NEURAL CORRELATES OF RESPONSE ANTICIPATION & COGNITIVE CONTROL IN ED

这个子项目是利用由NIH/NCRR资助的中心拨款提供的资源的许多研究子项目之一。子项目和调查员(PI)可能从另一个NIH来源获得了主要资金，因此可能会出现在其他CRISE条目中。列出的机构是针对中心的，而不一定是针对调查员的机构。被诊断为厌食症或神经性暴食症的进食障碍(ED)患者中，有很高比例的人对当前选择的治疗方法没有反应。这组患者更容易辍学，使用更多的临床资源，并遵循包括死亡在内的疾病的慢性演变。这些影响对患者和家庭是毁灭性的，并涉及到高昂的社会成本。研究可能解释持续性ED精神病理的病因和维持的机制对于提高其诊断、治疗和最终预防具有重要意义。在ED诊断类别中，暴饮暴食是最常见的行为。暴饮暴食的显著特征是对进食过程失去控制。暴饮暴食的EDS患者治疗反应较差的一个预测因素是高度的饮食限制和高度的负面影响。这两者的结合与较低的冲动控制力、较大的进食量和共病的精神病理有关。相反，持续的恢复或治疗的早期改善似乎与更能控制自己冲动的人的纯饮食亚型有关。然而，严格的饮食控制模式也可能导致严重的体重减轻，就像急性神经性厌食症一样。参与情绪和行为灵活认知控制的神经系统位于大脑前额叶皮质。然而，这个系统的有效运作是由纹状体调节的。据我们所知，目前还没有关于皮质-纹状体功能在进食障碍的病因和维持中的直接作用的研究，尽管最近对临床、行为和神经成像研究的综述表明，进食障碍个体存在损害的间接证据。因此，本研究的目的是绘制自愿者EDS患者的皮质-纹状体回路的活动图，并将其与在功能磁共振成像(FMRI)实验中执行反应预期认知任务期间收集的数据进行比较，该任务旨在利用该神经网络。假设：1.当呈现准备和放松提示条件时，ED患者将表现出比对照组更大的尾状核和壳核激活(纹状体)。2.在反应预期任务的现成实验中，当呈现不一致和一致的目标条件时，ED患者在自愿抑制冲突的能力上表现出更大的低效，表现为LPFC激活较少，ACC激活较多。3.纹状体和ACC活性越高，ED症状越多，负性情绪越强，冲动控制力越低。4.与对照组相比，ED患者在反应预期任务的目标条件下的准确性和快速性较差。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. A high percentage of patients with an eating disorder (ED) diagnosis of anorexia or bulimia nervosa do not respond to current treatments of choice. This group of patients is more prone to drop out, use more clinical resources, and follow a chronic evolution of the disorder including death. The effects are devastating to patients and families and involve a high cost to society. Research into mechanisms that may explain the etiology and maintenance of persistent ED psychopathology is of great importance in order to improve its diagnosis, treatment and ultimately prevention. Binge eating is the most common behavior across ED diagnostic categories. The salient feature of a binge is loss of control over the eating episode. A predictor of poorer treatment response in individuals with EDs who binge-eat is high dietary restraint plus high negative affect. The combination of these two is related to lower impulse control, greater eating and comorbid psychopathology. Conversely, sustained recovery or early improvement from therapy seems related to a pure dietary subtype with individuals who are more able to control their impulses. However, a rigid pattern of dietary control may also lead to severe weight loss as in acute anorexia nervosa. Neural systems involved in flexible cognitive control of emotions and behaviors are located in the brain prefrontal cortex. However, an efficient functioning of this system is mediated by the striatum. To our knowledge, there are no studies on the direct contribution of cortico-striatal functioning to the etiology and maintenance of eating disorders, though a recent review of clinical, behavioral and neuroimaging studies shows indirect evidence of impairment in eating disordered individuals. Therefore, the aim of the present study is to map the activity of the cortico-striatal circuit in volunteered patients with EDs and compare it with data gathered from healthy adults during performance of a cognitive task of response anticipation designed to tap this neural network in a functional Magnetic Resonance Imaging (fMRI) experiment. Hypotheses: 1. When presented with ready versus relax cue condition in the task, ED patients will exhibit greater caudate and putamen activation (striatum) than controls. 2. When presented with incongruent versus congruent target conditions in the ready trials of the response anticipation task, ED patients will exhibit greater inefficiency in their ability to voluntary suppress the conflict as evidenced by less LPFC activation and greater ACC activation. 3. Greater striatal and ACC activity will correlate with greater ED symptomatology, negative affect and with lower impulse control. 4. ED patients will perform less accurately and rapidly in the target conditions of the response anticipation task than controls.