Different Types of Decision Making Impairments in Anorexia Nervosa

Research on neurocognitive aspects in Anorexia Nervosa (AN) has outlined a cognitive profile characterized by deficiency in the ability to set-shifting (cognitive flexibility) and weak central coherence. A smaller agreement emerges in relation to the compromission of decisional profiles frequently observed in patients with AN since both the complexity of the pathology and the executive function itself make it unclear the nature of these alterations and its relationships with specific or independent clinical and enviornmental variables. The aim of this study was: to investigate different types of decision-making (DM) ability, veridical and adaptive, in a sample of patients with AN using the Iowa Gambling Task and the Cognitive Bias Task; to analyze test performance using a specific cognitive model for the Iowa Gambling Task (Expectancy Valence Learning Model), and to study the relationship with clinical features, focusing on their relationship with neuropsychological profiles and clinical variables; to explore the neural correlations of the two tasks with functional connectivity; to observe the the impact of the genetic profile on different types of DM. Materials and Methods: The sample, consisting of 310 female subjects with AN lifetime and 301 female subjects without diagnosis of lifetime eating disorders, was tested in relation to DM abilities through the Iowa Gambling Task and cognitive Bias Task. All of the participants completed a baseline assessment including the Structured Clinical Interview (SCID) for the DSM-IV, section for eating disorders, and neuropsychological tests including the Wisconsin Card Sorting Test, and Trail Making Test for assessing abilities of abstraction and cognitive flexibility; 10 "and 30" interference memory test for evaluation of working memory, Stop Signal Task for evaluation of inibitory control. The Expectancy Valence Model (EVM) was used to analyze the results obtained in IGT. A genotyping was performed to evaluate the impact of the major polymorphisms implicated in decision-making (158 Val → Met) of the COMT gene and single nucleotide A / G polymorphism (SNP rs25531) of the serotonin carrier gene 5 - HTTLPR. In a smaller subgroup of 35 AN and 34 Healthy control seed based resting state Functional connectivity was explored. Compared to the group of healthy subjects, the decision-making profile of patients suffering from AN was worse in both Iowa Gambling Task (IGT), which evaluates veridical DM, and Cognitive Bias Task (Cbias), which evaluates adaptive DM, regardless of the diagnostic subtype (restrictive vs. binging/purging), psychopathology severity, scholarity, manual 3 dominance or outcome specific treatment. However in IGT the affective decision-making seems to be independent of IMC, conversely in Cbias the adaptive decisional profile was influenced by underweight. Both types of decision-making in patients were not affected by neurocognitive or clinical variables considered. The unfavorable geotype in AN resulted the homozygous for the met allele of the Comt gene and for the short variant of the serotonin transporter gene. The resting functional connectivity explored on the seeds of interest (executive network, orbitofrontal cortex, accumbens and amygdala) in a subgroup of patients and controls showed significantly different patterns of correlation with the scores of IGt and Cbias. In addition, different resting neural patterns appear to be involved in the two different tasks considered. Only in the AN group a positive correlation between the scores on IGT and the activity of the amygdala resulted. In AN group an higher coactivation within the executive, accumbens and orbitofrontal networks was linked to higher context-independency decisional style assessed with CBias, whereas for the executive network the opposite was true for healthy women. In summary our results confirm an impairment of different types of decision making in AN and highlitght the importance of assessing decisional processes with different specific tasks in clinical sample. In particular different maladaptative strategies are associated with ineffective decisional profiles in AN, consisting in a “myopia for the future” and “anxiety inhibition” in veridical situations and in a difficulty to update/review one’s own mindset according to new environmental stimuli (context indipendent reasoning strategies) in adaptive decisional framework. The severity of malnurishment seems to influence adaptive decisional style conferring a bias toward a context indipent reasoning, suggesting the need of metacognitive approach to help patients to be more aware of their tendency to automatically use selection bias in DM contexts. Genetic polimorphysms may in part account for the impaired decision making observed in AN patients, with a negative impact of met Comt allele and the short variant of 5HTTLPR polymorphism. Functional connectivity suggests the presence of different dysfunctional decision making networks in AN patients in the two decisional framework, confirming the importance of emotion and anxiety on decisional performance in AN. Since the cross sectional design of our study, further and longitudinal studies with recovered and at risk subjects are necessary to confirm our results

Social cognition in people with schizophrenia: A cluster-analytic approach

Background The study aimed to subtype patients with schizophrenia on the basis of social cognition (SC), and to identify cut-offs that best discriminate among subtypes in 809 out-patients recruited in the context of the Italian Network for Research on Psychoses. Method A two-step cluster analysis of The Awareness of Social Inference Test (TASIT), the Facial Emotion Identification Test and Mayer-Salovey-Caruso Emotional Intelligence Test scores was performed. Classification and regression tree analysis was used to identify the cut-offs of variables that best discriminated among clusters. Results We identified three clusters, characterized by unimpaired (42%), impaired (50.4%) and very impaired (7.5%) SC. Three theory-of-mind domains were more important for the cluster definition as compared with emotion perception and emotional intelligence. Patients more able to understand simple sarcasm (14 for TASIT-SS) were very likely to belong to the unimpaired SC cluster. Compared with patients in the impaired SC cluster, those in the very impaired SC cluster performed significantly worse in lie scenes (TASIT-LI <10), but not in simple sarcasm. Moreover, functioning, neurocognition, disorganization and SC had a linear relationship across the three clusters, while positive symptoms were significantly lower in patients with unimpaired SC as compared with patients with impaired and very impaired SC. On the other hand, negative symptoms were highest in patients with impaired levels of SC. Conclusions If replicated, the identification of such subtypes in clinical practice may help in tailoring rehabilitation efforts to the person's strengths to gain more benefit to the person

Social cognition in people with schizophrenia: A cluster-analytic approach

Background The study aimed to subtype patients with schizophrenia on the basis of social cognition (SC), and to identify cut-offs that best discriminate among subtypes in 809 out-patients recruited in the context of the Italian Network for Research on Psychoses. Method A two-step cluster analysis of The Awareness of Social Inference Test (TASIT), the Facial Emotion Identification Test and Mayer-Salovey-Caruso Emotional Intelligence Test scores was performed. Classification and regression tree analysis was used to identify the cut-offs of variables that best discriminated among clusters. Results We identified three clusters, characterized by unimpaired (42%), impaired (50.4%) and very impaired (7.5%) SC. Three theory-of-mind domains were more important for the cluster definition as compared with emotion perception and emotional intelligence. Patients more able to understand simple sarcasm (14 for TASIT-SS) were very likely to belong to the unimpaired SC cluster. Compared with patients in the impaired SC cluster, those in the very impaired SC cluster performed significantly worse in lie scenes (TASIT-LI <10), but not in simple sarcasm. Moreover, functioning, neurocognition, disorganization and SC had a linear relationship across the three clusters, while positive symptoms were significantly lower in patients with unimpaired SC as compared with patients with impaired and very impaired SC. On the other hand, negative symptoms were highest in patients with impaired levels of SC. Conclusions If replicated, the identification of such subtypes in clinical practice may help in tailoring rehabilitation efforts to the person's strengths to gain more benefit to the person

Different Types of Decision Making Impairments in Anorexia Nervosa

Research on neurocognitive aspects in Anorexia Nervosa (AN) has outlined a cognitive profile characterized by deficiency in the ability to set-shifting (cognitive flexibility) and weak central coherence. A smaller agreement emerges in relation to the compromission of decisional profiles frequently observed in patients with AN since both the complexity of the pathology and the executive function itself make it unclear the nature of these alterations and its relationships with specific or independent clinical and enviornmental variables. The aim of this study was: to investigate different types of decision-making (DM) ability, veridical and adaptive, in a sample of patients with AN using the Iowa Gambling Task and the Cognitive Bias Task; to analyze test performance using a specific cognitive model for the Iowa Gambling Task (Expectancy Valence Learning Model), and to study the relationship with clinical features, focusing on their relationship with neuropsychological profiles and clinical variables; to explore the neural correlations of the two tasks with functional connectivity; to observe the the impact of the genetic profile on different types of DM. Materials and Methods: The sample, consisting of 310 female subjects with AN lifetime and 301 female subjects without diagnosis of lifetime eating disorders, was tested in relation to DM abilities through the Iowa Gambling Task and cognitive Bias Task. All of the participants completed a baseline assessment including the Structured Clinical Interview (SCID) for the DSM-IV, section for eating disorders, and neuropsychological tests including the Wisconsin Card Sorting Test, and Trail Making Test for assessing abilities of abstraction and cognitive flexibility; 10 "and 30" interference memory test for evaluation of working memory, Stop Signal Task for evaluation of inibitory control. The Expectancy Valence Model (EVM) was used to analyze the results obtained in IGT. A genotyping was performed to evaluate the impact of the major polymorphisms implicated in decision-making (158 Val → Met) of the COMT gene and single nucleotide A / G polymorphism (SNP rs25531) of the serotonin carrier gene 5 - HTTLPR. In a smaller subgroup of 35 AN and 34 Healthy control seed based resting state Functional connectivity was explored. Compared to the group of healthy subjects, the decision-making profile of patients suffering from AN was worse in both Iowa Gambling Task (IGT), which evaluates veridical DM, and Cognitive Bias Task (Cbias), which evaluates adaptive DM, regardless of the diagnostic subtype (restrictive vs. binging/purging), psychopathology severity, scholarity, manual 3 dominance or outcome specific treatment. However in IGT the affective decision-making seems to be independent of IMC, conversely in Cbias the adaptive decisional profile was influenced by underweight. Both types of decision-making in patients were not affected by neurocognitive or clinical variables considered. The unfavorable geotype in AN resulted the homozygous for the met allele of the Comt gene and for the short variant of the serotonin transporter gene. The resting functional connectivity explored on the seeds of interest (executive network, orbitofrontal cortex, accumbens and amygdala) in a subgroup of patients and controls showed significantly different patterns of correlation with the scores of IGt and Cbias. In addition, different resting neural patterns appear to be involved in the two different tasks considered. Only in the AN group a positive correlation between the scores on IGT and the activity of the amygdala resulted. In AN group an higher coactivation within the executive, accumbens and orbitofrontal networks was linked to higher context-independency decisional style assessed with CBias, whereas for the executive network the opposite was true for healthy women. In summary our results confirm an impairment of different types of decision making in AN and highlitght the importance of assessing decisional processes with different specific tasks in clinical sample. In particular different maladaptative strategies are associated with ineffective decisional profiles in AN, consisting in a “myopia for the future” and “anxiety inhibition” in veridical situations and in a difficulty to update/review one’s own mindset according to new environmental stimuli (context indipendent reasoning strategies) in adaptive decisional framework. The severity of malnurishment seems to influence adaptive decisional style conferring a bias toward a context indipent reasoning, suggesting the need of metacognitive approach to help patients to be more aware of their tendency to automatically use selection bias in DM contexts. Genetic polimorphysms may in part account for the impaired decision making observed in AN patients, with a negative impact of met Comt allele and the short variant of 5HTTLPR polymorphism. Functional connectivity suggests the presence of different dysfunctional decision making networks in AN patients in the two decisional framework, confirming the importance of emotion and anxiety on decisional performance in AN. Since the cross sectional design of our study, further and longitudinal studies with recovered and at risk subjects are necessary to confirm our results.La ricerca sugli aspetti neurocognitivi nell’anoressia nervosa (AN) ha delineato un profilo cognitivo caratterizzato da deficit nell’abilità di set-shifting (flessibilità cognitiva) e da debole coerenza centrale. Un minor accordo emerge in relazione alla compromissione dei profili decisionali frequentemente osservata nelle pazienti con AN dal momento che la complessità della patologia e della funzione esecutiva stessa rendono poco chiara la natura di tali alterazioni e le relazioni con aspetti clinici specifici della malattia o indipendenti da essa. Il nostro studio si propone di valutare la capacità decisionale di un campione di pazienti affette da AN utilizzando l'Iowa Gambling Task, e il Cognitive Bias Task, di analizzare le performance al test utilizzando un modello cognitivo specifico per l’Iowa Gambling Task (Expectancy Valence model), e di studiare le relazioni tra i risultati ottenuti e le caratteristiche cliniche delle pazienti focalizzandoci nella loro relazione con aspetti caratteristici del profilo neuropsicologico e della presentazione della malattia come la precoce età di esordio. Approfondire i correlati anatomici, di connettività strutturale e funzionale delle perfomance ai due task e l’impatto dell’assetto genetico. Il campione, costituito da 310 soggetti di sesso femminile con diagnosi lifetime di AN e 301 soggetti di sesso femminile senza diagnosi di sturbo del comportamento alimentare è stato testato in relazione alle abilità decisionali attraverso l’Iowa Gambling Task. Tutti i soggetti, previo consenso informato, hanno completato una valutazione sia clinica che semistrutturata mediante la somministrazione dell’Intervista Clinica Strutturata (SCID) per il DSM-IV, sezione per i disturbi del comportamento alimentare. E’ stata somministrata una batteria di valutazione neuropsicologica includente: the WCST Wisconsin Card Sorting Test and Trail Making Tet sper la valutazione dell’abilità di astrazione e della flessibilità cognitiva; test di Memoria con interferenza a 10" e 30" per la valutazione della memoria di lavoro; SSRT per la valutazione del controllo inibitorio. E' stato utilizzato inoltre uno specifico modello cognitivo (Expectancy Valence model) al fine di analizzare i risultati ottenuti all'IGT. È stata effettuata una genotipizzazione per valutare l’impatto dei principali polimorfismi ritenuti implicati nelle performance decisionali (158 Val → Met del gene COMT, la variante corta e il polimorfismo a singolo nucleotide A/G (SNP rs25531) del gene del trasportatore della serotonina 5-HTTLPR. Un sottogruppo di 35 soggetti affetti da AN e 34 controlli sani infine si è sottoposto a risonanza magnetica funzionale a riposo. E’ stata condotta un’analisi della connettività funzionale basata su “seed” in specifiche regioni di interesse (network esecutivo, corteccia orbitofrontale, network dell’accumbens ed amigdala). I risultati confermano la presenza di un peggior profilo decisionale all’ IGT nelle pazienti affette da Anoressia nervosa indipendentemente dall’età del soggetto, tuttavia il deficit decisionale sembra essere indipendente dall’IMC nell IGT ma influenzato dal sotto peso nel Cbias. Entrambi i diversi tipi di decision making nelle pazienti non risentono dall’assetto neurocognitivo o dalle variabili cliniche prese in esame. L’assetto genetico sfavorevole nelle pazienti sembrerebbe essere l’omozigosi per l’allele met del gene Comt e per la variante S del trasportatore della serotonina. Rispetto al gruppo di soggetti sani, il profilo decisionale delle pazienti affette da Anoressia Nervosa è risultato peggiore sia allo Iowa Gambling Task (IGT), che valuta le abilità deciosionali di tipo veridico, che al Cognitive Bias Task (Cbias), che valuta le abilità decisionali di tipo adattativo, indipendentemente dal sottotipo diagnostico (restrittivo vs bulumico purgativo), psicopatologia, scolarità o dominanza manuale. La connettività funzionale a riposo esplorata sui seed di interesse (network esecutivo, corteccia orbitofrontale, accumbens e amigdala ) in un sottogruppo di pazienti e controlli ha mostrato nei due gruppi pattern significativamente diversi di correlazione con i punteggi all’IGt e al Cbias. Inoltre pattern neurali differenti a riposo sembrano essere coinvolti nei due diversi task considerati. È stata identificata solo nel gruppo di AN una correlazione positiva tra i punteggi all’IGT e l’attività dell’amigdala. Nelle pazienti una maggior coattivazione all’interno del network esecutivo , orbitofrontale e dell’accumbens è legata a performance decisionali maggiormente indipendenti dal contesto al Cbias, mentre per il network esecutivo accade il contrario nei soggetti sani

Neural signatures of the interaction between the 5-HTTLPR genotype and stressful life events in healthy women

A change in neural connectivity of brain structures implicated in the memory of negative life events has been hypothesized to explain the enhancement of memory encoding during the processing of negative stimuli in depressed patients. Here, we investigated the effects of the interaction between negative life events and the 5-HTTLPR genotype - a polymorphism of the serotonin transporter gene - on the functional and structural connectivity of the hippocampal area in 34 healthy women. All participants were genotyped for the presence of the 5-HTTLPR short variant and for the A/G single-nucleotide polymorphism; they underwent clinical assessment including structured diagnostic interviews to exclude the presence of psychiatric disorders and to assess the presence of stressful life events. Resting state functional magnetic resonance imaging and diffusion tensor imaging scans were performed. We found significant interactions between stressful events and the 5-HTTLPR genotype in both the functional connectivity of the parahippocampus with the posterior cingulate cortex and the structural connectivity between the hippocampus and both the amygdala and the putamen. In addition, we found several genotype-related differences in the relationship between functional/structural connectivity of the hippocampal area and the ability to update expectations or stress-related phenotypes, such as anxiety symptoms. If confirmed by future studies, these mechanisms may clarify the role of the 5HTTLPR genotype as a risk factor for depression, in interaction with negative events

Serotonin transporter gene polymorphism in eating disorders: Data from a new biobank and META-analysis of previous studies

<p><b>Objectives</b> Growing interest focuses on the association between 5-HTTLPR polymorphism and eating disorders (ED), but published findings have been conflicting. <b>Methods</b> The Italian BIO.VE.D.A. biobank provided 976 samples (735 ED patients and 241 controls) for genotyping. We conducted a literature search of studies published up to 1 April 2015, including studies reporting on 5HTTLPR genotype and allele frequencies in obesity and/or ED. We ran a meta-analysis, including data from BIO.VE.D.A. – comparing low and high-functioning genotype and allele frequencies in ED vs. controls. <b>Results</b> Data from 21 studies, plus BIO.VE.D.A., were extracted providing information from 3,736 patients and 2,707 controls. Neither low- nor high-functioning genotype frequencies in ED patients, with both bi- and tri-allelic models, differed from controls. Furthermore, neither low- nor high-functioning allele frequencies in ED or in BN, in both bi- and triallelic models, differed from control groups. After sensitivity analysis, results were the same in AN vs. controls. Results remained unaltered when investigating recessive and dominant models. <b>Conclusions</b> 5HTTLPR does not seem to be associated with ED in general, or with AN or BN in particular. Future studies in ED should explore the role of ethnicity and psychiatric comorbidity as a possible source of bias.</p

The influence of illness-related variables, personal resources and context-related factors on real-life functioning of people with schizophrenia

In people suffering from schizophrenia, major areas of everyday life are impaired, including independent living, productive activities and social relationships. Enhanced understanding of factors that hinder real-life functioning is vital for treatments to translate into more positive outcomes. The goal of the present study was to identify predictors of real-life functioning in people with schizophrenia, and to assess their relative contribution. Based on previous literature and clinical experience, several factors were selected and grouped into three categories: illness-related variables, personal resources and context-related factors. Some of these variables were never investigated before in relationship with real-life functioning. In 921 patients with schizophrenia living in the community, we found that variables relevant to the disease, personal resources and social context explain 53.8% of real-life functioning variance in a structural equation model. Neurocognition exhibited the strongest, though indirect, association with real-life functioning. Positive symptoms and disorganization, as well as avolition, proved to have significant direct and indirect effects, while depression had no significant association and poor emotional expression was only indirectly and weakly related to real-life functioning. Availability of a disability pension and access to social and family incentives also showed a significant direct association with functioning. Social cognition, functional capacity, resilience, internalized stigma and engagement with mental health services served as mediators. The observed complex associations among investigated predictors, mediators and real-life functioning strongly suggest that integrated and personalized programs should be provided as standard treatment to people with schizophrenia