Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Addictive and compulsive disorders > Module 7: Eating disorders > Flashcards

Module 7: Eating disorders Flashcards

Name/recognize the DSM-V diagnostic criteria for: Anorexia Nervosa [AN]/Bulimia Nervosa [BN]/Binge Eating Disorder [BED]) and Avoidant Restrictive Food Intake Disorder (ARFID), and their subtypes [paraphrasing] Indicate the relative prevalence and mortality rates of different ED's [paraphrasing] Recognize the correct diagnosis for different eating disorders based on case studies [evaluating] Name controlling behaviors in ED as well as negative consequences of food restriction/underweight [paraph

1
Q

What are the effects of anorexia nervosa?

A
  • intense fear of gaining weight
  • do not recognize severity of low body weight
  • disturbed in how they view their own body weight
  • exhaustion
  • low body temp
  • osteoporosis
  • stomach complaints
  • hormonal inconsistencies (absence of menstruation)
  • reduced metabolism
  • reduced thyroid functioning
  • skin problems
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How can AN develop?

A

Can start out as goal-directed action for weight loss but will lead to habits developing. These can be positively reinforced by weight loss and being in control, leads to enhanced reward sensitivity. Starvation can lead to stress which can result in accelerated habit formation. Also negative reinforcement in AN through avoidance and weight loss. Can become compulsive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How is cognitive control impaired in AN?

A
  • disturbed set-shifting meaning more preservative errors on Wisconsin Card Sorting Task
  • perform poorly on Iowa Gambling Task
  • stronger focus on delayed gratification and long-term goals
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Neuroscientific basis for dual process imbalance in AN

A
  • hyperactivity in caudate important for goal directed control
  • disturbed activity in corticostriatal networks important for balance, but not towards habits
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How much do habits contribute to AN?

A

Found patients to perform as well as control on slips-of-action task and shock avoidance paradigm. Perfectionism could reinforce stimulus-response associations between stable contexts. through rigid repetition of dieting and exercising. But more research needs to understand role of habits, but there is some support.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Causes of obesity

A
  • ‘obesogenic environment’ as there are tasty, high-calorie foods out there
  • lack of physical exercise
  • can lead to higher risk of cardiovascular diseases, diabetes, joint complaints and cancer, psychological complaints
  • evolution lead to preference for fat and sweet food to survive-> nucleus accumbens in network which regulates motivation and food-seeking
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Can obesity be linked to drug addiction?

A

Yes, found to be linked to same brain areas and compulsive as an unhealthy lifestyle continues despite negative consequences. But food addiction could only apply to some people like those with binge-eating disorder.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Cognitive remediation therapy

A

Improves cognitive processes to improve outcomes, uses specific and explicit training of strategies and transfer techniques. Small to moderate effects for SZ.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How does CRT improve cognitive flexibility in anorexia?

A

By training set shifting abilities and central coherence strength. It combines simple brain skills, reflecting on thinking styles and translates these to everyday life. Through repetition of cognitive exercise there can be changes in neural pathways and experience self-efficacy. Also allows for generalizing to life functioning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What have results found?

A

CRT improved flexibility in neuropsychological tasks, increased awareness of thinking styles, greater improvement in cognitive inefficiencies and improvement in quality of life. But unclear whether more effective than CBT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is a challenge in treating individuals with an eating disorder?

A

Low motivation to make behavioural changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How can CRT improve motivation?

A

Increases intrinsic motivation which is needed to translate cognitive gains into changes in everyday life, but this can change for those with SZ. NEAR program helps those become independent learners which showed improvements. Issues with these are linked to daily activities and functioning, matters how they perceive their competency and expectations regarding failure. Focusses on ease of tasks being done than achievement and has mixed results.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How could CRT be applied across eating disorders?

A

Issues with set-shifting and central coherence found across eating disorders. Inhibitory control difficulties for those with binge eating and bulimia. Memory-biases and decision making impairments found.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How could CRT be improved?

A
  • motivation important, but should be more personalized as not everyone has the same cognitive problems and evaluating how important CRT Is across eating disorders
  • identifying techniques that produce the largest cognitive change and combining CRT with other skill-based interventions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

fMRI support for habit model of AN

A

Dorsal striatum and dorsal frontostriatal systems have been found to be important for guiding food choices for patients with AN which have been linked to habits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How can behaviours become more problematic?

A

Emotional states can lead to restrictive food choices, maladaptive food choice linked to poorer prognosis, disordered mealtime behaviours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Which method is better than selective satiation?

A

Habit strength which is the likelihood that a behaviour is elicited by a stimulus or context and can predict future behaviour. Intentions found to be less relevant in guiding behaviour as habit strength increases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Method of this study

A

Patients randomly assigned to receive supportive psychotherapy with a regulating emotions and changing habits intervention (cue awareness, new behavioural routines, suppression of maladaptive habits and emotion regulation). First phase involved psychoeducation and then behavioural analysis which involved assessing external and internal cues. Then strategies for habit change were introduced like habit reversal stimulus control, urge exposure etc. Then alternate rewards were introduced. Then in the final phase patients evaluated progress in responding to cues with alternative actions and generalization of behaviour change. Primary outcome measure is SRHI.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Competing responses

A

Counteractions done until the urge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Stimulus control

A

Alteration of environment to discourage the behaviour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Urge exposure

A

Seeking opportunities to experience the urge and suppressing the habitual response

22
Q

Supportive psychotherapy

A

Consists of non-specific therapeutic factors and non-directive style. Emphasizes psychoeducation, goal-setting and psychosocial stressors and an empathic stance. Identifies motivations for treatment, core patterns and features and deal with barriers to recommendations

23
Q

Results of study

A

Significant effect of REACH on SRHI and treatment type was associated with greater caloric intake. Both interventions rated positively

24
Q

What should future studies focus on?

A
  • need to better address emotion regulation
  • no significant effect on REACH on BMI, but could be difficult to see
  • greater intake of food is encouraging as known to be resistant to change
25
Q

Arguments for food addiction

A
  • resemblance between overconsumption and substance use and scores on food addiction scale provides evidence of neurobiology of substance use
  • associated with changes to mesolimbic dopamine system
26
Q

Problems with food addiction

A
  • unclear which foods have a direct effect on the brain, some argue sugar plays this role but others belief that sugars and fats increase addiction liability
  • unclear how food addiction fits into problematic eating as seen as being separate from eating disorder but there is overlap
  • no convincing evidence of neurobiological changes, one study suggested reduce dopamine receptor density but not replicated
  • studies show addiction-like patterns in rats but driven by constraint and unclear whether can be translated to humans
27
Q

Arguments for food addiction

A
  • failure to control food intake is most obvious in overweight individuals
  • even though overweight individuals face negative health, social, financial consequences due to body weight, limiting their food intake is still difficult
  • energy dense food stimulate changes in the activity of brain structures involved in relapse like striatum and prefrontal cortical regions, amygdala, mesoaccumbens. Has been used for use of drugs to improve obesity
  • sugars seen to be responsible for addiction of combination of macronutrients in high-calorie food items could change eating behaviours through changes in brain motivation circuits
  • addiction should be viewed as related syndromes which share similar and some overlapping brain and behaviour changes. As features of SUDs differ depending on the substance, the core feature of lack of control should define addiction and brain and behaviour abnormalities with food are somewhat similar to drugs
28
Q

Core message of the article

A

The concept of food addiction is too loaded to convey meaning, but some do struggle with controlling their eating and the use of motivation circuits could be a starting point to understand brain mechanisms of over-eating.

29
Q

How could the field of food addiction change in the future?

A
  • the focus should be on empirical evidence rather than undermining the personal and clinical reality of urges
  • to start, need to compare brain motivation circuits of drugs and not assume that overeating is a form of addiction even though there is overlap
    -also acknowledge the differences in patterns of use and so having a more complete picture
30
Q

Important SUD concepts in the context of food consumption

A
  • drugs dysregulate striatal glutamate homeostasis leading to changes in nucleus accumbens and vigorous drug-seeking which needs to be considered with food consumption as tends to lie outside of striatum
  • extended access to drugs leads to brain deficits in the reward circuit, similarly found in obesity
  • drug consumption leads to habitual behaviours which is similar to obesity as well as the compulsive nature
  • importance of disrupted higher-order cortical circuits leading to reduce executive control, found to also change for those with overconsumption
  • the type and pattern of consumption is problematic, and most rodents pic a natural reward over a drug but little is known about the neurobiological mechanism behind energy dense foods
  • some genetic similarity but inconsistent but genes that increase the risk for substance us does not increase risk for obesity-> different biology
31
Q

Evaluation of a reverse modelling process

A
  • importance of reward circuity and mechanisms of appetitive regulation to understand drug addiction, but differences between them
  • more holistic approach in eating rather than just brain so role of other organs
  • complex systems in peripheral organs to inhibit appetite, could play a role in controlling drug intake
32
Q

Which disorders lead most often to obesity?

A

In 30-40% of cases bulimia nervosa and binge-eating disorder leads to obesity

33
Q

Avoidant-restrictive food intake disorder

A
  • weight loss or faltering growth
  • nutritional deficiencies
  • dependence on tube feeding
  • psychosocial impairment
  • absence in interest food and food selectivity based on sensory sensitivity
  • fear of negative consequences of eating
34
Q

Pica

A

Eating non-nutritive or non-food substances and triggers include boredom, curiosity or psychological tension

35
Q

Rumination

A

Regurgitation of food with no nausea, involuntary retching or disgust

36
Q

Comorbidities for those with eating disorders

A
  • mood and anxiety disorders
  • neurodevelopmental disorder
  • alcohol and substance use
  • personality disorders
  • diabetes can lead to premature death
  • autoimmune disorders like coeliac and Crohn’s disease
37
Q

Differential diagnosis and assessment

A
  • difficult to assess with schizophrenia and major depressive disorder
  • inflammatory bowel disease, diabetes, cerebral tumour can be mistaken for anorexia
  • consequences of anorexia: leukopenia, low blood glucose, raised liver enzymes and endocrine changes, electrolyte disturbances, hypotension and bradycardia
38
Q

Differential diagnosis with bulimia nervosa and binge eating disorder

A
  • overlap with atypical depression, 50% have symptoms of ADHD and 15% have impulsive behaviours
  • self harm, intense emotions and chaotic sleeping patterns
  • bipolar 2 and borderline
  • avoidant restrictive food intake can be mistaken for picky eating but low weight along developmental trajectory
  • pica for those with autism, intellectual disability, schizophrenia
39
Q

Epidemiology of eating disorders

A

Adolescents and young adults are at risk, rarely onset after 30. Anorexia starts earlier than bulimia nervosa or binge eating. Binge eating has less gender differences and a higher risk in ethnic minorities and individuals with higher weight. Prevalence of eating disorder has increased by 25% and 20% for those in treatment. Morality rate for anorexia is 5.9 and is the highest compared to other eating disorders. Very little individuals with an eating disorder meet criteria for pica and rumination

40
Q

What have animal models found about eating disorders?

A

Those who had starvation induced hyperactivity due to restricted feeding on a running wheel, found that those sensitive fear chose to exercise than eat. Those exposed to dietary changes and stress showed bio-behavioural changes to those found in addictions.

41
Q

What have genome wide association studies found?

A
  • 8 loci associated with anorexia and positive polygenic correlations with brain behaviours and personality traits.
  • negative polygenic correlations with traits linked to metabolic syndrome
  • binge eating disorders have lower levels of heritability and positive genetic correlations with alcohol problems and obesity
42
Q

Sociocultural context factors linked to eating disorders

A
  • low self esteem for all eating disorders
  • anorexia- problems with social cognition, social anxiety, social anhedonia and insecure attachment, high levels of perfectionism, problems with emotional processing
  • limited facial expressivity and reduced theory of mind
  • anomalies with attention and impulsivity, especially for cues related to food
  • related to changes in brain circuits and connectivity linked to reward, habit learning, interoception and construction of self
43
Q

What are the biological changes found?

A

Relative imbalance between top-down and bottom-up regulation of appetite, reversible structural reductions in brain tissue

44
Q

Why is social activity and social support important for recovery?

A

Can lead to impaired social functioning which results in social isolation or increased social media use.

45
Q

Why is it difficult to generalize evidence from trials to practice?

A

The exclusion and inclusion criteria is highly selective and there are many comorbidities in practice which are excluded

46
Q

What have results found about psychological treatments?

A
  • no difference across psychological treatments on weight gain and quality of life
  • family based approaches for adolescents and individual psychotherapies for adults, but not solid evidence for this
  • low BMI, motivation and binge-eating predicted dropout
  • mixed results on meal support
  • some benefits of family-based therapy, can be comparable to longer hospitalization
  • many improvements (25% recover fully) with structured individual therapies
  • inpatient treatment with digital interventions has been beneficial
47
Q

Treatment for anorexia nervosa

A

Some effectiveness of olanzapine but no difference in outcomes, oestrogen could be useful to prescribe to improve bone health in young girls and prevent osteoporosis

48
Q

Treatment for binge spectrum disorder

A
  • CBT has found to be the most effective, but for some it was difficult to abstain
  • Third wave behavioural therapies not more effective than CBT
  • pharmacological treatments have been found to be effective, but needs to be compared against side effects and attrition
  • sequence treatments of starting with guided self-help followed by CBT
49
Q

Treatments for other disorders

A

Family based treatment and CBT have been found to be effective for restrictive food intake disorder and some medications

50
Q

Emerging treatments

A

Cognitive remediation therapy has found to have some promise but more research is needed. Computerised trainings to modify neurocognitive processes related to inhibition, impulsivity and biases have been developed. Exposure based therapy could be effective in food-related fears and use of virtual reality in this. Deep brain stimulation and non-invasive deep brain stimulation lead to large and early improvements in mood and weight, more changes take more time to emerge

51
Q

Controversies in treatment

A
  • service related controversies (separation between services for children and adults which could cause distress)
  • ethical issues with neurosurgical approaches to anorexia and use of alternative treatments to avoid this
  • ethical issues about life-saving treatment like active refeeding, as against human rights but inability to see severity of disorder
52
Q

Outstanding research questions

A
  • comparing efficacy of different treatment settings and identifying factors for personalisation of treatment
  • better understanding common comorbidities
  • identifying risk factors, especially more longitudinal studies with power to consider interactions
  • use of genome wide association studies are needed
  • how to improve treatments thorugh understanding biological, behavioural and psychological mechanisms

Addictive and compulsive disorders (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions