Article

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: 12.3). 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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    • "One of the limitations of this study is that we did not use a measure of IQ. However, since previous studies did not find a relationship between set-shifting and IQ (Tchanturia et al., 2004; Holliday et al., 2005) and levels of education were equally distributed across the two conditions, we do not expect possible IQ-differences to have a significant effect on our results. Another limitation is that that 'the feeling of loss of control over eating' item (VAS) does not necessarily measure a behavioral loss of control. "
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    ABSTRACT: Executive functions play an important role in problem-solving and self-control. Set-shifting is an aspect of executive functioning and represents cognitive flexibility. The inability to control eating in Binge Eating Disorder (BED) may imply deficits in set-shifting which could be exacerbated by negative mood and depressive symptoms. The aim of the study was to test whether there is a causal relationship between set-shifting ability, changes in mood and loss of control over eating in BED. Seventy-five participants diagnosed with BED were randomly assigned to a negative or neutral mood induction. Set-shifting abilities, depressive symptoms, current mood and loss of control over eating were assessed. Having depressive symptoms and poorer set-shifting abilities resulted in a more negative mood after a negative mood induction, whereas this was not observed in the neutral mood induction. Post-hoc analyses revealed that individuals with poorer set-shifting abilities and more changes in negative mood, experienced more feelings of loss of control over eating than individuals whose set-shifting abilities were better and whose mood did not change. The results suggest that both depressive symptoms and deficits in set-shifting abilities may decrease an individual's ability to handle negative affect and increase loss of control over eating in individuals with BED.
    Full-text · Article · Dec 2015
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    • "Additionally, inefficient cognitive processing in AN appears to be familial, as it is also present in unaffected family members (Galimberti et al., 2013; Roberts et al., 2010; 2013). Much of this work has compared discordant sister pairs to unaffected sister pairs, finding poor neuropsychological processing in unaffected sisters compared to HC sisters (Holliday et al., 2005; Roberts et al., 2010). Tenconi et al., (2010) found poorer neuropsychological performance in a mixed sample of children, adolescents and adults with AN and their healthy unaffected sisters compared to HCs (Tenconi et al., 2010). "

    Full-text · Dataset · Nov 2015
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    • "Additionally, inefficient cognitive processing in AN appears to be familial, as it is also present in unaffected family members (Galimberti et al., 2013; Roberts et al., 2010; 2013). Much of this work has compared discordant sister pairs to unaffected sister pairs, finding poor neuropsychological processing in unaffected sisters compared to HC sisters (Holliday et al., 2005; Roberts et al., 2010). Tenconi et al., (2010) found poorer neuropsychological performance in a mixed sample of children, adolescents and adults with AN and their healthy unaffected sisters compared to HCs (Tenconi et al., 2010). "
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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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