Accuracy of estimating self and other body size among adolescent girls with anorexia nervosa.

This study aimed to analyze body size estimates of others by patients with anorexia nervosa (AN) and to identify any differences with the perception of their own body size. Adolescent females (age, 13-17 years) were enrolled into AN (n = 30) and control(n = 23) groups. The Subjective Body Dimensions Apparatus (SBDA) was used to evaluate body size estimates for oneself (self-estimation) and others (other-estimation). Participants also completed questionnaires assessing eating disorders and depressive symptoms. The AN and control groups scored significantly higher in self-estimation than in other-estimation. However, the AN group showed higher self-estimation scores than the control group for all the body parts and for the global silhouette (p < .001). Patients with more severe eating disorder symptomatology showed more distorted self-estimation (p < .05). No statistically significant differences were found in the other-estimation scores between the groups (p = .714), indicating that AN and control patients estimate the body sizes of others similarly. Eating disorder symptomatology correlates with self-estimation scores but not with other-estimation scores in adolescents with AN. No correlations existed between clinical symptomatology and other-estimation.

Efficacy of contextual therapies in perinatal depression and anxiety: A systematic review and meta-analysis.

BACKGROUND: There are previous meta-analyses on the efficacy of cognitive behavioral therapy or mindfulness-based therapies in the perinatal period, but no previous review has focused on contextual therapies as a whole. The aim of this study was to carry out a systematic review and meta-analysis of the efficacy of contextual therapies on depressive and anxious symptoms in women in the perinatal period. METHODS: A systematic search for randomized clinical trials has been carried out in the PUBMED, CINAHL, Psyc-INFO and Cochrane Library search engines. For the quantitative synthesis, the Morris effect size measure has been used. RESULTS: A total of 34 RCTs have been found, of which 30 have been used for meta-analysis. The mean effect size of the studies on depression scores was dppc2 = -0.81 (95% CI = -1.12 to -0.50), while it was dppc2 = -1.04 (95% CI = -1.54 to -0.53) in the case of studies on anxiety scores. These effect sizes decreased to medium effect sizes when corrected for publication bias. LIMITATIONS: The main limitations are the quality of the included studies, publication bias, and the limited number of studies on contextual therapies other than mindfulness-based therapies. CONCLUSIONS: In conclusion, this systematic review found a large number of efficacy studies on mindfulness-based therapies and a small number of studies on the other contextual therapies. The effect sizes found are consistent with previous meta-analyses in the perinatal period.

Longitudinal study in adolescent anorexia nervosa: evaluation of cortico-striatal and default mode network resting-state brain circuits.

Anorexia nervosa (AN) typically emerges in adolescence. The cortico-striatal system (CSTS) and the default mode network (DMN) are brain circuits with a crucial development during this period. These circuits underlie cognitive functions that are impaired in AN, such as cognitive flexibility and inhibition, among others. Little is known about their involvement in adolescent AN and how weight and symptom improvement might modulate potential alterations in these circuits. Forty-seven adolescent females (30 AN, 17 healthy control) were clinically/neuropsychologically evaluated and scanned during a 3T-MRI resting-state session on two occasions, before and after a 6-month multidisciplinary treatment of the AN patients. Baseline and baseline-to-follow-up between-group differences in CSTS and DMN resting-state connectivity were evaluated, as well as their association with clinical/neuropsychological variables. Increased connectivity between the left dorsal putamen and the left precuneus was found in AN at baseline. At follow-up, body mass index and clinical symptoms had improved in the AN group. An interaction effect was found in the connectivity between the right dorsal caudate to right mid-anterior insular cortex, with lower baseline AN connectivity that improved at follow-up; this improvement was weakly associated with changes in neuropsychological (Stroop test) performance. These results support the presence of CSTS connectivity alterations in adolescents with AN, which improve with weight and symptom improvement. In addition, at the level of caudate-insula connectivity, they might be associated with inhibitory processing performance. Alterations in CSTS pathways might be involved in AN from the early stages of the disorder.

Grupo de vínculo madre-bebé para mujeres con trastorno mental perinatal y sus lactantes / Grup de vincle mare-nadó per a dones amb trastorn mental perinatal i els seus lactants / Mother-Baby Bonding Group for women with perinatal mental disorders and their infants

Este estudio presenta el Grupo de Vínculo Madre-Bebé, una intervención grupal diseñada para la mejoría del vínculo en madres y sus lactantes menores de seis meses en tratamiento en nuestra unidad. Los resultados de las primeras 32 díadas participantes muestran una mejoría significativa en los sentimientos y la interacción de las madres hacia sus hijos tras la participación en el grupo, con menor rechazo y rabia hacia el bebé (p = 0,014), menor ansiedad en el cuidado, menos conductas de control, más sensibilidad materna, más colaboración del bebé y mejor sincronicidad entre ambos. Además, el porcentaje de mujeres con trastorno del vínculo al inicio del grupo disminuye tras la intervención. En conclusión, este estudio muestra la importancia de detectar y tratar las alteraciones del vínculo materno-filial en mujeres con trastorno mental perinatal, y hacerlo lo más precozmente posible para prevenir el impacto que puedan tener sobre el desarrollo del bebé.(AU)

This study presents the Mother-Baby Bonding Group, a group intervention treated in our Unit, designed to improve bonding between mothers and their infants under six months. Results from the first 32 participating dyads show a significant improvement in mothers' feelings and interaction towards their infants after participation in the group, with less rejection and anger towards the infant (p = 0.014), less caregiving anxiety, less controlling behaviours, more maternal sensitivity, more infant collaboration, and better synchronicity between them. In addition, the percentage of women with attachment disorder at baseline decreased after the intervention. In conclusion, this study shows the importance of detecting and treating maternal-filial bonding disorders in women with perinatal mental disorders, and to do so as early as possible to prevent the impact they may have on the baby's development.(AU)

Aquest estudi presenta el Grup de Vincle Mare-Nadó, una intervenció grupal dissenyada per a la millora del vincle en mares i els seus lactants menors de sis mesos en tractament a la nostra unitat. Els resultats de les primeres 32 díades participants mostren una milloria significativa en els sentiments i en la interacció de les mares envers els seus fills després de la participació en el grup, amb menor rebuig i ràbia cap al nadó (p = 0,014), menor ansietat en la cura, menys conductes de control, més sensibilitat materna, més col·laboració del nadó i millor sincronicitat entre tots dos. A més, el percentatge de dones amb trastorn del vincle a l'inici del grup disminueix després de la intervenció. En conclusió, aquest estudi mostra la importància de detectar i tractar les alteracions del vincle maternofilial en dones amb trastorn mental perinatal, i fer-ho el més precoçment possible per prevenir l'impacte que puguin tenir sobre el desenvolupament del nadó.(AU)

Brain Structure in Acutely Underweight and Partially Weight-Restored Individuals With Anorexia Nervosa: A Coordinated Analysis by the ENIGMA Eating Disorders Working Group.

BACKGROUND: The pattern of structural brain abnormalities in anorexia nervosa (AN) is still not well understood. While several studies report substantial deficits in gray matter volume and cortical thickness in acutely underweight patients, others find no differences, or even increases in patients compared with healthy control subjects. Recent weight regain before scanning may explain some of this heterogeneity. To clarify the extent, magnitude, and dependencies of gray matter changes in AN, we conducted a prospective, coordinated meta-analysis of multicenter neuroimaging data. METHODS: We analyzed T1-weighted structural magnetic resonance imaging scans assessed with standardized methods from 685 female patients with AN and 963 female healthy control subjects across 22 sites worldwide. In addition to a case-control comparison, we conducted a 3-group analysis comparing healthy control subjects with acutely underweight AN patients (n = 466) and partially weight-restored patients in treatment (n = 251). RESULTS: In AN, reductions in cortical thickness, subcortical volumes, and, to a lesser extent, cortical surface area were sizable (Cohen's d up to 0.95), widespread, and colocalized with hub regions. Highlighting the effects of undernutrition, these deficits were associated with lower body mass index in the AN sample and were less pronounced in partially weight-restored patients. CONCLUSIONS: The effect sizes observed for cortical thickness deficits in acute AN are the largest of any psychiatric disorder investigated in the ENIGMA (Enhancing Neuro Imaging Genetics through Meta Analysis) Consortium to date. These results confirm the importance of considering weight loss and renutrition in biomedical research on AN and underscore the importance of treatment engagement to prevent potentially long-lasting structural brain changes in this population.

External Validation and Test-Retest Reliability of Postpartum Bonding Questionnaire in Spanish Mothers.

The aim of the present study was to validate the Spanish Postpartum Bonding Questionnaire (PBQ) against external criteria of bonding disorder, as well as to establish its test-retest reliability. One hundred fifty-six postpartum women consecutively recruited from a perinatal mental health outpatient unit completed the PBQ at 4-6 weeks postpartum. Four weeks later, all mothers completed again the PBQ and were interviewed using the Birmingham Interview for Maternal Mental Health to establish the presence of a bonding disorder. Receiver operating characteristic curve analysis revealed an area under the curve (AUC) value for the PBQ total score of 0.93, 95% CI [0.88, 0.98], with the optimal cut-off of 13 for detecting bonding disorders (sensitivity: 92%, specificity: 87%). Optimal cut-off scores for each scale were also obtained. The test-retest reliability coefficients were moderate to good. Our data confirm the validity of PBQ for detecting bonding disorders in Spanish population.

Neonatal behavior of babies exposed to maternal depressive and anxiety disorders during perinatal period / Conducta neonatal en bebés expuestos a trastornos de depresión y de ansiedad maternos durante el período perinatal

Perinatal depression and perinatal anxiety can affect up to 20% of women during pregnancy and postpartum. Babies exposed to these pathologies sufferconsequences in their development at a cognitive, motor, emotional and social level. Some of these can be observed since birth. In addition, adverse effectshave been described in the behavior of the newborn exposed to psychopharmacotherapy during pregnancy. The aims of the study were to observe the neonatal behavior of babies exposed to perinatal depression or anxiety and to compare it between both diagnostic groups of mothers. The cohort included 86 newborns, from 2 to 67 days of chronological age (29 ± 13.4, 48% females), exposed to maternal depression (n = 27) or anxiety (n = 59). The Neonatal Behavior Assessment Scale, 4th edition, (Brazelton and Nugent, 2011) was administered at a maternal mental health unit to register the neonatal behavior. Chi-squareand Student t-test analyses were calculated to compare item scores and percentages of suboptimal responses between both groups; Pearson correlations were calculated to analyze the relation of obstetric and psychiatric variables of mothers and the behavior of newborns. Significant differences between groups were found only regarding the change in skin color, with higher percentages of suboptimal responses in the group exposed to anxiety than to depression (24% versus 4%, Chi2 = 3.89; p < .05). Correlation analyses show that, although the birth weight is positively related to the interactive social orientation (tracing face and voice: r = .28, p = .02), the last was affected negatively by the dose of antidepressants during the third trimester of pregnancy (tracing face and voice: r =-.31, p = 0.03), indicating that higher doses of antidepressant was related with lower interactive social orientation. (AU)

La depresión y la ansiedad perinatales afectan hasta el 20% de las mujeres durante embarazo y postparto. Los bebés expuestos a ellas sufren consecuencias en su desarrollo a nivel cognitivo, motor y socioemocional, y pueden observarse desde el nacimiento. Además, se han descrito efectos adversos en la conducta del neonato expuesto a psicofármacos durante la gestación. Los objetivos de este estudio fueron observar la conducta neonatal de bebés expuestos a depresión y ansiedad perinatal y compararla entre ambos grupos de diagnóstico materno. La cohorte incluyó 86 neonatos, entre 2 y 67 días de edad cronológica (29 ± 13.4, 48% mujeres), expuestos a depresión (n = 27) o ansiedad (n = 59) materna. La Escala de Evaluación de la Conducta Neonatal, 4ª edición, (Brazelton y Nugent, 2011) fue administrada en una unidad de salud mental perinatal para registrar la conducta neonatal. Se realizaron análisis de Chi-cuadrado y t de Student para compararlas puntuaciones en los ítems y los porcentajes de respuestas subóptimas entre ambos grupos; se calcularon índices de correlación de Pearson para analizar la relación entre variables obstétricas y psiquiátricas de las madres y la conducta de los bebés. Únicamente se encontraron diferencias significativas entrelos grupos diagnósticos respecto al cambio del color de la piel, con porcentajes mayores de respuesta subóptima en el grupo expuesto a ansiedad que a depresión (24% versus 4%, Chi2 = 3.89; p < .05). Los análisis de correlación muestran que, aunque el mayor peso al nacer se relaciona positivamente con la respuesta social-interactiva (orientación a cara y voz: r = .28, p = .02), ésta se ve afectada negativamente por el uso de antidepresivos durante el tercer trimestre de gestación (orientación a cara y voz: r = -.31, p = .03), indicando que a mayores dosis, peor orientación social-interactiva. (AU)

Cortical thickness 20 years after diagnosis of anorexia nervosa during adolescence.

OBJECTIVE: The objective of the present study is to evaluate cortical thickness (CT) abnormalities using FreeSurfer in adult subjects who had an onset of anorexia nervosa during their adolescence some 20 years previously, and to compare them with control subjects. METHODS: Fifty-four participants, including 26 women who were diagnosed and treated for AN during adolescence some 20 years previously and 28 healthy women of similar age and geographical area were assessed using structured interviews and MRI scans. Prior AN subjects were divided into two groups depending on their current eating disorder status (recovered or not recovered from any eating disorder). In all subjects, CT was measured using FreeSurfer. RESULTS: A significantly lower CT was observed in the eating disorder group than in the control group in the right post-central gyrus and the lateral occipital cortex. The recovered eating disorder group only had lower CT in the post-central gyrus. Within all subjects with prior AN, no correlations were found between lower CT in these areas and clinical variables. DISCUSSION: CT is reduced some 20 years after diagnosis of AN especially in the parietal and precentral areas, even in subjects without any current ED diagnosis.

Personality disorder traits, obsessive ideation and perfectionism 20 years after adolescent-onset anorexia nervosa: a recovered study.

PURPOSE: The many studies examining the relationship between anorexia nervosa (AN) and personality abnormalities have observed high comorbidity. However, no definitive studies to date have established whether there is a causal connection or whether it is a complication. The current study aimed to explore the nature of the relationship between personality disorder (PD) traits, obsessionality and perfectionism, using a study design that allows the testing of some comorbidity models. METHODS: Twenty-nine women were recruited from a group of former AN patients treated during their adolescence in a specialized unit around 20 years before the time of this study. They were divided into two groups according to the current presence of eating disorder (ED) symptoms (current-ED, n = 11; recovered, n = 18). Both groups were compared to a matched control group (n = 29) regarding current PD traits, obsessive beliefs and perfectionism. RESULTS: Borderline PD traits, most cluster C PD traits and overestimation of threat were more common in the current-ED group than in the control and recovered groups. Obsessive-compulsive PD traits, intolerance of uncertainty, and perfectionism were also significantly more prevalent in the current-ED group compared to controls but did not reach significance when compared to the recovered group. No significant differences were found between the recovered and control groups. CONCLUSION: Our results mostly support the personality abnormalities observed as a transient effect related to the presence of ED psychopathology in patients with adolescent-onset AN. LEVEL OF EVIDENCE: Level III, case-control analytic studies.

Functional MRI with a set-shifting task in adolescent anorexia nervosa: A cross-sectional and follow-up study.

Studies of set-shifting in adolescent AN present conflicting results, since not all have found differences with regard to controls. To date, no functional Magnetic Resonance Imaging (fMRI) studies have been carried out in adolescent patients, nor have patients been assessed after weight recovery. In this study, 30 female AN patients aged 12-17 and 16 matched control subjects were assessed both at baseline and after six months and renutrition using a structured diagnostic interview, clinical and neurocognitive scales, and fMRI during a set-shifting task. Adolescent AN patients presented similar performance on different neurocognitive tests and also on a set-shifting task during fMRI, but they showed a lower activation in the inferior and middle occipital and lingual gyri, fusiform gyri and cerebellum during the set-shifting task. No correlations were found between decreased activation and clinical variables such as body mass index, eating or depressive symptoms. After six months of treatment and renutrition in AN patients, there were no differences between patients and controls. These results show that adolescent AN patients have lower activation in relevant brain areas during a set-shifting task, and support the use of fMRI with set-shifting paradigms as a biomarker in future studies.

Two-year follow-up of treated adolescents with early-onset bipolar disorder: Changes in neurocognition.

BACKGROUND: Few studies have analyzed the course of neurocognition in treated children and adolescents with early-onset bipolar disorder (EOBD) and shown improvements in attention, working memory, and verbal memory after treatment. The aim of this study was to determine the progress over two years in neuropsychological performance of a sample of medicated adolescents with EOBD compared to healthy controls (HC). METHODS: Twenty adolescents, diagnosed in clinical setting as DSM-IV bipolar disorder, treated for two years, euthymic, and 20 gender and age-matched HC were assessed at two moments in reasoning, verbal and visual memory, working memory, speed, visual-motor skills and executive function. Multivariate analyses of variance was carried out to analyze the differences between groups over time, and to monitor the influence of psychotic symptoms and type of mood-stabilizer. RESULTS: The entire sample improved on verbal and visual memory tests (verbal recall p<0.01; visual recall p<0.001). Moreover, patients improved more than controls in verbal reasoning (p<0.01), working memory (p<0.01), processing speed (p<0.01) and visual-motor skills (p<0.001). Psychotic symptoms and treatment with lithium were associated with poorer development in executive control tasks. LIMITATIONS: Sample size was small and groups were re-evaluated in slight different follow-up periods. Doses of antipsychotics drugs over time were not controlled. CONCLUSIONS: Processing speed and visual-motor skills in the EOBD group normalized during follow-up. Executive functioning, working memory, and verbal and visual memory remained impaired in patients versus controls. The knowledge of cognitive deficits due to normal course of illness or to drug effects allows better therapeutic strategies.

Adolescent Anorexia Nervosa: cognitive performance after weight recovery.

OBJECTIVE: Although there is no definitive consensus on the impairment of neuropsychological functions, most studies of adults with Anorexia Nervosa (AN) find impaired functioning in cognitive domains such as visual-spatial abilities. The objective of this study is to assess the cognitive functions in adolescents with AN before and after weight recovery and to explore the relationship between cognitive performance and menstruation. METHODS: Twenty-five female adolescents with AN were assessed by a neuropsychological battery while underweight and then following six months of treatment and weight recovery. Twenty-six healthy female subjects of a similar age were also evaluated at both time points. RESULTS: Underweight patients with AN showed worse cognitive performance than control subjects in immediate recall, organization and time taken to copy the Rey's Complex Figure Test (RCFT). After weight recovery, AN patients presented significant improvements in all tests, and differences between patients and controls disappeared. Patients with AN and persistence of amenorrhea at follow-up (n=8) performed worse on Block Design, delayed recall of Visual Reproduction and Stroop Test than patients with resumed menstruation (n=14) and the control group, though the two AN groups were similar in body mass index, age and psychopathological scale scores. CONCLUSION: Weight recovery improves cognitive functioning in adolescents with AN. The normalization of neuropsychological performance is better in patients who have recovered at least one menstrual cycle. The normalization of hormonal function seems to be essential for the normalization of cognitive performance, even in adolescents with a very short recovery time.

Cognitive reserve as a predictor of two year neuropsychological performance in early onset first-episode schizophrenia.

INTRODUCTION: The concept of cognitive reserve (CR) has been defined as individual differences in the efficient utilization of brain networks which allow some people to cope better than others with brain pathology. CR has been developed mainly in the field of aging and dementia after it was observed that there appears to be no direct relationship between the degree of brain pathology and the severity of clinical manifestations of this damage. The present study applies the concept of CR to a sample of children and adolescents with a first episode of schizophrenia, aiming to assess the possible influence of CR on neuropsychological performance after two year follow-up, controlling for the influence of clinical psychopathology. METHODS: 35 patients meeting DSM-IV criteria for schizophrenia or schizoaffective disorder (SSD) and 98 healthy controls (HC) matched for age and gender were included. CR was assessed at baseline, taking into account premorbid IQ, educational-occupational level and leisure activities. Clinical and neuropsychological assessments were completed by all patients at two year follow-up. RESULTS: The CR proxy was able to predict working memory and attention at two year follow-up. Verbal memory and cognitive flexibility were not predicted by any of the variables included in the regression model. The SSD group obtained lower scores than HC on CR. CR measures correctly classified 79.8% of the sample as being SSD or HC. CONCLUSIONS: Lower scores on CR were observed in SSD than in HC and the CR measure correctly classified a high percentage of the sample into the two groups. CR may predict SSD performance on working memory and attention tasks.

Two-year follow-up of cognitive functions in schizophrenia spectrum disorders of adolescent patients treated with electroconvulsive therapy.

OBJECTIVE: The aim of the current study was to investigate the long-term cognitive effects of electroconvulsive therapy (ECT) in a sample of adolescent patients in whom schizophrenia spectrum disorders were diagnosed. METHODS: The sample was composed of nine adolescent subjects in whom schizophrenia or schizoaffective disorder was diagnosed according to DSM-IV-TR criteria on whom ECT was conducted (ECT group) and nine adolescent subjects matched by age, socioeconomic status, and diagnostic and Positive and Negative Syndrome Scale (PANSS) total score at baseline on whom ECT was not conducted (NECT group). Clinical and neuropsychological assessments were carried out at baseline before ECT treatment and at 2-year follow-up. RESULTS: Significant differences were found between groups in the number of unsuccessful medication trials. No statistically significant differences were found between the ECT group and the NECT group in either severity as assessed by the PANSS, or in any cognitive variables at baseline. At follow-up, both groups showed significant improvement in clinical variables (subscales of positive, general, and total scores of PANSS and Clinical Global Impressions-Improvement). In the cognitive assessment at follow-up, significant improvement was found in both groups in the semantic category of verbal fluency task and digits forward. However, no significant differences were found between groups in any clinical or cognitive variable at follow-up. Repeated measures analysis found no significant interaction of time×group in any clinical or neuropsychological measures. CONCLUSIONS: The current study showed no significant differences in change over time in clinical or neuropsychological variables between the ECT group and the NECT group at 2-year follow-up. Thus, ECT did not show any negative influence on long-term neuropsychological variables in our sample.

Clinical and biological correlates of adolescent anorexia nervosa with impaired cognitive profile.

Some neuropsychological studies of anorexia nervosa (AN) have yielded conflicting results, and it has been established that not all adult patients with AN are cognitively impaired. The objective of this study is to determine the percentage of adolescents with AN who present worse cognitive functioning according to neuropsychological criteria of cognitive impairment, and to study their clinical characteristics. Thirty-seven adolescents (11-18 years) with a diagnosis of AN in an acute state of the illness and with low body mass index (BMI) were compared with 41 healthy subjects of the same sex and similar age and intelligence using a comprehensive neuropsychological battery. Overall, AN patients took longer to copy Rey's Figure than the control group (p = 0.001). Thirty per cent of patients showed impaired neuropsychological functioning (defined as scoring two standard deviations lower than the average or lower than their intelligence level in two tasks) with worse performance on visuo-spatial tasks. This subgroup of patients presented lower BMI (p = 0.023) and higher trait anxiety (p = 0.028). The performance of adolescents in an acute state of AN was similar to that of the healthy control group, with the exception of lower time to completion in copying a complex figure. However, cognitive performance varied in these patients, being clearly impaired in one-third of the sample. The cognitive impairment subgroup showed lower BMI and higher anxiety. Longitudinal follow-up studies are necessary to assess the stability of this profile after longer treatment periods.

Early-onset bipolar disorder: how about visual-spatial skills and executive functions?

Early-onset bipolar disorder is an impairing condition that is strongly associated with genetic inheritance. Neurocognitive deficits are core traits of this disorder which seem to be present in both young and adult forms. Deficits in verbal memory and attention are persistent within euthymic phases in bipolar adults, adolescents, and children. In younger samples, including type I or II and not otherwise specified patients, executive functions are not widely impaired and the existence of visual-spatial deficits remains unclear. The main aim of this study was to compare the neurocognitive performance in young stabilized type I or II bipolar patients and healthy controls. Fifteen medicated adolescents with bipolar disorder and 15 healthy adolescents, matched in age and gender, were compared on visual-spatial skills (reasoning, memory, visual-motor accuracy) and executive functioning (attention and working memory, set-shifting, inhibition) using t-tests and MANCOVA. Correcting for verbal competence, MANCOVA showed that patients performed significantly worse than controls in letters and numbers sequencing (P = 0.003), copy (P < 0.001) and immediate recall (P = 0.007) of the Rey Complex Figure Test, interference of the Stroop Color-Word Test (P = 0.007) and non-perseverative errors on the Wisconsin Card Sorting Test (P = 0.038). Impaired cognitive performance was found in young bipolar patients in working memory, visual-motor skills, and inhibitory control.

A cross-sectional and follow-up functional MRI study with a working memory task in adolescent anorexia nervosa.

Structural and functional brain abnormalities have been described in anorexia nervosa (AN). The objective of this study was to examine whether there is abnormal regional brain activation during a working memory task not associated with any emotional stimuli in adolescent patients with anorexia and to detect possible changes after weight recovery. Fourteen children and adolescents (age range 11-18 years) consecutively admitted with DSM-IV diagnosis of AN and fourteen control subjects of similar age were assessed by means of psychopathological scales and functional magnetic resonance imaging (fMRI) during a working memory task. After seven months of treatment and weight recovery, nine AN patients were reassessed. Before treatment, the AN group showed significantly higher activation than controls in temporal and parietal areas and especially in the temporal superior gyrus during performance of the cognitive task. Control subjects did not show greater activation than AN patients in any region. A negative correlation was found between brain activation and body mass index and a positive correlation between activation and depressive symptomatology. At follow-up after weight recovery, AN patients showed a decrease in brain activation in these areas and did not present differences with respect to controls. These results show that adolescent AN patients showed hyperactivation in the parietal and especially the temporal lobe during a working memory task, suggesting that they must make an additional effort to perform at normal levels. This activation correlated with clinical variables. In these young patients, differences with respect to controls disappeared after weight recovery.

Prefrontal brain metabolites in short-term weight-recovered adolescent anorexia nervosa patients.

Various neuroimaging techniques have revealed morphological and functional alterations in anorexia nervosa (AN), although few spectroscopic magnetic resonance studies have examined short-term weight-recovered AN patients. Subjects were 32 female adolescent patients (between 13 and 18 years old) seen consecutively in our department and who met DSM-IV diagnostic criteria for AN. All of them had received a minimum of six months of treatment and were short-term weight-recovered (for one to three months) with a body mass index ranging from 18 to 23. A group of 20 healthy female volunteer controls of similar age were also included. All subjects were assessed with psychopathological scales and magnetic resonance spectroscopy. Total choline (Cho) (p=0.007) and creatine (Cr) (p=0.008) levels were significantly higher in AN patients than in controls. AN patients receiving psychopharmacological treatment with SSRIs (N=9) had metabolite levels similar to control subjects, but patients without this treatment did not. The present study shows abnormalities in brain neurometabolites related to Cho compounds and Cr in the prefrontal cortex in short-term weight-recovered adolescent AN patients, principally in patients not undergoing psychopharmacological treatment. More studies with larger samples are necessary to test the generalizability of the present results.