Cognitive and quality-of-life related factors of body mass index (BMI) improvement after deep brain stimulation in the subcallosal cingulate and nucleus accumbens in treatment-refractory chronic anorexia nervosa.

BACKGROUND: Up to 20% of the cases of anorexia nervosa (AN) are chronic and treatment-resistant. Recently, the efficacy of deep brain stimulation (DBS) for severe cases of AN has been explored, with studies showing an improvement in body mass index and other psychiatric outcomes. While the effects of DBS on cognitive domains have been studied in patients with other neurological and psychiatric conditions so far, no evidence has been gathered in AN. METHODS: Eight patients with severe, chronic, treatment-resistant AN received DBS either to the nucleus accumbens (NAcc) or subcallosal cingulate (SCC; four subjects on each target). A comprehensive battery of neuropsychological and clinical outcomes was used before and 6-month after surgery. FINDINGS: Although Body Mass Index (BMI) did not normalise, statistically significant improvements in BMI, quality of life, and performance on cognitive flexibility were observed after 6 months of DBS. Changes in BMI were related to a decrease in depressive symptoms and an improvement in memory functioning. INTERPRETATION: These findings, although preliminary, support the use of DBS in AN, pointing to its safety, even for cognitive functioning; improvements of cognitive flexibility are reported. DBS seems to exert changes on cognition and mood that accompany BMI increments. Further studies are needed better to determine the impact of DBS on cognitive functions.

A Randomized Trial of Deep Brain Stimulation to the Subcallosal Cingulate and Nucleus Accumbens in Patients with Treatment-Refractory, Chronic, and Severe Anorexia Nervosa: Initial Results at 6 Months of Follow Up.

BACKGROUND: The main objective of this study was to assess the safety and efficacy of deep brain stimulation (DBS) in patients with severe anorexia nervosa (AN). METHODS: Eight participants received active DBS to the subcallosal cingulate (SCC) or nucleus accumbens (NAcc) depending on comorbidities (affective or anxiety disorders, respectively) and type of AN. The primary outcome measure was body mass index (BMI). RESULTS: Overall, we found no significant difference (p = 0.84) between mean preoperative and postoperative (month 6) BMI. A BMI reference value (BMI-RV) was calculated. In patients that received preoperative inpatient care to raise the BMI, the BMI-RV was defined as the mean BMI value in the 12 months prior to surgery. In patients that did not require inpatient care, the BMI-RV was defined as the mean BMI in the 3-month period before surgery. This value was compared to the postoperative BMI (month 6), revealing a significant increase (p = 0.02). After 6 months of DBS, five participants showed an increase of ≥10% in the BMI-RV. Quality of life was improved (p = 0.03). Three cases presented cutaneous complications. CONCLUSION: DBS may be effective for some patients with severe AN. Cutaneous complications were observed. Longer term data are needed.

Social-cognitive bias and depressive symptoms in outpatients with bipolar disorder.

A deficit of social cognition in bipolar disorder has been shown, even when patients are stable. This study compares the attribution of intentions (social-cognitive bias) in a group of 37 outpatients with bipolar disorder with 32 matched control subjects. Bipolar patients scored significantly higher in the Ambiguous Intentions Hostility Questionnaire, showing an angry and intentionality bias (P = .001, P = .02). Differences in blame scale and hostility bias did not reach statistical significance, but a trend was found (P = .06). Bipolar patients with depressive symptoms presented a higher score in the angry bias scale (P = .03) and aggressivity bias scale (P = .004). The global functioning (GAF) correlates significantly with intentionality (P = .005), angry (P = .027), and aggressivity (P = .020) biases. Bipolar patients show a social-cognitive bias that may play a role in their functional outcome.

Health-related quality of life according to the main caregiver in patients with home nutritional support.

BACKGROUND AND OBJECTIVE: We intended to know the degree of agreement between the quality of life's perception of patients with home nutritional support and that of their main caregiver in the different dimensions. We also aimed to establish the predictive ability of the health-related quality of life (HRQL) punctuation of the caregiver about the patient, fixed up by other variables. METHOD: We evaluated the HRQL with the EuroQol-5D (EQ-5D) questionnaire in 245 patients by means of a direct interview with them and with their main caregiver. The patients came from 13 hospitals of the National Health System and they were selected sequentially according to their visits to the hospital or at home. RESULTS: The agreement obtained in the EQ-5D components was high, except for the anxiety component, which had a 58% concordance (McNemar's test, p = 0.005; kappa = 0.340, p < 0.001). When studying the agreement between the patient punctuation and that of the main caregiver, an intraclass correlation coefficient (ICC) = 0.887 (95% confidence interval [CI], 0.852-0.913) was obtained. When studying the predictive ability of the caregiver's punctuation about the patient, we obtained an R2 = 0.649 with a regression coefficient of 0.803 (95% CI, 0.725-0.882) in the EQ-5D, while in the visual analogical scale an ICC = 0.823 (95% CI, 0.771-0.863) was obtained, and an R2 = 0.475 with a regression coefficient of 0.719 (95% CI, 0.617-0.822) was found. CONCLUSIONS: A caregiver's evaluation can be useful to have an approximation to the patient's perception when he/she does not have the ability to communicate. The approach is better if we consider the variables sex, pathological group, age of the caregiver or the evaluation of changes in the health state for the last 12 months.