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Forester G, Johnson JS, Reilly EE, Lloyd EC, Johnson E, Schaefer LM. Back to the future: Progressing memory research in eating disorders. Int J Eat Disord 2023; 56:2032-2048. [PMID: 37594119 PMCID: PMC10843822 DOI: 10.1002/eat.24045] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/17/2023] [Accepted: 08/02/2023] [Indexed: 08/19/2023]
Abstract
OBJECTIVE Human behaviors, thoughts, and emotions are guided by memories of the past. Thus, there can be little doubt that memory plays a fundamental role in the behaviors (e.g., binging), thoughts (e.g., body-image concerns), and emotions (e.g., guilt) that characterize eating disorders (EDs). Although a growing body of research has begun to investigate the role of memory in EDs, this literature is limited in numerous ways and has yet to be integrated into an overarching framework. METHODS In the present article, we provide an operational framework for characterizing different domains of memory, briefly review existing ED memory research within this framework, and highlight crucial gaps in the literature. RESULTS We distinguish between three domains of memory-episodic, procedural, and working-which differ based on functional attributes and underlying neural systems. Most recent ED memory research has focused on procedural memory broadly defined (e.g., reinforcement learning), and findings within all three memory domains are highly mixed. Further, few studies have attempted to assess these different domains simultaneously, though most behavior is achieved through coordination and competition between memory systems. We, therefore, offer recommendations for how to move ED research forward within each domain of memory and how to study the interactions between memory systems, using illustrative examples from other areas of basic and clinical research. DISCUSSION A stronger and more integrated understanding of the mechanisms that connect memory of past experiences to present ED behavior may yield more comprehensive theoretical models of EDs that guide novel treatment approaches. PUBLIC SIGNIFICANCE Memories of previous eating-related experiences may contribute to the onset and maintenance of eating disorders (EDs). However, research on the role of memory in EDs is limited, and distinct domains of ED memory research are rarely connected. We, therefore, offer a framework for organizing, progressing, and integrating ED memory research, to provide a better foundation for improving ED treatment and intervention going forward.
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Affiliation(s)
- Glen Forester
- Center for Biobehavioral Research, Sanford Research, Fargo, North Dakota, USA
| | - Jeffrey S. Johnson
- Center for Biobehavioral Research, Sanford Research, Fargo, North Dakota, USA
- Department of Psychology, North Dakota State University, Fargo, North Dakota, USA
| | - Erin E. Reilly
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
| | - E. Caitlin Lloyd
- Columbia University Irving Medical Center, New York, New York, USA
- New York State Psychiatric Institute, New York, New York, USA
| | - Emily Johnson
- Department of Psychology, North Dakota State University, Fargo, North Dakota, USA
| | - Lauren M. Schaefer
- Center for Biobehavioral Research, Sanford Research, Fargo, North Dakota, USA
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota, USA
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Zorowitz S, Solis J, Niv Y, Bennett D. Inattentive responding can induce spurious associations between task behaviour and symptom measures. Nat Hum Behav 2023; 7:1667-1681. [PMID: 37414886 PMCID: PMC11170515 DOI: 10.1038/s41562-023-01640-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 05/23/2023] [Indexed: 07/08/2023]
Abstract
Although online samples have many advantages for psychiatric research, some potential pitfalls of this approach are not widely understood. Here we detail circumstances in which spurious correlations may arise between task behaviour and symptom scores. The problem arises because many psychiatric symptom surveys have asymmetric score distributions in the general population, meaning that careless responders on these surveys will show apparently elevated symptom levels. If these participants are similarly careless in their task performance, this may result in a spurious association between symptom scores and task behaviour. We demonstrate this pattern of results in two samples of participants recruited online (total N = 779) who performed one of two common cognitive tasks. False-positive rates for these spurious correlations increase with sample size, contrary to common assumptions. Excluding participants flagged for careless responding on surveys abolished the spurious correlations, but exclusion based on task performance alone was less effective.
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Affiliation(s)
- Samuel Zorowitz
- Princeton Neuroscience Institute, Princeton University, Princeton, NJ, USA.
| | - Johanne Solis
- Rutgers-Princeton Center for Computational Cognitive Neuropsychiatry, Rutgers University, Newark, NJ, USA
| | - Yael Niv
- Princeton Neuroscience Institute, Princeton University, Princeton, NJ, USA
- Department of Psychology, Princeton University, Princeton, NJ, USA
| | - Daniel Bennett
- School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
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3
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Thomas KS, Birch RE, Jones CRG, Vanderwert RE. Neural Correlates of Executive Functioning in Anorexia Nervosa and Obsessive-Compulsive Disorder. Front Hum Neurosci 2022; 16:841633. [PMID: 35693540 PMCID: PMC9179647 DOI: 10.3389/fnhum.2022.841633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
Anorexia nervosa (AN) and obsessive-compulsive disorder (OCD) are commonly reported to co-occur and present with overlapping symptomatology. Executive functioning difficulties have been implicated in both mental health conditions. However, studies directly comparing these functions in AN and OCD are extremely limited. This review provides a synthesis of behavioral and neuroimaging research examining executive functioning in AN and OCD to bridge this gap in knowledge. We outline the similarities and differences in behavioral and neuroimaging findings between AN and OCD, focusing on set shifting, working memory, response inhibition, and response monitoring. This review aims to facilitate understanding of transdiagnostic correlates of executive functioning and highlights important considerations for future research. We also discuss the importance of examining both behavioral and neural markers when studying transdiagnostic correlates of executive functions.
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Affiliation(s)
- Kai S. Thomas
- School of Psychology, Cardiff University, Cardiff, United Kingdom
- Cardiff University Centre for Human Developmental Science, School of Psychology, Cardiff University, Cardiff, United Kingdom
| | | | - Catherine R. G. Jones
- School of Psychology, Cardiff University, Cardiff, United Kingdom
- Cardiff University Centre for Human Developmental Science, School of Psychology, Cardiff University, Cardiff, United Kingdom
| | - Ross E. Vanderwert
- School of Psychology, Cardiff University, Cardiff, United Kingdom
- Cardiff University Centre for Human Developmental Science, School of Psychology, Cardiff University, Cardiff, United Kingdom
- Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University, Cardiff, United Kingdom
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4
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Abstract
Anhedonia is frequently observed among individuals with eating disorders (ED), though its relevance to ED pathology and clinical outcomes remain poorly understood. This chapter will present the latest findings regarding anhedonia in ED, with the majority of data available for anorexia nervosa (AN) and bulimia nervosa (BN). We consider anhedonia from the mechanistic lens of altered reward processing, with attention given to subjective experience, neurotransmitter function, neural correlates, and cognitive performance corresponding to distinct components of reward (i.e., liking, wanting, and learning). Findings from animal models are also highlighted. The chapter concludes with a discussion of implications for treatment and future directions aimed at better understanding anhedonia in ED.
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Affiliation(s)
- Susan M Murray
- Department of Psychiatry, University of California San Diego, UCSD Eating Disorders Center for Treatment and Research, San Diego, CA, USA
| | - Carina S Brown
- Department of Psychiatry, University of California San Diego, UCSD Eating Disorders Center for Treatment and Research, San Diego, CA, USA
| | - Walter H Kaye
- Department of Psychiatry, University of California San Diego, UCSD Eating Disorders Center for Treatment and Research, San Diego, CA, USA
| | - Christina E Wierenga
- Department of Psychiatry, University of California San Diego, UCSD Eating Disorders Center for Treatment and Research, San Diego, CA, USA.
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5
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Giel KE, Conzelmann A, Renner TJ, Richter T, Martin Benito S, Zipfel S, Schag K. Attention allocation to illness-compatible information discriminates women with active versus weight-recovered anorexia nervosa. Int J Eat Disord 2020; 53:1270-1279. [PMID: 31840847 DOI: 10.1002/eat.23209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 11/19/2019] [Accepted: 11/24/2019] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Biased attention for disorder-relevant information plays a crucial role in the maintenance of different mental disorders including eating disorders and might be of use to define recovery beyond symptom-related criteria. METHOD We assessed attention deployment using eye tracking in a cued choice viewing paradigm to two different categories of disorder-relevant stimuli in 24 individuals with acute anorexia nervosa (AN), 20 weight-recovered individuals with a history of AN (WRAN) and 23 healthy control participants (CG). Picture pairs consisted of a food stimulus or a picture depicting physical activity and a matched control stimulus (household item/physical inactivity). Participants rated the valence of stimuli afterwards. RESULTS The groups did not differ in initial attention deployment. In later processing stages, AN patients showed a generalized attentional avoidance of food and control pictures as compared to CG, while WRAN individuals were in between. AN patients showed an attentional bias toward physical activity pictures as compared to WRAN individuals, but not the CG. AN individuals rated the food pictures and the pictures showing physical inactivity as less pleasant than the CG, while WRAN individuals were in between. DISCUSSION Attention deployment is partly changed in WRAN as compared to the acute AN group, especially with regard to a shift away from illness-compatible stimuli (physical activity), and this might be a useful recovery criterion. Valence rating of food stimuli might be an additional useful tool to distinguish between acutely ill and weight-recovered individuals. Attentional biases for illness-compatible stimuli might qualify as a valuable approach to defining recovery in AN.
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Affiliation(s)
- Katrin E Giel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany.,Competence Center for Eating Disorders, Tübingen, Germany
| | - Annette Conzelmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany.,Department of Psychology (Clinical Psychology II), Private University of Applied Sciences, Göttingen, Germany
| | - Tobias J Renner
- Competence Center for Eating Disorders, Tübingen, Germany.,Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany
| | - Tabea Richter
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Hospital Christophsbad, Göppingen, Germany
| | - Sebastian Martin Benito
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany.,Center for Schooling Quality and Teacher Training, Schools Psychological Counseling Center Backnang, Regional Office Schwäbisch Gmünd, Schwäbisch Gmünd, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany.,Competence Center for Eating Disorders, Tübingen, Germany
| | - Kathrin Schag
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany.,Competence Center for Eating Disorders, Tübingen, Germany
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6
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Haynos AF, Lavender JM, Nelson J, Crow SJ, Peterson CB. Moving towards specificity: A systematic review of cue features associated with reward and punishment in anorexia nervosa. Clin Psychol Rev 2020; 79:101872. [PMID: 32521390 DOI: 10.1016/j.cpr.2020.101872] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 03/16/2020] [Accepted: 05/24/2020] [Indexed: 12/13/2022]
Abstract
Models of anorexia nervosa (AN) posit that symptoms are maintained through deficient reward and enhanced punishment processing. However, theoretical and empirical inconsistencies highlight the need for a more nuanced conceptualization of this literature. Our goal was to comprehensively review the research on reward and punishment responding in AN from a cue-specific lens to determine which stimuli evoke or discourage reward and punishment responses in this population, and, ultimately, what properties these rewarding and punishing cues might share. A systematic review interrogating reward and punishment responses to specific cues yielded articles (n = 92) that examined responses to disorder relevant (e.g., food) and irrelevant (e.g., money) stimuli across self-report, behavioral, and biological indices. Overall, in most studies individuals with AN exhibited aversive responses to cues signaling higher body weights, social contexts, and monetary losses, and appetitive responses to cues for weight loss behaviors and thinness. Findings were more mixed on responses to palatable food and monetary gains. Results highlight that reward and punishment responding in AN are context specific and may be affected by varied stimulus qualities (e.g., predictability, controllability, delay, effort). Increasing specificity in future research on reward and punishment mechanisms in AN will better inform development of precisely-targeted interventions.
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Affiliation(s)
- Ann F Haynos
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, United States of America.
| | - Jason M Lavender
- Military Cardiovascular Outcomes Research (MiCOR) Program, Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America; The Metis Foundation, San Antonio, TX, United States of America
| | - Jillian Nelson
- Department of Psychology, George Mason University, Fairfax, VA, United States of America
| | - Scott J Crow
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, United States of America; The Emily Program, St. Paul, MN, United States of America
| | - Carol B Peterson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, United States of America; The Emily Program, St. Paul, MN, United States of America
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7
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King JA, Bernardoni F, Geisler D, Ritschel F, Doose A, Pauligk S, Pásztor K, Weidner K, Roessner V, Smolka MN, Ehrlich S. Intact value-based decision-making during intertemporal choice in women with remitted anorexia nervosa? An fMRI study. J Psychiatry Neurosci 2020; 45:108-116. [PMID: 31595737 PMCID: PMC7828910 DOI: 10.1503/jpn.180252] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Extreme restrictive food choice in anorexia nervosa is thought to reflect excessive self-control and/or abnormal reward sensitivity. Studies using intertemporal choice paradigms have suggested an increased capacity to delay reward in anorexia nervosa, and this may explain an unusual ability to resist immediate temptation and override hunger in the long-term pursuit of thinness. It remains unclear, however, whether altered delay discounting in anorexia nervosa constitutes a state effect of acute illness or a trait marker observable after recovery. METHODS We repeated the analysis from our previous fMRI investigation of intertemporal choice in acutely underweight patients with anorexia nervosa in a sample of weight-recovered women with anorexia nervosa (n = 36) and age-matched healthy controls (n = 36) who participated in the same study protocol. Follow-up analyses explored functional connectivity separately in both the weight-recovered/healthy controls sample and the acute/healthy controls sample. RESULTS In contrast to our previous findings in acutely underweight patients with anorexia nervosa, we found no differences between weight-recovered patients with anorexia nervosa and healthy controls at either behavioural or neural levels. New analysis of data from the acute/healthy controls sample sample revealed increased coupling between dorsal anterior cingulate cortex and posterior brain regions as a function of decision difficulty, supporting the hypothesis of altered neural efficiency in the underweight state. LIMITATIONS This was a cross-sectional study, and the results may be task-specific. CONCLUSION Although our results underlined previous demonstrations of divergent temporal reward discounting in acutely underweight patients with anorexia nervosa, we found no evidence of alteration in patients with weight-recovered anorexia nervosa. Together, these findings suggest that impaired valuebased decision-making may not constitute a defining trait variable or “scar” of the disorder.
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Affiliation(s)
- Joseph A. King
- From the Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (King, Bernardoni, Geisler, Ritschel, Doose, Pauligk, Pásztor, Ehrlich); the Translational Developmental Neuroscience Section, Eating Disorder Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Ritschel, Roessner, Ehrlich); the Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Weidner); and the Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany (Smolka)
| | - Fabio Bernardoni
- From the Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (King, Bernardoni, Geisler, Ritschel, Doose, Pauligk, Pásztor, Ehrlich); the Translational Developmental Neuroscience Section, Eating Disorder Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Ritschel, Roessner, Ehrlich); the Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Weidner); and the Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany (Smolka)
| | - Daniel Geisler
- From the Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (King, Bernardoni, Geisler, Ritschel, Doose, Pauligk, Pásztor, Ehrlich); the Translational Developmental Neuroscience Section, Eating Disorder Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Ritschel, Roessner, Ehrlich); the Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Weidner); and the Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany (Smolka)
| | - Franziska Ritschel
- From the Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (King, Bernardoni, Geisler, Ritschel, Doose, Pauligk, Pásztor, Ehrlich); the Translational Developmental Neuroscience Section, Eating Disorder Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Ritschel, Roessner, Ehrlich); the Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Weidner); and the Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany (Smolka)
| | - Arne Doose
- From the Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (King, Bernardoni, Geisler, Ritschel, Doose, Pauligk, Pásztor, Ehrlich); the Translational Developmental Neuroscience Section, Eating Disorder Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Ritschel, Roessner, Ehrlich); the Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Weidner); and the Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany (Smolka)
| | - Sophie Pauligk
- From the Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (King, Bernardoni, Geisler, Ritschel, Doose, Pauligk, Pásztor, Ehrlich); the Translational Developmental Neuroscience Section, Eating Disorder Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Ritschel, Roessner, Ehrlich); the Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Weidner); and the Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany (Smolka)
| | - Konrad Pásztor
- From the Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (King, Bernardoni, Geisler, Ritschel, Doose, Pauligk, Pásztor, Ehrlich); the Translational Developmental Neuroscience Section, Eating Disorder Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Ritschel, Roessner, Ehrlich); the Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Weidner); and the Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany (Smolka)
| | - Kerstin Weidner
- From the Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (King, Bernardoni, Geisler, Ritschel, Doose, Pauligk, Pásztor, Ehrlich); the Translational Developmental Neuroscience Section, Eating Disorder Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Ritschel, Roessner, Ehrlich); the Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Weidner); and the Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany (Smolka)
| | - Veit Roessner
- From the Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (King, Bernardoni, Geisler, Ritschel, Doose, Pauligk, Pásztor, Ehrlich); the Translational Developmental Neuroscience Section, Eating Disorder Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Ritschel, Roessner, Ehrlich); the Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Weidner); and the Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany (Smolka)
| | - Michael N. Smolka
- From the Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (King, Bernardoni, Geisler, Ritschel, Doose, Pauligk, Pásztor, Ehrlich); the Translational Developmental Neuroscience Section, Eating Disorder Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Ritschel, Roessner, Ehrlich); the Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Weidner); and the Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany (Smolka)
| | - Stefan Ehrlich
- From the Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (King, Bernardoni, Geisler, Ritschel, Doose, Pauligk, Pásztor, Ehrlich); the Translational Developmental Neuroscience Section, Eating Disorder Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Ritschel, Roessner, Ehrlich); the Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Weidner); and the Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany (Smolka)
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Berner LA, Romero EM, Reilly EE, Lavender JM, Kaye WH, Wierenga CE. Task-switching inefficiencies in currently ill, but not remitted anorexia nervosa. Int J Eat Disord 2019; 52:1316-1321. [PMID: 31584714 PMCID: PMC8127723 DOI: 10.1002/eat.23175] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 08/13/2019] [Accepted: 09/07/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Models of anorexia nervosa (AN) posit that set-shifting deficits may contribute to behavioral inflexibility and extreme dietary restriction. Findings from neurocognitive studies of set-shifting in AN have been somewhat mixed, perhaps due to the use of tasks that cannot distinguish shifting from other processes (i.e., learning). To more precisely characterize cognitive flexibility and selectively assess this process independent of rule learning and feedback sensitivity, we examined task-switching ability in AN. METHOD Women ill with AN, subthreshold AN or atypical AN (IAN; n = 40), women remitted from AN (RAN; n = 24), and age-matched healthy control women (n = 42) completed a computerized cued color-shape task-switching paradigm. Groups were compared on mix costs (reflecting global cognitive control) and switch costs (reflecting transient cognitive control). RESULTS Although mix costs were equivalent across groups, switch costs were more pronounced in the IAN group, as indicated by a group-by-trial type interaction for reaction times on stay and switch trials. DISCUSSION Findings indicate that IAN, but not RAN, have difficulty flexibly switching between cognitive task sets, and suggest that prior findings of set-shifting deficits in AN may reflect difficulty with cognitive flexibility independent of learning deficits. As such, task-switching may represent a promising adjunctive treatment target.
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9
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Mehl N, Morys F, Villringer A, Horstmann A. Unhealthy yet Avoidable-How Cognitive Bias Modification Alters Behavioral and Brain Responses to Food Cues in Individuals with Obesity. Nutrients 2019; 11:E874. [PMID: 31003487 PMCID: PMC6521098 DOI: 10.3390/nu11040874] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 04/12/2019] [Accepted: 04/15/2019] [Indexed: 12/24/2022] Open
Abstract
Obesity is associated with automatically approaching problematic stimuli, such as unhealthy food. Cognitive bias modification (CBM) could beneficially impact problematic approach behavior. However, it is unclear which mechanisms are targeted by CBM in obesity. Candidate mechanisms include: (1) altering reward value of food stimuli; and (2) strengthening inhibitory abilities. Thirty-three obese adults completed either CBM or sham training during functional magnetic resonance imaging (fMRI) scanning. CBM consisted of implicit training to approach healthy and avoid unhealthy foods. At baseline, approach tendencies towards food were present in all participants. Avoiding vs. approaching food was associated with higher activity in the right angular gyrus (rAG). CBM resulted in a diminished approach bias towards unhealthy food, decreased activation in the rAG, and increased activation in the anterior cingulate cortex. Relatedly, functional connectivity between the rAG and right superior frontal gyrus increased. Analysis of brain connectivity during rest revealed training-related connectivity changes of the inferior frontal gyrus and bilateral middle frontal gyri. Taken together, CBM strengthens avoidance tendencies when faced with unhealthy foods and alters activity in brain regions underpinning behavioral inhibition.
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Affiliation(s)
- Nora Mehl
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, 04103 Leipzig, Germany.
- MaxNetAging Research School, 18057 Rostock, Germany.
| | - Filip Morys
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, 04103 Leipzig, Germany.
- Leipzig University Medical Centre, IFB Adiposity Diseases, 04103 Leipzig, Germany.
| | - Arno Villringer
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, 04103 Leipzig, Germany.
- Leipzig University Medical Centre, IFB Adiposity Diseases, 04103 Leipzig, Germany.
- Leipzig University Medical Centre, Collaborative Research Centre 1052-A5, 04103 Leipzig, Germany.
| | - Annette Horstmann
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, 04103 Leipzig, Germany.
- Leipzig University Medical Centre, IFB Adiposity Diseases, 04103 Leipzig, Germany.
- Leipzig University Medical Centre, Collaborative Research Centre 1052-A5, 04103 Leipzig, Germany.
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland.
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10
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Abstract
Anorexia nervosa is a complex psychiatric illness associated with food restriction and high mortality. Recent brain research in adolescents and adults with anorexia nervosa has used larger sample sizes compared with earlier studies and tasks that test specific brain circuits. Those studies have produced more robust results and advanced our knowledge of underlying biological mechanisms that may contribute to the development and maintenance of anorexia nervosa. It is now recognized that malnutrition and dehydration lead to dynamic changes in brain structure across the brain, which normalize with weight restoration. Some structural alterations could be trait factors but require replication. Functional brain imaging and behavioral studies have implicated learning-related brain circuits that may contribute to food restriction in anorexia nervosa. Most notably, those circuits involve striatal, insular, and frontal cortical regions that drive learning from reward and punishment, as well as habit learning. Disturbances in those circuits may lead to a vicious cycle that hampers recovery. Other studies have started to explore the neurobiology of interoception or social interaction and whether the connectivity between brain regions is altered in anorexia nervosa. All together, these studies build upon earlier research that indicated neurotransmitter abnormalities in anorexia nervosa and help us develop models of a distinct neurobiology that underlies anorexia nervosa.
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Affiliation(s)
- Guido K W Frank
- Department of Psychiatry, University of Colorado, Anschutz Medical Campus, Aurora, CO, 80045, USA.,Neuroscience Program, University of Colorado, Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Megan E Shott
- Department of Psychiatry, University of Colorado, Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Marisa C DeGuzman
- Department of Psychiatry, University of Colorado, Anschutz Medical Campus, Aurora, CO, 80045, USA.,Neuroscience Program, University of Colorado, Anschutz Medical Campus, Aurora, CO, 80045, USA
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11
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Murray SB, Strober M, Craske MG, Griffiths S, Levinson CA, Strigo IA. Fear as a translational mechanism in the psychopathology of anorexia nervosa. Neurosci Biobehav Rev 2018; 95:383-395. [DOI: 10.1016/j.neubiorev.2018.10.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 10/11/2018] [Accepted: 10/22/2018] [Indexed: 12/30/2022]
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12
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Hildebrandt T, Schulz K, Schiller D, Heywood A, Goodman W, Sysko R. Evidence of prefrontal hyperactivation to food-cue reversal learning in adolescents with anorexia nervosa. Behav Res Ther 2018; 111:36-43. [PMID: 30292918 DOI: 10.1016/j.brat.2018.08.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 08/09/2018] [Accepted: 08/22/2018] [Indexed: 12/15/2022]
Abstract
Food avoidance in anorexia nervosa (AN) has been hypothesized to occur as a result of deficits in reversal learning and altered neuronal processing of food-cue relationships. Extant findings suggest that those with AN may rely on heightened recruitment of prefrontal regions during initial formation of food-cue learning and difficulty extinguishing these relationships may result from elevated insula activity. We tested this hypothesis by comparing behavioral and neuronal responses to food-cue acquisition and reversal between adolescents with AN and healthy controls. Compared to controls, acquisition of a food-cue association and its reversal were associated with elevated prefrontal activation in adolescents with AN. There were no significant differences between groups in insula activation and no behavioral differences in the ability to acquire or reverse the food-cue association. The results suggest that adolescents with AN recruit prefrontal regulatory networks to acquire and alter expectancies to food. This pattern of top-down prefrontal control suggests that clinical interventions that target changes in food-cue relationships and rely on cognitive control may be less effective. Interventions that alter behavior without reliance on this top-down control may have advantages with this population.
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Affiliation(s)
- Tom Hildebrandt
- Eating and Weight Disorders Program, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Kurt Schulz
- Department of Psychiatry and Icahn School of Medicine, Mount Sinai, New York, NY, USA.
| | - Daniela Schiller
- Department of Psychiatry and Icahn School of Medicine, Mount Sinai, New York, NY, USA.
| | - Ashley Heywood
- Eating and Weight Disorders Program, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Wayne Goodman
- Department of Psychiatry and Icahn School of Medicine, Mount Sinai, New York, NY, USA.
| | - Robyn Sysko
- Department of Psychiatry and Icahn School of Medicine, Mount Sinai, New York, NY, USA.
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13
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Costanzo F, Menghini D, Maritato A, Castiglioni MC, Mereu A, Varuzza C, Zanna V, Vicari S. New Treatment Perspectives in Adolescents With Anorexia Nervosa: The Efficacy of Non-invasive Brain-Directed Treatment. Front Behav Neurosci 2018; 12:133. [PMID: 30083095 PMCID: PMC6064943 DOI: 10.3389/fnbeh.2018.00133] [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] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 06/13/2018] [Indexed: 01/29/2023] Open
Abstract
Poor treatment outcomes are available for anorexia nervosa (AN) and treatment innovations are urgently needed. Recently, non-invasive neuromodulation tools have suggested to have potential for reducing an symptomatology targeting brain alterations. The objective of the study was to verify whether left anodal/right cathodal prefrontal cortex transcranial direct current stimulation (tDCS), may aid in altering/resetting inter-hemispheric balance in patients with AN, re-establishing control over eating behaviors. Twenty-three adolescents with an underwent a treatment as usual (AU), including nutritional, pharmacological, and psychoeducational treatment, plus 18 sessions of tDCS (TDCS+AU = n11; mean age = 13.9, SD = 1.8 years) or a family based therapy (FBT+AU = n12, mean age = 15.1, SD = 1.5 years). Psychopathological scales and the body mass index (BMI) were assessed before and after treatment. After 6 weeks of treatment, the BMI values increased only in the tDCS group, even at 1-month follow-up. Independently of the treatment, all participants improved in several psychopathological measures, included AN psychopathology and mood and anxiety symptoms. Our results demonstrated for the first time a specific effect of the left anodal/right cathodal tDCS treatment protocol on stable weight gain and a superiority compared to an active control treatment for adolescents with AN. Results were interpreted as a possible direct/indirect effect of tDCS in into some pathophysiological mechanisms of AN, involving the mesocortical dopaminergic pathways and the promotion of food intake. This pilot study opens new perspectives in the treatment of an in adolescence, supporting the targeted and beneficial effects of a brain-based treatment.
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Affiliation(s)
- Floriana Costanzo
- Child Neuropsychiatric Unit, Department of Neuroscience, Bambino Gesù Children Hospital, Rome, Italy
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14
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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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15
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Farrar DC, Mian AZ, Budson AE, Moss MB, Killiany RJ. Functional brain networks involved in decision-making under certain and uncertain conditions. Neuroradiology 2017; 60:61-69. [PMID: 29164280 DOI: 10.1007/s00234-017-1949-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 11/09/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to describe imaging markers of decision-making under uncertain conditions in normal individuals, in order to provide baseline activity to compare to impaired decision-making in pathological states. METHODS In this cross-sectional study, 19 healthy subjects ages 18-35 completed a novel decision-making card-matching task using a Phillips T3 Scanner and a 32-channel head coil. Functional data were collected in six functional runs. In one condition of the task, the participant was certain of the rule to apply to match the cards; in the other condition, the participant was uncertain. We performed cluster-based comparison of the two conditions using FSL fMRI Expert Analysis Tool and network-based analysis using MATLAB. RESULTS The uncertain > certain comparison yielded three clusters-a midline cluster that extended through the midbrain, the thalamus, bilateral prefrontal cortex, the striatum, and bilateral parietal/occipital clusters. The certain > uncertain comparison yielded bilateral clusters in the insula, parietal and temporal lobe, as well as a medial frontal cluster. A larger, more connected functional network was found in the uncertain condition. CONCLUSION The involvement of the insula, parietal cortex, temporal cortex, ventromedial prefrontal cortex, and orbitofrontal cortex of the certain condition reinforces the notion that certainty is inherently rewarding. For the uncertain condition, the involvement of the prefrontal cortex, parietal cortex, striatum, thalamus, amygdala, and hippocampal involvement was expected, as these are areas involved in resolving uncertainty and rule updating. The involvement of occipital cortical involvement and midbrain involvement may be attributed to increased visual attention and increased motor control.
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Affiliation(s)
- Danielle C Farrar
- Department of Anatomy and Neurobiology, Boston University School of Medicine, 650 Albany St, Basement, Boston, MA, 02118, USA.
| | - Asim Z Mian
- Department of Radiology, Boston University School of Medicine, Boston, MA, USA
| | | | - Mark B Moss
- Department of Anatomy and Neurobiology, Boston University School of Medicine, 650 Albany St, Basement, Boston, MA, 02118, USA
| | - Ronald J Killiany
- Department of Anatomy and Neurobiology, Boston University School of Medicine, 650 Albany St, Basement, Boston, MA, 02118, USA
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16
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Brooks SJ, Funk SG, Young SY, Schiöth HB. The Role of Working Memory for Cognitive Control in Anorexia Nervosa versus Substance Use Disorder. Front Psychol 2017; 8:1651. [PMID: 29018381 PMCID: PMC5615794 DOI: 10.3389/fpsyg.2017.01651] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 09/07/2017] [Indexed: 01/20/2023] Open
Abstract
Prefrontal cortex executive functions, such as working memory (WM) interact with limbic processes to foster impulse control. Such an interaction is referred to in a growing body of publications by terms such as cognitive control, cognitive inhibition, affect regulation, self-regulation, top-down control, and cognitive–emotion interaction. The rising trend of research into cognitive control of impulsivity, using various related terms reflects the importance of research into impulse control, as failure to employ cognitions optimally may eventually result in mental disorder. Against this background, we take a novel approach using an impulse control spectrum model – where anorexia nervosa (AN) and substance use disorder (SUD) are at opposite extremes – to examine the role of WM for cognitive control. With this aim, we first summarize WM processes in the healthy brain in order to frame a systematic review of the neuropsychological, neural and genetic findings of AN and SUD. In our systematic review of WM/cognitive control, we found n = 15 studies of AN with a total of n = 582 AN and n = 365 HC participants; and n = 93 studies of SUD with n = 9106 SUD and n = 3028 HC participants. In particular, we consider how WM load/capacity may support the neural process of excessive epistemic foraging (cognitive sampling of the environment to test predictions about the world) in AN that reduces distraction from salient stimuli. We also consider the link between WM and cognitive control in people with SUD who are prone to ‘jumping to conclusions’ and reduced epistemic foraging. Finally, in light of our review, we consider WM training as a novel research tool and an adjunct to enhance treatment that improves cognitive control of impulsivity.
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Affiliation(s)
- Samantha J Brooks
- Functional Pharmacology, Department of Neuroscience, Uppsala UniversityUppsala, Sweden.,Department of Psychiatry and Mental Health, University of Cape TownCape Town, South Africa
| | - Sabina G Funk
- Department of Psychiatry and Mental Health, University of Cape TownCape Town, South Africa
| | - Susanne Y Young
- Department of Psychiatry, Stellenbosch UniversityBellville, South Africa
| | - Helgi B Schiöth
- Functional Pharmacology, Department of Neuroscience, Uppsala UniversityUppsala, Sweden
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