Neurodevelopmental Processes of Social Cognition in Anorexia Nervosa and Autism

描述(由申请人提供)：神经性厌食症(AN)患者中自杀死亡的比例不成比例，标准化死亡率表明，与年龄匹配的队列相比，自杀死亡风险高57倍。这些令人震惊的统计数字说明了AN的丧失能力、令人困惑和孤立的性质，这是一种严重的精神疾病，对受影响个人及其家人的生物、情感和心理社会功能产生负面影响。纵向研究表明，社会功能受损会增加致命后果的风险。即使在康复后，社会损害仍然存在，并影响生活质量。尽管有这些知识，但人们对AN中的社会信息处理知之甚少。仔细研究AN的社会认知可以阐明可能影响结果和疗效的受损过程：难以形成治疗联盟，身体形象障碍，同理心受损，以及缺乏安全的依恋。自闭症谱系障碍(ASD)的症状，特别是在影响社会认知的认知领域，在慢性AN患者中表现过度，并在康复后持续存在。相比之下，自闭症患者的进食障碍得到了广泛的认可，但很少成为系统研究的主题。相对于AN，ASD中的社会信息处理被很好地刻画，并且可能有助于在AN中描述这些领域的特征。这项研究的目标是：1)提供有助于社会信息处理的行为、视觉和神经认知过程的详细特征；2)通过表征病程中的变化，区分低体重状态对这些缺陷的贡献；3)比较与高功能自闭症女性相关的社会认知神经回路；以及4)开发一种新的范式，以评估在情感平衡的条件下父母和孩子互动期间的社会信息处理。我们将使用一系列神经心理和社会认知测量、查看动态面部情感刺激时的功能磁共振成像以及查看社交信息处理任务时的眼球跟踪来实现这些目标。复杂的方法表征了社会信息处理缺陷的认知过程，并映射到功能神经回路，可能会极大地增强我们对AN病理生理学的知识，并可能为有效的治疗开发开辟新的途径。

DESCRIPTION (provided by applicant): Death by suicide occurs in a disproportionate percentage of individuals with anorexia nervosa (AN), with a standardized mortality ratio indicating a 57 fold greater risk of death from suicide relative to an age-matched cohort. These shocking statistics speak to the incapacitating, perplexing, and isolating nature of AN, a severe psychiatric illness that negatively impacts the biological, emotional, and psychosocial functioning of both the affected individual and her or his family. Longitudinal studies indicate impaired social functioning increases risk for fatal outcomes. Social impairment persists and affects quality of life even after recovery. Despite this knowledge, very little is known about social information processing in AN. Careful study of social cognition in AN may elucidate impaired processes that may influence outcome and therapeutic efficacy: difficulty forming therapeutic alliances, disturbances in body image, impaired empathy, and dearth of secure attachments. Symptoms of autistic spectrum disorders (ASD), particularly in cognitive domains that impact social cognition, are overrepresented in individuals with chronic AN and persist after recovery. In contrast, eating disturbances in ASD are widely acknowledged, but are seldom the topic of systematic inquiry. Relative to AN, social information processing in ASD is well characterized and may help to inform the characterization of these domains in AN. The goals of this investigation are: 1) to provide a detailed characterization of the behavioral, visual, and neurocognitive processes that subserve social information processing in AN; 2) to differentiate the contribution of low weight status on these deficits by characterizing changes over the course of illness, 3) to compare the neurocircuitry of social cognition in relation to females with high functioning autism; and 4) to develop a new paradigm for assessing social information processing during parent and child interactions across emotionally valanced conditions. We will achieve these goals using a battery of neuropsychological and social cognitive measures, fMRI while viewing dynamic facial affective stimuli, and eye-tracking while viewing social information processing tasks. Sophisticated methodologies that characterize the cognitive processes that underlie social information processing deficits and map onto functional neurocircuits may greatly enhance our knowledge of the pathophysiology of AN and may open new avenues for effective treatment development.