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

神经性厌食症（AN）是一种复杂的饮食失调，具有很高的生理和心理风险，在精神疾病中死亡率最高。对于临床医生和研究人员来说，治疗耐药性是一个巨大的挑战，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。研究人员对患有厌食症的人的思维方式和情绪状况进行了研究，结果表明，患有厌食症的人和从未患过厌食症的人在思维过程上存在差异。这些问题包括思维方式不灵活的倾向，陷入细节，以及在识别和表达情感以及与他人互动等社交功能方面存在困难。脑成像研究也强调了AN患者在这些过程中的不同脑功能模式。这些困难被认为是导致这种障碍发展和维持的一个主要因素。这些特征也定义了自闭症谱系障碍（ASD）的症状，这使得研究集中在AN和ASD之间的重叠上。尽管ASD和AN的性别比例相反（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的成年女性中，有一部分人的自闭症症状水平升高。这种升高的ASD特征也与较差的治疗效果有关。很少有研究集中在这种疾病的早期阶段，研究迫切需要检查患有AN的年轻人在首次出现这种疾病时的认知和神经生物学特征，同时考虑到ASD症状在他们康复中的潜在作用。研究在思考和情绪处理过程中的大脑活动主要是在成人an人群中进行的，需要进一步的研究来探索患有an的年轻人的大脑活动是否存在类似的异常和差异，以及随着疾病的进展或体重的恢复，这种情况会如何变化。探索年轻人在发病初期、发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疾病早期阶段的治疗方法，破坏疾病进展，减少个体发展为更严重和持久形式的疾病的百分比。这项研究首次整合了创新的神经成像方法、神经认知测量方法，并在首次就诊时对合并ASD症状的青少年AN患者的大脑进行了分析。这将有助于研究临床特征、思维和社会功能风格之间的相互作用。在基线评估中，那些从疾病中恢复的青少年AN患者和年龄匹配的健康个体将被要求完成临床和神经心理学评估、核磁共振扫描和问卷调查。患有当前AN和恢复AN的参与者将被要求在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。我们将利用这些数据建立影响AN的关键因素数据库，包括认知、情绪、脑成像标记。这项研究和未来基于这项研究的更大规模调查将有助于在早期阶段识别最脆弱的患者，以及那些不太可能对当前干预措施做出反应的患者。这些发现可以应用于创建更个性化的支持和治疗策略。

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.