Neural predictors of outcome during relapse prevention treatment for anorexia nervosa

神经性厌食症(AN)是一种破坏性的精神疾病，发病率和死亡率都很高。 急性治疗后复发率为40%-80%。食物摄入量的极端限制是中心 疾病中的行为障碍，并显著增加复发的风险。疾病之后是 治疗反应的不同病程和临床预测因素在很大程度上是未知的。适应不良 AN中的行为具有行为和神经特征，表明有习惯性控制。然而，基于大脑的因素 与长期疗效和治疗反应有关的研究尚未见报道。在精神病学的其他领域，两者 持续性疾病的神经预测因素和治疗反应的神经预测因素通过 神经活动和神经连接的模式。通过研究AN结果的神经预测因素，这项研究 解决了关于AN治疗知识的一个严重差距。 这项发展性研究将利用现有的临床试验，提供预防复发的治疗方法 对于体重正常者作为我们治疗计划中的住院患者。干预， 复发预防和改变习惯(REACH+)，目标是习惯性控制不适应行为， 特别是对食物摄入量的限制。REACH+比较了认知和行为的不同版本 随机设计的心理治疗干预。 拟议的R21将获得已达到完全体重的住院患者的fMRI数据 恢复，在开始REACH+治疗之前。为了确定结果的神经预测因素，我们将获得功能磁共振成像 在任务期间的活动具有既定的实用程序，用于捕获预测疾病复发的不良适应限制 (食物选择任务)以及休息时的功能连接。我们将测试这些神经标志物是否能预测 出院后体重斜率，一个确定的长期结果的标志，以测试生物标志物 旧病复发。此外，我们还将在认知控制任务中使用已建立的实用程序获取fMRI活动 预测认知行为疗法的反应(在非AN人群中)。我们将探索个人是否 认知控制相关活动的差异，以及休息状态连接的其他模式，中度 对REACH+中包含的行为和认知干预的变化的反应。通过评估神经性 活动预测结果，这项工作是响应NIMH的号召，开发与临床相关的 恢复和复发的生物标志物。这项研究将为个性化研究开辟新的途径 医学在一个国家。

Anorexia nervosa (AN) is a devastating psychiatric illness with significant morbidity and mortality rates, and relapse rates ranging from 40-80% after acute treatment. Extreme restriction of food intake is the central behavioral disturbance in illness, and confers significantly greater risk for relapse. Illness follows a heterogeneous course and clinical predictors of response to treatment are largely unknown. Maladaptive behavior in AN has behavioral and neural features suggesting habitual control. Yet, brain-based factors that relate to long-term outcomes and treatment response have not been studied. In other areas of psychiatry, both neural predictors of persistent illness and neural predictors of treatment response have been identified through patterns of neural activity and neural connectivity. By studying neural predictors of outcome in AN, this study addresses a critical gap in knowledge about the treatment of AN. This developmental study will leverage an existing clinical trial providing relapse prevention treatment for AN for individuals with AN who normalized weight as inpatients in our treatment program. The intervention, Relapse Prevention and Changing Habits (REACH+), targets habitual control of maladaptive behavior, especially restriction of food intake. REACH+ compares different versions of cognitive and behavioral psychotherapeutic interventions in a randomized design. The proposed R21 will acquire fMRI data from patients hospitalized for AN who have achieved full weight restoration, prior to starting REACH+ treatment. To identify neural predictors of outcome, we will acquire fMRI activity during a task with established utility in capturing the maladaptive restriction that predicts relapse in AN (Food Choice Task) as well as functional connectivity at rest. We will test whether these neural markers predict weight slope after hospital discharge, an established marker of longer-term outcome, to test for biomarkers of relapse. In addition, we will acquire fMRI activity during a cognitive control task with established utility in predicting response to cognitive behavior therapy (in non-AN populations). We will explore whether individual differences in cognitive control-related activity, as well as other patterns of resting state connectivity, moderate response to variations in behavioral and cognitive interventions included in REACH+. By evaluating how neural activity predicts outcome, this work is responsive to the NIMH call for the development of clinically relevant biomarkers of recovery and relapse in AN. This study will establish new avenues for research in personalized medicine in AN.