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Adams KL, Mandy W, Catmur C, Bird G. Potential mechanisms underlying the association between feeding and eating disorders and autism. Neurosci Biobehav Rev 2024; 162:105717. [PMID: 38754718 DOI: 10.1016/j.neubiorev.2024.105717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/26/2024] [Accepted: 05/07/2024] [Indexed: 05/18/2024]
Abstract
There is a reliable association between autism and Feeding and Eating Disorders. Concerningly, where these two conditions co-occur, clinical outcomes of Feeding and Eating Disorders are significantly worse, and treatment less effective, than when the Feeding and Eating Disorders occur in neurotypical individuals. Problematically, the reason for the association between autism and Feeding and Eating Disorders is poorly understood, which constrains advances in clinical care. This paper outlines several possible mechanisms that may underlie the observed association and suggests ways in which they may be empirically tested. Mechanisms are split into those producing an artefactual association, and those reflecting a genuine link between conditions. Artefactual associations may be due to conceptual overlap in both diagnostic criteria and measurement, Feeding and Eating Disorders causing transient autistic traits, or the association being non-specific in nature. A genuine association between autism and Feeding and Eating Disorders may be due to common causal factors, autism directly or indirectly causing Feeding and Eating Disorders, and Feeding and Eating Disorders being a female manifestation of autism.
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Affiliation(s)
- Kiera Louise Adams
- Department of Experimental Psychology, University of Oxford, Oxford, UK.
| | - William Mandy
- Division of Psychology and Language, University College London, London, UK
| | - Caroline Catmur
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Geoffrey Bird
- Department of Experimental Psychology, University of Oxford, Oxford, UK
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2
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Frost-Karlsson M, Capusan AJ, Perini I, Olausson H, Zetterqvist M, Gustafsson PA, Boehme R. Neural processing of self-touch and other-touch in anorexia nervosa and autism spectrum condition. Neuroimage Clin 2022; 36:103264. [PMID: 36451367 PMCID: PMC9668667 DOI: 10.1016/j.nicl.2022.103264] [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: 05/19/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The tactile sense plays a crucial role in the development and maintenance of a functional bodily self. The ability to differentiate between self- and nonself-generated touch contributes to the perception of the bodies' boundaries and more generally to self-other-distinction, both of which are thought be altered in anorexia nervosa (AN) and autism spectrum condition (AS). While it has been suggested that AN and AS are characterized by overlapping symptomatology, they might differ regarding body perception and self-other-distinction. METHODS Participants with a diagnosis of AN (n = 25), AS (n = 29), and a comparison group without diagnoses (n = 57) performed a self-other-touch task during functional brain imaging. In the experimental conditions, they stroked their own arm or were stroked on the arm by an experimenter. RESULTS As shown previously, the CG group showed lower activation or deactivation in response to self-touch compared to social touch from someone else. A main group effect was found in areas including somatosensory cortex, frontal and temporal gyri, insula, and subcortical regions. This was driven by increased activations in participants with AN, while participants in the AS group showed mostly comparable activations to the comparison group. CONCLUSIONS AN diagnosis was associated with an increased neural activity in response to both self-touch and social touch. Failure to attenuate self-touch might relate to altered predictions regarding the own body and reduced perception of bodily boundaries. Participants with an AS diagnosis were mostly comparable to the comparison group, potentially indicating unaltered tactile self-other-distinction.
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Affiliation(s)
- Morgan Frost-Karlsson
- Center for Social and Affective Neuroscience, Linköping University, Department of Biomedical and Clinical Sciences, 58185 Linköping, Sweden
| | - Andrea Johansson Capusan
- Center for Social and Affective Neuroscience, Linköping University, Department of Biomedical and Clinical Sciences, 58185 Linköping, Sweden,Department of Psychiatry in Linköping and Department of Biomedical and Clinical Sciences, Linköping University, 58185 Linköping, Sweden
| | - Irene Perini
- Center for Social and Affective Neuroscience, Linköping University, Department of Biomedical and Clinical Sciences, 58185 Linköping, Sweden,Center for Medical Imaging and Visualization, Linköping University, 58185 Linköping, Sweden
| | - Håkan Olausson
- Center for Social and Affective Neuroscience, Linköping University, Department of Biomedical and Clinical Sciences, 58185 Linköping, Sweden,Department of Clinical Neurophysiology, Linköping University Hospital, 58185 Linköping, Sweden,Center for Medical Imaging and Visualization, Linköping University, 58185 Linköping, Sweden
| | - Maria Zetterqvist
- Center for Social and Affective Neuroscience, Linköping University, Department of Biomedical and Clinical Sciences, 58185 Linköping, Sweden,Department of Child and Adolescent Psychiatry in Linköping and Department of Biomedical and Clinical Sciences, Linköping University, 58185 Linköping, Sweden
| | - Per A. Gustafsson
- Center for Social and Affective Neuroscience, Linköping University, Department of Biomedical and Clinical Sciences, 58185 Linköping, Sweden,Department of Child and Adolescent Psychiatry in Linköping and Department of Biomedical and Clinical Sciences, Linköping University, 58185 Linköping, Sweden
| | - Rebecca Boehme
- Center for Social and Affective Neuroscience, Linköping University, Department of Biomedical and Clinical Sciences, 58185 Linköping, Sweden,Center for Medical Imaging and Visualization, Linköping University, 58185 Linköping, Sweden,Corresponding author at: Center for Social and Affective Neuroscience, The Department of Biomedical and Clinical Sciences, Linköping University, S-581 83 Linköping, Sweden.
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3
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Susta M, Bizik G, Yamamotova A, Petranek S, Kadochova M, Papezova H. The sight of one’s own body: Could qEEG help predict the treatment response in anorexia nervosa? Front Psychol 2022; 13:958501. [PMID: 36300071 PMCID: PMC9592122 DOI: 10.3389/fpsyg.2022.958501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/21/2022] [Indexed: 11/13/2022] Open
Abstract
Aims of the studyThe study aims to identify the differences in brain activity between participants with anorexia nervosa and healthy control using visual stimulus conditions combined with the quantitative dense-array EEG recording analysis method called Brain Activation Sequences (BAS).Materials and methods23 participants with anorexia nervosa and 21 healthy controls were presented with visual stimuli, including the subject’s facial expressions and body images. The 128-channel EEG data were processed using BAS and displayed as activity in up to 66 brain regions. Subsequent cluster analysis was used to identify groups of participants exhibiting area-specific activation patterns.ResultsCluster analysis identified three distinct groups: one including all healthy controls (HC) and two consisting of all participants with anorexia (AN-I with 19 participants and AN-II with four participants). The AN-I and AN-II groups differed in their response to treatment. Comparisons of HC vs. AN confirmed the dominance of the right cerebral hemisphere in participants with anorexia nervosa in two of the three reported conditions. The facial expressions condition, specifically the facial reaction expressing disgust, indicates the existence of a social attentional bias toward faces, whereas emotions remained undetected in participants. High limbic activity, medial frontal gyrus involvement, low fusiform cortex activity, and milder visual cortex activity in healthy controls compared to participants indicate that the facial expression stimulus is perceived by healthy subjects primarily as an emotion, not as the face itself. In the body image condition, participants showed higher activity in the fusiform gyrus and right insula, indicating activation of the brain’s “fear network.”ConclusionThe study describes a specific pattern of brain activation in response to facial expression of disgust and body images that likely contributes to social-cognitive and behavioral impairments in anorexia. In addition, the substantial difference in the pattern of brain activation within the participants with AN and its association with treatment resistance deserves special attention because of its potential to develop a clinically useful prediction tool and identify potential targets for, for example, neuromodulatory treatments and/or individualized psychotherapy.
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Affiliation(s)
- Marek Susta
- Department of Public Health, St. Elisabeth University, Bratislava, Slovakia
| | - Gustav Bizik
- Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark
- *Correspondence: Gustav Bizik,
| | - Anna Yamamotova
- Department of Physiology, Third Faculty of Medicine, Charles University, Prague, Czechia
| | - Svojmil Petranek
- Health Care Facility, Department of the Interior, Prague, Czechia
| | - Marie Kadochova
- Department of Public Health, St. Elisabeth University, Bratislava, Slovakia
| | - Hana Papezova
- Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czechia
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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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Abstract
In the last decades, increasing attention has been provided to socio-cultural and neurobiological factors involved in the psychopathology of feeding and eating disorders (FED), encouraging a multifactorial approach. In this framework, several authors stressed an association between FED and other kinds of psychiatric disorders from both a psychopathological and a neurobiological point of view. In particular, many promising contributions are focusing on the possible link between FED and autism spectrum disorder (ASD). Growing interest about this association rose from the frequently reported evidence of ASD-like traits amongst FED patients and abnormal eating behaviors amongst patients with ASD. This narrative review overview aims to summarize the most relevant findings about the overlap between different kinds of FED and the autism spectrum, taking into account the most recent hypotheses about the psychopathology of both these conditions. While most of the studies focused on anorexia nervosa, both ASD and autistic traits seem to be detectable also in other kinds of FED. In addition, the recently increased interest toward a dimensional approach to psychopathology led to progressively broadening the concept of ASD, focusing on its subthreshold and gender-specific manifestations and on its link with other psychiatric conditions, including FED. Globally the studies summarized here provide further support to theoretical models featuring a neurodevelopmental approach for mental disorders. In particular, FED have been conceptualized as a possible psychopathological trajectory of a neurodevelopmental alteration, toward which female gender would act as one of many predisposing factors.
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Sader M, Williams JHG, Waiter GD. A meta-analytic investigation of grey matter differences in anorexia nervosa and autism spectrum disorder. EUROPEAN EATING DISORDERS REVIEW 2022; 30:560-579. [PMID: 35526083 PMCID: PMC9543727 DOI: 10.1002/erv.2915] [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: 03/17/2022] [Accepted: 04/21/2022] [Indexed: 11/11/2022]
Abstract
Recent research reports Anorexia Nervosa (AN) to be highly dependent upon neurobiological function. Some behaviours, particularly concerning food selectivity are found in populations with both Autism Spectrum Disorder (ASD) and AN, and there is a proportionally elevated number of anorexic patients exhibiting symptoms of ASD. We performed a systematic review of structural MRI literature with the aim of identifying common structural neural correlates common to both AN and ASD. Across 46 ASD publications, a meta‐analysis of volumetric differences between ASD and healthy controls revealed no consistently affected brain regions. Meta‐analysis of 23 AN publications revealed increased volume within the orbitofrontal cortex and medial temporal lobe, and adult‐only AN literature revealed differences within the genu of the anterior cingulate cortex. The changes are consistent with alterations in flexible reward‐related learning and episodic memory reported in neuropsychological studies. There was no structural overlap between ASD and AN. Findings suggest no consistent neuroanatomical abnormality associated with ASD, and evidence is lacking to suggest that reported behavioural similarities between those with AN and ASD are due to neuroanatomical structural similarities. Findings related to neuroanatomical structure in AN/ASD demonstrate overlap and require revisiting. Meta‐analytic findings show structural increase/decrease versus healthy controls (LPFC/MTL/OFC) in AN, but no clusters found in ASD. The neuroanatomy associated with ASD is inconsistent, but findings in AN reflect condition‐related impairment in executive function and sociocognitive behaviours.
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Affiliation(s)
- Michelle Sader
- Translational Neuroscience, Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK
| | - Justin H G Williams
- Translational Neuroscience, Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK
| | - Gordon D Waiter
- Biomedical Imaging Centre, Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK
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Vicarious ratings of social touch the effect of age and autistic traits. Sci Rep 2021; 11:19336. [PMID: 34588542 PMCID: PMC8481497 DOI: 10.1038/s41598-021-98802-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/15/2021] [Indexed: 11/28/2022] Open
Abstract
Tactile sensitivities are common in Autism Spectrum Conditions (autism). Psychophysically, slow, gentle stroking touch is typically rated as more pleasant than faster or slower touch. Vicarious ratings of social touch results in a similar pattern of velocity dependent hedonic ratings as directly felt touch. Here we investigated whether adults and children’s vicarious ratings vary according to autism diagnosis and self-reported autistic traits. Adults’ scoring high on the AQ rated stroking touch on the palm as less pleasant than a Low AQ group. However, in contrast to our hypothesis, we did not find any effect of autism diagnosis on children’s touch ratings despite parental reports highlighting significant somatosensory sensitivities. These results are discussed in terms of underpinning sensory and cognitive factors.
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8
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Su T, Gong J, Tang G, Qiu S, Chen P, Chen G, Wang J, Huang L, Wang Y. Structural and functional brain alterations in anorexia nervosa:A multimodal meta-analysis of neuroimaging studies. Hum Brain Mapp 2021; 42:5154-5169. [PMID: 34296492 PMCID: PMC8449099 DOI: 10.1002/hbm.25602] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/10/2021] [Accepted: 07/12/2021] [Indexed: 12/26/2022] Open
Abstract
Anorexia nervosa (AN) is a complex psychiatric disorder with poorly understood etiology. Numerous voxel‐based morphometry (VBM) and resting‐state functional imaging studies have provided strong evidence of abnormal brain structure and intrinsic and functional activities in AN, but with inconsistent conclusions. Herein, a whole‐brain meta‐analysis was conducted on VBM (660 patients with AN, and 740 controls) and resting‐state functional imaging (425 patients with AN, and 461 controls) studies that measured differences in the gray matter volume (GMV) and intrinsic functional activity between patients with AN and healthy controls (HCs). Overall, patients with AN displayed decreased GMV in the bilateral median cingulate cortex (extending to the bilateral anterior and posterior cingulate cortex), and left middle occipital gyrus (extending to the left inferior parietal lobe). In resting‐state functional imaging studies, patients with AN displayed decreased resting‐state functional activity in the bilateral anterior cingulate cortex and bilateral median cingulate cortex, and increased resting‐state functional activity in the right parahippocampal gyrus. This multimodal meta‐analysis identified reductions of gray matter and functional activity in the anterior and median cingulate in patients with AN, which contributes to further understanding of the pathophysiology of AN.
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Affiliation(s)
- Ting Su
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, China.,Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, China
| | - Jiaying Gong
- Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, China.,Department of Radiology, Six Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Guixian Tang
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, China.,Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, China
| | - Shaojuan Qiu
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Pan Chen
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, China.,Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, China
| | - Guanmao Chen
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, China.,Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, China
| | - Junjing Wang
- Department of Applied Psychology, Guangdong University of Foreign Studies, Guangzhou, China
| | - Li Huang
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Ying Wang
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, China
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9
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Isaksson M, Ghaderi A, Wolf-Arehult M, Ramklint M. Overcontrolled, undercontrolled, and resilient personality styles among patients with eating disorders. J Eat Disord 2021; 9:47. [PMID: 33863394 PMCID: PMC8052746 DOI: 10.1186/s40337-021-00400-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 03/26/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Personality has been suggested to be an important factor in understanding onset, maintenance, and recovery from eating disorders (ED). The objective of the current study was to evaluate personality style in different ED diagnostic groups as classified in the Diagnostic and Statistical Manual of Mental Disorders, Fifth edition (DSM-5). METHODS The overcontrolled, undercontrolled, and resilient personality styles were compared in four groups of patients with EDs: anorexia nervosa restricting (ANr) (n = 34), anorexia nervosa binge eating/purging (ANbp) (n = 31), atypical anorexia nervosa (AAN) (n = 29), and bulimia nervosa (BN) (n = 76). These groups were compared with a group of patients with borderline personality disorder (BPD) (n = 108), and a non-clinical group (NC) (n = 444). Patient data were collected at two outpatient clinics in Uppsala, Sweden. NC control data were collected through convenience sampling. Participants filled out questionnaires assessing personality style. RESULTS The main findings were more pronounced overcontrol reported by the ANr and AAN groups compared with the BN, BPD, and NC groups, and no significant difference in resilience between the ED and the NC groups. Considerable variability of over- and undercontrol was also found within each group. CONCLUSIONS The results replicate previous findings when EDs are classified according to current diagnostic criteria (DSM-5). Taking personality styles into account may improve our understanding of certain characteristics in EDs, such as social deficits and rigidity that are attributed to poor treatment outcome.
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Affiliation(s)
- Martina Isaksson
- Department of Neuroscience, Psychiatry, Uppsala University, Entrance 10, Floor 3B, SE-751 85, Uppsala, Sweden.
| | - Ata Ghaderi
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77, Stockholm, Sweden.,Stockholm Centre for Eating Disorders, Stockholm Health Care Services, Stockholm County Council, SE-171 77, Stockholm, Sweden
| | - Martina Wolf-Arehult
- Department of Neuroscience, Psychiatry, Uppsala University, Entrance 10, Floor 3B, SE-751 85, Uppsala, Sweden.,Psychiatry Northwest, Region Stockholm, Clinical Management, PO Box 98, SE-191 22, Sollentuna, Sweden
| | - Mia Ramklint
- Department of Neuroscience, Psychiatry, Uppsala University, Entrance 10, Floor 3B, SE-751 85, Uppsala, Sweden
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10
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Fornaro M, Sassi T, Novello S, Anastasia A, Fusco A, Senatore I, de Bartolomeis A. Prominent autistic traits and subthreshold bipolar/mixed features of depression in severe anorexia nervosa. ACTA ACUST UNITED AC 2019; 42:153-161. [PMID: 31691722 PMCID: PMC7115451 DOI: 10.1590/1516-4446-2019-0500] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 07/22/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Autistic traits are associated with a burdensome clinical presentation of anorexia nervosa (AN), as is AN with concurrent depression. The aim of the present study was to explore the intertwined association between complex psychopathology combining autistic traits, subthreshold bipolarity, and mixed depression among people with AN. METHOD Sixty patients with AN and concurrent major depressive episode (mean age, 22.2±7 years) were cross-sectionally assessed using the Autism-Spectrum Quotient test (AQ-test), the Hamilton depression scales for depression and anxiety, the Young Mania Rating Scale (YMRS), the Hypomania-Checklist-32 (HCL-32), second revision (for subthreshold bipolarity), the Brown Assessment and Beliefs Scale (BABS), the Yale-Brown-Cornell Eating Disorders Scale (YBC-EDS), and the Eating Disorder Examination Questionnaire (EDE-Q). Cases were split into two groups depending on body mass index (BMI): severe AN (AN+) if BMI < 16, not severe (AN-) if BMI ≥ 16. RESULTS The "subthreshold bipolarity with prominent autistic traits" pattern correctly classified 83.6% of AN patients (AN+ = 78.1%; AN- = 91.3%, Exp(B) = 1.391). AN+ cases showed higher rates of positive scores for YMRS items 2 (increased motor activity-energy) and 5 (irritability) compared to AN- cases. CONCLUSIONS In our sample, depressed patients with severe AN had more pronounced autistic traits and subtly mixed bipolarity. Further studies with larger samples and prospective follow-up of treatment outcomes are warranted to replicate these findings.
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Affiliation(s)
- Michele Fornaro
- Dipartimento di Neuroscienze, Sezione di Psichiatria, Università Federico II di Napoli, Italy
| | - Teresa Sassi
- Dipartimento di Neuroscienze, Sezione di Psichiatria, Università Federico II di Napoli, Italy
| | - Stefano Novello
- Dipartimento di Neuroscienze, Sezione di Psichiatria, Università Federico II di Napoli, Italy
| | | | - Andrea Fusco
- Dipartimento di Neuroscienze, Sezione di Psichiatria, Università Federico II di Napoli, Italy
| | - Ignazio Senatore
- Dipartimento di Neuroscienze, Sezione di Psichiatria, Università Federico II di Napoli, Italy
| | - Andrea de Bartolomeis
- Dipartimento di Neuroscienze, Sezione di Psichiatria, Università Federico II di Napoli, Italy
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11
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Tonacci A, Calderoni S, Billeci L, Maestro S, Fantozzi P, Ciuccoli F, Morales MA, Narzisi A, Muratori F. Autistic traits impact on olfactory processing in adolescent girls with Anorexia Nervosa restricting type. Psychiatry Res 2019; 274:20-26. [PMID: 30776708 DOI: 10.1016/j.psychres.2019.02.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 01/03/2019] [Accepted: 02/11/2019] [Indexed: 10/27/2022]
Abstract
The correct functioning of the chemosensory pathway is pivotal for the attitude towards feeding. In some neuropsychiatric disorders, abnormalities of the sensory processing dramatically affect feeding behavior; however, evidences for an olfactory involvement in Anorexia Nervosa (AN) are still controversial. We administered a complete olfactory testing battery, the Sniffin' Sticks Extended Test, to a cohort of 19 girls with Restrictive Anorexia Nervosa (AN-R) and 19 healthy controls. A battery of questionnaires aiming to evaluate eating attitude, psychopathologic disorders and autistic traits was also administered. No difference was found between the two groups in any of the olfactory tasks. Despite the lack of correlation between olfaction and disease severity, however, olfactory performances were related to autistic traits in anorectic girls (r = -0.489, p = 0.039). Girls with AN-R do not appear to have an impaired olfactory function with respect to controls. However, a possible correlation between olfactory ability and autistic traits was discovered. In light of such findings, the role of possible relations between social functioning-related features and olfactory processing in AN-R is discussed.
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Affiliation(s)
- Alessandro Tonacci
- Institute of Clinical Physiology, National Research Council of Italy (CNR), Pisa, Italy
| | - Sara Calderoni
- IRCCS Fondazione Stella Maris, Pisa, Italy; Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
| | - Lucia Billeci
- Institute of Clinical Physiology, National Research Council of Italy (CNR), Pisa, Italy
| | | | | | | | - Maria Aurora Morales
- Institute of Clinical Physiology, National Research Council of Italy (CNR), Pisa, Italy
| | | | - Filippo Muratori
- IRCCS Fondazione Stella Maris, Pisa, Italy; Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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12
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Crucianelli L, Serpell L, Paloyelis Y, Ricciardi L, Robinson P, Jenkinson P, Fotopoulou A. The effect of intranasal oxytocin on the perception of affective touch and multisensory integration in anorexia nervosa: protocol for a double-blind placebo-controlled crossover study. BMJ Open 2019; 9:e024913. [PMID: 30878983 PMCID: PMC6429868 DOI: 10.1136/bmjopen-2018-024913] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Anorexia nervosa (AN) is an eating disorder characterised by restriction of energy intake, fears of gaining weight and related body image disturbances. The oxytocinergic system has been proposed as a pathophysiological candidate for AN. Oxytocin is a neuropeptide involved in bodily processes (eg, breast feeding) and in the onset of social behaviours (eg, bonding). Studies investigating the effect of intranasal oxytocin (IN-OT) in AN showed that it can improve attentional bias for high-calorie food and fat bodies stimuli, and related stress. However, less is known about the effect of IN-OT on bodily awareness and body image distortions, key features of the disorder linked to its development, prognosis and maintenance. Here, we aim to investigate the effect of IN-OT on the perception of affective, C-tactile-optimal touch, known to be impaired in AN and on multisensory integration processes underlying a body ownership illusion (ie, rubber hand illusion). For exploratory purposes, we will also investigate the effect of IN-OT on another interoceptive modality, namely cardiac awareness and its relationship with affective touch. DESIGN, METHODS AND ANALYSIS Forty women with AN and forty matched healthy controls will be recruited and tested in two separate sessions; self-administering IN-OT (40 IU) or placebo, intranasally, in a pseudo-randomised manner. The data from this double-blind, placebo-controlled, cross-over study will be analysed using linear mixed models that allow the use of both fixed (treatment levels) and random (subjects) effects in the same analysis. To address our main hypotheses, separate analyses will be run for the affective touch task, where the primary outcome dependent variable will be the pleasantness of the touch, and for the rubber hand illusion, where we will investigate multisensory integration quantified as subjective embodiment towards the rubber hand. In the latter, we will manipulate the synchronicity of touch and the size of the hand. ETHICS AND DISSEMINATION Ethics approval has been obtained by National Research Ethics Service NRES Committee London (Queen's Square Committee, ref number 14/LO/1593). The results will be disseminated through conference presentations and publication in peer-reviewed journals.
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Affiliation(s)
- Laura Crucianelli
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Lucy Serpell
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Yannis Paloyelis
- Department of Neuroimaging Science, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Lucia Ricciardi
- Cardiovascular Sciences Research Centre, St George’s Hospital, London, UK
| | - Paul Robinson
- Barnet Enfield and Haringey Mental Health Trust, London, UK
- Faculty of Medical Sciences, University College London, London, UK
| | - Paul Jenkinson
- Department of Psychology and Sport Sciences, University of Hertfordshire, Hatfield, UK
| | - Aikaterini Fotopoulou
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
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13
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Gabriel T, Paul S, Berger A, Massoubre C. Anorexia Nervosa and Autism Spectrum Disorders: Future Hopes Linked to Mucosal Immunity. Neuroimmunomodulation 2019; 26:265-275. [PMID: 31715599 DOI: 10.1159/000502997] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 08/28/2019] [Indexed: 11/19/2022] Open
Abstract
Mental health is becoming a public health priority worldwide. Anorexia nervosa and autism spectrum disorders are 2 important types of childhood disorders with a bad prognosis. They share cognitive impairments and, in both cases, the microbiota appears to be a crucial factor. Alteration of the microbiota-gut-brain axis is an appealing hypothesis to define new pathophysiological mechanisms. Mucosal immunity plays a key role between the microbiota and the brain. The mucosal immune system receives and integrates messages from the intestinal microenvironment and the microbiota and then transmits the information to the nervous system. Abnormalities in this sensorial system may be involved in the natural history of mental diseases and might play a role in their maintenance. This review aims to highlight data about the relationship between intestinal mucosal immunity and these disorders. We show that shared cognitive impairments could be found in these 2 disorders, which both present dysbiosis. This literature review provides details on the immune status of anorexic and autistic patients, with a focus on intestinal mucosal factors. Finally, we suggest future research hypotheses that seem important for understanding the implication of the gut-brain-axis in psychiatric diseases.
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Affiliation(s)
- Tristan Gabriel
- Laboratoire d'Immunologie, GIMAP/EA3064, Université de Lyon, CIC 1408 Vaccinology, Saint-Etienne, France
- Centre Référent des Troubles du Comportement Alimentaire, CHU Saint Etienne Hôpital Nord, Saint-Etienne, France
| | - Stéphane Paul
- Laboratoire d'Immunologie, GIMAP/EA3064, Université de Lyon, CIC 1408 Vaccinology, Saint-Etienne, France
| | - Anne Berger
- Laboratoire d'Immunologie, GIMAP/EA3064, Université de Lyon, CIC 1408 Vaccinology, Saint-Etienne, France
| | - Catherine Massoubre
- Centre Référent des Troubles du Comportement Alimentaire, CHU Saint Etienne Hôpital Nord, Saint-Etienne, France,
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14
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Margari L, Palumbi R, Peschechera A, Craig F, de Giambattista C, Ventura P, Margari F. Sex-Gender Comparisons in Comorbidities of Children and Adolescents With High-Functioning Autism Spectrum Disorder. Front Psychiatry 2019; 10:159. [PMID: 30971962 PMCID: PMC6445051 DOI: 10.3389/fpsyt.2019.00159] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 03/04/2019] [Indexed: 01/18/2023] Open
Abstract
Over the last few years, new studies focused their attention on the gender-related features in high-functioning autism spectrum disorder (HFA), often leading to controversial results. Another interesting aspect of these subtype of patients is linked to the complexity of clinical presentation, where besides core symptoms, other co-occurrence disorders may complicate the diagnostic evaluation. Therefore, we retrospectively studied 159 HFA patients, male and female, investigating their comorbidities and to find any gender difference. For each patient, were evaluated the presence/absence, type and gender distribution of psychopathological comorbidities, according to DSM-5 diagnostic criteria. The total sample was divided in 100 male and 59 female patients, age and intelligence quotient matched. In our sample, the psychiatric comorbidities observed were Attention Deficit Hyperactivity Disorder, Anxiety Disorders, Depressive Disorders, Bipolar Disorder, Obsessive-Compulsive Disorder, and Anorexia Nervosa. No statistical significant differences were found between male and female HFA patients comorbidities except for Anorexia Nervosa. In both male and female patients, attention deficit and hyperactivity disorder and anxiety disorders were found in high percentage. In conclusion, our investigation showed that a statistical significant difference of comorbidity between male and female HFA patients was found only for AN diagnosis. However, the question about the distinction between female and male HFA patients remains quite interesting and an open area of research for future studies.
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Affiliation(s)
- Lucia Margari
- Basic Medical Sciences Neuroscience and Sense Organs Department, University of Bari Aldo Moro, Bari, Italy
| | - Roberto Palumbi
- Basic Medical Sciences Neuroscience and Sense Organs Department, University of Bari Aldo Moro, Bari, Italy
| | - Antonia Peschechera
- Basic Medical Sciences Neuroscience and Sense Organs Department, University of Bari Aldo Moro, Bari, Italy
| | - Francesco Craig
- Unit for Severe Disabilities in Developmental Age and Young Adults, Developmental Neurology and Neurorehabilitation, Scientific Institute IRCCS E. Medea, Brindisi, Italy
| | - Concetta de Giambattista
- Basic Medical Sciences Neuroscience and Sense Organs Department, University of Bari Aldo Moro, Bari, Italy
| | - Patrizia Ventura
- Basic Medical Sciences Neuroscience and Sense Organs Department, University of Bari Aldo Moro, Bari, Italy
| | - Francesco Margari
- Basic Medical Sciences Neuroscience and Sense Organs Department, University of Bari Aldo Moro, Bari, Italy
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15
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Zhang S, Wang W, Su X, Kemp GJ, Yang X, Su J, Tan Q, Zhao Y, Sun H, Yue Q, Gong Q. Psychoradiological investigations of gray matter alterations in patients with anorexia nervosa. Transl Psychiatry 2018; 8:277. [PMID: 30546047 PMCID: PMC6293321 DOI: 10.1038/s41398-018-0323-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 10/23/2018] [Accepted: 11/13/2018] [Indexed: 02/05/2023] Open
Abstract
Anorexia nervosa (AN) is a severe psychiatric disorder with high mortality. The underlying neurobiological mechanisms are not well understood, and high-resolution structural magnetic resonance brain imaging studies have given inconsistent results. Here we aimed to psychoradiologically define the most prominent and replicable abnormalities of gray matter volume (GMV) in AN patients, and to examine their relationship to demographics and clinical characteristics, by means of a new coordinate-based meta-analytic technique called seed-based d mapping (SDM). In a pooled analysis of all AN patients we identified decreased GMV in the bilateral median cingulate cortices and posterior cingulate cortices extending to the bilateral precuneus, and the supplementary motor area. In subgroup analysis we found an additional decreased GMV in the right fusiform in adult AN, and a decreased GMV in the left amygdala and left anterior cingulate cortex in AN patients without comorbidity (pure AN). Thus, the most consistent GMV alterations in AN patients are in the default mode network and the sensorimotor network. These psychoradiological findings of the brain abnormalities might underpin the neuropathophysiology in AN.
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Affiliation(s)
- Simin Zhang
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, 610041, Chengdu, China
| | - Weina Wang
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, 610041, Chengdu, China
| | - Xiaorui Su
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, 610041, Chengdu, China
| | - Graham J Kemp
- Liverpool Magnetic Resonance Imaging Centre (LiMRIC) and Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Xibiao Yang
- Department of Radiology, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, 610041, Chengdu, China
| | - Jingkai Su
- Department of Radiology, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, 610041, Chengdu, China
| | - Qiaoyue Tan
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, 610041, Chengdu, China
| | - Youjin Zhao
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, 610041, Chengdu, China
| | - Huaiqiang Sun
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, 610041, Chengdu, China
| | - Qiang Yue
- Department of Radiology, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, 610041, Chengdu, China.
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, 610041, Chengdu, China.
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