The improvement in neurocognitive functioning in anorexia nervosa adolescents throughout the integrative model of psychotherapy including cognitive remediation therapy.

BACKGROUND: Patients with anorexia nervosa (AN) experience difficulties in neurocognitive functioning in the acute phase of illness which might be related to clinical presentation, but also in the apparently remitted state after weight recovery. Among the most commonly reported persistent deficits is cognitive inflexibility, which can be interpreted as a vulnerability trait or a "neuropsychological scar" reflecting the detrimental effect of prolonged semi-starvation in patients with a long duration of illness. Studies of adolescent samples with a relatively short clinical course may enable avoiding the effect of prolonged illness and help to determine whether neuropsychological deficits are trait or state dependent. The aim of this study is to assess cognitive functioning in adolescents with AN before and after the inpatient treatment programme, including cognitive remediation therapy (CRT). METHODS: Forty-seven adolescent female inpatients with AN diagnosed according to DSM-5 and fifty healthy female adolescents matched for the education level and age were recruited. The patients underwent a multimodal treatment including a ten-week CRT. The standardized and cross-validated neuropsychological (Trail Making Test - TMT A and B, Color-Word Stroop Task - CWST, Ruff Figural Fluency Test - RFFT) and clinical measurements (Beck Depression Inventory - BDI, Eating Attitude Test - EAT-26, Yale-Brown Obsessive Compulsive Scale - Y-BOCS) were used to assess both clinical (in the acute phase and after partial weight recovery) and control subjects. RESULTS: Initially, AN patients performed significantly worse compared to the controls, but afterwards, inpatient treatment improvement was noted on all examined measures. In a few subtests (TMT, CWST) performance of AN patients after the programme was still significantly poorer than in HC. CONCLUSIONS: Cognitive inflexibility in adolescent AN patients, as measured with TMT, CWST, and RFFT tends to improve after therapy. Nevertheless, a few neuropsychological subtests which did not show complete normalization may warrant attention in subsequent studies. Further research including control intervention is needed to conclude whether CRT intervention affects the outcome.

[Psychiatry throughout ages: rethinking anorexia nervosa as a viable behavior in a specific sociocultural context?]. / Z historii psychiatrii: anorexia nervosa jako optymalne zachowanie w socjokulturowym kontekscie.

Anorexia nervosa when described from a critical, historical perspective, may be successfully construed as a viable psychiatric illness. Just as fasting girls and victorian anorexics gained attention and respect in their families and communities, modern adolescent anorexics often derive reinforcement from peers and community acceptance of their self-starvation. This theoretical construction makes it possible to explain the changing nature of anorexia nervosa trough the ages and its' continued increase as well.