure-rating scale and compared the results with their body mass index (BMI). Correlations between indices of the IGT and distortion in body image were then explored. The results revealed significant differences between the groups in terms of evolving performance on the partial IGT. Patients with ED performed worse than their healthy counterparts in the last 40 trials and exhibited greater distortions in their body image, especially in terms of overestimation. Indices of these distortions were negatively correlated with the total IGT. These results are compatible with the SMH because they suggest that patients with ED evinced blindness with regard to the future, as described by their authors. In addition, a negative correlation was found between the IGT and PDBI, showing that a more distorted body image was associated with lower IGT, that is, more disadvantageous or riskier decisions were made by the subjects with more distortion.
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Affiliation(s)
- Concha Martínez-García
- Department of Developmental and Educational Psychology, University of Huelva, Huelva, Spain
| | - Cecilio Parra-Martínez
- Department of Chemistry, Faculty of Experimental Sciences, Research Center for Natural Resources, Health and the Environment (RENSMA), University of Huelva, Huelva, Spain
| | - Ángel T. Parra
- Department of Medicine, University of Seville, Seville, Spain
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15
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Ciberti A, Cavalletti M, Palagini L, Mariani MG, Dell'Osso L, Mauri M, Maglio A, Mucci F, Marazziti D, Miniati M. Decision-Making, Impulsiveness and Temperamental Traits in Eating Disorders. CLINICAL NEUROPSYCHIATRY 2020; 17:199-208. [PMID: 34908995 PMCID: PMC8629064 DOI: 10.36131/cnfioritieditore20200401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To explore decision-making, impulsiveness and temperamental traits in patients suffering from eating disorders (EDs), as compared with healthy controls (HC). METHOD Fifty-one patients affected by ED (fourteen with anorexia restricting subtype, AN-R; fourteen with bulimia, BN; thirteen with anorexia bingeing/purging subtype, AN-BP; ten with binge-eating disorder, BED) and twenty-eight HC. The patients, recruited at the Section of Psychiatry of the University of Pisa (Italy, were evaluated with a battery of neuropsychological questionnaires, including the IOWA Gambling Task (IGT), the Barratt Impulsiveness Scale (BIS-11), the Temperament and Character Inventory (TCI), the Frontal Assessment Battery (FAB) and the Hamilton Depression Rating Scale (HAM-D). RESULTS The results indicated that AN-R, AN-BP and BN patients showed poorer IGT performances than HC (p < .05), while BED performances were similar to those of HC. IGT scores suggested the existence of similarities in decision-making performances of AN-BP and BN patients, as they performed differently from HC starting from block 3 (F(16.2)=1.7). In addition, differences between AN-BP/BN and AN-R patients were detected, given that they performed differently starting from block 4. As far as BIS-11 is concerned, AN-BP and BN patients reached the highest BIS total scores, when compared with the other groups. Further, they shared similar temperamental and impulsiveness profiles, as demonstrated by their BIS-11 'motor impulsiveness' scores, and by their TCI 'novelty seeking', 'reward dependence' and 'persistence' dimensions. The post-hoc analyses revealed that both AN groups (namely, AN-R and AN-BP) scored significantly lower than HC on the FAB. No patients fulfilled the criteria for the diagnosis of a current major depression. CONCLUSIONS Decision-making deficits are common in EDs. In AN-R these seem related to cognitive styles, while in AN-BP and BN patients with temperament features and impulsiveness traits.
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Affiliation(s)
- Agnese Ciberti
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | | | - Laura Palagini
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | | | - Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Mauro Mauri
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Alessandra Maglio
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Federico Mucci
- Department of Clinical and Experimental Medicine, University of Pisa, Italy.,Department of Biotechnology, Chemistry and Pharmacy, University of Siena, Italy
| | - Donatella Marazziti
- Department of Clinical and Experimental Medicine, University of Pisa, Italy.,Saint Camillus International University of Health and Medical Sciences, Rome, Italy.,Brain Research Foundation, Lucca, Italy
| | - Mario Miniati
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
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16
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Abstract
AbstractAlcohol-dependent individuals usually favor instant gratification of alcohol use and ignore its long-term negative consequences, reflecting impaired decision-making. According to the somatic marker hypothesis, decision-making abilities are subtended by an extended brain network. As chronic alcohol consumption is known to be associated with brain shrinkage in this network, the present study investigated relationships between brain shrinkage and decision-making impairments in alcohol-dependent individuals early in abstinence using voxel-based morphometry. Thirty patients performed the Iowa Gambling Task and underwent a magnetic resonance imaging investigation (1.5T). Decision-making performances and brain data were compared with those of age-matched healthy controls. In the alcoholic group, a multiple regression analysis was conducted with two predictors (gray matter [GM] volume and decision-making measure) and two covariates (number of withdrawals and duration of alcoholism). Compared with controls, alcoholics had impaired decision-making and widespread reduced gray matter volume, especially in regions involved in decision-making. The regression analysis revealed links between high GM volume in the ventromedial prefrontal cortex, dorsal anterior cingulate cortex and right hippocampal formation, and high decision-making scores (P < 0.001, uncorrected). Decision-making deficits in alcoholism may result from impairment of both emotional and cognitive networks.
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17
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A further assessment of decision-making in anorexia nervosa. Eur Psychiatry 2020; 30:121-7. [DOI: 10.1016/j.eurpsy.2014.08.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 05/20/2014] [Accepted: 08/18/2014] [Indexed: 11/20/2022] Open
Abstract
AbstractObjective:Anorexia nervosa (AN) may be associated with impaired decision-making. Cognitive processes underlying this impairment remain unclear, mainly because previous assessments of this complex cognitive function were completed with a single test. Furthermore, clinical features such as mood status may impact this association. We aim to further explore the hypothesis of altered decision-making in AN.Method:Sixty-three adult women with AN and 49 female controls completed a clinical assessment and were assessed by three tasks related to decision-making [Iowa Gambling Task (IGT), Balloon Analogue Risk Task (BART), Probabilistic Reversal Learning Task (PRLT)].Results:People with AN had poorer performance on the IGT and made less risky choices on the BART, whereas performances were not different on PRLT. Notably, AN patients with a current major depressive disorder showed similar performance to those with no current major depressive disorder.Conclusion:These results tend to confirm an impaired decision making-process in people with AN and suggest that various cognitive processes such as inhibition to risk-taking or intolerance of uncertainty may underlie this condition Furthermore, these impairments seem unrelated to the potential co-occurent major depressive disorders.
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18
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Behavioral and Electrophysiological Arguments in Favor of a Relationship between Impulsivity, Risk-Taking, and Success on the Iowa Gambling Task. Brain Sci 2019; 9:brainsci9100248. [PMID: 31554273 PMCID: PMC6826503 DOI: 10.3390/brainsci9100248] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 09/08/2019] [Accepted: 09/21/2019] [Indexed: 11/30/2022] Open
Abstract
The aim of the present study was to investigate the relationship between trait impulsivity, risk-taking, and decision-making performance. We recruited 20 healthy participants who performed the Iowa Gambling Task (IGT) and the Balloon Analog Risk Task (BART) to measure decision-making and risk-taking. The impulsivity was measured by the Barratt Impulsiveness Scale. Resting-state neural activity was recorded to explore whether brain oscillatory rhythms provide important information about the dispositional trait of impulsivity. We found a significant correlation between the ability to develop a successful strategy and the propensity to take more risks in the first trials of the BART. Risk-taking was negatively correlated with cognitive impulsivity in participants who were unable to develop a successful strategy. Neither risk-taking nor decision-making was correlated with cortical asymmetry. In a more exploratory approach, the group was sub-divided in function of participants’ performances at the IGT. We found that the group who developed a successful strategy at the IGT was more prone to risk, whereas the group who failed showed a greater cognitive impulsivity. These results emphasize the need for individuals to explore their environment to develop a successful strategy in uncertain situations, which may not be possible without taking risks.
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Abstract
The ability to decide advantageously among options that vary in both their risks and rewards is critical for survival and well-being. Previous work shows that some forms of risky decision-making are robustly modulated by monoamine signaling, but it is less clear how monoamine signaling modulates decision-making under risk of explicit punishment. The goal of these experiments was to determine how this form of decision-making is modulated by dopamine, serotonin, and norepinephrine signaling, using a task in which rats choose between a small, 'safe' food reward and a large food reward associated with variable risks of punishment. Preference for the large, risky reward (risk-taking) was reduced by administration of a D2/3 dopamine receptor agonist (bromocriptine) and a selective D2 agonist (sumanirole). The selective D3 agonist PD128907 appeared to attenuate reward discrimination abilities but did not affect risk-taking per se. In contrast, drugs targeting serotonergic and noradrenergic signaling had few if any effects on choice behavior. These data suggest that in contrast to other forms of risky decision-making, decision-making under risk of punishment is selectively modulated by dopamine signaling, predominantly through D2 receptors.
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Verharen JPH, Danner UN, Schröder S, Aarts E, van Elburg AA, Adan RAH. Insensitivity to Losses: A Core Feature in Patients With Anorexia Nervosa? BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2019; 4:995-1003. [PMID: 31262707 DOI: 10.1016/j.bpsc.2019.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 05/02/2019] [Accepted: 05/02/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Patients with anorexia nervosa (AN) demonstrate aberrations in choice behavior, including impairments in laboratory measures of decision making. Although a wealth of studies suggest that these aberrations arise from alterations in value processing, it remains unclear by which core component of value processing this is mediated. METHODS We fit trial-by-trial data of patients with AN (n = 60 first cohort, n = 216 second cohort) and healthy control participants (n = 55) performing the Iowa Gambling Task to a computational model based on prospect utility theory. We determined, per participant, the best-fit model parameters and compared these between the groups. RESULTS Analyses revealed a decreased estimate of model parameter λ in patients with AN, indicative of an attenuation of loss-aversive behavior in the Iowa Gambling Task. In comparison, measures of reward sensitivity, value-based learning, and exploration versus exploitation were unaltered in patients with AN. A measurement in a second independent cohort replicated the finding that loss aversion, typically observed in healthy individuals, is reduced in patients with AN. CONCLUSIONS We show that patients with AN, in contrast to healthy control participants, demonstrate reduced loss-aversive behavior. This finding provides important fundamental insights into the decision-making capacity of patients with AN, suggesting alterations in the mechanisms involved in value processing related to negative feedback.
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Affiliation(s)
- Jeroen P H Verharen
- Brain Center Rudolf Magnus, Department of Translational Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Unna N Danner
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands; Altrecht Eating Disorders Rintveld, Zeist, The Netherlands
| | | | - Emmeke Aarts
- Department of Methodology and Statistics, Utrecht University, Utrecht, The Netherlands
| | - Annemarie A van Elburg
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands; Altrecht Eating Disorders Rintveld, Zeist, The Netherlands
| | - Roger A H Adan
- Brain Center Rudolf Magnus, Department of Translational Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands; Altrecht Eating Disorders Rintveld, Zeist, The Netherlands; Institute of Physiology and Neuroscience, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
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Lamanna J, Sulpizio S, Ferro M, Martoni R, Abutalebi J, Malgaroli A. Behavioral assessment of activity-based-anorexia: how cognition can become the drive wheel. Physiol Behav 2019; 202:1-7. [DOI: 10.1016/j.physbeh.2019.01.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 01/17/2019] [Accepted: 01/19/2019] [Indexed: 12/19/2022]
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Giannunzio V, Degortes D, Tenconi E, Collantoni E, Solmi M, Santonastaso P, Favaro A. Decision-making impairment in anorexia nervosa: New insights into the role of age and decision-making style. EUROPEAN EATING DISORDERS REVIEW 2018; 26:302-314. [PMID: 29665149 DOI: 10.1002/erv.2595] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 02/04/2018] [Accepted: 03/08/2018] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Patients with anorexia nervosa (AN) often report difficulties in decision making, which may interfere with treatment. The aim of this study was to investigate decision making in a large sample of adolescent and adult patients with AN, by using the Iowa gambling task. METHOD Participants were 611 female individuals (310 patients and 301 controls) who underwent neuropsychological and clinical assessment. RESULTS Significantly poorer decision-making performance was observed in adult patients, whereas no difference emerged between affected and nonaffected adolescents. Both adolescent and adult patients were characterized by trends for higher levels of attention to losses in comparison with healthy controls. Although healthy adult women exhibited better decision-making performance than healthy adolescents, in AN, there was no improvement of decision making with age. A cluster analysis identified 2 different styles of decision making in both patients and controls: a conservative style and an impulsive style. DISCUSSION Our study provides evidence of dysfunctional decision making in adult patients with AN and reveals an association between poor decision making and excessive punishment sensitivity in AN. The clinical and scientific implications of these findings merit further exploration.
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Affiliation(s)
- Valeria Giannunzio
- Department of Neurosciences, Padua Neuroscience Center, University of Padova, Italy
| | - Daniela Degortes
- Department of Neurosciences, Padua Neuroscience Center, University of Padova, Italy
| | - Elena Tenconi
- Department of Neurosciences, Padua Neuroscience Center, University of Padova, Italy
| | - Enrico Collantoni
- Department of Neurosciences, Padua Neuroscience Center, University of Padova, Italy
| | - Marco Solmi
- Department of Neurosciences, Padua Neuroscience Center, University of Padova, Italy
| | - Paolo Santonastaso
- Department of Neurosciences, Padua Neuroscience Center, University of Padova, Italy
| | - Angela Favaro
- Department of Neurosciences, Padua Neuroscience Center, University of Padova, Italy
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Tamiya H, Ouchi A, Chen R, Miyazawa S, Akimoto Y, Kaneda Y, Sora I. Neurocognitive Impairments Are More Severe in the Binge-Eating/Purging Anorexia Nervosa Subtype Than in the Restricting Subtype. Front Psychiatry 2018; 9:138. [PMID: 29713293 PMCID: PMC5911723 DOI: 10.3389/fpsyt.2018.00138] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 03/29/2018] [Indexed: 12/29/2022] Open
Abstract
Objective: To evaluate cognitive function impairment in patients with anorexia nervosa (AN) of either the restricting (ANR) or binge-eating/purging (ANBP) subtype. Method: We administered the Japanese version of the MATRICS Consensus Cognitive Battery to 22 patients with ANR, 18 patients with ANBP, and 69 healthy control subjects. Our participants were selected from among the patients at the Kobe University Hospital and community residents. Results: Compared to the healthy controls, the ANR group had significantly lower visual learning and social cognition scores, and the ANBP group had significantly lower processing speed, attention/vigilance, visual learning, reasoning/problem-solving, and social cognition scores. Compared to the ANR group, the ANBP group had significantly lower attention/vigilance scores. Discussion: The AN subtypes differed in cognitive function impairments. Participants with ANBP, which is associated with higher mortality rates than ANR, exhibited greater impairment severities, especially in the attention/vigilance domain, confirming the presence of impairments in continuous concentration. This may relate to the impulsivity, an ANBP characteristic reported in the personality research. Future studies can further clarify the cognitive impairments of each subtype by addressing the subtype cognitive functions and personality characteristics.
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Affiliation(s)
- Hiroko Tamiya
- Department of Psychiatry, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Atushi Ouchi
- Department of Psychiatry, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Runshu Chen
- Department of Psychiatry, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shiho Miyazawa
- Department of Biological Psychiatry, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoritaka Akimoto
- Department of Information & Management Systems Engineering, Nagaoka University of Technology, Nagaoka, Japan
| | | | - Ichiro Sora
- Department of Psychiatry, Kobe University Graduate School of Medicine, Kobe, Japan
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Na E, Kang B, Kim MS. Decision-Making Deficits Are Associated With Learning Impairments in Female College Students at High Risk for Anorexia Nervosa: Iowa Gambling Task and Prospect Valence Learning Model. Front Psychiatry 2018; 9:759. [PMID: 30740067 PMCID: PMC6357925 DOI: 10.3389/fpsyt.2018.00759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 12/20/2018] [Indexed: 11/13/2022] Open
Abstract
This study investigated deficits in decision-making ability in female college students at high risk for anorexia nervosa (AN) using the Iowa Gambling Task (IGT) and the prospect valence learning (PVL) model. Based on scores on the Korean version of the Eating Attitude Test-26 (KEAT-26), participants were assigned to either the high risk for AN group (n = 42) or the control group (n = 43). The high risk for AN group exhibited significantly lower total net scores and block net scores on the third, fourth, and fifth blocks of the IGT than the control group did. The high risk for AN group selected cards significantly more often from the disadvantageous A and B decks and less often from the advantageous D deck than the control group did. In addition, the block net scores of the high risk for AN group did not differ across the five blocks, whereas those of the control group increased as the trials progressed. There was a significant negative correlation between IGT total net score and total score on the KEAT-26. The high risk for AN group had significantly lower values than the control group on the learning and response consistency parameters of the PVL model. These results indicate that female college students at high risk for AN have deficits in decision-making ability, and that these deficits are related to difficulties in remembering experience obtained from earlier trials and applying it to later trials. These difficulties further lead them to make decisions randomly.
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Affiliation(s)
- Eunchan Na
- Department of Psychology, Sungshin Women's University, Seoul, South Korea
| | - Bitna Kang
- Jakwang Child & Family Clinic, Seoul, South Korea
| | - Myung-Sun Kim
- Department of Psychology, Sungshin Women's University, Seoul, South Korea
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Abstract
The relationship between obesity and cognitive impairment is important given the globally ageing population in whom cognitive decline and neurodegenerative disorders will carry grave individual, societal and financial burdens. This review examines the evidence for the link between obesity and cognitive function in terms of both the immediate effects on cognitive performance, and effects on the trajectory of cognitive ageing and likelihood of dementia. In mid-life, there is a strong association between obesity and impaired cognitive function. Anthropometric measures of obesity are also associated with reduced neural integrity (e.g. grey and white matter atrophy). Increasing age coupled with the negative metabolic consequences of obesity (e.g. type 2 diabetes mellitus) are likely to significantly contribute to cognitive decline and incidence of dementia. Stress is identified as a potential risk factor promoting abdominal obesity and contributing to impaired cognitive function. However, the potentially protective effects of obesity against cognitive decline in older age require further examination. Finally, surgical and whole diet interventions, which address obesity may improve cognitive capacity and confer some protection against later cognitive decline. In conclusion, obesity and its comorbidities are associated with impaired cognitive performance, accelerated cognitive decline and neurodegenerative pathologies such as dementia in later life. Interventions targeting mid-life obesity may prove beneficial in reducing the cognitive risks associated with obesity.
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Steinglass JE, Lempert KM, Choo TH, Kimeldorf MB, Wall M, Walsh BT, Fyer AJ, Schneier FR, Simpson HB. Temporal discounting across three psychiatric disorders: Anorexia nervosa, obsessive compulsive disorder, and social anxiety disorder. Depress Anxiety 2017; 34:463-470. [PMID: 28009473 PMCID: PMC5869031 DOI: 10.1002/da.22586] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 11/06/2016] [Accepted: 11/08/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Temporal discounting refers to the tendency for rewards to lose value as the expected delay to receipt increases. Individuals with anorexia nervosa (AN) have been found to show reduced temporal discounting rates, indicating a greater preference for delayed rewards compared to healthy peers. Obsessive-compulsive disorder (OCD) and social anxiety disorder (SAD) commonly co-occur with AN, and anxiety has been related to development and prognosis of AN. We examined whether reduced temporal discounting is present across these potentially related disorders, and explored the relationship between temporal discounting and anxiety transdiagnostically. METHODS One hundred ninety six individuals (75 healthy controls (HC); 50 OCD; 27 AN; 44 SAD) completed two temporal discounting tasks in which they chose between smaller-sooner and larger-later monetary rewards. Two measures of discounting-discount rate and discount factor-were compared between diagnostic groups, and associations with anxious traits were examined. RESULTS Individuals with AN showed decreased temporal discounting compared to HC. OCD and SAD groups did not differ significantly from HC. Across the sample, anxiety was associated with decreased discounting; more anxious individuals showed a greater preference for delayed reward. CONCLUSIONS We replicated the findings that individuals with AN show an increased preference for delayed reward relative to HC and that individuals with OCD do not differ from HC. We also showed that individuals with SAD do not differ from HC in discounting. Across this large sample, two measures of anxious temperament were associated with temporal discounting. These data raise new questions about the relationship between this dimensional trait and psychopathology.
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Affiliation(s)
- Joanna E. Steinglass
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA
| | | | - Tse-Hwei Choo
- Department of Biostatistics, Columbia University Medical Center, New York, NY, USA
| | | | - Melanie Wall
- New York State Psychiatric Institute, New York, NY, USA,Department of Biostatistics, Columbia University Medical Center, New York, NY, USA
| | - B. Timothy Walsh
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA
| | - Abby J. Fyer
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA
| | - Franklin R. Schneier
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA
| | - H. Blair Simpson
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA
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Gat-Lazer S, Geva R, Gur E, Stein D. Reward Dependence and Harm Avoidance among Patients with Binge-Purge Type Eating Disorders. EUROPEAN EATING DISORDERS REVIEW 2017; 25:205-213. [DOI: 10.1002/erv.2505] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 12/20/2016] [Accepted: 01/23/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Sigal Gat-Lazer
- Department of Psychology, Gonda Multidisciplinary Brain Research Center; Bar-Ilan University; Ramat Gan Israel
- Day Care Unit, Rehabilitation Hospital; Sheba Medical Center; Ramat Gan Israel
| | - Ronny Geva
- Department of Psychology, Gonda Multidisciplinary Brain Research Center; Bar-Ilan University; Ramat Gan Israel
| | - Eitan Gur
- Eating Disorders Department, Psychiatric Division, Rehabilitation Hospital; Sheba Medical Center; Ramat Gan Israel
| | - Daniel Stein
- Pediatric Psychosomatic Department, Edmond and Lily Safra Children's Hospital; Sheba Medical Center; Ramat Gan Israel
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Matsumoto J, Hirano Y, Hashimoto K, Ishima T, Kanahara N, Niitsu T, Shiina A, Hashimoto T, Sato Y, Yokote K, Murano S, Kimura H, Hosoda Y, Shimizu E, Iyo M, Nakazato M. Altered serum level of matrix metalloproteinase-9 and its association with decision-making in eating disorders. Psychiatry Clin Neurosci 2017; 71:124-134. [PMID: 27891714 DOI: 10.1111/pcn.12490] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 11/13/2016] [Accepted: 11/16/2016] [Indexed: 12/11/2022]
Abstract
AIM The aims of this study were to determine whether the serum levels of precursor brain-derived neurotrophic factor (proBDNF), mature BDNF (mBDNF), and matrix metalloproteinase-9 (MMP-9) are altered in patients with eating disorders (ED), including anorexia nervosa (AN) and bulimia nervosa (BN), and to explore whether those levels are associated with decision-making abilities. METHODS Nineteen women with AN, 28 women with BN, and 22 age-matched healthy control women (HC) were enrolled in the current study. All participants had their decision-making abilities assessed using the Iowa Gambling Task (IGT). Their eating-related pathophysiology and depressive/anxiety symptoms were also evaluated. RESULTS The MMP-9 level in AN was significantly lower than that in either BN or HC, but the serum levels of proBDNF and mBDNF did not differ among the three groups. Investigation of the serum levels of proBDNF and MMP-9 in patients with ED and controls revealed a significant correlation between them. In the BN, there were positive correlations between mBDNF level and IGT performance and also between MMP-9 level and IGT performance, but these correlations did not occur in AN. The MMP-9 level was positively associated with the Symptom Scale, one of the subscales of the Bulimic Investigatory Test, Edinburgh, only in AN. CONCLUSION These results suggest that the serum level of MMP-9 plays a role in the pathophysiology of AN, and both the serum levels of mBDNF and MMP-9 may be associated with decision-making abilities in patients with BN.
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Affiliation(s)
- Junko Matsumoto
- Department of Regional Disaster Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yoshiyuki Hirano
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
| | | | | | | | - Tomihisa Niitsu
- Departments of Psychiatry, Graduate School of Medicine, Chiba University, Chiba, Japan
| | | | - Tasuku Hashimoto
- Departments of Psychiatry, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yasunori Sato
- Global Clinical Research, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Koutaro Yokote
- Clinical Cell Biology and Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Shunichi Murano
- Department of Regional Disaster Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hiroshi Kimura
- Departments of Psychiatry, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yutaka Hosoda
- Departments of Psychiatry, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Eiji Shimizu
- Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masaomi Iyo
- Center for Forensic Mental Health, Chiba, Japan.,Departments of Psychiatry, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Michiko Nakazato
- Research Center for Child Mental Development, Chiba University, Chiba, Japan.,Departments of Psychiatry, Graduate School of Medicine, Chiba University, Chiba, Japan
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Danner UN, Sternheim L, Bijsterbosch JM, Dingemans AE, Evers C, van Elburg AA. Influence of negative affect on decision making in women with restrictive and binge-purge type anorexia nervosa. Psychiatry Res 2016; 239:39-46. [PMID: 27137960 DOI: 10.1016/j.psychres.2016.02.054] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 02/16/2016] [Accepted: 02/22/2016] [Indexed: 01/26/2023]
Abstract
The present study aims to examine the influence of negative affect on decision making in women with anorexia nervosa (AN) compared to healthy control women and, secondly, to assess differences between the restrictive (ANR) and binge-purge (ANBP) subtypes. One hundred four women (32 with ANR, 32 with ANBP, and 40 healthy controls) participated. All women were asked to watch either a negative or a control film fragment, both followed by the Bechara Gambling Task (BGT). Before and after the fragments negative affect was measured. Additionally, relevant characteristics (e.g., overall depressive symptoms) were assessed. Differences in negative affect did not influence decision making performance. Independent of affective state, decision making was found to be impaired in women with ANBP (no learning effect on the BGT), but not in women with ANR. These findings highlight the importance of considering different AN subtypes when examining decision making processes. However, the role of negative affect on decision making remains uncertain. Since other affect related factors such as affect dysregulation may also play a role, future studies on decision making in AN should take the role of affect into account.
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Affiliation(s)
- Unna N Danner
- Altrecht Eating Disorders Rintveld, Altrecht Mental Health Institute, The Netherlands; Utrecht Research Group Eating disorders, The Netherlands
| | - Lot Sternheim
- Altrecht Eating Disorders Rintveld, Altrecht Mental Health Institute, The Netherlands; Utrecht Research Group Eating disorders, The Netherlands; Department of Clinical and Health Psychology, Utrecht University, The Netherlands
| | - Jojanneke M Bijsterbosch
- Altrecht Eating Disorders Rintveld, Altrecht Mental Health Institute, The Netherlands; Utrecht Research Group Eating disorders, The Netherlands
| | | | - Catharine Evers
- Department of Clinical and Health Psychology, Utrecht University, The Netherlands
| | - Annemarie A van Elburg
- Altrecht Eating Disorders Rintveld, Altrecht Mental Health Institute, The Netherlands; Utrecht Research Group Eating disorders, The Netherlands; Department of Clinical and Health Psychology, Utrecht University, The Netherlands
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Yano M, Kawano N, Tanaka S, Kohmura K, Katayama H, Nishioka K, Ozaki N. Dysfunction of response inhibition in eating disorders. J Clin Exp Neuropsychol 2016; 38:700-8. [DOI: 10.1080/13803395.2016.1151480] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Neveu R, Fouragnan E, Barsumian F, Carrier E, Lai M, Nicolas A, Neveu D, Coricelli G. Preference for Safe Over Risky Options in Binge Eating. Front Behav Neurosci 2016; 10:65. [PMID: 27065829 PMCID: PMC4815053 DOI: 10.3389/fnbeh.2016.00065] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 03/23/2016] [Indexed: 11/13/2022] Open
Abstract
Binge eating has been usually viewed as a loss of control and an impulsive behavior. But, little is known about the actual behavior of binging patients (prevalently women) in terms of basic decision-making under risk or under uncertainty. In healthy women, stressful cues bias behavior for safer options, raising the question of whether food cues that are perceived as threatening by binging patients may modulate patients’ behaviors towards safer options. A cross-sectional study was conducted with binging patients (20 bulimia nervosa (BN) and 23 anorexia nervosa binging (ANB) patients) and two control groups (22 non-binging restrictive (ANR) anorexia nervosa patients and 20 healthy participants), without any concomitant impulsive disorder. We assessed decisions under risk with a gambling task with known probabilities and decisions under uncertainty with the balloon analog risk taking task (BART) with unknown probabilities of winning, in three cued-conditions including neutral, binge food and stressful cues. In the gambling task, binging and ANR patients adopted similar safer attitudes and coherently elicited a higher aversion to losses when primed by food as compared to neutral cues. This held true for BN and ANR patients in the BART. After controlling for anxiety level, these safer attitudes in the food condition were similar to the ones under stress. In the BART, ANB patients exhibited a higher variability in their choices in the food compared to neutral condition. This higher variability was associated with higher difficulties to discard irrelevant information. All these results suggest that decision-making under risk and under uncertainty is not fundamentally altered in all these patients.
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Affiliation(s)
- Rémi Neveu
- Neuroscience Research Center, CNRS, Université de LyonLyon, France; Praxis, Ville-la-GrandFrance
| | - Elsa Fouragnan
- Institute of Psychology and Neurosciences, University of Glasgow Glasgow, Scotland, UK
| | - Franck Barsumian
- Neuroscience Research Center, CNRS, Université de Lyon Lyon, France
| | | | | | | | - Dorine Neveu
- Université Montpellier 1, INSERM U 1058 Montpellier, France
| | - Giorgio Coricelli
- Neuroscience Research Center, CNRS, Université de LyonLyon, France; Department of Economics, University of Southern CaliforniaLos Angelès, CA, USA
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Carral-Fernández L, González-Blanch C, Goddard E, González-Gómez J, Benito-González P, Bustamante-Cruz E, Gómez Del Barrio A. Planning Abilities in Patients with Anorexia Nervosa Compared with Healthy Controls. Clin Neuropsychol 2016; 30:228-42. [PMID: 26959649 DOI: 10.1080/13854046.2016.1147603] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Altered cognitive functioning could have an important role in the development and maintenance of Anorexia Nervosa (AN). The majority of previous research has focused on flexibility and global-detail processing. The aim of this study was to explore planning abilities in women with AN. METHOD Women with AN (n = 32) were compared to healthy controls (n = 42) using two different types of neuropsychological tasks for the assessment of planning abilities: Tower of London (ToL), a classic measure of planning abilities, and Zoo Map test, a more ecologically valid planning measure. Measures of AN psychopathology, anxiety, depression, and obsessive compulsivity were also collected. RESULTS The AN group did not differ from controls in the ToL (all p-values p > .05), although they performed significantly worse than controls in the main score of the Zoo Map (p = .02). A worse performance in the Zoo Map test More was associated with more eating disorders (rho = -.44, p = .018) and depressive (rho = -.42, p = .026) symptoms in the AN group. CONCLUSIONS Our study suggests the presence of subtle planning difficulties in women with AN which might be better detected using tasks with increased ecological validity.
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Affiliation(s)
- Laura Carral-Fernández
- a Marqués de Valdecilla Public Foundation-Research Institute (FMV-IFIMAV) , Santander , Spain.,b Public Health Institute Carlos III, Ministry of Science and Innovation - Government of Spain , Madrid , Spain.,c Eating Disorders Unit, Department of Psychiatry , University Hospital "Marqués de Valdecilla" , Santander , Spain
| | - César González-Blanch
- d Mental Health Centre , University Hospital "Marqués de Valdecilla" , Santander , Spain
| | - Elizabeth Goddard
- e Section of Eating Disorders, Department of Psychological Medicine , King's College London, Institute of Psychiatry , London , UK
| | - Jana González-Gómez
- a Marqués de Valdecilla Public Foundation-Research Institute (FMV-IFIMAV) , Santander , Spain.,c Eating Disorders Unit, Department of Psychiatry , University Hospital "Marqués de Valdecilla" , Santander , Spain
| | - Pilar Benito-González
- c Eating Disorders Unit, Department of Psychiatry , University Hospital "Marqués de Valdecilla" , Santander , Spain
| | - Encarnación Bustamante-Cruz
- c Eating Disorders Unit, Department of Psychiatry , University Hospital "Marqués de Valdecilla" , Santander , Spain
| | - Andrés Gómez Del Barrio
- c Eating Disorders Unit, Department of Psychiatry , University Hospital "Marqués de Valdecilla" , Santander , Spain.,f CIBERSAM, Centro Investigación Biomédica en Red Salud Mental , Madrid , Spain
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Wu M, Brockmeyer T, Hartmann M, Skunde M, Herzog W, Friederich HC. Reward-related decision making in eating and weight disorders: A systematic review and meta-analysis of the evidence from neuropsychological studies. Neurosci Biobehav Rev 2015; 61:177-96. [PMID: 26698021 DOI: 10.1016/j.neubiorev.2015.11.017] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 11/30/2015] [Indexed: 02/02/2023]
Abstract
Eating disorders (EDs) and overweight/obesity (OW/OB) are serious public health concerns that share common neuropsychological features and patterns of disturbed eating. Reward-related decision making as a basic neurocognitive function may trans-diagnostically underlie both pathological overeating and restricted eating. The present meta-analysis synthesizes the evidence from N=82 neuropsychological studies for altered reward-related decision making in all ED subtypes, OW and OB. The overall effect sizes for the differences between currently-ill ED patients and OW/OB people and controls were Hedge's g=-0.49 [CI: -0.63; -0.35], and Hedge's g=-0.39 [CI: -0.53; -0.25], respectively. Decision making was found to be altered to similar degrees in all ED subtypes and OB. Effect sizes, however, diverged for the different measures of decision making. Adolescents appear to be less affected than adults. When foods were used as rewarding stimuli, decision making was found to be intact in OB. The findings support that altered general reward-related decision making is a salient neuropsychological factor across eating and weight disorders in adulthood.
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Affiliation(s)
- Mudan Wu
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg Heidelberg, Germany; Department of Psychology, College of Education, Shanghai Normal University, Shanghai, China
| | - Timo Brockmeyer
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg Heidelberg, Germany.
| | - Mechthild Hartmann
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg Heidelberg, Germany
| | - Mandy Skunde
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg Heidelberg, Germany
| | - Wolfgang Herzog
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg Heidelberg, Germany; Department of Psychosomatic Medicine and Psychotherapy, LVR-Klinikum, University Duisburg-Essen, Essen, Germany
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Guillaume S, Gorwood P, Jollant F, Van den Eynde F, Courtet P, Richard-Devantoy S. Impaired decision-making in symptomatic anorexia and bulimia nervosa patients: a meta-analysis. Psychol Med 2015; 45:3377-3391. [PMID: 26497047 DOI: 10.1017/s003329171500152x] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Impaired decision-making is a potential neurocognitive phenotype of eating disorders. It is therefore important to disentangle the decision-making deficits associated with the eating disorder subtypes and determine whether this putative impairment is a state or trait marker of the disease or more related to starvation. We systematically reviewed the literature on decision-making in eating disorders and conducted a meta-analysis to explore its role in anorexia nervosa (AN), bulimia nervosa (BN) and binge-eating disorder (BED). METHOD A search of the Medline and EMBASE databases and article references was performed. A total of 23 studies (2044 participants) met the selection criteria. When the Iowa gambling task (IGT) was used in at least three of the studies, a meta-analysis was run. RESULTS IGT performance was significantly worse in patients with an eating disorder diagnosis (AN, BN or BED) compared with healthy controls, indicating that eating disorders have a negative effect on decision-making. Hedges' g effect sizes were moderate to large (-0.72 in AN, -0.62 in BN, and -1.26 in BED). Recovered AN patients had IGT scores similar to those of healthy controls. Restrictive AN patients had significantly lower IGT net scores than purging AN patients, and both AN subtypes had worse performances than healthy controls. Age and body mass index did not explain results. CONCLUSIONS Decision-making was significantly altered in patients with eating disorders. Poor decision-making was more pronounced during the acute phase than in the recovered state of AN. Nutritional status during the acute phase of the disease did not seem to influence decision-making skills.
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Affiliation(s)
- S Guillaume
- Université Montpellier I & CHU Montpellier & Inserm,U1061,Montpellier,France
| | - P Gorwood
- CMME (Groupe Hospitalier Sainte-Anne),Université Paris Descartes,Paris,France
| | - F Jollant
- Department of Psychiatry & Douglas Mental Health University Institute,McGill Group for Suicide Studies,McGill University,Montréal (Québec),Canada
| | - F Van den Eynde
- Department of Psychiatry & Douglas Mental Health University Institute,McGill University,Montréal (Québec),Canada
| | - P Courtet
- Université Montpellier I & CHU Montpellier & Inserm,U1061,Montpellier,France
| | - S Richard-Devantoy
- Department of Psychiatry & Douglas Mental Health University Institute,McGill Group for Suicide Studies,McGill University,Montréal (Québec),Canada
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Gastrointestinal symptoms and disorders in patients with eating disorders. Clin J Gastroenterol 2015; 8:255-63. [PMID: 26499370 DOI: 10.1007/s12328-015-0611-x] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 10/07/2015] [Indexed: 12/14/2022]
Abstract
The two most clinically serious eating disorders are anorexia nervosa and bulimia nervosa. A drive for thinness and fear of fatness lead patients with anorexia nervosa either to restrict their food intake or binge-eat then purge (through self-induced vomiting and/or laxative abuse) to reduce their body weight to much less than the normal range. A drive for thinness leads patients with bulimia nervosa to binge-eat then purge but fail to reduce their body weight. Patients with eating disorders present with various gastrointestinal disturbances such as postprandial fullness, abdominal distention, abdominal pain, gastric distension, and early satiety, with altered esophageal motility sometimes seen in patients with anorexia nervosa. Other common conditions noted in patients with eating disorders are postprandial distress syndrome, superior mesenteric artery syndrome, irritable bowel syndrome, and functional constipation. Binge eating may cause acute gastric dilatation and gastric perforation, while self-induced vomiting can lead to dental caries, salivary gland enlargement, gastroesophageal reflux disease, and electrolyte imbalance. Laxative abuse can cause dehydration and electrolyte imbalance. Vomiting and/or laxative abuse can cause hypokalemia, which carries a risk of fatal arrhythmia. Careful assessment and intensive treatment of patients with eating disorders is needed because gastrointestinal symptoms/disorders can progress to a critical condition.
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Abbate-Daga G, Buzzichelli S, Marzola E, Aloi M, Amianto F, Fassino S. Does depression matter in neuropsychological performances in anorexia nervosa? A descriptive review. Int J Eat Disord 2015; 48:736-45. [PMID: 26032280 DOI: 10.1002/eat.22399] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 12/16/2014] [Accepted: 02/12/2015] [Indexed: 01/12/2023]
Abstract
OBJECTIVE This review aims to examine the impact of depressive symptoms on the assessment of cognitive flexibility, central coherence, and decision-making in individuals with anorexia nervosa (AN). METHOD An online search was carried out using PubMed and PsycInfo. Articles were selected for review if they were published in English between 1990 and 2014 and used the Wisconsin Card Sorting Test, the Trail Making Task parts A and B, the Brixton Test, the Rey-Osterrieth Complex Figure Test, and/or the Iowa Gambling Task. RESULTS Sixty-two studies were included. Thirty (48%) of the studies statistically assessed the association between depression and neurocognition in AN versus healthy controls. Where significant correlations were found, it became clear that the more serious the depression, the greater the neuropsychological impairment. Only six (10%) studies examined whether increased depressive symptoms were able to eliminate the differences between individuals with AN and healthy controls, and one study found that depressive symptoms did eliminate group differences in cognitive flexibility and decision-making. DISCUSSION Only a subgroup of articles on neuropsychology in AN adjusted for depression. However, given the role of depression that some articles suggest, future studies should pay closer attention to the evaluation of this potential confounder.
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Affiliation(s)
- Giovanni Abbate-Daga
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Sara Buzzichelli
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Enrica Marzola
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Matteo Aloi
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy.,Ambulatory for Clinical Research and Treatment of Eating Disorders, Department of Health Sciences, University "Magna Graecia", Catanzaro, Italy
| | - Federico Amianto
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Secondo Fassino
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
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Giustiniani J, Gabriel D, Nicolier M, Monnin J, Haffen E. Neural Correlates of Successful and Unsuccessful Strategical Mechanisms Involved in Uncertain Decision-Making. PLoS One 2015; 10:e0130871. [PMID: 26086196 PMCID: PMC4472228 DOI: 10.1371/journal.pone.0130871] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Accepted: 05/26/2015] [Indexed: 11/28/2022] Open
Abstract
The ability to develop successful long-term strategies in uncertain situations relies on complex neural mechanisms. Although lesion studies have shown some of the mechanisms involved, it is still unknown why some healthy subjects are able to make the right decision whereas others are not. The aim of our study was to investigate neurophysiological differences underlying this ability to develop a successful strategy in a group of healthy subjects playing a monetary card game called the Iowa Gambling Task (IGT). In this task, subjects have to win and earn money by choosing between four decks of cards, two were advantageous in the long term and two disadvantageous. Twenty healthy right-handed subjects performed the IGT while their cerebral activity was recorded by electroencephalography. Based on their behavioral performances, two groups of subjects could clearly be distinguished: one who selected the good decks and thus succeeded in developing a Favorable strategy (9 subjects) and one who remained Undecided (11 subjects). No neural difference was found between each group before the selection of a deck, but in both groups a greater negativity was found emerging from the right superior frontal gyrus 600 ms before a disadvantageous selection. During the processing of the feedback, an attenuation of the P200 and P300 waveforms was found for the Undecided group, and a P300 originating from the medial frontal gyrus was found in response to a loss only in the Favorable group. Our results suggest that undecided subjects are hyposensitive to the valence of the cards during gambling, which affects the feedback processing.
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Affiliation(s)
- Julie Giustiniani
- Department of Clinical Psychiatry, University Hospital, Besançon, France
- CIC-1431 Inserm, University Hospital, Besançon, France
| | - Damien Gabriel
- EA 481, Laboratory of Neurosciences, University of Franche-Comté, Besançon, France
- CIC-1431 Inserm, University Hospital, Besançon, France
- * E-mail:
| | - Magali Nicolier
- Department of Clinical Psychiatry, University Hospital, Besançon, France
- EA 481, Laboratory of Neurosciences, University of Franche-Comté, Besançon, France
- CIC-1431 Inserm, University Hospital, Besançon, France
| | - Julie Monnin
- Department of Clinical Psychiatry, University Hospital, Besançon, France
- EA 481, Laboratory of Neurosciences, University of Franche-Comté, Besançon, France
- CIC-1431 Inserm, University Hospital, Besançon, France
| | - Emmanuel Haffen
- Department of Clinical Psychiatry, University Hospital, Besançon, France
- EA 481, Laboratory of Neurosciences, University of Franche-Comté, Besançon, France
- CIC-1431 Inserm, University Hospital, Besançon, France
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Maintenance of parasympathetic inhibition following emotional induction in patients with restrictive type anorexia nervosa. Psychiatry Res 2015; 225:651-7. [PMID: 25500345 DOI: 10.1016/j.psychres.2014.11.030] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Revised: 10/30/2014] [Accepted: 11/07/2014] [Indexed: 11/21/2022]
Abstract
This study aimed to explore changes in heart rate variability (HRV), a proxy for parasympathetic activity characterizing emotion regulation processes before, during and after negative emotional induction in patients suffering from restrictive type anorexia nervosa (AN-RT). We compared two methods of HRV analysis, the Fast Fourier Transform high frequency (FFT-HF) and a specific HRV high frequency analysis technique, namely, the wavelet transform HRV (WT-HRV). A sample of 16 inpatients with AN-RT was compared to 24 control participants. Heart rate (HR) was continuously recorded for 5 min before the beginning of the video until 5 min after the video. The participants answered questionnaires concerning their eating behaviors, mood disorders and difficulties in emotion regulation. During the entire procedure, the FFT-HF in patients was lower than that in controls. Using the WT-HRV, the patients did not differ from the controls at baseline, and only the controls showed a decrease during emotional induction. After the video, the WT-HRV in patients began to decrease during the first 2 min of emotional recovery although the WT-HRV in controls was already increased. These results highlighted the disturbances in the physiological dynamics of emotion regulation processes in patients with AN-RT.
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Oltra-Cucarella J, Rojo Moreno L, Arribas Sáiz P, Sanguesa García C, Latorre Paniagua P, Hidalgo Muñoz E, Rojo Bofill L. Impaired executive functioning influences verbal memory in anorexia nervosa. Eat Behav 2015; 16:47-53. [PMID: 25464067 DOI: 10.1016/j.eatbeh.2014.10.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 10/19/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND How executive functioning affects delayed verbal recall in AN has never been tested. We investigated the influence of speed of information processing (SIP) and inhibition on delayed verbal recall in females with AN. METHODS Measures of SIP and inhibition from 35 females with AN were analyzed using hierarchical multiple regression after controlling for age, depressive symptomatology and body mass index. Each predictor was evaluated using structure coefficients, common variance and dominance weights. RESULTS The combination of measures of SIP and inhibition accounted for almost 80% of the variance on the delayed recall of the story recall task. When the rest of the variables were partialled out, SIP and inhibition accounted for more than 50% of the variance. CONCLUSIONS As it occurs with visuospatial abilities in AN, basic cognitive abilities such as speed of information processing and cognitive inhibition may affect other cognitive functions such as delayed verbal memory regardless of immediate recall. These findings may help interpret performance on cognitive tests in future research.
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Affiliation(s)
| | - L Rojo Moreno
- Unit of Infant/Juvenile Psychiatry and Eating Disorders, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain, CIBERESP
| | - P Arribas Sáiz
- Unit of Infant/Juvenile Psychiatry and Eating Disorders, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
| | - C Sanguesa García
- Unit of Infant/Juvenile Psychiatry and Eating Disorders, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
| | - P Latorre Paniagua
- Unit of Infant/Juvenile Psychiatry and Eating Disorders, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
| | - E Hidalgo Muñoz
- Unit of Infant/Juvenile Psychiatry and Eating Disorders, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
| | - L Rojo Bofill
- Psychiatry Service, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
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Bickel WK, Quisenberry AJ, Moody L, Wilson AG. Therapeutic Opportunities for Self-Control Repair in Addiction and Related Disorders: Change and the Limits of Change in Trans-Disease Processes. Clin Psychol Sci 2015; 3:140-153. [PMID: 25664226 PMCID: PMC4314724 DOI: 10.1177/2167702614541260] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Contemporary neuro-economic approaches hypothesize that self-control failure results from drugs annexing normal learning mechanisms that produce pathological reward processing and distort decision-making as a result from the dysregulation of two valuation systems. An emphasis on processes shared across different diseases and disorders is at odds with the contemporary approach that assumes unique disease etiologies and treatments. Studying trans-disease processes can identify mechanisms that operate in multiple disease states and ascertain if factors that influence processes in one disease state may be applicable to all disease states. In this paper we review the dual model of self-control failure, the Competing Neurobehavioral Decision Systems approach, the relationship of delay discounting to the relative control of these two systems, and evidence that the executive system can be strengthened. Future research that could result in more potent interventions for executive system improvement and potential constraints on the repair of self-control failure are discussed.
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Affiliation(s)
| | | | - Lara Moody
- Virginia Tech Carilion Research Institute, Roanoke, VA
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Matsumoto J, Hirano Y, Numata N, Matzuzawa D, Murano S, Yokote K, Iyo M, Shimizu E, Nakazato M. Comparison in decision-making between bulimia nervosa, anorexia nervosa, and healthy women: influence of mood status and pathological eating concerns. J Eat Disord 2015; 3:14. [PMID: 25838916 PMCID: PMC4383070 DOI: 10.1186/s40337-015-0050-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 03/08/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Decision-making is reported to be impaired in anorexia nervosa (AN) and bulimia nervosa (BN), but the influence of mood status, pathophysiological eating, and weight concerns on the performance of decision-making ability between AN and BN is still unclear. The aims of this study were to investigate differential impairments in the decision-making process between AN, BN, and healthy controls (HC), and secondly, to explore the role of mood status, such as anxiety, depression, pathological eating, and weight concerns, in decision-making ability. METHODS Patients suffering from AN (n = 22), BN (n = 36) and age-matched HC (n = 51) were assessed for their decision-making abilities using the Iowa Gambling Task (IGT). Self-reported questionnaires including the Eating Disorder Examination Questionnaire (EDE-Q), the Bulimia Investigatory Test, Edinburgh (BITE), the Eating Disorders Inventory, the Maudsley Obsessive-Compulsive Inventory measuring obsessive-compulsive traits, the Hospital Anxiety and Depression Scale, and the Toronto Alexithymia Scale were used to assess pathological eating concerns and attitude to feelings. RESULTS Significant differences in IGT performance were observed between BN and HC. Significant negative correlation was found between IGT performance and the BITE symptom subscale in AN. In BN, there was a negative correlation between the EDE-Q weight concerns subscale and IGT performance. It was also found that increased anxiety, depression, and eating/weight concerns predicted poorer decision-making. CONCLUSION Different patterns of association between pathological eating concerns/behaviors and performances in decision-making ability were found between AN, BN, and HC. Anxiety, depressive mood status, and eating/weight concerns were related to decision-making ability.
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Affiliation(s)
- Junko Matsumoto
- United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University and University of Fukui, Suita, Japan ; Research Center for Child Mental Development, Graduate School of Medicine, Chiba University, Chiba, Japan ; Department of Regional Disaster Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan ; Tochigi Shimotsuga General Hospital, Tochigi Medical Center, Tochigi, Japan
| | - Yoshiyuki Hirano
- United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University and University of Fukui, Suita, Japan ; Research Center for Child Mental Development, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Noriko Numata
- Research Center for Child Mental Development, Graduate School of Medicine, Chiba University, Chiba, Japan ; Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Daisuke Matzuzawa
- United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University and University of Fukui, Suita, Japan ; Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Shunichi Murano
- Tochigi Shimotsuga General Hospital, Tochigi Medical Center, Tochigi, Japan
| | - Koutaro Yokote
- Department of Clinical Cell Biology and Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masaomi Iyo
- Department of Child Psychiatry, Graduate School of Medicine, Chiba University, Chiba, Japan ; Department of Psychiatry, Graduate School of Medicine, Chiba University, Chiba, Japan ; Center for Forensic Mental Health, Chiba University, Chiba, Japan
| | - Eiji Shimizu
- United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University and University of Fukui, Suita, Japan ; Research Center for Child Mental Development, Graduate School of Medicine, Chiba University, Chiba, Japan ; Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Michiko Nakazato
- United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University and University of Fukui, Suita, Japan ; Research Center for Child Mental Development, Graduate School of Medicine, Chiba University, Chiba, Japan ; Department of Child Psychiatry, Graduate School of Medicine, Chiba University, Chiba, Japan
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Wu M, Brockmeyer T, Hartmann M, Skunde M, Herzog W, Friederich HC. Set-shifting ability across the spectrum of eating disorders and in overweight and obesity: a systematic review and meta-analysis. Psychol Med 2014; 44:3365-3385. [PMID: 25066267 DOI: 10.1017/s0033291714000294] [Citation(s) in RCA: 123] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND In this meta-analysis we review the findings from neuropsychological studies on set-shifting in people with eating disorders (EDs) or overweight/obesity. METHOD Four databases (PubMed, PsycINFO, PSYNDEX and Web of Science) were searched for eligible studies. Effect sizes (ESs) were pooled using random-effects models. Moderator analyses were conducted for ED and overweight/obese subgroups, adult/adolescent samples and measures of set-shifting. RESULTS Sixty-four studies with a total of 1825 ED patients [1394 anorexia nervosa (AN), 376 bulimia nervosa (BN) and 55 binge eating disorder (BED)] and 10 studies with a total of 449 overweight/obese individuals were included. The meta-analysis revealed a small to medium ES for inefficient set-shifting across all three ED diagnoses (Hedges' g = -0.45). Subgroup analyses yielded small to medium ESs for each ED subtype (g = -0.44 for AN, -0.53 for BED, -0.50 for BN), which did not differ significantly. There was a medium ES for restricting type AN (ANR; g = -0.51) but no significant ES for binge/purge type AN (AN/BP; g = -0.18). A medium ES was found across obesity studies (g = -0.61). The ES across overweight studies was not significant (g = -0.07). Adult samples did not differ from adolescent samples in either ED or overweight/obesity studies. The different set-shifting measures were associated with largely varying ESs. CONCLUSIONS The meta-analysis provides strong support that inefficient set-shifting is a salient neuropsychological phenomenon across ED subtypes and obesity, but is less prominent in AN/BP and overweight. Compulsivity seems to be a common underlying factor supporting a dimensional and transdiagnostic conceptualization of EDs and obesity.
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Affiliation(s)
- M Wu
- Department of General Internal Medicine and Psychosomatics,University of Heidelberg,Germany
| | - T Brockmeyer
- Department of General Internal Medicine and Psychosomatics,University of Heidelberg,Germany
| | - M Hartmann
- Department of General Internal Medicine and Psychosomatics,University of Heidelberg,Germany
| | - M Skunde
- Department of General Internal Medicine and Psychosomatics,University of Heidelberg,Germany
| | - W Herzog
- Department of General Internal Medicine and Psychosomatics,University of Heidelberg,Germany
| | - H-C Friederich
- Department of General Internal Medicine and Psychosomatics,University of Heidelberg,Germany
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Bodell LP, Keel PK, Brumm MC, Akubuiro A, Caballero J, Tranel D, Hodis B, McCormick LM. Longitudinal examination of decision-making performance in anorexia nervosa: before and after weight restoration. J Psychiatr Res 2014; 56:150-7. [PMID: 24939417 PMCID: PMC4127974 DOI: 10.1016/j.jpsychires.2014.05.015] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 04/21/2014] [Accepted: 05/20/2014] [Indexed: 01/30/2023]
Abstract
BACKGROUND This study aimed to extend previous work on decision-making deficits in anorexia nervosa (AN) by using a longitudinal design to examine decision-making before and after weight restoration. METHODS Participants were 22 women with AN and 20 healthy comparison participants who completed the Iowa Gambling Task (IGT). Decision-making was assessed both before and after weight restoration in a subset of 14 AN patients. Self-report and interview assessments were used to measure psychological correlates of decision-making performance including depression, anxiety, and eating disorder symptoms, and magnetic resonance imaging (MRI) scans were conducted to explore associations between brain volume in the orbitofrontal cortex (OFC) and decision-making in individuals with AN. RESULTS Currently ill AN patients performed worse on the IGT compared to the control group. Although decision-making performance did not improve significantly with weight restoration in the full AN sample, AN patients who were poor performers at baseline did improve task performance with weight-restoration. When actively ill, lower body mass index (BMI) and decreased left medial OFC volume were significantly associated with worse IGT performance, and these associations were no longer significant after weight restoration. CONCLUSIONS Findings suggest that decision-making deficits in AN in the acute phase of illness are associated with low weight and decreased left medial OFC volume, but increases in brain volume and BMI may not have been sufficient to improve decision-making in all patients. Findings contribute to a model for understanding how some patients may sustain self-starvation, and future work should examine whether decision-making deficits predict relapse.
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Affiliation(s)
- Lindsay P Bodell
- Florida State University, Department of Psychology, United States.
| | - Pamela K Keel
- Florida State University, Department of Psychology, United States
| | - Michael C Brumm
- University of Iowa Carver College of Medicine, Department of Psychiatry, United States
| | - Ashley Akubuiro
- University of Iowa, Department of Neuroscience, United States
| | | | - Daniel Tranel
- University of Iowa Carver College of Medicine, Division of Behavioral Neurology and Cognitive Neuroscience, United States; University of Iowa, Department of Psychology, United States
| | - Brendan Hodis
- University of Iowa Carver College of Medicine, United States
| | - Laurie M McCormick
- University of Iowa Carver College of Medicine, Department of Psychiatry, United States; University of the Virgin Islands, United States; Roy Lester Schneider Hospital, United States.
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Abstract
OBJECTIVES To assess decision-making under explicit risk conditions in relapsing-remitting multiple sclerosis patients and its relationship to decisions made under conditions of ambiguity. To assess cognitive functions related to decision-making performance in patients with multiple sclerosis (MS). SETTING MS center in Buenos Aires, Argentina. PARTICIPANTS 27 patients with relapsing-remitting multiple sclerosis and 27 sex-matched, age-matched and education-matched healthy controls. INTERVENTION Neuropsychological assessment and decision-making evaluation using the Game of Dice Task and the Iowa Gambling Task. OUTCOMES Game of Dice Task and the Iowa Gambling Task scores. RESULTS Patients with MS showed significantly poorer performance on the Game of Dice Task, choosing disadvantageous dice more often (p=0.019), as well as significantly lower overall scores in the Iowa Gambling Task (p=0.007). Block analysis showed that patients with MS and controls had scores that were comparable for blocks 1 and 2 (p=0.15 and p=0.24, respectively). Conversely, patients with MS scored poorly on blocks 4 (p=0.003) and 5 (p=0.023), the last two of the test, corresponding to decision-making under conditions of risk. Finally, the Game of Dice Task performance together with the last three blocks of the Iowa Gambling Task were correlated with visuospatial learning, processing speed and working memory but not with executive functioning. CONCLUSIONS Patients with MS showed deficits in decision-making under risk conditions, which might be related to deficits in visuospatial learning, processing speed and working memory.
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Affiliation(s)
- Mauricio F Farez
- Department of Neurology, Raúl Carrea Institute for Neurological Research (FLENI), Buenos Aires, Argentina
| | - Lucía Crivelli
- Department of Neurology, Raúl Carrea Institute for Neurological Research (FLENI), Buenos Aires, Argentina
| | - Ramón Leiguarda
- Department of Neurology, Raúl Carrea Institute for Neurological Research (FLENI), Buenos Aires, Argentina
| | - Jorge Correale
- Department of Neurology, Raúl Carrea Institute for Neurological Research (FLENI), Buenos Aires, Argentina
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Park RJ, Godier LR, Cowdrey FA. Hungry for reward: How can neuroscience inform the development of treatment for Anorexia Nervosa? Behav Res Ther 2014; 62:47-59. [PMID: 25151600 DOI: 10.1016/j.brat.2014.07.007] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 07/04/2014] [Accepted: 07/16/2014] [Indexed: 12/29/2022]
Abstract
Dysfunctional reward from the pursuit of thinness presents a major challenge to recovery from Anorexia Nervosa (AN). We explore the neuroscientific basis of aberrant reward in AN, with the aim of generating novel hypotheses for translational investigation, and elucidate disease mechanisms to inform the development of targeted interventions. Relevant neuroimaging and behavioural studies are reviewed. These suggest that altered eating in AN may be a consequence of aberrant reward processing combined with exaggerated cognitive control. We consider evidence that such aberrant reward processing is reflected in the compulsive behaviours characterising AN, with substantial overlap in the neural circuits implicated in reward processing and compulsivity. Drawing on contemporary neuroscientific theories of substance dependence, processes underpinning the shift from the initially rewarding pursuit of thinness to extreme and compulsive weight control behaviours are discussed. It is suggested that in AN, weight loss behaviour begins as overtly rewarding, goal-directed and positively reinforced, but over time becomes habitual and increasingly negatively reinforced. Excessive habit formation is suggested as one underlying mechanism perpetuating compulsive behaviour. Ongoing research into the behavioural and neural basis of aberrant reward in AN is required to further elucidate mechanisms. We discuss clinical and transdiagnostic implications, and propose that future treatment innovation may benefit from the development of novel interventions targeting aberrant reward processing in AN.
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Affiliation(s)
- Rebecca J Park
- Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, Oxford, OX3 7JX, United Kingdom.
| | - Lauren R Godier
- Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, Oxford, OX3 7JX, United Kingdom
| | - Felicity A Cowdrey
- Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, Oxford, OX3 7JX, United Kingdom
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Lindner SE, Fichter MM, Quadflieg N. Set-Shifting and its Relation to Clinical and Personality Variables in Full Recovery of Anorexia Nervosa. EUROPEAN EATING DISORDERS REVIEW 2014; 22:252-9. [DOI: 10.1002/erv.2293] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
| | - Manfred M. Fichter
- Department of Psychiatry; University of Munich (LMU); Munich Germany
- Schoen Hospital Roseneck for Behavioral Medicine; Prien Germany
| | - Norbert Quadflieg
- Department of Psychiatry; University of Munich (LMU); Munich Germany
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Hubbeling D. Decision-making capacity should not be decisive in emergencies. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2014; 17:229-238. [PMID: 24370815 DOI: 10.1007/s11019-013-9534-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Examples of patients with anorexia nervosa, depression or borderline personality disorder who have decision-making capacity as currently operationalized, but refuse treatment, are discussed. It appears counterintuitive to respect their treatment refusal because their wish seems to be fuelled by their illness and the consequences of their refusal of treatment are severe. Some proposed solutions have focused on broadening the criteria for decision-making capacity, either in general or for specific patient groups, but these adjustments might discriminate against particular groups of patients and render the process less transparent. Other solutions focus on preferences expressed when patients are not ill, but this information is often not available. The reason for such difficulties with assessing decision-making capacity is that the underlying psychological processes of normal decision-making are not well known and one cannot differentiate between unwise decisions caused by an illness or other factors. The proposed alternative, set out in this paper, is to allow compulsory treatment of patients with decision-making capacity in cases of an emergency, if the refusal is potentially life threatening, but only for a time-limited period. The argument is also made for investigating hindsight agreement, in particular after compulsory measures.
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Affiliation(s)
- Dieneke Hubbeling
- Wandsworth Crisis and Home Treatment Team, South West London and St. George's Mental Health NHS Trust, 61 Glenburnie Road, London, SW17 7DJ, UK,
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Psychopathological and personality traits underlie decision making in recent onset medication naïve anorexia nervosa: a pilot study. Psychiatry Res 2014; 216:89-96. [PMID: 24512735 DOI: 10.1016/j.psychres.2013.12.052] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 12/21/2013] [Accepted: 12/29/2013] [Indexed: 01/08/2023]
Abstract
The Iowa Gambling Task (IGT) analyzes the ability of participants to sacrifice immediate rewards in view of a long term gain. Anorexia Nervosa (AN) in addition to weight loss and body image disturbances is also characterized by the tendency to make decisions that may result in long-term negative outcomes. Studies that analyzed IGT performance in patients with AN were not consistent with each other. Fifteen adolescents with AN and 15 matched controls carried out IGT after being clinically and neuropsychologically evaluated. An interesting generalized estimating equation approach showed that four independent clinical variables, and not the group, explained IGT performances, such as blocks repetition, anxiety, psychogenic eating disorders and self transcendence. The impairment of decision making is not related to the diagnosis of AN, but it is driven by high levels of anxiety and self transcendence. Instead, some psychogenic eating disorders traits, related to illness severity, positively affected IGT performance in the whole sample. IGT impairment in AN found by prior studies could be related to these clinical features which are not always taken into account.
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Validity and reliability of the behavior rating inventory of executive function - adult version in a clinical sample with eating disorders. Eat Behav 2014; 15:175-81. [PMID: 24854800 DOI: 10.1016/j.eatbeh.2014.01.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 11/29/2013] [Accepted: 01/22/2014] [Indexed: 11/20/2022]
Abstract
This study is a preliminary investigation of the reliability and validity of the Behavior Rating Inventory of Executive Function - Adult Version (BRIEF-A) in a clinical sample of patients with eating disorders (ED). Participants were 252 adult females who were referred to a centre for the treatment of EDs, as well as 31 individuals who completed the informant version of the BRIEF-A. Patients completed the BRIEF-A and other psychological measures on one occasion during their initial clinic visit, and informants nominated by patients completed the informant version at home. Reliability analyses revealed high internal consistency (Cronbach's alpha) of the two indices (Metacognition Index and Behavioral Regulation Index), and for the Global Executive Composite (GEC) of the BRIEF-A (α = .96). Convergent validity was shown by a high positive relationship between the self-report and informant-report versions of the BRIEF-A, and between the GEC and the Anxiety and Depression scales. Construct validity was assessed by an exploratory and confirmatory factor analysis. The BRIEF-A may be a reliable and valid tool for measuring executive functioning (EF) in an ED population, and may serve as an initial screening tool of EF for clinicians and researchers.
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50
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Brockmeyer T, Skunde M, Wu M, Bresslein E, Rudofsky G, Herzog W, Friederich HC. Difficulties in emotion regulation across the spectrum of eating disorders. Compr Psychiatry 2014; 55:565-71. [PMID: 24411653 DOI: 10.1016/j.comppsych.2013.12.001] [Citation(s) in RCA: 174] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 11/14/2013] [Accepted: 12/01/2013] [Indexed: 10/25/2022] Open
Abstract
Theoretical models consider difficulties in emotion regulation (ER) as central trans-diagnostic phenomena across the spectrum of eating disorders (ED). However, there is a lack of studies directly comparing ED subtypes regarding ER problems. Furthermore, patients with anorexia nervosa-restricting type (AN-R) and patients with AN-binge/purge type (AN-BP) have usually been merged into one overall AN group in previous research on ER. In order to overcome these limitations of previous studies, the present study investigated specific ER difficulties in 120 patients with different ED subtypes, including AN-R, AN-BP, bulimia nervosa (BN), and binge-eating disorder (BED). As compared to 60 healthy normal-weight controls (NWC) and 29 healthy over-weight controls (OWC), all ED subtypes reported greater difficulties in ER. ED subtypes did not differ regarding most domains of ER except BED showing less severe ER difficulties in some domains. In addition, AN-BP but not BN reported greater impulse control difficulties than AN-R and BED. The findings underscore the relevance of ER difficulties in ED and support the trans-diagnostic view of ER difficulties being present across the whole spectrum of ED. In addition, the present results suggest that certain domains of ER may be linked more closely to certain ED subtypes than to others.
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Affiliation(s)
- Timo Brockmeyer
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany.
| | - Mandy Skunde
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Mudan Wu
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Esther Bresslein
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Gottfried Rudofsky
- Division of Endocrinology and Metabolism, Department of Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Wolfgang Herzog
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
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