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Nutrients Aug 2019Anorexia nervosa (AN) is an eating disorder often occurring in adolescence. AN has one of the highest mortality rates amongst psychiatric illnesses and is associated...
Anorexia nervosa (AN) is an eating disorder often occurring in adolescence. AN has one of the highest mortality rates amongst psychiatric illnesses and is associated with medical complications and high risk for psychiatric comorbidities, persisting after treatment. Remission rates range from 23% to 33%. Moreover, weight recovery does not necessarily reflect cognitive recovery. This issue is of particular interest in adolescence, characterized by progressive changes in brain structure and functional circuitries, and fast cognitive development. We reviewed existing literature on fMRI studies in adolescents diagnosed with AN, following PRISMA guidelines. Eligible studies had to: (1) be written in English; (2) include only adolescent participants; and (3) use block-design fMRI. We propose a pathogenic model based on normal and AN-related neural and cognitive maturation during adolescence. We propose that underweight and delayed puberty-caused by genetic, environmental, and neurobehavioral factors-can affect brain and cognitive development and lead to impaired cognitive flexibility, which in turn sustains the perpetuation of aberrant behaviors in a vicious cycle. Moreover, greater punishment sensitivity causes a shift toward punishment-based learning, leading to greater anxiety and ultimately to excessive reappraisal over emotions. Treatments combining physiological and neurobehavioral rationales must be adopted to improve outcomes and prevent relapses.
Topics: Adolescent; Adolescent Behavior; Adolescent Development; Age Factors; Anorexia Nervosa; Brain; Cognition; Cognition Disorders; Feeding Behavior; Female; Humans; Magnetic Resonance Imaging; Mental Health; Puberty, Delayed; Recovery of Function; Risk Factors; Sex Factors; Treatment Outcome
PubMed: 31443192
DOI: 10.3390/nu11081907 -
Neuroscience and Biobehavioral Reviews Aug 2019The comorbidity between discrete clinical diagnosis occurs in higher levels than prevalence rates, indicating that mental disorders are systematically overcategorized.... (Meta-Analysis)
Meta-Analysis
The comorbidity between discrete clinical diagnosis occurs in higher levels than prevalence rates, indicating that mental disorders are systematically overcategorized. Dimensional models - as the Internalizing-Externalizing Spectrum - claim for a common latent structure of psychopathology. The current meta-analysis aims to evaluate whether the externalizing and internalizing latent factors of the psychopathological spectrum display common and distinctive neurobiological substrates, as unveiled by Error-Related Negativity (ERN) modulation. A systematic search of the literature was conducted and a total of 99 articles (160 studies, N = 8123) were included in the quantitative analysis. A dissociable effect was found: reduced ERN amplitude was observed in externalizing, while increased ERN amplitude was reported in internalizing. Larger effects were documented in all the externalizing dimensions (except for alcohol abuse) and were moderated by frontal electrode sites and tasks requiring inhibition. In internalizing, the overall effect was less robust. Disorder severity and tasks with punishment contingencies moderated the findings, and anxiety and obsessive-compulsive traits were the unique dimensions of internalizing accounting for the ERN increased amplitude. Overall, our findings highlight that ERN reduction interacts with the multiple phenotypic expressions of externalizing at a general level, while more specific factors - such as differences in sensitivity and aversion to errors - may explain increased ERN amplitude in internalizing.
Topics: Behavioral Symptoms; Biomarkers; Cerebral Cortex; Evoked Potentials; Executive Function; Humans; Impulsive Behavior; Mental Disorders
PubMed: 31220503
DOI: 10.1016/j.neubiorev.2019.06.013