E. Galimberti

Executive functioning in anorexia nervosa patients and their unaffected relatives

Formal genetic studies suggested a substantial genetic influence for anorexia nervosa (AN), but currently results are inconsistent. The use of the neurocognitive endophenotype approach may facilitate our understanding of the AN pathophysiology. We investigated decision-making, set-shifting and planning in AN patients (n=29) and their unaffected relatives (n=29) compared to healthy probands (n=29) and their relatives (n=29). The Iowa Gambling Task (IGT), the Tower of Hanoi (ToH) and the Wisconsin Card Sorting Test (WCST) were administered. Concordance rates and heritability indices were also calculated in probands/relatives. Impaired performance on the IGT and the WCST were found in both AN probands and their relatives, although planning appeared to be preserved. The IGT heritability index suggested the presence of genetic effects that influence this measure. No evidence for genetic effects was found for the WCST. The results suggest the presence of a shared dysfunctional executive profile in women with AN and their unaffected relatives, characterized by deficient decision-making and set-shifting. Concordance analysis strongly suggests that these impairments aggregate in AN families, supporting the hypothesis that they may constitute biological markers for AN. Decision-making impairment presents a moderate heritability, suggesting that decision-making may be a candidate endophenotype for AN.

Motor inhibition and cognitive flexibility in eating disorder subtypes

Anorexia Nervosa (AN) and Bulimia Nervosa (BN) are complex Eating Disorders (EDs). Even if are considered two different diagnostic categories, they share clinical relevant characteristics. The evaluation of neurocognitive functions, using standardized neuropsychological assessment, could be a interesting approach to better understand differences and similarities between diagnostic categories and clinical subtypes in EDs thus improving our knowledge of the pathophisiology of EDs spectrum. This study explored cognitive flexibility and motor inhibition in patients with AN considering both Restricter and Binge/Purge subtypes, patients with BN and healthy comparisons subjects (HC). Intra-Extra Dimentional Set shifting Test and Stop Signal Task, selected from CANTAB battery, were administered to analyzed set-shifting and motor inhibition respectively. AN patients showed a deficient motor inhibition compared to HC, while no evidence for impaired motor inhibition was found in BN patients; a significant relationship between commission errors in the Stop Signal Task and attentional impulsiveness was found. Moreover, no difference in set-shifting abilities was found comparing all clinician groups and HC. So our results indicated no cognitive impairment in these two cognitive functions in BN patients, while AN and BN showed different performances in motor inhibition. A similar cognitive profile was found in other obsessive compulsive spectrum disorders. Finally, the paper suggests a new interactive approach for the study of cognitive profile in psychiatric disorders; it might be more useful since it is more closely related to the executive functions complexity.

Effects of gender and executive function on visuospatial working memory in adult obsessive–compulsive disorder

Visuospatial working memory (VSWM) is the ability of the brain to transiently store and manipulate visual information. VSWM deficiencies have been reported in obsessive–compulsive disorder (OCD), but not consistently, perhaps due to variability in task design and clinical patient factors. To explore this variability, this study assessed effects of the design factors task difficulty and executive organizational strategy and of the clinical factors gender, OCD symptom dimension, and duration of illness on VSWM in OCD. The CANTAB spatial working memory, spatial recognition memory, delayed matching to sample, and stop signal tasks were administered to 42 adult OCD patients and 42 age- and sex-matched healthy controls. Aims were to detect a possible VSWM deficit in the OCD sample, to evaluate influences of the above task and patient factors, to determine the specificity of the deficit to the visuospatial subdomain, and to examine effects of sustained attention as potential neurocognitive confound. We confirmed previous findings of a VSWM deficit in OCD that was more severe for greater memory load (task difficulty) and that was affected by task strategy (executive function). We failed to demonstrate significant deficits in neighboring or confounding neurocognitive subdomains (visual object recognition or visual object short-term memory, sustained attention). Notably, the VSWM deficit was only significant for female patients, adding to evidence for sexual dimorphism in OCD. Again as in prior work, more severe OCD symptoms in the symmetry dimension (but no other dimension) significantly negatively impacted VSWM. Duration of illness had no significant effect on VSWM. VSWM deficits in OCD appear more severe with higher task load and may be mediated through poor task strategy. Such deficits may present mainly in female patients and in (male and female) patients with symmetry symptoms.

Smoking, physical activity and respiratory irregularities in patients with panic disorder.

BACKGROUND In the past decades different evidences suggested a relationship between panic disorder (PD) and respiration, among which the presence of different respiratory irregularities at rest in PD patients. It has been hypothesized that PD could be characterized by a dysfunction of those areas involved in the central control of respiration. The aim of the present study was to elucidate possible differences in breath-by-breath respiratory function at rest between a sample of PD patients with agoraphobia and healthy controls (HC), with particular attention to smoking and physical activity as possible relevant factors in the understanding of respiratory dynamics in PD. METHODS Respiratory physiology was assessed in 32 PD patients and 24 HC. Respiratory rate (RR), tidal volume (VT), minute ventilation (VE), and end-tidal CO2 (pCO2) have been assessed. RESULTS A significant diagnosis-by-smoking interaction was found for mean RR and VT. Mean pCO2 was significantly higher in active than in sedentary patients. Anxiety state did not account for the results. CONCLUSIONS Our findings suggest an abnormal regulation of the respiratory system as a key mechanism in PD. In future studies it should be useful t o stratify data taking into account level and intensity of physical activity and smoking behaviour, as well as to consider the cardiac profile and the effect of those variables able to modulate the homeostatic brain functioning. .

Low baseline startle in anorexia nervosa patients

This study examined baseline startle magnitude, using eye blink response and skin conductance response in anorexia nervosa patients. Twenty female in-patients with anorexia nervosa and an equal number of female healthy controls were tested. Baseline startle response was assessed during blank screens while four startling loud sounds (a 116 dB, 1s, 250 Hz tone) were delivered with a time interval ranging from 35 to 55 s. It was investigated if BMI and state anxiety correlated with physiological responses. The clinical sample showed a lower baseline startle reflex measured with both indices, than healthy controls. Across the whole sample, a single regression model partially explained the relationship between BMI and baseline skin conductance response.

P01-138 - Impaired discriminative fear learning in panic disorder

Objectives Fear conditioning (FC) has been proposed as crucial factor in the etiology and maintenance of panic disorder (PD). This study compared the acquisition of discriminative fear learning between PD patients and healthy subjects (CTR). The main purpose was to test the hypothesis that abnormalities in this process may exist in this population, particularly referred to conditioned responses (CRs) and discriminative fear learning acquisition. Methods Aversive discriminative conditioning paradigm was administered to 45 patients with a DSM-IV diagnosis of PD with agoraphobia and to 43 healthy subjects. The visual-auditory conditioning paradigm is composed by four visual stimuli as conditioned stimulus (CSs) and a startlingly loud sound as the unconditioned stimulus (US). Only one stimulus (CS+) was followed by the US, instead remainder stimuli were never paired with the US (CS-). The protocol consisted of 3 phases: habituation (HAB), acquisition (ACQ) and extinction (EXT). Skin conductance response (SCR) was used as dependent variable. Results During HAB phase no differences were found in response to all stimuli. During ACQ phase, the two groups did not differ in response to CS+; instead patients showed significantly greater reactivity to CS- than controls. Conclusion Results suggest equal level of fear acquisition and impaired discriminative fear learning in PD population; moreover discriminative deficit is driven by enhanced safety learning rather than any abnormality in excitatory danger learning. Enhanced responding to CS- among PD may also be interpreted as over-generalization of conditioned fear. Our result have important clinical implication, particularly for behaviour cognitive therapy in Panic Disorder.

P02-301 - Cognitive and psycopathological dimentions of eating disorders

Objectives Several studies have examined the neuropsychological functioning in patients with Eating Disorders (ED) suggesting that they could be related to an impairment in several areas. We investigate such cognitive functions especially decision making and visual-spatial memory in an independent sample of patients suffering from ED and to evaluate possible differences between patients suffering from Anorexia Nervosa (AN) and Bulimia Nervosa (BN) as well as between ED subjects and healthy controls. Methods Trial Making Test (TMT), Iowa Gambling Task (IGT) and Gambling Task (GT) were administered to 15 AN patients 12 BN patients and 19 healthy subjects. Results We observed that 80% of AN and the 75% of BN subjects performed poorly in the IGT compared to the healthy subjects (36,8%). Similarly, ED patients committed more mistakes and employed more time to complete TMT compared to healthy controls. However, no significant difference was found between ED groups and healthy subjects with respect to GT. Further, no significant difference was observed between AN and BN subjects with respect to IGT and GT. Conclusion Our results suggested that patients with ED could have a significant deficit in visual-spatial attention. As a consequence they need more time to complete the task and make more mistakes. Furthermore ED patient had a deficit in decision making tasks as well. This could reflect deficits in planning long term strategies to approach problems, possibly leading to improper behaviors for the control of their weight.

P01-137 - Application of implicit association test to self-esteem construct

Objectives Researchers have assumed that self-esteem operate only in a conscious mode. In the last years, researchers showed that self-esteem is determined by both explicit and implicit process and new instruments, like Implicit Association Test (IAT), has been designed to measure implicit self-esteem. IAT measures the relative strength of association between pairs of concepts. This study investigated the correlations between implicit and explicit measures of self-esteem. We also investigate which type of the implicit instrument is preferable for an application to patients with a diagnosis of Social Phobia. Methods A traditional IAT (IAT-A) and a single-category IAT (SC-A) measuring implicit self-esteem were structured. IAT instruments and a traditional self-reports that assessed self-esteem were administered to 25 healthy subjects. BIDR, a self-report that assess the socially desirable responding bias, was also administered. Results No correlation between IAT-A and SC-A was found. IAT-A and SC-A did not show correlations with explicit self-esteem measures. Moreover, IAT-A showed a significant correlation with BIDR. At last, a significant correlations between explicit self-esteem measures was found. Conclusion Results suggested a distinction between implicit and explicit self-esteem construct. This distinction has important clinical implication. Because off IAT-A is more complex and needs more cognitive resources it could be suppose that this test leaves space to deliberative processes, so automaticity in responding could be reduced. In conclusion, above the theoretical basis of the original model, SC-A results preferable to apply in a clinical sample, for its simplicity and its low correlation with the BIDR.

P01-150 - Response inhibition in the obsessive-compulsive spectrum

Introduction Some authors suggest that Anorexia Nervosa (AN) could be considered as part of the Obsessive Compulsive Spectrum. Obsessive-compulsive disorder (OCD) might be best characterized in terms of failures in cognitive and behavioral inhibitory functions. Impairments in intentionally inhibiting simple motor actions (Response Inhibition) have been demonstrated in these patients but no studies were conducted in AN patients. Objective The aim of this study was to evaluate Response Inhibition (RI) in patients with Obsessive Compulsive Disorder (OCD), patients with Anorexia Nervosa (AN) and Healthy Controls (HC). Methods 29 HC, 17 patients with OCD and 15 patients with AN were recruited. Stop Signal Task (SST) selected from Cambridge Neuropsychological Test Automated Battery (CANTAB) was administered to all participants. SST is based on the Logans theory and it gives an index of Response Inhibition, called Stop Signal Reaction Time (SSRT). Results A significant difference in SSRT between HC and the clinical groups was found. No differences in SSRT and number of “Direction Errors” were found between OCD and AN groups. No gender influence on the SST performance was found.OCD group showed slower reaction times to the main task than AN and HC. Conclusion Results from neuropsychological assessment have shown a deficit in the Response Inhibition in OCD and AN patients, in line with our hypothesis. Findings supports evidences in literature about OCD patients, but it represents a pioneer result in the contest of AN patients.

P02-125 - Implicit associations in eating disorders: An experimental study using implicit associations test

Introduction Greenwald et al. (1998) developed The implicit Association Test (IAT) to measure automatic concept-attribute associations. The assumption of the test is that strongly associated (compatible) attribute-concept pairs should be easier to classify together than are weakly associated or opposed (incompatible) attribute concepts. Ease of classifying is measured by the response times and errors in performing such categorizations. Objectives The aim of this study was the evaluation, at an implicit level, of the attitude concerning fat people in a sample of Eating Disorders (ED). Methods A IAT modeled to assess self-esteem the attitude concerning fat and slim persons has been administered to 17 Anorexia Nervosa (AN), 14 Bulimia Nervosa (BN), 17 Binge Eating (BED) patients and 32 healthy controls (HC). In IAT, the target categories were represented by the words «FAT-SLIM» and «good / bad». Stimuli were images of faces of overweight and normal weight people and positive/negative word. A positive IAT effect underline an implicit tendency to associate the category «FAT» with positive attributes, instead a negative IAT effect suggest an implicit tendency to associate the same category with negative attributes. Results Results showed a significant difference between HC and clinical groups in implicit attitude concerning overweight persons. HC showed positive IAT effect, instead AN, BN and BED showed a negative IAT effect. No correlations between implicit attitude and clinical variables were found. Conclusion These results suggest a common implicit tendency in ED’s groups, compared with controls, to negatively judge overweight persons.