The Triple A study (Adolescents with Anorexia and Autism): A search for biomarkers

Triple A 研究（患有厌食症和自闭症的青少年）：寻找生物标志物

• 批准号: MR/R004595/1
• 负责人: Kate Tchanturia
• 金额: $ 23.19万
• 依托单位: King's College London
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2017
• 资助国家: 英国
• 起止时间: 2017 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FR004595%2F1
• 关键词: Triple; study; Adolescents; Anorexia; Autism

Anorexia Nervosa (AN) is a complex eating disorder, associated with a high physical and psychological risks, it has the highest death rate amongst psychiatric disorders. Treatment resistance is a huge challenge for clinicians and researchers, as approximately 50% of individuals diagnosed with AN do not respond to treatment and go on to develop a more severe and chronic form of the disorder. Research exploring thinking styles and the emotional profile of individuals with AN have demonstrated differences in thinking processes between those with AN and those who have never had an eating disorder. These include tendencies towards an inflexible thinking style, becoming stuck in details and difficulty with social functions such as recognising and expressing emotions and interacting with others. Brain imaging studies have also highlighted different patterns of brain function during these processes in individuals with AN. These difficulties are suggested to be a major contributing factor to the development and maintenance of the disorder. These characteristics are also defining symptoms of Autism Spectrum Disorder (ASD), which has led to research focussing on the overlap between AN and ASD. Although ASD and AN are associated with opposite gender ratios (ASD being more common in males, AN more common in females), recent findings demonstrate that a proportion of adult females with severe and chronic AN have elevated levels of autistic symptoms. Such elevated ASD traits are also associated with poorer treatment outcomes.There is little work focussing on this illness profile at the early stages of the disorder, and research is urgently need to examine both the cognitive and neurobiological profile of young people with AN when they first present with the disorder, also considering the potential role of ASD symptoms in their recovery. Research examining brain activity during thinking and emotional processing has largely been conducted within an adult AN population, and further research is required to explore if there are similar abnormalities and differences in the brain activation of young people with AN, and how this may change as the illness progresses or when weight is restored. Exploring the impact on the brain at first presentation, during the illness and after recovery in young people will help define risk and maintaining factors and help predict treatment outcome. Overall, this work is likely to help develop treatment targeted at early illness stages, disrupt illness progression and reduce the percentage of individual going on to develop a more severe and enduring form of the disorder. This study is the first of its kind to integrate innovative neuroimaging methods, neuro-cognitive measures and to develop profiles of the brain of adolescent AN patients with combined ASD symptoms when they are first presenting for treatment. This will allow for the study of the interaction between clinical features, thinking and social functioning styles. At baseline assessment adolescent patients with AN, those that have recovered from the disorder and age-matched healthy individuals will be asked to complete clinical and neuropsychological assessments, an MRI scan and questionnaires. Participants with current AN and recovered AN will then be asked to repeat these measures six months later (following treatment) to identify any differences in that may help predict treatment response or relapse. We will use this data to build a database of critical factors influencing AN, including cognitive, emotional, brain imaging markers. This research and future larger scale investigations based on this study will help identify the most vulnerable patients at an earlier stage and those individuals unlikely to respond to current interventions. These findings may then be applied to create a more individualised support and treatment strategies.

神经性厌食症（AN）是一种复杂的进食障碍，具有较高的生理和心理风险，是精神疾病中死亡率最高的疾病。治疗耐药性对临床医生和研究人员来说是一个巨大的挑战，因为大约50%被诊断患有AN的个体对治疗没有反应，并继续发展为更严重和慢性的疾病形式。探索AN患者的思维方式和情感特征的研究表明，AN患者和从未患有饮食失调症的人之间的思维过程存在差异。这些包括思维方式僵化的倾向，陷入细节和社交功能的困难，如识别和表达情感以及与他人互动。脑成像研究还强调了AN患者在这些过程中大脑功能的不同模式。这些困难被认为是一个主要的促进因素的发展和维护的障碍。这些特征也是自闭症谱系障碍（ASD）的定义症状，这导致研究集中在AN和ASD之间的重叠。虽然ASD和AN与相反的性别比例相关（ASD在男性中更常见，AN在女性中更常见），但最近的研究结果表明，患有严重和慢性AN的成年女性的比例升高了自闭症症状。这种升高的ASD特征也与较差的治疗结果有关。在疾病的早期阶段，很少有工作集中在这种疾病的特征上，迫切需要研究AN年轻人首次出现这种疾病时的认知和神经生物学特征，同时考虑ASD症状在其恢复中的潜在作用。研究在思考和情绪处理过程中的大脑活动主要是在成年AN人群中进行的，需要进一步研究以探索年轻AN患者的大脑激活是否存在类似的异常和差异，以及随着疾病的进展或体重恢复，这种情况可能会如何变化。探索年轻人在首次出现时、患病期间和康复后对大脑的影响，将有助于确定风险和维持因素，并有助于预测治疗结果。总的来说，这项工作可能有助于开发针对早期疾病阶段的治疗方法，中断疾病进展，并减少继续发展更严重和持久的疾病形式的个体比例。这项研究是第一个整合创新的神经成像方法，神经认知措施，并在首次接受治疗时开发具有ASD症状的青少年AN患者的大脑概况。这将有助于研究临床特征、思维和社会功能方式之间的相互作用。在基线评估时，将要求青少年AN患者、已从疾病中恢复的患者和年龄匹配的健康个体完成临床和神经心理学评估、MRI扫描和问卷调查。然后，将要求当前AN和已恢复AN的参与者在6个月后（治疗后）重复这些测量，以确定可能有助于预测治疗反应或复发的任何差异。我们将使用这些数据来建立一个影响AN的关键因素数据库，包括认知，情绪，脑成像标记物。这项研究和未来基于这项研究的更大规模的调查将有助于在早期阶段确定最脆弱的患者，以及那些不太可能对当前干预措施做出反应的人。这些研究结果可以用于创建更个性化的支持和治疗策略。

项目成果

Social attention in anorexia nervosa and autism spectrum disorder: Role of social motivation.

• DOI: 10.1177/13623613211060593
• 发表时间: 2022-10
• 期刊: AUTISM
• 影响因子: 5.2
• 作者: Kerr-Gaffney, Jess;Jones, Emily;Mason, Luke;Hayward, Hannah;Murphy, Declan;Loth, Eva;Tchanturia, Kate
• 通讯作者: Tchanturia, Kate

The emotional face of anorexia nervosa: The neural correlates of emotional processing.

• DOI: 10.1002/hbm.25417
• 发表时间: 2021-07
• 期刊: Human brain mapping
• 影响因子: 4.8
• 作者: Halls D;Leslie M;Leppanen J;Sedgewick F;Surguladze S;Fonville L;Lang K;Simic M;Nicholls D;Williams S;Tchanturia K
• 通讯作者: Tchanturia K