A systematic review and metaanalysis of set-shifting ability in eating disorders.Psychol. Med., 37:1075-1084

Division of Psychological Medicine, Eating Disorders Research Unit, Department of Academic Psychiatry, King's College, Guy's Hospital, London, UK.
Psychological Medicine (Impact Factor: 5.94). 09/2007; 37(8):1075-84. DOI: 10.1017/S0033291707009877
Source: PubMed


The aim was to critically appraise and synthesize the literature relating to set-shifting ability in eating disorders. PsycINFO, Medline, and Web of Science databases were searched to December 2005. Hand searching of eating-disorder journals and relevant reference sections was also undertaken.
The 15 selected studies contained both eating disorder and healthy control groups, and employed at least one of the following six neuropsychological measures of set-shifting ability; Trail Making Test (TMT), Wisconsin Card Sort Test (WCST), Brixton task, Haptic Illusion, CatBat task, or the set-shifting subset of the Cambridge Neuropsychological Test Automated Battery (CANTAB). The outcome variable was performance on the set-shifting aspect of the task. Pooled standardized mean differences (effect sizes) were calculated.
TMT, WCST, CatBat and Haptic tasks had sufficient sample sizes for meta-analysis. These four tasks yielded acceptable pooled standardized effect sizes (0.36; TMT -1.05; Haptic) with moderate variation within studies (as measured by confidence intervals). The Brixton task showed a small pooled mean difference, and displayed more variation between sample results. The effect size for CANTAB set shifting was 0.17.
Problems in set shifting as measured by a variety of neuropsychological tasks are present in people with eating disorders.

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    • "Inefficient cognitive processing, namely poor set shifting and global processing abilities, have been consistently reported in adults with AN (Lang et al., 2014a; Roberts et al., 2007; Tchanturia et al., 2012). This cognitive style is also present in an attenuated form in individuals who are weightrestored (Harrison et al., 2011; Roberts et al., 2010; Tchanturia et al., 2012). "
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    ABSTRACT: Objectives: Inefficient set shifting and poor global processing are thought to be possible traits in anorexia nervosa (AN). This study aimed to investigate the neuropsychological processing style of unaffected mothers of offspring with AN (unaffected AN mothers). Methods: The performance of 21 unaffected AN mothers were compared to 20 mothers of healthy control offspring on neuropsychological measures of set shifting (Wisconsin Card Sorting Test, WCST) and central coherence (Fragmented Pictures Task, FPT, and Rey Osterrieth Complex Figures Task, ROCFT). Associations between neuropsychological performance and clinical measures were examined in the unaffected AN mothers group. Results: There were significant differences in perseverative errors on the WCST (P≤0.01), with the unaffected mothers displaying a more inflexible thinking style compared to the control group. There were also significant differences on the FPT (P ≤ 0.01) and the ROCFT (P ≤ 0.01), whereby unaffected AN mothers showed lower levels of global processing. Conclusions. The results of this study support the idea of the familial nature of cognitive styles in AN. The implications of these findings are discussed.
    Full-text · Article · Nov 2015 · The World Journal of Biological Psychiatry
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    • "In the related disorder OCD, most studies show evidence of deficits in set-shifting ((Kuelz et al., 2004; Penades et al., 2005; Rampacher et al., 2010) and see review (Kuelz et al., 2004)). Multiple studies in anorexia nervosa, a related disorder involving body image disturbance, also have found impairments in set-shifting (for review see (Roberts et al., 2007)). "
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    ABSTRACT: Body dysmorphic disorder (BDD) is characterized by distressing and often debilitating preoccupations with misperceived defects in appearance. Research suggests that aberrant visual processing may contribute to these misperceptions. This study used two tasks to probe global and local visual processing as well as set shifting in individuals with BDD. Eighteen unmedicated individuals with BDD and 17 non-clinical controls completed two global-local tasks. The embedded figures task requires participants to determine which of three complex figures contained a simpler figure embedded within it. The Navon task utilizes incongruent stimuli comprised of a large letter (global level) made up of smaller letters (local level). The outcome measures were response time and accuracy rate. On the embedded figures task, BDD individuals were slower and less accurate than controls. On the Navon task, BDD individuals processed both global and local stimuli slower and less accurately than controls, and there was a further decrement in performance when shifting attention between the different levels of stimuli. Worse insight correlated with poorer performance on both tasks. Taken together, these results suggest abnormal global and local processing for non-appearance related stimuli among BDD individuals, in addition to evidence of poor set-shifting abilities. Moreover, these abnormalities appear to relate to the important clinical variable of poor insight. Further research is needed to explore these abnormalities and elucidate their possible role in the development and/or persistence of BDD symptoms.
    Full-text · Article · Oct 2014 · Journal of Psychiatric Research
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    • "However, candidate biomarkers might be identified by examining the brain circuitry underlying the cognitive inefficiencies reported in AN (Tchanturia et al., 2012a; Fonville et al., 2013). AN is associated with a specific neuropsychological profile, including impaired set shifting (e.g., inflexibility and perseveration) and weak central coherence (exaggerated focus on detail to the neglect of the whole) (Tchanturia et al., 2012b, 2001, 2002, 2004; Holliday et al., 2006; Lock et al., 2011; Roberts et al., 2007; Benson et al., 2010; Harrison et al., 2010). This cognitive style appears to be heritable, persists after recovery, and is seen in relatives without AN (Fossella et al., 2003; Treasure, 2007; Wade and Bulik, 2007; Grice et al., 2002). "
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    ABSTRACT: Background Patients with Anorexia Nervosa (AN) have neuropsychological deficits in Set-Shifting (SS) and central coherence (CC) consistent with an inflexible thinking style and overly detailed processing style, respectively. This study investigates brain activation during SS and CC tasks in patients with AN and tests whether this activation is a biomarker that predicts response to treatment.. Methods FMRI data were collected from 21 females with AN while performing an SS task (the Wisconsin Card Sort) and a CC task (embedded figures), and used to predict outcome following 16 weeks of treatment (either 16 weeks of cognitive behavioral therapy or 8 weeks cognitive remediation therapy followed by 8 weeks of cognitive behavioral therapy). Results Significant activation during the SS task included bilateral dorsolateral and ventrolateral prefrontal cortex and left anterior middle frontal gyrus. Higher scores on the neuropsychological test of SS (measured outside the scanner at baseline) were correlated with greater DLPFC and VLPFC/insula activation. Improvements in SS following treatment were significantly predicted by a combination of low VLPFC/insula and high anterior middle frontal activation (R squared = .68, p = .001). For the CC task, visual and parietal cortical areas were activated, but were not significantly correlated with neuropsychological measures of CC and did not predict outcome. Conclusion Cognitive flexibility requires the support of several prefrontal cortex resources. As previous studies suggest that the VLPFC is important for selecting context-appropriate responses, patients who have difficulties with this skill may benefit the most from cognitive therapy with or without cognitive remediation therapy. The ability to sustain inhibition of an unwanted response, subserved by the anterior middle frontal gyrus, is a cognitive feature that predicts favorable outcome to cognitive treatment. CC deficits may not be an effective predictor of clinical outcome.
    Full-text · Article · Oct 2014 · Journal of Psychiatric Research
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