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Meneguzzo P, Terlizzi S, Maggi L, Todisco P. The loneliness factor in eating disorders: Implications for psychopathology and biological signatures. Compr Psychiatry 2024; 132:152493. [PMID: 38696935 DOI: 10.1016/j.comppsych.2024.152493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 04/07/2024] [Accepted: 04/26/2024] [Indexed: 05/04/2024] Open
Abstract
OBJECTIVES Eating disorders (ED) are severe psychiatric conditions. While the biological consequences of EDs are well established, including an increase in inflammatory biomarkers, the influence of psychological factors, such as loneliness, has only recently gained attention in research. Loneliness has been associated with more severe psychopathology in ED patients, while its association with inflammatory biomarkers has only been explored in the general population. For these reasons, we aimed to investigate any possible associations between psychological features, trauma, and inflammatory biomarkers with loneliness in people with ED. METHODS This study examined the interaction between loneliness, eating psychopathology, and biological markers in people with EDs. A group of 97 female patients with various diagnoses of ED was assessed for loneliness, general and eating psychopathology, traumatic history during childhood, and clinical biomarkers such as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and urinary-free cortisol (UFC). RESULTS The results indicated that individuals with ED who reported moderate to severe loneliness also displayed greater general psychopathology (p = 0.001), weight concerns (p = 0.007), and physical neglect during childhood (p = 0.006). Furthermore, people with higher levels of loneliness also had higher inflammatory indexes (ESR p = 0.001, CRP p = 0.027) and were positively correlated with markers of stress reaction such as UFC (p < 0.05). CONCLUSION The findings underscore the importance of considering loneliness in the assessment of individuals with an ED. We observed notable associations between loneliness and increased psychopathology (both general and specific to eating), as well as higher levels of inflammation and childhood physical neglect. Addressing loneliness may contribute to improving overall well-being and potentially support recovery. This consideration encompasses both psychological and physical factors that interplay in the clinical presentation of individuals.
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Affiliation(s)
- Paolo Meneguzzo
- Department of Neuroscience, University of Padova, via Giustiniani 2, 35128 Padova, Italy; Padova Neuroscience Center, University of Padova, Padova, Italy.
| | - Samira Terlizzi
- Eating Disorders Unit, Casa di Cura Villa Margherita - Neomesia, Arcugnano, Vicenza, Italy.
| | - Luca Maggi
- Eating Disorders Unit, Casa di Cura Ville di Nozzano - Neomesia, Nozzano, Lucca, Italy
| | - Patrizia Todisco
- Eating Disorders Unit, Casa di Cura Villa Margherita - Neomesia, Arcugnano, Vicenza, Italy
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Ghosh S, Burger P, Simeunovic-Ostojic M, Maas J, Petković M. Review of machine learning solutions for eating disorders. Int J Med Inform 2024; 189:105526. [PMID: 38935998 DOI: 10.1016/j.ijmedinf.2024.105526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 06/10/2024] [Accepted: 06/14/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Eating Disorders (EDs) are one of the most complex psychiatric disorders, with significant impairment of psychological and physical health, and psychosocial functioning, and are associated with low rates of early detection, low recovery and high relapse rates. This underscores the need for better diagnostic and treatment methods. OBJECTIVE This narrative review explores current Machine Learning (ML) and Artificial Intelligence (AI) applications in the domain of EDs, with a specific emphasis on clinical management in treatment settings. The primary objective are to (i) decrease the knowledge gap between ED researchers and AI-practitioners, by presenting the current state-of-the-art AI applications (including models for causality) in different ED use-cases; (ii) identify limitations of these existing AI interventions and how to address them. RESULTS AI/ML methods have been applied in different ED use-cases, including ED risk factor identification and incidence prediction (including the analysis of social media content in the general population), diagnosis, monitoring patients and treatment response and prognosis in clinical populations. A comparative analysis of AI-techniques deployed in these use-cases have been performed, considering factors such as complexity, flexibility, functionality, explainability and adaptability to healthcare constraints. CONCLUSION Multiple restrictions have been identified in the existing methods in ML and Causality in terms of achieving actionable healthcare for ED, like lack of good quality and quantity of data for models to train on, while requiring models to be flexible, high-performing, yet being explainable and producing counterfactual explanations, for ensuring the fairness and trustworthiness of its decisions. We conclude that to overcome these limitations and for future AI research and application in clinical management of ED, (i) careful considerations are required with regards to AI-model selection, and (ii) joint efforts from ED researcher and patient community are essential in building better quality and quantity of dedicated ED datasets and secure AI-solution framework.
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Affiliation(s)
- Sreejita Ghosh
- Dept. M & CS, Technical University of Eindhoven, Groene Loper 5, 5612 AZ Eindhoven, the Netherlands.
| | - Pia Burger
- Center of Eating Disorders, GGZ Oost-Brabant, Wesselmanlaan 25a, 5707 HA Helmond, the Netherlands.
| | | | - Joyce Maas
- Center of Eating Disorders, GGZ Oost-Brabant, Wesselmanlaan 25a, 5707 HA Helmond, the Netherlands; Dept. Medical and Clinical Psychology, Tilburg University, Prof. Cobbenhagenlaan, 5037 AB Tilburg, the Netherlands
| | - Milan Petković
- Dept. M & CS, Technical University of Eindhoven, Groene Loper 5, 5612 AZ Eindhoven, the Netherlands; Philips Hospital Patient Monitoring, High Tech Campus 34, 5656 AE Eindhoven, the Netherlands
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Bevilacqua A, Santini F, La Porta D, Cimino S. Association of serotonin receptor gene polymorphisms with anorexia nervosa: a systematic review and meta-analysis. Eat Weight Disord 2024; 29:31. [PMID: 38668826 PMCID: PMC11052845 DOI: 10.1007/s40519-024-01659-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 04/13/2024] [Indexed: 04/29/2024] Open
Abstract
PURPOSE Several studies have investigated the association between anorexia nervosa and polymorphisms of genes regulating serotonin neurotransmission, with a focus on the rs6311 polymorphism of 5-HTR2A. However, inconsistent results of these studies and conflicting conclusions of existing meta-analyses complicate the understanding of a possible association. We have updated these results and evaluated the involvement of other serotonin receptor gene polymorphisms in anorexia nervosa. METHODS Adhering to PRISMA guidelines, we have searched studies on anorexia nervosa and serotonin-regulating genes published from 1997 to 2022, selected those concerning receptor genes and meta-analyzed the results from twenty candidate gene studies on the 5-HTR2A rs6311 polymorphism and the 5-HTR2C rs6318 polymorphism. RESULTS Present analyses reveal an association for the 5-HTR2A rs6311 polymorphism, with G and A alleles, across eighteen studies (2049 patients, 2877 controls; A vs. G allele, Odds Ratio = 1.24; 95% Confidence Interval = 1.06-1.47; p = 0.009). However, after geographic subgrouping, an association emerged only in a Southern European area, involving five studies (722 patients, 773 controls; A vs. G allele, Odds Ratio = 1.82; 95% Confidence Interval = 1.41-2.37; p < 0.00001). No association was observed for the 5-HTR2C rs6318 polymorphism across three studies. CONCLUSIONS To date, the involvement in the pathophysiology of anorexia nervosa of the 5-HTR2A rs6311 polymorphism appears limited to a specific genetic and/or environmental context, while that of the 5-HTR2C rs6318 polymorphism seems excluded. Genome-wide association studies and epigenetic studies will likely offer deeper insights of genetic and environmental factors possibly contributing to the disorder. LEVEL OF EVIDENCE III Evidence obtained from well-designed cohort or case-control analytic studies. Clinical trial registration PROSPERO registration number: CRD42021246122.
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Affiliation(s)
- Arturo Bevilacqua
- Department of Dynamic, Clinical Psychology and Health Studies, Sapienza University of Rome, Via Dei Marsi 78, 00185, Rome, Italy.
- Systems Biology Group Lab and The Experts Group on Inositols in Basic and Clinical Research (EGOI), Research Center in Neurobiology Daniel Bovet (CRiN), Rome, Italy.
| | - Francesca Santini
- Department of Psychology of Development and Socialization Processes, Sapienza University of Rome, Via Dei Marsi 78, 00185, Rome, Italy
| | - Daniela La Porta
- Department of Psychology, Sapienza University of Rome, Via Dei Marsi 78, 00185, Rome, Italy
| | - Silvia Cimino
- Department of Dynamic, Clinical Psychology and Health Studies, Sapienza University of Rome, Via Dei Marsi 78, 00185, Rome, Italy
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Charrat JP, Massoubre C, Germain N, Gay A, Galusca B. Systematic review of prospective studies assessing risk factors to predict anorexia nervosa onset. J Eat Disord 2023; 11:163. [PMID: 37730675 PMCID: PMC10510169 DOI: 10.1186/s40337-023-00882-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 09/03/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND According to case‒control studies, a multitude of factors contribute to the emergence of anorexia nervosa (AN). The present systematic review examines prospective studies specifically designed to evaluate the prediction of AN onset. METHODS According to the ARMSTAR 2 and PRISMA 2020 checklists, the PubMed, PsycINFO and Cochrane databases were searched. The methodological quality of the studies was assessed with the Downs and Black checklist. RESULTS Three articles concerning prospective studies of the general population were ultimately included in the review. The methodological quality of these studies was not optimal. Bidirectional amplification effects were observed between risk factors, some of which could have a relative predictive force as low bodyweight or body dissatisfaction. Even if not included according to specified criteria for this systematic review 11 longitudinal studies, with retrospective analysis of AN onset' prediction, were also discussed. None of these studies asserted the predictive value of particular risk factors as low body weight, anxiety disorders or childhood aggression. CONCLUSIONS To date there are insufficient established data to propose predictive markers of AN onset for predictive actions in pre-adolescent or adolescent populations. Future work should further evaluate potential risk factors previously identified in case‒control/retrospective studies within larger prospective investigations in preadolescent populations. It is important to clearly distinguish predisposing factors from precipitating factors in subjects at risk of developing AN.
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Affiliation(s)
- Jean-Philippe Charrat
- TAPE (Eating Disorders, Addictions and Extreme Bodyweight) Laboratory, University Jean Monnet, Saint Etienne, France.
- Centre TCA, Hôpital Nord, Batiment A, CHU Saint Etienne, 42055, Saint Etienne Cedex 2, France.
| | - Catherine Massoubre
- TAPE (Eating Disorders, Addictions and Extreme Bodyweight) Laboratory, University Jean Monnet, Saint Etienne, France
- Centre TCA, Hôpital Nord, Batiment A, CHU Saint Etienne, 42055, Saint Etienne Cedex 2, France
- Referral Center for Eating Disorders, Saint Etienne University Hospital, Saint Etienne, France
| | - Natacha Germain
- TAPE (Eating Disorders, Addictions and Extreme Bodyweight) Laboratory, University Jean Monnet, Saint Etienne, France
- Centre TCA, Hôpital Nord, Batiment A, CHU Saint Etienne, 42055, Saint Etienne Cedex 2, France
- Referral Center for Eating Disorders, Saint Etienne University Hospital, Saint Etienne, France
| | - Aurélia Gay
- TAPE (Eating Disorders, Addictions and Extreme Bodyweight) Laboratory, University Jean Monnet, Saint Etienne, France
- Addictology Department, Saint Etienne University Hospital, Saint Etienne, France
| | - Bogdan Galusca
- TAPE (Eating Disorders, Addictions and Extreme Bodyweight) Laboratory, University Jean Monnet, Saint Etienne, France
- Centre TCA, Hôpital Nord, Batiment A, CHU Saint Etienne, 42055, Saint Etienne Cedex 2, France
- Referral Center for Eating Disorders, Saint Etienne University Hospital, Saint Etienne, France
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Via E, Contreras-Rodríguez O. Binge-Eating Precursors in Children and Adolescents: Neurodevelopment, and the Potential Contribution of Ultra-Processed Foods. Nutrients 2023; 15:2994. [PMID: 37447320 DOI: 10.3390/nu15132994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/12/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
Binge-eating disorder (BED) is a highly prevalent disorder. Subthreshold BED conditions (sBED) are even more frequent in youth, but their significance regarding BED etiology and long-term prognosis is unclear. A better understanding of brain findings associated with BED and sBED, in the context of critical periods for neurodevelopment, is relevant to answer such questions. The present narrative review starts from the knowledge of the development of emotional self-regulation in youth, and the brain circuits supporting emotion-regulation and eating behaviour. Next, neuroimaging studies with sBED and BED samples will be reviewed, and their brain-circuitry overlap will be examined. Deficits in inhibition control systems are observed to precede, and hyperactivity of reward regions to characterize, sBED, with overlapping findings in BED. The imbalance between reward/inhibition systems, and the implication of interoception/homeostatic processing brain systems should be further examined. Recent knowledge of the potential impact that the high consumption of ultra-processed foods in paediatric samples may have on these sBED/BED-associated brain systems is then discussed. There is a need to identify, early on, those sBED individuals at risk of developing BED at neurodevelopmental stages when there is a great possibility of prevention. However, more neuroimaging studies with sBED/BED pediatric samples are needed.
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Affiliation(s)
- Esther Via
- Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Santa Rosa 39-57, 08950 Esplugues de Llobregat, Spain
- Department of Child and Adolescent Mental Health, Hospital Sant Joan de Déu, Passeig Sant Joan de Déu, 2, 08950 Esplugues de Llobregat, Spain
| | - Oren Contreras-Rodríguez
- Medical Imaging, Girona Biomedical Research Institute (IdIBGi), Parc Hospitalari Martí i Julià-Edifici M2, Salt, 17190 Girona, Spain
- Health Institute Carlos III (ISCIII) and CIBERSAM, 28029 Madrid, Spain
- Department of Psychiatry and Legal Medicine, Faculty of Medicine, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
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Meneguzzo P, Mancini C, Terlizzi S, Sales C, Francesconi MF, Todisco P. Urinary free cortisol and childhood maltreatments in eating disorder patients: New evidence for an ecophenotype subgroup. EUROPEAN EATING DISORDERS REVIEW 2022; 30:364-372. [PMID: 35274398 PMCID: PMC9314975 DOI: 10.1002/erv.2896] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 01/31/2022] [Accepted: 03/01/2022] [Indexed: 12/14/2022]
Abstract
Introduction Increasing neurobiological evidence has suggested the presence of a specific ecophenotype in people with eating disorders (EDs) linked to early maltreatment. Urinary‐free cortisol could strengthen the data and show specific relationships between maltreated subtypes and the hormonal profiles of patients with EDs. This study aims to evaluate the presence of different urinary cortisol in drug‐free patients in the acute phase of the disorder and its relationship with childhood maltreatment. Methods A sample of 78 female patients with ED is included in the study. Childhood maltreatment history and 24‐h urinary free cortisol (24‐h UFC) are evaluated at a specialised ED ward admission. Results Patients with a maltreatment history show more blunted 24‐h UFC levels than peers without childhood maltreatment (p = 0.001). Regression analysis showed that child abuse is a predictor of the reduction of 24‐h UFC (p < 0.001), with physical abuse (p = 0.011) and sexual abuse (p = 0.050) that could have a more specific impact than other maltreatment subtypes. Discussion Childhood maltreatment should be evaluated in ED patients due to its biological impact on the hormonal stress axis, which could impair the ability of patients to respond to standardized ED treatment. Eating disorder patients with history of maltreatment showed a reduced 24‐h urinary free cortisol. New data support the evidence about the presence of an ecophenotype ED subgroup. Reduced 24‐h urinary free cortisol is significantly correlated with child abuses.
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Affiliation(s)
- Paolo Meneguzzo
- Eating Disorders UnitCasa di Cura“Villa Margherita”, Arcugnano (VI)VicenzaItaly
- Department of NeuroscienceUniversity of Padovavia Giustiniani 2PadovaItaly
- Padova Neuroscience CenterUniversity of PadovaPadovaItaly
| | - Cecilia Mancini
- Experimental Medicine DepartmentFood Science and Human Nutrition Research UnitSapienza University of RomeRomeItaly
| | - Samira Terlizzi
- Eating Disorders UnitCasa di Cura“Villa Margherita”, Arcugnano (VI)VicenzaItaly
| | - Chiara Sales
- Eating Disorders UnitCasa di Cura“Villa Margherita”, Arcugnano (VI)VicenzaItaly
| | | | - Patrizia Todisco
- Eating Disorders UnitCasa di Cura“Villa Margherita”, Arcugnano (VI)VicenzaItaly
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Meneguzzo P, Cazzola C, Castegnaro R, Buscaglia F, Bucci E, Pillan A, Garolla A, Bonello E, Todisco P. Associations Between Trauma, Early Maladaptive Schemas, Personality Traits, and Clinical Severity in Eating Disorder Patients: A Clinical Presentation and Mediation Analysis. Front Psychol 2021; 12:661924. [PMID: 33868136 PMCID: PMC8044897 DOI: 10.3389/fpsyg.2021.661924] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/11/2021] [Indexed: 12/12/2022] Open
Abstract
Background: The literature has shown a significant association between traumatic experiences and eating psychopathology, showing a greater symptomatology in patients with trauma history. Less is known about the associations between trauma and cognitive schemas, and personality traits and the differences between childhood and adulthood trauma experiences. Thus, this paper aims to assess the clinical and psychological characteristics of eating disorder (ED) patients, looking for differences between patients without a history of trauma and patients with trauma experiences, as well as at possible differences between exposure in childhood, adulthood, or repeated events. Another aim of the paper is to evaluate the possible mediation role of cognitive schemas and personality traits in the relationship between early trauma and eating psychopathology. Methods: From January to November 2020, 115 consecutive inpatients admitted for a specific multidisciplinary ED treatment in a dedicated Unit were evaluated for trauma, differentiating between trauma occurring in childhood and adulthood. The subjects were evaluated for early maladaptive schemas (EMS), personality traits, trauma symptomatology, quality of life, and specific psychopathologies linked to EDs. Mediation analyses between childhood and adulthood trauma and eating psychopathology were performed, with EMS and personality traits as mediators. Results: Patients with a history of trauma showed higher physical and psychological symptomatology scores, with a more impaired clinical profile in patients with both childhood and adulthood trauma exposure. The mediation analysis showed a specific mediator role for the “disconnection and rejection (DR)” EMS factor in the relationship between childhood trauma (cT) and eating psychopathology. Conclusion: Trauma experiences are associated with more severe clinical symptomatology in EDs and may need a specific assessment in patients with failed outpatient standard treatments. Specific cognitive schemas linked to DR domain should be evaluated in treatments for ED patients with history of trauma due to the mediation role between trauma and eating psychopathology. The need for outcome studies about treatment approaches for ED patients with history of trauma is discussed.
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Affiliation(s)
- Paolo Meneguzzo
- Eating Disorders Unit, Casa di Cura "Villa Margherita", Arcugnano, Italy.,Department of Neuroscience, University of Padova, Padova, Italy
| | - Chiara Cazzola
- Eating Disorders Unit, Casa di Cura "Villa Margherita", Arcugnano, Italy
| | - Roberta Castegnaro
- Eating Disorders Unit, Casa di Cura "Villa Margherita", Arcugnano, Italy
| | | | - Enrica Bucci
- Eating Disorders Unit, Casa di Cura "Villa Margherita", Arcugnano, Italy
| | - Anna Pillan
- Eating Disorders Unit, Casa di Cura "Villa Margherita", Arcugnano, Italy
| | - Alice Garolla
- Eating Disorders Unit, Casa di Cura "Villa Margherita", Arcugnano, Italy
| | - Elisa Bonello
- Eating Disorders Unit, Casa di Cura "Villa Margherita", Arcugnano, Italy
| | - Patrizia Todisco
- Eating Disorders Unit, Casa di Cura "Villa Margherita", Arcugnano, Italy
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Fleming C, Le Brocque R, Healy K. How are families included in the treatment of adults affected by eating disorders? A scoping review. Int J Eat Disord 2021; 54:244-279. [PMID: 33345319 DOI: 10.1002/eat.23441] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 11/30/2020] [Accepted: 11/30/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The involvement of families in the treatment of adults with eating disorders is recommended as a core component of comprehensive care, yet little is known about the optimal way to implement or routinely facilitate this. This article evaluates the recent evidence on the inclusion of families in treatment programs for adults with eating disorders. METHOD A systematic literature search was conducted to identify evidence of family inclusive treatment approaches for adults with eating disorders. A scoping review framework was applied to assess and synthesize findings. RESULTS Sixty-eight studies were identified. Substantial conceptual research contributing to the theoretical basis of current practice with families of adults with eating disorders and clinical applications in current use were identified. Most research used uncontrolled studies with few experimental designs, reflecting the standing of the extant literature. Common elements of existing approaches have been distinguished and shared core components of interventions identified. DISCUSSION Results confirmed that family members of adults were willing to be involved with eating disorder treatment services and appeared to respond to interventions of varying intensity and duration. The impact on individual patients, and effect on treatment outcomes, are yet to be established. The localized settings of existing studies, the homogenous nature of interventions used, and the limited diversity in research subjects, make it difficult to generalize from the results to the wide range of adult eating disorder presentations seen in practice. Suggestions for future research and further clinical developments are discussed.
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Affiliation(s)
- Carmel Fleming
- School of Nursing, Midwifery, and Social Work, The University of Queensland, Brisbane, Queensland, Australia.,Queensland Health Metro North Hospital and Health Service, Queensland Eating Disorder Service, Brisbane, Australia
| | - Robyne Le Brocque
- School of Nursing, Midwifery, and Social Work, The University of Queensland, Brisbane, Queensland, Australia
| | - Karen Healy
- School of Nursing, Midwifery, and Social Work, The University of Queensland, Brisbane, Queensland, Australia
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9
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Is Serum BDNF Altered in Acute, Short- and Long-Term Recovered Restrictive Type Anorexia Nervosa? Nutrients 2021; 13:nu13020432. [PMID: 33572701 PMCID: PMC7910942 DOI: 10.3390/nu13020432] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/22/2021] [Accepted: 01/25/2021] [Indexed: 12/19/2022] Open
Abstract
Brain-derived neurotrophic factor (BDNF), a neurotrophin involved in the regulation of food intake and body weight, has been implicated in the development and maintenance of Anorexia nervosa (AN). The majority of previous studies reported lower BDNF levels in acutely underweight AN patients (acAN) and increasing levels after weight rehabilitation. Here, we investigated serum BDNF concentrations in the largest known AN sample to date, both before and after weight restoration therapy. Serum BDNF was measured in 259 female volunteers: 77 in-patient acAN participants of the restrictive type (47 reassessed after short-term weight rehabilitation), 62 individuals long-term recovered from AN, and 120 healthy controls. We validated our findings in a post-hoc mega-analysis in which we reanalyzed combined data from the current sample and those from our previous study on BDNF in AN (combined sample: 389 participants). All analyses carefully accounted for known determinants of BDNF (age, sex, storage time of blood samples). We further assessed relationships with relevant clinical variables (body-mass-index, physical activity, symptoms). Contrary to our hypotheses, we found zero significant differences in either cross-sectional or longitudinal comparisons and no significant relationships with clinical variables. Together, our study suggests that BDNF may not be a reliable state- or trait-marker in AN after all.
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Tahıllıoğlu A, Özcan T, Yüksel G, Majroh N, Köse S, Özbaran B. Is aripiprazole a key to unlock anorexia nervosa?: A case series. Clin Case Rep 2020; 8:2827-2834. [PMID: 33363831 PMCID: PMC7752603 DOI: 10.1002/ccr3.3271] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 07/23/2020] [Accepted: 07/24/2020] [Indexed: 12/12/2022] Open
Abstract
Aripiprazole contributes an increase in body mass index and attenuation in anorexia nervosa (AN) symptoms, leading clinical improvements with lower side-effect profile; but it is not enough to cure comorbid depressive symptoms in AN.
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Affiliation(s)
- Akın Tahıllıoğlu
- Department of Child and Adolescent PsychiatryFaculty of MedicineEge UniversityIzmirTurkey
| | - Tuğçe Özcan
- Department of Child and Adolescent PsychiatryFaculty of MedicineEge UniversityIzmirTurkey
| | - Gamze Yüksel
- Department of Child and Adolescent PsychiatryFaculty of MedicineEge UniversityIzmirTurkey
| | - Noorjahan Majroh
- Department of Child and Adolescent PsychiatryFaculty of MedicineEge UniversityIzmirTurkey
| | - Sezen Köse
- Department of Child and Adolescent PsychiatryFaculty of MedicineEge UniversityIzmirTurkey
| | - Burcu Özbaran
- Department of Child and Adolescent PsychiatryFaculty of MedicineEge UniversityIzmirTurkey
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11
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Goldberg JO, Flett GL. What Celebrity Case Studies Can Teach about Clinical Formulation of Mental Health Conditions. THE JOURNAL OF PSYCHOLOGY 2020; 154:662-679. [PMID: 32865473 DOI: 10.1080/00223980.2020.1791788] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
A key challenge in the 'making of the psychologist' is how to teach clinical case formulation, which goes beyond just listing the symptoms that make the 'diagnosis'. One approach which has been both effective and popular among students entails employing case studies of individuals who are celebrities with known mental health conditions and then exploring not only their presenting problems and symptoms, but also a detailed analysis of biopsychosocial predisposing concerns, precipitating events, perpetuating circumstances, and protective factors. Nine cases deemed to be particularly suitable for such psychobiographical instruction are reviewed to illustrate the learning points about case formulation. The cases were chosen because they provide a breadth of presenting symptoms and the individuals under consideration are ones who for the most part have been self-disclosing about their conditions, which makes the clinical material accessible for study; a number have been leaders in the fight against mental illness stigma. The use of celebrity case accounts serves to develop talents in case formulation and appreciation for the complexity of people and the developmental influences in identity formation. Further pedagogic benefits are heightened awareness of mental health stigma issues and the personal and societal barriers individuals face in seeking needed help.
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12
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Kamody RC, Yonkers K, Pluhar EI, Olezeski CL. Disordered Eating Among Trans-Masculine Youth: Considerations Through a Developmental Lens. LGBT Health 2020; 7:170-173. [PMID: 32380892 DOI: 10.1089/lgbt.2019.0354] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
As with male populations more generally, eating disorder symptom expression among trans-masculine youth is understudied. Gender minority individuals are at increased risk for eating disorders; however, culturally responsive and developmentally tailored research is limited. Although all gender minority individuals may experience elevated risk for developing eating disorders, the focus of this article is trans-masculine youth. We provide a theoretical conceptualization of eating disorder symptom expression among this understudied group, and propose novel directions for research, particularly for youth at pubertal onset. Adolescence as a critical developmental period for intervention is highlighted.
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Affiliation(s)
- Rebecca C Kamody
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA.,Yale Medicine Pediatric Gender Program, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Kimberly Yonkers
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA.,Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
| | - Emily I Pluhar
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Christy L Olezeski
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA.,Yale Medicine Pediatric Gender Program, Yale New Haven Hospital, New Haven, Connecticut, USA
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13
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Abstract
Bulimia nervosa (BN) shares central features with substance-related and addictive disorders. The metabotropic glutamate receptor subtype 5 (mGlu5) plays an important role in addiction. Based on similarities between binge eating and substance-related and addictive disorders, we investigated mGlu5 in vivo in 15 female subjects with BN and 15 matched controls. We measured mGlu5 distribution volume ratio (DVR) with positron emission tomography (PET) using [11 C]ABP688. In BN mGlu5 DVR was higher in the anterior cingulate cortex (ACC), subgenual prefrontal cortex, and straight gyrus (p < 0.05). In BN, higher mGlu5 DVR in various brain regions, including ACC, pallidum, putamen, and caudate, positively correlated with "maturity fears" as assessed using the Eating Disorder Inventory-2 (p < 0.05). In BN and controls, smokers had globally decreased mGlu5 DVR. We present the first evidence for increased mGlu5 DVR in BN. Our findings suggest that pharmacological agents inhibiting mGlu5 might have a therapeutic potential in BN.
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14
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Radical Acceptance and Obesity-Related Health Conditions: A Case Report. J Clin Psychol Med Settings 2020; 27:217-225. [DOI: 10.1007/s10880-019-09696-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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15
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Abstract
Eating disorders are severe psychiatric illnesses with a typical age of onset in adolescence. Brain research in youth and young adults may help us identify specific neurobiology that contributes to onset and maintenance of those disorders. This article provides a state-of-the-art review of our current understanding of the neurobiology of anorexia nervosa and bulimia nervosa. This includes brain structure and function studies to understand food restriction, binge-eating or purging behaviors, cognitive and emotional factors, as well as interoception. Binge-eating disorder and avoidant restrictive food intake disorder are also discussed, but the literature is still very small.
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16
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Steding J, Boehm I, King JA, Geisler D, Ritschel F, Seidel M, Doose A, Jaite C, Roessner V, Smolka MN, Ehrlich S. Goal-directed vs. habitual instrumental behavior during reward processing in anorexia nervosa: an fMRI study. Sci Rep 2019; 9:13529. [PMID: 31537862 PMCID: PMC6753148 DOI: 10.1038/s41598-019-49884-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 08/30/2019] [Indexed: 12/18/2022] Open
Abstract
Previous studies have proposed that altered reward processing and elevated cognitive control underlie the etiology of anorexia nervosa (AN). A newly debated notion suggests altered habit learning and an overreliance on habits may contribute to the persistence of AN. In weight-recovered AN patients, we previously found neuroimaging-based evidence for unaltered reward processing, but elevated cognitive control. In order to differentiate between state versus trait factors, we here contrast the aforementioned hypotheses in a sample of acutely underweight AN (acAN) patients. 37 acAN patients and 37 closely matched healthy controls (HC) underwent a functional MRI while performing an established instrumental motivation task. We found no group differences with respect to neural responses during the anticipation or receipt of reward. However, the behavioral response data showed a bimodal distribution, indicative for a goal-directed (gAN) and a habit-driven (hAN) patient subgroup. Additional analyses revealed decreased mOFC activation during reward anticipation in hAN, which would be in line with a habit-driven response. These findings provide a new perspective on the debate regarding the notion of increased goal-directed versus habitual behavior in AN. If replicable, the observed dissociation between gAN and hAN might help to tailor therapeutic approaches to individual patient characteristics.
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Affiliation(s)
- Julius Steding
- Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Ilka Boehm
- Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Joseph A King
- Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Daniel Geisler
- Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Franziska Ritschel
- Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Maria Seidel
- Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Arne Doose
- Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Charlotte Jaite
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Michael N Smolka
- Department of Psychiatry and Neuroimaging Center, TU Dresden, Dresden, Germany
| | - Stefan Ehrlich
- Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Dresden, Germany. .,Translational Developmental Neuroscience Section, Department of Child and Adolescent Psychiatry, Eating Disorders Research and Treatment Center, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany.
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17
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Mehler PS, O'Melia A, Brown C, Gibson D, Hollis J, Westmoreland P. Medical complications of bulimia nervosa. Br J Hosp Med (Lond) 2019; 78:672-677. [PMID: 29240508 DOI: 10.12968/hmed.2017.78.12.672] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Bulimia nervosa is a psychiatric disorder with many different medical sequelae. This article reviews the principal medical complications associated with bulimia nervosa, and emphasizes the importance of a timely approach to diagnosis and management.
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Affiliation(s)
- Philip S Mehler
- Founder and Executive Medical Director ACUTE at Denver Health, Chief Medical Officer, Eating Recovery Center of Denver, Denver, CO 80204, USA
| | - Anne O'Melia
- Psychiatrist, Eating Recovery Center of Denver, Denver, CO, USA
| | - Carrie Brown
- Hospitalist, Denver Health and Hospital Authority, Denver, CO, USA
| | - Dennis Gibson
- Hospitalist, Denver Health and Hospital Authority, Denver, CO, USA
| | - Jeff Hollis
- Hospitalist, Denver Health and Hospital Authority, Denver, CO, USA
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18
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Frank GKW, DeGuzman MC, Shott ME. Motivation to eat and not to eat - The psycho-biological conflict in anorexia nervosa. Physiol Behav 2019; 206:185-190. [PMID: 30980856 DOI: 10.1016/j.physbeh.2019.04.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 04/09/2019] [Accepted: 04/09/2019] [Indexed: 12/15/2022]
Abstract
Anorexia nervosa is a severe psychiatric illness with high mortality. Brain imaging research has indicated altered reward circuits in the disorder. Here we propose a disease model for anorexia nervosa, supported by recent studies, that integrates psychological and biological factors. In that model, we propose that there is a conflict between the conscious motivation to restrict food, and a body-homeostasis driven motivation to approach food in response to weight loss. These opposing motivations trigger anxiety, which maintains the vicious cycle of ongoing energy restriction and weight loss.
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Affiliation(s)
- Guido K W Frank
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, CO, USA; Department of Neuroscience, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, CO, USA.
| | - Marisa C DeGuzman
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, CO, USA; Department of Neuroscience, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, CO, USA
| | - Megan E Shott
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, CO, USA
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19
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Berner LA, Wang Z, Stefan M, Lee S, Huo Z, Cyr M, Marsh R. Subcortical Shape Abnormalities in Bulimia Nervosa. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2019; 4:1070-1079. [PMID: 30846367 DOI: 10.1016/j.bpsc.2018.12.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 12/24/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Bulimia nervosa (BN) is associated with functional abnormalities in frontostriatal and frontolimbic circuits. Although structural alterations in the frontal portions of these circuits have been observed, this is the first study of subcortical surface morphometry and the largest study of subcortical volume in BN. METHODS Anatomical magnetic resonance scans were acquired from 62 female participants with full and subthreshold BN (mean age ± SD, 18.7 ± 4.0 years) and 65 group-matched healthy control participants (mean age ± SD, 19.3 ± 5.7 years). General linear models were used to compare groups and assess the significance of group-by-age interactions on the shape and total volume of 15 subcortical structures (p < .05, familywise error corrected). Associations with illness severity and duration were assessed in the BN group. RESULTS Subcortical volumes did not differ across groups, but vertexwise analyses revealed inward shape deformations on the anterior surface of the pallidum in BN relative to control participants that were associated with binge-eating frequency and illness duration. Inward deformations on the ventrolateral thalamus and dorsal amygdala were more pronounced with advancing age in the BN group, and inward deformations on the caudate, putamen, and amygdala were associated with self-induced vomiting frequency. CONCLUSIONS Our findings point to localized deformations on the surface of subcortical structures in areas that comprise both reward and cognitive control circuits. These deformations were more pronounced among older BN participants and among those with the most severe symptoms. Such precise localization of alterations in subcortical morphometry may ultimately aid in efforts to identify markers of risk and BN persistence.
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Affiliation(s)
- Laura A Berner
- Department of Psychiatry, University of California, San Diego, San Diego, California.
| | - Zhishun Wang
- Division of Child and Adolescent Psychiatry, Columbia University Medical Center and the New York State Psychiatric Institute, New York, New York
| | - Mihaela Stefan
- Division of Child and Adolescent Psychiatry, Columbia University Medical Center and the New York State Psychiatric Institute, New York, New York
| | - Seonjoo Lee
- Division of Child and Adolescent Psychiatry, Columbia University Medical Center and the New York State Psychiatric Institute, New York, New York
| | - Zhiyong Huo
- Division of Child and Adolescent Psychiatry, Columbia University Medical Center and the New York State Psychiatric Institute, New York, New York; Key Laboratory of Image Communication and Image Processing, Nanjing University of Posts and Telecommunications, Nanjing, China
| | - Marilyn Cyr
- Division of Child and Adolescent Psychiatry, Columbia University Medical Center and the New York State Psychiatric Institute, New York, New York
| | - Rachel Marsh
- Division of Child and Adolescent Psychiatry, Columbia University Medical Center and the New York State Psychiatric Institute, New York, New York
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20
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Timko CA, DeFilipp L, Dakanalis A. Sex Differences in Adolescent Anorexia and Bulimia Nervosa: Beyond the Signs and Symptoms. Curr Psychiatry Rep 2019; 21:1. [PMID: 30637488 PMCID: PMC6559358 DOI: 10.1007/s11920-019-0988-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW We review research related to sex differences in eating disorders (EDs) in adolescents. Prior work has explored clinical differences; thus, we examine literature in areas identified as playing an etiological or maintenance role in EDs including: genetics, hormones, neurocognitive inefficiencies, and reward circuitry. RECENT FINDINGS Sex steroids appear to a play role in the unmasking of genetic risk for development of EDs and puberty may be a heightened period of risk for females. While neurocognitive differences have been well studied in adults with ED, research with adolescents has been less conclusive. Recent work suggests that neural circuitry involved in reward and punishment may play role in development and maintenance of EDs in females. Males are underrepresented in these areas of research. Given known sex differences in healthy adolescents, it is likely there are sex differences in the putative biological etiology/maintenance of EDs. Males should be included in future research.
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Affiliation(s)
- C Alix Timko
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Department of Child and Adolescent Psychiatry and Behavioral Science, Robert's Center for Pediatric Research, 2716 South Street, 8-212, Philadelphia, PA, 19146, USA.
| | - Levi DeFilipp
- Department of Child and Adolescent Psychiatry and Behavioral Science, Robert's Center for Pediatric Research, 2716 South Street, 8-212, Philadelphia, PA, 19146, USA
| | - Antonios Dakanalis
- Department of Medicine and Surgery, University of Milano Bicocca, Cadore 48, 20900, Monza, Italy
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21
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Murray SB, Strober M, Craske MG, Griffiths S, Levinson CA, Strigo IA. Fear as a translational mechanism in the psychopathology of anorexia nervosa. Neurosci Biobehav Rev 2018; 95:383-395. [DOI: 10.1016/j.neubiorev.2018.10.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 10/11/2018] [Accepted: 10/22/2018] [Indexed: 12/30/2022]
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22
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Frank GKW, DeGuzman MC, Shott ME, Laudenslager ML, Rossi B, Pryor T. Association of Brain Reward Learning Response With Harm Avoidance, Weight Gain, and Hypothalamic Effective Connectivity in Adolescent Anorexia Nervosa. JAMA Psychiatry 2018; 75:1071-1080. [PMID: 30027213 PMCID: PMC6233809 DOI: 10.1001/jamapsychiatry.2018.2151] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
IMPORTANCE Anorexia nervosa (AN) is associated with adolescent onset, severe low body weight, and high mortality as well as high harm avoidance. The brain reward system could have an important role in the perplexing drive for thinness and food avoidance in AN. OBJECTIVE To test whether brain reward learning response to taste in adolescent AN is altered and associated with treatment response, striatal-hypothalamic connectivity, and elevated harm avoidance. DESIGN, SETTING, AND PARTICIPANTS In this cross-sectional multimodal brain imaging study, adolescents and young adults with AN were matched with healthy controls at a university brain imaging facility and eating disorder treatment program. During a sucrose taste classical conditioning paradigm, violations of learned associations between conditioned visual and unconditioned taste stimuli evoked the dopamine-related prediction error (PE). Dynamic effective connectivity during sweet taste receipt was studied to investigate hierarchical brain activation across the brain network that regulates eating. The study was conducted from July 2012 to May 2017, and data were analyzed from June 2017 to December 2017. MAIN OUTCOMES AND MEASURES Prediction error brain reward response across the insula, caudate, and orbitofrontal cortex; dynamic effective connectivity between hypothalamus and ventral striatum; and treatment weight gain, harm avoidance scores, and salivary cortisol levels and their correlations with PE brain response. RESULTS Of 56 female participants with AN included in the study, the mean (SD) age was 16.6 (2.5) years, and the mean (SD) body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) was 15.9 (0.9); of 52 matched female controls, the mean (SD) age was 16.0 (2.8) years, and the mean (SD) BMI was 20.9 (2.1). Prediction error response was elevated in participants with AN in the caudate head, nucleus accumbens, and insula (multivariate analysis of covariance: Wilks λ, 0.707; P = .02; partial η2 = 0.296), which correlated negatively with sucrose taste pleasantness. Bilateral AN orbitofrontal gyrus rectus PE response was positively correlated with harm avoidance (right ρ, 0.317; 95% CI, 0.091 to 0.539; P < .02; left ρ, 0.336; 95% CI, 0.112 to 0.550; P < .01) but negatively correlated with treatment BMI change (right ρ, -0.282; 95% CI, -0.534 to -0.014; P < .04; left ρ, -0.268; 95% CI, -0.509 to -0.018; P < .045). Participants with AN showed effective connectivity from ventral striatum to hypothalamus, and connectivity strength was positively correlated with insula and orbitofrontal PE response. Right frontal cortex PE response was associated with cortisol, which correlated with body dissatisfaction. CONCLUSIONS AND RELEVANCE These results further support elevated PE signal in AN and suggest a link between PE and elevated harm avoidance, brain connectivity, and weight gain in AN. Prediction error may have a central role in adolescent AN in driving anxiety and ventral striatal-hypothalamus circuit-controlled food avoidance.
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Affiliation(s)
- Guido K. W. Frank
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora,Neuroscience Program, University of Colorado Anschutz Medical Campus, Aurora
| | - Marisa C. DeGuzman
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora,Neuroscience Program, University of Colorado Anschutz Medical Campus, Aurora
| | - Megan E. Shott
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora
| | - Mark L. Laudenslager
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora
| | - Brogan Rossi
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora
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23
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Affiliation(s)
- Joanna E Steinglass
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York.,Department of Psychiatry, New York State Psychiatric Institute, New York
| | - Karin Foerde
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York.,Department of Psychiatry, New York State Psychiatric Institute, New York
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24
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Neural Correlates of Impaired Reward-Effort Integration in Remitted Bulimia Nervosa. Neuropsychopharmacology 2018; 43:868-876. [PMID: 29105662 PMCID: PMC5809799 DOI: 10.1038/npp.2017.277] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 09/26/2017] [Accepted: 10/30/2017] [Indexed: 12/28/2022]
Abstract
The integration of reward magnitudes and effort costs is required for an effective behavioral guidance. This reward-effort integration was reported to be dependent on dopaminergic neurotransmission. As bulimia nervosa has been associated with a dysregulated dopamine system and catecholamine depletion led to reward-processing deficits in remitted bulimia nervosa, the purpose of this study was to identify the role of catecholamine dysfunction and its relation to behavioral and neural reward-effort integration in bulimia nervosa. To investigate the interaction between catecholamine functioning and behavioral, and neural responses directly, 17 remitted bulimic (rBN) and 21 healthy individuals (HC) received alpha-methyl-paratyrosine (AMPT) over 24 h to achieve catecholamine depletion in a randomized, crossover study design. We used functional magnetic resonance imaging (fMRI) and the monetary incentive delay (MID) task to assess reward-effort integration in relation to catecholaminergic neurotransmission at the behavioral and neural level. AMPT reduced the ability to integrate rewards and efforts effectively in HC participants. In contrast, in rBN participants, the reduced reward-effort integration was associated with illness duration in the sham condition and unrelated to catecholamine depletion. Regarding neural activation, AMPT decreased the reward anticipation-related neural activation in the anteroventral striatum. This decrease was associated with the AMPT-induced reduction of monetary earning in HC in contrast to rBN participants. Our findings contributed to the theory of a desensitized dopaminergic system in bulimia nervosa. A disrupted processing of reward magnitudes and effort costs might increase the probability of maintenance of bulimic symptoms.
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25
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Structural Neuroimaging of Anorexia Nervosa: Future Directions in the Quest for Mechanisms Underlying Dynamic Alterations. Biol Psychiatry 2018; 83:224-234. [PMID: 28967386 PMCID: PMC6053269 DOI: 10.1016/j.biopsych.2017.08.011] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 07/21/2017] [Accepted: 08/14/2017] [Indexed: 02/07/2023]
Abstract
Anorexia nervosa (AN) is a serious eating disorder characterized by self-starvation and extreme weight loss. Pseudoatrophic brain changes are often readily visible in individual brain scans, and AN may be a valuable model disorder to study structural neuroplasticity. Structural magnetic resonance imaging studies have found reduced gray matter volume and cortical thinning in acutely underweight patients to normalize following successful treatment. However, some well-controlled studies have found regionally greater gray matter and persistence of structural alterations following long-term recovery. Findings from diffusion tensor imaging studies of white matter integrity and connectivity are also inconsistent. Furthermore, despite the severity of AN, the number of existing structural neuroimaging studies is still relatively low, and our knowledge of the underlying cellular and molecular mechanisms for macrostructural brain changes is rudimentary. We critically review the current state of structural neuroimaging in AN and discuss the potential neurobiological basis of structural brain alterations in the disorder, highlighting impediments to progress, recent developments, and promising future directions. In particular, we argue for the utility of more standardized data collection, adopting a connectomics approach to understanding brain network architecture, employing advanced magnetic resonance imaging methods that quantify biomarkers of brain tissue microstructure, integrating data from multiple imaging modalities, strategic longitudinal observation during weight restoration, and large-scale data pooling. Our overarching objective is to motivate carefully controlled research of brain structure in eating disorders, which will ultimately help predict therapeutic response and improve treatment.
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26
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Abstract
INTRODUCTION Anorexia nervosa (AN), bulimia nervosa (BN) and binge eating disorder (BED) are the primary eating disorders (EDs). The only psychopharmacological treatment options for EDs with approval in some countries include fluoxetine for BN and lisdexamfetamine for BED. Given the high comorbidity and genetic correlations with other psychiatric disorders, it seems possible that novel medications for these conditions might also be effective in EDs. Areas covered: The current scientific literature has increased our understanding of how medication could be beneficial for patients with EDs on a molecular, functional and behavioral level. On the basis of theoretical considerations about neurotransmitters, hormones and neural circuits, possible drug targets for the treatment of EDs may include signal molecules and receptors of the self-regulatory system such as serotonin, norepinephrine and glutamate, the hedonic system including opioids, cannabinoids and dopamine and the hypothalamic homeostatic system including histamine, ghrelin, leptin, insulin, and glucagon-like peptide-1. Expert commentary: The latest research points to an involvement of both the immune and the metabolic systems in the pathophysiology of EDs and highlights the importance of the microbiome. Therefore, the next few years may unveil drug targets for EDs not just inside and outside of the brain, but possibly even outside of the human body.
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Affiliation(s)
- Hubertus Himmerich
- a Department of Psychological Medicine , King's College London , London , UK
| | - Janet Treasure
- a Department of Psychological Medicine , King's College London , London , UK
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27
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Frank GK, Shott ME, Hagman JO, Schiel MA, Deguzman M, Rossi B. The partial dopamine D2 receptor agonist aripiprazole is associated with weight gain in adolescent anorexia nervosa. Int J Eat Disord 2017; 50:447-450. [PMID: 28334444 PMCID: PMC5392387 DOI: 10.1002/eat.22704] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 02/26/2017] [Accepted: 03/01/2017] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Finding medication to support treatment of anorexia nervosa has been difficult. Neuroscience-based approaches may help in this effort. Recent brain imaging studies in adults and adolescents with anorexia nervosa suggest that dopamine-related reward circuits are hypersensitive and could provide a treatment target. METHODS Here, we present a retrospective chart review of 106 adolescents with anorexia nervosa some of whom were treated with the dopamine D2 receptor partial agonist aripiprazole during treatment in a specialized eating disorder program. RESULTS The results show that aripiprazole treatment was associated with greater increase in body mass index (BMI) during treatment. DISCUSSION The use of dopamine receptor agonists may support treatment success in anorexia nervosa and should be further investigated.
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Affiliation(s)
- Guido K.W. Frank
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado,Department of Neuroscience, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Megan E. Shott
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Jennifer O. Hagman
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Marissa A. Schiel
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Marisa Deguzman
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado,Department of Neuroscience, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Brogan Rossi
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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28
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Frank GKW. Brain Reward Processing in Eating Disorders: Opportunities to Build Upon? J Am Acad Child Adolesc Psychiatry 2016; 55:929-930. [PMID: 27806859 DOI: 10.1016/j.jaac.2016.07.779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 09/01/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Guido K W Frank
- University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, CO.
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