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1.
J Psychiatr Res ; 167: 71-77, 2023 Sep 28.
Article in English | MEDLINE | ID: mdl-37839390

ABSTRACT

Anorexia nervosa (AN) is a psychiatric disorder with a tenuous longitudinal course marked by a high risk of relapse. Previous studies suggest that aberrant threat perception and reward processing operate in many with AN, and may produce obstacles to treatment engagement; therefore, these could potentially represent predictors for longitudinal clinical outcomes. In this study, anxiety and reward symptoms, behaviors, and neural circuit connectivity were measured in intensively treated AN-restrictive subtype patients (n = 33) and healthy controls (n = 31). Participants underwent an fMRI experiment using a monetary reward task in combination with either overlapping individually tailored anxiety-provoking words or neutral words. Behavioral/psychometric measures consisted of reaction times on the monetary reward task and self-ratings on anxiety symptoms at study entry. We tested multimodal, multivariate models based on neural, behavioral, and psychometric measures of reward and anxiety to predict physiological (Body Mass Index; BMI) and psychological (eating disorder symptom severity) longitudinal outcomes in AN over six months. Our results indicated that higher anxiety symptom psychometric scores significantly predicted BMI reductions at follow-up. Untreated anxiety after intensive treatment could put individuals with AN at heightened risk for weight loss. This represents a potentially modifiable risk factor that could be targeted more aggressively to help reduce the chance of future clinical worsening.

2.
Transl Psychiatry ; 7(9): e1230, 2017 09 05.
Article in English | MEDLINE | ID: mdl-28872637

ABSTRACT

Cognitive-behavioral therapy (CBT) is effective for obsessive compulsive disorder (OCD); however, little is understood about its mechanisms related to brain network connectivity. We examined connectivity changes from resting-state functional magnetic resonance imaging data pre-to-post-CBT in 43 OCD participants, randomized to receive either 4 weeks of intensive CBT or 4 weeks waitlist followed by 4 weeks of CBT, and 24 healthy controls before and after 4 weeks of no treatment. Network-based-statistic analysis revealed large-magnitude increases in OCD connectivity in eight networks. Strongest increases involved connectivity between the cerebellum and caudate/putamen, and between the cerebellum and dorsolateral/ventrolateral prefrontal cortices. Connectivity increases were associated with increased resistance to compulsions. Mechanisms of CBT may involve enhanced cross-network integration, both within and outside of classical cortico-striatal-thalamo-cortical regions; those involving cerebellar to striatal and prefrontal regions may reflect acquisition of new non-compulsive goal-directed behaviors and thought patterns. Our findings have implications for identifying targets for enhancing treatment efficacy and monitoring treatment progress.


Subject(s)
Cerebellum/physiopathology , Cognitive Behavioral Therapy/methods , Connectome/methods , Neostriatum/physiopathology , Nerve Net/physiopathology , Obsessive-Compulsive Disorder/physiopathology , Obsessive-Compulsive Disorder/therapy , Outcome Assessment, Health Care/methods , Prefrontal Cortex/physiopathology , Adult , Cerebellum/diagnostic imaging , Female , Humans , Magnetic Resonance Imaging , Male , Neostriatum/diagnostic imaging , Nerve Net/diagnostic imaging , Obsessive-Compulsive Disorder/diagnostic imaging , Prefrontal Cortex/diagnostic imaging , Young Adult
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