Topic 4: Anorexia Nervosa Flashcards
DSM 5 diagnosis of AN
A: restriction of energy intake relative to requirements, leading to significant low body weight
B: intense fear of gaining weight (even though having a significant low body weight)
C: disturbance in the way in which one’s body weight or shape is experienced
Treatment of AN
- hospitalization
- medications
- psychotherapy
Etiology AN
- sociocultural factors
- genetic component
- neurotransmitters (serotonin, norepinephrine and dopamine)
- brain morphology: sulcal widening, ventricular dilatation, and cortical atrophy
Which neurotransmitters have been found to exist at abnormal levels in individuals with AN?
- serotonin
- norepinephrine
- dopamine
What about brain morphology in AN ?
- sulcal widening
- ventricular dilatation
- cortical atrophy
Neuropsychological impairments in AN
A broad range of cognitive functions have been found to be impaired, but the prominent characteristics are attentional impairment and difficulties in executive functions
Patterns of neuropsychological deficits in AN have been linked to ….
Abnormalities in parietal and prefrontal circuits
What is set-shifting?
Ability to move back and forth between multiple tasks, operations or mental sets
What kind of function is set-shifting?
An executive function
Which tests measure set-shifting?
- TMT
- Wisconsin cart sorting test
- haptic illusion test
Is set-shifting a persistent deficit ?
Set-shifting difficulties appear to persist after recovery.
They appear to be a ‘trait’ impairment (in contrast to ‘state’ impairment)
There is a genetical component
Mental rigidity in AN is linked to ….
Persistent abnormalities in the serotonin system
The serotonin system is strongly implicated in the regulation of ….
Impulsivity and cognitive inflexibility
Central coherence is …
The natural tendency for people to integrate incoming information into context, gestalt and meaning
Weak central coherence
A bias towards local processing at the expense of global meaning (predominant processing style among individuals with autism spectrum disorders)
Two dimensions of weak central coherence
- Bias towards superior detail processing
2. Weakness for global integration
Conclusion about central coherence in AN
- people with AN have difficulties in global processing
- less certain as to whether they have superior local processing
Weak coherence in AN patients may trigger ….
Behavioral and cognitive traits of AN such as perfectionism and fear of mistakes
Relative difficulty in integrative processing in AN may explain in part …
The neglect of long-term health consequences
Definition of AN
Mental disorder characterized by the pursuit of extreme thinness and by extreme loss of weight
Which traits are well documented as being comorbid in AN
Obsessive-compulsive traits
Neuropsychological profile of patients with AN
Superior detailed or local processing and a deficit in mental set-shifting
Hypothesis in the article from Lopez about AN
Both superior and local processing and difficulties in set-shifting underlie obsessive compulsive traits such as perfectionism and rigidity, and therefore have a role in maintaining AN
What is the aim of the paper from Lopez on AN
To describe a short intervention designed to translate the results from neuropsychological testing into everyday life and to eating symptoms.
What happens in session 1 in the treatment of AN from Lopez
Neuropsychological assessment and self report questionnaires
What happens in session 2 from the therapy from Lopez for AN
- feedback: on the neuropsychological assessment
- formulation: discussion of the role that extreme performance in either of these traits plays in life and how they may have evolved and shaped life course
- transcending targets
Two subtypes of AN
- restricting type (RAN)
- binge-eating/purging type (BPAN)
Impulsivity is more reported in which type of AN?
More reported in BPAN compared with RAN
of which spectrum of disorders is AN part
Obsessive-compulsive spectrum
Empirical evidence suggests that OCD personality traits are significant vulnerability factors in the complex etiology of eating disorders, why?
1- the have been found to be precursors to illness
2- they remain after recovery
3- they are present in relatives of ED probands
4- they are associated with illness outcome
Problems in set-shifting may underlie several cognitive deficits including …
Cognitive inflexibility and response inflexibility
Two components of the adolescent brain development
1 = collaborative brain function 2 = social information processing network
What is collaborative brain function?
The improvement of connections between the prefrontal cortex and important subcortical structures, such as the basal ganglia an the thalamus, allows the modulation of subcortical regions by the executive area of the brain
Why is the preferential cognitive style relating to weak central coherence associated with reduced connectivity throughout the brain?
because the persistence of a stage of highly demanding emotional distress, which is brought about by poor regulation of the stress respond and the modification of the HPA axis interrupts the developmental transition from localized to distributed brain function
What suggests the ‘social information processing network’?
That changes in the neurohumoral milieu impact on the affective node and subsequently the assignment of emotional significance.
Changes in connectivity as a result of neurodevelopmental maturation impact on the ‘cognitive regulatory node’ and subsequently its higher order processes.
Damasio’s somatic marker hypothesis
States that emotional feedback facilitate judgement about risk
What is cognitive remediation therapy?
An approach that helps the patient to engage in stimulating and positive mental activities without the burden or complexity of confronting issues or emotion that relate to their eating disorder
