Longitudinal Assessment of Eating-related Anxiety in Anorexia Nervosa

神经性厌食症饮食相关焦虑的纵向评估

• 批准号: 10447413
• 负责人: Kimberly Smith
• 金额: $ 18.42万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-03-01 至 2027-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10447413
• 关键词: Address; Admission activity; American; Amygdaloid structure; Anorexia Nervosa; Anxiety; Behavior; Behavior Disorders; Behavior Therapy; Behavioral; Biological; Biological Markers; Body mass index; Brain; Brain imaging; Budgets; Calories; Carbohydrates; Caring; Choice Behavior; Clinical; Consumption; Data; Data Analyses; Disease; Disease remission; Eating; Eating Behavior; Eating Disorders; Emotions; Enteral Feeding; Environment; Exposure to; Faculty; Fatty acid glycerol esters; Food; Fright; Functional Magnetic Resonance Imaging; Goals; Grant; Hospitals; Individual; Inpatients; Institution; Interdisciplinary Study; Length of Stay; Machine Learning; Medical Research; Mentors; Nature; Neurobiology; Patients; Pattern; Protocols documentation; Psychiatry; Psychometrics; Recovery; Refractory; Relapse; Research; Research Personnel; Research Training; Resistance; Risk Factors; Starvation; Statistical Methods; Stimulus; Techniques; Testing; Therapeutic; Thinking; Time; Training; Training Programs; Translational Research; Treatment outcome; United States; Universities; Weight; Weight Gain; Writing; anxiety treatment; base; career; career development; classical conditioning; clinical practice; clinically relevant; collaborative environment; design; experimental study; food avoidance; food consumption; habituation; improved; instrument; interdisciplinary approach; medical schools; neural circuit; neural patterning; neurobehavioral; neuroimaging; neuromechanism; nutrition; personalized care; personalized medicine; phenomenological models; programs; public health relevance; reduced food intake; relating to nervous system; response; restrictive eating; skills; social; statistics; tool; treatment program; weight restoration

Project Summary. Anorexia nervosa (AN) is a behavioral disorder marked by self-starvation and fear of weight gain. Weight restoration to a BMI of 19-21 remains the mainstay of treatment for severe AN despite relapse rates in the first year of up to 50%. The mechanisms underlying these high relapse rates remain unknown. Meal- associated anxiety is a striking feature in patients with AN. As the disorder develops, eating behaviors are in- creasingly driven by what appears to be a conditioned avoidance of energy dense foods, known as fear foods, suggesting that exposure-based approaches to treatment may help drive remission. However, in many intensive treatment programs, tube feeding over meal-based nutrition is increasingly the approach. Thus, the need is great for determining what mechanisms and approaches underly the successful treatment of AN and what neurobehavioral factors render individuals responsive versus resistant to treatment. Research: Ex- periments will address the extent to which habituation of learned aversions to fear foods following meal-based exposure generalizes across similar types of foods (Aim 1). Task-based fMRI combined with this behavioral approach will allow the determination of the neural substrates of habituated anxiety responses (Aim 2a). Finally, a machine-learning approach will be used to predict anxiety ratings based on baseline neural activation and identify individuals responsive vs resistant to treatment (Aim 2b). By demonstrating the significance of addressing food-related anxiety as a primary treatment target and examining the neural circuitry activated by fear foods, this project has potential to 1) alter how AN is treated across multiple levels of care and social eating settings, and 2) enhance understanding of the neurobiology that sustains treatment refractoriness. Career Development: The training plan will provide the PI with a) clinically relevant training in the phenomenology of AN, clinical course, and validated instruments used to assess eating disorders important to formulating clinically relevant hypotheses and data interpretation, b) hands-on training in advanced statistical methods for fMRI data, c) opportunity to integrate her training in factors that influence food choice with obtained results, and d) training in grant writing and career development to launch an independent research career. Environment: Johns Hopkins is an excellent environment for collaborative, interdisciplinary, and translational research in healthy and disease states and is focused on mentoring junior faculty. The Johns Hopkins Hospital is ranked #1 in the nation for Psychiatry, with the School of Medicine being the leading research medical institution in the United States and the Eating Disorder Program nationally recognized as a leading program for eating disorder treatment. Career Goal: The proposed research and training program is targeted to meet the PI's overall career goal of becoming an independent academic researcher investigating the biological basis of eating disorders at a university setting by providing the skills and pilot data necessary for larger R01 proposals to examine neural mechanisms underlying the driven nature of eating disorder behaviors with the goal of improving existing treatments and personalizing care.

项目摘要。神经性厌食症（AN）是一种以自我饥饿和对体重的恐惧为特征的行为障碍 增益尽管有复发率，但体重恢复到19-21的BMI仍然是治疗重度AN的主要方法 在第一年，高达50%。这些高复发率背后的机制仍然未知。吃饭- 相关焦虑是AN患者的显著特征。随着疾病的发展，饮食行为- 越来越多地受到似乎是对能量密集食物的条件性回避的驱使，被称为恐惧食物， 这表明，基于安全的治疗方法可能有助于推动缓解。然而，在许多密集 在治疗方案中，越来越多的方法是管饲而不是膳食营养。因此，需要 对于确定成功治疗AN的机制和方法非常重要， 哪些神经行为因素使个体对治疗有反应而不是有抵抗力。研究： 实验将解决在何种程度上的习惯，学习厌恶恐惧食物后，膳食为基础的 暴露在类似类型的食物中普遍存在（目标1）。基于任务的功能磁共振成像结合这种行为 这种方法将允许确定习惯性焦虑反应的神经底物（目标2a）。最后， 机器学习方法将用于根据基线神经激活来预测焦虑评级， 确定对治疗有反应和有抗性的个体（目标2b）。通过展示解决 将食物相关焦虑作为主要治疗目标，并检查由恐惧食物激活的神经回路， 该项目有可能1）改变AN在多个护理水平和社会饮食环境中的治疗方式， 2)增强对维持治疗无效性的神经生物学的理解。职业发展：The 培训计划将为PI提供a）AN现象学的临床相关培训，临床课程， 以及用于评估饮食失调的有效工具，这些工具对制定临床相关假设很重要 和数据解释，B）功能磁共振成像数据的先进统计方法的实践培训，c）机会， 将她在影响食物选择的因素方面的培训与所获得的结果相结合，以及d）撰写资助书的培训 和职业发展，开展独立的研究生涯。环境：约翰霍普金斯是一个优秀的 健康和疾病状态的协作，跨学科和转化研究的环境， 专注于指导初级教员约翰霍普金斯医院在全国精神病学排名第一， 医学院是美国领先的研究医疗机构， 该计划被全国公认为饮食失调治疗的领先计划。职业目标：建议 研究和培训计划的目标是满足PI的整体职业目标，成为一个独立的 学术研究人员调查饮食失调的生物学基础，在一所大学的设置，提供 更大的R 01提案所需的技能和试点数据，以检查驱动的神经机制 饮食失调行为的本质，目的是改善现有的治疗和个性化护理。