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Roff C, Cook-Cottone C. Assisted death in eating disorders: a systematic review of cases and clinical rationales. Front Psychiatry 2024; 15:1431771. [PMID: 39143961 PMCID: PMC11322357 DOI: 10.3389/fpsyt.2024.1431771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Accepted: 07/12/2024] [Indexed: 08/16/2024] Open
Abstract
Background Assisted dying for reasons solely related to an eating disorder (ED) has occurred in multiple countries, including those which restrict the practice to individuals with a terminal condition. The aims of this systematic review were to (1) identify all known cases of assisted deaths among patients with EDs and (2) describe the clinical rationales used to grant patients' requests for assisted death. Methods We conducted a systematic search of peer-reviewed studies and publicly available government reports to identify cases of assisted death in patients with EDs. In reports that included qualitative data about the case, clinical rationales were extracted and grouped into domains by qualitative content analysis. Results We identified 10 peer-reviewed articles and 20 government reports describing at least 60 patients with EDs who underwent assisted dying between 2012 and 2024. Clinical rationales were categorized into three domains: irremediability, terminality, and voluntary request. Reports emphasized that patients with EDs who underwent assisted death had terminal, incurable, and/or untreatable conditions and had adequate decision-making capacity to make a life-ending decision. Most government reports did not include descriptive-enough data to verify psychiatric conditions. Conclusion The results of our systematic review underscore considerable gaps in the reporting of assisted death in patients with psychiatric conditions, posing substantial concerns about oversight and public safety. In many cases, the clinical rationales that were used to affirm patients with EDs were eligible for assisted death lack validity and do not cohere with empirical understanding.
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Affiliation(s)
| | - Catherine Cook-Cottone
- Department of Counseling, School, and Educational Psychology, University at Buffalo, Buffalo, NY, United States
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Carlson JL, Lemly DC. Medical Considerations and Consequences of Eating Disorders. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2024; 22:301-306. [PMID: 38988462 PMCID: PMC11231475 DOI: 10.1176/appi.focus.20230042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 07/12/2024]
Abstract
Eating disorders may result in medical complications that affect every body system with both acute and chronic consequences. Although some medical complications may require acute medical hospitalization to manage, other complications, such as low bone mineral density, may not present until malnutrition has become chronic. It is critical for team members to be aware of the early clinical signs of malnutrition and disordered eating behaviors, as well as longer-term complications that may affect their patients. When identifying eating disorder concerns, appropriate colleagues from the medical, nutrition, and psychiatric fields can be engaged in order to collaborate on stabilizing and improving the health of patients.
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Affiliation(s)
- Jennifer L Carlson
- Department of Pediatrics, Division of Adolescent Medicine, Stanford University School of Medicine, Palo Alto, California (Carlson); Division of General Internal Medicine, Division of Adolescent and Young Adult Medicine, Massachusetts General Hospital, and Department of Pediatrics, Harvard Medical School, Boston (Lemly)
| | - Diana C Lemly
- Department of Pediatrics, Division of Adolescent Medicine, Stanford University School of Medicine, Palo Alto, California (Carlson); Division of General Internal Medicine, Division of Adolescent and Young Adult Medicine, Massachusetts General Hospital, and Department of Pediatrics, Harvard Medical School, Boston (Lemly)
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Lyall AE, Breithaupt L, Ji C, Haidar A, Kotler E, Becker KR, Plessow F, Slattery M, Thomas JJ, Holsen LM, Misra M, Eddy KT, Lawson EA. Lower region-specific gray matter volume in females with atypical anorexia nervosa and anorexia nervosa. Int J Eat Disord 2024; 57:951-966. [PMID: 38366701 PMCID: PMC11018478 DOI: 10.1002/eat.24168] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/18/2024]
Abstract
OBJECTIVE Few studies have focused on brain structure in atypical anorexia nervosa (atypical AN). This study investigates differences in gray matter volume (GMV) between females with anorexia nervosa (AN) and atypical AN, and healthy controls (HC). METHOD Structural magnetic resonance imaging data were acquired for 37 AN, 23 atypical AN, and 41 HC female participants. Freesurfer was used to extract GMV, cortical thickness, and surface area for six brain lobes and associated cortical regions of interest (ROI). Primary analyses employed linear mixed-effects models to compare group differences in lobar GMV, followed by secondary analyses on ROIs within significant lobes. We also explored relationships between cortical gray matter and both body mass index (BMI) and symptom severity. RESULTS Our primary analyses revealed significant lower GMV in frontal, temporal and parietal areas (FDR < .05) in AN and atypical AN when compared to HC. Lobar GMV comparisons were non-significant between atypical AN and AN. The parietal lobe exhibited the greatest proportion of affected cortical ROIs in both AN versus HC and atypical AN versus HC. BMI, but not symptom severity, was found to be associated with cortical GMV in the parietal, frontal, temporal, and cingulate lobes. No significant differences were observed in cortical thickness or surface area. DISCUSSION We observed lower GMV in frontal, temporal, and parietal areas, when compared to HC, but no differences between AN and atypical AN. This indicates potentially overlapping structural phenotypes between these disorders and evidence of brain changes among those who are not below the clinical underweight threshold. PUBLIC SIGNIFICANCE Despite individuals with atypical anorexia nervosa presenting above the clinical weight threshold, lower cortical gray matter volume was observed in partial, temporal, and frontal cortices, compared to healthy individuals. No significant differences were found in cortical gray matter volume between anorexia nervosa and atypical anorexia nervosa. This underscores the importance of continuing to assess and target weight gain in clinical care, even for those who are presenting above the low-weight clinical criteria.
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Affiliation(s)
- Amanda E. Lyall
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, MA
- Mass General Brigham Multidisciplinary Eating Disorders Research Collaborative, Mass General Brigham, Boston, MA
| | - Lauren Breithaupt
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, MA
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, MA
- Mass General Brigham Multidisciplinary Eating Disorders Research Collaborative, Mass General Brigham, Boston, MA
| | - Chunni Ji
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, MA
- Mass General Brigham Multidisciplinary Eating Disorders Research Collaborative, Mass General Brigham, Boston, MA
- Division of Women’s Health, Department of Medicine, and Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Anastasia Haidar
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, MA
| | - Elana Kotler
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, MA
| | - Kendra R Becker
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, MA
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, MA
- Mass General Brigham Multidisciplinary Eating Disorders Research Collaborative, Mass General Brigham, Boston, MA
| | - Franziska Plessow
- Neuroendocrine Unit, Massachusetts General Hospital, Harvard Medical School, MA
- Mass General Brigham Multidisciplinary Eating Disorders Research Collaborative, Mass General Brigham, Boston, MA
| | - Meghan Slattery
- Neuroendocrine Unit, Massachusetts General Hospital, Harvard Medical School, MA
| | - Jennifer J. Thomas
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, MA
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, MA
- Mass General Brigham Multidisciplinary Eating Disorders Research Collaborative, Mass General Brigham, Boston, MA
| | - Laura M. Holsen
- Mass General Brigham Multidisciplinary Eating Disorders Research Collaborative, Mass General Brigham, Boston, MA
- Division of Women’s Health, Department of Medicine, and Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Madhusmita Misra
- Division of Pediatric Endocrinology, Massachusetts General Hospital, Harvard Medical School, MA
- Neuroendocrine Unit, Massachusetts General Hospital, Harvard Medical School, MA
- Mass General Brigham Multidisciplinary Eating Disorders Research Collaborative, Mass General Brigham, Boston, MA
| | - Kamryn T. Eddy
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, MA
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, MA
- Mass General Brigham Multidisciplinary Eating Disorders Research Collaborative, Mass General Brigham, Boston, MA
| | - Elizabeth A. Lawson
- Neuroendocrine Unit, Massachusetts General Hospital, Harvard Medical School, MA
- Mass General Brigham Multidisciplinary Eating Disorders Research Collaborative, Mass General Brigham, Boston, MA
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Halls D, Leppanen J, Kerr‐Gaffney J, Simic M, Nicholls D, Mandy W, Williams S, Tchanturia K. Examining the relationship between autistic spectrum disorder characteristics and structural brain differences seen in anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2022; 30:459-473. [PMID: 35570362 PMCID: PMC9546313 DOI: 10.1002/erv.2910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/01/2022] [Accepted: 04/08/2022] [Indexed: 11/16/2022]
Abstract
Cortical differences have been reported in Anorexia Nervosa (AN) compared with healthy controls (HC); however, it is unclear if Autism Spectrum Disorder (ASD) characteristics are related to these cortical differences. The aim of this study was to examine if structural measures were correlated to ASD traits in AN. In total 184 female participants participated in the study; 57 acutely underweight AN participants (AAN), 59 weight-restored participants (WR) and 68 HC. Participants underwent structural magnetic resonance imaging as well as completing the Autism Diagnostic Observation schedule, second edition to examine ASD characteristics. Group differences in curvature, gyrification, surface area, thickness, global grey matter and white matter were measured. Correlation and regression analysis were conducted to examine the relationship between cortical measures and ASD characteristics. Two decreased gyrification clusters in the right post central and supramarginal gyrus and decreased global grey matter were observed in the AAN group compared to HC and WR. No correlations between ASD traits and structural measures existed. Our results suggest structural differences seen in individuals with AN do not appear to be related to ASD characteristics.
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Affiliation(s)
- Daniel Halls
- King's College London (KCL), Institute of PsychiatryPsychology and Neuroscience (IoPPN)Psychological MedicineLondonUK
| | - Jenni Leppanen
- King's College LondonCentre for Neuroimaging SciencesLondonUK
| | - Jess Kerr‐Gaffney
- King's College London (KCL), Institute of PsychiatryPsychology and Neuroscience (IoPPN)Psychological MedicineLondonUK
| | - Mima Simic
- South London and Maudsley NHS Foundation TrustLondonUK
| | | | - William Mandy
- Division of Psychology and Language SciencesUniversity College LondonLondonUK
| | - Steven Williams
- King's College LondonCentre for Neuroimaging SciencesLondonUK
| | - Kate Tchanturia
- King's College London (KCL), Institute of PsychiatryPsychology and Neuroscience (IoPPN)Psychological MedicineLondonUK
- South London and Maudsley NHS Foundation TrustLondonUK
- Psychology DepartmentIllia State UniversityTbilisiGeorgia
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Doose A, Hellerhoff I, Tam FI, King JA, Seidel M, Geisler D, Plähn HCI, Roessner V, Akgün K, Ziemssen T, Ehrlich S. Neural and glial damage markers in women after long-term weight-recovery from anorexia nervosa. Psychoneuroendocrinology 2022; 135:105576. [PMID: 34781223 DOI: 10.1016/j.psyneuen.2021.105576] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 10/06/2021] [Accepted: 10/22/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE The acute state of anorexia nervosa (AN) is accompanied by increased peripheral concentrations of brain-derived damage markers indicative of ongoing neural and glial damage processes. Although these findings correspond with well-documented structural brain changes in the disorder, it remains unclear whether abnormal levels of brain-derived damage markers persist after long-term weight-recovery from AN. METHODS To address this question, we used single-molecule array (Simoa) technology to measure serum levels of neurofilament light (NF-L), tau protein and glial fibrillary acidic protein (GFAP) in a group of 55 long-term weight-recovered women with a history of AN (recAN) and 55 age-matched healthy controls. Strict exclusion criteria allowed us to control for confounds present in previous studies including most importantly neurological conditions. RESULTS We found not only no group differences but also statistical evidence for equal damage marker levels between groups using Bayesian hypothesis testing. CONCLUSION These results provide evidence for the absence of neuronal and glial damage processes after long-term weight-recovery from AN. Together, our findings are indicative of complete normalization following long-term weight restoration provide hope that recovery from AN halts neuronal damage processes and support the need to test potential candidates for therapeutic interventions including pharmacological neuroprotection.
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Affiliation(s)
- Arne Doose
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Inger Hellerhoff
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany; Eating Disorder Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Friederike I Tam
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany; Eating Disorder Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Joseph A King
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Maria Seidel
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Daniel Geisler
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Hans Christian I Plähn
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Katja Akgün
- Center of Clinical Neuroscience, Neurological Clinic, University Hospital Carl Gustav Carus, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Tjalf Ziemssen
- Center of Clinical Neuroscience, Neurological Clinic, University Hospital Carl Gustav Carus, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Stefan Ehrlich
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany; Eating Disorder Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.
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Vidal L, Ortega MA, Alvarez-Mon MA, Álvarez-Mon M, Lahera G. Volumetric Alterations of the Cerebral Cortex in Eating Disorders. J Clin Med 2021; 10:jcm10235480. [PMID: 34884181 PMCID: PMC8658332 DOI: 10.3390/jcm10235480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/10/2021] [Accepted: 11/18/2021] [Indexed: 11/16/2022] Open
Abstract
Eating disorders are relatively frequent psychiatric disorders that can produce serious consequences at the brain level. In an effort to clarify the neurobiological mechanisms of their pathogenesis, some studies have suggested the existence of modifications of the cortical architecture in eating disorders, but it is unknown whether the alterations described are a cause or consequence of eating disorders. The main objective of this systematic review is to collect the evidence available about the volumetric alterations of the cerebral cortex in eating disorders in adults and their apparent relationship with the pathogenesis of the disease. Initially, 91 articles were found by a search that included the terms anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder, gray matter, cortical thickness (CT), and brain volume. To pare down the articles, the following inclusion criteria were applied: (1) cortical thickness and/or gray matter volume (GMV) in patients with anorexia, bulimia nervosa, or binge-eating disorder was the main measure of the study; and (2) the sample was adult patients aged 18–65. The exclusion criteria were as follows: (1) articles that did not analyze cortical thickness or gray matter volume; (2) studies with patients with comorbidities; and (3) studies in patients who did not meet the DSM-IV/DSM-V criteria. In the first phase of selection, we proceeded to read the titles and abstracts as a first screen, thereby excluding 62 studies, followed by a complete critical reading of the 29 remaining articles. In this last phase, nine studies were excluded because they did not specify the eating disorder subtype, they included adolescents, or they did not measure GMV or CT. Finally, after the above systematic selection process, 20 articles were included in this review. Despite the methodological heterogeneity of the studies, there was some agreement between them. They showed an overall reduction in GMV in eating disorders, as well as alterations in certain regions of the cerebral cortex. Some of the most often mentioned cortical areas were the frontal, cingulate, and right orbitofrontal cortices, the precuneus, the right insula, and some temporoparietal gyri in cases of AN, with greater cortical involvement in frontotemporal and medial orbitofrontal regions in BN and binge eating disorder. Likewise, certain cortical regions, such as the left inferior frontal gyrus, the precuneus, the right superior motor area, the cingulate cortex, the insula, and the medial orbitofrontal sulcus, often remained altered after recovery from AN, making them potential cortical areas involved in the etiopathogenesis of AN. A reduction in GMV in specific areas of the CNS can inform us about the neurobiological mechanisms that underlie eating disorders as well as give us a better understanding of their possible consequences at the brain level.
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Affiliation(s)
- Laura Vidal
- Department of Medicine and Medical Specialities, University of Alcala, 28801 Alcalá de Henares, Spain; (L.V.); (M.A.A.-M.); (M.Á.-M.); (G.L.)
| | - Miguel A Ortega
- Department of Medicine and Medical Specialities, University of Alcala, 28801 Alcalá de Henares, Spain; (L.V.); (M.A.A.-M.); (M.Á.-M.); (G.L.)
- Ramón y Cajal Institute of Sanitary Researcsh, 28034 Madrid, Spain
- Cancer Registry and Pathology Department, Hospital Universitario Principe de Asturias, 28806 Alcalá de Henares, Spain
- Correspondence:
| | - Miguel Angel Alvarez-Mon
- Department of Medicine and Medical Specialities, University of Alcala, 28801 Alcalá de Henares, Spain; (L.V.); (M.A.A.-M.); (M.Á.-M.); (G.L.)
- Ramón y Cajal Institute of Sanitary Researcsh, 28034 Madrid, Spain
- Department of Psychiatry and Mental Health, Hospital Universitario Infanta Leonor, 28031 Madrid, Spain
| | - Melchor Álvarez-Mon
- Department of Medicine and Medical Specialities, University of Alcala, 28801 Alcalá de Henares, Spain; (L.V.); (M.A.A.-M.); (M.Á.-M.); (G.L.)
- Ramón y Cajal Institute of Sanitary Researcsh, 28034 Madrid, Spain
- Immune System Diseases-Rheumatology, Oncology Service an Internal Medicine, University Hospital Príncipe de Asturias, 28806 Alcalá de Henares, Spain
| | - Guillermo Lahera
- Department of Medicine and Medical Specialities, University of Alcala, 28801 Alcalá de Henares, Spain; (L.V.); (M.A.A.-M.); (M.Á.-M.); (G.L.)
- Ramón y Cajal Institute of Sanitary Researcsh, 28034 Madrid, Spain
- Psychiatry Service, Center for Biomedical Research in the Mental Health Network, University Hospital Príncipe de Asturias, 28806 Alcalá de Henares, Spain
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Cortical thickness 20 years after diagnosis of anorexia nervosa during adolescence. Eur Arch Psychiatry Clin Neurosci 2021; 271:1133-1139. [PMID: 30847623 DOI: 10.1007/s00406-019-00992-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 02/22/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The objective of the present study is to evaluate cortical thickness (CT) abnormalities using FreeSurfer in adult subjects who had an onset of anorexia nervosa during their adolescence some 20 years previously, and to compare them with control subjects. METHODS Fifty-four participants, including 26 women who were diagnosed and treated for AN during adolescence some 20 years previously and 28 healthy women of similar age and geographical area were assessed using structured interviews and MRI scans. Prior AN subjects were divided into two groups depending on their current eating disorder status (recovered or not recovered from any eating disorder). In all subjects, CT was measured using FreeSurfer. RESULTS A significantly lower CT was observed in the eating disorder group than in the control group in the right post-central gyrus and the lateral occipital cortex. The recovered eating disorder group only had lower CT in the post-central gyrus. Within all subjects with prior AN, no correlations were found between lower CT in these areas and clinical variables. DISCUSSION CT is reduced some 20 years after diagnosis of AN especially in the parietal and precentral areas, even in subjects without any current ED diagnosis.
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Oliva R, Baiano M, Salvo P, Cereser L, Castiello U, Begliomini C. Metacognition in individuals recovered from anorexia nervosa: a voxel-based morphometry study. Psychiatry Res Neuroimaging 2020; 304:111138. [PMID: 32702602 DOI: 10.1016/j.pscychresns.2020.111138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 07/09/2020] [Accepted: 07/14/2020] [Indexed: 02/07/2023]
Abstract
Recent evidence shows that individuals with Anorexia Nervosa (AN) can be characterized by dysfunctional metacognition as well as reductions of gray matter volumes (GMV) in prefrontal brain regions involved in cognitive processes. However, whether these differences are reversible or stable markers has yet to be understood. Thus, we aimed at characterizing metacognition and brain morphometry in individuals recovered from AN (rec-AN). A combined psychometric-brain morphometry investigation on metacognitive functioning in rec-AN individuals was conducted. Fifteen healthy controls (HC) and fifteen rec-AN women underwent a psychometric assessment for metacognitive functioning and a high-resolution T1-weighted Magnetic Resonance Imaging measurement to assess global and regional brain volumes, using Voxel-Based Morphometry. The two groups did not differ for metacognitive functioning and GMV, while regional GMV reductions were observed in rec-AN compared to HC in the left Inferior Frontal Gyrus (IFG). While changes in metacognitive abilities may not represent a stable trait of AN, regional GMV reductions in brain regions devoted to specific cognitive functions, such as inhibitory/top-down control processes, can act as a neurobiological fingerprint for such condition. These findings can represent a promising hint for future investigations on the maintaining factors of AN.
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Affiliation(s)
- Rossella Oliva
- Department of General Psychology, University of Padova, Italy
| | - Monica Baiano
- Centro Unico Disturbi del Comportamento alimentare, Clinica Psichiatrica, Dipartimento di Salute Mentale - Azienda Sanitaria Universitaria Friuli Centrale, Italy
| | - Pierandrea Salvo
- Eating disorders Centre Portogruaro, AULSS 4 Veneto Orientale, Italy
| | - Lucia Cereser
- Eating disorders Centre Portogruaro, AULSS 4 Veneto Orientale, Italy
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De Groote S, Goudman L, Van Schuerbeek P, Peeters R, Sunaert S, Linderoth B, De Andrés J, Rigoard P, De Jaeger M, Moens M. Effects of spinal cord stimulation on voxel-based brain morphometry in patients with failed back surgery syndrome. Clin Neurophysiol 2020; 131:2578-2587. [PMID: 32927213 DOI: 10.1016/j.clinph.2020.07.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/30/2020] [Accepted: 07/26/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Despite the clinical effectiveness of Spinal Cord Stimulation (SCS), potential structural brain modifications have not been explored. Our aim was to identify structural volumetric changes during subsensory SCS, in patients with Failed Back Surgery Syndrome (FBSS). METHODS In this cohort study, twenty-two FBSS patients underwent a magnetic resonance imaging protocol before SCS and 3 months after SCS. Clinical parameters were correlated with volumetric changes, calculated with voxel-based morphometry. RESULTS After 3 months, a significant volume decrease was found in the inferior frontal gyrus, precuneus, cerebellar posterior lobe and middle temporal gyrus. Significant increases were found in the inferior temporal gyrus, precentral gyrus and the middle frontal gyrus after SCS. Additionally, significant increases in volume of superior frontal and parietal white matter and a significant decrease in volume of white matter underlying the premotor/middle frontal gyrus were revealed after SCS. A significant correlation was highlighted between white matter volume underlying premotor/middle frontal gyrus and leg pain relief. CONCLUSIONS This study revealed for the first time that SCS is able to induce volumetric changes in gray and white matter, suggesting the reversibility of brain alterations after chronic pain treatment. SIGNIFICANCE Volumetric brain alterations are observable after 3 months of subsensory SCS in FBSS patients.
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Affiliation(s)
- Sander De Groote
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Lisa Goudman
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium; STIMULUS consortium (reSearch and TeachIng neuroModULation Uz bruSsel), Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium.; Pain in Motion International Research Group, Belgium; Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090 Brussels, Belgium
| | - Peter Van Schuerbeek
- Department of Radiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Ronald Peeters
- Department of Radiology, Universitair Ziekenhuis Leuven, UZ Herestraat 49-bus 7003 54, 3000 Leuven, Belgium
| | - Stefan Sunaert
- Department of Radiology, Universitair Ziekenhuis Leuven, UZ Herestraat 49-bus 7003 54, 3000 Leuven, Belgium
| | - Bengt Linderoth
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jose De Andrés
- Surgical Specialties Department Valencia University Medical School, and Department of Anesthesiology Critical Care and Pain Management, General University Hospital, Valencia, Spain
| | - Philippe Rigoard
- Department of Neurosurgery, Poitiers University Hospital, Poitiers, France; Institut Pprime UPR 3346, CNRS, University of Poitiers, Poitiers, ISAE-ENSMA, France; PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, Poitiers, France
| | - Mats De Jaeger
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Maarten Moens
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium; STIMULUS consortium (reSearch and TeachIng neuroModULation Uz bruSsel), Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium.; Department of Radiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium; Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090 Brussels, Belgium.
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Kaufmann LK, Hänggi J, Jäncke L, Baur V, Piccirelli M, Kollias S, Schnyder U, Martin-Soelch C, Milos G. Age influences structural brain restoration during weight gain therapy in anorexia nervosa. Transl Psychiatry 2020; 10:126. [PMID: 32366823 PMCID: PMC7198513 DOI: 10.1038/s41398-020-0809-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 04/15/2020] [Accepted: 04/17/2020] [Indexed: 01/22/2023] Open
Abstract
Neuroimaging studies on anorexia nervosa (AN) have consistently reported globally reduced gray matter in patients with acute AN. While first studies on adolescent AN patients provide evidence for the reversibility of these impairments after weight gain, longitudinal studies with detailed regional analysis for adult AN patients are lacking and factors associated with brain restitution are poorly understood. We investigated structural changes in anorexia nervosa using T1-weighted magnetic resonance images with surface-based morphometry. The sample consisted of 26 adult women with severe AN and 30 healthy controls. The longitudinal design comprised three time points, capturing the course of weight-restoration therapy in AN patients at distinct stages of weight gain (BMI ≤ 15.5 kg/m2; 15.5 < BMI < 17.5 kg/m2; BMI ≥ 17.5 kg/m2). Compared to controls, AN patients showed globally decreased cortical thickness and subcortical volumes at baseline. Linear mixed effect models revealed the reversibility of these alterations, with brain restoration being most pronounced during the first half of treatment. The restoration of cortical thickness of AN patients negatively correlated with age, but not duration of illness. After weight restoration, residual group differences of cortical thickness remained in the superior frontal cortex. These findings indicate that structural brain alterations of adult patients with severe AN recuperate independently of the duration of illness during weight-restoration therapy. The temporal pattern of brain restoration suggests a decrease in restoration rate over the course of treatment, with patients' age as a strong predictor of brain restitution, possibly reflecting decreases of brain plasticity as patients grow older.
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Affiliation(s)
- Lisa-Katrin Kaufmann
- Department of Consultation-Liaison Psychiatry and Psychosomatics, University Hospital Zurich, University of Zurich, Zurich, Switzerland. .,Division of Neuropsychology, Department of Psychology, University of Zurich, Zurich, Switzerland. .,Unit of Clinical and Health Psychology, Department of Psychology, University of Fribourg, Fribourg, Switzerland.
| | - Jürgen Hänggi
- grid.7400.30000 0004 1937 0650Division of Neuropsychology, Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Lutz Jäncke
- grid.7400.30000 0004 1937 0650Division of Neuropsychology, Department of Psychology, University of Zurich, Zurich, Switzerland ,grid.7400.30000 0004 1937 0650International Normal Aging and Plasticity Imaging Center (INAPIC), University of Zurich, Zurich, Switzerland ,grid.7400.30000 0004 1937 0650University Research Priority Program (URPP) “Dynamic of Healthy Aging”, University of Zurich, Zurich, Switzerland
| | - Volker Baur
- grid.7400.30000 0004 1937 0650Department of Consultation-Liaison Psychiatry and Psychosomatics, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Marco Piccirelli
- grid.412004.30000 0004 0478 9977Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland
| | - Spyros Kollias
- grid.412004.30000 0004 0478 9977Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland
| | - Ulrich Schnyder
- grid.7400.30000 0004 1937 0650University of Zurich, Zurich, Switzerland
| | - Chantal Martin-Soelch
- grid.8534.a0000 0004 0478 1713Unit of Clinical and Health Psychology, Department of Psychology, University of Fribourg, Fribourg, Switzerland
| | - Gabriella Milos
- grid.7400.30000 0004 1937 0650Department of Consultation-Liaison Psychiatry and Psychosomatics, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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11
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Insular Cell Integrity Markers Linked to Weight Concern in Anorexia Nervosa-An MR-Spectroscopy Study. J Clin Med 2020; 9:jcm9051292. [PMID: 32365843 PMCID: PMC7288299 DOI: 10.3390/jcm9051292] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 12/29/2022] Open
Abstract
Objective: An insular involvement in the pathogenesis of anorexia nervosa (AN) has been suggested in many structural and functional neuroimaging studies. This magnetic resonance spectroscopy (MRS) study is the first to investigate metabolic signals in the anterior insular cortex in patients with AN and recovered individuals (REC). Method: The MR spectra of 32 adult women with AN, 21 REC subjects and 33 healthy controls (HC) were quantified for absolute N-acetylaspartate (NAA), glutamate + glutamine (Glx), total choline, myo-inositol, creatine concentrations (mM/L). After adjusting the metabolite concentrations for age and partial gray/white matter volume, group differences were tested using one-way multivariate analyses of variance (MANOVA). Post-hoc analyses of variance were applied to identify those metabolites that showed significant group effects. Correlations were tested for associations with psychometric measures (eating disorder examination), duration of illness, and body mass index. Results: The MANOVA exhibited a significant group effect. The NAA signal was reduced in the AN group compared to the HC group. The REC and the HC groups did not differ in metabolite concentrations. In the AN group, lower NAA and Glx signals were related to increased weight concern. Discussion: We interpret the decreased NAA availability in the anterior insula as a signal of impaired neuronal integrity or density. The association of weight concern, which is a core feature of AN, with decreased NAA and Glx indicates that disturbances of glutamatergic neurotransmission might be related to core psychopathology in AN. The absence of significant metabolic differences between the REC and HC subjects suggests that metabolic alterations in AN represent a state rather than a trait phenomenon.
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12
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Bilateral concomitant femoral neck stress fracture in a sedentary patient with anorexia nervosa. Trauma Case Rep 2020; 27:100302. [PMID: 32322651 PMCID: PMC7162967 DOI: 10.1016/j.tcr.2020.100302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2020] [Indexed: 12/15/2022] Open
Abstract
A 27 years old sedentary woman presented bilateral femoral neck stress fractures after having clinically recovered from anorexia nervosa and was treated with bilateral internal fixation. Conclusion Although light exercise is usually considered after recovery from anorexia nervosa to improve bone quality, this case of a sedentary patient suggests that weight gain, per se, could increase the stress fracture risk. Because of the physiological and psychological characteristics, these patients should be treated with a multi-disciplinary approach.
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13
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Goitia B, Bruno D, Abrevaya S, Sedeño L, Ibáñez A, Manes F, Sigman M, Sinay V, Torralva T, Duncan J, Roca M. The relationship between executive functions and fluid intelligence in multiple sclerosis. PLoS One 2020; 15:e0231868. [PMID: 32320404 PMCID: PMC7176096 DOI: 10.1371/journal.pone.0231868] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 04/02/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND & OBJECTIVE Deficits in cognitive functions dependent upon the integrity of the prefrontal cortex have been described in Multiple Sclerosis (MS). In a series of studies we have shown that fluid intelligence (g) is a substantial contributor to frontal deficits and that, for some classical "executive" tasks, frontal deficits were entirely explained by g. However, for another group of frontal tasks deficits remained once g was introduced as a covariate. This second set of tests included multitasking and theory of mind tasks. In the present study, we aimed at determining the role of fluid intelligence in frontal deficits seen in patients with MS. METHODS A group of patients with Relapsing Remitting MS (n = 36) and a group of control subjects (n = 42) were assessed with a battery of classical executive tests (which included the Wisconsin Card Sorting Test, Verbal Fluency, and Trail Making Test B), a multitasking test, a theory of mind test and a fluid intelligence test. RESULTS MS patients showed significant deficits in the fluid intelligence task. We found differences between patients and control subjects in all tests except for the multitasking test. The differences in the classical executive tests became non-significant once fluid intelligence was introduced as a covariate, but differences in theory of mind remained. CONCLUSIONS The present results suggest that fluid intelligence can be affected in MS and that this impairment can play a role in the executive deficits described in MS.
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Affiliation(s)
- Belén Goitia
- Institute of Translational and Cognitive Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina
- Laboratory of Neuroscience, Torcuato Di Tella University, Buenos Aires, Argentina
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Diana Bruno
- Institute of Translational and Cognitive Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina
| | - Sofía Abrevaya
- Institute of Translational and Cognitive Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Lucas Sedeño
- Institute of Translational and Cognitive Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Agustín Ibáñez
- Institute of Translational and Cognitive Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
- Center for Social and Cognitive Neuroscience (CSCN), School of Psychology, Universidad Adolfo Ibáñez, Santiago, Chile
- Universidad Autónoma del Caribe, Barranquilla, Colombia
- Centre of Excellence in Cognition and its Disorders, Australian Research Council (ACR), Sydney, Australia
| | - Facundo Manes
- Institute of Translational and Cognitive Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Mariano Sigman
- Laboratory of Neuroscience, Torcuato Di Tella University, Buenos Aires, Argentina
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Vladimiro Sinay
- Institute of Translational and Cognitive Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina
| | - Teresa Torralva
- Institute of Translational and Cognitive Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina
| | - John Duncan
- Medical Research Council (MRC) Cognition and Brain Sciences Unit, Cambridge, United Kingdom
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - María Roca
- Institute of Translational and Cognitive Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
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14
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King JA, Bernardoni F, Geisler D, Ritschel F, Doose A, Pauligk S, Pásztor K, Weidner K, Roessner V, Smolka MN, Ehrlich S. Intact value-based decision-making during intertemporal choice in women with remitted anorexia nervosa? An fMRI study. J Psychiatry Neurosci 2020; 45:108-116. [PMID: 31595737 PMCID: PMC7828910 DOI: 10.1503/jpn.180252] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Extreme restrictive food choice in anorexia nervosa is thought to reflect excessive self-control and/or abnormal reward sensitivity. Studies using intertemporal choice paradigms have suggested an increased capacity to delay reward in anorexia nervosa, and this may explain an unusual ability to resist immediate temptation and override hunger in the long-term pursuit of thinness. It remains unclear, however, whether altered delay discounting in anorexia nervosa constitutes a state effect of acute illness or a trait marker observable after recovery. METHODS We repeated the analysis from our previous fMRI investigation of intertemporal choice in acutely underweight patients with anorexia nervosa in a sample of weight-recovered women with anorexia nervosa (n = 36) and age-matched healthy controls (n = 36) who participated in the same study protocol. Follow-up analyses explored functional connectivity separately in both the weight-recovered/healthy controls sample and the acute/healthy controls sample. RESULTS In contrast to our previous findings in acutely underweight patients with anorexia nervosa, we found no differences between weight-recovered patients with anorexia nervosa and healthy controls at either behavioural or neural levels. New analysis of data from the acute/healthy controls sample sample revealed increased coupling between dorsal anterior cingulate cortex and posterior brain regions as a function of decision difficulty, supporting the hypothesis of altered neural efficiency in the underweight state. LIMITATIONS This was a cross-sectional study, and the results may be task-specific. CONCLUSION Although our results underlined previous demonstrations of divergent temporal reward discounting in acutely underweight patients with anorexia nervosa, we found no evidence of alteration in patients with weight-recovered anorexia nervosa. Together, these findings suggest that impaired valuebased decision-making may not constitute a defining trait variable or “scar” of the disorder.
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Affiliation(s)
- Joseph A. King
- From the Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (King, Bernardoni, Geisler, Ritschel, Doose, Pauligk, Pásztor, Ehrlich); the Translational Developmental Neuroscience Section, Eating Disorder Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Ritschel, Roessner, Ehrlich); the Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Weidner); and the Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany (Smolka)
| | - Fabio Bernardoni
- From the Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (King, Bernardoni, Geisler, Ritschel, Doose, Pauligk, Pásztor, Ehrlich); the Translational Developmental Neuroscience Section, Eating Disorder Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Ritschel, Roessner, Ehrlich); the Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Weidner); and the Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany (Smolka)
| | - Daniel Geisler
- From the Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (King, Bernardoni, Geisler, Ritschel, Doose, Pauligk, Pásztor, Ehrlich); the Translational Developmental Neuroscience Section, Eating Disorder Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Ritschel, Roessner, Ehrlich); the Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Weidner); and the Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany (Smolka)
| | - Franziska Ritschel
- From the Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (King, Bernardoni, Geisler, Ritschel, Doose, Pauligk, Pásztor, Ehrlich); the Translational Developmental Neuroscience Section, Eating Disorder Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Ritschel, Roessner, Ehrlich); the Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Weidner); and the Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany (Smolka)
| | - Arne Doose
- From the Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (King, Bernardoni, Geisler, Ritschel, Doose, Pauligk, Pásztor, Ehrlich); the Translational Developmental Neuroscience Section, Eating Disorder Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Ritschel, Roessner, Ehrlich); the Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Weidner); and the Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany (Smolka)
| | - Sophie Pauligk
- From the Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (King, Bernardoni, Geisler, Ritschel, Doose, Pauligk, Pásztor, Ehrlich); the Translational Developmental Neuroscience Section, Eating Disorder Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Ritschel, Roessner, Ehrlich); the Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Weidner); and the Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany (Smolka)
| | - Konrad Pásztor
- From the Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (King, Bernardoni, Geisler, Ritschel, Doose, Pauligk, Pásztor, Ehrlich); the Translational Developmental Neuroscience Section, Eating Disorder Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Ritschel, Roessner, Ehrlich); the Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Weidner); and the Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany (Smolka)
| | - Kerstin Weidner
- From the Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (King, Bernardoni, Geisler, Ritschel, Doose, Pauligk, Pásztor, Ehrlich); the Translational Developmental Neuroscience Section, Eating Disorder Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Ritschel, Roessner, Ehrlich); the Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Weidner); and the Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany (Smolka)
| | - Veit Roessner
- From the Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (King, Bernardoni, Geisler, Ritschel, Doose, Pauligk, Pásztor, Ehrlich); the Translational Developmental Neuroscience Section, Eating Disorder Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Ritschel, Roessner, Ehrlich); the Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Weidner); and the Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany (Smolka)
| | - Michael N. Smolka
- From the Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (King, Bernardoni, Geisler, Ritschel, Doose, Pauligk, Pásztor, Ehrlich); the Translational Developmental Neuroscience Section, Eating Disorder Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Ritschel, Roessner, Ehrlich); the Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Weidner); and the Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany (Smolka)
| | - Stefan Ehrlich
- From the Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (King, Bernardoni, Geisler, Ritschel, Doose, Pauligk, Pásztor, Ehrlich); the Translational Developmental Neuroscience Section, Eating Disorder Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Ritschel, Roessner, Ehrlich); the Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany (Weidner); and the Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany (Smolka)
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15
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van Zutphen L, Maier S, Siep N, Jacob GA, Tüscher O, van Elst LT, Zeeck A, Arntz A, O'Connor MF, Stamm H, Hudek M, Joos A. Intimate stimuli result in fronto-parietal activation changes in anorexia nervosa. Eat Weight Disord 2019; 24:1155-1164. [PMID: 29397562 DOI: 10.1007/s40519-017-0474-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 12/18/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Intimacy is a key psychological problem in anorexia nervosa (AN). Empirical evidence, including neurobiological underpinnings, is however, scarce. OBJECTIVE In this study, we evaluated various emotional stimuli including intimate stimuli experienced in patients with AN and non-patients, as well as their cerebral response. METHODS Functional magnetic resonance imaging was conducted using stimuli with positive, neutral, negative and intimate content. Participants (14 AN patients and 14 non-patients) alternated between passive viewing and explicit emotion regulation. RESULTS Intimate stimuli were experienced less positively in AN patients compared to non-patients. AN patients showed decreased cerebral responses in superior parietal cortices in response to positive and intimate stimuli. Intimate stimuli led to stronger activation of the orbitofrontal cortex, and lower activation of the bilateral precuneus in AN patients. Orbitofrontal responses decreased in AN patients during explicit emotion regulation. CONCLUSIONS These results show that intimate stimuli are of particular importance in AN patients, who show experiential differences compared to non-patients and altered activation of orbitofrontal and parietal brain structures. This supports that AN patients have difficulties with intimacy, attachment, self-referential processing and body perception. LEVEL OF EVIDENCE Level III, case-control study.
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Affiliation(s)
- L van Zutphen
- Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands
| | - S Maier
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center, University of Freiburg Faculty of Medicine, University of Freiburg, Hauptstraße 8, 79104, Freiburg, Germany.,Department of Psychiatry and Psychotherapy, Medical Center, University of Freiburg Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - N Siep
- Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands
| | - G A Jacob
- Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - O Tüscher
- Department of Psychiatry and Psychotherapy, University of Mainz, Mainz, Germany
| | - L Tebartz van Elst
- Department of Psychiatry and Psychotherapy, Medical Center, University of Freiburg Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - A Zeeck
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center, University of Freiburg Faculty of Medicine, University of Freiburg, Hauptstraße 8, 79104, Freiburg, Germany
| | - A Arntz
- Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands.,Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - M-F O'Connor
- Department of Psychology, University of Arizona, Tucson, USA
| | - H Stamm
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center, University of Freiburg Faculty of Medicine, University of Freiburg, Hauptstraße 8, 79104, Freiburg, Germany
| | - M Hudek
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center, University of Freiburg Faculty of Medicine, University of Freiburg, Hauptstraße 8, 79104, Freiburg, Germany
| | - Andreas Joos
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center, University of Freiburg Faculty of Medicine, University of Freiburg, Hauptstraße 8, 79104, Freiburg, Germany. .,Department of Psychotherapeutic Neurology, Kliniken Schmieder Gailingen, Gailingen, Germany.
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16
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Gaudio S, Carducci F, Piervincenzi C, Olivo G, Schiöth HB. Altered thalamo–cortical and occipital–parietal– temporal–frontal white matter connections in patients with anorexia and bulimia nervosa: a systematic review of diffusion tensor imaging studies. J Psychiatry Neurosci 2019; 44:324-339. [PMID: 30994310 PMCID: PMC6710091 DOI: 10.1503/jpn.180121] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Anorexia nervosa and bulimia nervosa are complex mental disorders, and their etiology is still not fully understood. This paper reviews the literature on diffusion tensor imaging studies in patients with anorexia nervosa and bulimia nervosa to explore the usefulness of white matter microstructural analysis in understanding the pathophysiology of eating disorders. METHODS We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify diffusion tensor imaging studies that compared patients with an eating disorder to control groups. We searched relevant databases for studies published from database inception to August 2018, using combinations of select keywords. We categorized white matter tracts according to their 3 main classes: projection (i.e., thalamo–cortical), association (i.e., occipital–parietal–temporal–frontal) and commissural (e.g., corpus callosum). RESULTS We included 19 papers that investigated a total of 427 participants with current or previous eating disorders and 444 controls. Overall, the studies used different diffusion tensor imaging approaches and showed widespread white matter abnormalities in patients with eating disorders. Despite differences among the studies, patients with anorexia nervosa showed mainly white matter microstructural abnormalities of thalamo–cortical tracts (i.e., corona radiata, thalamic radiations) and occipital–parietal–temporal–frontal tracts (i.e., left superior longitudinal and inferior fronto-occipital fasciculi). It was less clear whether white matter alterations persist after recovery from anorexia nervosa. Available data on bulimia nervosa were partially similar to those for anorexia nervosa. LIMITATIONS Study sample composition and diffusion tensor imaging analysis techniques were heterogeneous. The number of studies on bulimia nervosa was too limited to be conclusive. CONCLUSION White matter microstructure appears to be affected in anorexia nervosa, and these alterations may play a role in the pathophysiology of this eating disorder. Although we found white matter alterations in bulimia nervosa that were similar to those in anorexia nervosa, white matter changes in bulimia nervosa remain poorly investigated, and these findings were less conclusive. Further studies with longitudinal designs and multi-approach analyses are needed to better understand the role of white matter changes in eating disorders.
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Affiliation(s)
- Santino Gaudio
- From the Department of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden (Gaudio, Olivo, Schiöth); the Centre for Integrated Research, Area of Diagnostic Imaging, Universita Campus Bio-Medico di Roma, Rome, Italy (Gaudio); the Department of Physiology and Pharmacology, Neuroimaging Laboratory, Sapienza University, Rome, Italy (Carducci, Piervincenzi); and the Institute for Translational Medicine and Biotechnology, Sechenov First Moscow State Medical University, Moscow, Russia (Schiöth)
| | - Filippo Carducci
- From the Department of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden (Gaudio, Olivo, Schiöth); the Centre for Integrated Research, Area of Diagnostic Imaging, Universita Campus Bio-Medico di Roma, Rome, Italy (Gaudio); the Department of Physiology and Pharmacology, Neuroimaging Laboratory, Sapienza University, Rome, Italy (Carducci, Piervincenzi); and the Institute for Translational Medicine and Biotechnology, Sechenov First Moscow State Medical University, Moscow, Russia (Schiöth)
| | - Claudia Piervincenzi
- From the Department of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden (Gaudio, Olivo, Schiöth); the Centre for Integrated Research, Area of Diagnostic Imaging, Universita Campus Bio-Medico di Roma, Rome, Italy (Gaudio); the Department of Physiology and Pharmacology, Neuroimaging Laboratory, Sapienza University, Rome, Italy (Carducci, Piervincenzi); and the Institute for Translational Medicine and Biotechnology, Sechenov First Moscow State Medical University, Moscow, Russia (Schiöth)
| | - Gaia Olivo
- From the Department of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden (Gaudio, Olivo, Schiöth); the Centre for Integrated Research, Area of Diagnostic Imaging, Universita Campus Bio-Medico di Roma, Rome, Italy (Gaudio); the Department of Physiology and Pharmacology, Neuroimaging Laboratory, Sapienza University, Rome, Italy (Carducci, Piervincenzi); and the Institute for Translational Medicine and Biotechnology, Sechenov First Moscow State Medical University, Moscow, Russia (Schiöth)
| | - Helgi B. Schiöth
- From the Department of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden (Gaudio, Olivo, Schiöth); the Centre for Integrated Research, Area of Diagnostic Imaging, Universita Campus Bio-Medico di Roma, Rome, Italy (Gaudio); the Department of Physiology and Pharmacology, Neuroimaging Laboratory, Sapienza University, Rome, Italy (Carducci, Piervincenzi); and the Institute for Translational Medicine and Biotechnology, Sechenov First Moscow State Medical University, Moscow, Russia (Schiöth)
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17
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Leppanen J, Sedgewick F, Cardi V, Treasure J, Tchanturia K. Cortical morphometry in anorexia nervosa: An out-of-sample replication study. EUROPEAN EATING DISORDERS REVIEW 2019; 27:507-520. [PMID: 31172616 PMCID: PMC6698193 DOI: 10.1002/erv.2686] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 05/01/2019] [Accepted: 05/09/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND Acute anorexia nervosa (AN) is frequently accompanied by reduced global cortical volume. Investigations of local cortical alterations in AN have revealed widespread reduction in cortical thickness, gyrification, and curvature. The aim of the present study was to combine data from two previous studies to replicate previous findings. METHODOLOGY Magnetic resonance imaging (MRI) images from 46 adult women with AN and 54 age-matched healthy comparison (HC) women were analysed using FreeSurfer. Group differences in cortical volume and local cortical measures, including gyrification, curvature, thickness, and area, were examined controlling for dataset and age. RESULTS The AN group had reduced global cortical volume relative to the HC group. The AN group also had reduction in local cortical gyrification, small localised clusters of reduced cortical thickness, in the occipital and parietal cortices, and surface area in the frontal and temporal cortices. The AN group also had increased cortical thickness in the ACC relative to the HC participants. CONCLUSIONS The present findings replicate and validate previous findings of reduced global cortical volume and local gyrification in acute AN. The findings highlight the need for further investigation of local cortical folding, thickness, and surface area in AN to gain further insight into the biological underpinnings of AN.
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Affiliation(s)
- Jenni Leppanen
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, King's College London, London, UK
| | - Felicity Sedgewick
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, King's College London, London, UK
| | - Valentina Cardi
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, King's College London, London, UK
| | - Janet Treasure
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, King's College London, London, UK.,South London and Maudsley Mental Health NHS Foundation Trust, Section of Eating Disorders, London, UK
| | - Kate Tchanturia
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, King's College London, London, UK.,South London and Maudsley Mental Health NHS Foundation Trust, Section of Eating Disorders, London, UK.,Department of Psychology, Illia State University, Tbilisi, Georgia
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18
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Nickel K, Joos A, Tebartz van Elst L, Holovics L, Endres D, Zeeck A, Maier S. Altered cortical folding and reduced sulcal depth in adults with anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2019; 27:655-670. [DOI: 10.1002/erv.2685] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 03/25/2019] [Accepted: 04/17/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Kathrin Nickel
- Section for Experimental Neuropsychiatry, Department of Psychiatry and PsychotherapyMedical Center – University of Freiburg, Faculty of Medicine, University of Freiburg Freiburg Germany
| | - Andreas Joos
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center – University of FreiburgFaculty of Medicine, University of Freiburg Freiburg Germany
- Psychotherapeutic NeurologyKliniken Schmieder Gailingen Germany
| | - Ludger Tebartz van Elst
- Section for Experimental Neuropsychiatry, Department of Psychiatry and PsychotherapyMedical Center – University of Freiburg, Faculty of Medicine, University of Freiburg Freiburg Germany
| | - Lukas Holovics
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center – University of FreiburgFaculty of Medicine, University of Freiburg Freiburg Germany
| | - Dominique Endres
- Section for Experimental Neuropsychiatry, Department of Psychiatry and PsychotherapyMedical Center – University of Freiburg, Faculty of Medicine, University of Freiburg Freiburg Germany
| | - Almut Zeeck
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center – University of FreiburgFaculty of Medicine, University of Freiburg Freiburg Germany
| | - Simon Maier
- Section for Experimental Neuropsychiatry, Department of Psychiatry and PsychotherapyMedical Center – University of Freiburg, Faculty of Medicine, University of Freiburg Freiburg Germany
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center – University of FreiburgFaculty of Medicine, University of Freiburg Freiburg Germany
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19
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Yue L, Wang Y, Kaye WH, Kang Q, Huang JB, Cheung EFC, Xiao SF, Wang Z, Chen J, Chan RCK. Structural alterations in the caudate nucleus and precuneus in un-medicated anorexia nervosa patients. Psychiatry Res Neuroimaging 2018; 281:12-18. [PMID: 30212787 DOI: 10.1016/j.pscychresns.2018.08.009] [Citation(s) in RCA: 8] [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: 03/27/2018] [Revised: 08/13/2018] [Accepted: 08/15/2018] [Indexed: 12/15/2022]
Abstract
Anorexia nervosa (AN) is a mental disorder characterized by a preoccupation with thinness and may be associated with brain structural alteration. The aim of the study was to examine the brain structural alteration in AN patients, including subcortical structure volume and cortical thickness. Thirty-five un-medicated AN patients and 20 matched healthy controls underwent structural magnetic resonance imaging brain scans. High resolution structural images were acquired on a SIEMENS 3T scanner and preprocessed using FreeSurfer software. Subcortical structure volume and cortical thickness were compared between the two groups. We found larger percentage of caudate volume relative to total grey matter (GM) volume in the AN group. Reduced cortical thickness at the left precuneus was also observed in AN patients. Moreover, an interaction between group and hemisphere was found, suggesting that cortical thinning was more prominent in the left hemisphere in AN patients. These findings provide further evidence for structural brain abnormalities in patients with AN.
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Affiliation(s)
- Ling Yue
- Department of Clinical Psychology, Shanghai Jiao Tong University School of Medicine, Shanghai Mental Health Centre, Shanghai Clinical Centre for Mental Disorders, Shanghai, China
| | - Yi Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China
| | - Walter H Kaye
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Qing Kang
- Department of Clinical Psychology, Shanghai Jiao Tong University School of Medicine, Shanghai Mental Health Centre, Shanghai Clinical Centre for Mental Disorders, Shanghai, China
| | - Jia-Bin Huang
- Department of Clinical Psychology, Shanghai Jiao Tong University School of Medicine, Shanghai Mental Health Centre, Shanghai Clinical Centre for Mental Disorders, Shanghai, China
| | - Eric F C Cheung
- Department of Adult Psychiatry, Castle Peak Hospital, Hong Kong, China
| | - Shi-Fu Xiao
- Department of Clinical Psychology, Shanghai Jiao Tong University School of Medicine, Shanghai Mental Health Centre, Shanghai Clinical Centre for Mental Disorders, Shanghai, China
| | - Zhen Wang
- Department of Clinical Psychology, Shanghai Jiao Tong University School of Medicine, Shanghai Mental Health Centre, Shanghai Clinical Centre for Mental Disorders, Shanghai, China
| | - Jue Chen
- Department of Clinical Psychology, Shanghai Jiao Tong University School of Medicine, Shanghai Mental Health Centre, Shanghai Clinical Centre for Mental Disorders, Shanghai, China.
| | - Raymond C K Chan
- Department of Clinical Psychology, Shanghai Jiao Tong University School of Medicine, Shanghai Mental Health Centre, Shanghai Clinical Centre for Mental Disorders, Shanghai, China; Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China; Translational Neuropsychology and Applied Cognitive Neuroscience Laboratory, Shanghai Mental Health Centre, Shanghai Jiaotong University, Shanghai, China.
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20
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Abstract
PURPOSE OF REVIEW This review delineates issues in the conceptualization and operationalization of eating disorder recovery, highlights recent findings about recovery (since 2016), and proposes future directions. RECENT FINDINGS A longstanding problem in the field is that there are almost as many different definitions of recovery in eating disorders as there are studies on the topic. Yet, there has been a general shift to accepting that psychological/cognitive symptoms are important to recovery in addition to physical and behavioral indices. Further, several operationalizations of recovery have been proposed over the past two decades, and some efforts to validate operationalizations exist. However, this work has had limited impact and uptake, such that the field is suffering from "broken record syndrome," where calls are made for universal definitions time and time again. It is critical that proposed operationalizations be compared empirically to help arrive at a consensus definition and that institutional/organizational support help facilitate this. Themes in recent recovery research include identifying predictors, examining biological/neuropsychological factors, and considering severe and enduring anorexia nervosa. From qualitative research, those who have experienced eating disorders highlight recovery as a journey, as well as factors such as hope, self-acceptance, and benefiting from support from others as integral to the process of recovery. The field urgently needs to implement a universal definition of recovery that is backed by evidence, that can parsimoniously be implemented in clinical practice, and that will lead to greater harmonization of scientific findings.
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21
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Hernigou J, Koulischer S, Maes R. Bilateral Simultaneous Femoral Neck Stress Fracture Despite Clinical Recovery from Anorexia Nervosa: A Case Report. JBJS Case Connect 2018; 7:e12. [PMID: 29244693 DOI: 10.2106/jbjs.cc.16.00047] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
CASE A 38-year-old woman who had returned to sports activity (running) after having clinically recovered from anorexia nervosa presented with a bilateral femoral neck stress fracture that was treated with bilateral hip osteosynthesis. CONCLUSION Although exercise is usually considered to be beneficial for health, heavy exercise (such as running) after recovery from anorexia nervosa may be associated with an increased risk of fracture.
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22
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Phillipou A, Rossell SL, Gurvich C, Castle DJ, Abel LA, Nibbs RG, Hughes ME. Differences in regional grey matter volumes in currently ill patients with anorexia nervosa. Eur J Neurosci 2018; 47:177-183. [PMID: 29244231 DOI: 10.1111/ejn.13793] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 10/29/2017] [Accepted: 12/01/2017] [Indexed: 01/03/2023]
Abstract
Neurobiological findings in anorexia nervosa (AN) are inconsistent, including differences in regional grey matter volumes. Methodological limitations often contribute to the inconsistencies reported. The aim of this study was to improve on these methodologies by utilising voxel-based morphometry (VBM) analysis with the use of diffeomorphic anatomic registration through an exponentiated lie algebra algorithm (DARTEL), in a relatively large group of individuals with AN. Twenty-six individuals with AN and 27 healthy controls underwent a T1-weighted magnetic resonance imaging (MRI) scan. AN participants were found to have reduced grey matter volumes in a number of areas including regions of the basal ganglia (including the ventral striatum), and parietal and temporal cortices. Body mass index (BMI) and global scores on the Eating Disorder Examination Questionnaire (EDE-Q) were also found to correlate with grey matter volumes in a region of the brainstem (including the substantia nigra and ventral tegmental area) in AN, and predicted 56% of the variance in grey matter volumes in this area. The brain regions associated with grey matter reductions in AN are consistent with regions responsible for cognitive deficits associated with the illness including anhedonia, deficits in affect perception and saccadic eye movement abnormalities. Overall, the findings suggest reduced grey matter volumes in AN that are associated with eating disorder symptomatology.
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Affiliation(s)
- Andrea Phillipou
- Department of Optometry & Vision Sciences, The University of Melbourne, Melbourne, VIC, Australia.,Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia.,Department of Mental Health, The Austin Hospital, Melbourne, VIC, Australia.,Department of Psychiatry, St Vincent's Hospital, Melbourne, VIC, Australia.,Centre for Mental Health, Swinburne University of Technology, John St, Hawthorn, Melbourne, VIC, 3122, Australia
| | - Susan Lee Rossell
- Department of Psychiatry, St Vincent's Hospital, Melbourne, VIC, Australia.,Centre for Mental Health, Swinburne University of Technology, John St, Hawthorn, Melbourne, VIC, 3122, Australia.,Monash Alfred Psychiatry Research Centre, Monash University & The Alfred Hospital, Melbourne, VIC, Australia
| | - Caroline Gurvich
- Monash Alfred Psychiatry Research Centre, Monash University & The Alfred Hospital, Melbourne, VIC, Australia
| | - David Jonathan Castle
- Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia.,Department of Psychiatry, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Larry Allen Abel
- Department of Optometry & Vision Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Richard Grant Nibbs
- Centre for Mental Health, Swinburne University of Technology, John St, Hawthorn, Melbourne, VIC, 3122, Australia
| | - Matthew Edward Hughes
- Centre for Mental Health, Swinburne University of Technology, John St, Hawthorn, Melbourne, VIC, 3122, Australia
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23
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Martin Monzon B, Henderson LA, Madden S, Macefield VG, Touyz S, Kohn MR, Clarke S, Foroughi N, Hay P. Grey matter volume in adolescents with anorexia nervosa and associated eating disorder symptoms. Eur J Neurosci 2017; 46:2297-2307. [PMID: 28833732 DOI: 10.1111/ejn.13659] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 07/26/2017] [Accepted: 08/09/2017] [Indexed: 01/01/2023]
Abstract
Anorexia nervosa (AN) is a mental health disorder of complex aetiology. Previous neuroimaging studies have found consistent global reductions in global grey matter volume of underweight girls with AN; however, differences in regional grey matter volumes are less consistent. The aims of this study were to investigate grey matter regional volumes of adolescent girls with AN before and after weight recovery and the relationship of any changes with clinical characteristics. We collected high-resolution T1-weighted images from 26 underweight girls with AN before weight gain and 20 healthy control volunteers. Clinical features were assessed using the Eating Disorder Examination Questionnaire. AN subjects displayed reduced grey matter volumes in the insula, amygdala, prefrontal, hippocampal and cingulate cortices and the precuneus, relative to healthy controls. In a subset of 10 AN subjects who were followed after weight recovery, grey matter volumes increased to near-control levels in the orbito- and medial prefrontal, insular, left hippocampal and mid- and posterior cingulate cortices and precuneus. The recovery of the right anterior thalamus and the left orbitofrontal cortex was correlated with improvements in eating concerns and shape concerns, respectively. However, large parts of the anterior cingulate cortex, caudate nuclei and right hippocampus did not display any grey matter recovery following a short-term of treatment. These results show that in adolescents with AN, some brain regions display marked recovery in grey matter volume following weight recovery, whereas others do not, considering grey mater recovery possibly linked to symptom improvement.
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Affiliation(s)
- Beatriz Martin Monzon
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, Sydney, NSW, 2751, Australia
| | - Luke A Henderson
- Department of Anatomy and Histology, University of Sydney, Sydney, NSW, Australia
| | - Sloane Madden
- School of Medicine, University of Sydney, Sydney, NSW, Australia
| | | | - Stephen Touyz
- Clinical Psychology Unit, School of Psychology, University of Sydney, Sydney, NSW, Australia
| | - Michael R Kohn
- Centre for Research into Adolescents' Health (CRASH), Millennium Institute, University of Sydney, Sydney, NSW, Australia
| | - Simon Clarke
- Centre for Research into Adolescents' Health (CRASH), Millennium Institute, University of Sydney, Sydney, NSW, Australia
| | - Nasim Foroughi
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, Sydney, NSW, 2751, Australia
| | - Phillipa Hay
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, Sydney, NSW, 2751, Australia
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24
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Bang L, Rø Ø, Endestad T. Threat-Detection and Attentional Bias to Threat in Women Recovered from Anorexia Nervosa: Neural Alterations in Extrastriate and Medial Prefrontal Cortices. EUROPEAN EATING DISORDERS REVIEW 2016; 25:80-88. [DOI: 10.1002/erv.2494] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 11/09/2016] [Accepted: 11/10/2016] [Indexed: 12/16/2022]
Affiliation(s)
- Lasse Bang
- Regional Department for Eating Disorders, Division of Mental Health and Addiction; Oslo University Hospital; Oslo Norway
| | - Øyvind Rø
- Regional Department for Eating Disorders, Division of Mental Health and Addiction; Oslo University Hospital; Oslo Norway
- Division of Mental Health and Addiction, Institute of Clinical Medicine; University of Oslo; Oslo Norway
| | - Tor Endestad
- Department of Psychology; University of Oslo; Oslo Norway
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