Is Impaired Set-Shifting an Endophenotype of Anorexia Nervosa?

Division of Psychological Medicine, Institute of Psychiatry, King's College London, UK.
American Journal of Psychiatry (Impact Factor: 13.56). 01/2006; 162(12):2269-75. DOI: 10.1176/appi.ajp.162.12.2269
Source: PubMed

ABSTRACT Set-shifting difficulties have been reported in subjects with anorexia nervosa and appear to persist after recovery; therefore, they may be endophenotypic traits. The goals of this study were to investigate whether set-shifting difficulties are familial by examining discordant sister-pairs in comparison with healthy unrelated women and to replicate, with a broader battery, the lack of influence of an acute illness state on neuropsychological performance.
Forty-seven pairs of sisters discordant for anorexia nervosa and 47 healthy unrelated women who were comparable in age and IQ completed neuropsychological tasks selected to assess set-shifting ability. Analyses of variance with standard errors that are robust against correlations within family clusters were used to compare the groups. Results were adjusted for obsessive-compulsive, anxiety, and depression symptoms. Subjects with acute (N=24) and fully remitted (N=23) anorexia nervosa were compared to assess state versus trait effects.
Sisters with and without anorexia nervosa took significantly longer than unrelated healthy women to shift their cognitive set (CatBat task) and demonstrated greater perceptual rigidity (Haptic Illusion task) but did not differ significantly from each other. Women with anorexia nervosa were slower than other groups on Trail Making tasks. Women who had fully recovered from anorexia nervosa made significantly fewer errors than those with acute anorexia nervosa on the Trail Making alphabet task, but these subgroups did not differ on other measures.
Both affected and unaffected sisters had more set-shifting difficulties than unrelated healthy women. This finding, together with the replicated finding that set-shifting difficulties persist after recovery, suggests that set-shifting difficulties are trait characteristics and may inform the search for the endophenotype in anorexia nervosa.

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Available from: Kate Tchanturia, Jul 31, 2015
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    • "Some set-shifting impairments have also been reported in first degree relatives of those with AN. Thus, set-shifting difficulties have been proposed as a possible endophenotype for AN (Holliday et al., 2005). "
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    ABSTRACT: Objectives Recent research suggests certain neuropsychological deficits occur in anorexia nervosa (AN). The role of starvation in these deficits remains unclear. Studies of individuals without AN can elucidate our understanding of the effect of short-term starvation on neuropsychological performance. Methods Using a within-subjects repeated measures design, 60 healthy female participants were tested once after fasting for 18 hours, and once when satiated. Measures included two tasks to measure central coherence and a set-shifting task. Results Fasting exacerbated set-shifting difficulties on a rule-change task. Fasting was associated with stronger local and impaired global processing, indicating weaker central coherence. Conclusions Models of AN that propose a central role for set-shifting difficulties or weak central coherence should also consider the impact of short-term fasting on these processes.
    PLoS ONE 10/2014; 9(10). DOI:10.1371/journal.pone.0110743 · 3.53 Impact Factor
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    • "Les résultats ne montrent pas de différence significative entre les sujets anorexiques et leurs soeurs dans les tâches de « set-shifting », mais des performances significativement moindres des soeurs par rapport à la population générale, celles-ci se révélant plus lentes lors de la réalisation de tâches de « set-shifting » et plus rigides dans la réalisation de tâches perceptives. Les auteurs soulignent que les résultats à ces tests sont similaires pour trois groupes de patients à un stade différent de la maladie (aigu, rémission pondérale récente, guérison) [14]. La réduction de la flexibilité cognitive et perceptuelle serait donc un trait familial, facteur de risque au développement d'une AM, et indépendant du statut nutritionnel. "
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    ABSTRACT: Introduction Anorexia nervosa is a serious psychiatric disorder, for which very few validated therapeutic strategies exist. The specific sociocognitive style of anorexic patients has already been described in the 1960s: it involves a concrete style with abstraction difficulties. Current neuropsychological tests have contributed to a more precise definition of these difficulties. Neuropsychological data: is there a specific cognitive profile? Contrary to common beliefs, these patients’ intellectual performances are not superior to those of the general population. However, detailed comparisons of profiles on the Weschler Scales suggest difficulties in synthesizing information and better abilities in concrete problem solving. Excessive attention to details The dominant hypothesis concerning the attentional dimension is the existence of a weakness in central coherence, resulting in superior detail processing and a weakness in global integration. This trend appears to be stable even after the normalization of nutritional status. Impaired cognitive flexibility The impairment of set-shifting abilities leads to rigidity, expressed by inflexibility and perseveration, both in reasoning and behaviour. This reduced cognitive flexibility appears to persist after recovery, and may constitute a familial trait. In addition, this likely endophenotype seems to be independent from obsessional traits. Controversial social skill Alexithymia is frequently described in anorexic individuals. It is the verbal description of feelings which seems to be particularly impaired. It may explain underlying difficulties in empathy. Indeed, these subjects have lower scores on emotional tests drawn from the theory of mind. These cognitive abnormalities are well documented in pervasive developmental disorders. Neuroanatomical data: neuroimaging in support of limbic and fronto-striatal abnormalities Evidence from neuroimaging suggests abnormalities in cortical and subcortical structures, involving the temporal and orbito-frontal lobes. Various functional hypotheses are formulated, involving fronto-striatothalamic circuits, amygdala or insula. Is anorexia nervosa a developmental disorder? Pervasive developmental disorders are over-represented among anorexic subjects in comparison to the general population. Conversely, restrictive and selective eating disorders are more frequent among individuals presenting an autistic spectrum disorder. Therapeutic implications and future directions In view of the common cognitive and neuroanatomical data that are found in anorexia nervosa and neurodevelopmental disorders, we adhere to the hypothesis that anorexia nervosa may be similar to a neurodevelopmental disorder. Clinical observations suggest that this hypothesis may be especially relevant in the early forms of anorexia nervosa. These cognitive data confirm the potential relevance of new therapeutic modalities such as cognitive remediation. Initial results from its application to anorexia nervosa seem promising. Conclusion A review of the recent literature highlights the possible existence of a developmental impairment of cortical and subcortical structures, associated with specific abnormalities in cognitive development such as a weakness in central coherence, reduced set-shifting ability and poor social skills. On this basis, cognitive remediation may be a promising therapeutic innovation.
    L Encéphale 04/2014; 40(2):160–167. DOI:10.1016/j.encep.2012.06.004 · 0.60 Impact Factor
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    • "Iowa Gambling Task Fagundo et al., 2012; Lindner et al., 2012; Guillaume et al., 2010; Salvador et al., 2010; Brogan et al., 2010; Bosanac et al., 2007; Tchanturia et al., 2007; Cavedini et al., 2006 Trail Making Test Roberts et al., 2007; Holliday et al., 2005; Oltra-Cucarella et al., 2013 Rey-Osterrieth Complex Figure Zuchova et al., 2013; Favaro et al., 2012; Roberts et al., 2013; Andrés-Perpiñá et al., 2011; Alvarado-Sánchez et al., 2009; Lopez et al., 2008a; Lopez et al., 2008b; Oltra-Cucarella et al., 2013 Embedded Figure Test Roberts et al., 2013; Lopez et al., 2008a; Lopez et al., 2008b Stroop Test Kingston et al., 1996; Steinglass et al., 2006; Kemps et al., 2010; Van den Eynde et al., 2012; Oltra-Cucarella et al., 2013 Brixton Spatial Anticipation Test Lounes et al., 2011; Roberts et al., 2007; Tchanturia et al., 2004 Block Design Lopez et al., 2008a CatBat task Roberts et al., 2007; Holliday et al., 2005 Digit Symbol Test Pieters et al., 2004; Palaziduo et al., 1990 Haptic Illusion Roberts et al., 2007; Holliday et al., 2005; Tchanturia et al., 2004 Verbal Fluency test Stedal et al., 2013; Tchanturia et al., 2004 Complimentary Contributor Copy "
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    ABSTRACT: The present chapter deals with the ego-syntonicity that characterizes all Eating Disorders (EDs), but mainly Anorexia Nervosa. Many ED patients identify themselves with their disorder to the point of considering it their “lifestyle”, which suggests that these patients value their symptoms as rational and desirable, in spite of their unpleasant consequences. The identification with the disorder might be associated with the patients’ low insight and low motivation to change, two characteristics that make them especially resistant to treatment and cause high rates of therapy withdrawal. Despite the importance of ego-syntonicity and ego-dystonicity in both EDs psychopathology and treatment, there are few studies about this topic. The main aim of this chapter is to review studies about ego-syntonicity and ego-dystonicity in EDs, providing the latest studies, advances, and measures related to these concepts. In doing so, we first highlight different definitions of ego-syntonicity and its counterpart, ego-dystonicity, with a special emphasis on the most comprehensive definition, provided by Purdon, Cripps, Faull, Joseph, and Rowa [Purdon, Cripps, Faull, Joseph, Rowa, 2007]. Second, we will focus on ED ego-syntonicity and ego-dystonicity as two different but related multidimensional constructs. From our point of view, this approach allows a more adequate understanding of the ambivalence ED patients typically feel about their symptoms. Third, we examine the low insight and treatment resistance found in EDs, analyzing the association between low motivation to change and the ego-syntonicity/ego-dystonicity of eating-intrusive and repetitive thoughts about appearance, diet and exercise in these patients. And finally, we discuss the need for studies that take into account patients’ appraisal of ego-syntonicity about their symptoms, in order to provide the opportunity to design more tailored treatments that will increase patients’ motivation and adherence.
    New Developments in Anorexia Nervosa Research, Series: Eating Disorders in the 21st Century edited by C.Gramaglia, P. Zeppegno, 01/2014: chapter Ego-syntonicity and eating disorders: pages 1-13; Nova Science Publishers, Inc.., ISBN: 978-1-63117-551-0; 978-1-63117-552-7 (ebook)
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