Olfactory capacity in anorexia nervosa: correlations with set-shifting ability.

PURPOSE: The purpose of this study is to examine olfactory capacity in adults with anorexia nervosa (AN), in terms of odor identification and odor threshold and search for possible correlations between odor identification and cognitive flexibility in this population. METHODS: Thirty-nine patients diagnosed with AN and 60 healthy participants, participated. Odor identification was assessed using the University Pennsylvania Smell Identification Test and a two alternative forced choice, ascending method with n-butanol was used to assess odor threshold. Cognitive flexibility was determined using the Intra/Extra-Dimensional Set-Shift test (IED), a subtest of the Cambridge Neuropsychological Test Automated Battery (CANTAB). RESULTS: Patients with AN presented a poorer performance in odor identification compared with controls (p = 0.001). No differences were found in odor threshold, between the two groups. Patients with AN exhibited poor cognitive flexibility compared with controls (p = 0.003). A significant correlation between odor identification and cognitive flexibility was documented in AN (p = 0.01), but not in controls. CONCLUSION: Our findings suggest that olfactory capacity is altered in AN: Qualitative characteristics of olfaction were affected in patients with AN (lower odor identification), while there was no difference in quantitative characteristics (odor threshold) compared with controls. Furthermore, odor identification in AN was correlated to cognitive flexibility. LEVEL OF EVIDENCE: Level III: case-control analytic study.

Personality dimensions could explain resilience in patients with eating disorders.

PURPOSE: Resilience can be defined as the ability to maintain health in the face of adversity. Resilience has been associated with personality traits. Personality traits in the context of Eating Disorders (ED) have also been examined. However, the relationship between resilience and personality profile in patients with ED has not been studied. The aim of this study is to investigate whether personality dimensions impact on resilience, in patients with ED, compared to healthy participants. METHODS: Connor and Davidson resilience scale, as a measure of resilience and temperament-character inventory, as a measure of personality dimensions, were completed by 100 participants: 50 (50%) healthy University students (controls subgroup) and 50 (50%) patients with ED, matched on age and gender. RESULTS: Patients with ED showed lower resilience than healthy participants and scored higher on harm avoidance, and lower on reward dependence, self-directedness and cooperativeness than controls. Lower harm avoidance, higher persistence and higher self-directedness were associated with resilience in both subgroups. Self-directedness and persistence predicted resilience in both subgroups. Only Harm Avoidance predicted resilience in patients' subgroup. CONCLUSION: To our knowledge, there are no existing data examining the effect of personality dimensions in resilience, in the context of ED. We found that only the effect of Harm Avoidance in resilience was different among the participants' subgroups. In conclusion, Harm Avoidance could explain differences in resilience between healthy participants and patients with ED. LEVEL OF EVIDENCE: Level III: case-control analytic study.

Using Electroencephalogram-Extracted Nonlinear Complexity and Wavelet-Extracted Power Rhythm Features during the Performance of Demanding Cognitive Tasks (Aristotle's Syllogisms) in Optimally Classifying Patients with Anorexia Nervosa.

Anorexia nervosa is associated with impaired cognitive flexibility and central coherence, i.e., the ability to provide an overview of complex information. Therefore, the aim of the present study was to evaluate EEG features elicited from patients with anorexia nervosa and healthy controls during mental tasks (valid and invalid Aristotelian syllogisms and paradoxes). Particularly, we examined the combination of the most significant syllogisms with selected features (relative power of the time-frequency domain and wavelet-estimated EEG-specific waves, Higuchi fractal dimension (HFD), and information-oriented approximate entropy (AppEn)). We found that alpha, beta, gamma, theta waves, and AppEn are the most suitable measures, which, when combined with specific syllogisms, form a powerful tool for efficiently classifying healthy subjects and patients with AN. We assessed the performance of triadic combinations of "feature-classifier-syllogism" via machine learning techniques in correctly classifying new subjects in these two groups. The following triads attain the best classifications: (a) "AppEn-invalid-ensemble BT classifier" (accuracy 83.3%), (b) "Higuchi FD-valid-linear discriminant" (accuracy 75%), (c) "alpha amplitude-valid-SVM" (accuracy 83.3%), (d) "alpha RP-paradox-ensemble BT" (accuracy 85%), (e) "beta RP-valid-ensemble" (accuracy 85%), (f) "gamma RP-valid-SVM" (accuracy 85%), and (g) "theta RP-valid-KNN" (accuracy 80%). Our findings suggest that anorexia nervosa has a specific information-processing style across reasoning tasks in the brain as measured via EEG activity. Our findings also contribute to further supporting the view that entropy-oriented, i.e., information-based features (the AppEn measure used in this study) are promising diagnostic tools (biomarkers) in clinical applications related to medical classification problems. Furthermore, the main EEG-specific frequency waves are extremely enhanced and become powerful classification tools when combined with Aristotle's syllogisms.

Similar or Different Neuropsychological Profiles? Only Set Shifting Differentiates Women With Bipolar vs. Borderline Personality Disorder.

There is ongoing debate about the similarities and differences between bipolar disorder (BD) and borderline personality disorder (BPD). Very few studies have concurrently assessed their neuropsychological profile and only on a narrow array of neuropsychological tests. We aimed to investigate the differences of these two patient groups on visual memory, executive function, and response inhibition. Twenty-nine BD patients, 27 BPD patients and 22 controls (all female) were directly compared on paired associates learning (PAL), set shifting (ID/ED), problem solving (SOC), and response inhibition (SSRT) using Cambridge Neuropsychological Test Automated Battery (CANTAB). Rank-normalized outcomes were contrasted in one-way ANOVA tests. Discriminant analysis was finally performed to predict BD or BPD patient status. BD patients performed significantly worse than controls on all tasks. BPD patients performed significantly worse than HC on all tests except SST. Significant differences between the two patient groups were recorded only on ID/ED, where BPD patients performed worse (p = 0.044). A forward stepwise discriminant analysis model based on ID/ED and SOC predicted correctly patients' group at 67.9% of cases. In conclusion, BD and BPD female patients appear to be more similar than different as regards their neuropsychological functions. This study is the first to show that BPD patients display more deficits than BD patients when directly compared on the set shifting executive function test, a marker of cognitive flexibility. Discerning BD from BPD patients through neuropsychological performance is promising but would improve by using additional subtler tests and psychometric evaluation.

Adipokines in anorexia nervosa: A systematic review and meta-analysis.

OBJECTIVE: The association between adipokine dysregulation and weight loss of patients with anorexia nervosa (AN) has been long investigated, in search of a causal relationship. We sought to: a) synthesize the available evidence on potential differences between AN patients and controls with regards to adipokine measurements (namely, leptin, adiponectin, resistin, soluble leptin receptor, visfatin, vaspin and omentin), b) estimate the potential differences between constitutionally thin (CT) subjects and AN patients, and c) present the available evidence with regards to biomarker efficacy of adipokines in AN. METHODS: A structured literature search, last updated in 2/2019, was conducted in the following databases: MEDLINE, clinicaltrials.gov, PsycINFO, PSYNDEX and WHO Registry Network. The primary outcome was the standardized mean difference of each adipokine between AN patients and controls of normal BMI. Secondary outcomes included the correlation of leptin with BMI and bone mineral density among AN patients. The study protocol is published in PROSPERO (CRD42018116767). RESULTS: In a total of 622 screened studies, after exclusion of non-relevant articles and duplicates, 84 reports on leptin, 31 reports on adiponectin, 12 on resistin, 10 on soluble leptin receptor, 5 on visfatin, 3 on vaspin and omentin were finally included in the meta-analysis. Publication bias assessment underlined the possibility of non-significant studies being underrepresented; still, significant heterogeneity renders this statement inconclusive. Leptin [ELISA: SMD (95% CI): -3.03 (-4, -2.06)], radioimmunoassay [RIA: -3.84 (-4.71, -2.98)] and resistin [-1.67 (-2.85, -0.48)] were significantly lower in patients with AN compared with controls, whereas visfatin decrease did not reach significance (-2.03 (-4.38, 0.3). Mean adiponectin, vaspin and soluble leptin receptor levels were significantly higher. In subgroup analysis, a significantly attenuated SMD was reported in ELISA studies compared with RIA studies. Leptin was significantly lower in AN patients compared to CT subjects and BMI marginally did not appear to confound the result. In all analyses, except for the correlation of leptin with BMI in AN patients, high heterogeneity was present. Meta-regression analysis indicated a potential confounding action of controls' BMI and age on leptin SMD and between-assay differences. Publication bias assessment underlined the possibility of nonsignificant studies being underrepresented; still, further investigation did not corroborate this and significant heterogeneity renders this statement inconclusive. CONCLUSION: A distinct profile of adipokine dysregulation is apparent in AN patients, following the anticipated pattern of low BMI. A precise estimation of the magnitude is hindered by heterogeneity, partly caused by varying assays and methodologies. Interestingly, while mean leptin levels are lower in AN subjects compared with constitutionally thin women, there is an overlap in individual levels between the two groups and therefore, they cannot be used to differentiate between these states.

Attitudes of mental health private practitioners dealing with patients with schizophrenia: a qualitative study from Greece.

BACKGROUND: Attitudes of patients, their relatives and caregivers toward psychosocial interventions have been identified through different studies. However, the attitudes of psychiatrists have not been documented in Greece. AIM: (i) To document the attitudes of psychiatrists toward psychosocial interventions for patients with schizophrenia. (ii) To identify their knowledge regarding ongoing programs, as well as their opinion on the availability of organized support structures. MATERIALS AND METHODS: A two-phase qualitative study was carried-out in representative regions of Greece. A questionnaire was administered to 26 randomly-selected psychiatrists in private practice in the context of an online survey about schizophrenia (PONTE). RESULTS: All respondents considered the role of the family as being critical and the majority (80%) highlighted the efficacy of family counseling among the psychosocial therapeutic strategies. Half of the psychiatrists reported an ineffective information network on support programs, and most of the respondents (73%) considered the available psychosocial support programs to be insufficient. CONCLUSION: An insufficient network of organized support structures for patients with schizophrenia is reported by Greek psychiatrists. There is consensus for the need to involve family members during psychosocial treatment.