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Atiq MA, Baker MR, Voort JLV, Vargas MV, Choi DS. Disentangling the acute subjective effects of classic psychedelics from their enduring therapeutic properties. Psychopharmacology (Berl) 2024:10.1007/s00213-024-06599-5. [PMID: 38743110 DOI: 10.1007/s00213-024-06599-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 04/24/2024] [Indexed: 05/16/2024]
Abstract
Recent research with classic psychedelics suggests significant therapeutic potential, particularly for neuropsychiatric disorders. A mediating influence behind symptom resolution is thought to be the personal insight - at times, bordering on the mystical - one acquires during the acute phase of a psychedelic session. Indeed, current clinical trials have found strong correlations between the acute subjective effects (ASE) under the influence of psychedelics and their enduring therapeutic properties. However, with potential barriers to widespread clinical implementation, including the healthcare resource-intensive nature of psychedelic sessions and the exclusion of certain at-risk patient groups, there is an active search to determine whether ASE elimination can be accompanied by the retention of persisting therapeutic benefits of these class of compounds. Recognizing the aberrant underlying neural circuitry that characterizes a range of neuropsychiatric disorders, and that classic psychedelics promote neuroplastic changes that may correct abnormal circuitry, investigators are rushing to design and discover compounds with psychoplastogenic, but not hallucinogenic (i.e., ASE), therapeutic potential. These efforts have paved the discovery of 'non-psychedelic/subjective psychedelics', or compounds that lack hallucinogenic activity but with therapeutic efficacy in preclinical models. This review aims to distill the current evidence - both clinical and preclinical - surrounding the question: can the ASE of classic psychedelics be dissociated from their sustained therapeutic properties? Several plausible clinical scenarios are then proposed to offer clarity on and potentially answer this question.
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Affiliation(s)
- Mazen A Atiq
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA.
| | - Matthew R Baker
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA
| | - Jennifer L Vande Voort
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA
| | - Maxemiliano V Vargas
- Institute for Psychedelics and Neurotherapeutics, University of California, Davis, Davis, CA, USA
| | - Doo-Sup Choi
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA.
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA.
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2
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Ledwos N, Rodas JD, Husain MI, Feusner JD, Castle DJ. Therapeutic uses of psychedelics for eating disorders and body dysmorphic disorder. J Psychopharmacol 2023; 37:3-13. [PMID: 36515406 DOI: 10.1177/02698811221140009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Clinical use of psychedelics has gained considerable attention, with promising benefits across a range of mental disorders. Current pharmacological and psychotherapeutic treatments for body dysmorphic disorder (BDD) and eating disorders (EDs) have limited efficacy. As such, other treatment options such as psychedelic-assisted therapies are being explored in these clinical groups. AIMS This systematic review evaluates evidence related to the therapeutic potential of psychedelics in individuals diagnosed with BDD and EDs. METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a systematic review of all study designs published to the end of February 2022 that identified changes in ED/BDD symptom severity from psychedelics using validated measures to assess symptom changes. RESULTS Our search detected a total of 372 studies, of which five met inclusion criteria (two exploratory studies, two case reports, and one prospective study). These were included in the data evaluation. Effects of psychedelics on BDD and various ED symptoms were identified mostly through thematic analyses and self-reports. CONCLUSIONS Our findings highlight that more research is needed to determine the safety and efficacy of psychedelics in BDD and EDs and we suggest avenues for future exploration.
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Affiliation(s)
- Nicole Ledwos
- Centre for Complex Interventions, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Justyne D Rodas
- Centre for Complex Interventions, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - M Ishrat Husain
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jamie D Feusner
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - David J Castle
- Centre for Complex Interventions, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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3
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Fu H, Rong J, Chen Z, Zhou J, Collier T, Liang SH. Positron Emission Tomography (PET) Imaging Tracers for Serotonin Receptors. J Med Chem 2022; 65:10755-10808. [PMID: 35939391 DOI: 10.1021/acs.jmedchem.2c00633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Serotonin (5-hydroxytryptamine, 5-HT) and 5-HT receptors (5-HTRs) have crucial roles in various neuropsychiatric disorders and neurodegenerative diseases, making them attractive diagnostic and therapeutic targets. Positron emission tomography (PET) is a noninvasive nuclear molecular imaging technique and is an essential tool in clinical diagnosis and drug discovery. In this context, numerous PET ligands have been developed for "visualizing" 5-HTRs in the brain and translated into human use to study disease mechanisms and/or support drug development. Herein, we present a comprehensive repertoire of 5-HTR PET ligands by focusing on their chemotypes and performance in PET imaging studies. Furthermore, this Perspective summarizes recent 5-HTR-focused drug discovery, including biased agonists and allosteric modulators, which would stimulate the development of more potent and subtype-selective 5-HTR PET ligands and thus further our understanding of 5-HTR biology.
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Affiliation(s)
- Hualong Fu
- Key Laboratory of Radiopharmaceuticals, Ministry of Education, College of Chemistry, Beijing Normal University, Beijing 100875, China
| | - Jian Rong
- Division of Nuclear Medicine and Molecular Imaging, Massachusetts General Hospital, Boston, Massachusetts 02114, United States.,Department of Radiology, Harvard Medical School, Boston, Massachusetts 02115, United States
| | - Zhen Chen
- Jiangsu Co-Innovation Center of Efficient Processing and Utilization of Forest Resources, International Innovation Center for Forest Chemicals and Materials, College of Chemical Engineering, Nanjing Forestry University, Nanjing, Jiangsu 210037, China
| | - Jingyin Zhou
- Key Laboratory of Radiopharmaceuticals, Ministry of Education, College of Chemistry, Beijing Normal University, Beijing 100875, China
| | - Thomas Collier
- Division of Nuclear Medicine and Molecular Imaging, Massachusetts General Hospital, Boston, Massachusetts 02114, United States.,Department of Radiology, Harvard Medical School, Boston, Massachusetts 02115, United States
| | - Steven H Liang
- Division of Nuclear Medicine and Molecular Imaging, Massachusetts General Hospital, Boston, Massachusetts 02114, United States.,Department of Radiology, Harvard Medical School, Boston, Massachusetts 02115, United States
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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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Keeler JL, Treasure J, Juruena MF, Kan C, Himmerich H. Ketamine as a Treatment for Anorexia Nervosa: A Narrative Review. Nutrients 2021; 13:4158. [PMID: 34836413 PMCID: PMC8625822 DOI: 10.3390/nu13114158] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 11/16/2021] [Accepted: 11/18/2021] [Indexed: 02/05/2023] Open
Abstract
Anorexia nervosa (AN) is a highly complex disorder to treat, especially in severe and enduring cases. Whilst the precise aetiology of the disorder is uncertain, malnutrition and weight loss can contribute to reductions in grey and white matter of the brain, impairments in neuroplasticity and neurogenesis and difficulties with cognitive flexibility, memory and learning. Depression is highly comorbid in AN and may be a barrier to recovery. However, traditional antidepressants are often ineffective in alleviating depressive symptoms in underweight patients with AN. There is an urgent need for new treatment approaches for AN. This review gives a conceptual overview for the treatment of AN with ketamine. Ketamine has rapid antidepressant effects, which are hypothesised to occur via increases in glutamate, with sequelae including increased neuroplasticity, neurogenesis and synaptogenesis. This article provides an overview of the use of ketamine for common psychiatric comorbidities of AN and discusses particular safety concerns and side effects. Potential avenues for future research and specific methodological considerations are explored. Overall, there appears to be ample theoretical background, via several potential mechanisms, that warrant the exploration of ketamine as a treatment for adults with AN.
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Affiliation(s)
- Johanna Louise Keeler
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AF, UK; (J.T.); (H.H.)
| | - Janet Treasure
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AF, UK; (J.T.); (H.H.)
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham BR3 3BX, UK;
| | - Mario F. Juruena
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham BR3 3BX, UK;
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AF, UK
| | - Carol Kan
- Eating Disorder Service, Central and North West London NHS Foundation Trust, 1 Nightingale Place, Kensington & Chelsea, London SW10 9NG, UK;
| | - Hubertus Himmerich
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AF, UK; (J.T.); (H.H.)
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham BR3 3BX, UK;
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6
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Linardon J, Greenwood CJ, Fuller-Tyszkiewicz M, Macdonald JA, Spry E, Hutchinson DM, Youssef GJ, Sanson A, Wertheim EH, McIntosh JE, Le Grange D, Letcher P, Olsson CA. Young adult mental health sequelae of eating and body image disturbances in adolescence. Int J Eat Disord 2021; 54:1680-1688. [PMID: 34240437 DOI: 10.1002/eat.23575] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/22/2021] [Accepted: 06/24/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE There has been interest in the antecedents and mental health impacts of eating and body image disturbances in adolescence. Less is known about longer-term mental health impacts into young adulthood, as longitudinal studies with data spanning this developmental period are rare. We capitalize on mental health data collected across adolescence and young adulthood from a population-based cohort study that has been following >2000 Australian children and their families from infancy to young adulthood. METHOD This sample comprised 1,568 participants who completed the Eating Disorder Inventory drive for thinness and bulimic behavior (the severity of binge-purge patterns) subscales, and a modified version of the body dissatisfaction subscale in mid-adolescence (15-16 years), or the Depression Anxiety Stress Scales in young adulthood (19-20, 23-24, and 27-28 years). RESULTS After adjusting for baseline demographic and prior mental health factors (<13 years of age), all three indices of eating and body image disturbances in adolescence predicted each mental health outcome in young adulthood. Mental health risks associated with adolescent body dissatisfaction and bulimic behavior scores remained stable across young adulthood, with men having more pronounced problems associated with bulimic behavior scores than women. In contrast, mental health risks associated with adolescent drive for thinness scores diminished across this period similarly for men and women. DISCUSSION Findings suggest that adolescent eating and body image disturbances may have long-term mental health impacts that extend into young adulthood. This underscores the need for early preventative intervention, and longer-term monitoring and support for body image and eating disturbances.
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Affiliation(s)
- Jake Linardon
- Centre for Social and Early Emotional Development and School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Christopher J Greenwood
- Centre for Social and Early Emotional Development and School of Psychology, Deakin University, Geelong, Victoria, Australia.,Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Matthew Fuller-Tyszkiewicz
- Centre for Social and Early Emotional Development and School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Jacqui A Macdonald
- Centre for Social and Early Emotional Development and School of Psychology, Deakin University, Geelong, Victoria, Australia.,Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Elizabeth Spry
- Centre for Social and Early Emotional Development and School of Psychology, Deakin University, Geelong, Victoria, Australia.,Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Delyse M Hutchinson
- Centre for Social and Early Emotional Development and School of Psychology, Deakin University, Geelong, Victoria, Australia.,Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Royal Children's Hospital, Melbourne, Victoria, Australia.,National Drug and Alcohol Research Centre, The University of New South Wales, Randwick, New South Wales, Australia
| | - George J Youssef
- Centre for Social and Early Emotional Development and School of Psychology, Deakin University, Geelong, Victoria, Australia.,Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Ann Sanson
- Department of Paediatrics, The University of Melbourne, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Eleanor H Wertheim
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Jennifer E McIntosh
- Centre for Social and Early Emotional Development and School of Psychology, Deakin University, Geelong, Victoria, Australia.,Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Royal Children's Hospital, Melbourne, Victoria, Australia.,School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, Eating Disorders Program, University of California, San Francisco, San Francisco, California, USA
| | - Primrose Letcher
- Centre for Social and Early Emotional Development and School of Psychology, Deakin University, Geelong, Victoria, Australia.,Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Craig A Olsson
- Centre for Social and Early Emotional Development and School of Psychology, Deakin University, Geelong, Victoria, Australia.,Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Royal Children's Hospital, Melbourne, Victoria, Australia
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7
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Herman A, Bajaka A. The role of the intestinal microbiota in eating disorders - bulimia nervosa and binge eating disorder. Psychiatry Res 2021; 300:113923. [PMID: 33857846 DOI: 10.1016/j.psychres.2021.113923] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 04/01/2021] [Indexed: 02/08/2023]
Abstract
Bulimia nervosa (BN) and binge eating disorder (BED) are both eating disorders (EDs) characterised by episodes of overeating in which large amounts of food are consumed in short periods. The aetiology of BN and BED is not fully understood. Psychological and social factors influence the development of BN and BED, but biological factors such as neurohormones that regulate hunger and satiety, or neurotransmitters responsible for mood and anxiety play a significant role in sustaining symptoms. Increasing numbers of studies confirm the relationship between the composition of intestinal microbiota and the regulation of appetite, mood, and body mass. In this manuscript, we will describe the mechanisms by which intestinal dysbiosis can play an important role in the aetiology of binge eating episodes based on current understanding. Understanding the two-way relationship between BN and BED and alterations in the intestinal microbiota suggest the utility of new treatment methods of these disorders aimed at improving the composition of the intestinal microflora.
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Affiliation(s)
- Anna Herman
- Department of Child Psychiatry, Medical University of Warsaw, 61 Żwirki i Wigury St., 02-091 Warsaw, Poland.
| | - Armand Bajaka
- Department of Child Psychiatry, Medical University of Warsaw, 61 Żwirki i Wigury St., 02-091 Warsaw, Poland
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Abstract
This paper introduces a new construct, the 'pivotal mental state', which is defined as a hyper-plastic state aiding rapid and deep learning that can mediate psychological transformation. We believe this new construct bears relevance to a broad range of psychological and psychiatric phenomena. We argue that pivotal mental states serve an important evolutionary function, that is, to aid psychological transformation when actual or perceived environmental pressures demand this. We cite evidence that chronic stress and neurotic traits are primers for a pivotal mental state, whereas acute stress can be a trigger. Inspired by research with serotonin 2A receptor agonist psychedelics, we highlight how activity at this particular receptor can robustly and reliably induce pivotal mental states, but we argue that the capacity for pivotal mental states is an inherent property of the human brain itself. Moreover, we hypothesize that serotonergic psychedelics hijack a system that has evolved to mediate rapid and deep learning when its need is sensed. We cite a breadth of evidences linking stress via a variety of inducers, with an upregulated serotonin 2A receptor system (e.g. upregulated availability of and/or binding to the receptor) and acute stress with 5-HT release, which we argue can activate this primed system to induce a pivotal mental state. The pivotal mental state model is multi-level, linking a specific molecular gateway (increased serotonin 2A receptor signaling) with the inception of a hyper-plastic brain and mind state, enhanced rate of associative learning and the potential mediation of a psychological transformation.
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Affiliation(s)
- Ari Brouwer
- Centre for Psychedelic Research, Imperial College London, London, United Kingdom
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9
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Umeda K, Kawakami I, Ikeda K, Tanei ZI, Matsubara T, Murayama S, Murahashi Y, Niizato K, Oshima K, Iritani S. Case report of anorexia nervosa showing periventricular gliosis at autopsy. Neuropathology 2021; 41:127-132. [PMID: 33474800 DOI: 10.1111/neup.12711] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 09/08/2020] [Accepted: 09/11/2020] [Indexed: 01/14/2023]
Abstract
Anorexia nervosa (AN) is a serious eating disorder characterized by self-starvation and extreme weight loss. It has the highest mortality rate among all psychiatric disorders. Recent research indicates that malnutrition in AN patients induces various kinds of functional brain damage, but the pathophysiology of AN remains unclear. We report here the neuropathological findings of a 31-year-old Japanese woman. At age 24, she had a fear of gaining weight and reduced her dietary intake; she had extremely low body weight associated with overeating then self-induced vomiting. She was clinically diagnosed as having AN and was admitted to a psychiatric hospital with severe depression and suicidal thoughts. At age 31, she died despite intensive physical care and psychotherapy. Neuropathological examination revealed increased capillary blood vessels and slight fibrillary gliosis in the mammillary bodies, with similarities to Wernicke encephalopathy. The brainstem exhibited the characteristic features of central pontine myelinolysis, characterized by a sharply demarcated region of myelin pallor and relative sparing of axons. Senile changes, including neurofibrillary tangles/senile plaques, were not significant. Severe fibrillary gliosis was prominent around periventricular regions, including the caudate nucleus and nucleus accumbens, which are associated with cognition, emotion, and emotional behaviors via the dopaminergic pathways. These findings indicate that prolonged malnutrition in AN patients may induce brain damage, leading to dysfunction of the reward-related dopaminergic pathways. Furthermore, they represent the first pathological evidence that dysfunction of the cortico-limbic-striatal circuitry is involved in the pathophysiology of psychiatric symptoms in AN patients.
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Affiliation(s)
- Kentaro Umeda
- Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan.,Department of Psychiatry, Nagoya University, Nagoya, Japan
| | - Ito Kawakami
- Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan.,Department of Neuropathology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan.,Dementia Research Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Kenji Ikeda
- Dementia Research Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Zen-Ichi Tanei
- Department of Neuropathology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Tomoyasu Matsubara
- Department of Neuropathology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Shigeo Murayama
- Department of Neuropathology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Yuki Murahashi
- Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan
| | - Kazuhiro Niizato
- Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan
| | - Kenichi Oshima
- Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan
| | - Shuji Iritani
- Department of Psychiatry, Nagoya University, Nagoya, Japan
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Kočárová R, Horáček J, Carhart-Harris R. Does Psychedelic Therapy Have a Transdiagnostic Action and Prophylactic Potential? Front Psychiatry 2021; 12:661233. [PMID: 34349678 PMCID: PMC8327748 DOI: 10.3389/fpsyt.2021.661233] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 06/04/2021] [Indexed: 12/20/2022] Open
Abstract
Addressing global mental health is a major 21st-century challenge. Current treatments have recognized limitations; in this context, new ones that are prophylactic and effective across diagnostic boundaries would represent a major advance. The view that there exists a core of transdiagnostic overlap between psychiatric disorders has re-emerged in recent years, and evidence that psychedelic therapy holds promise for a range of psychiatric disorders supports the position that it may be transdiagnostically effective. Here, we propose that psychedelic therapy's core, transdiagnostically relevant action lies in its ability to increase neuronal and mental plasticity, thus enhancing the potential for change, which we consider to be a key to its therapeutic benefits. Moreover, we suggest that enhanced plasticity via psychedelics, combined with a psychotherapeutic approach, can aid healthy adaptability and resilience, which are protective factors for long-term well-being. We present candidate neurological and psychological markers of this plasticity and link them with a predictive processing model of the action of psychedelics. We propose that a model of psychedelic-induced plasticity combined with an adequate therapeutic context has prophylactic and transdiagnostic potential, implying that it could have a broad, positive impact on public health.
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Affiliation(s)
- Rita Kočárová
- Department of Translational Neuroscience, National Institute of Mental Health, Klecany, Czechia.,Department of Psychology, Faculty of Arts, Charles University, Prague, Czechia.,Beyond Psychedelics, Prague, Czechia
| | - Jiří Horáček
- Department of Applied Neuroscience and Neuroimaging, National Institute of Mental Health, Klecany, Czechia.,Third Faculty of Medicine, Charles University, Prague, Czechia
| | - Robin Carhart-Harris
- Centre for Psychedelic Research, Imperial College London, London, United Kingdom
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11
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Stern SA, Bulik CM. Alternative Frameworks for Advancing the Study of Eating Disorders. Trends Neurosci 2020; 43:951-959. [PMID: 33139082 DOI: 10.1016/j.tins.2020.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/27/2020] [Accepted: 10/05/2020] [Indexed: 12/20/2022]
Abstract
Eating disorders are life-interrupting psychiatric conditions with high morbidity and mortality, yet the basic mechanisms underlying these conditions are understudied compared with other psychiatric disorders. In this opinion, we suggest that recent knowledge gleaned from genomic and neuroimaging investigations of eating disorders in humans presents a rich opportunity to sharpen animal models of eating disorders and to identify neural mechanisms that contribute to the risk and maintenance of these conditions. Our article reflects the state of the science, with a primary focus on anorexia nervosa (AN) and binge-eating behavior, and encourages further study of all conditions categorized under feeding and eating disorders.
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Affiliation(s)
- Sarah A Stern
- Max Planck Florida Institute for Neuroscience, Jupiter, FL, USA; Department of Molecular Genetics, Rockefeller University, New York, NY, USA
| | - Cynthia M Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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12
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Peplinska-Miaskowska J, Wichowicz H, Smolenski RT, Jablonska P, Kaska L. Comparison of plasma nucleotide metabolites and amino acids pattern in patients with binge eating disorder and obesity. NUCLEOSIDES NUCLEOTIDES & NUCLEIC ACIDS 2020; 40:32-42. [PMID: 33021434 DOI: 10.1080/15257770.2020.1825733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Binge eating disorder (BED) increasingly affects population, but the mechanisms of the disease and its biomarkers are not well characterized. Recently, plasma purines, pyrimidines, amino acid and nicotinamide metabolites profiling attracted attention in studies on pathology and biomarkers of mental disorders but has not been adequately studied in BED. Blood and plasma samples were taken from patients with adult obese with BED (n = 20) and control adult obese without BED (n = 17). Plasma samples were analyzed for nucleotides and amino acid concentrations with high-performance liquid chromatography-mass spectrometry. BED had a significantly (p < 0.05) lower uridine and hypoxanthine to creatinine ratio compared to the control group. Among the amino acids BED patients had significantly (p < 0.05) lower concentrations of glutamic acid, leucine, isoleucine and the whole branched-chain amino acids group, while the concentration of citrulline was increased. Among nicotinamide metabolites, 1-methylnicotinamide levels were significantly (p < 0.05) lower. This study highlights potential use of profiling nucleotide metabolite and amino acid pattern in BED patients that may provide information on mechanisms and potential biomarkers. However, further investigation in larger population is necessary to identify clinical correlates of the observed changes.
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Affiliation(s)
| | - Hubert Wichowicz
- Department of Psychiatry, Medical University of Gdansk, Gdansk, Poland.,Pomeranian University in Słupsk, Institute of Health Sciences Słupsk ul
| | | | - Patrycja Jablonska
- Department of Biochemistry, Medical University of Gdansk, Gdansk, Poland
| | - Lukasz Kaska
- Department of General, Endocrine and Transplant Surgery, Medical University of Gdansk, Gdansk, Poland
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13
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Gianni AD, De Donatis D, Valente S, De Ronchi D, Atti AR. Eating disorders: Do PET and SPECT have a role? A systematic review of the literature. Psychiatry Res Neuroimaging 2020; 300:111065. [PMID: 32234640 DOI: 10.1016/j.pscychresns.2020.111065] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 03/04/2020] [Accepted: 03/06/2020] [Indexed: 02/08/2023]
Abstract
A systematic review was implemented according to PRISMA guidelines on Pubmed, Psychinfo, Medline, Embase to fill the existing literature gap on the effectiveness of using Positron Emission Tomography (PET) and Single Photon Emission Computed Tomography (SPECT) in Anorexia Nervosa (AN), Bulimia Nervosa (BN) and Binge Eating Disorder (BED). Twenty-two articles were included. Four studies reported an increased density in 5-hydroxytryptamine receptor (5-HT1A) in fronto-temporo-parietal regions in both affected and recovered AN as well as in BN. The 5-HT transporter (5-HTT) binding was increased or diminished in different specific cortical areas and in relation to Eating Disorder (ED) subtypes. Some evidences of blunted Dopamine (DA) release in the putamen in BN patients suggest that their DA function might be impaired as in addictive behaviours. Studies estimating the regional Cerebral Blood Flow (rCBF) with SPECT demonstrated that temporal areas seem to play a key role in ED corroborating the hypothesis of a cingulate-temporal cortical dysfunction in AN. In addition, alterations of both parietal and prefrontal cortex provide a possible common neural substrate in AN. Studies included in this review are heterogeneous preventing robust conclusions, however, our findings add knowledge on some of the neurotransmitters involved in ED.
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Affiliation(s)
- Angela Di Gianni
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy.
| | - Domenico De Donatis
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy.
| | - Stefano Valente
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy.
| | - Diana De Ronchi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy.
| | - Anna Rita Atti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy.
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14
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Pietrini F, Castellini G, Ricca V, Polito C, Pupi A, Faravelli C. Functional neuroimaging in anorexia nervosa: A clinical approach. Eur Psychiatry 2020; 26:176-82. [PMID: 20934859 DOI: 10.1016/j.eurpsy.2010.07.011] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Revised: 07/20/2010] [Accepted: 07/21/2010] [Indexed: 11/18/2022] Open
Abstract
AbstractAimsTo provide a review of the available literature about the functional neuroimaging of anorexia nervosa, and to summarize the possible role of neurobiological factors in its pathogenesis.MethodsA systematic review of the literature was performed using PubMed and Medline electronic database (1950–September 2009). Eligible studies were restricted to those involving the main parameters of cerebral activity and functional neuroimaging techniques. Findings of the reviewed studies have been grouped on a diagnostic subtype basis, and their comparison has been interpreted in terms of concordance.ResultsWe found a high level of concordance among available studies with regard to the presence of frontal, parietal and cingulate functional disturbances in both anorexia nervosa restricting and binge/purging subtypes. Concordance among studies conducted regardless of the anorexia nervosa subtypes suggests an alteration in temporal and parietal functions and striatal metabolism.ConclusionsThe most consistent alterations in anorexia nervosa cerebral activity seem to involve the dorsolateral prefrontal cortex, the inferior parietal lobule, the anterior cingulate cortex and the caudate nucleus. They may affect different neural systems such as the frontal visual system, the attention network, the arousal and emotional processing systems, the reward processing network, and the network for the body schema.
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Affiliation(s)
- F Pietrini
- Psychiatric Unit, Department of Neuropsychiatric Sciences, Florence University School of Medicine, Viale Morgagni 85, Florence, Italy
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15
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Lock J, Nicholls D. Toward A Greater Understanding of the Ways Family-Based Treatment Addresses the Full Range of Psychopathology of Adolescent Anorexia Nervosa. Front Psychiatry 2020; 10:968. [PMID: 32038319 PMCID: PMC6993050 DOI: 10.3389/fpsyt.2019.00968] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 12/09/2019] [Indexed: 01/30/2023] Open
Abstract
Family-based treatment (FBT) for anorexia nervosa (AN) is an empirically supported treatment for this disorder. Derived from several different schools of family therapy, it is a highly focused approach that initially targets weight restoration under parental management at home. However, the view that manualized FBT is solely a behavioral therapy directing parents to refeed their children AN with the single purpose of weight gain is a common but misleading over simplification of the therapy. Indeed, weight restoration is the main goal only in phase 1 of this 3-phase treatment. When practiced with fidelity and skill, FBT's broadest aim is to promote adolescent development without AN thoughts and behaviors interfering and disrupting these normal processes. Although weight restoration is a key starting point in FBT, the entire course of treatment takes into consideration the ongoing impact of starvation, cognitions, emotions, and behaviors on adolescent development. These factors associated with maintaining low weight are viewed in FBT as interfering with the adolescent being able to take up the tasks of adolescence and thus must be overcome before fully turning to those broader adolescent tasks. In addition, FBT recognizes that adolescence takes place in the context of family and community and respects the importance of learning in a home environment both for weight gain as well as related developmental tasks to have a lasting effect. Specifically, in this article we describe how the current FBT manualized approach addresses temperament/personality traits, emotional processing, cognitive content and process, social communication and connections, psychiatric comorbidity, and family factors. This report makes no claim to superiority of FBT compared to other therapies in addressing these broader concerns nor does it add interventions to augment the current manual to improve FBT.
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Affiliation(s)
- James Lock
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Dasha Nicholls
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, United Kingdom
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16
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Bachner-Melman R, Lev-Ari L, Zohar AH, Lev SL. Can Recovery From an Eating Disorder Be Measured? Toward a Standardized Questionnaire. Front Psychol 2018; 9:2456. [PMID: 30618916 PMCID: PMC6297874 DOI: 10.3389/fpsyg.2018.02456] [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: 10/08/2018] [Accepted: 11/20/2018] [Indexed: 01/12/2023] Open
Abstract
Background: There is a clear need for a standardized definition of recovery from eating disorders (EDs) and for self-report instruments to assess where individuals with an ED are situated at a given point of time along their process of illness and recovery. It has been acknowledged that psychological and cognitive symptoms are important to recovery in addition to physical and behavioral indices. This study proposes a 28-item multidimensional questionnaire encompassing the main features of recovery from ED, derived from the endorsement of different criteria by people with a lifetime ED diagnosis, family members and ED clinicians. Methods: Participants were 213 volunteers over the age of 18 (118 people with a lifetime ED diagnosis, 58 healthy family members of people with EDs and 37 ED clinicians), who completed the ED-15 and indicated online how important they thought each of 56 criteria were for recovery from an ED. Results: Four factors were identified in an exploratory factor analysis: Lack of Symptomatic Behavior (LSB), Acceptance of Self and Body (ASB), Social and Emotional Connection (SEC), and Physical Health (PH). Confirmatory factor analysis using the seven highest loading items from each subscale confirmed the structure validity of a shortened version of this questionnaire, the Eating Disorders Recovery Endorsement Questionnaire (EDREQ), which had excellent goodness-of-fit indices. Despite a few between-group differences, there was general agreement that LSB was most salient to recovery, followed by ASB, SEC, and PH in that order. Conclusion: Despite the absence of a standardized definition of recovery from ED, there is a general consensus about its components. The EDREQ is a psychometrically sound questionnaire containing items that people with an ED history, their family members and therapists all define as important components of recovery. The inclusion of emotional and psychosocial aspects of recovery in addition to symptomatic and medical aspects is important to expand treatment goals and the concept of recovery from EDs beyond symptom relief and the absence of disease markers. As a clinical tool, the EDREQ stands to assist in setting and refining therapeutic goals throughout therapy, and in establishing standardized, comparable norms for recovery levels in research.
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Affiliation(s)
- Rachel Bachner-Melman
- Clinical Psychology Graduate Program, Ruppin Academic Center, Hadera, Israel
- The Paul Baerwald School of Social Work and Social Welfare, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Lilac Lev-Ari
- Clinical Psychology Graduate Program, Ruppin Academic Center, Hadera, Israel
| | - Ada H. Zohar
- Clinical Psychology Graduate Program, Ruppin Academic Center, Hadera, Israel
| | - Shay Lee Lev
- Clinical Psychology Graduate Program, Ruppin Academic Center, Hadera, Israel
- Student Counselling Service, University of Haifa, Haifa, Israel
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17
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Lee DJ, Elias GJB, Lozano AM. Neuromodulation for the treatment of eating disorders and obesity. Ther Adv Psychopharmacol 2018; 8:73-92. [PMID: 29399320 PMCID: PMC5788100 DOI: 10.1177/2045125317743435] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 10/24/2017] [Indexed: 12/25/2022] Open
Abstract
Eating disorders and obesity adversely affect individuals both medically and psychologically, leading to reduced life expectancy and poor quality of life. While there exist a number of treatments for anorexia, morbid obesity and bulimia, many patients do not respond favorably to current behavioral, medical or bariatric surgical management. Neuromodulation has been postulated as a potential treatment for eating disorders and obesity. In particular, deep brain stimulation and transcranial non-invasive brain stimulation have been studied for these indications across a variety of brain targets. Here, we review the neurobiology behind eating and eating disorders as well as the current status of preclinical and clinical neuromodulation trials for eating disorders and obesity.
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Affiliation(s)
- Darrin J Lee
- Division of Neurosurgery, Toronto Western Hospital, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Gavin J B Elias
- Division of Neurosurgery, Toronto Western Hospital, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Andres M Lozano
- Division of Neurosurgery, Toronto Western Hospital, Department of Surgery, University of Toronto, 399 Bathurst St., West Wing 4-431, Toronto, ON M5T 2S8, Canada
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18
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Berner LA, Simmons AN, Wierenga CE, Bischoff-Grethe A, Paulus MP, Bailer U, Ely AV, Kaye WH. Altered interoceptive activation before, during, and after aversive breathing load in women remitted from anorexia nervosa. Psychol Med 2018; 48:142-154. [PMID: 28714434 PMCID: PMC5990016 DOI: 10.1017/s0033291717001635] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND The neural mechanisms of anorexia nervosa (AN), a severe and chronic psychiatric illness, are still poorly understood. Altered body state processing, or interoception, has been documented in AN, and disturbances in aversive interoception may contribute to distorted body perception, extreme dietary restriction, and anxiety. As prior data implicate a potential mismatch between interoceptive expectation and experience in AN, we examined whether AN is associated with altered brain activation before, during, and after an unpleasant interoceptive state change. METHODS Adult women remitted from AN (RAN; n = 17) and healthy control women (CW; n = 25) underwent functional magnetic resonance imaging during an inspiratory breathing load paradigm. RESULTS During stimulus anticipation, the RAN group, relative to CW, showed reduced activation in right mid-insula. In contrast, during the aversive breathing load, the RAN group showed increased activation compared with CW in striatum and cingulate and prefrontal cortices (PFC). The RAN group also showed increased activation in PFC, bilateral insula, striatum, and amygdala after stimulus offset. Time course analyses indicated that RAN responses in interoceptive processing regions during breathing load increased more steeply than those of CW. Exploratory analyses revealed that hyperactivation after breathing load was associated with markers of past AN severity. CONCLUSIONS Anticipatory deactivation with a subsequent exaggerated brain response during and after an aversive body state may contribute to difficulty predicting and adapting to internal state fluctuation. Because eating changes our interoceptive state, restriction may be one method of avoiding aversive, unpredictable internal change in AN.
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Affiliation(s)
- Laura A. Berner
- Department of Psychiatry, University of California, San Diego, CA
| | - Alan N. Simmons
- Department of Psychiatry, University of California, San Diego, CA
- VA San Diego Healthcare System, San Diego, CA
| | - Christina E. Wierenga
- Department of Psychiatry, University of California, San Diego, CA
- VA San Diego Healthcare System, San Diego, CA
| | | | | | - Ursula Bailer
- Department of Psychiatry, University of California, San Diego, CA
- Medical University of Vienna, Department of Psychiatry and Psychotherapy, Division of Biological Psychiatry
| | - Alice V. Ely
- Department of Psychiatry, University of California, San Diego, CA
| | - Walter H. Kaye
- Department of Psychiatry, University of California, San Diego, CA
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19
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Lipsman N, Lozano AM, Hamani C. Neuromodulation in Anorexia Nervosa. Neuromodulation 2018. [DOI: 10.1016/b978-0-12-805353-9.00088-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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20
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Hazari PP, Pandey A, Chaturvedi S, Mishra AK. New Trends and Current Status of Positron-Emission Tomography and Single-Photon-Emission Computerized Tomography Radioligands for Neuronal Serotonin Receptors and Serotonin Transporter. Bioconjug Chem 2017; 28:2647-2672. [PMID: 28767225 DOI: 10.1021/acs.bioconjchem.7b00243] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The critical role of serotonin (5-hydroxytryptamine; 5-HT) and its receptors (5-HTRs) in the pathophysiology of diverse neuropsychiatric and neurodegenerative disorders render them attractive diagnostic and therapeutic targets for brain disorders. Therefore, the in vivo assessment of binding of 5-HT receptor ligands under a multitude of physiologic and pathologic scenarios may support more-accurate identification of disease and its progression and the patient's response to therapy as well as the screening of novel therapeutic strategies. The present Review aims to focus on the current status of radioligands used for positron-emission tomography (PET) and single-photon-emission computerized tomography (SPECT) imaging of human brain serotonin receptors. We further elaborate upon and emphasize the attributes that qualify a radioligand for theranostics on the basis of its frequency of use in clinics, its benefit to risk assessment in humans, and its continuous evolution, along with the major limitations.
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Affiliation(s)
- Puja Panwar Hazari
- Division of Cyclotron and Radiopharmaceutical Sciences, Institute of Nuclear Medicine and Allied Sciences , Brig S.K. Mazumdar Road, Delhi 110054, India
| | - Ankita Pandey
- Division of Cyclotron and Radiopharmaceutical Sciences, Institute of Nuclear Medicine and Allied Sciences , Brig S.K. Mazumdar Road, Delhi 110054, India
| | - Shubhra Chaturvedi
- Division of Cyclotron and Radiopharmaceutical Sciences, Institute of Nuclear Medicine and Allied Sciences , Brig S.K. Mazumdar Road, Delhi 110054, India
| | - Anil Kumar Mishra
- Division of Cyclotron and Radiopharmaceutical Sciences, Institute of Nuclear Medicine and Allied Sciences , Brig S.K. Mazumdar Road, Delhi 110054, India
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21
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Kang Q, Chen J, Yu S, Yuan A, Zhang Y, Zhang R, Jiang W, Zhang C, Zhang H, Zhang M, Xiao Z. Association of the 5-HT 2A receptor gene promoter polymorphism-1438G/A with anorexia nervosa and psychopathological traits in the Chinese Han population: A preliminary study. Asia Pac Psychiatry 2017. [PMID: 28639321 DOI: 10.1111/appy.12284] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The aim of the study was to explore the possible role of the 5-HT2A -1438G/A polymorphism in the susceptibility to anorexia nervosa (AN) in the Chinese Han population. METHODS The -1438G/A polymorphism of 249 female AN patients, 228 matched healthy controls, and 198 trios was genotyped using SNaP shot assay. Psychopathological traits of eating-disordered behaviors in AN subjects were examined using the Chinese version of the Eating Disorder Examination Questionnaire. RESULTS Neither the case-control analysis nor the transmission disequilibrium test revealed significant associations between the -1438G/A polymorphism and AN (P > .05). However, AA homozygote patients with AN had lower weight and shape concern scores of the EDE-Q6.0 than those of GA heterozygotes (P < .05). DISCUSSION Our findings suggested that female AN patients with 5-HT2A -1438AA genotype may be characterized by less severe eating-disordered psychopathological traits in the Chinese Han population.
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Affiliation(s)
- Qing Kang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jue Chen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shunying Yu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Aihua Yuan
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yanxia Zhang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ran Zhang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenhui Jiang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chen Zhang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haiyin Zhang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mingdao Zhang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zeping Xiao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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22
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Abstract
Anorexia nervosa has the highest mortality rate among all psychiatric illnesses, as it can result in significant psychopathology along with life-threatening medical complications. Atypical anorexia nervosa is a new variant described in the latest DSM edition, which has much in common with anorexia nervosa and also can result in significant morbidity and mortality. The evolution of the criteria for these illnesses is reviewed, and the two are compared and contrasted in this article. Important labs to monitor for in those with these illnesses, along with an emphasis on the monitoring of vital signs and weight, are reviewed here. The necessity for close psychiatric monitoring of safety concerns, including suicidal thoughts, is also stressed. The etiology and the treatment of these illnesses are reviewed from a biopsychosocial approach; and lastly, the prognosis of these illnesses is discussed.
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Affiliation(s)
- Lindsay Moskowitz
- Department of Psychiatry, Northwell Health, New Hyde Park, NY; Hofstra-Northwell School of Medicine, Hempstead, NY
| | - Eric Weiselberg
- Division of Adolescent Medicine, Cohen Children׳s Medical Center, Northwell Health, New Hyde Park, NY; Hofstra-Northwell School of Medicine, Hempstead, NY
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23
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Geisler D, Ritschel F, King JA, Bernardoni F, Seidel M, Boehm I, Runge F, Goschke T, Roessner V, Smolka MN, Ehrlich S. Increased anterior cingulate cortex response precedes behavioural adaptation in anorexia nervosa. Sci Rep 2017; 7:42066. [PMID: 28198813 PMCID: PMC5304157 DOI: 10.1038/srep42066] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 12/07/2016] [Indexed: 01/28/2023] Open
Abstract
Patients with anorexia nervosa (AN) are characterised by increased self-control, cognitive rigidity and impairments in set-shifting, but the underlying neural mechanisms are poorly understood. Here we used functional magnetic resonance imaging (fMRI) to elucidate the neural correlates of behavioural adaptation to changes in reward contingencies in young acutely ill AN patients. Thirty-six adolescent/young adult, non-chronic female AN patients and 36 age-matched healthy females completed a well-established probabilistic reversal learning task during fMRI. We analysed hemodynamic responses in empirically-defined regions of interest during positive feedback and negative feedback not followed/followed by behavioural adaptation and conducted functional connectivity analyses. Although overall task performance was comparable between groups, AN showed increased shifting after receiving negative feedback (lose-shift behaviour) and altered dorsal anterior cingulate cortex (dACC) responses as a function of feedback. Specifically, patients had increased dACC responses (which correlated with perfectionism) and task-related coupling with amygdala preceding behavioural adaption. Given the generally preserved task performance in young AN, elevated dACC responses specifically during behavioural adaption is suggestive of increased monitoring for the need to adjust performance strategies. Higher dACC-amygdala coupling and increased adaptation after negative feedback underlines this interpretation and could be related to intolerance of uncertainty which has been suggested for AN.
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Affiliation(s)
- Daniel Geisler
- Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.,Eating Disorder Treatment and Research Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Franziska Ritschel
- Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.,Eating Disorder Treatment and Research Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Joseph A King
- Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.,Eating Disorder Treatment and Research Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Fabio Bernardoni
- Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.,Eating Disorder Treatment and Research Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Maria Seidel
- Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.,Eating Disorder Treatment and Research Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Ilka Boehm
- Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.,Eating Disorder Treatment and Research Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Franziska Runge
- Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.,Eating Disorder Treatment and Research Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Thomas Goschke
- Department of Psychology, Institute of General Psychology, Biopsychology and Methods of Psychology, Technische Universität Dresden, Dresden, Germany
| | - Veit Roessner
- Eating Disorder Treatment and Research Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Michael N Smolka
- Department of Psychiatry and Neuroimaging, Technische Universität Dresden, Dresden, Germany
| | - Stefan Ehrlich
- Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.,Eating Disorder Treatment and Research Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
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24
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Mishra A, Anand M, Umesh S. Neurobiology of eating disorders - an overview. Asian J Psychiatr 2017; 25:91-100. [PMID: 28262179 DOI: 10.1016/j.ajp.2016.10.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 09/03/2016] [Accepted: 10/09/2016] [Indexed: 12/12/2022]
Affiliation(s)
- Anand Mishra
- Central Institute of Psychiatry, Ranchi, Jharkhand, India.
| | - Manu Anand
- Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | - Shreekantiah Umesh
- K.S. Mani Centre for Cognitive Neurosciences, Central Institute of Psychiatry, Ranchi, Jharkhand, India
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25
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Schultz CC, Wagner G, de la Cruz F, Berger S, Reichenbach JR, Sauer H, Bär KJ. Evidence for alterations of cortical folding in anorexia nervosa. Eur Arch Psychiatry Clin Neurosci 2017; 267:41-49. [PMID: 26678081 DOI: 10.1007/s00406-015-0666-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 12/06/2015] [Indexed: 12/13/2022]
Abstract
Anorexia nervosa (AN) is highly heritable, and the perspective on the etiology of AN has changed from a behavioral to a neurobiological and neurodevelopmental view. However, cortical folding as an important marker for deviations in brain development has yet rarely been explored in AN. Hence, in order to determine potential cortical folding alterations, we investigated fine-grained cortical folding in a cohort of 26 patients with AN, of whom 6 patients were recovered regarding their weight at the time point of MRI measurement. MRI-derived cortical folding was computed and compared between patients and healthy controls at about 150,000 points per hemisphere using a surface-based technique (FreeSurfer). Patients with AN exhibited highly significant increased cortical folding in a right dorsolateral prefrontal cortex region (DLPFC). Furthermore, a statistical trend in the same direction was found in the right visual cortex. We did not find a correlation of local cortical folding and current symptoms of the disease. In conclusion, our analyses provide first evidence that altered DLPFC cortical folding plays a role in the etiology of AN. The absence of correlations with clinical parameters implicates a relatively independence of cortical folding alterations from the current symptomatology and might thus be regarded as a trait characteristic of the disease potentially related to other neurobiological features of AN.
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Affiliation(s)
- C Christoph Schultz
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, 07740, Jena, Germany.
| | - Gerd Wagner
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, 07740, Jena, Germany.,Psychiatric Brain & Body Research Group Jena, Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Feliberto de la Cruz
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, 07740, Jena, Germany.,Psychiatric Brain & Body Research Group Jena, Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Sandy Berger
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, 07740, Jena, Germany.,Psychiatric Brain & Body Research Group Jena, Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Jürgen R Reichenbach
- Medical Physics Group, Institute for Diagnostic and Interventional Radiology, Jena University Hospital, Jena, Germany
| | - Heinrich Sauer
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, 07740, Jena, Germany
| | - Karl J Bär
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, 07740, Jena, Germany.,Psychiatric Brain & Body Research Group Jena, Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
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26
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Dunlop KA, Woodside B, Downar J. Targeting Neural Endophenotypes of Eating Disorders with Non-invasive Brain Stimulation. Front Neurosci 2016; 10:30. [PMID: 26909013 PMCID: PMC4754427 DOI: 10.3389/fnins.2016.00030] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 01/25/2016] [Indexed: 12/14/2022] Open
Abstract
The term "eating disorders" (ED) encompasses a wide variety of disordered eating and compensatory behaviors, and so the term is associated with considerable clinical and phenotypic heterogeneity. This heterogeneity makes optimizing treatment techniques difficult. One class of treatments is non-invasive brain stimulation (NIBS). NIBS, including repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), are accessible forms of neuromodulation that alter the cortical excitability of a target brain region. It is crucial for NIBS to be successful that the target is well selected for the patient population in question. Targets may best be selected by stepping back from conventional DSM-5 diagnostic criteria to identify neural substrates of more basic phenotypes, including behavior related to rewards and punishment, cognitive control, and social processes. These phenotypic dimensions have been recently laid out by the Research Domain Criteria (RDoC) initiative. Consequently, this review is intended to identify potential dimensions as outlined by the RDoC and the underlying behavioral and neurobiological targets associated with ED. This review will also identify candidate targets for NIBS based on these dimensions and review the available literature on rTMS and tDCS in ED. This review systematically reviews abnormal neural circuitry in ED within the RDoC framework, and also systematically reviews the available literature investigating NIBS as a treatment for ED.
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Affiliation(s)
- Katharine A. Dunlop
- Institute of Medical Sciences, University of TorontoToronto, ON, Canada
- MRI-Guided rTMS Clinic, University Health NetworkToronto, ON, Canada
| | - Blake Woodside
- Institute of Medical Sciences, University of TorontoToronto, ON, Canada
- Department of Psychiatry, University Health NetworkToronto, ON, Canada
- Department of Psychiatry, University of TorontoToronto, ON, Canada
- Eating Disorders Program, University Health NetworkToronto, ON, Canada
| | - Jonathan Downar
- Institute of Medical Sciences, University of TorontoToronto, ON, Canada
- MRI-Guided rTMS Clinic, University Health NetworkToronto, ON, Canada
- Department of Psychiatry, University Health NetworkToronto, ON, Canada
- Department of Psychiatry, University of TorontoToronto, ON, Canada
- Toronto Western Research Institute, University Health NetworkToronto, ON, Canada
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Treasure J, Zipfel S, Micali N, Wade T, Stice E, Claudino A, Schmidt U, Frank GK, Bulik CM, Wentz E. Anorexia nervosa. Nat Rev Dis Primers 2015; 1:15074. [PMID: 27189821 DOI: 10.1038/nrdp.2015.74] [Citation(s) in RCA: 178] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Anorexia nervosa (AN) is a psychiatric condition characterized by severe weight loss and secondary problems associated with malnutrition. AN predominantly develops in adolescence in the peripubertal period. Without early effective treatment, the course is protracted with physical, psychological and social morbidity and high mortality. Despite these effects, patients are noted to value the beliefs and behaviours that contribute to their illness rather than regarding them as problematic, which interferes with screening, prevention and early intervention. Involving the family to support interventions early in the course of the illness can produce sustained changes; however, those with a severe and/or protracted illness might require inpatient nursing support and/or outpatient psychotherapy. Prevention programmes aim to moderate the overvaluation of 'thinness' and body dissatisfaction as one of the proximal risk factors. The low prevalence of AN limits the ability to identify risk factors and to study the timing and sex distribution of the condition. However, genetic profiles, premorbid features, and brain structures and functions of patients with AN show similarities with other psychiatric disorders and contrast with obesity and metabolic disorders. Such studies are informing approaches to address the neuroadaptation to starvation and the other various physical and psychosocial deficits associated with AN. This Primer describes the epidemiology, diagnosis, screening and prevention, aetiology, treatment and quality of life of patients with AN.
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Affiliation(s)
- Janet Treasure
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London SE5 8AF, UK
| | - Stephan Zipfel
- Department of Psychosomatic Medicine, University of Tuebingen, Tuebingen, Germany
| | - Nadia Micali
- University College London, Institute of Child Health, Behavioural and Brain Sciences Unit, London, UK.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Tracey Wade
- School of Psychology, Flinders University, Adelaide, Australia
| | - Eric Stice
- Oregon Research Institute, Eugene, Oregon, USA
| | - Angélica Claudino
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Ulrike Schmidt
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London SE5 8AF, UK
| | - Guido K Frank
- Eating Disorder Centre of Denver, University of Colorado, Denver, Colorado, USA
| | - Cynthia M Bulik
- University of North Carolina at Chapel Hill, North Carolina, USA.,Karolinska Institutet, Stockholm, Sweden
| | - Elisabet Wentz
- Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg Sweden
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Culbert KM, Racine SE, Klump KL. Research Review: What we have learned about the causes of eating disorders - a synthesis of sociocultural, psychological, and biological research. J Child Psychol Psychiatry 2015; 56:1141-64. [PMID: 26095891 DOI: 10.1111/jcpp.12441] [Citation(s) in RCA: 284] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/11/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Eating disorders are severe psychiatric disorders with a complex etiology involving transactions among sociocultural, psychological, and biological influences. Most research and reviews, however, focus on only one level of analysis. To address this gap, we provide a qualitative review and summary using an integrative biopsychosocial approach. METHODS We selected variables for which there were available data using integrative methodologies (e.g., twin studies, gene-environment interactions) and/or data at the biological and behavioral level (e.g., neuroimaging). Factors that met these inclusion criteria were idealization of thinness, negative emotionality, perfectionism, negative urgency, inhibitory control, cognitive inflexibility, serotonin, dopamine, ovarian hormones. Literature searches were conducted using PubMed. Variables were classified as risk factors or correlates of eating disorder diagnoses and disordered eating symptoms using Kraemer et al.'s (1997) criteria. FINDINGS Sociocultural idealization of thinness variables (media exposure, pressures for thinness, thin-ideal internalization, thinness expectancies) and personality traits (negative emotionality, perfectionism, negative urgency) attained 'risk status' for eating disorders and/or disordered eating symptoms. Other factors were identified as correlates of eating pathology or were not classified given limited data. Effect sizes for risk factors and correlates were generally small-to-moderate in magnitude. CONCLUSIONS Multiple biopsychosocial influences are implicated in eating disorders and/or disordered eating symptoms and several can now be considered established risk factors. Data suggest that psychological and environmental factors interact with and influence the expression of genetic risk to cause eating pathology. Additional studies that examine risk variables across multiple levels of analysis and that consider specific transactional processes amongst variables are needed to further elucidate the intersection of sociocultural, psychological, and biological influences on eating disorders.
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Affiliation(s)
| | - Sarah E Racine
- Department of Psychology, Ohio University, Athens, OH, USA
| | - Kelly L Klump
- Department of Psychology, Michigan State University, East Lansing, MI, USA
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Hayes DJ, Lipsman N, Chen DQ, Woodside DB, Davis KD, Lozano AM, Hodaie M. Subcallosal Cingulate Connectivity in Anorexia Nervosa Patients Differs From Healthy Controls: A Multi-tensor Tractography Study. Brain Stimul 2015; 8:758-68. [PMID: 26073966 DOI: 10.1016/j.brs.2015.03.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 03/18/2015] [Accepted: 03/21/2015] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Anorexia nervosa is characterized by extreme low body weight and alterations in affective processing. The subcallosal cingulate regulates affect through wide-spread white matter connections and is implicated in the pathophysiology of anorexia nervosa. OBJECTIVES We examined whether those with treatment refractory anorexia nervosa undergoing deep brain stimulation (DBS) of the subcallosal white matter (SCC) show: (1) altered anatomical SCC connectivity compared to healthy controls, (2) white matter microstructural changes, and (3) microstructural changes associated with clinically-measured affect. METHODS Diffusion magnetic resonance imaging (dMRI) and deterministic multi-tensor tractography were used to compare anatomical connectivity and microstructure in SCC-associated white matter tracts. Eight women with treatment-refractory anorexia nervosa were compared to 8 age- and sex-matched healthy controls. Anorexia nervosa patients also completed affect-related clinical assessments presurgically and 12 months post-surgery. RESULTS (1) Higher (e.g., left parieto-occipital cortices) and lower (e.g., thalamus) connectivity in those with anorexia nervosa compared to controls. (2) Decreases in fractional anisotropy, and alterations in axial and radial diffusivities, in the left fornix crus, anterior limb of the internal capsule (ALIC), right anterior cingulum and left inferior fronto-occipital fasciculus. (3) Correlations between dMRI metrics and clinical assessments, such as low pre-surgical left fornix and right ALIC fractional anisotropy being related to post-DBS improvements in quality-of-life and depressive symptoms, respectively. CONCLUSIONS We identified widely-distributed differences in SCC connectivity in anorexia nervosa patients consistent with heterogenous clinical disruptions, although these results should be considered with caution given the low number of subjects. Future studies should further explore the use of affect-related connectivity and behavioral assessments to assist with DBS target selection and treatment outcome.
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Affiliation(s)
- Dave J Hayes
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Toronto Western Research Institute, Division of Brain, Imaging and Behaviour - Systems Neuroscience, University Health Network, Toronto, Ontario M5T 2S8, Canada; Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada
| | - Nir Lipsman
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Toronto Western Research Institute, Division of Brain, Imaging and Behaviour - Systems Neuroscience, University Health Network, Toronto, Ontario M5T 2S8, Canada; Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada
| | - David Q Chen
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Toronto Western Research Institute, Division of Brain, Imaging and Behaviour - Systems Neuroscience, University Health Network, Toronto, Ontario M5T 2S8, Canada; Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada
| | - D Blake Woodside
- Department of Psychiatry, University of Toronto, Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada
| | - Karen D Davis
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Toronto Western Research Institute, Division of Brain, Imaging and Behaviour - Systems Neuroscience, University Health Network, Toronto, Ontario M5T 2S8, Canada; Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada
| | - Andres M Lozano
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Toronto Western Research Institute, Division of Brain, Imaging and Behaviour - Systems Neuroscience, University Health Network, Toronto, Ontario M5T 2S8, Canada; Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada
| | - Mojgan Hodaie
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Toronto Western Research Institute, Division of Brain, Imaging and Behaviour - Systems Neuroscience, University Health Network, Toronto, Ontario M5T 2S8, Canada; Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada.
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von Hausswolff-Juhlin Y, Brooks SJ, Larsson M. The neurobiology of eating disorders--a clinical perspective. Acta Psychiatr Scand 2015; 131:244-55. [PMID: 25223374 DOI: 10.1111/acps.12335] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/18/2014] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To provide a neurobiological basis of eating disorders for clinicians and to enlighten how comparing neurobiology and eating disorders with neurobiology of other psychiatric illnesses can improve treatment protocols. METHOD A selective review on the neurobiology of eating disorders. The article focuses on clinical research on humans with consideration of the anatomical, neural, and molecular basis of eating disorders. RESULTS The neurobiology of people with eating disorders is altered. Many of the neurobiological regions, receptors, and chemical substrates that are affected in other mental illnesses also play an important role in eating disorders. More knowledge about the neurobiological overlap between eating disorders and other psychiatric populations will help when developing treatment protocols not the least regarding that comorbidity is common in patients with EDs. CONCLUSION Knowledge about the underlying neurobiology of eating disorders will improve treatment intervention and will benefit from comparisons with other mental illnesses and their treatments.
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Affiliation(s)
- Y von Hausswolff-Juhlin
- Center for Psychiatry Research, Karolinska Institute, Stockholm, Sweden; Stockholm Centre for Eating Disorders, Stockholm, Sweden
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Brambilla F, Amianto F, Dalle Grave R, Fassino S. Lack of efficacy of psychological and pharmacological treatments of disorders of eating behavior: neurobiological background. BMC Psychiatry 2014; 14:376. [PMID: 25539757 PMCID: PMC4311492 DOI: 10.1186/s12888-014-0376-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Accepted: 12/19/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Treatments of eating disorders result too often in partial psychological and physical remission, chronicization, dropout, relapse and death, with no fully known explanations for this failure. In order to clarify this problem, we conducted three studies to identify the biochemical background of cognitive-behavioural psychotherapy (CBT), individual psychology brief psychotherapy (IBPP), and psychotherapy-pharmacotherapy with CBT + olanzapine in anorexics (AN) and bulimics (BN) by measuring the levels of plasma homovanillic acid (HVA) for dopamine secretion, plasma 3-methoxy-4-hydroxy-phenylglycol (MHPG) for noradrenalin secretion, and platelet [3H]-Paroxetin-binding Bmax and Kd for serotonin transporter function. The data were then compared with psychopathological and physical alterations. METHODS Study 1 investigated the effects of 4 months of CBT on plasma HVA, MHPG and [3H]-Par-binding in 14 AN-restricted, 14 AN-bingeing/purging, and 22 BN inpatients. Study 2 investigated the effects of 4 months of IBPP on plasma HVA in 15 AN and 17 BN outpatients. Study 3 investigated the effect of 3 months of CBT + olanzapine (5 mg/day) in 30 AN outpatients. The data were analyzed using one-way ANOVA for repeated measures for the changes between basal and post-treatment biological and psychological parameters, two-way ANOVA for repeated measures for the differences in the psychobiological data in the 3 groups, Spearman's test for the correlations between basal and final changes in the psychological and biological scores. RESULTS Study 1 revealed significant amelioration of the psychopathology in the AN and BN patients, no effects on HVA, MHPG or Paroxetin binding Kd, and a significant increase in Par-binding Bmax only in the BN patients. Study 2 revealed a significant effect of IBPP on psychopathology in the AN and BN patients, and a significant increase in HVA only in the BN patients. Study 3 revealed a significant positive effect of CBT + olanzapine therapy on the psychopathology and increased HVA values. No correlations were observed in the 3 groups between biological and psychological effects of the three treatments. CONCLUSIONS Our data advance suggestions on the mechanism of action of the three therapies; however, the lack of correlations between biochemical and psychological effects casts doubt on their significance. Clinical Trials.gov. Identifier NCT01990755 .
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Leblanc V, Bégin C, Hudon AM, Royer MM, Corneau L, Dodin S, Lemieux S. Gender differences in the long-term effects of a nutritional intervention program promoting the Mediterranean diet: changes in dietary intakes, eating behaviors, anthropometric and metabolic variables. Nutr J 2014; 13:107. [PMID: 25416917 PMCID: PMC4247653 DOI: 10.1186/1475-2891-13-107] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 11/12/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Long-term adherence to principles of the Mediterranean diet (MedDiet) following a nutritional intervention promoting the Mediterranean food pattern in Canadian men and women is not known. Moreover, gender differences in dietary and metabolic profile in such an intervention context has never been addressed. Objective was to determine gender differences in long-term effects of a 12-week nutritional intervention program promoting the adoption of the MedDiet and based on the Self-Determination Theory (SDT) on dietary intakes, eating behaviors, anthropometric and metabolic variables, in men and women presenting cardiovascular risk factors. METHODS Sixty-four men and 59 premenopausal women were recruited. The 12-week nutritional program used a motivational interviewing approach and included individual and group sessions. A food frequency questionnaire was administered to evaluate dietary intakes from which a Mediterranean score (Medscore) was derived and the Three-Factor Eating Questionnaire allowed assessment of eating behaviors. Measurements were performed at baseline and after the 12-week nutritional intervention, and then at 3 and 6-month post intervention. RESULTS No gender difference was observed in changes in the Medscore during the nutritional intervention and follow-up. However, the Medscore returned towards baseline values during follow-up in men and women (P < 0.0001). Men reported larger decreases in red and processed meat and larger increases in whole fruit intakes than women (P = 0.03 and P = 0.04, respectively). Men showed a greater decrease in habitual susceptibility to disinhibition than women (P = 0.03). A gender by time interaction was found for waist circumference, i.e. men had lower waist circumference at the end of the intervention as well as at follow-up than at baseline while women's waist circumference decreased in response to the intervention only (P = 0.05). As for metabolic variables, changes observed in total-cholesterol (C) to HDL-C ratio, triglyceride levels and triglycerides to HDL-C ratio were more pronounced in men than in women after the intervention as well as at follow-up (P ≤ 0.03). CONCLUSIONS Our results indicate that the 12-week nutritional intervention based on the SDT leads to more pronounced beneficial changes in long-term dietary intakes in men than in women and to greater improvements in metabolic profile in men. TRIAL REGISTRATION Current Controlled Trials NCT01852721.
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Affiliation(s)
- Vicky Leblanc
- />Institute of Nutrition and Functional Foods, Laval University, 2440 Hochelaga Boulevard, Québec, G1V 0A6 Canada
| | - Catherine Bégin
- />School of Psychology, Laval University, Pavillon Félix-Antoine Savard, 2325 rue des Bibliothèques, Québec, G1V 0A6 Canada
| | - Anne-Marie Hudon
- />Institute of Nutrition and Functional Foods, Laval University, 2440 Hochelaga Boulevard, Québec, G1V 0A6 Canada
| | - Marie-Michelle Royer
- />Institute of Nutrition and Functional Foods, Laval University, 2440 Hochelaga Boulevard, Québec, G1V 0A6 Canada
| | - Louise Corneau
- />Institute of Nutrition and Functional Foods, Laval University, 2440 Hochelaga Boulevard, Québec, G1V 0A6 Canada
| | - Sylvie Dodin
- />Institute of Nutrition and Functional Foods, Laval University, 2440 Hochelaga Boulevard, Québec, G1V 0A6 Canada
- />Department of Obstetrics and Gynaecology, Laval University, Pavillon Ferdinand-Vandry, 1050 Medicine Avenue, Québec, G1V 0A6 Canada
| | - Simone Lemieux
- />Institute of Nutrition and Functional Foods, Laval University, 2440 Hochelaga Boulevard, Québec, G1V 0A6 Canada
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Effects of serotonin-2A receptor binding and gender on personality traits and suicidal behavior in borderline personality disorder. Psychiatry Res 2014; 222:140-8. [PMID: 24751216 PMCID: PMC4115284 DOI: 10.1016/j.pscychresns.2014.03.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 01/27/2014] [Accepted: 03/21/2014] [Indexed: 01/14/2023]
Abstract
Impulsivity and aggressiveness are personality traits associated with a vulnerability to suicidal behavior. Behavioral expression of these traits differs by gender and has been related to central serotonergic function. We assessed the relationships between serotonin-2A receptor function, gender, and personality traits in borderline personality disorder (BPD), a disorder characterized by impulsive-aggression and recurrent suicidal behavior. Participants, who included 33 BPD patients and 27 healthy controls (HC), were assessed for Axis I and II disorders with the Structured Clinical Interview for DSM-IV and the International Personality Disorders Examination, and with the Diagnostic Interview for Borderline Patients-Revised for BPD. Depressed mood, impulsivity, aggression, and temperament were assessed with standardized measures. Positron emission tomography with [(18)F]altanserin as ligand and arterial blood sampling was used to determine the binding potentials (BPND) of serotonin-2A receptors in 11 regions of interest. Data were analyzed using Logan graphical analysis, controlling for age and non-specific binding. Among BPD subjects, aggression, Cluster B co-morbidity, antisocial PD, and childhood abuse were each related to altanserin binding. BPND values predicted impulsivity and aggression in BPD females (but not BPD males), and in HC males (but not HC females.) Altanserin binding was greater in BPD females than males in every contrast, but it did not discriminate suicide attempters from non-attempters. Region-specific differences in serotonin-2A receptor binding related to diagnosis and gender predicted clinical expression of aggression and impulsivity. Vulnerability to suicidal behavior in BPD may be related to serotonin-2A binding through expression of personality risk factors.
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Katayama H, Kohmura K, Tanaka S, Imaeda M, Kawano N, Noda Y, Nishioka K, Ando M, Aleksic B, Iidaka T, Ozaki N. Social insecurity in relation to orbitofrontal activity in patients with eating disorders: a near-infrared spectroscopy study. BMC Psychiatry 2014; 14:173. [PMID: 24924100 PMCID: PMC4067083 DOI: 10.1186/1471-244x-14-173] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Accepted: 06/05/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Functional neuroimaging techniques are widely used to elucidate changes in brain activity, and various questionnaires are used to investigate psychopathological features in patients with eating disorders (ED). It is well known that social skills and interpersonal difficulties are strongly associated with the psychopathology of patients with ED. However, few studies have examined the association between brain activity and social relationships in patients with ED, particularly in patients with extremely low body weight. METHODS In this study, 22-channel near-infrared spectroscopy was used to quantify regional hemodynamic changes during a letter fluency task (LFT) in 20 female patients with ED with a mean body mass index of 14.0 kg/m(2) and 31 female controls (CTLs). Symptoms were assessed using the Eating Disorder Inventory-2 and Beck Depression Inventory. We hypothesized that frontal activity in patients with ED would be lower than in CTLs and would show different correlations with psychopathological features compared with CTLs. RESULTS The LFT performance and score on the social insecurity subscale of the Eating Disorder Inventory-2 were significantly higher in the ED group than in the CTL group. The mean change in oxygenated hemoglobin (oxy-Hb) in bilateral frontal regions during the LFT was significantly smaller in the ED group than in the CTL group. Social insecurity score was positively correlated with the concentration of oxy-Hb in the bilateral orbitofrontal cortex in the ED group but not in the CTL group. CONCLUSIONS These results suggest that activity of the orbitofrontal cortex is associated with social insecurity and disturbed in patients with ED. Therefore, disturbed orbitofrontal cortex activity may underlie the lack of insight and social isolation that is characteristic of patients with ED.
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Affiliation(s)
- Hiroto Katayama
- Department of Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi-ken 466-8550, Japan
| | - Kunihiro Kohmura
- Department of Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi-ken 466-8550, Japan
| | - Satoshi Tanaka
- Department of Psychiatry, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi-ken 466-8550, Japan
| | - Miho Imaeda
- Department of Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi-ken 466-8550, Japan
| | - Naoko Kawano
- Department of Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi-ken 466-8550, Japan
| | - Yukihiro Noda
- Division of Clinical Science and Neuropsychopharmacology, Graduate School of Pharmacy, Meijo University, 150 Yagotoyama, Tenpaku-ku, Nagoya, Aichi-ken 468-8503, Japan
- The Academic Frontier Project for Private Universities, Comparative Cognitive Science Institutes, Meijo University, 1-501 Shiogamaguchi, Tenpaku-ku, Nagoya, Aichi-ken 468-8502, Japan
| | - Kazuo Nishioka
- Department of Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi-ken 466-8550, Japan
| | - Masahiko Ando
- Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Aichi-ken 466-8550, Japan
| | - Branko Aleksic
- Department of Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi-ken 466-8550, Japan
| | - Tetsuya Iidaka
- Department of Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi-ken 466-8550, Japan
| | - Norio Ozaki
- Department of Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi-ken 466-8550, Japan
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Evaluating the potential of deep brain stimulation for treatment-resistant anorexia nervosa. HANDBOOK OF CLINICAL NEUROLOGY 2014; 116:271-6. [PMID: 24112901 DOI: 10.1016/b978-0-444-53497-2.00022-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/17/2023]
Abstract
Anorexia nervosa is a chronic and debilitating psychiatric disorder associated with one of the highest mortality rates of any psychiatric condition. Despite advances in neuroimaging, genetics, pharmacology, and psychosocial interventions in the last half-century, little progress has been made in altering the natural history of the condition or its outcomes. Evidence is now emerging that the condition is, at least in part, maintained by dysfunctional activity in key neuroanatomic circuits subserving illness-maintaining symptoms. Abnormal reward processing, compulsive hyperactivity, chronic anxiety, and depression, all suggest that anorexia nervosa shares much in common with other conditions, such as major depression and obsessive-compulsive disorder, for which surgical therapy with deep brain stimulation (DBS) has been tried, with promising results. As a result, the use of DBS in treatment-resistant anorexia nervosa should be evaluated in carefully designed, early-phase feasibility trials.
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Lipsman N, Woodside DB, Lozano AM. Neurocircuitry of limbic dysfunction in anorexia nervosa. Cortex 2014; 62:109-18. [PMID: 24703713 DOI: 10.1016/j.cortex.2014.02.020] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 12/30/2013] [Accepted: 02/20/2014] [Indexed: 01/12/2023]
Abstract
Anorexia Nervosa (AN) is a serious psychiatric condition marked by firmly entrenched and maladaptive behaviors and beliefs about body, weight and food, as well as high rates of psychiatric comorbidity. The neural roots of AN are now beginning to emerge, and appear to be related to dysfunctional, primarily limbic, circuits driving pathological thoughts and behaviors. As a result, the significant physical symptoms of AN are increasingly being understood at least partially as a result of abnormal or dysregulated emotional processing. This paper reviews the nature of limbic dysfunction in AN, and how structural and functional imaging has implicated distinct emotional and perceptual neural circuits driving AN symptoms. We propose that top-down and bottom-up influences converge on key limbic modulatory structures, such as the subcallosal cingulate and insula, whose normal functioning is critical to affective regulation and emotional homeostasis. Dysfunctional activity in these structures, as is seen in AN, may lead to emotional processing deficits and psychiatric symptoms, which then drive maladaptive behaviors. Modulating limbic dysregulation may therefore be a potential treatment strategy in some AN patients.
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Affiliation(s)
- Nir Lipsman
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, Canada.
| | - D Blake Woodside
- Department of Psychiatry, Toronto General Hospital, University Health Network, Canada
| | - Andres M Lozano
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, Canada
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Abstract
OBJECTIVE Recent advances in neuroimaging techniques have enabled a better understanding of the neurobiological underpinnings of anorexia nervosa (AN). The aim of this paper was to summarise our current understanding of the neurobiology of AN. METHODS The literature was searched using the electronic databases PubMed and Google Scholar, and by additional hand searches through reference lists and specialist eating disorders journals. Relevant studies were included if they were written in English, only used human participants, had a specific AN group, used clinical populations of AN, group comparisons were reported for AN compared to healthy controls and not merely AN compared to other eating disorders or other psychiatric groups, and were not case studies. RESULTS The systematic review summarises a number of structural and functional brain differences which are reported in individuals with AN, including differences in neurotransmitter function, regional cerebral blood flow, glucose metabolism, volumetrics and the blood oxygen level dependent response. CONCLUSION Several structural and functional differences have been reported in AN, some of which reverse and others which persist following weight restoration. These findings have important implications for our understanding of the neurobiological underpinnings of AN, and further research in this field may provide new direction for the development of more effective treatments.
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Affiliation(s)
- Andrea Phillipou
- 1Department of Optometry and Vision Sciences, The University of Melbourne, Melbourne, Australia
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Storage S, Mandelkern MA, Phuong J, Kozman M, Neary MK, Brody AL. A positive relationship between harm avoidance and brain nicotinic acetylcholine receptor availability. Psychiatry Res 2013; 214:415-21. [PMID: 24148908 PMCID: PMC3851586 DOI: 10.1016/j.pscychresns.2013.07.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Revised: 06/22/2013] [Accepted: 07/25/2013] [Indexed: 01/28/2023]
Abstract
Prior research indicates that disturbance of cholinergic neurotransmission reduces anxiety, leading to the hypothesis that people with heightened cholinergic function have a greater tendency toward anxiety-like and/or harm-avoidant behavior. We sought to determine if people with elevated levels of harm avoidance (HA), a dimension of temperament from the Temperament and Character Inventory (TCI), have high α4β2* nicotinic acetylcholine receptor (nAChR) availability. Healthy adults (n=105; 47 non-smokers and 58 smokers) underwent bolus-plus-continuous infusion positron emission tomography (PET) scanning using the radiotracer 2-[18F]fluoro-3-(2(S)azetidinylmethoxy) pyridine (abbreviated as 2-FA). During the uptake period of 2-FA, participants completed the TCI. The central study analysis revealed a significant association between total HA and mean nAChR availability, with higher total HA scores being linked with greater nAChR availability. In examining HA subscales, both 'Fear of Uncertainty' and 'Fatigability' were significant, based on higher levels of these characteristics being associated with greater nAChR availabilities. This study adds to a growing body of knowledge concerning the biological basis of personality and may prove useful in understanding the pathophysiology of psychiatric disorders (such as anxiety disorders) that have similar characteristics to HA. Study findings may indicate that heightened cholinergic neurotransmission is associated with increased anxiety-like traits.
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Affiliation(s)
- Steven Storage
- UCLA School of Medicine, Los Angeles, California, USA,Department of Research, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Mark A. Mandelkern
- Department of Research, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA,Department of Physics, University of California at Irvine, California, USA
| | - Jonathan Phuong
- Department of Research, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Maggie Kozman
- Department of Research, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Meaghan K. Neary
- Department of Research, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Arthur L. Brody
- UCLA School of Medicine, Los Angeles, California, USA,Department of Research, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA,Department of Psychiatry, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA,Corresponding author at: UCLA Department of Psychiatry & Biobehavioral Sciences 300 UCLA Medical Plaza, Suite 2200 Los Angeles, CA 90095. Tel.: +310 268 4778; fax: +310 206 2802.
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Abstract
In numerous pathological states, the brain can restrict food intake to a lethal level despite mounting requirements for energy as seen in adolescents with anorexia nervosa. How the brain reduces food intake to the point of death while eating is a cornerstone of survival that remains just as ‘cryptic’ as the association between anorexia and overeating. This review provides a recent snapshot of the neural underpinnings of the rewarding effects of anorexia that may compete with the adaptive decision-making process to eat, and with survival instinct. Among a plethora of factors, impaired activity of the serotonin receptors in the reward system underlies the ability of animals to self-impose food restriction, and the transition from under- to over-eating. However, the triumvirate association between serotonin, overeating and addiction appears unlikely. Considering the implication of the serotonin receptors in the hypothalamus, anorexia and bulimia nervosa could result from an impairment of a ‘synchronic activity’ between the autonomic and voluntary nervous systems.
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Affiliation(s)
- Valérie Compan
- Centre National de la Recherche Scientifique, UnitéMixte de Recherche-5203, Institut de Génomique Fonctionnelle, Montpellier, F-34094, France and Institut National de la Santé et de la Recherche Médicale, U661, Montpellier, F-34094, France and Universités de Montpellier 1 & 2, UMR-5203, Montpellier, F-34094, France and Université de Nîmes, Nîmes, F-30000, France
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41
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Lipsman N, Woodside DB, Giacobbe P, Hamani C, Carter JC, Norwood SJ, Sutandar K, Staab R, Elias G, Lyman CH, Smith GS, Lozano AM. Subcallosal cingulate deep brain stimulation for treatment-refractory anorexia nervosa: a phase 1 pilot trial. Lancet 2013; 381:1361-1370. [PMID: 23473846 DOI: 10.1016/s0140-6736(12)62188-6] [Citation(s) in RCA: 166] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Anorexia nervosa is characterised by a chronic course that is refractory to treatment in many patients and has one of the highest mortality rates of any psychiatric disorder. Deep brain stimulation (DBS) has been applied to circuit-based neuropsychiatric diseases, such as Parkinson's disease and major depression, with promising results. We aimed to assess the safety of DBS to modulate the activity of limbic circuits and to examine how this might affect the clinical features of anorexia nervosa. METHODS We did a phase 1, prospective trial of subcallosal cingulate DBS in six patients with chronic, severe, and treatment-refractory anorexia nervosa. Eligible patients were aged 20-60 years, had been diagnosed with restricting or binge-purging anorexia nervosa, and showed evidence of chronicity or treatment resistance. Patients underwent medical optimisation preoperatively and had baseline body-mass index (BMI), psychometric, and neuroimaging investigations, followed by implantation of electrodes and pulse generators for continuous delivery of electrical stimulation. Patients were followed up for 9 months after DBS activation, and the primary outcome of adverse events associated with surgery or stimulation was monitored at every follow-up visit. Repeat psychometric assessments, BMI measurements, and neuroimaging investigations were also done at various intervals. This trial is registered with ClinicalTrials.gov, number NCT01476540. FINDINGS DBS was associated with several adverse events, only one of which (seizure during programming, roughly 2 weeks after surgery) was serious. Other related adverse events were panic attack during surgery, nausea, air embolus, and pain. After 9 months, three of the six patients had achieved and maintained a BMI greater than their historical baselines. DBS was associated with improvements in mood, anxiety, affective regulation, and anorexia nervosa-related obsessions and compulsions in four patients and with improvements in quality of life in three patients after 6 months of stimulation. These clinical benefits were accompanied by changes in cerebral glucose metabolism (seen in a comparison of composite PET scans at baseline and 6 months) that were consistent with a reversal of the abnormalities seen in the anterior cingulate, insula, and parietal lobe in the disorder. INTERPRETATION Subcallosal cingulate DBS seems to be generally safe in this sample of patients with chronic and treatment-refractory anorexia nervosa. FUNDING Klarman Family Foundation Grants Program in Eating Disorders Research and Canadian Institutes of Health Research.
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Affiliation(s)
- Nir Lipsman
- Division of Neurosurgery, Toronto Western Hospital, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - D Blake Woodside
- Department of Psychiatry, University of Toronto, Toronto General Hospital, ON, Canada
| | - Peter Giacobbe
- Department of Psychiatry, University of Toronto, Toronto General Hospital, ON, Canada
| | - Clement Hamani
- Division of Neurosurgery, Toronto Western Hospital, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Jacqueline C Carter
- Department of Psychiatry, University of Toronto, Toronto General Hospital, ON, Canada
| | | | - Kalam Sutandar
- Department of Psychiatry, University of Toronto, Toronto General Hospital, ON, Canada
| | - Randy Staab
- Division of Psychiatry, Credit Valley Hospital, Mississauga, ON, Canada
| | - Gavin Elias
- Division of Neurosurgery, Toronto Western Hospital, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Christopher H Lyman
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Gwenn S Smith
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andres M Lozano
- Division of Neurosurgery, Toronto Western Hospital, Department of Surgery, University of Toronto, Toronto, ON, Canada.
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42
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Mettler LN, Shott ME, Pryor T, Yang TT, Frank GK. White matter integrity is reduced in bulimia nervosa. Int J Eat Disord 2013; 46:264-73. [PMID: 23354827 PMCID: PMC3722416 DOI: 10.1002/eat.22083] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/19/2012] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To investigate brain white matter (WM) functionality in bulimia nervosa (BN) in relation to anxiety. METHOD Twenty-one control women (CW, mean age 27 ± 7 years) and 20 BN women (mean age 25 ± 5 years) underwent brain diffusion tensor imaging to measure fractional anisotropy (FA; an indication of WM axon integrity) and the apparent diffusion coefficient (ADC; reflecting WM cell damage). RESULTS FA was decreased in BN in the bilateral corona radiata extending into the posterior limb of the internal capsule, the corpus callosum, the right sub-insular WM, and right fornix. In CW but not BN, trait anxiety correlated negatively with fornix, corpus callosum, and left corona radiata FA. ADC was increased in BN compared with CW in the bilateral corona radiata, corpus callosum, inferior fronto-occipital, and uncinate fasciculus. Alterations in BN WM functionality were not due to structural brain alterations. DISCUSSION WM integrity is disturbed in BN, especially in the corona radiata, which has been associated with taste and brain reward processing. Whether this is a premorbid condition or an effect from the illness is yet uncertain. The relationships between WM FA and trait anxiety in CW but not BN may suggest that altered WM functionality contributes to high anxious traits in BN.
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Affiliation(s)
- Lisa N. Mettler
- University of Colorado School of Medicine, Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Megan E. Shott
- University of Colorado School of Medicine, Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Tony T. Yang
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of California, San Francisco, CA, USA,Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of California, San Diego, CA, USA
| | - Guido K.W. Frank
- University of Colorado School of Medicine, Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA,Neuroscience Program, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
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Gicquel L. Anorexia nervosa during adolescence and young adulthood: towards a developmental and integrative approach sensitive to time course. ACTA ACUST UNITED AC 2013; 107:268-77. [PMID: 23542549 DOI: 10.1016/j.jphysparis.2013.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Anorexia nervosa is situated at the junction between two time scales, the time scale of adolescence, in which intense physiological and psychological upheavals are occurring over a relatively short period of time, and the time scale of the potentially chronic evolution of the disease over the course of the patient's lifespan. This second time scale links the critical period of adolescence with the pre-morbid period, during which a complex state of vulnerability, often unseen and unheard, combines with different risk factors, which may be isolated, associated, dissociated or concomitant, to produce the emergence of anorexia; it ushers also adolescence into the period of adulthood, flagged with the reorganization that occurs in the course of the healing process (in case of recovery), or pervaded by somatic and mental distress (in cases where the condition becomes chronic). Given the lifespan nature of the disease, it is difficult to differentiate premorbid pathogenic factors from changes resulting from the acute or chronic phases of the illness. It is also difficult to establish straightforward correlations between physiological disturbances and their clinical consequences, or conversely to assume that the restoration of physiological parameters means the disappearance of the underlying mental disorder. Taken together, these observations support an approach to anorexia nervosa that is both developmental and integrative, taking into account both the complexity of the pathways involved and the developmental timescales of these pathways. This type of approach can help to adjust therapeutic strategies and thus enhance prognosis, in particular by integrating the temporal parameter into the dynamics of care plans.
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Affiliation(s)
- Ludovic Gicquel
- INSERM U 894 Team 1, Centre de Psychiatrie et de Neurosciences, Paris, France.
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44
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Bailer UF, Frank GK, Price JC, Meltzer CC, Becker C, Mathis CA, Wagner A, Barbarich-Marsteller NC, Bloss CS, Putnam K, Schork NJ, Gamst A, Kaye WH. Interaction between serotonin transporter and dopamine D2/D3 receptor radioligand measures is associated with harm avoidant symptoms in anorexia and bulimia nervosa. Psychiatry Res 2013; 211:160-8. [PMID: 23154100 PMCID: PMC3880148 DOI: 10.1016/j.pscychresns.2012.06.010] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Revised: 06/25/2012] [Accepted: 06/29/2012] [Indexed: 10/27/2022]
Abstract
Individuals with anorexia nervosa (AN) and bulimia nervosa (BN) have alterations of measures of serotonin (5-HT) and dopamine (DA) function, which persist after long-term recovery and are associated with elevated harm avoidance (HA), a measure of anxiety and behavioral inhibition. Based on theories that 5-HT is an aversive motivational system that may oppose a DA-related appetitive system, we explored interactions of positron emission tomography (PET) radioligand measures that reflect portions of these systems. Twenty-seven individuals recovered (REC) from eating disorders (EDs) (7 AN-BN, 11 AN, 9 BN) and nine control women (CW) were analyzed for correlations between [(11)C]McN5652 and [(11)C]raclopride binding. There was a significant positive correlation between [(11)C]McN5652 binding potential (BP(non displaceable(ND))) and [(11)C]Raclopride BP(ND) for the dorsal caudate, antero-ventral striatum (AVS), middle caudate, and ventral and dorsal putamen. No significant correlations were found in CW. [(11)C]Raclopride BP(ND), but not [(11)C]McN5652 BP(ND), was significantly related to HA in REC EDs. A linear regression analysis showed that the interaction between [(11)C]McN5652 BP(ND) and [(11)C]raclopride BP(ND) in the dorsal putamen significantly predicted HA. This is the first study using PET and the radioligands [(11)C]McN5652 and [(11)C]raclopride to show a direct relationship between 5-HT transporter and striatal DA D2/D3 receptor binding in humans, supporting the possibility that 5-HT and DA interactions contribute to HA behaviors in EDs.
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Affiliation(s)
- Ursula F. Bailer
- University of California San Diego, Department of Psychiatry, La Jolla, CA,Medical University of Vienna, Department of Psychiatry and Psychotherapy, Division of Biological Psychiatry, Vienna, Austria
| | - Guido K. Frank
- Department of Psychiatry, University of Colorado Denver, Children’s Hospital Colorado, Aurora, CO, USA,Department of Neuroscience, University of Colorado Denver; Anschutz Medical Campus, Aurora, CO, USA
| | - Julie C. Price
- University of Pittsburgh, School of Medicine, Department of Radiology, Presbyterian University Hospital, Pittsburgh, PA
| | - Carolyn C. Meltzer
- University of Pittsburgh, School of Medicine, Department of Radiology, Presbyterian University Hospital, Pittsburgh, PA,University of Pittsburgh, School of Medicine, Department of Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh, PA,Emory School of Medicine, Departments of Radiology, Neurology, and Psychiatry and Behavioral Sciences, Atlanta, Georgia, and Adjunct Professor of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Carl Becker
- University of Pittsburgh, School of Medicine, Department of Radiology, Presbyterian University Hospital, Pittsburgh, PA
| | - Chester A. Mathis
- University of Pittsburgh, School of Medicine, Department of Radiology, Presbyterian University Hospital, Pittsburgh, PA
| | - Angela Wagner
- University of California San Diego, Department of Psychiatry, La Jolla, CA
| | | | - Cinnamon S. Bloss
- Scripps Genomic Medicine, Scripps Translational Science Institute (STSI), and Scripps Health, La Jolla, CA
| | - Karen Putnam
- Department of Environmental Health, Division of Epidemiology and Biostatistics, University of Cincinnati, School of Medicine, Cincinnati, Ohio
| | - Nicholas J. Schork
- Department of Environmental Health, Division of Epidemiology and Biostatistics, University of Cincinnati, School of Medicine, Cincinnati, Ohio
| | - Anthony Gamst
- University of California San Diego, Department of Biostatistics and Bioinformatics, La Jolla, CA
| | - Walter H. Kaye
- University of California San Diego, Department of Psychiatry, La Jolla, CA,Corresponding author: Walter H. Kaye, M.D., University of California, San Diego, UCSD Department of Psychiatry, 8950 Villa La Jolla Drive, Suite C – 207, La Jolla, California 92037, Tel. (858) 534 3951, FAX: (858) 534 6727,
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Mestre TA, Zurowski M, Fox SH. 5-Hydroxytryptamine 2A receptor antagonists as potential treatment for psychiatric disorders. Expert Opin Investig Drugs 2013; 22:411-21. [DOI: 10.1517/13543784.2013.769957] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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46
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Kaye WH, Wierenga CE, Bailer UF, Simmons AN, Bischoff-Grethe A. Nothing tastes as good as skinny feels: the neurobiology of anorexia nervosa. Trends Neurosci 2013; 36:110-20. [PMID: 23333342 PMCID: PMC3880159 DOI: 10.1016/j.tins.2013.01.003] [Citation(s) in RCA: 315] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Accepted: 01/07/2013] [Indexed: 01/30/2023]
Abstract
Individuals with anorexia nervosa (AN) engage in relentless restrictive eating and often become severely emaciated. Because there are no proven treatments, AN has high rates of relapse, chronicity, and death. Those with AN tend to have childhood temperament and personality traits, such as anxiety, obsessions, and perfectionism, which may reflect neurobiological risk factors for developing AN. Restricted eating may be a means of reducing negative mood caused by skewed interactions between serotonin aversive or inhibitory and dopamine reward systems. Brain imaging studies suggest that altered eating is a consequence of dysregulated reward and/or awareness of homeostatic needs, perhaps related to enhanced executive ability to inhibit incentive motivational drives. An understanding of the neurobiology of this disorder is likely to be important for developing more effective treatments.
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Affiliation(s)
- Walter H Kaye
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.
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47
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Neuropsychology and anorexia nervosa. Cognitive and radiological findings. NEUROLOGÍA (ENGLISH EDITION) 2012. [DOI: 10.1016/j.nrleng.2011.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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48
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Neuropsicología y anorexia nerviosa. Hallazgos cognitivos y radiológicos. Neurologia 2012; 27:504-10. [DOI: 10.1016/j.nrl.2011.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Revised: 07/15/2011] [Accepted: 08/26/2011] [Indexed: 12/28/2022] Open
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49
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Frank GK, Kaye WH. Current status of functional imaging in eating disorders. Int J Eat Disord 2012; 45:723-36. [PMID: 22532388 PMCID: PMC3872533 DOI: 10.1002/eat.22016] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/11/2012] [Indexed: 11/11/2022]
Abstract
Eating Disorders are complex psychiatric problems that involve biologic and psychological factors. Brain imaging studies provide insights about how functionally connected brain networks may contribute to disturbed eating behavior, resulting in food refusal and altered body weight, but also body preoccupations and heightened anxiety. In this article, we review the current state of brain imaging in eating disorders, and how such techniques may help identify pathways that could be important in the treatment of those often detrimental disorders.
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Affiliation(s)
- Guido K.W. Frank
- University of Colorado Denver, Departments of Child & Adolescent Psychiatry and Neuroscience, Aurora CO
| | - Walter H. Kaye
- University of California San Diego, Department of Psychiatry, La Jolla CA
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50
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Frieling H, Fischer J, Wilhelm J, Engelhorn T, Bleich S, Hillemacher T, Dörfler A, Kornhuber J, de Zwaan M, Peschel T. Microstructural abnormalities of the posterior thalamic radiation and the mediodorsal thalamic nuclei in females with anorexia nervosa--a voxel based diffusion tensor imaging (DTI) study. J Psychiatr Res 2012; 46:1237-42. [PMID: 22770509 DOI: 10.1016/j.jpsychires.2012.06.005] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Revised: 06/11/2012] [Accepted: 06/12/2012] [Indexed: 01/12/2023]
Abstract
Gray matter abnormalities have been found in anorexia nervosa (AN) in several brain regions. However, little is known about white matter abnormalities under the condition of AN. To comprehensively assess the microstructural integrity of white matter pathways in women with anorexia nervosa, we performed voxel-based Diffusion Tensor Imaging (DTI). 21 women with AN according to DSM-IV criteria (9 of them recovered) and 20 female age-matched healthy control subjects were enrolled in the study. The patients had a mean body mass index of 17.2 kg/m(2) (controls: 19.6 kg/m(2)). High resolution T1 images (MP-RAGE) and DTI were performed on a 3 T Siemens-scanner. Images were pre-processed and analyzed using a modified protocol for DTI in SPM2. Fractional anisotropy (FA) maps were compared using t-tests (p < 0.05, corrected). Compared with controls, AN patients showed bilateral reductions of FA maps in the posterior thalamic radiation which includes the optic radiation, and the left mediodorsal thalamus. Our study is limited by the small sample size and its cross-sectional design. A longitudinal design with the same individuals assessed when acutely ill and recovered is warranted for future studies. For the first time, the findings of our DTI study identified disturbances of associational and commissural fibers in the bilateral occipitotemporal white matter. The results help narrowing the prevailing biological models of AN by suggesting that body image distortion is related to microstructural alterations of white matter tracts connecting the extrastriate visual cortex with other brain regions involved in body perception.
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Affiliation(s)
- Helge Frieling
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany.
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