Characterizing Decision-Making in Anorexia Nervosa Under Conditions of Risk and Ambiguity using Computational Neuroimaging

项目总结/摘要 神经性厌食症（AN）是所有精神疾病中最致命的一种，与严重的医学疾病有关。 后果和功能障碍。尽管进行了大量的研究， 仍然未知，现有心理治疗的结果仍然不理想。以前的一些工作， AN提示了决策的改变，对风险的敏感性，以及额纹状体回路活动的改变 可能与疾病的维持有关。然而，这项工作在其调查结果中混合，可能 其次是对决策的子组成部分和/或相关背景影响的有限考虑 在这个过程中借鉴行为经济学和计算神经科学的工作，以及临床 有证据表明，许多与食物和体重有关的结果是不确定/模糊的，我们建议决定- 制作具有AN的个体的简档可以更好地由模糊性厌恶来表征，使得敏感性 模糊的结果中断了成功的基于价值的决策，并导致维持 尽管功能和个人成本显著，但饮食限制。为了验证这一假设，我们将收集行为 来自AN女性、限制型（n=65，年龄16-22岁）和健康对照（HC）的选择和神经数据 受试者（n=65），同时完成一个经过充分验证的决策任务，允许分离风险和 模棱两可的决定。此外，AN组将提供基线和6个月时的症状测量结果 随访以探索任务表现与症状持续性的关系。我们假设 与HC相比，AN组将表现出更大的模糊厌恶和不一致的选择行为 以价值为基础的决策模式（目标1）。在神经水平上，我们预计， 与HC相比，AN患者在模糊试验期间将在额纹状体区域表现出差异激活， 而不是风险（目标2）。最后，我们希望，神经和行为参数衡量模糊厌恶 将与BMI、饮食限制和AN的认知症状在横截面上和随时间的推移相关， 对模棱两可的决定表现出更大厌恶的个体体重会更低， 参与症状，支持我们假设的维持机制（目标3）。总体而言，目前 该项目将提供一个重要的下一步，朝着更精确的认知特征， 个人AN。在追求这一知识，与R15区域奖的目标一致，目前 该项目将同时为霍夫斯特拉大学的研究生和本科生提供宝贵的 在神经影像学，计算方法和临床研究方面的实践经验。

PROJECT SUMMARY/ABSTRACT Anorexia nervosa (AN) is the deadliest of all mental illnesses and is associated with significant medical consequences and functional impairment. Despite significant research efforts, the etiology of the disorder remains unknown, and outcomes from existing psychological treatments remain suboptimal. Some prior work in AN has suggested alterations in decision-making, sensitivity to risk, and altered activity in frontostriatal circuits may be involved in the maintenance of the disorder. However, this work has been mixed in its findings, likely secondary to limited consideration of subcomponents of decision-making and/or relevant contextual influences on this process. Drawing from work in behavioral economics and computational neuroscience, alongside clinical evidence that many outcomes related to food and weight are uncertain/ambiguous, we propose that the decision- making profile of individuals with AN may be better characterized by ambiguity aversion, such that a sensitivity toward ambiguous outcomes interrupts successful value-based decision-making and results in maintenance of dietary restraint despite significant functional and personal cost. To test this hypothesis, we will gather behavioral choice and neural data from females with AN, restricting type (n=65, ages 16-22) and healthy control (HC) subjects (n=65) while completing a well-validated decision-making task that allows separation of risky and ambiguous decisions. Additionally, the AN group will provide measures of symptoms at baseline and 6-month follow-up to explore how performance on the task relates to the persistence of symptoms. We hypothesize that the AN group will demonstrate increased ambiguity aversion compared to HC and choice behavior inconsistent with prevailing models of value-based decision-making (Aim 1). On the neural level, we expect that, compared to HC, individuals with AN will demonstrate differential activation in frontostriatal regions during ambiguous trials, rather than risk (Aim 2). Lastly, we expect that neural and behavioral parameters gauging ambiguity aversion will relate to BMI, dietary restriction, and cognitive symptoms of AN both cross-sectionally and over time, such that individuals demonstrating greater aversion to ambiguous decisions will have lower body weights and greater engagement in symptoms, supporting our hypothesized maintenance mechanism (Aim 3). Overall, the current project will provide an important next step toward a more precise characterization of the cognitive profile of individuals with AN. In pursuing this knowledge, consistent with the goal of the R15 AREA award, the current project will simultaneously provide graduate and undergraduate students at Hofstra University with invaluable hands-on experiences in neuroimaging, computational methods, and clinical research.