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Introduction to Psychopathology
Transcript of Introduction to Psychopathology
By Phien Vo
How does brain chemistry and cognitive function differ in women suffering from Anorexia Nervosa (AN) as opposed to that of non-eating disordered females? Definition of Anorexia Nervosa (AN) Cognitive function in AN Brain Structure in AN Brain-derived Neurotrophic Factor (BDNF) in AN Serotonin (5-HT) in AN DEFINITION Serious eating disorder
Mortality higher than any other psychiatric illness
Common amongst women aged between 13-19 DSM-IV-TR Weight loss (BMI < 17.5)
Failure to attain expected weight gain during periods of growth
Intense fear of gaining weight
Body image disturbance
Amenorrhoea Prognosis 20% develop chronic eating disorder
5% die of the condition Cognitive function Higher IQ was observed in weight-recovered anorexics
National Adult Reading Test & Weschler Intelligence Scale: weight-recovered anorexics scored 10.8 units and 5.9 units above the IQ of non-anorexics, respectively
Mean IQ of weight-recovered anorexics: 109.3-119.1 compared to 96.1-117.6 in current low-weight anorexics POSSIBLE REASON? Increased regional cerebral blood flow (rCBF) in weight-recovered anorexics SPECT:
Hypoperfusion of temporal lobe, parietal lobe, frontal lobe, thalamus, and caudate nuclei in anorexics prior to treatment
Increased rCBF in the bilateral parietal lobe, thalamus, and cerebellum after a four-month treatment period where weight restoration was the aim Anterior Ventral Striatum:
Non-anorexics: Strong differences between positive and negative experiences
Anorexics: Little difference between positive and negative experiences
Caudate Nuclei: More active in anorexic women than non-eating disordered controls Brain Structure Reduced brain matter volume in anorexic women compared to non-anorexic women
Those who had AN the longest had the greatest gray matter deficit
Anorexics received treatment (weight restoration)? --> Loss of brain volume began to reverse Brain-derived Neurotrophic factor (BDNF) Abundantly expressed protein in the CNS
Essential in development of CNS and neuronal survival & repair
Decreased production of BDNF in anorexic women
Low BDNF = low self image, appearance of affective disorders (anxiety, depression), poor performance on cognitive tests Higher serum BDNF in weight-recovered anorexics
Higher BDNF = higher IQ?
Increased BDNF is associated with the regenerative process after prolonged malnutrition --> BDNF may surface as a valuable indication of AN and recovery from AN Serotonin (5-HT) Reduced brain 5-HT activity in anorexic women
BDNF encourages survival and differentiation of 5-HT neurons
Anorexic women: Reduced 5-HT binding index in the left frontal cortex, bilateral parietal cortex, and bilateral occiptal cortex
Parietal dysfunction: Responsible for the disturbed body image perception and deficits in visual-spatial construction and mental arithmetic experienced by anorexics.
Frontal cortex: common cause of deficits in attention and problem-solving abilities 96% of anorexics exhibit symptoms of other psychiatric illnesses, e.g. depression, OCD - commonly responsive to antidepressant medication (e.g. SSRIs)
60% of individuals with AN are given SSRIs
In terms of malnutrition and weight restoration, SSRIs have no proven benefit in its use as pharmacological treatment SSRIs reduce the risk of relapse when given after weight restoration (may be due to reductions in obsession, compulsion, and other psychological disturbances)
SSRIs enhance BDNF expression --> improve anorexics' self-esteem, lessen their anxious and depresssed state, and increase their cognitive ability To conclude... Brain abnormalities found in anorexics are reversible after weight restoration
Anorexic women have lower BDNF levels and low levels of 5-HT neuronal activity LIMITATIONS OF STUDIES Cohort studies were too small --> larger prospective studies are needed to verify the findings and form a definitive conclusion
Classification of AN purely according to BMI --> NICE guidelines state that they should not be considered the sole indicators of AN, as they can be unreliable in adults and especially children --> Future cohort studies must distinguish anorexics from non-anorexics not only by weight/BMI, but also by the DSM-IV-TR criteria. REFERENCES:
Burghardt R, Eckart S, Ehrlich S, Franke L, Hellweg R, Lehmkuhl U, et al. (2009): Serum brain-derived neurotrophic factor and peripheral indicators of the serotonin system in underweight and weight-recovered adolescent girls and women with anorexia nervosa; 34(4):323-329.
Ishibashi M, Komatsu H, Matsuishi T, Nagamitsu S, Ozono S, Yamashita Y. (2010): Regional cerebral blood flow changes in early-onset anorexia nervosa before and after weight gain; 32(8):625-630.
Kaye W. (2008): Neurobiology of anorexia and bulimia nervosa; 94(1):121-135.
Audenaert K, Dierckx RA, Dumont F, Goethals I, Heeringen C, Mertens J, et al. (2003): Decreased 5-HT2a receptor binding in patients with anorexia nervosa; 44(2):163-169.
Attia E, Carter JC, Devlin MJ, Kaplan AS, Olmsted M, Parides M, et al. (2006): Fluoxetine after weight restoration in anorexia nervosa: a randomised controlled trial; 295(22):2605-2612.
National Institute of Clinical Excellence (2004): eating disorders: Core interventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders; Clinical guideline 9; London: NICE.