42
EDRS 2013
making in patients with ANr and ANbp in comparison to healthy women
Methods
:
Participants were female ANr (n=32) or ANbp (n=31) patients
and healthy women (n=30). Negative emotions were manipulated by
asking half of the participants to watch a sad movie and the other half a
neutral movie. Several questionnaires (emotion regulation, depression,
eating pathology) were administered and decision making was assessed
using the Iowa Gambling Task
Results
:
No decision making difficulties
were found after experiencing negative emotions. However, in the neutral
condition the ANbp and control groups showed difficulties, but not the ANr
group. Decision making did not correlate with clinical characteristics in
the patient groups
Conclusions
:
The role of emotions in decision making
seem to differ between the AN subtypes. Women with ANbp may be more
influenced by the experience of emotions than women with ANr. This may
have clinical implications
F18
rTMS of the Dorsomedial Prefrontal Cortex Achieves Robust and
Durable Improvements in Comorbid OCD and PTSD symptoms in
Patients With Anorexia or Bulimia Nervosa
Jonathan Downar
1,2
,
Katharine Dunlop
1
,
Nathan Bakker
1
,
Tim Salomons
2
,
Joseph Geraci
2
,
Patricia Colton
1,2
,
Marion Olmsted
1,2
,
Peter Giacobbe
1,2
,
Blake Woodside
1,2
1
University of Toronto, Toronto, ON, Canada,
2
University Health Network,
Toronto, ON, Canada
Introduction
:
Obsessive-compulsive disorder (OCD) and post-traumatic
stress disorder (PTSD) are common comorbidities in patients with eating
disorders and are significant impediments to successful treatment. We
have previously obtained promising results with rTMS of the dorsomedial
prefrontal cortex (DMPFC) as a treatment for binge and purge behaviours.
This brain region has also been implicated in the pathophysiology of OCD
and of PTSD in structural and functional neuroimaging studies. Here
we present the effects of DMPFC-rTMS on comorbid OCD and PTSD
symptoms in patients undergoing treatment of anorexia or bulimia nervosa.
Methods
:
Under MRI guidance, 12 patients with OCD and/or PTSD
comorbid with anorexia or bulimia nervosa underwent 20-30 daily sessions
of bilateral DMPFC-rTMS at 10 Hz, 120% resting motor threshold, 3000
pulses per hemisphere over 4-6 weeks.
Results
:
Robust improvements in
OCD symptoms were noted, with YBOCS scores improving from 30.5±4.5
before treatment to 10.2±5.7 after treatment, for a mean reduction of
66
±18.7%. PTSD symptoms also improved markedly, with PCL-C scores
improving by a mean of 60.2%. Dissociative episodes and intrusive
recollections showed the earliest and most dramatic reductions during
the course of treatment.
Conclusion
:
DMPFC-rTMS may represent
an effective new therapeutic option for OCD and in particular for PTSD
comorbidities in patients with eating disorders. A sham-controlled trial in a
larger group of patients may be warranted.
F19
Impulsivity and Shape Concerns: Piloting a “Go-No Go Food” Task
Dawn M Eichen
1,2
,
John R Best
2
,
Denise E Wilfley
2
,
John L Evenden
3
,
Michael McCloskey
1
1
Temple University Department of Psychology, Philadelphia, PA, USA,
2
Washington University School of Medicine Department of Psychiatry, St.
Louis, MO, USA,
3
WiltonLogic LLC, Media, PA, USA
Objective:
Individuals with eating disorders, particularly bulimia nervosa
and binge eating disorder, demonstrate high levels of impulsivity. This
study
piloted
a “Go-No Go” task utilizing food stimuli to determine whether
shape concern, a key aspect of eating disorder symptomatology, is
related to performance on the “Go-No Go food” task. It was hypothesized
that shape concern on the Eating Disorders Examination Questionnaire
(
EDE-Q) and trait impulsivity (UPPS-P) would predict errors of commission
on the “Go-No Go food” task.
Methods:
Undergraduate Women (N=97)
completed online self-report measures (EDE-Q; UPPS-P Impulsivity scale)
and participated in the behavioral “Go- No Go Food” laboratory task. The
“
Go-No Go Food” task (developed for this study) required participants to
click on the target picture as quickly as possible when it was a picture of
a dessert and not click if the picture was a vegetable.
Results: Although
the overall linear regression model was not significant (R
2
=.043;
F
=2.14
p
=ns), there was a significant main effect of shape concern
(
β=.23;
t
=2.03;
p
<.05). Neither the main effect of impulsivity (β
=
-.06;
t
=-.55;
p=ns
)
nor the interaction between impulsivity and shape concerns (β
=
.10;
t
=.95;
p
=ns) was significant.
Conclusion:
These results demonstrate that
women with higher shape concerns were more likely to make commission
errors, thereby acted more impulsively, on a novel “Go No-Go Food”
behavioral task. Shape concern may reflect a general preoccupation with
food, creating a hyperactive approach response towards food stimuli and a
diminished ability to withhold those responses.
F20
Do Anorexia Patients Have Mental Capacity?
Isis FFM Elzakkers
1
,
Unna N Danner
1
,
Hans W Hoek
1,3,4,5
,
Annemarie A van
Elburg
1,2
1
Altrecht Eating Disorders Rintveld, Zeist, Netherlands,
2
University Medical
Center, Utrecht, Netherlands,
3
Parnassia Bavo Psychiatric Institute, The
Hague, Netherlands,
4
Department of Psychiatry, University Medical Center,
Groningen, Netherlands,
5
Department of Epidemiology, Mailman School of
Public Health, Columbia University, New York, NY, USA
Introduction
A striking feature of anorexia nervosa (AN) patients is their
reluctance to engage in treatment (in which weight gain is often a central
feature) despite serious physical and psychological consequences and
severely diminished quality of life. Neuropsychological research has shown
decision making problems in AN patients. The question arises whether
or not AN patients have the mental capacity required to make decisions
regarding treatment.
Methods
This study has investigated the mental
capacity of 65 adult AN patients in two ways. Mental capacity as judged by
the clinician and mental capacity assessed with a semi structured interview,
the MacCAT-T. Furthermore patients were assessed on measures of
depression (Becks Depression Inventory), anxiety (Spielberger Trait
Anxiety Inventory), alexithymia (Toronto Alexithymia Scale), worry
(
catastrophising worry interview), cognitive inflexibility (Wisconsin Card
Sorting Task and the Rey Complex Figure Test) and decision making
abilities (Iowa Gambling Task and Game of Dice Task). Clinical data such
as BMI, ED severity, age of onset, duration of illness and medication were
collected.
Results
Data collection will be completed in July 2013 and the
results will be presented at the EDRS 2013 for the first time.
Conclusions
This is the first large study regarding mental capacity done in an adult AN
population. Results will be highly relevant to daily practice. New avenues
for future research will become apparent.
F21
Repetitive Transcranial Magnetic Stimulation (RTMS) Treatment in
Eating Disorders: An Exploratory Study
Ana Carolina Faedrich dos Santos
1
,
Carolina Meira Moser
2
,
Frederique
Van den Eynde
3
,
Maria Inês Lobato
1,2
,
Miriam Garcia Brunstein
1,2
1
Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil,
2
Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil,
3
McGill
University, Montreal, QC, Canada
Introduction:
Repetitive Transcranial Magnetic Stimulation (rTMS) is an
established treatment for severe depression and may constitute a novel
approach to treating eating disorders (ED). Data on the acceptability and
potential efficacy of rTMS for ED are very scarce. The objective of the
current study was therefore to investigate the acceptability and efficacy
of an rTMS intervention for people with a severe ED.
Methods
:
Ten ED
patients (DSM-IV-TR; 5 anorexia nervosa; 2 bulimia nervosa; 3 ED not
otherwise specified) were enrolled. Participants received 10 sessions (in a
2-
week period) of high frequency (HF; 20hz) (i.e. stimulatory) rTMS applied
to the left dorsolateral prefrontal cortex (DPLFC) (3000 pulses per session).
Eating disorder symptom levels as well as associated affective and general
psychopathology (symptom checklist – 90) were assessed with self-report
questionnaires (e.g. Eating Disorder Examination Questionnaire) and
clinician-rated scales (e.g. Hamilton Depression Rating Scale).
Results:
Eight out of 10 patients completed the study; drop-out (n=2, anorexia
nervosa) was due to side-effects (headache, discomfort at stimulation
area on the skull). Six participants had a marked overall improvement; two
patients showed minimal changes from pre- to post-rTMS.
Conclusions
:
Our findings suggest that HF rTMS to the left DLPFC is a safe and well-
accepted intervention that may reduce ED symptomatology and general
psychopathology in people with an ED.
F22
Lost Weight or Low Weight?: Weight Suppression in Adolescent
Eating Disorders
Kathleen Kara Fitzpatrick
1
,
Rebecka Peebles
2
,
Danielle Colborn
1
,
James D
Lock
1
1
Stanford University Medical Center, Stanford, CA, USA,
2
Children’s
Hospital of Philadelphia, Philadelphia, PA, USA
Weight suppression (WS), the discrepancy between an individual’s highest
and lowest weight, has been suggested as playing a role in understanding
eating pathology. In particular, WS has been linked to weight gain in
treatment for bulimia nervosa (BN) and anorexia nervosa (AN) and cross-
over from AN to BN (Butryn, et al., 2006; Carter, et al., 2008; Wildes &
Marcus, 2012). Relationship to treatment outcome is less clear, with one
study indicating that WS influences treatment outcome among adults
with BN, while other data is less conclusive. To date, WS has not been
evaluated in adolescents. The impact of sub-threshold weight during the
sensitive period of adolescent brain development has been suggested
to lead to potential scarring effects and this may represent a pathway to
more entrenched features of disease (Casey et al., 2010; Darcy et al.,
2012;
Fitzpatrick, et al., 2012). The current study evaluated the relationship
between weight suppression and symptoms of eating pathology among
adolescents with AN, BN and ED NOS. Data from 74 (current) adolescents
was correlated with eating symptomatology (EDE) to clarify the relationship
POSTER SESSION 2 ABSTRACTS
