Cognitive remediation in anorexia nervosa and related conditions: a systematic review.

Research evidence for cognitive remediation therapy's (CRT) effectiveness for anorexia nervosa (AN) has been gathering. This approach is also increasingly being implemented in other disorders including major depressive disorder, obsessive-compulsive disorder and autistic spectrum disorder that share commonalities with AN in neuropsychological profiles and clinical presentations. This systematic literature review identified and appraised the current evidence base to see whether evidence from related conditions could be integrated into the theoretical understanding of CRT for AN as well as future AN treatment developments and research. Overall, CRT studies in AN report promising findings, and CRT appears to be associated with improvements in set-shifting and in central coherence. Cognitive remediation approaches in other conditions also show promising evidence in associated improvements in areas of executive functioning and information processing; links are made between AN treatment and what future treatment developments could consider.

Work and social adjustment in patients with anorexia nervosa.

OBJECTIVE AND METHODS: The Work and Social Adjustment Scale (WSAS) assesses patients' perceptions of impairment in everyday functioning and has been reported as a simple and reliable self-report measure in different psychiatric disorders. This study compared WSAS data from an anorexia nervosa (AN) patient group with that from healthy controls (HCs) and published data from other patient groups. A total of 160 female participants (AN, 77; HC, 83) completed the WSAS as well as measures of eating disorder symptom severity and brief assessments of anxiety and depression. RESULTS: Work and Social Adjustment Scale scores for the AN group were found to be in the severely impaired range, whereas the scores for those within the HC group indicated very little, or no impairment. Total WSAS scores in the AN group were significantly correlated with severity of clinical symptoms, and eating disorder-specific symptoms were the best predictor of social and occupational functional impairment. The greatest impairment in the AN group was reported in the realm of social leisure. CONCLUSIONS: Consistent with reports in other clinical populations, it is suggested that the WSAS could be an extremely useful and meaningful measure to assess social and occupational functioning in people with eating disorders, in addition to eating disorder-specific assessments.

Meal support using mobile technology in Anorexia Nervosa. Contextual differences between inpatient and outpatient settings.

The aim of this study was to examine the impact of a "supported eating" intervention using mobile technology in patients with Anorexia Nervosa (AN). Twenty Inpatients and 18 Outpatients with AN underwent a test meal on two occasions, whilst listening to either a short video-clip ('vodcast'), or music delivered on an MP4 player. Self-report and behavioural measures were collected before and after each test meal. Differences were found between the inpatient and outpatient settings. Inpatients drank more of the test meal and had increased levels of vigilance to food after the test meal, in both conditions. When the support conditions (Vodcast vs. Music) were compared, inpatients seemed to benefit more from listening to music (reduced distress and more smoothie drunk), whereas outpatients benefitted more from using the vodcast (reduced distress, more smoothie drunk, and reduced vigilance to food). The context in which the intervention was delivered had an impact on self-report and behavioural measures collected during the test meal. This suggests that the form of meal support in AN needs to match the context.

Assessment of cognitive flexibility in anorexia nervosa--self-report or experimental measure? A brief report.

This study investigated the correspondence between self-report and experimental measures of cognitive flexibility in individuals with anorexia nervosa (AN) and healthy controls (HCs). Ninety-four participants (45 individuals with AN and 49 HCs) completed the self-report Cognitive Flexibility Scale (CFS) and an experimental task, the Brixton Spatial Anticipation Test. The AN group performed poorly on both measures of cognitive flexibility compared with HCs. There was no significant correlation between the CFS scores and the errors on the Brixton Test for both groups. The findings suggest there is poor correspondence between the self-report measure of cognitive flexibility and performance on the flexibility test. These two assessment tools therefore cannot be used interchangeably to assess cognitive flexibility. Flexibility is an important clinical characteristic in AN. The results suggest that self-report and behavioral measures can be complementary, but cannot be used as an alternative to one another.

Evaluation of enhanced attention to local detail in anorexia nervosa using the embedded figures test; an FMRI study.

The behavioural literature in anorexia nervosa and autism spectrum disorders has indicated an overlap in cognitive profiles. One such domain is the enhancement of local processing over global processing. While functional imaging studies of autism spectrum disorder have revealed differential neural patterns compared to controls in response to tests of local versus global processing, no studies have explored such effects in anorexia nervosa. This study uses functional magnetic resonance imaging in conjunction with the embedded figures test, to explore the neural correlates of this enhanced attention to detail in the largest anorexia nervosa cohort to date. On the embedded figures tests participants are required to indicate which of two complex figures contains a simple geometrical shape. The findings indicate that whilst healthy controls showed greater accuracy on the task than people with anorexia nervosa, different brain regions were recruited. Healthy controls showed greater activation in the precuneus whilst people with anorexia nervosa showed greater activation in the fusiform gyrus. This suggests that different cognitive strategies were used to perform the task, i.e. healthy controls demonstrated greater emphasis on visuospatial searching and people with anorexia nervosa employed a more object recognition-based approach. This is in accordance with previous findings in autism spectrum disorder using a similar methodology and has implications for therapies addressing the appropriate adjustment of cognitive strategies in anorexia nervosa.