Impact of Impulsivity and Therapy Response in Eating Disorders from a Neurophysiological, Personality and Cognitive Perspective

Impulsivity, as a multidimensional construct, has been linked to eating disorders (EDs) and may negatively impact treatment response. The study aimed to identify the dimensions of impulsivity predicting poor remission of ED symptoms. A total of 37 ED patients underwent a baseline assessment of impulsive personality traits and inhibitory control, including the Stroop task and the emotional go/no-go task with event-related potentials (ERPs) analysis. The remission of EDs symptomatology was evaluated after 3 months of cognitive-behavioral therapy (CBT) and at a 2-year follow-up. Poor remission after CBT was predicted by poor inhibitory control, as measured by the Stroop task. At 2 years, the risk of poor remission was higher in patients with higher novelty seeking, lower inhibitory control in the Stroop and in ERPs indices (N2 amplitudes) during the emotional go/no-go task. The present results highlight inhibitory control negatively impacting both short- and long-term symptomatology remission in ED patients. On the other hand, high novelty seeking and ERPs indices of poor inhibition seem to be more specifically related to long-term remission. Therefore, a comprehensive assessment of the impulsivity dimension in patients with ED is recommended to tailor treatments and improve their efficacy.

Clinical and Neurophysiological Correlates of Emotion and Food Craving Regulation in Patients with Anorexia Nervosa

Background: Difficulties in emotion regulation and craving regulation have been linked to eating symptomatology in patients with anorexia nervosa (AN), contributing to the maintenance of their eating disorder. Methods: To investigate clinical and electrophysiological correlates of these processes, 20 patients with AN and 20 healthy controls (HC) completed a computerized task during EEG recording, where they were instructed to down-regulate negative emotions or food craving. Participants also completed self-report measures of emotional regulation and food addiction. The P300 and Late Positive Potential (LPP) ERPs were analysed. Results: LPP amplitudes were significantly smaller during down-regulation of food craving among both groups. Independent of task condition, individuals with AN showed smaller P300 amplitudes compared to HC. Among HC, the self-reported use of re-appraisal strategies positively correlated with LPP amplitudes during emotional regulation task, while suppressive strategies negatively correlated with LPP amplitudes. The AN group, in comparison to the HC group, exhibited greater food addiction, greater use of maladaptive strategies, and emotional dysregulation. Conclusions: Despite the enhanced self-reported psychopathology among AN, both groups indicated neurophysiological evidence of food craving regulation as evidenced by blunted LPP amplitudes in the relevant task condition. Further research is required to delineate the mechanisms associated with reduced overall P300 amplitudes among individuals with AN.

Decreased Corticospinal Excitability after the Illusion of Missing Part of the Arm

Previous studies on body ownership illusions have shown that under certain multimodal conditions, healthy people can experience artificial body-parts as if they were part of their own body, with direct physiological consequences for the real limb that gets 'substituted.' In this study we wanted to assess (a) whether healthy people can experience 'missing' a body-part through illusory ownership of an amputated virtual body, and (b) whether this would cause corticospinal excitability changes in muscles associated with the 'missing' body-part. Forty right-handed participants saw a virtual body from a first person perspective but for half of them the virtual body was missing a part of its right arm. Single pulse transcranial magnetic stimulation was applied before and after the experiment to left and right motor cortices. Motor evoked potentials (MEPs) were recorded from the first dorsal interosseous (FDI) and the extensor digitorum communis (EDC) of each hand. We found that the stronger the illusion of amputation and arm ownership, the more the reduction of MEP amplitudes of the EDC muscle for the contralateral sensorimotor cortex. In contrast, no association was found for the EDC amplitudes in the ipsilateral cortex and for the FDI amplitudes in both contralateral and ipsilateral cortices. Our study provides evidence that a short-term illusory perception of missing a body-part can trigger inhibitory effects on corticospinal pathways and importantly in the absence of any limb deafferentation or disuse.

Unexpected online gambling disorder in late-life: a case report

Background: The lifetime prevalence of problem or Gambling disorder (GD) in the elderly (i.e., those over 60 years old) is reported to range from 0.01 to 10.9%. Research has identified several specific risk factors and vulnerabilities in the elderly. Since the late 1990s, an increase in online GD has been observed in the youth population, whereas casinos, slot machines, and bingo seem to be the activities of choice among the elderly. Interestingly, online GD has not been described in the elderly to date.

Case Description: We report an 83-year-old man who started online casino gambling from the age of 80 years, leading to debts that exceeded €30,000. He underwent a full clinical and neuropsychological assessment, without any evidence of cognitive impairment or any associated neurodegenerative disease. However, he had risk factors for GD, including adjustment disorder, stressful life events, previous offline casino GD when 50 years old, and dysfunctional personality traits. The change to online GD may have been due to his isolation, movement difficulties, and his high level of education, which facilitated his access to the Internet. Care management focused on individual cognitive-behavioral therapy.

Conclusion: The prevalence of online GD may be underestimated among the elderly, and may increase among isolated old people with movement difficulties and ready access to the Internet. However, late-life GD should be considered a diagnosis of elimination, requiring a full medical, psychiatric (including suicide risk), and cognitive assessment. Specific therapeutic approaches need to be proposed and developed.