El funcionamiento cognitivo como endofenotipo de la anorexia nerviosa. Estudio en familiares no afectados por la enfermedad / Cognitive functioning as an endophenotype of anorexia nervosa. A study in first-degree relatives unaffected by the disease

Resumen El perfil cognitivo de los pacientes con anorexia nerviosa se caracteriza por dificultades en la flexibilidad mental y en la coherencia central. El objetivo de este trabajo fue analizar si los familiares de primer grado no afectados de los pacientes presentan estas dificultades cognitivas, que podrían representar rasgos endofenotípicos de la enfermedad. Fueron estudiadas 34 mujeres: 17 familiares de primer grado (madres y hermanas) de pacientes con anorexia nerviosa y 17 controles sanos agrupados por edad y escolaridad. Se consideraron el índice de masa corporal, la ansiedad, la depresión, los síntomas obsesivo-compulsivos y los relacionados con los trastornos alimentarios. Se evaluó la coherencia central, mediante la copia de la Figura Compleja de Rey, y la flexibilidad mental, mediante el test de Stroop, el test de los trazos B y el test de fluencia fonológica. Los familiares de pacientes con anorexia nerviosa presentaron un menor rendimiento en las medidas de coherencia central (p < .05) y en fluencia fonológica (p < .05) que los controles sanos. Se observó una correlación entre el test de Stroop y los síntomas de depresión y trastornos alimentarios (p < .05). Los familiares de primer grado no afectados de pacientes con anorexia nerviosa presentaron dificultades en la coherencia central y, en menor grado, en la flexibilidad mental. Los resultados en los familiares indican que este perfil podría ser mediado genéticamente, constituyendo un rasgo característico de la anorexia nerviosa y, por ende, un posible candidato a endofenotipo neuropsicológico de esta enfermedad.

Abstract The cognitive profile of patients with anorexia nervosa is characterized by difficulties in central coherence and mental flexibility. Central coherence is defined by the ability to integrate incoming information in its own context, and weakness in central coherence is characterized by poor overall processing and superior detail processing. Mental flexibility is defined by the ability to change the course of a thought or action according to the demands of the environment. Alterations in this cognitive domain generate rigid and inflexible behavior. An open question in the literature is whether these cognitive characteristics are a transient state derived from the disease or whether they are stable traits associated with anorexia nervosa and endophenotypical features of this disease. The concept of endophenotype refers to the internal phenotype that is not clinically appreciable but can be observed indirectly through deficits that arise in the performance of certain neuropsychological tests. In recent years the search for endophenotypes has been renewed in the field of psychiatry as they would constitute an important route for the understanding of the biological and genetic bases of mental illnesses, constituting markers that allow a diagnosis before the onset of clinical symptomatology. For a cognitive marker to be considered an endophenotype it must meet a series of characteristics such as being measurable, inherited, found in patients with and without active disease and in first-degree relatives not affected by the disease. The aim of the present study was to assess whether difficulties in central coherence and mental flexibility are shared by unaffected first-degree relatives of patients with anorexia nervosa and thus constitute an endophenotypical feature of this disease. This is a cross-sectional, descriptive-comparative study in which 34 women participated: 17 unaffected first-degree relatives of patients with anorexia nervosa (mothers and sisters) and 17 healthy controls matched by age and education. For the study of central coherence the copy of Rey's Complex Figure was used and to assess set-shifting the Stroop test, the Trail Making Test B and the Phonological Fluency test were used. Demographic and clinical aspects such as age, educational level, body mass index, anxiety, depression, obsessive-compulsive and eating disorder related symptoms were also evaluated. First-degree relatives of patients with anorexia nervosa showed lower performance on measures of central coherence (p < .05) and phonological fluency (p < .05) than healthy controls. A correlation was observed between the Stroop test and depression and eating disorders symptoms (p < .05). The results of this study show that unaffected first-degree relatives of patients with anorexia nervosa presented alterations in central coherence and, to a lesser degree, in mental flexibility. These results, in addition to previous research in which difficulties persisted even after recovery, indicate that these alterations could be genetically mediated, constituting a characteristic trait of anorexia nervosa and therefore a possible candidate for neuropsychological endophenotype of this disease. Regarding practical implications of the study, the findings reinforce the importance of cognitive remediation treatments not only for patients with anorexia nervosa but also emphasize that they could be useful for unaffected family members. Taking into account that family intervention is a widely used tool in the psychological treatment of anorexia, improving the perception of the patient and his relatives about cognitive biases, could contribute to raising awareness of the disease, something that patients with anorexia nervosa do not usually have, and generate a positive impact on the response to treatment as a whole.

Impaired theory of mind in unaffected first-degree relatives of patients with anorexia nervosa.

OBJECTIVE: Previous studies have shown theory of mind (ToM) is affected in patients with anorexia nervosa (AN). There has also been growing interest in the study of endophenotypes in psychiatric disorders, since they allow better understanding of genetic mechanisms underlying different conditions, making them potential targets for future treatment. The goal of this study was to investigate whether ToM inefficiencies observed in patients with AN, are shared by unaffected first-degree relatives. METHOD: Performance on two ToM tasks (Reading the Mind in the Eyes and Faux Pas Test) were compared in 17 unaffected first-degree relatives of AN patients and in 17 healthy individuals matched for age and level of education. Depression, anxiety, obsessive compulsive, and eating disorder symptoms were also assessed and correlated with ToM and clinical/demographic variables. RESULTS: Significant differences between groups were observed in all ToM tasks, with relatives of AN patients showing poorer performance. ToM assessment did not correlate with any clinical or demographic variable. CONCLUSIONS: The preliminary results of this study suggest unaffected first-degree relatives of AN patients display similar patterns of difficulty in ToM as reported previously for AN patients, supporting the hypothesis that ToM inefficiencies are a familial trait in this condition.

Emotional reactivity to social stimuli in patients with eating disorders.

Patients with eating disorders often display a wide range of difficulties in psychosocial functioning. Most of the studies on this subject have focused on theory of mind; however, little is known about the subjective emotional reactivity of patients to social situations. The aim of this study was to evaluate the patients' perceptions of their own emotions when viewing pictures with social content. Emotional reactivity was assessed in 85 women (29 with anorexia nervosa, 28 with bulimia nervosa, and 28 healthy controls) by using 30 images from the International Affective Picture System. Images were divided into categories based on its social content and its emotional valence. The emotional response was evaluated through the Self-Assessment Manikin. Patients with bulimia nervosa presented higher arousal and lower control when viewing images with social content of pleasant, unpleasant, and neutral valence. Patients with anorexia nervosa reported higher arousal and lower control only for social images with neutral valence. There were no differences between groups for the control images. The finding of specific differences in emotional reactivity to pictures with social content contributes to a more accurate understanding of the difficulties of patients in social situations.

Theory of mind and central coherence in eating disorders: two sides of the same coin?

The aim of this study was to evaluate central coherence and theory of mind (ToM) and explore the relationships between these domains in patients with eating disorders (ED). ToM and central coherence were assessed in 72 women [24 with anorexia nervosa (AN), 24 with bulimia nervosa (BN) and 24 healthy controls (HC)]. The Reading the Mind in the Eyes (RME) and the Faux Pas Test (FPT) to measure ToM, and the copy strategy of the Rey-Osterrieth Complex Figure Test to assess central coherence were used. It was observed that patients with ED had a decrease in central coherence skills compared with the control group; that patients with anorexia had a poor performance on RME ToM task compared with BN patients and HCs, and also that these measures were related in both clinical groups. The statistically significant correlation between them suggests that the central coherence and ToM measures might involve common cognitive processes. These results provide a better understanding of the nature of the socio-cognitive deficits observed in patients with eating disorders.

Theory of mind in eating disorders and their relationship to clinical profile.

OBJECTIVE: This study aimed to assess cognitive and affective theory of mind (ToM) in patients with eating disorders and to explore its relationship with the clinical and psychopathological profile. METHOD: Theory of mind was assessed in 65 women, consisting of 22 with anorexia nervosa (AN), 19 with bulimia nervosa (BN), and 24 healthy controls (HC), using the Reading the Mind in the Eyes Test and the Faux Pas Test. These tasks evaluate affective and cognitive ToM, respectively. We also examined the correlations between performance on ToM tasks and the clinical psychopathological profile, which was extensively evaluated through self-report instruments and clinical interviews. RESULTS: Patients with AN had poorer performance than BN patients and HCs had in the affective ToM task, particularly in recognizing negative emotions and emotions in male eyes. Moreover, this deficit showed no correlation with the psychopathological profile. Performance in the BN group was equivalent to that of HCs in both tasks. CONCLUSIONS: In this study, patients with AN showed an impairment in affective ToM, independent of their clinical status. Consistent with other studies, our findings demonstrate a specific difficulty in social cognition in patients with AN. This may be a trait marker in this population and should be considered in treatment. Furthermore, patients with AN and BN have different difficulty profiles in this domain of social cognition.

Psiconeuroinmunoendocrinología en enfermedades autoinmunes (LES) / Psychoneuroimmunoendocrinology in autoimmune disease

When we first defined in 1990 the term Psychoneuroimmunoendocrinology considering the interrelation of both the immune and the endocrine systems, the neurotransmitter receptors and the endocrine systems, the neurotransmitter receptors and the main findings in the field of psychology, an increasing ethusiasm was originated following the expression of these concepts, and rapidly clinical physicians and immunotherapeutists hypothesized the possibility of the existence of a molecular basis in the observations produced daily during their assistance. The authors describe these immuno-neuroendocrinal interactions, with special reference to psychoneuroimmuno-endocrinology in the systemic lulpus erythmatosus

Psiconeuroinmunoendocrinología en enfermedades autoinmunes (LES) / Psychoneuroimmunoendocrinology in autoimmune disease

When we first defined in 1990 the term Psychoneuroimmunoendocrinology considering the interrelation of both the immune and the endocrine systems, the neurotransmitter receptors and the endocrine systems, the neurotransmitter receptors and the main findings in the field of psychology, an increasing ethusiasm was originated following the expression of these concepts, and rapidly clinical physicians and immunotherapeutists hypothesized the possibility of the existence of a molecular basis in the observations produced daily during their assistance. The authors describe these immuno-neuroendocrinal interactions, with special reference to psychoneuroimmuno-endocrinology in the systemic lulpus erythmatosus